Human Leukocyte Antigen Sensitization After Cryopreserved Human Meniscal Transplantations1,2

Er, van Arkel; Em, van den Berg-Loonen; Jw, van Wersch; Hh, de Boer

doi:10.1097/00007890-199708150-00026

Cited by 26 publications

(10 citation statements)

References 11 publications

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“…Proteoglycan and linked proteins have been documented to be immunogenic, as evidenced by the presence of anti-matrix antibodies in animal models. Most authors continue to express concern over cell surface antigens present in allograft bone cartilage tissues (36), and several authors have documented humoral and cellular mediated immune responses to osteochondral and meniscal allograft transplantation (37)(38)(39). Moreover, additional papers have been published, which document that humoral as well as cell mediated immune responses to osteochondral meniscal allograft transplantation exist.…”

Section: Immunological Reactlons To Meniscal Transplantation (E Marlmentioning

confidence: 99%

Meniscal substitutes – human experience

Goble¹,

Kohn

Verdonk

et al. 1999

Scandinavian Med Sci Sports

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A number of clinical series have described the effect of meniscus allograft replacement in humans. The general indication has been disabling pain following loss of a meniscus in a skeletally mature individual. Overall, healing of the graft to the capsule occurs in up to 80% of all transplants. Revascularization and cell repopulation is found in all grafts but is highly variable. The risk for graft failure seems to be greater with irradiated grafts and in patients with grade III or IV osteoarthritic changes. In most series, patients experienced a decrease in pain and an increase in activity level postoperatively. In many series, concominant surgery (cruciate ligament reconstruction or osteotomy) had been performed. Meniscus replacement with frozen or cryopreserved allografts seems to give the most promising short‐term results in patients with post‐meniscectomy pain. Controlled, randomized prospective studies are needed to confirm a long‐term benefit and better define transplantation indications. Viable meniscus allografts seem to survive transplantation, as donor cells were found in the graft after 2 years. Clinically, pain was reduced and activity increased following transplantation, but after 4 years some of these gains were lost. There was no correlation between postoperative findings on MRI and clinical outcome. Meniscal replacement with a quadriceps tendon autograft in humans resulted in pain reduction, but at second‐look arthroscopy, only 2 of 9 tendon autografts looked like a meniscus. Six were in position but still looked like tendons. Total medial meniscus replacement by quadriceps tendon autrograft is still an experimental procedure. There is no proof at present that meniscal substitutes (meniscus allografts or tendon autografts) in humans can protect the hyaline cartilage of the knee from the degeneration, following loss of a meniscus. There is some evidence in animal experiments that under circumstances not yet exactly known, a meniscus substitute can have a protective effect on articular cartilage. Three factors have been identified that prevent proper meniscal function: poor fixation of the meniscal horns, no contact of the graft with the articulating surfaces under load and incorrect positioning of the horns. Meniscal allograft transplantation sensitizes humoral and cell mediated immune systems. Bone plugs attached to meniscal allograft tissue may increase cell surface antigenicity. Deep freezing and especially freeze drying of meniscal tissue decreases host immunogenicity. Cryopreservation maintains the content of donor HLA encoded antigens and is likely more sensitizing to the host. The clinical importance of immune responses to meniscal allografts is not known, but it has not been shown to result in graft failure or rejection. Prospective studies are needed.

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Section: Immunological Reactlons To Meniscal Transplantation (E Marlmentioning

confidence: 99%

Meniscal substitutes – human experience

Goble¹,

Kohn

Verdonk

et al. 1999

Scandinavian Med Sci Sports

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“…Four types of menisci are used as meniscal allografts: fresh, cryopreserved, lyophilized, and freeze‐thawed (fresh‐frozen), with the freeze‐thawed meniscus being the most widely used in clinical practice . However, the use of freeze‐thawed menisci has several issues, including disease transmission and immune rejection …”

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confidence: 99%

“…5 However, the use of freezethawed menisci has several issues, including disease transmission 6,7 and immune rejection. [8][9][10] One strategy for overcoming immune rejection is to decellularize the meniscus, which removes the donor's cells while preserving the tissue structure. 11,12 Three procedures for decellularizing the meniscus have been reported: the use of trypsin, 13 sodium dodecyl sulfate, 14 or Triton-X 100.…”

mentioning

confidence: 99%

Comparison of High‐Hydrostatic‐Pressure Decellularized Versus Freeze‐Thawed Porcine Menisci

