Special issue on rotator cuff biology and healingBiologic approaches to enhance rotator cuff healing after injury
Section snippets
Methods
We used the PubMed and Google Scholar search engines to search the literature using the following search terms: growth factor, factor, gene therapy, stem cell, mesenchymal, or bone marrow combined with rotator cuff, supraspinatus, or infraspinatus, and included all permutations. We selected the papers that studied growth factors or stem cells alone in RC repair. Only 3 reports were found that used stem cells in RC therapy, and we thus expanded our stem cell search to include selected studies on
Growth factors
Numerous growth factors, including the bone morphogenetic proteins (BMPs), basic fibroblast growth factor (bFGF), platelet-derived growth factor (PDGF), and transforming growth factor-β (TGF-β), can be found in the RC in predictable expression patterns during the early healing process. Many of these growth factors have a unique temporal expression profile and are thought to play an important role in directing tissue formation during the acute phase of RC healing.29, 60 Therefore, the ability of
Stem cell augmentation of tendon healing and RC repair
In this section, literature records on the use of stem cells for RC repair are reviewed, and significant findings are listed for each population. It is worth mentioning that tendon-derived stem/progenitor cells (TSPCs) have been isolated and cultured from human, mouse, rabbit, and rat tendons.3, 49, 50, 63 Data obtained thus far has shown that TSPCs can differentiate, form tendon-like tissue, and have the ability to synthesize tendon extracellular matrix. However, no studies using TSPCs to
Discussion
Augmentation of RC repair by growth factors and stem cells is intended to enhance the repair process, improve the mechanical force of the tendon, and reduce the rates of rerupture. This review has focused on research that investigated the influence of individual growth factors or stem cells from a single source to augment tendon healing and RC repair. Overall, data presented by several investigators indicate only a modest improvement in structure and biomechanics of tendon in RC repair after
Conclusions
Few studies exist documenting the role of stem cells, MDSCs in particular, in tendon tissue engineering; however, our laboratory has previously shown that the injection of MDSCs into the supraspinatus tendon of athymic rats resulted in the engraftment of transplanted cells into a continuous, longitudinal pattern, with a morphology comparable to resident tendon fibers.44 The ability of MDSCs to improve tendon healing has not been fully demonstrated thus far and remains a goal of future studies,
Acknowledgment
The authors are grateful to Aaron Boyer for technical help.
Disclaimer
Funds used in the preparation of this manuscript were provided by the Henry Mankin Endowed Chair at the University of Pittsburgh to Johnny Huard. Some of the data included were obtained through research funded by a Orthopaedic Research Education Foundation (OREF) grant to Vonda J. Wright.
Johnny Huard receives remuneration as a consultant and also receives royalties from Cook MyoSite, Inc, Pittsburgh, PA, USA. None of the other authors, their immediate families, and any research foundations with
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Investigational Review Board approval was not required for this review article.