The Feasibility of Using Human Primary Chondrocytes Derived from Osteoarthritic Patients Overexpressed with SOX9 Seeded on PLGA-Fibrin Hybrid Scaffolds for Cartilage Engineering

Authors

  • Norhamiza Mohamad Sukri Department of Biomedical ScienceKulliyyah of Allied Health Sciences International Islamic University MalaysiaJalan Sultan Ahmad ShahBandar Indera Mahkota25200 Kuantan, Pahang, MALAYSIA
  • Munirah Sha'ban Department of Physical Rehabilitation SciencesKulliyyah of Allied Health Sciences International Islamic University MalaysiaJalan Sultan Ahmad ShahBandar Indera Mahkota25200 Kuantan, Pahang, MALAYSIA
  • Muhammad Aa’zamuddin Ahmad Radzi Department of Biomedical ScienceKulliyyah of Allied Health Sciences International Islamic University MalaysiaJalan Sultan Ahmad ShahBandar Indera Mahkota25200 Kuantan, Pahang, MALAYSIA
  • Rozlin Abdul Rahman Department of Physical Rehabilitation SciencesKulliyyah of Allied Health Sciences International Islamic University MalaysiaJalan Sultan Ahmad ShahBandar Indera Mahkota25200 Kuantan, Pahang, MALAYSIA
  • Ahmad Hafiz Zulkifly Department of Orthopaedics, Traumatology, and Rehabilitation, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Sultan Haji Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia.

DOI:

https://doi.org/10.11113/mjfas.v18n3.2344

Keywords:

Articular cartilage, chondrocytes, osteoarthritis, SOX9, Overexpression, gene transfer, PLGA, fibrin, ectopic implantation model.

Abstract

This study aimed to find an optimal formulation to form 3D hyaline-like cartilage substitutes using the tissue engineering triads. The primary cells taken from osteoarthritic patients were overexpressed with transcriptional factor SRY (Sex Determining Region Y)-Box 9 (SOX9) using Lipofectamine 2000™ through a non-viral transfection method. The transfected and non-transfected cells were seeded on poly(lactic-co-glycolic acid) (PLGA) based scaffolds with and without fibrin. The arrangement resulted in four experimental groups. The 3D ‘cells-scaffolds’ tissue constructs were cultured for three weeks and implanted ectopically in nude mice for four weeks. The evaluations include macroscopic and microscopic study, gene expression analyses, and sulfated glycosaminoglycan (sGAG) assay, focusing on the cartilage properties. A biomechanical evaluation was performed only on post-implanted constructs. All in vitro, two- and four-week post-implanted constructs exhibited firm and smooth hyaline-like cartilage appearance. In vitro constructs showed sparse cells distribution with minimal cartilaginous tissue formation. However, a high density, lacunae-encapsulated chondrocytes embedded within the basophilic ground substances was observed in all post-implanted constructs. It is supported by positive-brownish precipitation immunolocalisation against collagen type II. Besides, molecular analysis showed that COL2A1 and other cartilaginous markers were also expressed. Increased sGAG content and compressive strain could be observed in vitro and in vivo. Although quantitatively, no significant statistical differences were found between the four groups, the qualitative results indicated that SOX9-overexpressed cells, PLGA, and fibrin combination guides hyaline-like cartilage formation better than other groups. Hence, the combination may be studied in a big animal model to develop its potential for future clinical application.

References

M. Sha’ban and M.A. Ahmad Radzi, Scaffolds for Cartilage Regeneration: To Use or Not to Use?, Vol. 1249, 2020.

T. Cheng, N.C. Maddox, A.W. Wong, R. Rahnama and A.C. Kuo, Comparison of gene expression patterns in articular cartilage and dedifferentiated articular chondrocytes, Journal of Orthopaedic Research, 30, 2012.

S.S. Kenneth, A.G. Christina and N.C. Heather, Joints, in Anatomy & Physiology: The Unity of Form and Function, McGraw-Hill Education, New York, pp. 267–298, 2021.

M. Frederic and F.B. Edwin, The Skeletal System, in Essentials of Anatomy and Physiology, Pearson Education, Inc., Hoboken, NJ, pp. 142–190, 2020.

