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Many clinical studies of regenerative medicine using bone marrow-derived mesenchymal stem cells (MSCs) have been conducted globally. We initiated clinical studies using MSCs in 2001, and have now treated over 100 cases with patients aged 0–92 years. In a few cases involving patients with chronic heart failure (CHF), we observed that MSCs proliferated poorly. This contrasts with cell therapy studies wherein MSCs of patients with CHF were used for treatment. The effects of serum on the proliferation of MSCs from donors with normal heart function and with CHF have not been reported. Moreover, whether cell therapy is effective for elderly patients remains uncertain. Therefore, characterization of MSCs from aged donors and/or donors with CHF is urgently required. We retrospectively analyzed the population doubling times (PDTs) of MSCs between the first and second passages. Although we had data for many samples of well expanded MSCs from aged donors, a positive correlation was observed between donor age and PDT. A trend toward reduced variance in PDTs was observed in MSCs were supplemented with fetal bovine serum (FBS) compared to those supplemented with autologous serum. When autologous serum was used, the average PDT of MSCs from donors with CHF was significantly longer than that of MSCs from donors without CHF. In contrast, when FBS was used, similar PDTs were observed in MSCs from donors with and without CHF. Thus, FBS promotes MSC expansion even from donors with CHF, and that MSC-based regenerative medicine might be feasible even for elderly patients. This article is protected by copyright. All rights reserved.

In the human body, cells having self-renewal and multi-differentiation capabilities reside in many tissues and are called adult stem cells. In bone marrow tissue, two types of stem cells are well known: hematopoietic stem cells and mesenchymal stem cells (MSCs). Though the number of MSCs in bone marrow tissue is very low, it can be increased by in vitro culture of the marrow, and culture-expanded MSCs are available for various tissue regeneration.The culture-expanded MSCs can further differentiate into osteogenic cells such as bone forming osteoblasts by culturing the MSCs in an osteogenic medium. This paper discusses osteogenically differentiated MSCs derived from the bone marrow of patients. Importantly, the differentiation can be achieved on ceramic surfaces which demonstrate mineralized bone matrix formation as well as appearance of osteogenic cells. The cell/matrix/ceramic constructs could show immediate in vivo bone formation and are available for bone reconstruction surgery.Currently, MSCs are clinically available for the regeneration of various tissues due to their high proliferation/differentiation capabilities. However, the capabilities are still limited and thus technologies to improve or recover the inherent capabilities of MSCs are needed.

Mesenchymal stem cells (MSCs) are among the most promising sources of stem cells for regenerative medicine. However, the range of their differentiation ability is very limited. In this study, we explored prospective cell surface markers of human MSCs that readily differentiate into cardiomyocytes. When the cardiomyogenic differentiation potential and the expression of cell surface markers involved in heart development were analyzed using various immortalized human MSC lines, the MSCs with high expression of N-cadherin showed a higher probability of differentiation into beating cardiomyocytes. The differentiated cardiomyocytes expressed terminally differentiated cardiomyocyte-specific markers such as α-actinin, cardiac troponin T, and connexin-43. A similar correlation was observed with primary human MSCs derived from bone marrow and adipose tissue. Moreover, N-cadherin-positive MSCs isolated with N-cadherin antibody-conjugated magnetic beads showed an apparently higher ability to differentiate into cardiomyocytes than the N-cadherin-negative population. Quantitative polymerase chain reaction analyses demonstrated that the N-cadherin-positive population expressed significantly elevated levels of cardiomyogenic progenitor-specific transcription factors, including Nkx2.5, Hand1, and GATA4 mRNAs. Our results suggest that N-cadherin is a novel prospective cell surface marker of human MSCs that show a better ability for cardiomyocyte differentiation.

Various mesenchymal stromal cells (MSCs) have been applied to regenerative medicine. MSCs derived from periodontal tissue could also be a useful cell source for alveolar bone regeneration. However, only a few attempts of direct comparisons have been made between MSCs from periodontal tissues and those from other somatic tissues. The purpose of this study was to clarify the osteogenic characteristics of mesenchymal stromal cells derived from bone marrow (BMSCs), adipose tissue (ASCs) and periodontal ligament (PDLSCs). BMSCs, ASCs and PDLSCs were isolated from Fisher 344 rats. After 1 week of primary culture, stromal cells were subjected to cell surface analysis and osteogenic differentiation. The cells were subcultured for 2 weeks with and without osteogenic supplements (OS), followed by biochemical and histological analyses. With regard to cell surface antigens, all MSCs were positive for CD29 and CD90 and negative for CD45. With regard to osteogenic differentiation, BMSCs with OS had the highest ALP activity, calcium uptake and osteocalcin content. Without OS, PDLSCs had the highest levels of these bone differentiation markers. RT-PCR analysis and histological analysis showed similar trends. These results indicate that PDLSCs are an ideal candidate for alveolar bone regeneration.

Mesenchymal stromal cells (MSCs) derived from human bone marrow have capability to differentiate into cells of mesenchymal lineage (7). Especially, the differentiation capability towards osteogenic cells is very well known. We have already used the patient's MSCs for the treatments of osteoarthritis (8), bone necrosis (2) and bone tumor cases (5). In most cases, the MSCs were culture- expanded from patient's fresh bone marrow cells, and then combined with porous ceramics. The MSCs/ceramics composites were further cultured in a medium containing dexamethasone to promote osteogenic differentiation of the MSCs. In this culture condition, we could detect bone forming osteoblasts together with mineralized bone matrix on the ceramics (7); therefore, we could fabricate cultured bone using patient's bone marrow and ceramics. However, the proliferation and differentiation capability of the MSCs are variable and many lose their capabilities after several passages. With the aim of conferring higher capability on human bone marrow MSCs, some of transcription factors could be introduced into the MSCs. This review paper demonstrates the importance of the transcription factors to promote the osteogenesis as well as proliferation capabilities of human MSCs.

