# Patent

## Title
Enhancement of skeletal muscle stem cell engraftment by dual delivery of VEGF and IGF-1

## Abstract

An improved device and method for extended repair and regeneration of muscle tissue. An exemplary device comprises (a) a scaffold comprising an ECM component; (b) a combination of growth factors such as VEGF and IGF; and (c) a population of myogenic cells. Implantation of the device leads to muscle regeneration and repair over an extended period of time.

## Background
RELATED APPLICATIONS
This application is a national stage application, filed under 35 U.S.C. §371, of International Application No. PCT/US2011/027446, filed Mar. 7, 2011, which claims the benefit of U.S. Provisional Application No. 61/339,526, filed Mar. 5, 2010, the contents of which are incorporated by references in their entireties.


STATEMENT AS TO FEDERALLY SPONSORED RESEARCH
This invention was made with government support under DE013349 and AG029705 awarded by the National Institutes of Health. The government has certain rights in the invention.


SEQUENCE LISTING
The instant application contains a Sequence Listing which has been submitted electronically in ASCII format and is hereby incorporated by reference in its entirety. Said ASCII copy, created on Jan. 18, 2016, is named 117823_08402_ST25.txt and is 24,576 bytes in size.
BACKGROUND OF THE INVENTION
Musculoskeletal disorders and diseases are the leading cause of disability in the United States and account for more that one-half of all chronic conditions in people over 50 years of age in developed countries.
Among various musculoskeletal injuries, soft tissue skeletal muscle injuries often cause a significant loss of flexibility and strength. Incomplete healing of these injuries could lead to a frequent reinjury of skeletal muscles. This scenario is especially common for athletes and military personnel, for whom the risks of traumatic skeletal muscle injuries are common.
SUMMARY OF THE INVENTION
The invention features an improved device and method for extended repair and regeneration of muscle tissue due to injury such as combat injury, lacerations, traumatic physical accidents (e.g., major surgeries, car accidents, work-related accidents) or disease such as muscular dystrophies, multiple sclerosis, heart disorders, lung disorders, and urinary tract disorders such as incontinence. The device is used as injectable delivery vehicle for the regeneration of muscle tissue and comprises a hydrogel. The hydrogel comprises a vascular endothelial growth factor (VEGF) or a combination of VEGF and Insulin-like growth factor (IGF), e.g. Insulin-like growth factor-1 (IGF-1), for use as injectable delivery vehicle for the regeneration or innervation of muscle tissue. The VEGF+IGF combination leads to a synergistic regeneration effect on muscle tissue.
The hydrogel optionally further comprises a population of myogenic cells, e.g., satellite cells or myoblasts. Such cells are obtained by biopsy from mature muscle tissue of the individual to be treated. The myogenic cells are seeded into or onto the hydrogel ex vivo. Alternatively, the cells are seeded into or onto the hydrogel in vivo following insertion of the hydrogel into the subject. The cells are expanded ex vivo or used directly, i.e., without expansion in culture prior to seeding the hydrogel.
The hydrogel, if to be used to transplant cells, comprises pores to permit the structure to be seeded with cells and to allow the cells to proliferate and migrate out to the structure to relocate to bodily tissues such as the injured or diseased muscle in need of repair or regeneration. For example, cells are seeded at a concentration of about 1×104 to 1×107 cells/ml and are administered dropwise onto a dried hydrogel device. The dose of the gel/device to be delivered to the subject is scaled depending on the magnitude of the injury or diseased area, e.g., one milliliter of gel for a relatively small defect and up to 50 mls of gel for a large wound.
The hydrogel composition permits cell movement throughout the structure. Cells move through a structure by virtue porosity (e.g., pores that are at least one micron in size); by virtue of their ability to deform the material, e.g., squeeze through the material or push their way out of the material; or by virtue of the cell's ability to degrade the material. The scaffold preferably comprises pores, e.g., nanopores (0.1-100 micron diameter), micropores (1-50 micron diameter), or macropores (50-500 micron diameter). For example, the hydrogel comprises macropores that are characterized by a diameter of 400-500 microns. The gel delivery devices are suitable for treatment of human beings, as well as animals such as horses, cats, or dogs.
In some embodiments, the hydrogel is characterized by shape-memory. The polymer chains of the hydrogel are covalently crosslinked and/or oxidized. Such hydrogels are suitable for minimally-invasive delivery. Prior to delivery into the human body, such a hydrogel is lyophyllized and compressed prior to administration to a subject for the regeneration of muscle tissue. Minimally-invasive delivery is characterized by making only a small incision into the body. For example, the hydrogel is administered to a muscle of a subject using a needle or angiocatheter. Alternatively, the hydrogel delivery vehicles are administered to the body using conventional surgical techniques.
An exemplary device is characterized by the following components. The device comprises (a) a scaffold comprising an ECM component; (b) a combination of growth factors, said combination comprising VEGF and IGF; and (c) a population of myogenic cells, e.g., such as satellite cells. The growth factors are incorporated into or coated onto said scaffold composition and are released from the scaffold at approximately the same rate or at different rates. For example, VEGF is released from the scaffold composition at a first rate and IGF is released from the scaffold composition at a second rate. The scaffold may comprise nanopores, micropores, or macropores. For example, the scaffold comprises an open, interconnected macroporous structure.
Methods of muscle repair and regeneration comprise introducing into a tissue the device described above. Implantation of the device leads to muscle regeneration and repair over an extended period of time, e.g., 2, 4, 6, 8, 10, 12, 16, weeks or more post implantation. Although the methods and devices are applicable to many different tissue types, a preferred tissue comprises primarily skeletal muscle tissue, cardiac muscle, or smooth muscle tissue.
The devices and methods are particularly useful for treatment of aged subjects, because the naturally-occurring regeneration of muscle tissue decreases dramatically with the age of an individual. Children or teenager comprise a basal level of muscle regeneration after injury or disease, and the devices and methods of the invention enhance that level of regeneration. However, aged subjects (e.g., 20-30 years of age, and more particularly 35, 40, 50, 60, 70, 80, 90 or more years of age) are characterized by minimal or no basal regenerative activity. In such individuals, the hydrogel delivery vehicles comprising VEGF+IGF led to significant muscle regeneration, a surprisingly beneficial effect.
The growth factors used in therapeutic applications are purified. A purified composition such as a protein or peptide is at least 60%, by weight, free from proteins and naturally occurring organic molecules with which it is naturally associated. Preferably, the preparation is at least 75%, more preferably 90%, and most preferably at least 99%, by weight, the desired composition. A purified protein or polypeptide may be obtained, for example, by affinity chromatography. A purified nucleic acid, polypeptide, or other molecule is one that has been separated from the components that naturally accompany it. Typically, the polypeptide is substantially pure when it is at least 60%, 70%, 80%, 90%, 95%, or even 99%, by weight, free from the proteins and naturally-occurring organic molecules with which it is naturally associated. For example, a substantially pure polypeptide may be obtained by extraction from a natural source, by expression of a recombinant nucleic acid in a cell that does not normally express that protein, or by chemical synthesis.
Publications, U.S. patents and applications, GENBANKTM/NCBI accession numbers, and all other references cited herein, are hereby incorporated by reference.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a diagram of the study protocol. Primary GFP myoblasts (green), isolated from transgenic Tg(ACTbEGFP)1Osb, constitutively expressing GFP in all the cells, were seeded in a macroporous RGD-modified alginate gel (blue) encapsulating VEGF (red) and IGF-1 (yellow). Wild type C57BL/6J mice were injured with a myotoxin injection first and an ischemia damage was further induced after 6 days by a femoral artery and vein ligation before the treatment. (a). Photograph of the macroporous square-shaped alginate scaffold (5×5×2 mm) in a lyophilized form. (b). Scaffold implant after 2 weeks from treatment. (c-d). Tibialis cross-sections, H&E stained before (c) and after (d) muscle injury. (e). Complete loss of locomotion of the injured hindlimb after injuries.
FIG. 2 is a series of photomicrographs showing identification of donor myoblasts engraftment. Representative images showing GFP expression (green) by immunofluorescence on transverse sections of muscle harvested 6 weeks after transplantation and treatment.
FIGS. 3A-B are a bar graph and photograph showing muscle weight and size, respectively. (FIG. 3A) The weight of the uninjured tibialis muscles (Control) at 3 days, 2 weeks and 6 weeks is compared with the muscles after myotoxin/ischemia injury and treatment with blank alginate gel (Alginate Gel), alginate gel delivering VEGF and IGF-1 (gel/VEGF+IGF), alginate gel delivering cells and VEGF and IGF-1 (Gel/VEGF/IGF-1+cells) and, bolus delivery of cells and VEGF and IGF-1 in PBS (Bolus). Values represent mean±SD (n=6) in all graphs. p<0.05 level the means are significantly different (FIG. 3B) Photographs of explanted tibialis anterior at 3 days following treatment with blank alginate gel and alginate gel delivering cells and VEGF and IGF-1 (Gel/VEGF/IGF-1+cells). Size bars are shown on the photomicrographs.
FIGS. 4A-B are a bar graph and a series of photomicrographs showing analysis of muscle regeneration. (FIG. 4A) The number of centrally located nuclei of regenerating fibers at 3 days and 6 weeks after the induction of myotoxin/ischemia injury was quantified. (FIG. 4B) Representative photomicrographs of tibialis tissue sections from injured hindlimbs of C57 mice at postoperative 3 days and 6 weeks, stained with H&E. Cross and longitudinal section respectively of injured muscles treated with blank alginate gel (Alginate Gel), alginate gel delivering VEGF and IGF-1 (gel/VEGF+IGF), alginate gel delivering cells and VEGF and IGF-1 (Gel/VEGF/IGF-1+cells) and, bolus delivery of cells and VEGF and IGF-1 in PBS (Bolus). High power magnification are shown on the side. ANOVA statistical tests were performed on all data sets. At p<0.05 level the means are significantly different.
FIGS. 5A-B are a bar graph and a series of photomicrographs showing quantification of blood vessel densities. (FIG. 5A) Quantification of blood vessel densities in tibialis muscles at 3 days and 6 weeks after induction of myotoxin/ischemia injury and treatment with blank alginate gel (alginate gel), alginate gel delivering VEGF and IGF-1 (gel/VEGF+IGF), alginate gel delivering cells and VEGF and IGF-1 (Gel/VEGF/IGF-1+cells), bolus delivery of cells and VEGF and IGF-1 in PBS (Bolus) and, control (non-operated) limb. Values are mean±SD. p<0.05. (FIG. 5B) Photomicrographs of the entire tibialis section were obtained postoperative 6 wks, and immunostained for the endothelial marker CD-31.
FIGS. 6A-B are a series of laser Doppler images and a line graph showing blood perfusion. (FIG. 6A) Representative color-coded laser Doppler perfusion imaging (LDPI) images at various time points (after surgery, at 3 days, 2, 4 and 6 weeks post-operation) of mice for all the conditions analyzed. (FIG. 6B) LDPI blood perfusion analysis of C57 mice hindlimbs treated with (black square) blank alginate gel, (gray circle) alginate gel delivering VEGF and IGF-1, (gray triangle) alginate gel delivering cells and VEGF and IGF-1 and, (black diamond) bolus delivery of VEGF and IGF-1 in PBS. p<0.05; mean values are presented with SD.
FIGS. 7A-B are a bar graph and a series of photomicrographs showing functional properties of skeletal muscles and interstitial fibrotic collagen deposition (slow & fast myofibers). (FIG. 7A) Tetanic force of the anterior tibialis muscles of mice were measured at 3 days. 2 and 6 weeks after treatment. Tetanic force was normalized to each muscle's weight to obtain weight-corrected specific force. Stimulation was evoked via parallel wire electrodes with 2.0 ms pulse width and 1 sec train duration, and the maximal stimulation was measured at 15V-300 Hz. Mean values are presented with SD; p<0.05 (FIG. 7B) Representative photomicrographs show the deposition of interstitial fibrotic collagen of tissue sections stained with Masson's trichromic in tibialis muscles from uninjured hindlimbs (control) and hindlimbs of mice at postoperative 3 days, 2 weeks and 6 weeks treated with blank alginate gel (Alginate Gel), alginate gel delivering VEGF and IGF-1 (gel/VEGF+IGF), alginate gel delivering cells and VEGF and IGF-1 (Gel/VEGF/IGF-1+cells) and, bolus delivery of cells and VEGF and IGF-1 in PBS (Bolus). Images are representative of 5 independent experiments.
FIG. 8 is a line graph showing regional blood flow following gel delivery of VEGF and/or IGF.
FIG. 9 is a line graph showing ischemic grade/score following gel delivery of VEGF and/or IGF.
FIG. 10 is a bar graph showing the ability of animals to locomote and bear body weight following gel delivery of VEGF and/or IGF.
FIG. 11 is a bar graph showing the results of a muscle function test following gel delivery of VEGF and/or IGF.
FIGS. 12A-B are line graphs, and FIGS. 12 C-E are photomicrographs showing that local delivery of VEGF promotes nerve regeneration and facilitates recovery following nerve damage in ischemic and healthy muscle.
FIGS. 13A-C are photomicrographs and FIG. 13D is a line graph showing that neural regeneration by exogenous VEGF is time and dose-dependent.
FIGS. 14A-D are photomicrographs and FIGS. 14 E-F are line graphs showing that local delivery of VEGF promotes the maturation of motor axons in motor endplates and neuromuscular junction remodeling after the ischemic injury and neural crush.
FIGS. 15A-C are a series of photomicrographs of stained cryosections showing that injection of VEGF-loaded hydrogels into ischemic tibialis anterior muscles elevates the expression of neurotrophic factors within 7 days after the injury.
FIG. 16A is a series of photomicrographs, FIG. 16B is a bar graph showing that injection of alginate hydrogels supplemented with VEGF and Netrin-1 significantly elevates levels of neuromuscular junction innervation within 7 days of ischemic injury in TA muscle of mouse hindlimb.
FIGS. 17A-C are photomicrographs. SEM image of the lyophilized porous 5% 1LMW:1HMW scaffold is shown in FIG. 17A, and confocal imaging of PMMGFP cells growing on the RGD modified 5% 1LMW:1HMW scaffold 30 mins after seeding and after 2 weeks in culture are shown in FIGS. 17B-C. The average pore size, calculated from the SEM images, was 412±17 μm. Data represent mean±SEM (n=4). Low molecular weight (LMW) range from 5000-50,000, while high molecular weight (HWM) range from 100,000-500,000.
FIGS. 18A-H is a series of photographs showing dehydrated scaffold/delivery vehicle for minimally invasive delivery. The lyophilized scaffold is compressed from a thickness of around 1 mm (FIGS. 18A and 18B) to a thickness of 0.1 mm (FIG. 18C), cut to desired size (13.5×2.6 mm2) (FIG. 18D), rolled up into a tight cylinder around a 10 G needle (FIGS. 18E and 18F), and delivered through 1.8 mm (FIGS. 181 and 18D) angiocath (FIGS. 18F and 18G) to achieve minimally invasive delivery through a 2-3 mm incision in the skin. The scaffold has been rehydrated with DPBS from the 10 G needle (FIG. 18H), which is also used to deliver a 50 μL suspension of cells and growth factors to rehydrate the scaffold immediately after insertion next to the injured muscle. The scaffold absorbs the DPBS solution and rapidly (<30 seconds) and recovers its original 3D dimensions (FIG. 18G).
FIG. 19 depicts a scheme for the synthesis and cross-linking of poly(aldehyde guluronate).
FIG. 20 depicts a scheme for the preparation of covalently cross-linked alginate scaffolds.