M. Cucchiarini, C. Henrionnet, D. Mainard, A. Pinzano and H. Madry, New trends in articular cartilage repair, Journal of Experimental Orthopaedics, 2, 2015.

J.A. Buckwalter, H.J. Mankin and A.J. Grodzinsky, Articular cartilage and osteoarthritis, Instructional course lectures 54, pp. 465–480, 2005.

J.K. Venkatesan, W. Meng, A. Rey-Rico, G. Schmitt, S. Speicher-Mentges, C. Falentin-Daudré et al., Enhanced Chondrogenic Differentiation Activities in Human Bone Marrow Aspirates via sox9 Overexpression Mediated by pNaSS-Grafted PCL Film-Guided rAAV Gene Transfer, Pharmaceutics, 12, 2020.

Malaysia Health Technology Assessment Section (MaHTAS), Clinical Practice Guidelines (CPG): Management of Osteoarthritis, 2nd ed. Malaysia Health Technology Assessment Section (MaHTAS) Medical Development Division, Ministry of Health Malaysia, Putrajaya, 2013.

S. Ulstein, A. Årøen, J.H. Røtterud, S. Løken, L. Engebretsen and S. Heir, Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up, Knee Surgery, Sports Traumatology, Arthroscopy, 22, 2014.

G. Filardo, E. Kon, F. Perdisa, C. Tetta, A. di Martino and M. Marcacci, Arthroscopic mosaicplasty: Long-term outcome and joint degeneration progression, The Knee, 22, 2015.

P. Niemeyer, S. Porichis, M. Steinwachs, C. Erggelet, P.C. Kreuz, H. Schmal et al., Long-term Outcomes After First-Generation Autologous Chondrocyte Implantation for Cartilage Defects of the Knee, The American Journal of Sports Medicine, 42, 2014.

M. Schinhan, M. Gruber, R. Dorotka, M. Pilz, D. Stelzeneder, C. Chiari et al., Matrix-associated autologous chondrocyte transplantation in a compartmentalized early stage of osteoarthritis, Osteoarthritis and Cartilage, 21, 2013.

R. Langer and J. Vacanti, Tissue engineering, Science, 260,1993.

L.E. Freed, G. Vunjak-Novakovic, R.J. Biron, D.B. Eagles, D.C. Lesnoy, S.K. Barlow et al., Biodegradable Polymer Scaffolds for Tissue Engineering, Nature Biotechnology, 12, 1994).

R. Mulligan, The basic science of gene therapy, Science, 260, 1993.

M. Sha’ban, S.H. Kim, R.B.H. Idrus and G. Khang, Fibrin and poly(lactic-co-glycolic acid) hybrid scaffold promotes early chondrogenesis of articular chondrocytes: an in vitro study, Journal of Orthopaedic Surgery and Research, 3, 2008.

Y. Zhang, F. Yang, K. Liu, H. Shen, Y. Zhu, W. Zhang et al., The impact of PLGA scaffold orientation on in vitro cartilage regeneration, Biomaterials, 33, 2012.

R. Abdul Rahman, N. Mohamad Sukri, N. Md Nazir, M.A. Ahmad Radzi, A.H. Zulkifly, A. Che Ahmad et al., The potential of 3-dimensional construct engineered from poly(lactic-co-glycolic acid)/fibrin hybrid scaffold seeded with bone marrow mesenchymal stem cells for in vitro cartilage tissue engineering, Tissue and Cell, 47, 2015.

S. Munirah, S. Kim, B. Ruszymah and G. Khang, The use of fibrin and poly(lactic-co-glycolic acid) hybrid scaffold for articular cartilage tissue engineering: an in vivo analysis, European Cells and Materials, 15, 2008.

W. Wang, B. Li, Y. Li, Y. Jiang, H. Ouyang and C. Gao, In vivo restoration of full-thickness cartilage defects by poly(lactide-co-glycolide) sponges filled with fibrin gel, bone marrow mesenchymal stem cells and DNA complexes, Biomaterials, 31, 2010.

H.J. Pulkkinen, V. Tiitu, P. Valonen, J.S. Jurvelin, M.J. Lammi and I. Kiviranta, Engineering of cartilage in recombinant human type II collagen gel in nude mouse model in vivo, Osteoarthritis and Cartilage, 18, 2010.