We have developed a new cell transplantation technique, in which mesenchymal stem cells (MSCs) were cultured and lifted as a cell sheet structure. The sheet formed bone tissue after in vivo transplantation at a subcutaneous site, without the need for any scaffold. The sheet could also be transplanted with a scaffold, such as hydroxyapatite (HA). Transplantation of this sheet/HA construct resulted in extensive bone formation. The purpose of the present study was to analyze the spatial distribution and biological potential of the osteogenic sheet/HA constructs. Histological examination showed that the construct allowed bone formation inside the pores, as well as outside the HA at 2 weeks after transplantation. Interestingly, when two HAs were wrapped in one sheet, the bone on the outside of one HA could bond to the bone on the other HA, resulting in union of two HAs. Biochemical investigation showed that the sheet/HA constructs had higher osteogenic potential than previous methods, such as MSC/HA constructs. Our results indicate that this transplantation technique using MSC sheets has the potential to be a useful tool in bone tissue engineering.

Although hydroxyapatite is commonly used as a scaffold for bone regeneration, sponges may be suitable because of the adaptability to the defect. To use as a scaffold, the fiber of sponge would be coated with any adhesive to storage stem cells in the sponges. Fiber in the structure of commercially available sponges was coated by immersion in dextran solution and air dried. After seeding of rat bone marrow cells (rBMCs), the sponges were implanted subcutis of rats for estimate osteogenesis in vivo. The level of osteocalcin was 25.28 ± 5.71 ng/scaffold and that of Ca was 129.20 ± 19.69 μg/scaffold. These values were significantly high- er than those in sponges without dextran coating (p < 0.01). It was thought that rBMCs could be stored on the shelf by dextran deposition in the fiber of the sponge. In vivo examination, dextran induced osteogenesis by rBMCs in many spaces in the inner structure of the sponge.

Diffusion chambers with rat bone marrow cells and demineralized bone matrix (DBM) were implanted subcutaneously to syngeneic 8-week-old rats and were harvested every week 3-7 weeks after implantation, and histochemical examination, determination of alkaline phosphatase activity, total calcium and phosphorus, the bone-specific vitamin K-dependent gla-containing protein (BGP) content, and detection of BGP mRNA relative to mineralization were performed. Alkaline phosphatase in diffusion chamber implants reached the highest activity at 4 weeks and then decreased. Calcium and phosphorus deposits occurred at 4 weeks after implantation and were followed by marked increases until 7 weeks, which was comparable to the accumulation of BGP. The BGP gene within the diffusion chambers began to be expressed at 5 weeks, and its expression increased markedly at 7 weeks after implantation. At 4-5 weeks after implantation, new bone adjacent to the membrane filters and cartilage toward the center of the diffusion chamber were observed histochemically. Light microscopic and immunohistologic examinations of chambers with marrow cells and DBM revealed production of mineralized matrices, typical of bone characterized by the appearance of BGP and mineralized nodules. In contrast, bone marrow cells alone did not show extensive bone formation and yielded very low values for these biochemical parameters. The present experiments demonstrate the potential of bone marrow cells and DBM to produce not only cartilage formation but also membranous bone formation associated with increasing expression of BGP mRNA during the later stages of bone formation, as well as a marked accumulation of BGP.

Mesenchymal stem cells (MSCs) derived from human bone marrow have capability to differentiate into cells of mesenchymal lineage. The cells have already been applied in various clinical situations because of their expansion and differentiation capabilities. The cells lose their capabilities after several passages, however. With the aim of conferring higher capability on human bone marrow MSCs, we introduced the Sox2 or Nanog gene into the cells. Sox2 and Nanog are not only essential for pluripotency and self-renewal of embryonic stem cells, but also expressed in somatic stem cells that have superior expansion and differentiation potentials. We found that Sox2-expressing MSCs showed consistent proliferation and osteogenic capability in culture media containing basic fibroblast growth factor (bFGF) compared to control cells. Significantly, in the presence of bFGF in culture media, most of the Sox2-expressing cells were small, whereas the control cells were elongated in shape. We also found that Nanog-expressing cells even in the absence of bFGF had much higher capabilities for expansion and osteogenesis than control cells. These results demonstrate not only an effective way to maintain proliferation and differentiation potentials of MSCs but also an important implication about the function of bFGF for self-renewal of stem cells including MSCs.

The purpose of this study was to estimate influence of lysine for osteogenesis in the porous hydroxyapatite (HA) scaffolds with bone marrow cells. The HA scaffolds were soaked in 100mM concentration of lysine solution. They were kept in bone marrow cell suspension at 1×106 cells/ml density. Another HA scaffolds without immersion in lysine solution were kept in the cell suspension at 1×106 or 1×107 cells/ml density. They were respectively implanted into dorsal subcutis of rats for 4 weeks. Serially sectioned paraffin specimens were made and observed histologically. In several sections, total pores and ones with bone were counted. Many pores containing bone were found in1×107 cells/ml concentration group. The significant difference was between 1×107 cells/ml group, the lysine group, and 1×106 cells/ml group. Although more bone formation was seen in lysine group than in 1×106 cells/ml group. There was no significant difference between the groups. Concentration of lysine to add in culture medium or scaffold should be improved respectively.

Porous hydroxyapatite (HA) scaffolds were processed in hyaluronic acid solution. Bone marrow cells obtained from the bone shaft of femurs of Fischer 344 rats at 1×106/ml concentration were seeded in pores of the scaffolds. The scaffolds were implanted in the dorsal subcutaneous tissue of rats for 2, 4, 6 or 8 weeks. Removed HA scaffolds at 2 and 4 week after dorsal subcutaneous implantation were histologically examined. At all experimental periods, osteocalcin in the scaffold was immunochemically measured for the quantitative analysis of osteogenesis by bone marrow cells in the porous HA scaffolds. Moreover, value of alkaline phosphatase (ALP) activity in the scaffolds was measured. Osteocalcin measured in scaffolds without bone marrow cells was 1.3 ng in an average and the ALP activity was 62.2 μmol at 4 week. In hyaluronic acid processed scaffold with bone marrow cells, quantity of osteocalcin increased from 1.6 ng at 2 week to 2.2 ng at 4 week after implantation of the scaffold. Histologically, many pores containing bone in the scaffolds immersed in hyaluronic acid solution were detected. Significant difference of the quantity of osteocalcin was recognized between 2 and 4 week implantation. There was no significant difference in the quantity of osteocalcin between the scaffolds implanted for 4 and 8 weeks. Value of ALP activity of the scaffold implanted for 4 weeks showed significant difference comparing with that implanted for 6 and 8 weeks. From the results of this study, quantitative increase of the bone formation in the pores of HA scaffolds would be able to observe from 6 to 8 weeks after implantation on the scaffolds by immersion in hyaluronic acid solution