DETAILED DESCRIPTION
The two main strategies today in cell therapy consist of the direct injection of cells into the damaged tissue or their pre-culture and transplantation on scaffolds that serve as a template for neo-tissue formation. However, modulation of tissue regeneration subsequent to injury by cell transplantation requires the survival of donor cells and their stable incorporation into the host tissue. Previous approaches have been limited by low survival and integration rate of injected cells into host tissue. The work described herein involves the transplantation of progenitor cells on cell-instructive scaffolds designed to maintain cell viability, promote cell activation (proliferation) and outward migration from the scaffold in order to promote repopulation of the host damaged tissue and regeneration of the myotoxin-injured skeletal muscle ischemia. The goal was to direct the myogenic cells to bypass their normal tendency to differentiate and remain in a proliferative phase until a sufficient number of cells is attained to regenerate the tissue.
Bolus delivery of VEGF and/or IGF is ineffective for tissue regeneration. However, dual delivery of VEGF with IGF-1 from macro-porous peptide-modified alginate scaffolds enhanced the engraftment of transplanted myogenic stem cells participating in subsequent rounds of injury repair, increased the proliferation of the satellite cells, limited fibrosis and, accelerated the regenerative process of injured skeletal muscle, resulting in increased muscle mass and most importantly, improved contractile function. Together, these results demonstrate the efficacy of finely controlled differentiated state of myogenic stem cell transplant for treating muscle degenerative disease or injury to muscle tissue.
Exemplary hydrogel delivery vehicles for muscle regeneration require the following components: (1) a composition to mediate adhesion of cells' (2) a composition to induce migration of cells into surrounding tissues; and (3) a composition to induce an angiogenic response. ECM molecules such as RGD peptides are useful to mediate cell adhesion and then migration. For muscle cells, e.g., myogenic cells such as satellite cells or myoblasts, IGF is useful to induce migration out of the scaffold delivery device and into surrounding muscular tissue. HGF and FGF2 is also useful for this purpose. The studies described herein indicate that IGF is as good as or even better than the combination of HGF and FGF2. Finally, VEGF is useful to induce the host angiogenic response. The presence of VEGF in the hydrogel leads to enhanced regeneration compared to the level in its absence.
Skeletal Muscle and Skeletal Muscle Injury
Skeletal muscle accounts for half of the total body mass and is the most abundant tissue of the human body. The major function of skeletal muscle is to coordinate body movements through attachment to the skeleton. To maintain its physiological function, the muscle tissue needs to be vascularized and innervated. A skeletal muscle is composed of many bundles of myofibers. A single myofiber is derived from the fusion of numerous myoblasts. Each myofiber contains many myofibrils, which are composed of repeating sarcomeres. Adult skeletal muscle has a large population of quiescent muscle stem cells termed satellite cells (2-3% of the nuclei in the tissue) that reside just outside the muscle fiber's plasma membrane.
When injured or otherwise compromised by disease (e.g., a degenerative disease), a skeletal muscle has limited ability to restore morphology and function. The major obstacle for skeletal muscle regeneration is fibrosis and formation of scar tissue during the muscle healing process, which leads to incomplete functional recovery, loss of flexibility, and muscle strength. The compositions and methods described herein speed up the repair process of muscle healing and reduce the formation of scar tissue.
Direct injection of muscle stem cells has been unsuccessful due to the rapid loss in viability of the majority of the cells. Prior to the invention, numerous reports have indicated that cultured myoblasts demonstrate poor engraftment efficiency when subsequently transplanted, with little functional impact. In contrast, the studies described herein demonstrate that delivery of cultured myoblasts on an appropriate delivery vehicle leads to a high level of engraftment, and profound functional impact.
Biodegradable scaffolds loaded with therapeutic molecules (VEGF and/or IGF), and in some cases loaded with myoblast cells, led to an enhancement in tissue regeneration. Among various musculoskeletal injuries, soft tissue skeletal muscle injuries often cause a significant loss of flexibility and strength. Incomplete healing of these injuries could lead to a frequent reinjury of skeletal muscles.
Satellite Cells
Muscle degeneration is rapidly followed by the activation of an auto-repairing process. This phase is characterized first by the activation of adult muscle satellite cells and the subsequent events: proliferation, differentiation, and fusion of these cells, leading to new myofiber formation and restoration of the functions of a contractile apparatus. With minor damage, skeletal muscles can often repair themselves by regenerating muscle fibers and restoring muscle strength. As soon as a muscle injury occurs, myogenic precursor cells are able to initiate rapid and efficient growth and regeneration. The predominant source of the myogenic precursor cells is satellite cells. Satellite cells are small mononuclear progenitor cells that reside between the basement membrane and sarcolemma of individual skeletal muscle fibers. They are involved in the normal growth of muscle, as well as regeneration following injury or disease. Their primary function is to mediate postnatal muscle growth and repair. They can be triggered to proliferate and differentiate into myogenic cells, fusing to augment existing muscle fibers and to form new fibers.
In undamaged muscle, the majority of satellite cells remain quiescent; however, in response to mechanical strain or injury, satellite cells become activated. When muscle cells undergo injury, quiescent satellite cells respond to the injury and are released from their niche. Satellite cells can be activated to give rise to skeletal myoblasts. The myoblasts in turn differentiate and form post-mitotic myotubes. These myotubes can facilitate muscle regeneration and repair by fusing into existing neighboring myofibers. Satellite cells are harvested from an individual to be treated and loaded into growth factor-containing hydrogels. Optionally, the harvested satellite cells are cultured ex vivo prior to being loaded onto the hydrogel (e.g., dehydrated doped hydrogel described below) and administered to the patient.
Satellite cells express a number of distinctive molecular markers that are used to identify and purify the cells (e.g., using flow cytometry and Fluorescence Activated Cell Sorting (FACS) analysis). For therapeutic application, the satellite cells need not be isolated from surrounding muscle tissue but transplanted on intact muscle fibers or merely gently dissociated prior to applying the cells to the scaffold/delivery vehicle. In some cases, freshly harvested cells (e.g., satellite cells on muscle fibers, rather than isolated, cultured cells) are preferable due to their greater capacity to generate tissue. In this case, fewer cells are required than when cultured cells are used. Human satellite cells are obtained by biopsy from a mature muscle, e.g., quadriceps, gluteus maximus, bicep, tricep, or any muscle of the individual to be treated. The cells are multiplied ex vivo or used without expanding the cells in culture. For example, the cell suspension to be used to seed the gel comprises muscle fibers and satellite cells. Alternatively, the suspension is a population of purified satellite cells. Prior to the invention, cultured myoblasts were not effective for muscle regeneration; however, cultured myoblasts delivered in the hydrogels of the invention proliferate and are induced to migrate due to the structure of the device and the presence of growth factors in the device leading to clinically beneficial muscle regeneration.
Activated quiescent satellite cells express myogenic transcription factors such as MyoD and/or Myf5. Pax-7 is expressed in both quiescent/or activated satellite cells. Proliferating satellite cells express muscle-specific filament proteins such as desmin as they differentiate to myoblasts. During the muscle repair process, proliferating myoblasts withdraw from the cell cycle to become terminally differentiated myocytes that express Myogenin and MRF4, and subsequently muscle-specific genes such as myosin heavy chain (MHC) and muscle creatine kinase (MCK) [20]. Finally, myocyte fusion gives rise to multinucleated myofibers, which then fuse to each other to form postmitotic muscle fibers or mature skeletal muscle tissue.
Tissue Remodeling and Fibrosis
After naturally-occurring satellite cell initiated regeneration occurs, tissue remodeling starts. Phagocytosis of the damaged tissue and formation of a connective-tissue scar (fibrosis) occurs. Fibrosis is a pathological process that impairs post-injury regeneration of muscle tissue. It starts roughly 2 weeks after injury and can last for up to 2 weeks. Fibrotic tissue inhibits the regenerative growth and reinnervation of muscle tissue, which in turn results in incomplete functional recovery, physical impairment of neighboring normal tissue structure, loss of strength and flexibility, and propensity of reinjury and even atrophy. The compositions and methods described herein speed up the process of muscle healing and reduce the formation of scar tissue following muscle damage.
Growth Factors
Muscle regeneration is regulated by multiple biochemical pathways in which inflammatory cytokines, and growth factors (Table 1) play important roles. The identification of factors that improve the process of muscle healing and reduce the formation of scar tissue is of great importance for restoring the function and structure of the injured muscle.







TABLE 1







Growth factors involved in muscle repair










Cell
Cell


Growth Factor
Proliferation
Differentiation





Hepatocyte growth factor (HGF)
Stimulates
Stimulates


Basic fibroblast growth factor (bFGF)
Stimulates
Stimulates


Insulin-like growth factor-1 (IGF-1)
Stimulates
Stimulates


Nerve growth factor (NGF)
Stimulates
Stimulates


Leukemia Inhibitory factor (LIF)
Stimulates
Stimulates


Acid fibroblast growth factor (aFGF)
Inhibits
Stimulates


Platelet-derived growth factor (PDGF-AA)
Inhibits
Stimulates


Platelet-derived growth factor (PDGF-BB)
Stimulates
Inhibits


Epidermal growth factor (EGF)
Inhibits
Inhibits


Transforming growth factor-α (TGF-α)
Inhibits
Inhibits


Transforming growth factor-β1(TGF-β1)
Inhibits
Inhibits









IGF compared to a combination of HGF and FGF2 for muscle regeneration

Both HGF and members of the FGF family have been widely used for inducing activation, proliferation and migration of the myoblast cells. Besides those factors, numerous other factors are involved as initiators of satellite cell activation showing both mitogenic and motogenic effects on satellite cells. The role of growth factors in skeletal muscle regeneration were compared in order to identify the best candidate to initiate satellite cell activation, stimulating cells to enter the cell cycle, and inducing their migration out of scaffolds. In particular, HGF, bFGF, IGF-1 (at concentrations ranging between 5, 100, 250 ng/gel for HGF; 5, 100, 250 ng/gel for bFGF and 2.5, 5, 12.5 ng/gel IGF-1) alone or in combination were added to a solution of G4RGDSP-modified alginate scaffolds, prior to gelation via calcium sulfate. The gels were cooled to produce macro-porous scaffolds with open interconnected pores, freeze dried and cell seeded (2×106 cell/mL; 50 μl of cell suspension/gel). The size and morphology of the pores in alginate scaffolds were imaged utilizing a scanning electron microscope. The SEM characterization showed 98% porosity with high pore connectivity of ovoidal-shaped pores with a diameter ranging between 0.009 to 0.130 mm. Scaffold fabrication/characterization and cell seeding is described below and in patent application U.S. Ser. No. 12/992,617, hereby incorporated by reference.
The release kinetics of the growth factors incorporated into the modified binary alginate scaffolds was then quantified. After the gels had completely polymerized, they were cut into 5 mm squares and placed in 24 well plates, and 1 mL of PBS was added to each well. At various time points, the PBS was removed and fresh PBS was added to the scaffolds. The PBS samples were measured for total factor content via quantitative ELISA and the results were compared to the initially incorporated growth factor. The quantification showed that IGF-1, likely due to its smaller size (7.5 Kda) and its non-heparin binding nature, showed a faster release; in fact, approximately 80% of the total IGF loaded was released in the first 24 h, then a sustained release of 0.05% was observed in the following weeks. Conversely, a sustained release was observed for the two heparin binding proteins bFGF and HGF, as previously described (Hill et al., Tissue Eng. 2006).
Primary myoblasts derived from 4-12 weeks-old C57BL/6 mice skeletal musculature were seeded into the scaffolds after being expanded in culture for 7 days and characterized for the expression of the myogenic protein, desmin. Analysis via light microscopy fields revealed that the cell cultures purified via Percoll density gradient fractionation consisted of a 95% desmin-positive population. The resulting cell viability and migration of myoblasts from alginate scaffolds incorporating the GFs alone or in combination was subsequently measured by maintaining scaffolds in culture for various time points. The cell viability inside the scaffold was high in all the conditions analyzed. In particular, the viability of primary myoblasts inside the scaffold was high (80-90%) with IGF-1, and this was a significant improvement compared to the control (blank alginate scaffold without any factors) and IGF at the concentration of 12.5 ng/gel. Conversely, a less pronounced increase (60-70%) of cell viability was found with the following combination of factors IGF100 ng/gel/FGF100 ng/gel; IGF100 ng/gel/HGF100 ng/gel; IGF100 ng/gel/FGF100 ng/gel/HGF100 ng/gel.
Furthermore, IGF-1 was shown to be more effective in inducing a sustained outward migration of the myoblasts when compared with the combination of all factors, both in a wound healing assay and when examining outward migration from macro-porous scaffolds. The results showed that IGF-1 release at all the concentration analysed (IGF 2.5, 5, 12.5 ng/gel) induced the activation of satellite cells promoting a sustained significant outward migration for an extended period of time (2 weeks). In particular, IGF (5 ng/gel) induced respectively a 1.6, 1.5, 1.9, 1.9, 2.9, 4-fold increase respectively at 24 h, 48 h, 72 h, 96 h, 1 week and 2 weeks compared to the control. Moreover, the IGF-1 release alone at the lowest concentrations (2.5 and 5 ng/gel) induced the activation of satellite cells promoting outward migration comparable with the combination of factors IGF100 ng/gel/HGF100 ng/gel and multiple release of IGF100 ng/gel/bFGF100 ng/gel/HGF100 ng/gel. Interestingly the combination of IGF/FGF induced a particular significant outward migration at 48 h followed by a little increase over time; conversely IGF 2.5 and IGF 5 ng/gel induced a sustained significant increase of outward migration over time.
To determine the speed of primary myoblast migration, cells were cultured in two-dimensional plates until near confluency. A scratch, simulating a wound, was generated along the middle line of the plate and the repair of the wound was recorded. The results showed that 7.5 h after the injury IGF-1 at 2.5 ng/gel induces a rapid wound healing when compared with all the other conditions (IGF 2.5, 5, 12.5 ng/gel; HGF 100 ng/gel; FGF 100 ng/gel; and the combinations HGF100 ng/gel/IGF100 ng/gel; FGF100 ng/gel/IGF100 ng/gel; FGF100 ng/gel/HGF100 ng/gel/IGF100 ng/gel).
The combination of factors was not as effective as the induction of IGF alone at the concentrations of 2.5 and 5 ng/gel. All these results together lead to the surprising conclusion that IGF alone is a better candidate to enhance both cell viability inside the scaffold and outward migration compared with all the other factors alone or in combination. Along with these findings, the data showed that macroporous alginate gels delivering IGF in combination with VEGF was shown to increase the speed of outward migration and the persistence time of migrating cells, and led to an improved design of a macroporous vehicle for primary myoblast delivery with potential utility for (ischemic) skeletal muscle tissue engineering able to maintain cell viability and promote a prolonged and sustained migration outward the vehicle.
Alginate modification and scaffold fabrication was carried out as follows. A solution of non-irradiated high-molecular-weight (2%, wt/vol) RGD-modified alginate was prepared in DMEM. HGF, bFGF, IGF-1 and VEGF165 were added to the alginate solution alone or in combination (at concentrations ranging between 5, 100, 250 ng/gel for HGF; 5, 100, 250 ng/gel for bFGF and 2.5, 5, 12.5 ng/gel IGF-1). A calcium sulfate slurry (0.41 g CaSO4/ml dd H2O) was added at a ratio of 40 μl of CaSO4 for 1 mL of alginate and vigorously mixed. The resulting solution was immediately expressed into the molds 2 mm depth. A sterile glass plate was placed over the mold and, after the alginate had completely gelled for 30 min, square of 5 mm×5 mm were cut using a blazer. To produce macro-porous scaffolds with open interconnected pores, the gels were cooled to −80° C., and the gels were lyophilized and stored at −20° C. until cell seeding. Fifty μl (100,000 cells/gel) of a cell suspension (2×106 cells/ml) was gently poured onto modified open-pore polymer scaffolds. The gel were incubated for about 20 min before adding a 500 μl of complete culture medium. The experiments were done in 12 well plates.
Growth factors incorporation and release were evaluated as follows. To determine the release kinetics of the growth factors incorporated into modified binary alginate scaffolds, a quantitative sandwich enzyme immunoassay technique (ELISA) was employed. Recombinant proteins (Santa Cruz Biotechnology) was incorporated into alginate solutions prior to gelling and gels were cast as previously described. After the gels had completely polymerized, they were cut into 5 mm squares and placed in 24 well plates, and 1 mL of PBS was added to each well. At various time points, the PBS was removed and stored at −80° C. and fresh PBS was added to the scaffolds. The PBS samples were measured for total GF content via quantitative ELISA (Quantikine, Minneapolis, Minn.), and the results were compared to the initially incorporated GF.
Myoblast purification culture, and characterization were carried out as follows. Primary myoblasts and both C2C12 and GFP-PMM23.8 cell lines were used. Myoblasts were derived from 4-12 weeks-old C57BL/6 and transgenic Tg(ACTbEGFP)1Osb, constitutively express GFP in all the cells, mice skeletal musculature. Under sterile conditions, the all musculature was surgically excised, finely minced, and disassociated in 0.02% Trypsin (Gibco/Invitrogen) and 2% collagenase type 4 (Worthington Biochemical, Lakewood, N.J.) for 60 min at 37° C./5% CO2 while agitating on an orbital shaker. Disassociated cells were strained through a 70 μm sieve, centrifuged at 1600 rpm for 5 min, and re-suspended in high-glucose DMEM, with added pyruvate (Gibco). The medium was further supplemented with 10% fetal bovine serum (FBS) and 10% penicillin/streptomycin (P/S, Gibco) and this was used in all cell culture studies (for both primary and cell line). Cells were plated and cultured at 37° C./5% CO2 for 72 h before media change. After 72 h in culture, the media were changed every 48 h until cells were 80% confluent (about 7 days). Cells were collected via centrifugation and overlaid on a Percoll gradient (Amersham Biosciences, Uppsala, Sweden) in a 15 mL Falcon tube. The gradient consisted of 3 mL of 20% Percoll diluted in DMEM (Invitrogen), 3 mL of 30% Percoll diluted in PBS (Gibco), and 3 mL of 50% Percoll diluted in DMEM (Invitrogen). Cells were immediately centrifuged at 1600 rpm for 20 min at 25° C. The cells from the 30% fraction were collected and re-suspended in high-glucose DMEM.
Immunohistochemistry analysis was carried out as follows. To characterize myoblast cultures for the expression of myogenic proteins, Percoll purified primary myoblasts were plated on sterile cover slips overnight and fixed in 0.2% paraformaldehyde for 20 min. Cover slips were rinsed in phosphate-buffered saline with 0.5% Triton-X (PBS-X) and incubated in Hoechst nuclear dye (1:1000). Cover slips were also incubated in an anti-desmin (1/100) monoclonal antibody (Chemicon, Temecula, Calif.) followed by immunofluorescent secondary antibody (1:1000) (FITC, Jackson Labs, West Grove, Pa.). After secondary antibody binding, cover slips were mounted on glass slides with aqueous mounting medium and sealed with clear nail polish. Slides were viewed with a conventional fluorescent light microscope (Nikon Eclipse E-800, Tokyo, Japan) or stored in total darkness for later analysis. Images were captured utilizing NIH imaging software (Bethesda, Md.), Spot digital camera (Sterling Heights, Mich.), and Adobe Photoshop (San Jose, Calif.).
Viability and proliferation were evaluated. To analyze the cell viability and proliferation within the scaffolds, the scaffolds were finely minced and treated with 1 mL of trypsin for 1 min at 37° C. and 7 mL 50 mM EDTA for 15 min at 37° C. All the volume (8 mL) of dissolved alginate and suspended cells were then counted under Coulter Cell (using as a blank the 50 mM EDTA), and 1 mL of this solution was then analysed for cell viability with V Cell via Trypan Blue exclusion (dead cells appear blue due to their inability to exclude Trypan Blue from their nucleus).
To measure the cell ability to migrate outward the scaffold, myoblasts were seeded in three-dimensional alginate scaffolds (2×106 cell/mL) in 24 well plates. In particular, a solution of cells in medium (30 μL) was pipetted into each lyophilized scaffold; the medium was rapidly absorbed. The resulting viability and migration of myoblasts from alginate scaffolds incorporating several GFs alone or in combination was subsequently measured by maintaining scaffolds in culture for various time points. To measure the outward migration of myoblasts, scaffolds were placed in new plates (24 well plates) every 24 hours, and the cells that had colonized the plates over the previous 24 h were removed via trypsinization and counted in a Coulter counter (Beckman) using as a blank the isotonic solution. The total number of cells that migrated out of the scaffold was normalized to the total number of cells initially seeded into the alginate scaffolds. Cells from separate isolations were used to generate each data set, and duplication of experiments with cells from a second, independent isolation was performed to confirm results.
To determine the speed of wound healing purified primary myoblasts were cultured in two-dimensional plates (2×106 cell/mL) until a nearly confluency (95%). A straight width limited scratch, simulating a wound, was generated with a 0.5-10 μl pipet tip under an angle of 30° along the middle line of the plate. The plate was then transferred to a microscope stage in a incubator maintained at 37° C. and 5% CO2, and the front of cells migrating into the wounded area was recorded. Acquisitions were taken every 10 min for 18 hours.
Scanning electron microscopy (SEM) was also used to characterize the scaffold delivery vehicles. The size and morphology of the pores in alginate scaffolds were imaged utilizing a scanning electron microscope (ISIDS 130, Topcon Techn. CA, Tokyo, Japan). All samples were dried and sputter coated (Desk II, Denton Vacuum, Moorestown, N.J.) prior to analysis. All statistical analysis was done using ANOVA test. Differences between conditions were considered significant if p<0.05.
Vascular Endothelial Growth Factor (VEGF, Also Known as VEGF-A)
The term “VEGF” broadly encompasses two families of proteins that result from the alternate splicing of a single gene, VEGF, composed of 8 exons. The alternate splice sites reside in the exons 6, 7, and 8. However, the alternate splice site in the terminal exon 8 is functionally important. One family of proteins arise from the proximal splice site and are denoted (VEGFxxx). Proteins produced by alternate splicing at this proximal location are PRO-angiogenic and are expressed conditionally (for instance, when tissues are hypoxic and secreted signals induce angiogenesis). The other family of proteins arise from the distal splice site and are denoted (VEGFxxxb). Proteins produced by alternate splicing at this distal location are ANTI-angiogenic and are expressed in healthy tissues under normal conditions.
VEGF exons 6 and 7 contain splice sites (result in the inclusion or exclusion of exons 6 and 7) that affect heparin binding affinity and amino acid number. Humans comprise VEGF121, VEGF121b, VEGF145, VEGF165, VEGF165b, VEGF189, and VEGF206. Heparin binding affinity, interactions with heparin surface proteoglycans (HSPGs) and neuropilin co-receptors on the cell surface mediated by amino acid sequences in exons 6 and 7 enhance the ability of VEGF variants to activate VEGF signaling receptors (VEGFRs).
Endogenous VEGF splice variants are released from cells as glycosylated disulfide-bonded dimers. Structurally VEGF belongs to the PDGF family of cysteine-knot growth factors comprising Placenta growth factor (PlGF), VEGF-B, VEGF-C and VEGF-D (the VEGF sub-family of growth factors). VEGF is sometimes referred to as VEGF-A to differentiate it from these related growth factors. The term “VEGF” used herein to describe the present invention is meant to refer to VEGF-A.
Members of the VEGF family stimulate cellular responses by binding to cell-surface tyrosine kinase receptors (the VEGFRs). VEGF-A binds to VEGFR-1 (also known as Flt-1) and VEGFR-2 (also known as KDR/Flk-1). VEGFR-2 is the predominant receptor for VEGF-A mediating almost all of the known cellular responses to this growth factor. The function of VEGFR-1 is unclear, although it is thought to modulate VEGFR-2 signaling. VEGFR-1 may also sequester VEGF from VEGFR-2 binding (which may be important during development).
Compositions, methods, and devices of the present invention comprise all VEGF polypeptides generated from alternative splicing including pro- and anti-angiogenic forms. Devices of the present invention administered to a subject contain only pro-angiogenic VEGF polypeptide splice forms. Alternatively, or in addition, devices of the present invention administered to a subject contain a mixture of pro- and anti-angiogenic VEGF polypeptide splice forms. Pro- and anti-angiogenic VEGF polypeptide splice forms are released by the scaffold composition of the device simultaneously or sequentially. For example, the opposing splice forms are released together in order to achieve a precise level of stimulation. Alternatively, the opposing splice forms are released sequentially to stimulate angiogenesis and subsequently attenuate the signal when the desired result has been achieved. In another embodiment, devices comprising pro-angiogenic VEGF polypeptide splice forms are placed at the target tissue site while devices comprising anti-angiogenic VEGF polypeptide splice forms are placed in surrounding tissues in order to prevent pro-angiogenic signals from disseminating into and stimulating non-target tissue.
Exemplary VEGF polypeptide splice forms comprised by the compositions, methods, and devices of the present invention include, but are not limited to, the polypeptides described by the following sequences and SED ID NOs. VEGF polypeptide splice forms are released from compositions, scaffolds, or devices of the present invention as naked, or glycosylated polypeptides. Alternatively, or in addition, VEGF polypeptide splice forms are monomers or disulfide-bonded dimers. In a preferred embodiment, VEGF polypeptide splice forms are released into target tissues from compositions, scaffolds, and/or devices of the present invention as glysosylated disulfide-bonded dimers.
Human VEGF148 comprises the following amino acid sequence (NCBI Accession No. NP_001020540 and SEQ ID NO: 1):