S. Munirah, O.C. Samsudin, B.S. Aminuddin and B.H.I. Ruszymah, Expansion of human articular chondrocytes and formation of tissue-engineered cartilage: A step towards exploring a potential use of matrix-induced cell therapy, Tissue and Cell, 42, 2010.

S.U. Song, Y.-D. Cha, J.-U. Han, I.-S. Oh, K.B. Choi, Y. Yi et al., Hyaline Cartilage Regeneration Using Mixed Human Chondrocytes and Transforming Growth Factor-β1-Producing Chondrocytes, Tissue Engineering, 11, 2005.

N. Md Nazir, A.H. Zulkifly, K.A. Khalid, I. Zainol, Z. Zamli and M. Sha’ban, Matrix Production in Chondrocytes Transfected with Sex Determining Region Y-box 9 and Telomerase Reverse Transcriptase Genes: An In Vitro Evaluation from Monolayer Culture to Three-Dimensional Culture, Tissue Engineering and Regenerative Medicine, 16, 2019.

N. Md Nazir, A.H. Zulkifly, K.A. Khalid, I. Zainol, Z. Zamli and M. Sha’ban, The Cartilaginous Tissue Formation using Sry (Sex Determining Region Y)-BOX9 and Telomerase Reverse Transcriptase Genes Transfected Chondrocytes: In vivo Approach, Sains Malaysiana, 49, 2020.

M. Sha’ban, S.O. Cassim, N.H. Mohd Yahya, A. Saim and R. Idrus, Sox-9 Transient Transfection Enhances Chondrogenic Expression of Osteoarthritic Human Articular Chondrocytes In Vitro: Preliminary Analysis, Tissue Engineering and Regenerative Medicine, 8, pp. 32–41, 2011.

A.H. Md Ali Tahir, M.A.I.M. Amin, A. Azhim and M. Sha’ban, Evaluation of cartilaginous extracellular matrix production in in vitro “cell-scaffold” construct, in 2018 IEEE EMBS Conference on Biomedical Engineering and Sciences, IECBES 2018 - Proceedings, 2019.

J.K. Venkatesan, M. Ekici, H. Madry, G. Schmitt, D. Kohn and M. Cucchiarini, SOX9 gene transfer via safe, stable, replication-defective recombinant adeno-associated virus vectors as a novel, powerful tool to enhance the chondrogenic potential of human mesenchymal stem cells, Stem Cell Research & Therapy, 3, 2012.

J.K. Venkatesan, A. Rey-Rico, G. Schmitt, A. Wezel, H. Madry and M. Cucchiarini, rAAV-mediated overexpression of TGF-β stably restructures human osteoarthritic articular cartilage in situ, Journal of Translational Medicine, 11, 2013.

C.H. Evans and J. Huard, Gene therapy approaches to regenerating the musculoskeletal system, Nature Reviews Rheumatology, 11, 2015.

L. Kupcsik, M.J. Stoddart, Z. Li, L.M. Benneker and M. Alini, Improving Chondrogenesis: Potential and Limitations of SOX9 Gene Transfer and Mechanical Stimulation for Cartilage Tissue Engineering, Tissue Engineering Part A, 16, 2010.

M. Cucchiarini, P. Orth and H. Madry, Direct rAAV SOX9 administration for durable articular cartilage repair with delayed terminal differentiation and hypertrophy in vivo, Journal of Molecular Medicine, 91, 2013.

N. Mohamad Sukri, M.A. Ahmad Radzi, R. Abdul Rahman, A.H. Zulkifly, A. Abdulahi Hashi and M. Sha’ban, Identifying the potential of transcription factor SOX9 gene transfer in chondrocytes differentiation and articular cartilage formation in vitro, Jurnal Teknologi, 77, 2015.

S.R. Tew, Y. Li, P. Pothacharoen, L.M. Tweats, R.E. Hawkins and T.E. Hardingham, Retroviral transduction with SOX9 enhances re-expression of the chondrocyte phenotype in passaged osteoarthritic human articular chondrocytes, Osteoarthritis and Cartilage, 13, 2005.

S. Gurusinghe, P. Young, J. Michelsen and P. Strappe, Suppression of dedifferentiation and hypertrophy in canine chondrocytes through lentiviral vector expression of Sox9 and induced pluripotency stem cell factors, Biotechnology Letters, 37, 2015.

