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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xml:lang="en" article-type="research-article">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">jfb</journal-id>
      <journal-title>Journal of Functional Biomaterials</journal-title>
      <abbrev-journal-title abbrev-type="publisher">J. Funct. Biomater.</abbrev-journal-title>
      <abbrev-journal-title abbrev-type="pubmed">Journal of Functional Biomaterials</abbrev-journal-title>
      <issn pub-type="epub">2079-4983</issn>
      <publisher>
        <publisher-name>Molecular Diversity Preservation International</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.3390/jfb3010023</article-id>
      <article-id pub-id-type="publisher-id">jfb-03-00023</article-id>
      <article-categories>
        <subj-group>
          <subject>Article</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Biomechanical Conditioning Enhanced Matrix Synthesis in Nucleus Pulposus Cells Cultured in Agarose Constructs with TGFβ</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Tilwani</surname>
            <given-names>Reshma K.</given-names>
          </name>
          <xref rid="af1-jfb-03-00023" ref-type="aff">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Bader</surname>
            <given-names>Dan L.</given-names>
          </name>
          <xref rid="af1-jfb-03-00023" ref-type="aff">1</xref>
          <xref rid="af2-jfb-03-00023" ref-type="aff">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Chowdhury</surname>
            <given-names>Tina T.</given-names>
          </name>
          <xref rid="af1-jfb-03-00023" ref-type="aff">1</xref>
          <xref rid="c1-jfb-03-00023" ref-type="corresp">*</xref>
        </contrib>
      </contrib-group>
      <aff id="af1-jfb-03-00023"><label>1 </label>School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK; Email: <email>ex07009@qmul.ac.uk</email> (R.K.T); Email: <email>d.l.bader@qmul.ac.uk</email> (D.L.B); Email: <email>t.t.chowdhury@qmul.ac.uk</email> (T.T.C)</aff>
      <aff id="af2-jfb-03-00023"><label>2 </label>School of Health Sciences, University of Southampton, Tremona Road, Southampton SO16 6YD, UK</aff>
      <author-notes>
        <corresp id="c1-jfb-03-00023"><label>*</label>Author to whom correspondence should be addressed; Email: <email>t.t.chowdhury@qmul.ac.uk</email>; Tel.: +44-0207-8827560; Fax: +44-0208-9833052.</corresp>
      </author-notes>
      <pub-date pub-type="epub">
        <day>05</day>
        <month>01</month>
        <year>2012</year>
      </pub-date>
      <pub-date pub-type="collection">
        <month>01</month>
        <year>2012</year>
      </pub-date>
      <volume>3</volume>
      <issue>1</issue>
      <fpage>23</fpage>
      <lpage>36</lpage>
      <history>
        <date date-type="received">
          <day>30</day>
          <month>11</month>
          <year>2011</year>
        </date>
        <date date-type="rev-recd">
          <day>23</day>
          <month>12</month>
          <year>2011</year>
        </date>
        <date date-type="accepted">
          <day>28</day>
          <month>12</month>
          <year>2011</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>© 2012 by the authors; licensee MDPI, Basel, Switzerland.</copyright-statement>
        <copyright-year>2012</copyright-year>
        <license xmlns:xlink="http://www.w3.org/1999/xlink" license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0/">
          <p>This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).</p>
        </license>
      </permissions>
      <abstract>
        <p>Biomechanical signals play an important role in normal disc metabolism and pathology. For instance, nucleus pulposus (NP) cells will regulate metabolic activities and maintain a balance between the anabolic and catabolic cascades. The former involves factors such as transforming growth factor-β (TGFβ) and mechanical stimuli, both of which are known to regulate matrix production through autocrine and paracrine mechanisms. The present study examined the combined effect of TGFβ and mechanical loading on anabolic activities in NP cells cultured in agarose constructs. Stimulation with TGFβ and dynamic compression reduced nitrite release and increased matrix synthesis and gene expression of aggrecan and collagen type II. The findings from this work has the potential for developing regenerative treatment strategies which could either slow down or stop the degenerative process and/or promote healing mechanisms in the intervertebral disc.</p>
      </abstract>
      <kwd-group>