1
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241
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Human VEGF165 comprises the following amino acid sequence (NCBI Accession No. NP_001020539 and SEQ ID NO: 2):









1
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181
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Human VEGF165b comprises the following amino acid sequence (NCBI Accession No. NP_001028928 and SEQ ID NO: 3):









1
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Human VEGF183 comprises the following amino acid sequence (NCBI Accession No. NP_001020538 and SEQ ID NO: 4):









1
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Human VEGF189 comprises the following amino acid sequence (NCBI Accession No. NP_003367 and SEQ ID NO: 5):









1
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241
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361
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Human VEGF206 comprises the following amino acid sequence (NCBI Accession No. NP_001020537 and SEQ ID NO: 6):









1
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Insulin-Like Growth Factor (IGF-1)

IGF-1 is a single chain polypeptide of 70 amino acids crosslinked by three disulfide bridges. (Rinderknecht et al., 1978, J. Biol. Chem. 253:2768-2776; sequence on p. 2771, hereby incorporated by reference). Human IGF-1 comprises the following amino acid sequence (GenBank: CAA01954.1 and SEQ ID NO: 7). Human IGF-1 can be purchased from R&D Systems (614 McKinley Place NE. Minneapolis, Minn. 55413)









1
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Human IGF-1B isoform comprises the following sequence (GenBank: CAA40093.1; SEQ ID NO: 8). The mature peptide comprises residues 49-118.









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Myoblast Transfer Therapy (MTT)

The descendents of satellite cells—myoblasts—have been considered as powerful candidates for cell-based therapies to treat muscle injury, muscular dystrophies, and other neuromuscular diseases. Myoblast transfer therapy (MTT) involves the intramuscular injection into host muscle of cultured muscle precursor cells—myoblasts are isolated from normal donor skeletal muscles, expanded in vitro, and injected to the muscle injury site of the recipient. However prior to the invention, this treatment was limited by the rapid and massive death of donor myoblasts following injection into the host muscle. The failure of MTT was due to a number of different reasons: host immune rejection to the injected myoblasts, poor migration of the cells, reduced cell myogenic potential after in vitro culture, mechanical stress, limited availability of oxygen and/or nutrient supply, and delayed clearance of metabolites. The invention solves these problems of earlier approaches in three significant ways: (1) the hydrogel delivery device provides temporary housing by virtue of its porosity and presence of ECM compositions (e.g., RGD-containing peptides) to mediate temporary adhesion of cells; (2) the presence of IGF in or on the delivery device induces migration of the cells (e.g., satellite cells or myoblasts) out of the scaffold device and into the subject's muscular tissue; and (3) VEGF in or on the device promotes a host angiogenic response. As a result, implantation of the VEGF-containing, IGF-containing, cell-seeded, ECM-derivatized hydrogel leads to enhanced muscle generarion that is superior to previous approaches.
Scaffold Compositions and Architecture
Components of the scaffolds are organized in a variety of geometric shapes (e.g., beads, pellets), niches, planar layers (e.g., sheets). For example, sheetlike are used in bandages or wound dressings. The device is placed on or administered into a target tissue. Devices are introduced into or onto a bodily tissue using a variety of known methods and tools, e.g., spoon, tweezers or graspers, hypodermic needle, endoscopic manipulator, endo- or trans-vascular-catheter, stereotaxic needle, snake device, organ-surface-crawling robot (United States Patent Application 20050154376; Ota et al., 2006, Innovations 1:227-231), minimally invasive surgical devices, surgical implantation tools, and transdermal patches.
A scaffold or scaffold device is the physical structure upon which or into which cells associate or attach, and a scaffold composition is the material from which the structure is made. For example, scaffold compositions include biodegradable or permanent materials such as those listed below. The mechanical characteristics of the scaffold vary according to the application or tissue type for which regeneration is sought. It is biodegradable (e.g., collagen, alginates, polysaccharides, polyethylene glycol (PEG), poly(glycolide) (PGA), poly(L-lactide) (PLA), or poly(lactide-co-glycolide) (PLGA) or permanent (e.g., silk). In the case of biodegradable structures, the composition is degraded by physical or chemical action, e.g., level of hydration, heat or ion exchange or by cellular action, e.g., elaboration of enzyme, peptides, or other compounds by nearby or resident cells. The consistency varies from a soft/pliable (e.g., a gel) to glassy, rubbery, brittle, tough, elastic, stiff. The structures contain pores, which are nanoporous, microporous, or macroporous, and the pattern of the pores is optionally homogeneous, heterogenous, aligned, repeating, or random.
Alginates are versatile polysaccharide based polymers that may be formulated for specific applications by controlling the molecular weight, rate of degradation and method of scaffold formation. Coupling reactions can be used to covalently attach bioactive epitopes, such as the cell adhesion sequence RGD to the polymer backbone. Alginate polymers are formed into a variety of scaffold types. Injectable hydrogels can be formed from low MW alginate solutions upon addition of a cross-linking agents, such as calcium ions, while macroporous scaffolds are formed by lyophilization of high MW alginate discs. The cross-linking is ionic or covalent (as in the case of shape-memory delivery devices).
Differences in scaffold formulation control the kinetics of scaffold degradation. Release rates of morphogens or other bioactive substances from alginate scaffolds is controlled by scaffold formulation to present morphogens in a spatially and temporally controlled manner. This controlled release not only eliminates systemic side effects and the need for multiple injections, but can be used to create a microenvironment that activates host cells at the implant site and transplanted cells seeded onto a scaffold.




The scaffold comprises a biocompatible polymer matrix that is optionally biodegradable in whole or in part. A hydrogel is one example of a suitable polymer matrix material. Examples of materials which can form hydrogels include polylactic acid, polyglycolic acid, PLGA polymers, alginates and alginate derivatives, gelatin, collagen, agarose, natural and synthetic polysaccharides, polyamino acids such as polypeptides particularly poly(lysine), polyesters such as polyhydroxybutyrate and poly-epsilon.-caprolactone, polyanhydrides; polyphosphazines, poly(vinyl alcohols), poly(alkylene oxides) particularly poly(ethylene oxides), poly(allylamines)(PAM), poly(acrylates), modified styrene polymers such as poly(4-aminomethylstyrene), pluronic polyols, polyoxamers, poly(uronic acids), poly(vinylpyrrolidone) and copolymers of the above, including graft copolymers.
The scaffolds are fabricated from a variety of synthetic polymers and naturally-occurring polymers such as, but not limited to, collagen, fibrin, hyaluronic acid, agarose, and laminin-rich gels. One preferred material for the hydrogel is alginate or modified alginate material. Alginate molecules are comprised of (1-4)-linked β-D-mannuronic acid (M units) and α L-guluronic acid (G units) monomers, which can vary in proportion and sequential distribution along the polymer chain. Alginate polysaccharides are polyelectrolyte systems which have a strong affinity for divalent cations (e.g. Ca+2, Mg+2, Ba+2) and form stable hydrogels when exposed to these molecules. See Martinsen A., et al., Biotech. & Bioeng., 33 (1989) 79-89.) For example, calcium cross-linked alginate hydrogels are useful for dental applications, wound dressings chondrocyte transplantation and as a matrix for other cell types.
An exemplary device utilizes an alginate or other polysaccharide of a relatively low molecular weight, preferably of size which, after dissolution, is at the renal threshold for clearance by humans, e.g., the alginate or polysaccharide is reduced to a molecular weight of 1000 to 80,000 daltons. Preferably, the molecular mass is 1000 to 60,000 daltons, particularly preferably 1000 to 50,000 daltons. It is also useful to use an alginate material of high guluronate content since the guluronate units, as opposed to the mannuronate units, provide sites for ionic crosslinking through divalent cations to gel the polymer. U.S. Pat. No. 6,642,363, incorporated herein by reference discloses methods for making and using polymers containing polysaccharides such as alginates or modified alginates that are particularly useful for cell transplantation and tissue engineering applications.
Useful polysaccharides other than alginates include agarose and microbial polysaccharides such as those listed in the table below.










Polysaccharide Scaffold Compositions










Polymersa
Structure







Fungal




Pullulan (N)
1,4-;1,6-α-D-Glucan



Scleroglucan (N)
1,3;1,6-α-D-Glucan



Chitin (N)
1,4-β-D-Acetyl Glucosamine



Chitosan (C)
1,4-β.-D-N-Glucosamine



Elsinan (N)
1,4-;1,3-α-D-Glucan



Bacterial



Xanthan gum (A)
1,4-β.-D-Glucan with D-mannose;




D-glucuronic




Acid as side groups



Curdlan (N)
1,3-β.-D-Glucan (with branching)



Dextran (N)
1,6-α-D-Glucan with some 1,2;1,3-;




1,4-α-linkages



Gellan (A)
1,4-β.-D-Glucan with rhamose,




D-glucuronic acid



Levan (N)
2,6-β-D-Fructan with some




β-2,1-branching



Emulsan (A)
Lipoheteropolysaccharide



Cellulose (N)
1,4-β-D-Glucan







aN—neutral, A = anionic and C = cationic.