H.N. Yang, J.S. Park, D.G. Woo, S.Y. Jeon, H.-J. Do, H.-Y. Lim et al., Chondrogenesis of mesenchymal stem cells and dedifferentiated chondrocytes by transfection with SOX Trio genes, Biomaterials, 32, 2011.

J.-M. Lee and G.-I. Im, SOX trio-co-transduced adipose stem cells in fibrin gel to enhance cartilage repair and delay the progression of osteoarthritis in the rat, Biomaterials, 33, 2012.

G.-I. Im, H.-J. Kim and J.H. Lee, Chondrogenesis of adipose stem cells in a porous PLGA scaffold impregnated with plasmid DNA containing SOX trio (SOX-5,-6 and -9) genes, Biomaterials, 32, 2011.

J.-M. Lee and G.-I. Im, SOX trio-co-transduced adipose stem cells in fibrin gel to enhance cartilage repair and delay the progression of osteoarthritis in the rat, Biomaterials, 33, 2012.

G.-I. Im and H.-J. Kim, Electroporation-mediated gene transfer of SOX trio to enhance chondrogenesis in adipose stem cells, Osteoarthritis and Cartilage, 19, 2011.

T. Ikeda, S. Kamekura, A. Mabuchi, I. Kou, S. Seki, T. Takato et al., The combination of SOX5, SOX6, and SOX9 (the SOX trio) provides signals sufficient for induction of permanent cartilage, Arthritis & Rheumatism, 50, 2004.

J. Haag, P.M. Gebhard and T. Aigner, SOX9 Gene Expression in Human Osteoarthritic Cartilage, Pathobiology, 75, 2008.

Tissue engineering. Available at http://www.namsa.co.uk/our-expertise/medical-device-expertise/tissue-engineering.

G. Khang, S.J. Lee, C.W. Han, J.M. Rhee and H.B. Lee, Preparation and Characterization of Natural/Synthetic Hybrid Scaffolds, 2003.

G. Chen, T. Sato, T. Ushida, R. Hirochika, Y. Shirasaki, N. Ochiai et al., The use of a novel PLGA fiber/collagen composite web as a scaffold for engineering of articular cartilage tissue with adjustable thickness, Journal of Biomedical Materials Research Part A, 67A, 2003.

M.C. Operti, A. Bernhardt, S. Grimm, A. Engel, C.G. Figdor and O. Tagit, PLGA-based nanomedicines manufacturing: Technologies overview and challenges in industrial scale-up, International Journal of Pharmaceutics, 605, 2021.

B. Li, F. Li, L. Ma, J. Yang, C. Wang, D. Wang et al., Poly(lactide-co-glycolide)/Fibrin Gel Construct as a 3D Model to Evaluate Gene Therapy of Cartilage in Vivo, Molecular Pharmaceutics, 11, 2014.

M.S. Norhamiza, M.J. Nurul Syamimi, M.M. Hanisah, Noorhidayah Md Nazir, Rozlin Abdul Rahman, A.R. Muhammad Aa’zamuddin et al., Cartilaginous Markers Expression in Human Articular Chondrocytes Overexpressed with SOX9 Gene, Regenerative Research, 3, pp. 131–132, 2014.

M.A.I. Mohamed Amin, A. Azhim, M.A. Mohamed Sideek, A.H. Zulkifly and M. Sha’ban, Current trends in gene-enhanced tissue engineering for articular cartilage regeneration in animal model, Transactions of the Persatuan Genetik Malaysia, 7, pp. 201–210, 2017.

G. Khang, S.H. Kim, J.M. Rhee, M. Sha’ban and R.B.H. Idrus, Synthetic/Natural Hybrid Scaffold for Cartilage and Disc Regenerations, in Biomaterials in Asia: In Commemoration of the 1st Asian Biomaterials Congress, T. Tetsuya, ed., World Scientific Publishing Co Pte Ltd, Singapore, 2008.

M. Mohd, M.A. Muhammad Azri, Z. Ahmad and S. Munirah, In vivo evaluation of 3-dimensional PLGA/Atelocollagen/Fibrin scaffolds for intervertebral disc (IVD) regeneration, Frontiers in Bioengineering and Biotechnology, 4, 2016.