        <kwd>TGFβ</kwd>
        <kwd>mechanical loading</kwd>
        <kwd>matrix synthesis</kwd>
        <kwd>nucleus pulposus</kwd>
        <kwd>intervertebral disc</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec sec-type="intro">
      <title>1. Introduction</title>
      <p>Intervertebral disc degeneration commonly leads to chronic back pain and has reached epidemic proportions in the UK [<xref ref-type="bibr" rid="B1-jfb-03-00023">1</xref>]. The main risks include mechanical, biochemical and genetic factors [<xref ref-type="bibr" rid="B2-jfb-03-00023">2</xref>,<xref ref-type="bibr" rid="B3-jfb-03-00023">3</xref>]. However, ageing and injury will inevitably contribute to the degenerative process [<xref ref-type="bibr" rid="B4-jfb-03-00023">4</xref>]. The disease has enormous socioeconomic consequences with estimated costs in the UK exceeding £10 billion per year resulting from social and healthcare expenditure and loss of productivity in the workplace. Although clinical treatments are aimed at providing symptomatic pain relief, they do not restore biomechanical function or address disability. Accordingly, emphasis should be placed on developing regenerative treatment strategies which either slow down or stop the degenerative process and/or promote healing mechanisms. This information is essential for identifying the appropriate parameters suitable for pharmacological and physiotherapeutic interventions in disc regeneration.</p>
      <p>Previous <italic>in vitro</italic> and animal studies have utilized a range of growth factors to upregulate the extracellular matrix and reverse degenerative disc disease in bovine, human and murine disc tissues [<xref ref-type="bibr" rid="B5-jfb-03-00023">5</xref>,<xref ref-type="bibr" rid="B6-jfb-03-00023">6</xref>,<xref ref-type="bibr" rid="B7-jfb-03-00023">7</xref>,<xref ref-type="bibr" rid="B8-jfb-03-00023">8</xref>]. For example, there is evidence that insulin growth factor (IGF-1), transforming growth factor-β (TGFβ), bone morphogenetic proteins (BMPs) and growth differentiation factor-5 (GDF-5) regulate matrix production largely through autocrine and paracrine mechanisms [<xref ref-type="bibr" rid="B9-jfb-03-00023">9</xref>,<xref ref-type="bibr" rid="B10-jfb-03-00023">10</xref>,<xref ref-type="bibr" rid="B11-jfb-03-00023">11</xref>,<xref ref-type="bibr" rid="B12-jfb-03-00023">12</xref>]. Growth factors could therefore be used to enhance disc regeneration [<xref ref-type="bibr" rid="B8-jfb-03-00023">8</xref>,<xref ref-type="bibr" rid="B13-jfb-03-00023">13</xref>,<xref ref-type="bibr" rid="B14-jfb-03-00023">14</xref>]. Furthermore, the anabolic response could be enhanced with the application of mechanical stimuli. Indeed, several research groups have developed bioreactor systems which enable application of physiological mechanical conditioning to cells cultured in 3D models. In particular, dynamic compression has been shown to maintain cellular phenotype and increased aggrecan gene expression and GAG content in human NP/alginate constructs [<xref ref-type="bibr" rid="B15-jfb-03-00023">15</xref>]. This type of anabolic response was mediated by the integrins and has been reported to be dependent on the duration and type of compression regimen employed [<xref ref-type="bibr" rid="B15-jfb-03-00023">15</xref>,<xref ref-type="bibr" rid="B16-jfb-03-00023">16</xref>,<xref ref-type="bibr" rid="B17-jfb-03-00023">17</xref>,<xref ref-type="bibr" rid="B18-jfb-03-00023">18</xref>,<xref ref-type="bibr" rid="B19-jfb-03-00023">19</xref>,<xref ref-type="bibr" rid="B20-jfb-03-00023">20</xref>]. In contrast, static compression was found to have detrimental effects including reduced cell viability and matrix synthesis in IVD tissues [<xref ref-type="bibr" rid="B21-jfb-03-00023">21</xref>,<xref ref-type="bibr" rid="B22-jfb-03-00023">22</xref>,<xref ref-type="bibr" rid="B23-jfb-03-00023">23</xref>,<xref ref-type="bibr" rid="B24-jfb-03-00023">24</xref>]. The importance of these findings emphasizes the nature of the mechanical stimulus in controlling anabolic and catabolic activities in NP cells. Furthermore, the combined action of growth factors and mechanical loading in modulating matrix synthesis has not been previously examined. The present study therefore explored the specific effects of TGFβ and dynamic compression on NP cells cultured in agarose constructs.</p>
    </sec>
    <sec>
      <title>2. Experimental Section</title>
      <sec>
        <title>2.1. NP Cell Isolation and Monolayer Culture</title>