Alginate Hydrogels as Cell/Growth Factor Delivery Vehicles

Hydrogels are made from water-soluble polymers and are a class of three-dimensional, water-swollen cross-linked homopolymers or copolymers. Alginates are a class of hydrogel-forming material that has been widely utilized in tissue engineering and drug delivery applications. They are a naturally derived polysaccharide, extracted from brown algae. Their chemical structure shows that they are copolymers of (1,4)-linked b-D-mannuronic acid (M) and a-L-guluronic acid (G). Alginate hydrogels are highly hydrated three-dimensional networks and their structure resembles the native ECM of tissues.
Alginate hydrogels have been used in the food industry and medicine due to their high biocompatibility and advantageous physical and chemical properties. Alginate hydrogels are easy to fabricate and process, and can be readily formed into defined structures and form three-dimensional matrices in a hydrated state. High water content is another unique property that makes alginate hydrogels resemble native tissues and thus makes them a good candidate material for cell culture matrix for tissue repair. In addition, they have material properties that are readily tunable by varying the type and degree of cross linking in the polymer network and other chemical or physical modifications.
Example 1
Functional Muscle Regeneration with Combined Delivery of Angiogenesis and Myogenesis Factors
Studies were carried out to investigate an interplay between VEGF and IGF-1 in ischemic muscle regeneration, and the possibility that dual sustained delivery of these two critical morphogens could induce the regeneration of functional muscle in ischemic hindlimbs. The impact of the distance of the muscle from the factor delivery site on the regeneration process was also examined by analysing distinct muscles in the hindlimbs. As targets for these experiments, we chose the gracilis and tibialis muscles, respectively corresponding to the muscle site of injection and a muscle distant to the site of polymer placement. The ultimate goal of this approach is to preserve the local progenitor cells from apoptosis and necrosis during the degeneration process, and instead to activate the progenitor cells to enter the proliferative phase and differentiate into contractile muscle fibers to regenerate functional tissue.
Regenerative efforts typically focus on the delivery of single factors, but it is likely that multiple factors regulating distinct aspects of the regenerative process (e.g., vascularization and stem cell activation) can be utilized in parallel to affect regeneration of functional tissues. This possibility was addressed in the context of ischemic muscle injury, which typically leads to necrosis and loss of tissue and function. The role of sustained delivery, via injectable gel, of a combination of vascular endothelial growth factor (VEGF) to promote angiogenesis and insulin growth factor-1 (IGF-1) to directly promote muscle regeneration and the return of muscle function in ischemic rodent hindlimbs was investigated. Sustained VEGF delivery alone led to neo-angiogenesis in ischemic limbs with complete return of tissue perfusion to normal levels by 3 weeks, as well as protection from hypoxia and tissue necrosis, leading to an improvement in muscle contractility. Sustained IGF-1 delivery alone was found to enhance muscle fiber regeneration and, protected cells from apoptosis. However, the combined delivery of VEGF and IGF-1 led to parallel angiogenesis, reinnervation and myogenesis, as satellite cell activation and proliferation was stimulated, cells were protected from apoptosis, the inflammatory response was muted, and highly functional muscle tissue was formed. In contrast, bolus delivery of factors did not have any benefit in neoangiogenesis and perfusion, and minimal effect on muscle regeneration. These results support the utility of simultaneously targeting distinct aspects of the regenerative process.
The following materials and methods were used to generate the data described in Example 1.
Growth Factor Incorporation and Release Kinetics
Ultrapure MVG alginate was purchased from ProNova Biomedical (Norway). Biodegradable gels were formed from a combination of polymer molecular weights. Alginates were reconstituted in EBM-2 (Cambrex Corporation, Walkersville, Md., USA) to obtain a 2% w/v solution prior to gelation, and cross-linked with aqueous slurries of a calcium sulphate solution (0.21 g CaSO4/mL dH2O) at a ratio of 25:1 (40 pl of CaSO4 per 1 mL of 2% w/v alginate solution). Alginates were pre-mixed with recombinant human VEGF165 protein (generously provided by Biological Resources Branch of the National Cancer Institute) and/or with recombinant human IGF1 (R&D System), at a final concentration of 60 pg/mL for each protein; in vitro release kinetics were measured using ELISA. Mixtures were allowed to gel for 30 min, and maintained at 4° C. prior to animal injections.
Animals and Surgical Procedures
Female C57BL/6J mice (6-7 weeks; Jackson Laboratories, Bar Harbour, Me., USA) were anesthetized with an intraperitoneal injection of a mixture of ketamine 80 mg/kg and xylazine 5 mg/kg prior to all surgical procedures. Hindlimb ischemia was induced by unilateral external iliac and femoral artery and vein ligation. After the vessel ligation, mice were injected with a total volume of 50 pl of alginate gel containing 3 pg of VEGF165 and/or 3 pg of IGF1, gel containing 3 pg of IGF-1, gel with no GFs, or a PBS solution containing 3 pg of VEGF165 and 3 pg of IGF-1 (bolus delivery). Injections were performed using a 25 G needle (Becton Dickinson, Franklin Lakes, N.J., USA), directly into the gracilis muscle (1-3 mm inside the muscle) at the site of vessel ligation. The incision was surgically closed, and animals monitored over time.
For analysis of reinnervation, hindlimb ischemia and gel delivery were carried out as described in transgenic C57BL/6 mice selectively expressing yellow fluorescent protein (YFP) under control of a thy-1 promoter in motoneurons.
Ischemia, Perfusion and Hypoxia Analysis
Measurements of the ischemic/normal limb blood flow ratio were performed on anesthetized animals (n=10) using a LDPI analyzer (Perimed AB, Stockholm, Sweden). Perfusion measurements were obtained by scanning entire hindlimbs under basal conditions and then weekly after surgery, and the ratio of perfusion of the ischemic to non-ischemic limb of the same animal was calculated. Tissue hypoxia was visualized in tissue sections using hydroxyprobe reagent, as per supplier instructions (Chemicon).
Histological Assessment of Skeletal Muscle
Mice were sacrificed and hindlimb muscle tissues (n=10 per time point per experimental condition) were processed for histological analyses. For regeneration metrics, the samples were stained with H&E, and fiber diameter and the number of centrally located nuclei were analyzed. Vascular ECs were identified by immunostaining for mouse CD31 (BD Biosciences Pharmingen, San Diego, Calif., USA). For measurement of capillary densities, histological analysis was performed in a blinded fashion as described. Immunostaining for Ki-67 (Ki-67 mouse IgG1, Dako, Carpinteria, Calif.) was performed to identify cell proliferation. Qualitative analysis of apoptosis was assessed by TUNEL assay (Roche). Interstitial fibrosis was morphometrically assessed in Masson Trichrome (Sigma Aldrich) stained sections.
Analysis of Reinnervation
Mice were anesthetized by an intraperitoneal injection of ketamine/xylazine and fixed by transcardial injection of 4% paraformaldehyde. The tibialis muscle was explanted, and stained with Alexa594-bungarotoxin (Invitrogen, Frederick, Md.) to visualize acetylcholine receptors. Innervation at the neuromuscular junction was imaged using a Zeiss Pascal 5 LSM upright laser scanning confocal microscope using an Ar laser to excite YFP at 488 nm, and a He/Ne laser to excite Alexa594 bungarotoxin at 543 nm. All images were processed using Zeiss software and images are displayed as Z-maximum intensity projections. Reinnervation was quantified by counting sites of overlap of motor neuron axon (yellow) and endplate (red) as a site of reinnervation. At least 50 NMJs were counted for each condition. Statistical significance was determined using unpaired ANOVA analysis.
Mechanical Measurements
Intact gracilis and tibialis muscles were dissected (n=5/condition), mounted vertically midway between two fine cylindrical parallel steel wire electrodes (1.6 mm diameter, 21 mm long), attached by their tendons to microclips connected to a force transducer (FORT 25, WPII, Sarasota, Fla., USA) and bathed in a physiological saline solution in a chamber oxygenated with 95% 02-5% CO2 at 25° C. Muscle length was adjusted until maximum twitch force was achieved (100-300 Hz). A wave pulse was initiated from a computer using a custom-written Lab VIEW program and delivered to the stimulation electrodes via a purpose-built power amplifier (QSC USA 1310). A switch on the amplifier permitted stimulation via wire electrodes. Contractions were continuously monitored on a LabView chart recorder, and contractions saved on a PC. Contractions were evoked every 5 min. Tetani were usually evoked at 3 00 Hz-1 5-20V with constant pulse width and train duration of 2 ms and 1 s, respectively. These stimulation frequencies and voltages were required to generate maximum force but exceed the naturally occurring median firing frequencies of 100-200 Hz in tibialis and gracilis. After force measurements were completed, the muscles were removed from the bath and weighed. Peak tetanic force was determined as the difference between the maximum force during a contraction and the baseline level, and specific force calculated by normalization by muscle weight.
Statistical Analyses
All results are expressed as mean±standard deviation (SD). Multivariate repeated-measures ANOVA was performed to test for interactions between conditions. Differences between conditions were considered significant if p value<0.05.
Dual Sustained Delivery of VEGF and IGF-1
Dual sustained delivery of these two critical morphogens induces the regeneration of functional muscle in ischemic hindlimbs. The impact of the distance of the muscle from the factor delivery site on the regeneration process was examined by analysing distinct muscles in the hindlimbs. The gracilis and tibialis muscles were chosen for the muscle site of injection and a muscle distant to the site of polymer placement, respectively. The goal of this approach was to preserve the local progenitor cells from apoptosis and necrosis during the degeneration process, and instead to activate the progenitor cells to enter the proliferative phase and differentiate into contractile muscle fibers to regenerate functional tissue.
Sustained VEGF&IGF-1 Presentation Enhance Muscle Size and Limb Vascularization
An ischemia injury was selected for these studies following analysis of the spontaneous recovery of muscle mechanical function subsequent to various types of injuries, including partial laceration, cryoinjury, and notexin injection. Ischemia led to the greatest loss of muscle function, as compared to the other injury models, and the least spontaneous return of function. Further, analysis of tissue sections 2 wks following injury revealed a largely necrotic defect with diffusely disorganized and disrupted/broken myofibers in the ischemic condition, supporting the stringency of this model.
Mice were treated at the time of induction of severe hindlimb ischemia with an injectable, degradable alginate gel. In vitro, after an initial burst, VEGF was released in a sustained manner over time, while IGF, due to its smaller size (7.5 Kda) and its non-heparin binding nature showed a faster release, approximately 80% of the total IGF loaded was released in the first 24 h. The following five interventions were analysed: (i) blank alginate gel, (ii) alginate gel delivering VEGF (3 ug), (iii) alginate gel delivering VEGF and IGF-1 (3 ug each), (iv) alginate gel delivering IGF-1 (3 ug), and (v) bolus delivery of VEGF and IGF-1 (3 ug each) in PBS.
Significant muscle loss was noted at seven weeks post-surgery with blank gel treatment, while injured muscles treated with gel containing both GFs were grossly larger. Quantification of the weight of these muscles revealed insignificant changes with gel releasing either VEGF or IGF alone, or with the saline bolus treatment, whereas statistically significant increases of 26%±1 l and 30%±22 occurred for the tibialis (distant to gel injection) and gracilis muscles (site of gel injection) respectively, receiving gel releasing both GFs as compared with the blank treatment. The large standard deviations in the gracilis muscle analysis were due to the difficulty in isolating the gracilis muscle from the other tightly associated muscles.
As the effects of the VEGF delivery on muscle regeneration were likely mediated by its effects on angiogenesis, the level of muscle hypoxia, perfusion of ischemic tissues, and tissue necrosis were next analyzed. Immunohistochemical analysis of tibialis and gracilis muscle tissues revealed that VEGF-delivering alginate gels (alginate/VEGF, and alginate VEGF/IGF-1) increased muscle blood vessel densities, as compared with injection of a blank vehicle or bolus delivery of VEGF/IGF. In particular, at 7 wks, VEGF delivery from the gels resulted in an approximately 2-fold increase in vessel density in tibialis muscle and 3-fold increase in the gracilis muscle, as compared to the ischemic hindlimb treated with the blank alginate. IGF delivery alone had no significant effect on vascularization in the gracilis muscle, and a modest effect in the tibialis. The bolus delivery had no effect on blood vessel densities, as compared to the controls.
A Laser Doppler Perfusion Imaging (LDPI) system was used to quantify perfusion. The regional blood flow was reduced immediately after surgery to approximately 20% of normal in all conditions, as expected. Alginate gel only treatment led to a slow increase in reperfusion over time, and the ischemic limbs for the most part remained necrotic. Bolus delivery resulted in little difference from the no-treatment control or blank alginate injection. In contrast, VEGF and dual GF delivery from the vehicle led to a final recovery of respectively 80% and 95% of normal limbs. In particular, animals treated with alginate gels delivering VEGF/IGF-1 showed a marked increase in blood flow starting around the 4th week after the injury, and an additional 20% increase at 7 weeks compared with the control. The level of tissue necrosis was also quantified by visual observation. Hindlimb ischemia led to severe toe or foot gangrene in control animals, but treatment with alginate gel with VEGF and VEGF/IGF largely spared the limbs from necrosis. Protection of myofibers from hypoxia was also observed with alginate gel VEGF and VEGF/IGF delivery, as based on hypoxia immunostaining.
VEGF and IGF-1 Induce Myoblast Proliferation and Protect Against Apoptosis
Immunostaining of tissue sections against the proliferation-associated protein Ki67 was performed to determine cell proliferation activity at early (2 weeks) and late (7 weeks) times. Abundant expression of Ki67 was detected in muscle tissues receiving alginate gels releasing VEGF alone and VEGF/IGF-1 in both tibialis and gracilis muscles at 2 weeks and 7 weeks. A less pronounced increase was observed with alginate gel delivering IGF, while no proliferation was observed in muscles treated with the blank vehicle. Furthermore, triple immunofluorescence for CD31, Ki67, and Dapi for nuclear staining suggested that both myoblasts and ECs proliferated at early stages of the reparative process. TUNEL analysis was performed to measure apoptosis in the regenerating muscles at 2 weeks post-ischemia. While significant apoptosis was observed in the blank vehicle group, apoptosis was reduced in the muscles treated with alginate delivering VEGF, and was significantly lower with vehicles delivering IGF alone. The combination of the two GFs was particularly effective in combating ischemia-induced apoptosis. Apoptosis was virtually absent in contra-lateral normoperfused muscles, as expected. Similar results were seen in five independent experiments.
Muscle Regeneration Enhanced by VEGF and IGF-1, Along with Reduced Fibrosis
To directly analyze muscle regeneration, the mean diameter of regenerated myofibers and number of centrally located nuclei in the resolving muscle tissue were quantified. The mean diameter of muscle fibers were quantitatively greater in muscles treated with alginate delivering both growth factors, as compared with alginate delivering only VEGF or IGF-1 or the two growth factors in bolus saline, in both tibialis and gracilis muscles. The tibialis muscles treated with alginate delivering VEGF or IGF-1 alone showed an approximately 10% increase in average diameter, while co-delivery of both GFs led to a 25% increase in the diameter of regenerating fibers, compared to the blank alginate gel, and a 19% increase compared to gel/VEGF (p<0.05). An increase was also observed in gracilis muscle with VEGF/IGF delivery from the alginate gels. At 2 wks post-injury the tibialis muscle fibers in the injury group treated with VEGF or IGF-1 alone also showed an approximately 40% increase in centrally located nuclei, versus a lesser increase of 30% with bolus factors delivery, as compared with the blank. The two factors in combination with alginate delivery led to a 53% and a 39% increase in centrally located nuclei, as compared with the blank alginate or alginate delivering VEGF alone. The number of centrally located nuclei in the gracilis fibers treated with alginate delivering both GFs increased  ̃70% and 20% increase, respectively, when compared with either the blank alginate or with alginate delivering VEGF only. Representative cross and longitudinal micro sections of tibialis tissue highlight the increase in centrally located myonuclei in the ischemic muscles treated with alginate delivering both GFs. Analysis of the muscle fiber types confirmed an active regenerative process induced by growth factor delivery. Type IIC fibers were noted at early times (3 days) following injury with delivery of growth factor from the gel, but were not present in uninjured control muscles or uninjured muscles treated with gel/growth factor. Further, analysis of injured muscle treated with gel delivering VEGF revealed a significant increase in myogenin positive cells, which contrasts with few myogenin-positive cells in control, uninjured muscle), also supporting an active muscle regeneration process.
Injured muscle tissue treated with blank alginate demonstrated significant interstitial fibrotic tissue. Control (non-operated) limbs demonstrated little fibrosis, as expected. However, limbs treated with alginate gel delivery of both GFs exhibited a significant decrease in fibrosis. A less pronounced reduction of fibrosis was observed with the two GFs delivered alone. Conversely, in the bolus injection condition a large content of fibrotic tissue was formed.
Growth Factor Delivery Promotes Earlier Regeneration of Damaged Neuromuscular Junctions
Induction of ischemia in the hindlimb and treatment with a blank hydrogel led to a significant loss of innervation at the neuromuscular junction (NMJ) in the tibialis muscle seven days after injury in control mice; by day fourteen complete reinnervation had occurred and NMJs appeared normal. In contrast, muscles treated with either IGF-1 alone or VEGF/IGF-1 had completely reformed NMJs and no damage to receptors or muscle fibers was observed at 7 days. At this time point, VEGF delivery also resulted in robust reinnervation of NMJs, although not to a significantly greater extent than the blank hydrogel.
Dual Gel Delivery of VEGF&IGF-1 Enhances the Contraction Force of Damaged Muscles
To test whether muscle changes induced by GF delivery would correspond to increased function, the contractile force of the muscles was analyzed. The weight normalized tetanic force of the tibialis and gracilis muscles were measured after maximal tetanic stimulation. Muscles treated with gel delivering both GFs showed a significant increase above normal values in the tetanic force at 2 wks postsurgery (2.3 and 7.9 fold increase, respectively, for tibialis and gracilis muscles, when compared with the blank) followed by a decrease toward the normal value at 7 wks. Animals receiving alginate delivering VEGF alone showed a similar trend, but the increase in the force of contraction was less pronounced. In particular, at 2 wks a 1.6 and 5.7 fold increase was measured, respectively in tibialis and gracilis muscles compared with alginate gel only. In contrast, the animal receiving alginate gel without GFs had a markedly lower contractile function at all time points.