F. Selvi, S. Çakarer, T. Can, S.İ. Kırlı Topçu, A. Palancıoğlu, B. Keskin et al., Effects of different suture materials on tissue healing, Journal of Istanbul University Faculty of Dentistry, 50, 2016.

J. Kiviranta, M. Tammi, J. Jurvelin, A.-M. Säämänen and H.J. Helminen, Fixation, decalcification, and tissue processing effects on articular cartilage proteoglycans, Histochemistry, 80, 1984.

K.L. Camplejohn and S.A. Allard, Limitations of safranin “O” staining in proteoglycan-depleted cartilage demonstrated with monoclonal antibodies, Histochemistry, 89, 1988.

R. Abdul Rahman, N. Mohamad Sukri, N. Md Nazir, M.A. Ahmad Radzi, A.H. Zulkifly, A. Che Ahmad et al., Evaluation of three-dimensional construct engineered from poly(lactic-co-glycolic acid)/fibrin hybrid scaffold using rabbit bone marrow mesenchymal stem cells for osteochondral defect repair, Jurnal Teknologi, 77, 2015.

F. Faul, E. Erdfelder, A.-G. Lang and A. Buchner, G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences, Behavior Research Methods, 39, 2007.

F. Faul, E. Erdfelder, A. Buchner and A.-G. Lang, Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses, Behavior Research Methods, 41, 2009.

J. Charan and N. Kantharia, How to calculate sample size in animal studies?, Journal of Pharmacology and Pharmacotherapeutics, 4, 2013.

T. Takebe, S. Kobayashi, H. Suzuki, M. Mizuno, Y.-M. Chang, E. Yoshizawa et al., Transient vascularization of transplanted human adult–derived progenitors promotes self-organizing cartilage, Journal of Clinical Investigation, 124, 2014.

D.S. Sparks, S. Saifzadeh, F.M. Savi, C.E. Dlaska, A. Berner, J. Henkel et al., A preclinical large-animal model for the assessment of critical-size load-bearing bone defect reconstruction, Nature Protocols, 15, 2020.

D. Barnewitz, M. Endres, I. Krüger, A. Becker, J. Zimmermann, I. Wilke et al., Treatment of articular cartilage defects in horses with polymer-based cartilage tissue engineering grafts, Biomaterials, 27, 2006.

L. Zevenbergen, W. Gsell, L. Cai, D.D. Chan, N. Famaey, J. vander Sloten et al., Cartilage-on-cartilage contact: effect of compressive loading on tissue deformations and structural integrity of bovine articular cartilage, Osteoarthritis and Cartilage, 26, 2018.

H.W. Lee, S.H. Seo, C.H. Kum, B.J. Park, Y.K. Joung, T. il Son et al., Fabrication and characteristics of anti-inflammatory magnesium hydroxide incorporated PLGA scaffolds formed with various porogen materials, Macromolecular Research, 22, 2014.

L. Zheng, J. Sun, X. Chen, G. Wang, B. Jiang, H. Fan et al., In Vivo Cartilage Engineering with Collagen Hydrogel and Allogenous Chondrocytes After Diffusion Chamber Implantation in Immunocompetent Host, Tissue Engineering Part A, 15, 2009.

M.-E. Al-Masawa, W.S. Wan Kamarul Zaman and K.-H. Chua, Biosafety evaluation of culture-expanded human chondrocytes with growth factor cocktail: a preclinical study, Scientific Reports 10, 2020.

M.-S. Lee, M.J. Stebbins, H. Jiao, H.-C. Huang, E.M. Leiferman, B.E. Walczak et al., Comparative evaluation of isogenic mesodermal and ectomesodermal chondrocytes from human iPSCs for cartilage regeneration, Science Advances, 7, 2021.

M. Anderson-Baron, Y. Liang, M. Kunze, A. Mulet-Sierra, M. Osswald, K. Ansari et al., Suppression of Hypertrophy During in vitro Chondrogenesis of Cocultures of Human Mesenchymal Stem Cells and Nasal Chondrocytes Correlates With Lack of in vivo Calcification and Vascular Invasion, Frontiers in Bioengineering and Biotechnology, 8, 2021.