Watanabe

Mizuno

Matsuda

et al. 2019

Journal Orthopaedic Research

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The meniscus functions as a load distributor and secondary stabilizer in the knee, and the loss of the meniscus increases the risk of osteoarthritis. Freeze‐thawed menisci are used in clinical practice to replace defective menisci; however, the disadvantages of freeze‐thawed tissues include disease transmission and immune rejection. In this study, we decellularized menisci using high hydrostatic pressure (HHP) and compared the decellularized menisci with freeze‐thawed menisci. Porcine menisci were either pressurized at 1,000 MPa for 10 min and then washed with DNase solution or frozen at −80°C for 2 days and thawed. These menisci then underwent in vitro histological, biochemical, and biomechanical comparisons with native menisci. The HHP‐treated and freeze‐thawed menisci were also subcutaneously implanted in a pig, and later harvested for histological analysis. The numbers of histologically detected cells were significantly lower and the amount of biochemically detected DNA was approximately 100‐fold lower in HHP‐treated than in native and freeze‐thawed menisci. The compression strength of the HHP‐decellularized menisci was decreased after 1 and 50 cycles at 20% strain but was unchanged in the freeze‐thawed menisci. After implantation, the numbers of multinucleated giant cells were significantly lower around the HHP‐treated menisci than around the freeze‐thawed menisci. Recellularization of the HHP‐decellularized menisci was confirmed. Thus, although the HHP‐decellularized menisci were mechanically inferior to the freeze‐thawed meniscus in vitro, they were immunologically superior. Our study is the first to demonstrate the use of HHP for decellularization of the meniscus. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2466–2475, 2019

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“…In accordance with previous studies, decellularized menisci lacked defined nuclear staining, demonstrating the absence of cellularity. Immunohistochemistry of fresh, cryopreserved, and frozen human menisci have shown that the presence of human leukocyte antigen and A, B, and H blood group antigens can complicate a meniscus allograft transplant [21, 38]. In this study, we have successfully removed donor cells while maintaining the overall structure of a human meniscal allograft.…”

Section: Discussionmentioning

confidence: 99%

“…Previous human retrieval studies and animal studies have reported incomplete cellular incorporation, absence of cell proliferation, and a microscopic immune response [19–21]. The high tissue density of the meniscus has been postulated to result in low cellular incorporation in meniscal allografts [22].…”

Section: Introductionmentioning

confidence: 99%

Enhanced cellular infiltration of human adipose-derived stem cells in allograft menisci using a needle-punch method

et al. 2016

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BackgroundThe meniscus plays a crucial role in knee joint stability, load transmission, and stress distribution. Meniscal tears are the most common reported knee injuries, and the current standard treatment for meniscal deficiency is meniscal allograft transplantation. A major limitation of this approach is that meniscal allografts do not have the capacity to remodel and maintain tissue homeostasis due to a lack of cellular infiltration. The purpose of this study was to provide a new method for enhanced cellular infiltration in meniscal allografts.MethodsTwenty medial menisci were collected from cadaveric human sources and split into five experimental groups: (1) control native menisci, (2) decellularized menisci, (3) decellularized menisci seeded with human adipose-derived stem cells (hASC), (4) decellularized needle-punched menisci, and (5) decellularized needle-punched menisci seeded with hASC. All experimental allografts were decellularized using a combined method with trypsin EDTA and peracetic acid. Needle punching (1-mm spacing, 28 G microneedle) was utilized to improve porosity of the allograft. Samples were recellularized with hASC at a density of 250 k/g of tissue. After 28 days of in vitro culture, menisci were analyzed for mechanical, biochemical, and histological characteristics.ResultsMenisci maintained structural integrity and material properties (compressive equilibrium and dynamic moduli) throughout preparations. Increased DNA content was observed in the needle-punched menisci but not in the samples without needle punching. Histology confirmed these results, showing enhanced cellular infiltration in needle-punched samples.ConclusionsThe enhanced infiltration achieved in this study could help meniscal allografts better remodel post-surgery. The integration of autologous adipose-derived stem cells could improve long-term efficacy of meniscal transplantation procedures by helping to maintain the meniscus in vivo.

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Human Leukocyte Antigen Sensitization After Cryopreserved Human Meniscal Transplantations1,2

Cited by 26 publications

References 11 publications

Meniscal substitutes – human experience

Meniscal substitutes – human experience

Comparison of High‐Hydrostatic‐Pressure Decellularized Versus Freeze‐Thawed Porcine Menisci

Enhanced cellular infiltration of human adipose-derived stem cells in allograft menisci using a needle-punch method

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