The results from these studies demonstrate a beneficial interplay between VEGF and IGF-1, when delivered appropriately, in enhancing skeletal muscle regeneration, revascularization, re-innervation and gain of function following ischemic injuries. Past therapies to regenerate ischemic tissues typically relied on bolus delivery or systemic administration of single growth factors. Vascular endothelial growth factor (VEGF) specifically has been widely used as a potent pro-angiogenic initiator in many strategies to treat ischemic diseases. However, the impact on salvaging and driving regeneration of ischemic muscle has not been addressed. Moreover, an extensive body of literature supports a role for insulin growth factor-1 (IGF-1) in regulating the establishment and maintenance of the mature muscle phenotype in normal and regenerating muscle tissue both in vitro and in vivo. In particular IGF-1 has been implicated in early and late stages of muscle developmental processes playing first a role in inducing myoblast proliferation, and subsequently promoting myogenic differentiation. Past approaches to exploit GF signalling in muscle regeneration typically utilized bolus GF delivery, which leads to rapid depletion of the factors in the target tissue. Supra-physiologic concentrations of growth factors are used in an effort to offset this issue, potentially leading to unwanted side-effects.
Sustained VEGF delivery alone from alginate gels had a significant impact on angiogenesis, and tissue perfusion, but a less pronounced effect on muscle regeneration. These results are in accord to previous reports that the sustained and controlled release of VEGF from both a PLG and the same injectable alginate-based vehicle stimulated angiogenesis, returned perfusion to normal levels, and prevented necrosis in ischemic hindlimbs. VEGF has also recently been implicated in muscle regeneration and muscle reinnervation via a direct neuro-protective and neuro-directing effect. The contractile activity of skeletal muscle, and hence its functionality, are regulated by the nervous system and loss of innervation leads to a decrease in satellite cell number and muscle atrophy. The results of this study suggest delivery of VEGF alone has profound effects on muscle regeneration, as increases in the diameter of regenerating fibers and the number of centrally located nuclei in muscle fibers, both hallmarks of regenerating myofibers, were found with gel-VEGF delivery. The contractile properties of the injured muscle were also improved with appropriate VEGF delivery.
IGF-1 delivery alone from alginate gels was found to have a modest effect on muscle fiber regeneration and cell protection from apoptosis. These data are consistent with data that increased levels of IGF-1 augmented tissue DNA content (resulting from activation of satellite cells) and muscle protein synthesis within existing myofibers. Gel-IGF-1 delivery alone also induced neo-angiogenesis in the tibialis muscle, and to a lesser effect in the gracilis muscle. This effect was likely secondary to the effects of IGF-1 on the muscle cells. The delivery approach used in this study resulted in an initial burst delivery of this factor, likely leading to a rapid diffusion of the factor from the site of the injection. A more sustained delivery of IGF-1 increases muscle regeneration.
Surprisingly, dual VEGF/IGF-I delivery from gels had a synergetic effect on the regenerative parameters in both of the analyzed muscles. In particular, both the mean fiber diameter and the number of centrally located nuclei in the fibers were significantly enhanced with alginate delivery of both GFs, showing a more pronounced response in the muscle where the gel was injected (gracilis). These results were qualitatively validated by an increased number of myoblasts found in an active proliferative state, the presence of myogenin positive cells, type IIC muscle fibers, and decreased cell apoptosis. These results demonstrate an enhancement in myoblast recruitment for neomuscle formation, which is consistent with the larger size and mass of these muscles. The enhanced myogenic regeneration in response to VEGF and VEGF/IGF sustained delivery could also be explained by the existence of a population of myoendothelial cells endowed with multilineage potential, including high muscle regenerative potential. Stimulation of angiogenesis may increase the pool of myogenic stem cells which are available to drive muscle regeneration. Furthermore, the combination of VEGF/IGF-1 was shown to alleviate ischemia with a return to normal hemodynamic levels and a better prevention of the necrosis associated with ischemia. Previous in vivo studies, using this same animal model, confirmed that the sustained delivery of bioactive growth factors (VEGF) from this gel system led to long-term (>15 days) elevated muscle levels. This contrasted with bolus delivery, as the factor concentration fell to undetectable levels within hours following that delivery approach. The sustained presence of factors enabled by alginate gel delivery correlated with the long-term alterations in the vascular and muscle tissue noted in the present study with gel delivery, as contrasted to bolus delivery.
As the peripheral nervous system is also affected by ischemic injury, the effects of sustained growth factor delivery on innervation at the neuromuscular junction (NMJ) was also examined. Ischemia is known to result in loss of NMJ innervation via degeneration of the presynaptic axon, and this was observed in the injury model used in this study. In the absence of growth factors, axons required two weeks to fully regenerate. In contrast, treatment with gels releasing either 1GF-1 alone, VEGF alone or IGF-1 and VEGF accelerated regeneration of damaged NMJs. IGF has been shown to have neuroprotective effects in mouse models of ALS, which is mediated by satellite cells and mature muscle fibers. Upregulation of IGF in these models also leads to a decrease in ubiquitin expression, suggesting that the mechanism of IGF neuroprotection may be inhibition of Wallerian degeneration. The reinnervation observed upon treatment with VEGF and IGF 1 suggests that gel delivery of factors is useful in treating the neurological complications of chronic ischemia. Together these effects played important roles in the early recovery of the mouse locomotive skills.
Most strikingly, tetanic force measurements of the tibialis and gracilis muscles demonstrated a significant increase to above normal levels with dual delivery of GFs versus the untreated (blank alginate) hindlimb, indicating functional muscle regeneration. In particular, an increase in force above normal (non-injured) muscle was noted at two weeks with these conditions, with a 2 and 8 fold increase in force for tibialis and gracilis, respectively, compared to the blank. Conversely, a significant decrease toward the normal value was observed, after 7 weeks, likely indicating an adaptation to normal physiologic requirements for these muscles. Increased muscle strength was also associated with a decrease in fibrotic tissues. Previous studies have shown a role of IGF-1 in finely modulating the balance between inflammation and regeneration, which is crucial for accelerating the functional recovery of injured muscle. After muscle injury, an inflammatory response is activated, but prolonged accumulation of fibrotic tissue limits muscle cell replacement, leading to less strength and functional depletion compared with normal muscles. The increased force observed in muscles with GFs delivery may also be related to enhanced reinnervation, although the specific mechanisms by which these GFs influence reinnervation remain to be defined.
In summary, the dual delivery of VEGF/IGF-1 from an injectable biodegradable hydrogel leads to a complete functional recovery of ischemic injured skeletal muscle. This strategy to enhance skeletal muscle regeneration represents a new therapeutic option for treatment of muscle damaged from a variety of causes. Additional factors which play roles in regulating the proliferation and differentiation of satellite cells and cells are optionally incorporated and delivered with this system.
Example 2
Activation of Transplanted Cells by Dual Delivery of VEGF and IGF-1 from a Macroporous Alginate Gel Leads to Regeneration of a Functional Muscle
Prior to the invention, the two main existing strategies in cell therapy consisted of the direct injection of cells into the damaged tissue or their pre-culture and transplantation on scaffolds that serve as a template for neo-tissue formation. However, modulation of tissue regeneration subsequent to injury by cell transplantation requires the survival of donor cells and their stable incorporation into the host tissue. The improved strategy described herein involves the transplantation of progenitor cells on cell-instructive scaffolds designed to maintain cell viability, promote cell activation (proliferation) and outward migration from the scaffold in order to promote repopulation of the host damaged tissue and regeneration of the myotoxin-injured skeletal muscle ischemia. The goal was to direct the myogenic cells to bypass their normal tendency to differentiate and remain in a proliferative phase until a sufficient number of cells is attained to regenerate the tissue.
Dual delivery of VEGF with IGF-1 from macro-porous peptide-modified alginate scaffolds enhanced the engraftment of transplanted myogenic stem cells participating in subsequent rounds of injury repair, increased the proliferation of the satellite cells, limited fibrosis and, accelerated the regenerative process of injured skeletal muscle, resulting in increased muscle mass and most importantly, improved contractile function. Together, these results demonstrate the efficacy of finely controlled differentiated state of myogenic stem cell transplant for treating muscle degenerative disease.
Design of Cell Therapy/Drug Delivery System for Muscle Generation
In normal/healthy muscle, highly specialized myofibers, the basic contractile units of skeletal muscle, have the intrinsic ability to contract and generate movement. In injured muscles, the loss of myofibers' contractility can induce severe functional deficiency. Among others cell populations found to be implicated in muscle regeneration, such as muscle-resident side population (muSP) multipotent adult progenitor cells (MAPC) bone marrow-derived cells, the activation of the satellite cells, a quiescent specialized sub-population of adult stem cells localized within the basal lamina of the myofibers, is believed to be primarily responsible in the physiologic muscle-regenerative potential. So far, skeletal muscle regenerative efforts focused on cell therapies or (single/multiple) drug delivery strategies. However, on one side cell therapies, either the direct injection of cells into the injured tissues and engineered tissue transplantation, are limited by the massive death of the donor cells and by the poor integration of the out of shelf tissues with the host/recipient. In the other side the drug delivery strategies are limited by the rapidly depleted local concentrations of growth factors (GFs) and by the loss of bioactivity of the morphogens seriously impaired by the degradation occurring by the fast enzymatic cleavage which takes place when they are exposed to the in vivo environment. Furthermore, both these approaches were found to induce a slight improvement in tissue muscle regeneration.
Myoblast fate is finely regulated through biochemical and/or biomechanical microenvironmental signals including both extracellular matrix molecules and growth factors. To enhance transplanted myoblast survival and proliferation and regulate the extent of differentiation a arginine, glycine, aspartic acid (RGD)-containing cell adhesion ligands and macroporous alginate gels were used to encapsulate the cells and preserve/protect them from apoptosis
Trophic factors regulate myoblast fate controlling the proliferation and differentiation of satellite cells. In vitro and in vivo studies have involved a number of factors, including both inflammatory cytokines, and growth factors, insulin growth factors acting as key modulatory role in muscle growth and regeneration. The release of single or multiple GFs (e.g. HGF, FGF-2, VEGF, IGF-1, PDGF-BB, etc) interspersed within natural or synthetic matrices (alginate PLG) occurs with a kinetics that is controlled by the physico-chemical properties of the scaffold material and therefore is finely tunable. In particular, the dual delivery of angiogenic (VEGF) and myogenic (IGF-1) factors from a biodegradable injectable alginate were found to promote skeletal muscle regeneration and induced a functional muscle regeneration of an ischemic musculoskeletal muscle. Efforts were undertaken to further improve the functional muscle recovery resulting from myotoxin-injured skeletal muscle ischemia by combining satellite cell transplantation and localized and sustained presentation of factors, i.e., those that modulate the angiogenesis (VEGF) and the myogenesis (IGF-1) processes.
The goal was to design a cell-instructive-scaffolds able to preserve exogenous progenitor cells from apoptosis and instead be activated and enter in the proliferative phase, migrate outward to the site of injury, fuse and differentiate in order to enhance repopulation of injured muscle from transplanted myoblasts and increase regeneration.
Donor myoblasts were obtained from transgenic Tg(ACTbEGFP)1Osb, constitutively expressing GFP in all the cells and were seeded in scaffolds formed from arginine, glycine, aspartic acid (RGD)-presenting polymer, which also provide a sustained delivery of VEGF and IGF-1, and transplanted into genetically matched normal mice to determine the engraftment and hence the participation of host versus donor cells in regeneration. The delivery of cells on scaffolds that preserve myoblast viability and promote their activation and migration, led to a massive engraftment and long-term contribution of the transplanted cells on and in the host injured muscle tissue. The system was found to accelerate the regenerative process of a severely injured skeletal muscle, reduce degeneration, limit fibrosis, increase muscle mass, and overall lead to a striking improvement of muscle contraction function.
The following materials and methods were used to generate the data described in Example 2.
Alginate Modification and Scaffold Fabrication
Ultrapure alginates were purchased from ProNova Biomedical (Norway). MVG alginate, a high-G-containing alginate (M/G ratio of 40/60 as specified by the manufacturer) was used as the high molecular weight (250 000 Da) component to prepare gels. Low molecular weight (LMW) alginate (50 000 Da) was obtained by γ-irradiating high molecular weight alginate with a cobalt-60 source for 4 h at a γ-dose of 5.0 Mrad (Phoenix Lab, University of Michigan, Ann Arbor, Mich., USA). Both alginate polymers were diluted to 1% w/v in double-distilled H2O, and 1% of the sugar residues in the polymer chains were oxidized with sodium periodate (Aldrich, St Louis, Mo., USA) by maintaining solutions in the dark for 17 h at room temperature. An equimolar amount of ethylene glycol (Fisher, Pittsburgh, Pa., USA) was added to stop the reaction, and the solution was subsequently dialyzed (MWCO 1000, Spectra/Por®) over 3 days. The solution was sterilized by filtration, lyophilized and stored at −20° C. Both alginates were modified with covalently conjugated oligopeptides with a sequence of G4RGDSP (Commonwealth Biotechnology, Richmond, Va.) at an average density of 3.4 mM peptide/mole of alginate monomer using carbodiimide chemistry as previously described. 2% irradiated alginate solutions were frozen and lyophilized until completely dry. Lyophilized alginate was added to MES buffer (Sigma-Aldrich, St. Louis, Mo.) to yield a 1% w/v solution, and EDC, Sulfo-NHS, and RGDSP peptide were added to the dissolved alginate and allowed to react for 20 h. The reaction was quenched with hydroxylamine, and the solution was dialyzed with decreasing concentrations of NaCl (7.5, 6.25, 5.0, 3.75, 2.5, 1.25, and 0%) over 3 days. The solution was purified via the addition of activated charcoal and subsequent sterile filtration. Sterile filtered alginate was frozen and lyophilized and stored at −20° C. The modified alginates were reconstituted in calcium-free DMEM (Invitrogen, Carlsbad, Calif.) to obtain 2% w/v solution (50% LMW/50% MVG used in all experiments) prior to gelation. Reconstituted alginate was stored at 4° C. To prepare gels, modified alginates were reconstituted in EBM-2 (Cambrex Corporation, Walkersville, Md., USA) to obtain a 2% w/v solution (50% LMW, 50% MVG used in all experiments) prior to gelation. The 2% w/v alginate solutions were cross-linked with aqueous slurries of a calcium sulphate solution (0.21 g CaSO4/mL distilled H2O) at a ratio of 25:1 (40 μl of CaSO4 per 1 mL of 2% w/v alginate solution) using a 1-mL syringe. Alginates were first mixed with recombinant human VEGF165 protein (Biological Resources Branch of National Cancer Institute) and/or with recombinant human IGF-1 (R&D system) by using two syringes coupled by a syringe connector at a final concentration of 60 ug/mL for each protein. The calcium slurry (Sigma, St Louis, Mo., USA) was then mixed with the resulting alginate/growth factor/s solution using two syringes coupled by a syringe connector to facilitate the mixing process and prevent entrapment of air bubbles during mixing. The resulting solution was immediately expressed into the molds 2 mm depth. A sterile glass plate was placed over the mold and, after the alginate had completely gelled for 30 min, square of 5 mm×5 mm were cut using a punch.
To produce macro-porous scaffolds with open interconnected pores, the gels were cooled to −80° C., and the gels were lyophilized/freeze dried and stored at −20° C. until cell seeding. Fifty μl (200.000 cells/gel) of a cell suspension (4×106 cells/ml) was gently poured onto modified open-pore polymer scaffolds. The gel were incubated for about 20 min before adding a 500 μl of complete culture medium, then maintained at 4° C. prior to animal implantation.
Scaffold manufacture, porosity, and characteristics are further described in U.S. Ser. No. 11/638,796, U.S. Ser. No. 12/665,761, PCT/US2009/045856, PCT/US2009/000914, U.S. Ser. No. 61/168,909, and U.S. Ser. No. 61/281,663, hereby incorporated by reference.
Myoblast Purification, Characterization and Cultures
Primary myoblasts were derived from 4-12 weeks-old wt C57BL/6 and transgenic Tg(ACTbEGFP)1Osb, constitutively expressing GFP in all the cells, mice skeletal musculature. After the sacrifice, the satellite cells were isolated from hindlimbs using standard methods. Under sterile conditions, hindlimb skeletal musculature was surgically excised, finely minced, and disassociated in 0.02% Trypsin (Gibco/Invitrogen) and 2% collagenase type 4 (Worthington Biochemical, Lakewood, N.J.) for 60 min at 37° C./5% CO2 while agitating on an orbital shaker. Disassociated cells were strained through a 70 μm sieve, centrifuged at 1600 rpm (Eppendorf 5810R) for 5 min, and re-suspended in high-glucose DMEM, with added pyruvate (Gibco). The medium was further supplemented with 10% fetal bovine serum (FBS) and 10% penicillin/streptomycin (P/S, Gibco) and this was used in all cell culture studies (for both primary and cell line). Cells were plated and cultured at 37° C./5% CO2 for 72 h before media change. After 72 h in culture, the media were changed every 48 h until cells were 80% confluent (about 7 days). Cells were collected via centrifugation and purified via Percoll (Amersham Biosciences, Uppsala, Sweden) fractionation. To characterize Percoll purified primary myoblast cultures, myogenic differentiation was assessed by staining with desmin (1/100; Santa Cruz Biotechnology, Santa Cruz, Calif.).
For clinical applications, as few as 10,000 cells, 1×104, 1×105, 1×106, 1×107 or 1×108 cells are used to seed a delivery scaffold. Sources and methods of obtaining myogenic cells for seeding are further described in Saverio et al., 2010, J. Clin. Invest. 120:11-19; hereby incorporated by reference.
Animals and Tissue Injury
GFP transgenic mice (C57BL/6-Tg(ACTbEGFP)1Osb) were used only as a cell source, conversely six-seven weeks-old female wt C57BL/6J mice (Jackson Laboratories, Bar Harbor, Me., USA), were used for treatments. Mice were anesthetized with an intraperitoneal injection of a mixture of ketamine 80 mg/kg and xylazine 5 mg/kg prior to all surgical procedures. For myotoxin injuries, the tibialis anterior muscles (TA) of the right legs of anesthetized mice were injected with 10 ul of 10 ug/ml Notexin Np myotoxin from Notechis Scutatus snake venom (Latexan) using a 5 ul Hamilton syringe. After 6 days from notexin injection, hindlimb ischemia was induced by unilateral external iliac and femoral artery and vein ligation. After the vessel ligation, the middle part of tibialis muscle was treated. The incision was surgically closed, and animals monitored over time.
Ischemia and Perfusion
Measurements of the ischemic/normal limb blood flow ratio were performed on anesthetized animals (n=10) using a LDPI analyzer (Perimed AB, Stockholm, Sweden). Perfusion measurements were obtained by scanning entire hindlimbs under basal conditions and then weekly after surgery, and the ratio of perfusion between ischemic to non-ischemic limb of the same animal was calculated.
Histological Assessment of Skeletal Muscle