Summery: As a tooth is composed of hard tissue covering pulp, it may be suitable for tooth regeneration to use porous cylindrical hydroxyapatite (HA) scaffolds with a hollow center. Generally, in vivo examination, bone marrow cell suspension for osteogenesis in cell/HA composite scaffold without subculture is prepared at a density of 1 x 10 7 cells/ml or higher. In dentistry, stem cells would be obtained from tooth pulp. For dentine formation, a smaller number of stem cells must be used. In this study, a suspension of rat bone marrow cells at 1 x 10 6 cells/ml of density was prepared to estimate the adhesive effect of laminin. After immersion of HA scaffold in laminin solution, bone marrow cells were seeded in the pores of the HA scaffolds by immersion in the cell suspension for preparing the cell/HA composite scaffolds. The specimens were respectively implanted in the dorsal subcutis of 7-week-old male Fischer 344 rats for 4 weeks for histological examination. Comparing with the results of in vivo examination, alkaline phosphatase activity of bone marrow cells on laminin-coated plate with and without dexamethasone cultured for 2 weeks was measured in vitro. It was considered that laminin contributed to bone formation in pores of a scaffold.

Heart failure is one of the most important cardiovascular health problems throughout the world and has high mortality, and there is a need to develop more effective therapeutic strategies to replace such specialized treatment as mechanical circulatory support and cardiac transplantation. Mesenchymal stem cells (MSC) are multipotent plastic-adherent cells obtained from bone marrow, adipose tissue, and other tissues and can be easily expanded in culture. The ability of MSC to differentiate into a variety of cells, including cardiomyocytes and vascular endothelial cells, make them an attractive therapeutic tool for heart failure. Recent in vitro and in vivo studies have revealed the underlying mechanisms of MSC in cardiac repair. MSC exert their role in cardiac regeneration not only by differentiating into specific cell types such as cardiomyocytes and vascular endothelial cells but also through paracrine effects via secretion of a variety of angiogenic, antiapoptotic, and mitogenic factors. Endogenous MSC as well as exogenously administered MSC have also been suggested to migrate and participate in cardiac repair. On the basis of information obtained from basic and translational research, several clinical trials have recently been started to evaluate the safety and efficacy of autologous MSC for heart failure.

According to previous reports, a large volume of bone marrow cells (1 × 10 7 cells/ml) is required for bone regeneration in the pores of a scaffold in vivo . We theorized that immersion of a porous hydroxyapatite (HA) scaffold in hyaluronic acid solution would facilitate bone formation in the scaffold at 1 × 10 6 cells/ml density of bone marrow cells. The cells were respectively seeded into pores of the cylindrical HA scaffolds with a hollow center after immersion in hyaluronic acid solution or in culture medium. The scaffolds were implanted in the dorsal subcutis of rats for 4 weeks. Thereafter, serially sectioned paraffin specimens were made and observed histologically. Bone formation was observed in many pores of HA scaffold by immersion in hyaluronic acid solution. However, there were no or less pores with new bone formation in the scaffold by immersion in culture medium. The cells were cultured with and without hyaluronic acid in vitro . There was no significant difference in bone formation in vitro with and without hyaluronic acid. The results of this study suggest that hyaluronic acid binds to the cells on the wall of three-dimensional structure and effectively promotes new bone formation.

Since 2001, we have started tissue engineered approach for hard tissue repair using mesenchymal stromal cells (MSCs) derived from patient’s bone marrow. MSCs were culture expanded on culture dish, then applied on various ceramics including hydroxyapatite (HA) ceramics. The MSCs on the ceramics were further cultured in osteogenic media to induce osteognenic differentiation. The differentiation resulted in appearance of bone forming osteoblasts as well as bone matrix on the ceramics, thus we could fabricate the tissue engineered bone. We have reported that the tissue engineered bone is effective for treatment of large bone defect, which is difficult to repair only with artificial materials such as HA ceramics. The present study focused on osteogenic capability of cryopreserved human MSCs derived from patients who already were treated by the tissue engineered bone. The MSCs showed high alkaline phosphatase activity together with abundant bone matrix formation when cultured in osteogenic media. The MSCs also showed in vivo new bone formation when implanted at subcutaneous sites of athymic nude rats. Based on the results, we concluded that the tissue engineering approach is a reliable method to be used in hard tissue regeneration.

Summary Objectives Human bone-marrow stromal cells are believed to be multipotent even in adults. This study assessed the effectiveness of autologous bone-marrow stromal cells, which were embedded within a collagen scaffold, to repair a full-thickness articular cartilage defect in the medial femoral condyle of an athlete. Patient and methods A 31-year-old male judo player suffering from pain in the right knee was reviewed. A 20×30-mm full-thickness cartilage defect (International Cartilage Repair Society classification (ICRS) grade IV) was revealed in the weight-bearing area of the medial femoral condyle. With the informed consent of the patient, the defect was treated with autologous bone-marrow stromal cells. Bone marrow was aspirated from the iliac crest of the patient 4 weeks before surgery. After removing the erythrocytes, the remaining cells were expanded in culture. Adherent cells were collected and embedded within a collagen gel, which was transferred to the articular cartilage defect in the medial femoral condyle. The implant was covered with an autologous periosteal flap. Results Seven months after surgery, arthroscopy revealed the defect to be covered with smooth tissues. Histologically, the defect was filled with a hyaline-like type of cartilage tissue which stained positively with Safranin-O. One year after surgery, the clinical symptoms had improved significantly. The patient had reattained his previous activity level and experienced neither pain nor other complications. Conclusions Our findings indicate that the transplantation of autologous bone-marrow stromal cells can promote the repair of large focal articular cartilage defects in young, active patients.