        <p>Bovine NP tissue (1.5 to 2.5 g) was isolated from caudal discs (3 discs per tail) of cattle aged less than 18 months from a local abattoir (Humphreys and Sons, Chelmsford, Essex, UK). Tails from 15 animals were used for all experiments. The tissue was diced and incubated on rollers in Dulbecco Modified Eagle Medium (DMEM)/F12 supplemented with penicillin/streptomycin (5%), ascorbic acid (2.5 µg/mL), amphoceterin B (5%), FCS (20%), collagenase type XI (0.8 mg/mL) and DNAse I (2.6 units/mL) for 16 h at 37 °C. The cell suspension was filtered through a 70 µM cell strainer, centrifuged at 2,000 rpm for 5 min and resuspended in media. Cells were subsequently expanded in monolayer culture in DMEM/F12 + 10% FCS until 80% confluent.</p>
      </sec>
      <sec>
        <title>2.2. Preparation of NP/Agarose Constructs</title>
        <p>Confluent NP cells (Passage 1) were detached with 0.2% trypsin and 0.1% EDTA and counted on a hemocytometer using the trypan blue exclusion assay. Viable NP cells were seeded into 3% agarose type VII (low gelling temperature agarose) or 4% agarose type IX (ultra-low temperature gelling agarose) at 4 million cells/mL, using well-established methods, as previously described [<xref ref-type="bibr" rid="B25-jfb-03-00023">25</xref>,<xref ref-type="bibr" rid="B26-jfb-03-00023">26</xref>]. The agarose concentration and type were chosen based on previous observations [<xref ref-type="bibr" rid="B25-jfb-03-00023">25</xref>,<xref ref-type="bibr" rid="B26-jfb-03-00023">26</xref>]. To review briefly, the cells were resuspended in medium at a cell concentration of 8 × 10<sup>6</sup> cells/mL and added to an equal volume of molten 6% (w/v) agarose type VII or 8% (w/v) agarose type IX in Earle Balanced Salt Solutions (EBSS) to yield a final cell concentration of 4 × 10<sup>6</sup> cells/mL in 3% (w/v) agarose type VII or 4% agarose type XI (Sigma-Aldrich, Poole, UK). This is equivalent to approximately 400,000 cells per construct. The chondrocyte/agarose suspension was transferred into a sterile stainless steel mold, containing holes 5 mm in diameter and 5 mm in height and allowed to gel at 4 °C for 20 min. NP/agarose constructs were equilibrated in culture in DMEM/F12 + 10% FCS for up to 72 h to enable re-differentiation prior to further cell culture or mechanical loading experiments. The NP/agarose constructs were subsequently cultured for 48 h either under free-swelling conditions or when subjected to dynamic compression (15%, 1 Hz frequency). At the end of the culture period, constructs and media samples were stored at −20 °C prior to biochemical analysis or examined for mechanical testing. In addition, cell viability was assessed using calcein AM (5 µM) and ethidium homodimer (5 µM) by fluorescence microscopy (Invitrogen, Paisley, UK), as previously described [<xref ref-type="bibr" rid="B25-jfb-03-00023">25</xref>].</p>
      </sec>
      <sec>
        <title>2.3. Dose-Response Effect of TGFβ in NP Cells Cultured in Agarose Constructs</title>
        <p>In separate experiments, equilibrated NP/agarose constructs (3%, type VII) were cultured for a further 48 h under free-swelling conditions in the presence and absence of 0.1, 1 and 10 ng/mL TGFβ<sub>3</sub> (Cambrex Bioscience, Wokingham, Berkshire). At the end of the experiment, constructs and media samples were stored at −20 °C prior to biochemical analysis.</p>
      </sec>
      <sec>
        <title>2.4. Application of Dynamic Compression</title>
        <p>In separate experiments, the combined effects of TGFβ and dynamic compression on protein synthesis and gene expression were examined in NP/agarose constructs (3%, type VII) cultured for 6 and 48 h. The bioreactor system has been extensively described previously [<xref ref-type="bibr" rid="B25-jfb-03-00023">25</xref>,<xref ref-type="bibr" rid="B26-jfb-03-00023">26</xref>]. To review briefly, equilibrated constructs were transferred into individual wells of a 24-well culture plate (Costar, High Wycombe, UK) and mounted within the bioreactor. One milliliter of media supplemented with either 0 or 10 ng mL<sup>−1</sup> TGFβ were introduced into each well. Two separate compression regimens were applied to constructs in a dynamic manner at a strain amplitude of 15% and a frequency of 1 Hz:</p>
        <p>1.5 h compression with a 22.5 h unstrained period repeated 2 × (1.5 h/22.5 h<sup>×2</sup>);</p>
        <p>1.5 h compression with a 4.5 h unstrained period repeated 8 × (1.5 h/4.5 h<sup>×8</sup>).</p>
        <p>Control constructs were maintained in an unstrained state within the bioreactor system and cultured for the same time period. At the end of the culture period, the constructs and corresponding media were immediately stored at −70 °C prior to analysis.</p>