At 3 days, 2 weeks and 6 weeks following induction of ischemic injury, anesthetized mice were sacrificed and hindlimb muscle tissues (n=10 per time point per experimental condition) were processed for histological analyses. For regeneration metrics, the samples were stained with hematoxylin and eosin. Images were captured at 20× magnification and merged in Adobe Photoshop (Adobe systems, San Jose, Calif.) and then the number of centrally located nuclei was manually measured and tallied. Vascular ECs were identified by immunostaining for mouse CD31 (BD Biosciences Pharmingen, San Diego, Calif., USA). For measurement of capillary densities, histological analysis was performed in a blinded fashion. All the merged tissue sections were randomly analyzed. The number of positively stained blood vessels was manually counted and normalized to the tissue area. Sections from each sample were visualized at 200 and 400 with an Olympus IX81 light microscope (Japan) connected to an Olympus DP70 digital image capture system (Japan), and analyzed using IPLab 3.7 software (Scanalytics, Rockville, Md., USA).
GFP expression was detected in both muscle cryo-section and paraffin-section of cells engrafted muscles respectively by direct GFP fluorescence and by anti-GFP immunofluorescence. In particular, muscle paraffin-sections were permeabilized with 1% BSA-0.2% Triton X100/PBS and 5% goat serum, and stained with 1:50 chicken anti-GFP (Molecular Probes) and, 1:200, 488 goat Alexa Fluor anti chicken (Molecular Probes). Interstitial fibrosis was morphometrically assessed in Masson Trichrome (Sigma Aldrich) stained sections.
Mechanical Measurements
At 3 days, 2 and 6 weeks following the treatment, C57BJ6 mice (n=5/conditions) were anesthetized before muscle isolation and then sacrificed by cervical dislocation. Intact Tibialis (T) muscles for each conditions (blank alginate, alginate+VEGF165/IGF-1, alginate+VEGF165/IGF-1 and cells, bolus of VEGF165/IGF-1 and cells) and the uninjured controlateral hindlimb were dissected for isolated muscle force measurements. The muscle was mounted vertically midway between two fine cylindrical parallel steel wire electrodes (1.6-mm diameter, 21 mm long), attached by its tendons to microclips connected to a force transducer (FORT 25, WPII, Sarasota, Fla., USA) and bathed in a physiological saline solution (in mM: 122.2 NaCl, 2.8 KCl, 1.2 KH2PO4, 25 NaHCO3, 1.2 MgSO4, 1.3 CaCl2, and 5 D-glucose in a chamber oxygenated with 95% O2-5% CO2. The experimental temperature (monitored in the bathing solution) was maintained at 25° C. The experimental protocol involved adjustment of muscle length until maximum twitch force was achieved (100-300 Hz). A wave pulse was initiated from a computer using a custom-written LabVIEW program and delivered to the stimulation electrodes via a purpose-built power amplifier (QSC USA 1310). A switch on the amplifier permitted stimulation via wire electrodes. Contractions were continuously monitored on a LabView chart recorder, and contractions saved on a PC. Contractions were evoked every 5 min.
Tetani were usually evoked at 300 Hz-15-20 V with constant pulse width and train duration of 2 ms and 1 s, respectively. These stimulation frequencies and voltages were required to generate maximum force but exceed the naturally occurring median firing frequencies of 100-200 Hz in Tibialis. After force measurements were completed the muscle were removed from the bath and weighed. Peak tetanic force was determined as the difference between the maximum force during a contraction and the baseline level, and specific force calculated based on muscle weight.
Statistical Analyses
All results are expressed as mean±standard deviation (SD). Multivariate repeated-measures ANOVA was performed to test for interaction between conditions. Differences between conditions were considered significant if p value<0.05.
Enhancement of Skeletal Muscle Stem Cell Engraftment by Dual Delivery of VEGF and IGF-1 from a Cell-Adhesive Macroporous Alginate Gel
In this study, tibialis muscle of each recipient C57BJ6 mouse was preinjured by intramuscular injection of notexin six day prior the transplantation in order to enhance the muscle regenerative response After 6 days, when presynaptic activity, blocking the release of acetylcholine, and the myotoxin effects exerted from Notexin Np injection was markedly diffused into the middle part of tibialis muscle, mice had undergone unilateral external iliac and femoral artery and vein ligation to induce a more severe hindlimb ischemia and treated. Analysis of the tissue sections at early time revealed a largely necrotic defect with diffusely disorganized and disrupted/broken myofibers in all the conditions analysed (FIG. 1 c-d). The combination of Notexin injection and ischemia injury was selected as the most severe injury model, comparing the recovery of the mechanical functionality of the tibialis muscles at 2 weeks between muscles subjected to different type of injuries, including partial laceration, cryoinjury, notexin injection alone or the previous combined with the femoral artery and vein ligation. At the time of vessel ligation the middle part of the tibialis muscle was treated. A macroporous, degradable RGD-modified alginate gel with open, interconnected pores was designed to deliver growth factors and/or GFP-primary myoblasts.
In particular, one of the following four treatments were used to heal the injury: (i) blank macroporous alginate vehicle, (ii) alginate vehicle delivering VEGF (3 μg) and IGF-1 (3 μg), (iii) alginate gel delivering VEGF and IGF-1 (3 μg each) and GFP-satellite cells (200.000 cells/gel) and, (iv) bolus of GFP-satellite cells (200.000 cells/gel) and VEGF and IGF-1 (3 μg each) in PBS. Even though no suture points, adhesive or glue were used to maintain the scaffold at the site of implantation, at the time of retrieval (3 days, 2 and, 6 weeks) the scaffolds were still localized where it was implanted initially (FIG. 1-b). A complete loss of locomotion of the injured hindlimb was immediately observed in all the condition analysed (FIG. 1-e).
The capacity of donor GFP-primary myoblasts to engraft in diseased muscle and to act as a regenerative precursor population to repair muscle, was first analysed. Engraftment of donor-derived myofibers in recipients was measured by direct epifluorescence for GFP on transverse and longitudinal sections of muscle harvested at 6 weeks after transplant. However, GFP detection by epifluorescence also was confirmed by immunofluorescence (FIG. 2). Analyses of transplanted tibialis muscles of recipient mice revealed a robust engraftment of donor-GFP myoblasts into the host regenerating muscle when cells were transplanted on scaffolds releasing VEGF/IGF-1 (FIG. 2). A more limited number of engrafted donor cells was found in the conditions by using direct myoblast bolus injection with GFs. No cells were noted in the other experimental treatment (alginate gel VEGF/IGF-1) and control conditions (blank alginate gel).
Furthermore, a significantly larger skeletal muscle mass was noted at 3 days in injured muscles treated with alginate gel containing/delivering both satellite cells and growth factors when compared with the blank alginate gel at the same time (FIG. 3 B). Quantification of the weight of these muscles confirmed a pronounced changes with alginate releasing either cells and VEGF/IGF-1, or VEGF/IGF-1 treatment with a statistically significant increases of 28.5% and 20.4% (FIG. 3 A) respectively, compared with blank alginate gel at early time (3 days) with the tendency to decrease gradually with time (showing respectively an increase of 22.7% and 1.2% at 2 weeks and 23% and 3.1% at 6 weeks). To directly analyze muscle regeneration, the number of postmitotic centrally located nuclei per length of myofiber in the resolving muscle tissue were quantified as index of newly regenerated myofibers (FIG. 4 A). At early time post-injury (3 days) the tibialis muscle fibers in the injury group treated with VEGF and IGF-1 without cell showed an approximately 60-50% increase in centrally located nuclei as compared with the blank and bolus factors delivery. The two factors in combination with cells alginate delivery led to a 78% and a 45% increase in centrally located nuclei per 100 um fiber length, as compared with the blank alginate or with alginate delivering GFs (FIG. 4 A). At 6 weeks post-injury the tibialis muscle fibers treated with alginate delivering cells and VEGF/IGF-1 showed an approximately 2.5 fold-increase in centrally located nuclei, while co-delivery of both GFs without cells led to a 1.27 fold increase in the number of centrally located nuclei, compared to the blank alginate gel, and a 3.1 fold increase compared to the bolus treatment (FIG. 4 A).
Representative cross and longitudinal microsections of tibialis tissue at postoperative 3 days and 6 weeks (FIG. 4 B), stained with H&E highlight the increase in centrally located myonuclei in the injured muscles treated with alginate delivering cells and VEGF//IGF-1. In mice treated with gels delivering cells and growth factors, multiple centrally located nuclei were observed in tissue cross sections under high power magnification. The capability of donor GFP-primary myoblasts transplantation to improve blood vessel density and hemodynamic recovery (the perfusion of ischemic injured tissues) was next analyzed. Immunohistochemical analysis was carried out on tibialis tissue sections for the presence of the endothelial marker CD31 (FIG. 5 A) at early time (3 days) and at the late time (6 weeks) post-treatment. In particular, at 3 days, it revealed that VEGF/IGF-1-delivering alginate gels (FIG. 5 A) increased muscle blood vessel densities of 1.4 fold and 1.2 fold, as compared respectively with injection of a blank vehicle or bolus delivery of cells and VEGF/IGF. At 6 weeks, VEGF/IGF-1 delivery from the gels resulted in an approximately 1.9 fold and 1.5 fold increase in vessel density in tibialis muscle as compared to the ischemic hindlimb treated with the blank alginate and bolus injection (FIG. 5A). Quantification revealed that gels delivering both myoblasts and GFs induce an even greater increase in blood vessel density leading to a 1.4-fold and 1.2-fold increase compared to gels delivering only growth factors respectively at 3 days and 6 weeks post treatment. Conversely, bolus delivery of cells and VEGF/IGF had no significant effect on vascularization and a modest effect is observed at early time as compared to the control (FIG. 5 A). Representative images of all the merged tissue sections at 6 weeks post-treatment are shown in FIG. 5 B.
A Laser Doppler Perfusion Imaging (LDPI) system was used to quantify perfusion of the hindlimbs (FIG. 6 A-B). Images indicate improved hemodynamic recovery of mice transplanted with alginate gel delivering both cells and GFs (FIG. 6 A). The GFs delivery alone produced a milder improvement of the clinical outcome. In particular quantification of the ischemic/non ischemic perfusion ratio (FIG. 6 B) revealed, after an expected 20% reduction of the blood flow immediately after surgery in all the conditions analysed, a slow increase in reperfusion in mice treated with blank alginate gel and bolus of cells and VEGF/IGF over time. In contrast, dual VEGF/IGF delivery from the alginate gel led to a gradually increase in tissue perfusion over time with a final recovery of 75% of normal limbs at 6 weeks. Interestingly, animals treated with alginate gels delivering both myoblasts and VEGF/IGF-1 showed a marked increase in blood flow starting from the first week after the injury with a 78.6%, and reaching a 99% recovery at 5 weeks compared respectively with 64.9% recovery induced by gel delivering VEGF/IGF-1 (FIG. 6 B).
To test whether muscle changes induced by GFs delivery and engraftment/incorporation by satellite cells might correspond to increased function and hence have a therapeutic benefit, the contractile force of the muscles was measured. The weight normalized tetanic force of the anterior tibialis (FIG. 7 A) were measured after maximal tetanic stimulation. At 3 days postsurgery, all the muscle treatments induced about 1.2 fold loss of the contractile force compared with the uninjured control. At 2 weeks postsurgery, muscles treated with alginate gel delivering VEGF/IGF-1 showed a significant increase above normal values in the tetanic force (1.2 fold and 3.2 fold increase, respectively when compared with the control and the blank alginate). A similar trend was observed in animals receiving bolus treatment. A more pronounced effect was measured with alginate gel delivering both satellite cells and VEGF/IGF-1 (2 fold and 1.6 increase respectively when compared with the control and the alginate gel delivering VEGF/IGF-1). However, a decrease toward the normal value was observed only in animals treated with alginate gel delivering satellite cells and VEGF/IGF-1 at 6 wks postsurgery. In fact, animals receiving alginate delivering only VEGF/IGF-1 or bolus treated showed a similar trend, but the decrease in the contractile function was markedly more pronounced.
Along with reduced recovery of the functional contractile properties, a large content of fibrotic tissue was formed, as imaged by Masson's trichrome staining (FIG. 7 B), in injured muscle tissue treated with either blank alginate and bolus injection over time, while control uninjured hindlimbs demonstrated little fibrotic tissue, as expected. Conversely, limbs treated with alginate gel delivering GFs alone and alginate gel delivering both myoblasts and VEGF/IGF-1 exhibited a significant decrease in fibrosis.
The strategy described herein involves the transplantation of satellite cells on scaffolds appropriately designed to maintain the viability of donor cells, promote their activation and their afterward cell spreading and migration outside the scaffold and their stable incorporation into the host tissue. This approach showed to be effective in inducing both a repopulation of the host damaged tissue and an enhancement of muscle repair.
Compared with standard approaches (cell therapy and drug delivery), the scaffold does not serve as a tissue template, but it has to mimic special tissue environment biochemical cues immediately surrounding (the precursor/progenitor) cells, so called “stem cell niche”. The device comprising cells and at least 2 factors (VEGF and IGF, in this case) effectively mimics a naturally-occurring stem cell niche. The niche is fundamental in controlling the stem cell behavior, in particular, the quiescence, self-renewal and cell fate commitment state of the implanted stem cells. The viability and the ability of myoblasts to migrate from vehicles are strongly regulated by four main factors, consisting of the presentation of adhesion ligands by the material vehicle, the material biodegradation, the pore structure/size and the release kinetics of growth factors from the vehicle material.
Covalent modification of alginate with the adhesion oligopeptides G4RGDSP prior to scaffold fabrication, compared with scaffold lacking cell adhesion ligands, was demonstrated diffusively to allow a controlled presentation of signals that promote and regulate cell adhesion to this polymer, and hence the viability and the proliferation of the primary myoblasts. In addition, the feasibility to control the molecular weight distribution of the polymer used to form gels allows to regulate gel degradation, the pore size (nano, micro, macro-pores) and the architectural structure (interconnected, aligned . . . ) of the polymer and hence, to modulate the viability of alginate encapsulated cells as well as their outward migration. In particular, as compared to nano- and micro-porous (10-20 μm pores) peptide modified scaffolds, myoblasts seeded in macroporous ( ̃200-400 μm) peptide modified scaffolds was demonstrated to improve both the viability and outward migration. Similar results were observed for smooth muscle cells, e.g., better proliferation on macroporous scaffolds. The incorporation of soluble factors significantly influences the proliferative/differentiation state of the transplanted myoblasts. The dual delivery of the pro-angiogenic regulator VEGF and the key regulator of satellite cells activation and differentiation IGF-1 (VEGF/IGF-1 alginate gel) from an alginate gel was investigated in both in vitro and in vivo (Example 1). The combination of these two factors was demonstrated to enhance functional contractile skeletal muscle regeneration, revascularization and re-innervation of muscle tissue. In contrast to other combinations tested (e.g., FGF-2, HGF), the VEGF/IGF combination was found to not only promote muscle regeneration but also to profoundly improve the contractile activity of the skeletal muscle. This surprising and significant advantage is due to the synergic effect exerted by both VEGF and IGF-1 on reinnervation.
These data indicate that controlled spatio-temporal release of the two critical morphogens, VEGF165 and IGF-1, from a macroporous RGD-modified alginate gel coupled with the transplantation of donor satellite cells induce surprising and remarkably more efficient functional muscle regeneration compared to any other known method. This effect was demonstrated using a severe ablating muscle injury model (myotoxin-ischemia induced skeletal muscle injury). The results of this study indicate that localized delivery of VEGF and IGF-1 from a macroporous scaffold into injured myotoxin-ischemic muscles significantly enhances muscle regeneration compared with the blank alginate treatment (FIGS. 3A-4B). These data confirm and extend findings showing a therapeutic benefit of the combined delivery of VEGF/IGF-1 from a alginate gel on the overall muscle regeneration process (Example 1).
Transplanting the cells with a scaffold that simultaneously delivers VEGF/IGF-1 dramatically enhanced the participation of transplanted cells in muscle regeneration (FIG. 2), promoting both cell viability and migration out of the scaffold in the surrounding injured tissue. The robust transplanted cell engraftment was maintained for extended period of time following the time of treatment in mice (6 weeks). This capacity of enduring in time indicated that the beneficial effect exerted by the dual delivery of the GFs creates an appropriate microenvironmental niche for a long-living progeny able to induce a lasting muscle regeneration process. Conversely, the direct bolus injection of primary satellite cells and GFs induced a significant lesser amount of transplanted cells engrafted in the host muscle; this effect was likely due to both the modality of delivery leading to a rapid lost of the GFs' bioactivity on one side and, to a massive death of the donor cells deprived of the adhesive initial polymeric support to the other side. The enhancement in satellite cells engraftment in the repair of severe ablative muscle injury is accompanied by a higher recruitment of activated myoblasts as shown by the quantitatively greater density of the centrally located nuclei per length of myofibers in muscle treated with scaffold delivering cells and growth factors. This result is also validated/consistent with the increase in size and weight of these muscle as compared with injured muscle treated with black alginate and bolus injection from early time (FIGS. 3A and 3B). A lesser increase in muscle regeneration parameters was observed with the implantation of alginate delivering only GFs, but still detectable as compared with blank alginate or bolus treatments.
The analysis of muscle injury section treated with localized sustained delivery of GFs and cells revealed a better resolved defect area at early time (FIG. 4 B) as compared with all the other conditions where the larger injured area were characterized by profoundly disorganized and necrotic myofibers at the same time point. The data indicate that the methods lead to a faster, more efficient, and more effective regenerative process due to a contribution of satellite cells both by fusion with existing host myofibers and/or by de novo myogenesis as a result of the microenvironment created by the device and the presence and tuned release of VEGF and IGF in concert. The synergistic effect was demonstrated by a clinically relevant outcome of markedly earlier recovery of the motility (walking ability) of the injured hindlimb.
In addition to an improved and early effect on myogenesis, the transplantation of cells from scaffolds delivering GFs promoted pronounced angiogenesis and the return to the normal level tissue perfusion as compared with all the other conditions, likely activating pathways controlling the endogenous activity of these cells. However, a slower but still significant pro-angiogenic effect was quantified (FIG. 5 A) in muscle injured treated with alginate gel delivering GFs at late time from treatment as observed in FIG. 5 B. Conversely, a modest increment in blood vessel density was induced by blank alginate gel and bolus treatments.
