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A major challenge facing the tissue engineering discipline is cartilage tissue repair and engineering, because of the highly specialized structure and limited repair capacity that cartilage possesses. Dental pulp stem cells (DPSCs) were identified about a decade ago as a potential candidate for cell based therapy and tissue engineering applications. The present study aimed to utilize gene therapy with isolated DPSCs to induce chondrogenic transgene expression and chondrogenic lineage differentiation, with the ultimate goal of engineering cartilage tissue-like constructs. We isolated DPSCs from human teeth extracted for orthodontic treatment. We further enriched the isolated population using immunomagnetic bead selection, which increased stem cell markers: Stro-1 and CD146, compared to unselected population. The DPSCs showed the ability to differentiate into the chondrogenic lineage when induced with recombinant hTGFβ-3 and when transduced with hTGFβ-3 transgene. We successfully constructed the recombinant adeno-associated viral vector encoding the human TGFβ-3, and determined the best multiplicity of infection for DPSCs. The transduced DPSCs highly expressed hTGFβ-3 for up to 60 days. Expression of chondrogenic markers; Collagen IIa1, Sox9, and aggrecan was verified by immunohistochemistry and mRNA. We successfully fabricated an electrospun nano-fiber scaffold upon which morphology, proliferation and viability of the DPSCs were examined. DPSCs attached and proliferated on nano-fiber scaffolds demonstrating better viability compared to micro-fiber scaffolds. Transduced cells expressed hTGFβ-3 protein up to 48 days. Cells seeded on nanofiber scaffolds showed higher expression levels compared to micro-fiber scaffolds or culture plate. Scaffolds seeded with DPSCs were implanted in nude mice. Immunohistochemistry for TGFβ-3 DPSCs constructs (n=5/group) showed cartilage-like matrix formation with glucoseaminoglycans as shown by Alcian blue. Immunostaining showed positivity for Collagen IIa1, Sox9 and aggrecan. Semi-thin sections of the transduced DPSCs constructs examined by transmission electron microscopy (TEM) showed chondrocytic cellular and intra-cellular features, as well as extracellular matrix formation (n=2/group). In vivo constructs with the TGFβ-3 DPSCs showed higher collagen type II and Sox9 mRNA expression relative to non-transduced DPSCs constructs (n=5/group). Western blot analysis confirmed this expression pattern on the protein level (n=3/group). Engineered constructs mechanical properties were examined and compared to patellar bovine cartilage to assess functionality (n=5/group). TGFβ-3 transduced DPSCs constructs showed a higher equilibrium elastic modulus compared to nontransduced constructs. Micro-fiber scaffolds constructs showed a higher elastic modulus (0.11 MPa, 18% of bovine cartilage), compared to nano-fiber constructs modulus (0.032 MPa, 6% of bovine cartilage). Nano-fiber based constructs showed a similar Poisson‘s ration to bovine cartilage, while that of micro-fiber scaffolds was lower. As an alternative gene delivery method, electroporation parameters for DPSCs transfection were optimized, and compared to commonly used chemical transfection methods. TGFβ-3 transfected DPSCs showed a significantly higher relative TGFβ-3 mRNA and protein expression compared to non transfected control and to eGFP transfected DPSCs. Transfected DPSCs showed increased relative expression of chondrogenic markers; Collagen II, Sox9 and aggrecan, compared to non transfected DPSCs. Successful chondrogenic differentiation of DPSCs gene therapy with TGFβ-3 transgene, and seeding them on PLLA/PGA scaffolds makes it a potential candidate for cartilage tissue engineering and cell based therapy. / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

Regeneration of the tissues to replace diseased, missing and traumatized dentin/pulp requires combining the recent progress in stem cell and tissue engineering research. Dental pulp stem cells (DPSCs) are considered as a promising population of cells in regenerative dentistry and shown to be able to produce dentin/pulp-like tissues following implantation in-vivo. Securing a good blood supply is critical in pulp regeneration, however, this is a challenging task due to the unique structure of the tooth, the anatomy of which permits only a microcirculatory system via a very small apical opening (<0.3-1mm). This limitation raises the need to develop novel methods to enhance angiogenesis during pulp regeneration. It was shown that DPSCs reside in the microvasculature region of the dental pulp and interact with perivascular cells. Therefore, endothelial cells could be a major source of modulators of pulp-dentin development and angiogenesis. If a pulp tissue substitute with pre-formed endothelial network could be engineered in-vitro, it would not only gain rapid anastomosis with host vasculature but also regulate DPSC function in pulp regeneration. In this study, for the first time, synergistic effects of DPSCs and human umbilical vein endothelial cells (HUVECs) on osteo/odontogenic differentiation and angiogenesis were investigated using two-dimensional and three-dimensional direct co-culture systems. Furthermore, the potential of three-dimensional DPSC constructs prevascularized with HUVECs in dental pulp regeneration in-vivo was exmined. HUVECs promoted odonto/osteogenic differentiation of DPSCs in direct two-dimensional co-cultures in-vitro. Further, addition of DPSCs stabilized the pre-existing vessel-like structures formed by HUVECs and increased the longevity of these structures on matrigel in-vitro. Using two different systems, scaffold-free self-assembling microtissue spheroids and peptide hydrogel scaffold, the interactions of DPSCs and HUVECs in three-dimensional cultures were investigated. The results demonstrated that DPSCs can self assemble into three-dimensional microtissue spheroids when cultured alone or with HUVECs. DPSCs promoted survival and vascular structure formation by HUVECs both in scaffold-free microtissue spheroids and peptide hydrogel scaffold. In contrast, HUVECs, when cultured alone, neither formed vascular structures nor survived in either of the 3D systems. The latter phenomenon was attributable to vascular endothelial growth factor secreted by DPSCs, a major factor responsible for endothelial function. Co-cultures also showed enhanced odonto/osteogenic differentiation in both three-dimensional microtissue spheroid and peptide hydrogel scaffold systems. Following implantation of tooth-root fragments filled with three-dimensional DPSC constructs into the subcutaneous space of immunodefficient mice, vascularised pulp-like tissue was regenerated within the root canals. Compared to DPSC-only group, DPSC/HUVEC co-culture groups showed higher vascularisation, extracellular matrix formation and mineralization in regenerated tissue. More importantly, HUVEC-lined vascular lumens were observed in regenerated tissues suggesting the successful integration of in-vitro formed pre-vascular structures to the host vasculature. In summary, the findings suggest that DPSCs and HUVECs display significant synergy during odonto/osteogenic differentiation and angiogenesis when co-cultured either in two-dimensional or three-dimensional culture systems. Unravelling these fundamental behavioural patterns of DPSCs provides novel insights into the process of pulp regeneration, leading to new avenues for more effective therapies in regenerative endodontics. / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy