Purpose: Successful tissue engineering matrices need to integrate strongly and stably with native tissues to maintain the integrity of the regenerating tissue since poor integration can cause an altered property of the implant and ultimately its degradation. Autologous chondrocyte implantation in combination with three-dimensional biocompatible substrates represents an approach to in-situ repair of relatively large cartilage lesions, which is known as matrix-assisted chondrocyte transplantation (MACT). However, current investigations on how substrate properties influence its integration with native articular cartilage are still limited. This study aimed to evaluate the effects of hydrogel stiffness on MACT-based cartilage tissue integration. Methods: Human articular chondrocytes were harvested from expired, but non-diseased osteochondral grafts extracted from corpses. Isolated cells were passaged twice and then pooled from three donors. Hydrogel precursor solutions were prepared by dissolving type VII agarose in ultrapure water at 0.5%, 1%, 2.5%, 5% and 7.5%, w/v. Each of the solutions was casted between two parallel glass plates separated by a ∼2-mm thick spacer and allowed to solidify on an ice pack for 1–3 minutes. The physical properties of the formed hydrogels were determined. An in-vitro disc-ring human cartilage explant model was employed to study cartilage integration, which allows for easy analysis of integration strength and cell migration. Briefly, human articular cartilage was devitalized through freeze-thaw cycles to eliminate potential cellular activities and preserve extracellular matrix structure. Devitalized cartilage was shaped into Ø8 mm × 2 mm thick discs by aseptically removing both superficial and deep zone cartilage tissues. A Ø4-mm central core was then punched out of each disc and the hole was filled with one of the hydrogel precursor solutions containing 40 x 106 chondrocytes per mL, followed by gelation. (The central hole was filled with 0.5% and 7.5% agarose gels shown in yellow and green colors, respectively.) Hydrogel-cartilage composites were individually cultivated in 24-well plates with the complete chondrocyte medium. At weeks 6 and 12, the composites were harvested for evaluation. A push-through test in which the hydrogel implant of a composite was gradually pushed out by a 1/8’’ plunger at a rate of 10 μm/s while the composite was placed on a custom-designed rigid annular ring with a 5-mm center hole was performed to quantify the adhesive strength at the integration interface. Statistical analyses were performed by one-way or two-way ANOVA in conjunction with the Bonferroni post test for multiple comparisons with significance at p < 0.05. Results: Hydrogel stiffness tested ranged from 0.5 to 15 kPa (n = 14). At week 6, there was no statistical significance observed in tissue integration. At week 12, adhesive stress in the 5% and 7.5% groups remained low whereas the 1% and 2.5% values were significantly higher than the corresponding 6-week values (ˆp < 0.05) with the strongest integration in the 2.5% group. After the push-through test, the hydrogel constructs were collected and evaluated mechanically. The construct stiffness remained similar after week 6 in both of the 5% and 7.5% groups while the hydrogel constructs in the other three groups continued to develop over time. For comparison, free-swelling hydrogel constructs without an outer cartilage annulus were cultured in parallel under identical conditions. Yet, similar tissue properties were determined in free-swelling and push-out samples within the same groups at each time point, suggesting that the presence of the devitalized outer cartilage ring does not significantly influence construct development. Conclusions: This study demonstrated that integration of implanted chondrocyte-laden agarose hydrogels with native human cartilage is significantly affected by substrate mechanics. An optimal hydrogel stiffness that yielded superior integration strength without compromising development of tissue-engineered constructs was identified (2.5% agarose). This work not only provides valuable information to surgeons who perform MACT in the future, but also opens a new avenue towards improvement in designing hydrogel platforms suitable for clinical uses.
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