Finally, the dual delivery of satellite cells and GFs from macroporous alginate gel reduced muscle inflammation and fibrosis (FIG. 7 B) and more importantly, improved strongly the muscle contractile function (FIG. 7 A). This result is related with the synergic effect played by IGF-1 in modulating inflammation and regeneration processes and in part with the proangiogenic and neuro-protective effect of VEGF. After a 2.2 fold (54.32%) loss of muscle strength immediately after the injury, a significant increase of the muscle strength, above the normal level, was observed after 2 weeks from the treatment, followed by a decrease around the normal value at 6 week post-treatment. This trend is likely associated to the two main phases of activation/proliferation and late differentiation of the myoblasts participating to the muscle regeneration process. These effects were consistent with the modest increase in the fibrotic tissue (FIG. 7 B). Conversely, the delivery of a combination of VEGF and IGF-1 from scaffolds, in the absence of transplanted cells, had a less pronounced effect on muscle regeneration.
The results provided startling evidence for the feasibility of stem cell niches molecular mimicry in vivo and in a accepted and clinically relevant animal model. In fact, the devices and methods described herein demonstrate that the use of cell-instructive scaffolds simultaneously function as a vehicle and a reservoir of progenitor cells and growth factors. The myogenic response in vivo and the transplanted cell fate was effectively modulated by the synergic cooperation between structural ECM components associated with angiogenic and myogenic growth factors.
Example 3
Muscle Regeneration and Revascularization in Aging Subjects
In young subjects, a nominal level of muscle regeneration/revascularization occurs after injury or disease to the tissue. As is discussed above, delivery of VEGF and IGF in a hydrogel matrix significantly enhances the regenerative effect. However in older individuals, the naturally-occurring regenerative response to injury/disease is greatly reduced or absent. In humans, the total lean body mass (LBM) declines by about 18% in men and by 27% in women from the second to eighth decade of life; the decline in LBM becomes detectable after the age of 45 years, and also reflects a loss of regenerative capacity. Thus, the VEGF/IGF devices and delivery methods are particularly useful for treatment of such individuals.
Studies were undertaken to evaluate the effect of hydrogel VEGF/IGF delivery to muscle tissue in young animals as compared to old animals. Preparation and delivery of growth-factor loaded hydrogels was carried out as described above. Rather than using young mice (e.g., 6-8 weeks of age), old mice (approximately 2 years of age) were tested. FIG. 8 shows regional blood perfusion of the hindlimb (ischemic vs nonischemic limb) of old mice. C57BL/6J old animals (>2 years old) displayed little to no spontaneous recover (gel), in terms of hemodynamic flow analysis, which contrasts to the situation in young mice. Mice treated with gel delivery of VEGF165 or IGF alone showed a low level of recovery, while gel delivery of both VEGF and IGF alone led to a much greater level of recovery. For example, the enhancement in perfusion with delivery of IGF and VEGF is greater than 3-fold, as compared to untreated subjects.
A distribution and level of ischemic severity displayed in the old animals is shown in FIG. 9. The ischemic grade used the following score: 0—autoamputation of leg; 1—leg necrosis; 2—foot necrosis; 3—two or more toe discoloration; 4—one toe discoloration; 5—two or more nail discoloration; 6—One nail discoloration; 7—No necrosis. The results indicated that gel delivery of VEGF and IGF together led to a much less ischemic injury than the factors alone, or control (gel with no factors).
In addition to evaluation of blood perfusion and ischemic severity, the functionality of the treated muscle tissue was determined. The Tarlov score is a functional test that directly evaluates the ability of animals to locomote and to bear their body weight via the inferior limbs. The Tarlov grade use the following score: 0—No movement; 1—Barely perceptible movement, no weight bearing; 2—frequent and vigorous movement, no weight bearing; 3—supports weight, may take 1 or 2 steps; 4—walks with only mild deficit; 5—normal but slow walking; 6—full and fast walking. Gel delivery of VEGF and IGF together led to a significant improvement (at least 1 and up to 2-3 units in Tarlov grade) in hindlimb function. Muscle function of hindlimbs of old animals was also evaluated using a force generation test at 12 weeks after surgery and polymeric vehicle treatment. The force generation (normalized to muscle mass) was measured by dissecting the muscle from the mice at the 12 week time point. Gel delivery of VEGF and IGF was found to lead to a significantly higher level of muscle regeneration and function, as compared to injured, control muscles treated with blank gel. Control, non-ischemic muscles are shown for comparison.
These surprising results indicate that co-delivery of VEGF and IGF to injured or diseased muscles is particularly efficacious for treatment to regenerate muscle tissue of aged individuals.
Example 4
Minimally Invasive Repair of Injured Skeletal Muscle with Biodegradable Scaffolds
The repair of damaged skeletal muscle may be enhanced by the injection of muscle stem cells and/or recombinant growth factors, but is currently limited by inefficient methods for their delivery. A degradable covalently cross-linked alginate scaffold was developed for delivery of progenitor muscle cells and growth factors to treat skeletal muscle injuries. This scaffold was highly porous and compressible, returning to its original shape when rehydrated (i.e., the scaffold is characterized as having “shape memory”). This composition allowed minimally invasive implantation of the scaffold via a catheter and, since the scaffold is degradable, there was no need for invasive follow-up surgery to remove the implant once its repair function was completed.
The shape-memory alginate hydrogels are covalently crosslinked and oxidized (to induce biodegradability). They are dry and porous. Following lyophillization and compression, the material is pliable (not brittle), e.g., it can be rolled up and put into a syringe/needle assembly or angiocatheter (e.g., 10-14 gauge) for in vivo delivery to the body. Once place in a desired location in the body, a syringe/needle assembly or catheter is used to subsequently deliver a cell suspension to the shape-memory device. Because the device is hydrophilic, it then soaks up the cells. The cells are then slowly released from the device and migrate out of the device to bodily tissues.
Cultured muscle progenitor cells delivered alone (i.e., in the absence of the hydrogel matrix/scaffold) are characterized by poor survival and little or no proliferation post-delivery in vivo. In contrast, muscle progenitor cells delivered within the scaffold survived for several weeks (3-4 weeks and longer), proliferated, and demonstrated active migration from the scaffold (i.e., out of the scaffold and into muscle tissue of the treated subject). The alginate scaffold was also capable of prolonged growth factor release.
A severe muscle injury model was used to test the ability of the growth factor-containing hydrogel scaffold to enhance the muscle repair process. The scaffold was used to deliver combinations of different treatments including primary murine muscle cells, IGF-1 and/or VEGF.
The implanted scaffolds delivering cells and IGF-1 enhanced cell survival and migration into the damaged muscle site compared to cells and IGF-1 injected without scaffolds, resulting in increased fusion of the injected cells with the regenerating host muscle fibers. The addition of VEGF to the scaffold promoted angiogenesis in the damaged muscle tissue, contributing to muscle repair. The combined delivery of VEGF and IGF-1 from the scaffold led to a significant reduction in fibrotic tissue and an increase in muscle contractile function compared to their delivery without a scaffold. The implanted scaffold did not stimulate an inflammatory response. Thus, the shape-memory alginate scaffold is useful as a synthetic matrix for use in a tissue repair to improve the restoration of the structure and function of severely injured skeletal muscle.
The 3-D degradable scaffold is highly compressible for in vivo delivery by catheter yet returns to its original shape in vivo (i.e. shape-memory characteristics), with the ability to deliver growth factors and muscle precursor cells in vivo for skeletal muscle repair. Transplanted cells in resorbable three-dimensional (3-D) scaffolds, with the local release of growth factors encapsulated in the scaffold, improve skeletal muscle regeneration compared to current technologies. Insertion of such a repair scaffold/cell/growth factor combination by minimally invasive surgical techniques, (e.g., using a needle or catheter) has wide clinical applicability.
The resorbable scaffold for delivery of growth factors and muscle progenitor cells mediates the localized release of growth factors and the enhancement of myoblast survival in the region of injured muscle tissues. Porous and biocompatible matrices provide space for cells to grow and survive and microenvironment for growth factor/drug retention and release. The devices and methods described represent a general approach to tissue regeneration that is applicable to the transplantation of many different cell types to enhance the regenerative response of multiple tissues.
Example 5
Neural Regeneration Using VEGF-Hydrogel Delivery Compositions
Hydrogel compositions, e.g., alginate gels, loaded with VEGF alone, i.e., in the absence of other growth factors, were found to prevent degeneration at the neuromuscular junction. FIGS. 12A-B show that innervation of neuromuscular junctions was significantly decreased following nerve crush injury in stemomas-toid muscle. Exogenous VEGF-gel delivery prevented complete degeneration and accelerated re-inervation. FIGS. 12C, D show that in the absence of exogenous VEGF, Wallerian degeneration of the nerves was observed within 24 h of the traumatic insult. Time-lapse imaging showing retraction of the motor axons (white arrows) due to the crush injury (FIG. 12E).
Neural regeneration by exogenous VEGF delivered in the context of a hydrogel is time and dose dependent. FIGS. 13A-C show dose-dependent neuromuscular joint innervations. Here, the optimal dose of VEGF was 3 μg. FIG. 13 D shows a timecourse of VEGF release from alginate hydrogels in vitro, showing the bulk release of VEGF within 7 days of incapsulation. The release kinetics are similar, regardless of the VEGF dose, with a rapid release for the first 5 days, followed by a slower, but continuing release for the duration of the analysis.
Maturation of motor axons in motor endplates and neuromuscular junction remodeling after the ischemic injury and neural crush was observed after local delivery of VEGF. Seven days after the injury, significant numbers of terminal axonal sprouts were present in NMJ treated with blank hydrogels, whereas VEGF delivery lowered the number of immature neuromuscular junctions (FIGS. 14 A, B). Multiple innervation was significantly increased in blank-supplemented muscles, whereas VEFG delivery resulted in one axon innervation of the motor endplate of injured muscle (FIGS. 14C,D). Both the percentage of neuromuscular junctions with multiple axons and % of neuromuscular junctions with axons that did not terminate at the motor endplate of the neuromuscular junctions (both halmarks of immature neuromuscular junctions) was reduced upon VEGF-gel delivery (FIG. 14E-F).
Injection of VEGF-loaded hydrogels into ischemic Tibialis Anterior muscles elevates the expression of neurotrophic factors within 7 days after the injury. Cryosections of the Tibilalis Anterior (TA) muscle showing elevated expression of Netrin-1 upon the delivery of VEGF (FIG. 15A). Panoramic images of the whole cryosection showing increased levels of Netrin-1 in VEGF supplemented ischemic TA muscle (FIG. 15B). Delivery of VEGF further elevated the expression levels of Neural Growth Factor (NGF) in ischemic TA muscles (FIG. 15C). The mechanism of VEGF-gel influence on the motor endplate reinnervations involves endogenous upregulation of these factors by endothelial cells.
Injection of alginate hydrogels supplemented with VEGF and Netrin-1 significantly elevates levels of neuromuscular junction innervation within 7 days of ischemic injury in TA muscle of mouse hindlimb. FIG. 16A shows representative images of neuromuscular junction innervation in ischemic TA muscles and increased innervation following VEGF and Netrin-1 delivery. FIG. 16B shows the results of a quantification of the TA innervation in ischemic TA muscles and a synergistic effect of the combined VEGF and Netrin-1 delivery. n=6 animals for each condition. Simultaneous delivery of VEGF and Netrin-1 enhances reinnervation of the motor endplates in a synergistic manner.
These data indicate that VEGF-containing hydrogels lead to a neuroprotection in the anatomical vicinity (at or near) of the site of administration. A therapeutic effect was noted at distances up to several centimeters away from the injection site. To treat a large tissue volume one would perform multiple gel injections, appropriately spaced in order to impact the entire tissue volume.
Example 6
Shape-Memory Polymers and Scaffolds
Shape memory polymers are characterized by their capacity to be highly compressed and recover their original shape from a stored packaged state in response to an environmental stimulus, e.g., administration into or onto a tissue of the body. Shape-memory materials, such as the compressed hydrogels described herein, are used to facilitate minimally invasive surgery by injection of a compressed structure which is a fraction of its original volume, but which then resumes its precompressed size and shape when implanted in vivo. The advantages of this type of material are that it combines the structure-defining property of implantable materials with the minimally invasive method for implantation of the material. This approach permits a less traumatic introduction of the implant into the body and reduces pain and recovery time. Macroporous alginate hydrogel scaffolds are prepared in predefined geometries, dehydrated and compressed into smaller, temporary forms. When rehydrated with a suspension of cells, e.g., by dropping a suspension of cells onto the dried scaffold, the scaffold returns to its original shape and was thus suitable for minimally invasive surgery. Dehydrated scaffolds are delivered through a needle or catheter and rehydrated in situ.
Macroporous scaffolds with shape memory are covalently crosslinked. A scheme for the synthesis and cross-linking of poly(aldehyde guluronate) is provided at FIG. 19 (Polymer, Bouhadir K H, Hausman D. S, Mooney D. J, Synthesis of cross-linked poly(aldehyde guluronate) hydrogels. 1999. 40: p. 3575-3584).
The combination of shape-memory capability and biodegradability increases the multi-functionality of a biomaterial in medical devices used for minimally invasive surgery. Implant materials are injected in a compressed state into the body through a small incision or puncture hole (e.g., using a needle or catheter). After implantation, the hydrogel becomes rapidly rehydrated and restored to its previously-designed 3D shape. After these 3D matrices have served their purposes (cell and growth factor delivery), removal of the implants by follow-up surgery is not necessary, as the implant degrades.
Polymer Degradation
Polymer degradation is controlled using a variety of techniques such as irradiation, oxidation, and/or varying the molecular weight distribution of the polymer chains. One way to enhance degradation properties of alginate polymer is irradiation. Polymer degradation results from changes in polymeric chemical structure initiated by high energy electrons generated by gamma irradiation. Low molecular weight (LMW) polymer can be generated as the product of irradiated high molecular weight (HMW) polymer, and is subject to faster degradation. Low molecular weight means 5000-50,000 daltons; High molecular weight means 100,000-500,000 daltons. The molecular weight of the LMW polymer generated is determined by the irradiation dose and time of exposure. The percent LMW polymer generated is determined by the strength of the irradiation beam and time of exposure.
Exemplary compositions include 5% 1LMW:1HMW.
Oxidation
Another approach to control alginate gel degradation is partial periodate oxidation which offers control over the degradation rate—increasing the degree of oxidation accelerates the rate of degradation. When alginate is oxidized by reacting with sodium periodate (NaIO4), the carbon-carbon bond of the cis-diol groups in the uronate residues are cleaved, and the aldehyde groups of oxidized hexuronic-acid residues spontaneously form six-membered hemiacetal rings with the closest hydroxyl groups on two adjacent, unoxidized sugar residues in the chains. This procedure alters the conformation of the molecules and creates hydrolytically labile bonds that facilitate faster degradation.
Alginates are naturally derived long chain polysaccharide copolymers formed by alternating or repeating the uronic functional units: mannuronic acid (M) and guluronic acid (G) and thus its chemical structure can be represented with MVG. Low molecular weight alginate can be generated by irradiating high molecular weight alginate at a dose of 5 Mrad for 4 hours. Both LMW and HMW alginate are then be oxidized by reacting with NaIO4. The extent of oxidation is dependant on the amount of NaIO4 reacted with the uronic acid function unit.
Molecular Weight Distribution
A third approach to regulate alginate gel degradation rate involves control over the molecular weight distribution of the polymer chains used to form scaffolds. Scaffolds formed from LMW polymer chains rapidly degrade in vivo but are mechanically weak. Therefore, the use of a bimodal molecular weight distribution combining HMW: LMW polymer in different ratios may result in the formation of mechanically stable gels with degradation rates that can be controlled.
Modification of the Scaffold with ECM Components
Modification of the scaffold for cell delivery includes binding of RGD peptides to encourage temporary cell adhesion. Generally, the surface chemistry conveyed through the adsorbed protein layer and macro-scale topographical features affect cell-surface interactions and greatly influence the success of an implant for tissue regeneration. Unmodified alginate does not facilitate mammalian cell adhesion due to its poor binding of serum proteins. Therefore, in order to allow the biomaterial to mimic the physicochemical properties of natural tissues for cell survival and proliferation, the surface and the bulk of the alginate needs modification by adding cell-binding peptides.
RGD (arginine-glycine-aspartic acid) is a peptide sequence that promotes cell adhesion and is present as the cell-binding domain of many extracellular matrix proteins. With RGD, the cells form attachments, which maintain and/or enhance cell survival and proliferation. In addition, these cell-peptide interactions may also promote other cell-specific functions, such as hormone production or cell migration into a repair site
Scaffold Manufacture
LMW alginate was generated by gamma irradiation of HMW LF 20/40 alginate (FMC Biopolymer, Philadelphia, Pa., USA) at 5.0 Mrad for 4 hours (h) with a cobalt-60 source for 4 h. To fabricate oxidized alginates, both LMW and HMW alginate were diluted to 1% w/v in ddH2O, and 1% and 5% and 10% of the sugar residues were oxidized using different amount of sodium periodate (Sigma-Aldrich, Saint Louis, Mo.) and maintaining solutions in the dark for 19 h at room temperature. An equimolar amount of ethylene glycol (Fisher scientific, Fair Lawn, N.J.) was added to quench the reaction, and the solution was subsequently dialyzed with Spectra/Por dialysis tubing (MWCO3500) (VWR International, Pittsburgh, Pa.), filtered and lyophilized to generate 1% and 5% and 10% oxidized LMW and HMW alginates. All alginate components were further modified with linear RGD peptide (G4RGDSP-OH) (Commonwealth Biotechnology, Inc.) using 1-ethyl-(dimethyl aminopropyl) carbodiimide (EDC Sigma-Aldrich), N-hydroxysulfosuccinimide (sulfo-NHS, Pierce, Rockford, Ill.), and the bifunctional cross-linker adipic acid dihydrazide (AAD, Sigma-Aldrich).
To prepare covalently cross-linked alginate scaffolds, sodium alginate 2% (w/v) was dissolved in MES buffer [0.1 M 2-(N-morpholino) ethanesulfonic acid (MES); 0.3 M NaCl], pH 6.0, and covalently cross-linked hydrogels were formed by standard carbodiimide chemistry using 1-ethyl-(dimethyl aminopropyl) carbodiimide (EDC), 1-hydroxybenzotriazole, and the bifunctional cross-linker adipic acid dihydrazide (AAD) (ratio of AAD:reactive groups on polymer; 1:20) as depicted in FIG. 20. Scaffolds were then placed in a large volume of distilled water, for a minimum of 24 hours, to attain equilibrium swelling and to remove residual unpolymerized chemicals.
Three different scaffolds were fabricated as follows, each with LMW and HMW alginates combined in a 1:1 weight ratio:

    A. 1% binary group—1% oxidized HMW alginate×1% oxidized LMW alginate—(percent of oxidation refers to the percent of the uronic groups that are oxidized)
    B. 5% binary group—5% oxidized HMW alginate×5% oxidized LMW alginate—
    C. 10% binary group—10% oxidized HMW alginate×10% oxidized LMW alginate—


The resulting alginate materials were then frozen at −20° C. and lyophilized to generate macroporous scaffolds. Scaffold porosity (void volume) and pore characteristics, equilibrium swelling ratios (Qs), were all determined as described below. Scaffold dimensions were measured with Vernier calipers, lyophilized and then rehydrated with distilled water to determine the ability of the scaffolds to return to their original dimensions.
Swelling Ratio (Q) and Porosity Measurements
Scaffolds were equilibrated in distilled water at room temperature. After removing excess liquid from the surfaces by blotting, the scaffolds were weighed (WS) and diameter and thickness measurements were taken using Vernier calipers. Scaffolds were then frozen, lyophilized as described above, and the weight measurements repeated (WD). The swelling ratio (QS) is defined as the mass ratio of absorbed water to dry scaffold, calculated from:

QS=(WS−WD)/WD. 

To determine the porosity (void volume) of the dry scaffolds, scaffolds were weighed (WS) and then reweighed after freezing and lyophilization (WD). The porosity was calculated from:

(WS−WD)/WS×100%

SEM Scaffold Surface Morphology
The lyophilized scaffolds were placed on the surface of carbon adhesive paper and coated with gold nano-particles by a sputter coater to make the surface conductive. Default settings used for coating were: 4 min, 25 mA, 1 coating for each sample. Images were taken by a HITACHI 2700 Scanning Electron Microscope (Voltage: 6 KV/Beam current: 6*/Scanning speed: 160). The images were collected with a Quartz PCI digital imaging system (Quartz Imaging Corporation) and analyzed with ImageJ software (NIH).
Cell Distribution in Scaffolds
PMMGFP cells (GFP transduced primary mouse myoblasts) were grown at low density in tissue culture plates, and harvested by trypsinization. Five hundred thousand cells/scaffold were suspended in 50 μl PMMGM [PMMGM: 20% Fetal bovine serum (FBS), 39% Dulbecco's Modified Eagle Medium (DMEM, Gibco), 39% Fibroblast growth medium (FGM, Lonza), 1% ITS Liquid Media Supplement (Sigma) and 1% penicillin/strepmyosin (Sigma)] and pipetted dropwise onto the scaffolds in 35 mm diameter tissue culture dishes. The dishes were placed for 30 min in a 5% CO2 humidified incubator at 37° C. before being covered with 1 ml PMMGM to immerse the scaffolds. The PMMGM was changed daily. Images were taken 2 weeks after the cells were seeded onto the scaffolds with a Leica TCS SP2 AOBS spectral confocal microscope. Images were acquired and analyzed with Leica confocal software (LCS) Version 2.5.
Shape Memory Properties of the Scaffold
Shape memory properties are important for delivery using a minimally invasive method. To evaluate the shape memory capacity of the 5% 1LMW:1HMW scaffold, the dehydrated and compressed scaffolds were rehydrated in vitro and investigated two main shape memory properties evaluated: porosity and swelling ratio. 1.2 mm-thick scaffolds were compressed at 500 psi to a thin film with an average thickness of 0.11 mm. Strikingly, the average swelling ratio was approximately 11, indicating that the scaffold can swell to  ̃11 times its volume after rehydration.










Shape memory parameters









Porosity
Swelling ratio
% of volume recovered













Cross-link density





Original scaffold
98.1 + 0.1%
 56.2 + 2.2
90.0% (compressed





manually)[80]


5% LMW:HMW
90.7 + 0.3%
11.36 + 0.2
80.62% (compressed





at 500 psi)









Average porosity and swelling ratio for 5% oxidized covalently cross-linked scaffold. The lyophilized 5% oxidized 1LMW:1HMW scaffolds were compressed at 500 psi to a thin layer (0.12 mm in depth, measured by Venier calipers) then rehydrated with distilled water until equilibrium. The porosity and swelling ratio are calculated from the weight before and after rehydration. The original scaffold refers to an unmodified HMW covalently cross-linked shape memory scaffold. The original scaffold was compressed manually. Data represent mean±SEM (n=4).
The porosity was measured at  ̃90.7%, which implied that the scaffolds are very porous and have high water content ( ̃90%). Collectively, these data indicate that the scaffolds made with the 5% oxidized LMW and 5% oxidized HMW at the ratio 1:1 maintained good shape memory properties after physical and chemical modifications to the original non-modified scaffolds. They also appear to have good porosity for cell uptake.
Scaffold Surface Morphology and Cell Distribution
The large porosity of the 5% 1LMW:1HMW scaffolds should offer a structural advantage for their use as a vehicle for delivery of cells for various repair and bioengineering applications. To further assess porosity of the scaffolds, their surface was imaged using a scanning electronic microscope (SEM). As illustrated in the FIG. 17a, the scaffolds were porous with the average pore size of 412 μm. This porosity feature facilitates cell infiltration and migration out of the scaffold as well as provides sufficient surface area for seeding significant cell numbers. In addition, the open porous structure facilitates exchange of nutrients and metabolites between seeded cells and the neighboring microenvironment.
To assess cell distribution on these scaffolds, they were RGD modified and loaded with PMMGFP cells as described above. The cell suspension settled well into the pores of the scaffold (FIG. 17b), and after two weeks of incubation, cells appeared to be well attached to the scaffold, growing in clusters (FIG. 17c). After 2 weeks in culture, the cells were viable and proliferating, as determined by an increase in the number of viable cells inside the scaffold (measured by GFP assay) and the cell clusters had an even distribution pattern on the scaffold. (FIG. 17c)
Scaffold Geometries for Tibialis Muscle Regeneration and Design Considerations
The shape-memory scaffolds are used as a delivery vehicle for cells and growth factors to promote regeneration of injured muscle. In addition to surgery, the scaffolds are administered implantion using a minimally invasive technique to deposit it next to an injured or diseased muscle site. Thus, the dimensions of the scaffolds were designed to match geometries of target tissues. A severe murine tibialis anterior injury model was used for in vivo studies. In this case, the scaffolds were generated to be the approximate length of a tibialis anterior (13.5 mm) and a width equal to the circumference of a tibialis anterior (2.6 mm). The size is varied to accommodate the target site in the subject and the mode of administration (e.g., surgery, needle, or catheter). In the mouse model, the scaffolds were approximately 1.1 mm thick after rehydration. With these dimensions, the 5% 1LMW:1HMW was processed and delivered through a 1.5 mm angiocath to lie next to the tibialis anterior muscle (FIG. 18).
After rehydration, the covalently cross-linked scaffolds made from the 5% oxidized low molecular weight and high molecular weight alginate in a 1:1 ratio recovered more than 70% of their original volume. The scaffolds are also capable of restoring to their original dimensions after compression and rehydration. These results show that the modified scaffolds possess good shape memory properties.
The surface morphology shown by SEM imaging of a lyophilized scaffold indicates that the scaffold has a porous and interconnected structure. The porosity was also measured from the same set of data that generates swelling ratio. The porosity property confers to this covalently cross-linked scaffold an appropriate structure for seeding cells, and facilitates exchange of nutrients and metabolites within the surrounding in vivo microenviroment. In addition, the porosity data indicates that the rehydrated scaffolds have a high water content, which resembles normal muscle tissues.
The shape memory properties permit delivery of the dehydrated scaffolds to the site of the muscle damage with ease and accuracy. The scaffold is injected in a compressed state into the body through a small incision. After the injection of the scaffold, a subsequent injection of aqueous solution containing growth factors and cells efficiently rehydrates and restores the scaffold geometries. Since the scaffold degrades within a pre-defined time interval, surgical removal is not necessary after the scaffold has served its purpose, i.e., improving the survival of delivered cells and releasing growth factors for improved muscle regeneration.
Myoblasts Proliferate and Migrate Out to the Hydrogel Scaffold into Muscle Tissue
Myoblasts proliferate and migrate out of the hydrogel scaffold and into recipient's muscle tissue continuously for at least 3 week period. To test cell proliferation on, and migration out of the alginate scaffolds, 0.3 million GFP transduced primary mouse myoblasts (PMMGFP) were seeded onto the scaffolds. The cells absorbed well into the porous scaffold material. Over a 3-week observation period, the cells proliferated and migrated from the scaffold onto the collagen-coated tissue culture plates (surrogate for muscle tissue of the subject). Cells migrated out of the scaffold 2 weeks after they were initially seeded and continued to grow on the plate surface. By the end of 3 weeks, there were approximately 0.81 million viable cells in the scaffold based on total GFP extraction and the cumulative number of cells that had migrated off the scaffold was approximately 0.11 million cells based on cell counts. These data indicate that myogenic cells proliferate and migrate out of the candidate scaffold continuously at a nearly constant rate during a 3-week period.
The efficiency of IGF-1 release from the scaffolds was also tested. Approximately 90% of the IGF-1 was released at a constant rate during the first three days, followed by sustained slower release rate from Day 3 to Day 14. By Day 14, nearly 100% of IGF-1 was released. Since IGF-1 was largely released within the first three days, IGF-1 has an effect on transplanted muscle progenitor cells and host satellite cells in the early stage of the injury recovery process. Satellite cells are activated immediately following injury as a pulse lasting for only a few days, and since IGF-1 stimulates proliferation and migration of satellite cells, the early burst release of IGF-1 from the scaffold is spatially and temporally synchronized with the activation of satellite cells. Upregulation of satellite cell proliferation and migration by IGF-1 further enhances myogenic cell-mediated skeletal muscle regeneration. The use of the scaffold to deliver growth factors provides the advantage of localized delivery, as growth factors are targeted to a small region near injury sites. By contrast, injected growth factors (in the absence of the hydrogel delivery vehicle/scaffold) are often either rapidly taken up by cells, quickly degraded, or bound up by extracellular matrix molecules, all of which cause a rapid decrease in their concentration. The scaffolds/vehicles described herein function as a localized delivery system for growth factors enhance the effects of the growth factors locally while eliminating side effects at other regions of the body, as would occur with systemic administration. Localized delivery limits the global impact of growth factors by minimizing their entry into the circulatory system. In addition, localized delivery reduces the amount of growth factors needed to achieve the desired effects. Thus, the biodegradable alginate scaffold has significant advantages as a vehicle for delivering cells and growth factors in vivo.
Growth Factor and Progenitor Cell Delivery from Scaffolds Promotes Muscle Regeneration
The scaffold serves as a temporary delivery vehicle for muscle progenitor cells and growth factors, while avoiding the chronic problems associated with long term biomaterial implantation. Enriched populations of myoblasts were seeded onto the scaffold and the role of vehicle design in cell survival and migration was examined. The data indicate that long-term survival and migration of cells from the polymeric delivery vehicles and into host muscle tissue was achieved. Muscle progenitor cells can continuously proliferate and migrate out of the alginate scaffold during a 3-week period and longer. The alginate scaffold is also capable of prolonging IGF-1 release from the scaffold while maintaining its high local concentration temporarily. These data indicate that the alginate scaffold functions as a degradable ECM and temporary delivery vehicle for muscle progenitor cells and growth factors, which is useful to restore the function and the structure of the injured skeletal muscle.
Other embodiments are within the following claims.

## Claims

1. A method of enhancing muscle tissue repair or regeneration,
comprising introducing into a muscle tissue of a human subject an injectable device comprising an alginate hydrogel comprising a combination of vascular endothelial growth factor 165 (VEGF165) and insulin-like growth factor-1 (IGF-1), wherein the alginate hydrogel comprises oxidized alginate, wherein the VEGF165 and the IGF-1 are released from the device into said muscle tissue, and wherein introduction of said device comprising a combination of VEGF165 and IGF-1 provides a synergistic muscle tissue regeneration effect in the human subject.

2. The method of claim 1, wherein said muscle tissue comprises skeletal muscle tissue.

3. The method of claim 1, wherein said muscle tissue comprises smooth muscle tissue.

4. The method of claim 1, wherein said muscle tissue comprises cardiac muscle tissue.

5. The method of claim 1, wherein introduction of said device comprising a combination of VEGF165 and IGF-1 provides an increase in blood vessel density in said muscle tissue.

6. The method of claim 1, wherein regional blood perfusion of muscle tissue is increased following introduction of said device.

7. The method of claim 1, wherein said device is introduced into a muscle tissue of the human subject using a needle.

8. The method of claim 1, wherein said device comprises macropores.

9. The method of claim 1, wherein said device further comprises a population of myogenic cells.

10. The method of claim 9, wherein said myogenic cells comprise myoblasts.

11. The method of claim 9, wherein said myogenic cells comprise satellite cells.

12. The method of claim 9, wherein said myogenic cells are seeded into or onto said hydrogel ex vivo.

13. The method of claim 1, wherein the alginate hydrogel comprises low molecular weight alginate and high molecular weight alginate.

14. The method of claim 13, wherein the alginate hydrogel comprises oxidized low molecular weight alginate and oxidized high molecular weight alginate.

15. The method of claim 14, wherein the ratio of low molecular weight to high molecular weight alginate is 1:1.

16. The method of claim 1, wherein the alginate hydrogel comprises 1%, 5%, or 10% oxidized alginate.

17. A method of treating an ischemic disease or ischemic injury in a human subject comprising introducing into a tissue of the human subject a device comprising an alginate hydrogel comprising a combination of vascular endothelial growth factor 165 (VEGF165) and insulin-like growth factor-1 (IGF 1), wherein the alginate hydrogel comprises oxidized alginate, wherein the VEGF165 and the IGF-1 are released from the device into the tissue, and wherein introduction of said device comprising a combination of VEGF165 and IGF-1 provides a synergistic muscle tissue regeneration or revascularization effect in the human subject.

18. The method of claim 17, wherein the ischemic disease comprises chronic ischemia.

19. The method of claim 1, wherein the alginate hydrogel further comprises non-oxidized alginate.