To investigate the effectiveness of autologous culture-expanded bone marrow mesenchymal cell transplantation for repairing articular cartilage defects, we transplanted autologous culture-expanded bone marrow mesenchymal cells into nine full-thickness articular cartilage defects of the patello-femoral joints (including two kissing lesions) in the knees of three patients, a 31 year-old female, a 44 year-old male and a 45 year-old male. Three weeks before transplantation, bone marrow blood was aspirated from the iliac crest. Adherent cells were cultured with media containing autologous serum. Single-passaged cells were collected, embedded in a collagen solution (5 x 10(6) cells/ml), placed on a collagen sheet, gelated, transplanted into the defect and covered with autologous periosteum or synovium. Six months after transplantation, the patients' clinical symptoms had improved and the improvements have been maintained over the follow-up periods (17-27 months). Histology of the first patient 12 months after the transplantation revealed that the defect had been repaired with the fibrocartilaginous tissue. Magnetic resonance imaging of the second patient 1 year after transplantation revealed complete coverage of the defect, but we were unable to determine whether or not the material that covered the defects was hyaline cartilage. Autologous bone marrow mesenchymal cells transplantation may be an effective approach to promote the repair of articular cartilage defects.

After culture expansion of mesenchymal stem cells (MSCs) from a few milliliter of fresh patient’s bone marrow, we applied the MSCs on alumina ceramic ankle prosthesis and further cultured in an osteogenic medium for 2 weeks. After the culture, the MSCs differentiated into osteoblasts, which fabricated bone matrix on the surface of ceramic prosthesis. The expansion of MSCs followed by osteogenic differentiation was done using the commercially available medium with some chemicals and patient’s own serum. The MSCs well proliferated and differentiated into osteoblasts, even the MSCs were from old aged (more than 70 years old) patients. The tissue engineered ceramic prostheses were implanted into osteoarthritic patients. Typical X-ray findings showed that radiodense areas began to appear around the cell-seeded areas on the prosthesis about 2 to 3 months after the operation. These findings confirmed the importance of tissue engineering approach for early bone fixation and the approach can be done using small number of bone marrow cells and patient’s own serum without adding animal-derived products.

The objective of this study was to evaluate cell adhesion and proliferation on the hydroxyapatite (HAp)-coated silk fibroin (SF) fabric. Nano-scaled sintered HAp particles were covalently coated on SF chemically modified by graft polymerization. After the fabrication of the HAp/SF composite, mesenchymal cells (MCs) derived from EGFP-expressing transgenic rat bone marrow were seeded on the composite and cultured for 10 days. Fluorescence and scanning electron microscopy (SEM) revealed that the cells adhered and actively proliferated on the composites comparable to those on tissue culture polystyrene (TCPS) dishes. The results suggest that the composites are suitable for mesenchymal cell culture scaffolds and useful materials for regenerative medicine.

A novel approach to the treatment of bone tumors using tissue-engineered implants is reported in this study. The number of mesenchymal stem cells (MSCs) obtained from each patient's bone marrow cells was first increased, and the MSCs were forced to differentiate into osteoblasts followed by bone matrix formation on hydroxyapatite (HA) ceramics. The strong osteogenic ability of the implants, as evidenced by high osteoblastic activity, was confirmed. Consequently, the HA surface was covered with the patient's derived cultured osteoblast/bone matrix. The tissue-engineered HA was used to fill the patient's bone cavity after tumor curettage. Immediate healing potential was found by serial plain radiographs and computed tomograhy images, and no adverse reactions were noted in these patients. The results indicate that tissue-engineered osteogenic ceramics might be an alternative to autologous bone grafts.

To observe living cell morphology on ceramics by light microscopy, we fabricated a new material-transparent beta - tricalcium phosphate (t-beta TCP) ceramic-for the purpose of serving as a tissue culture substrate. Bone marrow stromal cells (BMSCs) were obtained from rat femora and cultured on both t-beta TCP ceramic disks and culture grade polystyrene (PS) dishes in an osteogenic medium. After 1 day of culture, cell attachment and spreading on both the t-beta TCP and PS substrata were equally and clearly detected by ordinary light microscopy. After 14 days of culture, extensive cell growth, alkaline phosphatase (ALP) staining, and bone mineral deposition could be detected on both substrata. In addition, quantitative biochemical analyses revealed high DNA content, ALP activity, and osteocalcin content of these cultures. This experiment is significant in that all of the results were similarly observed on both the t-beta TCP and PS substrata, indicating the excellent properties of beta TCP ceramics for BMSCs culture towards osteogenic differentiation.

Background— Pluripotent mesenchymal stem cells (MSCs) differentiate into a variety of cells, including cardiomyocytes and vascular endothelial cells. However, little information is available about the therapeutic potency of MSC transplantation in cases of dilated cardiomyopathy (DCM), an important cause of heart failure. Methods and Results— We investigated whether transplanted MSCs induce myogenesis and angiogenesis and improve cardiac function in a rat model of DCM. MSCs were isolated from bone marrow aspirates of isogenic adult rats and expanded ex vivo. Cultured MSCs secreted large amounts of the angiogenic, antiapoptotic, and mitogenic factors vascular endothelial growth factor, hepatocyte growth factor, adrenomedullin, and insulin-like growth factor-1. Five weeks after immunization, MSCs or vehicle was injected into the myocardium. Some engrafted MSCs were positive for the cardiac markers desmin, cardiac troponin T, and connexin-43, whereas others formed vascular structures and were positive for von Willebrand factor or smooth muscle actin. Compared with vehicle injection, MSC transplantation significantly increased capillary density and decreased the collagen volume fraction in the myocardium, resulting in decreased left ventricular end-diastolic pressure (11±1 versus 16±1 mm Hg, P dP / dt (6767±323 versus 5138±280 mm Hg/s, P Conclusions— MSC transplantation improved cardiac function in a rat model of DCM, possibly through induction of myogenesis and angiogenesis, as well as by inhibition of myocardial fibrosis. The beneficial effects of MSCs might be mediated not only by their differentiation into cardiomyocytes and vascular cells but also by their ability to supply large amounts of angiogenic, antiapoptotic, and mitogenic factors.

Human bone marrow-derived mesenchymal cells contain mesenchymal stem cells (MSCs), which are well known for their osteo/chondrogenic potential and can be used for bone reconstruction. This article reports the viability of cryopreserved human mesenchymal cells and a comparison of the osteogenic potential between noncryopreserved and cryopreserved human mesenchymal cells with MSC-like characteristics, derived from the bone marrow of 28 subjects. The viability of cryopreserved mesenchymal cells was approximately 90% regardless of the storage term (0.3 to 37 months). It is clear by fluorescence-activated cell sorter analysis that the cell surface antigens of both noncryopreserved and cryopreserved mesenchymal cells were negative for hematopoietic cell markers such as CD14, CD34, CD45, and HLA-DR but positive for mesenchymal characteristics such as CD29 and CD105. To monitor the osteogenic potential of the cells, such as alkaline phosphatase (ALP) activity and in vitro mineralization, a subculture was conducted in the presence of dexamethasone, ascorbic acid, and glycerophosphate. No difference in osteogenic potential was found between cells with or without cryopreservation treatment. In addition, cells undergoing long-term cryopreservation (about 3 years) maintained high osteogenic potential. In conclusion, cryopreserved as well as noncryopreserved human mesenchymal cells could be applied for bone regeneration in orthopedics.

The purpose of this study was to estimate hard tissue formation in two types of porous columnar hydroxyapatite (HA) in order to use as a scaffold for regeneration of dentine-pulp complex. Hard tissue formation in the columnar HA scaffold with a hollow center was compared to that in the columnar HA scaffold without a hollow center. The scaffolds were immersed in hyaluronic acid sodium salt solution and were soaked in bone marrow cell suspension. They were respectively implanted into dorsal subcutis of rats for 4 weeks. Serially sectioned paraffin specimens were made and observed histologically. The scaffolds with a hollow center showed new hard tissue formation in many pores between the superficies and the wall of hollow. On the other hand, in the scaffolds without a hollow center, hard tissue formation was observed in only a few pores in the area near the external superficies. The results of this study suggested that the supply of nutrition and bioactive substance from the surrounding tissue were indispensable for differentiation of bone marrow cells and formation of new hard tissue in scaffold. A large contact area of a scaffold to the surrounding tissue may contribute to nutrition supply into the pores.

Alumina ceramics have excellent mechanical and biocompatible properties, but are bioinert and hence have no bone-bonding properties. We took a tissue engineering approach in an attempt to modify the ceramic surface and so provide an osteogenic/osteoconductive milieu. We used fresh human bone marrow cells obtained from the iliac crest by needle aspiration for culture expansion of mesenchymal stem cells (MSC) followed by in vitro osteogenic differentiation on both tissue culture polystyrene (TCPS) and alumina ceramics. We have succeeded in expanding the number of MSC from all 35 cases and compared the differentiation capability of selected MSC on alumina ceramics to that on TCPS. The cells on both substrata showed extensive alkaline phosphatase staining and mineralization as evidenced by calcein uptake. Biochemical analyses revealed high levels of alkaline phosphatase activity, osteocalcin expression, and calcium content. These data indicate that an alumina ceramic surface can support a differentiation cascade of MSC resulting in osteoblastic phenotype expression of the cells. Based on these results, we have performed clinical applications of tissue engineered total joint replacements for osteoarthritic patients.

Tissue engineering has been rapidly developing as an alternative approach to the repair and regeneration of damaged human tissue. A temporary scaffold is necessary to accommodate new cells and to guide the formation of tissue. Cell adhesion to a scaffold is the first step of cell behavior when it comes in contact with the scaffold surface and is an important consideration in tissue engineering. Bone marrow cells, chondrocytes, ligament cells and synovial cells were cultured in a PLGA–collagen hybrid mesh and their adhesion to the scaffold was studied. All four kinds of cells adhered to the hybrid mesh. The cells did not spread and showed a round morphology after culture for 30 min either in serum or in a serum-free medium. If cells were seeded at a high concentration, more cells were observed in the hybrid mesh. After culture for 6 h, the cells spread and showed a flatter morphology. The cells cultured in the serum medium spread out more than did those in serum-free medium. Calculations of cell seeding efficiencies were based on the number of cells that adhered to the mesh after culture for 30 min and for 6 h. The number of adhered cells increased with an increase of culture time for all four types of cells. For the mesenchymal stem cells, the medium composition and cell concentration affected seeding efficiency during the initial period. Cell seeding efficiency increased with an increase in cell concentration and the serum medium promoted cell adhesion, but not after culture for 6 h. The adhesion of the chondrocytes and ligament cells showed the same trend in that the efficiency of cell growth did not change in serum or serum-free medium, or in high or low cell concentration. For the synovial cells, cell concentration did not affect cell seeding efficiency, but more cells adhered to the hybrid mesh in the serum-free medium than did in the serum medium. These results suggest that the seeding conditions should be specified according the specific cell type when the PLGA–collagen hybrid mesh is used for tissue engineering.

A 3-mL sample of bone marrow was collected from the iliac bones of 27 orthopedic patients (8 men and 19 women with a mean age of 56.1 years [range, 17 to 76 years]), followed by culture in standard culture medium (minimal essential medium containing 15% fetal bovine serum). In all 7 patients randomly selected from these 27 patients, significant in vitro osteogenic ability of marrow mesenchymal cells was demonstrated by scanning electron microscopy and biochemical analyses. In all 27 cases, to investigate the in vivo osteogenic potential of this human cultured bone, porous ceramics were impregnated with marrow cells and subcultured in osteogenic culture medium (standard medium supplemented with sodium beta-glycerophosphate, vitamin C phosphate, and dexamethasone). After 3 weeks of subculture, the cultured artificial bones of the cultured bone/porous ceramics were grafted into the abdominal cavity of nude mice. Histological and biochemical (alkaline phosphatase activity and human osteocalcin) examinations indicated that the cultured artificial bone possessed significant ability to regenerate bone. This result suggests that the bone-regenerating ability of human marrow cells may not depend on age, and that cultured artificial bone may be useful for bone regeneration treatment if appropriate cultured marrow cells can be successfully prepared.

Cryopreserved human bone marrow-derived mesenchymal cells (hBMCs) were thawed and replated in culture dishes. Viability of the cells immediately after thawing was 98%. When the cells were cultured in the presence or absence of dexamethasone, the cells proliferated to reach confluency at culture day 7. The cells treated with dexamethasone formed abundant mineralized nodules at their extracellular regions after about culture day 14, while the cultures without dexamethasone did not exhibit bone formation. The calcein uptake into the extracellular matrix layer was detected in the dexamethasone-treated cells with the increase in fluorescent intensity with culture periods but not in the nontreated cells. These results suggest that human bone marrow-derived mesenchymal cells retain bone-forming capability even after cryopreservation/thawing.

As for regenerative medicine in hard tissue field, such as osteoarthritis or bone tumor cases, we have combined both artificial scaffolds and patient's own cells. Osteoarthritis causes the cartilage between the joints to break down, and surgery of total joint replacements using artifitial prosthesis is most common treatment. However, complicatedness which fail in the integrity between the host bone and prosthesis interface are not negligible. Concerning the treatments of bone tumor, synthetic calcium-phosphate ceramics are now available; however, massive bone defects cannot be treated with ceramics themselves. To overcome these problems, we have combined culture-expanded osteogenic cells with synthetic scaffolds. The cell source includes mesenchymal stem cells (MSCs) derived from small amount of patient's bone marrow. We seeded the cells on artificial scaffolds and further cultured to accomplish osteogenic differentiation, resulting in osteoblasts/bone matrix on the scaffolds. We have already applied the hybrid scaffold to more than 30 cases.

We evaluated the combination effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) and cultured rat bone marrow mesenchymal stem cells (MSCs) in atelopeptide type I collagen (AC) solution on osteogenesis in a diffusion chamber (DC) to develop a bone substitute having consistent osteogenic capability for clinical applications. The cultured MSCs were obtained by 10-day primary culture of fresh bone marrow cells of Fischer rats. We prepared three groups of DCs: AC solution with rhBMP-2, AC solution with cultured MSCs, and AC solution with rhBMP-2 and cultured MSCs. The prepared combined solutions were injected into DCs, which were subcutaneously implanted into the backs of syngeneic rats. DCs were harvested after 2, 4, or 8 weeks and analyzed for bone-forming capability by determining histological and osteoblastic biochemical markers. De novo bone formation was observed both inside and outside of the membrane filter of DCs in the group of AC solution with rhBMP-2 and cultured MSCs. The alkaline phosphatase activity and osteocalcin content in the group of AC solution with rhBMP-2 and cultured MSCs were significantly higher than those in the group of AC solution with cultured MSCs at any time. These findings indicate that AC aqueous solution is a useful material not only as a carrier of rhBMP-2 but also as a cell-anchorage for differentiation and proliferation of MSCs. Therefore, this study suggests that clinical repairs of bone defects are feasible using injectable AC solution with rhBMP-2 and cultured MSCs as a bone substitute.

This review article will present our work regarding osteopontin (OPN) function in bone remodeling and its application to tissue engineering in bone. OPN, one of the major non-collagenous bone proteins, has an important role in bone remodeling. Our study suggested that OPN acts not only as a trigger for osteoblast early differentiation but activates osteoclast resorption. On this point of view, we proposed a model of bone remodeling via integrin α V β 3 –OPN binding, in which OPN could act as a signal molecule between osteoblasts and osteoclasts in the process of remodeling. Moreover, OPN was shown to induce the in vivo osteogenesis of a bone marrow-derived osteoblast/porous hydroxyapatite (HA) constructs. Our application of adenovirus-mediated gene transfer of osteopontin to primary osteoblasts is also presented.

Mesenchymal stem cells reside in bone marrow and, when these cells are incorporated into porous ceramics, the composites exhibit osteo-chondrogenic phenotypic expression in ectopic (subcutaneous and intramuscular) or orthotopic sites. The expressional cascade is dependent upon the material properties of the delivery vehicle. Bioactive ceramics provide a suitable substrate for the attachment of the cells. This is followed by osteogenic differentiation directly on the surface of the ceramic, which results in bone bonding. Nonbioactive materials show neither surface-dependent cell differentiation nor bone bonding. The number of mesenchymal stem cells in fresh adult bone marrow is small, about one per one-hundred-thousand nucleated cells, and decreases with donor age. In vitro cell culture technology can be used to mitotically expand these cells without the loss of their developmental potency regardless of donor age. The implanted composite of porous ceramic and culture-expanded mesenchymal stem cells exhibits in vivo osteo-chondrogenic differentiation. In certain culture conditions, these stem cells differentiate into osteoblasts, which make bone matrix on the ceramic surface. Such in vitro prefabricated bone within the ceramic provides immediate new bone-forming capability after in vivo implantation. Prior to loading of the cultured, marrow-derived mesenchymal stem cells into the porous ceramics, exogenous genes can be introduced into these cells in culture. Combining in vitro manipulated mesenchymal stem cells with porous ceramics can be expected to effect sufficient new bone-forming capability, which can thereby provide tissue engineering approaches to patients with skeletal defects in order to regenerate skeletal tissues.

Autologous mesenchymal stem cells (MSCs) cultured with beta-tricalcium phosphate (beta-TCP) ceramics and with a free vascularized fibula were transplanted into three patients with steroid-induced osteonecrosis of the femoral head. The average follow-up period was 34 months and the average patient age at the time of surgery was 28 years old. Fifteen milliliters of bone marrow was obtained from the patients 4 weeks before surgery, and was used for in vitro proliferation of MSCs. beta-TCP granules were immersed in the MSC suspension and the cells were further cultured for 2 weeks. Cultured MSCs/beta-TCP composite granules were implanted into the cavity that remained after curettage of necrotic bone; and finally, a free vascularized fibula was grafted. All hips showed preoperative collapse and radiographic progression was observed in two hips postoperatively. Osteonecrosis did not progress any further and early bone regeneration was observed. This tissue-engineered approach has potentials for the treatment of osteonecrosis. However, our results suggested that the present procedure could not be used for cases with severe preoperative collapse.

The effect of aging on osteoblastic differentiation of marrow stromal stem cells was examined. Porous hydroxyapatite (HA) disks were soaked in cells suspensions of bone marrow cells from young (8 weeks) and old rats (60 weeks) and then implanted subcutaneously in syngeneic young and old rats. The bone marrow/HA composites were harvested 8 weeks later, and the contents of bone Gla protein (BGP) and alkaline phosphatase (ALP) activity in them were determined. Histologically, bone formation could be detected in all the composites in young recipient rats; however, some old bone marrow/HA composites in old recipients did not show bone formation and the bone volume in the young bone marrow/HA composites was greater than in the old bone marrow/HA composites. The ratios of ALP activities of young bone marrow/HA composites to old bone marrow/HA composites in young and old recipients were about five times and four times, respectively. The ratios of BGP contents of young bone marrow/HA to old bone marrow/HA composite in young and old recipients were about nine and eight times, respectively. The results suggest that the decreased bone formation observed in old bone marrow cells was due to a smaller population of stromal cells and/or decreased capacity of differentiation of stromal stem cells into osteogenic cells.