A. Tseng, I. Pomerantseva, M.J. Cronce, A.M. Kimura, C.M. Neville, M.A. Randolph et al., Extensively Expanded Auricular Chondrocytes Form Neocartilage In Vivo, Cartilage, 5, 2014.

Z. Yin, D. Li, Y. Liu, S. Feng, L. Yao, X. Liang et al., Regeneration of elastic cartilage with accurate human-ear shape based on PCL strengthened biodegradable scaffold and expanded microtia chondrocytes, Applied Materials Today, 20, 2020.

E.J. Bos, M. Pluemeekers, M. Helder, N. Kuzmin, K. van der Laan, M.-L. Groot et al., Structural and Mechanical Comparison of Human Ear, Alar, and Septal Cartilage, Plastic and Reconstructive Surgery - Global Open, 6, 2018.

M.Y. Mohamad, M.A.I. Mohamed Amin, A.F. Harun, N. Md Nazir, M.A. Ahmad Radzi, R. Hashim et al., Fabrication and characterization of three-dimensional poly(lactic-co-glycolic acid), atelocollagen, and fibrin bioscaffold composite for intervertebral disk tissue engineering application, Journal of Bioactive and Compatible Polymers, 32, 2017.

M. Sha’ban, S.J. Yoon, Y.K. Ko, H.J. Ha, S.H. Kim, J.W. So et al., Fibrin promotes proliferation and matrix production of intervertebral disc cells cultured in three-dimensional poly(lactic-co-glycolic acid) scaffold, Journal of Biomaterials Science, Polymer Edition, 19, 2008.

Y. Han and V. Lefebvre, L-Sox5 and Sox6 Drive Expression of the Aggrecan Gene in Cartilage by Securing Binding of Sox9 to a Far-Upstream Enhancer, Molecular and Cellular Biology, 28, 2008.

C.R. Lee, A.J. Grodzinsky and M. Spector, Biosynthetic response of passaged chondrocytes in a type II collagen scaffold to mechanical compression, Journal of Biomedical Materials Research, 64A, 2003.

M.G. Pandy, J.S. Merritt and R.E. Barr, Biomechanics of the Musculoskeletal System in Biomedical Engineering and Design Handbook, Volume 1, McGraw-Hill Education, New York, 2009.

X. Wei, T. Räsänen and K. Messner, Maturation-related compressive properties of rabbit knee articular cartilage and volume fraction of subchondral tissue, Osteoarthritis and Cartilage, 6, 1998.

J. Oinas, A.P. Ronkainen, L. Rieppo, M.A.J. Finnilä, J.T. Iivarinen, P.R. van Weeren et al., Composition, structure and tensile biomechanical properties of equine articular cartilage during growth and maturation, Scientific Reports, 8, 2018.

J.M. Lipman, C.A. McDevitt and L. Sokoloff, Xenografts of articular chondrocytes in the nude mouse, Calcified Tissue International, 35, 1983.

C. de Bari, F. Dell’Accio and F.P. Luyten, Failure of in vitro-differentiated mesenchymal stem cells from the synovial membrane to form ectopic stable cartilage in vivo, Arthritis & Rheumatism, 50, 2004.

E. Duval, C. Baugé, R. Andriamanalijaona, H. Bénateau, S. Leclercq, S. Dutoit et al., Molecular mechanism of hypoxia-induced chondrogenesis and its application in in vivo cartilage tissue engineering, Biomaterials, 33, 2012.

K.C. Aske and C.A. Waugh, Expanding the 3R principles, EMBO reports, 18, 2017.

M.A.@ T. Aisyah Hanani, A. Azran and S. Munirah, Chondrocytes-induced SOX5/6/9 and TERT genes for articular cartilage tissue engineering: hype or hope? Transactions of Persatuan Genetik Malaysia, 7, pp. 151–160, 2017.

J.-S. Lee and G.-I. Im, SOX Trio Decrease in the Articular Cartilage with the Advancement of Osteoarthritis, Connective Tissue Research, 52, 2011.

H. Madry, G. Kaul, D. Zurakowski, G. Vunjak-Novakovic and M. Cucchiarini, Cartilage constructs engineered from chondrocytes overexpressing IGF-I improve the repair of osteochondral defects in a rabbit model, European Cells and Materials, 25, 2013.

Downloads

Published

04-08-2022