Fresh marrow cells were obtained from the femora Fischer rats and cultured in a medium containing 15% fetal calf serum (FCS) to leach confluent. After trypsinization, cells were subcultured at a cell density of 100 × 103/35 mm well in the presence of FCS, 10 mM β-glycerophosphate, 82 μg/mL ascorbic acid phosphate, and 10-8M dexamethasone (Dex). Osteoblastic cells and microscopic mineralized nodules began to appear at about 1 week after the subculture, and at 2 weeks many macroscopic nodules that showed high alkaline phosphatase activity (ALP) and appearance of bone Gla protein (BGP) mRNA were evident. As demonstrated by in situ hybridization, the mRNA was manifested by cuboid-shaped cells (osteoblastic cells). X-ray diffraction (XRD) and Fourier-transform infrared spectroscopy (FTIR) showed the mineralization of fine crystals of hydroxyapatite comparable to natural rat bone mineral. In contrast to these findings, subculture done under the same conditions except for the lack of Dex did not show mineralized nodules, nor did they show the osteoblastic phenotype expression. These analyses indicate that Dex-induced mineralization using rat bone marrow cell culture is an in vitro counterpart of bone formed in vivo. Such a culture is useful for investigating materials/osteogenic cells interactions. © 1996 John Wiley & Sons, Inc.

We compared the osteogenic response in porous alumina (Al) and hydroxyapatite coated porous alumina ceramic (HA/Al) by grafting rat bone marrow cells with these implants subcutaneously in the back of syngeneic rats. The ceramics did not show any bone formation without marrow, but did when combined with marrow cells. The osteogenesis in HA/Al began directly on the ceramic surface, but in AI began away from the ceramic surface, and fibrous tissue interposition was seen between the de novo bone and its surface. Alkaline phosphatase activity and bone specific bone gla protein content in HA/Al with marrow were both about three times higher than in AI with marrow. These results indicate that HA/Al has excellent osteoconductive properties and that a composite of marrow and HA/Al is a clinically applicable osteogenic biomaterial.

Many kinds of bone graft materials have been developed and reported to repair various bone defects. The defects are usually created by surgical resection of pre-existing bone tissue. However, spontaneous healing of bone defects without implantation of materials could be seen, because bone tissue possesses inherent repairing property. The central portion of the lower jaw bone in many animals consists of fibrous tissue and is called the mandibular symphysis. It persists even in old animals and thus can be interpreted as a physiological bone gap or a non-healing bone defect. We implanted calcium phosphate porous ceramics alone or composites of the ceramics and bone marrow stromal cells (BMSCs) into the bone defect (mandibular symphysis) to examine whether it could be filled with new bone tissue, resulting in bone union. Eight weeks after implantation, micro-computed tomography (micro-CT) and histological and biomechanical analyses demonstrated that bone union of the mandibles occurred in all rats with composites but in none of those with ceramics alone. These results showed that the rat mandibular symphysis is a unique bone defect site for the evaluation of bone graft materials. These analyses demonstrated that ceramics alone could not contribute to bone healing in the defect; however, supplementation with BMSCs drastically changed the properties of the ceramics (turning them into osteogenic ceramics), which completely healed the defect. As BMSCs can be culture-expanded using small amounts of bone marrow, the use of the composites might have clinical significance for the reconstruction of various bone tissues, including facial bone.

When porous hydroxyapatite ceramics or rat bone marrow cells were implanted at subcutaneous sites, bone formation could not be detected at the sites. However, when composites of the ceramics and bone marrow were implanted, bone formation appeared at 3 weeks post implantation on the ceramic pore surface. Thus, the bone formed bonded to the ceramic. Bone Gla protein (BGP) is synthesized exclusively by bone or dentin-forming cells. Therefore, we analyzed gene expression of BGP in the composites by the northern blotting method. Total RNAs were extracted from the harvested implants, transferred to the nylon membranes, and hybridized to redialabeled probe. The probe used was oligonucleotides (46 mer) of rat BGP DNA. The BGP mRNA could not be detected in the bone marrow cells before the implantation or in the ceramic implantation without marrow cells. However, high level of the mRNA comparable with that in rat cancellous bone was found at 4 weeks post implantation of the composites. Thus, osteoblastic phenotype expression of undifferentiated cells on the surface of hydroxyapatite was confirmed. These results suggest that bioactive materials support the osteogenic differentiation on the surface and the differentiation finally results in tissue integration (bone bonding) with the materials.

The biological and biochemical effects of cadmium administration on bone marrow in rats were examined. When young adult rats were administered cadmium (Cd) repeatedly at a dose of 750 μg/kg body wt for up to 4 weeks, metallothionein mRNA was detected by a gene expression analysis in their bone marrow at 2 weeks after the first Cd administration, though the amounts were lower than those in liver. To determine the direct effect of cadmium on bone formation, the potential of Cd-treated bone marrow cells and demineralized bone matrix (DBM) to form bone and cartilage was assessed using a diffusion chamber (DC) in vivo , by histological examination, and by biochemical parameters such as alkaline phosphatase (ALP) activity, total calcium and phosphorus content, and the bone-specific vitamin K-dependent Gla-containing protein (BGP) content, relative to mineralization. Diffusion chambers were inoculated with DBM and bone marrow cells from either Cd-treated or nontreated rats (control) and were then implanted subcutaneously into syngeneic nontreated rats. The accumulation of BGP in DCs with Cd-treated bone marrow was significantly lower than that in control DCs. Unlike in control DC, a peak of ALP activity did not occur at 4 weeks postimplantation in DC implants inoculated with Cd-treated bone marrow; the ALP activity and calcium content in these implants were also significantly lower than those of the control bone marrow-containing chambers at the early stage of implantation. Histological examinations of chambers with Cd-treated marrow showed a decreased area of cartilage and bone foci compared with those in control chambers. These findings suggest that Cd administration inhibits the osteoblastic and chondroblastic differentiation path way in bone marrow through direct effects on these cells.

Among autologous somatic stem cells, bone marrow-derived mesenchymal stem cells (BMSCs) are the most widely used worldwide to repair not only mesenchymal tissues (bone, cartilage) but also many other kinds of tissues, including heart, skin, and liver. Autologous BMSCs are thought to be safe because of the absence of immunological reaction and disease transmission. However, it is possible that they will form tumours during long-term follow-up. In 1988, we transplanted autologous BMSCs to repair articular cartilage, which was the first such trial ever reported. Subsequently we performed this procedure in about 40 patients. Demonstration that neither partial infections nor tumours appeared in these patients provided strong evidence for the safety of autologous BMSC transplantation. Thus, in this study we checked these patients for tumour development and infections. Between January 1998 and November 2008, 41 patients received 45 transplantations. We checked their records until their last visit. We telephoned or mailed the patients who had not visited the clinics recently to establish whether there were any abnormalities in the operated joints. Neither tumours nor infections were observed between 5 and 137 (mean 75) months of follow-up. Autologous BMSC transplantation is a safe procedure and will be widely used around the world.

Mesenchymal stem cells (MSCs) are adult stem cells which show differentiation capabilities toward various cell lineages. We have already used MSCs for treatments of osteoarthritis, bone necrosis and bone tumor. For this purpose, culture expanded MSCs were combined with various ceramics and then implanted. Because of rejection response to allogeneic MSC implantation, we have utilized patients' own MSCs for the treatment. Bone marrow is a good cell source of MSCs, although the MSCs also exist in adipose tissue. When comparing osteogenic differentiation of these MSCs, bone marrow MSCs show more extensive bone forming capability than adipose MSCs. Thus, the bone marrow MSCs are useful for bone tissue regeneration. However, the MSCs show limited proliferation and differentiation capabilities that hindered clinical applications in some cases. Recent advances reveal that transduction of plural transcription factors into human adult cells results in generation of new type of stem cells called induced pluripotent stem cells (iPS cells). A drawback of the iPS cells for clinical applications is tumor formation after their in vivo implantation; therefore it is difficult to use iPS cells for the treatment. To circumvent the problem, we transduced a single factor of either SOX2 or NANOG into the MSCs and found high proliferation as well as osteogenic differentiation capabilities of the MSCs. The stem cells could be combined with bioceramics for clinical applications. Here, we summarize our recent technologies using adult stem cells in viewpoints of bone tissue regeneration.

Mesenchymal stem cells (MSCs) can differentiate into multiple cell lineages and are used for regenerative treatments for a variety of diseases. However, the patient's cells cannot be used to treat genetic diseases. Allogeneic cells can serve as an alternative but long-term survival is uncertain. Our experience of allo-transplantation to a patient with hypophosphatasia, which is caused by mutations of the tissue non-specific alkaline phosphatase (TNSALP) gene resulting in low serum alkaline phosphatase (ALP) activity and skeletal deformity, did not improve these clinical characteristics. Therefore, we sought to use autologous MSCs for the treatment of hypophosphatasia. MSCs derived from the patient's bone marrow had a similar profile when compared with well-reported MSCs. However, the MSCs had extremely low ALP activity and could not produce a mineralized bone matrix even under the osteogenic culture conditions. We therefore transduced a retroviral vector with TNSALP promoter-driven TNSALP gene in the MSCs. In the culture condition, the MSCs had about 7-fold higher ALP activity than did mock-transduced MSCs, and showed mineralization as well as bone-specific markers. Furthermore, the MSCs, but not mock-transduced MSCs, newly formed bone at the frequency of 50% in nude rats. Transplantation of the TNSALP-transduced autologous MSCs might become a new therapy for hypophosphatasia.

A scaffold is necessary for bone regeneration, because the structure of hard tissue is three-dimensional. For application in dentistry, it is desirable for the scaffold to be modified the geometry easily according to the defect. Therefore it is thought that a sponge is suitable as a scaffold. A sponge (Polyvinyl formal®: PVF) was purchased for this study. The sponge was made from polyvinyl alcohol (PVA) with formalin preparation. In this study, the PVF sponges were coated with dextran, because dextran may affect cell adhesion. The effect of dextran for hard tissue formation by bone marrow stem cells in the PVF scaffold was examined in vivo. PVF scaffolds (5x5x5 mm) were immersed in each dextran solution of 10 kDa (2 g/dl) and 500 kDa (4 g/dl) and air dried. The coating for the PVF scaffolds by dextran was confirmed by SEM. Rat femur bone marrow cells of 1.107 were seeded in PVF scaffolds. They were implanted for four weeks in rat dorsal subcutaneous tissue. In removed scaffolds, hard tissue formation was examined histologically. Bone formation was conspicuously found in the scaffold coated with 10 kDa of dextran. Value of ALP activity measured biochemically in the scaffold was 58.5 mM/scaffold. By immunochemical examination, it was measured that quantity of osteocalcin in the scaffold was 25.9 ng/scaffold and that of Ca was 129.2 ig/scaffold. These values showed a significantly higher in comparison with those of the scaffold with 500 kDa dextran coating and without coating. It was suggested in this study that coating of the scaffold with dextran induce increase of quantity of hard tissue formation in PVF scaffold in vivo. It is concluded that 10 kDa dextran coating of PVF scaffolds effectively contribute to adhesion of bone marrow cells in the scaffold.

Coralline hydroxyapatite ceramics alone (control) and the ceramics combined with rat marrow cells were implanted subcutaneously in the backs of syngeneic Fischer rats and harvested at 1,2,3,4,6,8 and 24 wk after surgery. None of the control ceramics (without marrow) showed bone formation. However, ceramics combined with marrow cells showed consistent new bone formation in the pore regions. Histometrical results revealed increased new bone formation over time. Undecalcified sections of the ceramics studied by fluorochrome labelling showed that the osteogenesis began directly on the surface of the ceramic and proceeded centripetally towards the centre of the pores (bonding osteogenesis). SEM-EPMA analysis of the bone-ceramic interface also revealed direct bonding of bone to the ceramic surface.