      </sec>
      <sec>
        <title>2.5. RNA Isolation, cDNA Synthesis and Real-Time qPCR</title>
        <p>RNA was isolated from NP cells cultured in agarose using protocols described in the QIAquick<sup> ℘ </sup> Spin gel extraction and RNeasy<sup> ℘ </sup> kits, as previously described (Qiagen,West Sussex, UK) [<xref ref-type="bibr" rid="B27-jfb-03-00023">27</xref>]. Following manufacturer’s instructions, Ambion’s DNA-<italic>free</italic> DNase treatment and removal reagents were used to eliminate any contaminating DNA from the RNA sample (Ambion Applied Biosystems, Warrington, UK). RNA was quantified on the Nanodrop ND-1000 spectrophotometer (LabTech, East Sussex, UK) and reverse transcribed (200 ng) in a 20 µL reaction volume using the manufacturer-supplied oligo (dT) primers. Minus reverse transcriptase (NoRT) control reactions were prepared for each sample by omitting the Stratascript℘ reverse transcriptase. Real-time quantitative PCR assays coupled with molecular beacon probes were performed in 25 µL reaction mixtures containing 1 µL cDNA, 12.5 µL Brilliant<sup> ℘ </sup> QRT-PCR Master Mix, primer pairs and probes listed in <xref ref-type="table" rid="jfb-03-00023-t001">Table 1</xref> and nuclease free PCR grade water to 25 µL (Sigma Genosys, Cambridge, UK). Each sample was run in duplicate on the 96-well thermal system of the M × 3000P quantitative PCR instrument (Stratagene, Amsterdam, the Netherland).</p>
        <table-wrap id="jfb-03-00023-t001" position="anchor">
          <object-id pub-id-type="pii">jfb-03-00023-t001_Table 1</object-id>
          <label>Table 1</label>
          <caption>
            <p>Description of the Beacon designer sequences used to quantify gene expression.</p>
          </caption>
          <table>
            <thead>
              <tr>
                <th>Gene</th>
                <th>Accession number</th>
                <th>Sequences</th>
              </tr>
            </thead>
            <tfoot>
              <tr>
                <td><bold>Note:</bold> The Beacon Designer software was used to design forward and reverse primer and probe sequences for molecular beacon applications (Sigma Genosys Ltd.: Cambridge, UK). Probes contain FAM or HEX as a 5'—reporter dye and DABCYL as 3'—quencher. Note that the arm sequences are underlined.</td>
              </tr>
            </tfoot>
            <tbody>
              <tr>
                <td>Aggrecan</td>
                <td>U76615</td>
                <td><italic>Reverse:</italic> 5'-GATGAAGTAGCAGGGGATGG-3'</td>
              </tr>
              <tr>
                <td>type II</td>
                <td>X02420</td>
                <td><italic>Reverse:</italic> 5'-AAGTCCGAACTGTGAGAGG-3'</td>
              </tr>
              <tr>
                <td>GAPDH</td>
                <td>U85042</td>
                <td><italic>Reverse:</italic> 5'-TTCAACGGCACAGTCAAGG-3'</td>
              </tr>
            </tbody>
          </table>
        </table-wrap>
        <p>Thermocycling conditions comprised of an initial polymerase activation step at 95 °C for 3 min, followed by denaturation of 35 cycles at 95 °C for 30 s, annealing at 55 °C for 1 min and extension at 72 °C for 1 min. PCR efficiencies for optimal primer pair and probe concentrations were derived from standard curves (<italic>n</italic> = 3) by preparing a ten-fold serial dilution of cDNA from a sample which represented the untreated control at time zero conditions. The real-time PCR efficiencies (E) of amplification for each target was defined according to the relationship, E = 10<sup>[−1/slope]</sup>. The <italic>R</italic><sup>2</sup> value of the standard curve exceeded 0.9998 and revealed efficiency values between 0.99 and 1.01.</p>
        <p>Fluorescence data was collected during the annealing stage of amplification and data was analyzed on the MxPro℘ qPCR software (version 3, Stratagene). Baselines and thresholds were automatically set by the RG-3000℘ qPCR software and used after manual inspection. The cycle threshold (C<sub>t</sub>) value for each duplicate reaction was expressed as the mean value and the results were exported into Microsoft Excel for further analysis. Relative quantification of aggrecan and collagen type II signals were accomplished by normalizing each target to the reference gene, GAPDH and to the calibrator sample by a comparative C<sub>t</sub> approach. For each sample, the ratio of target ∆Ct and reference ∆Ct was calculated, as previously described [<xref ref-type="bibr" rid="B27-jfb-03-00023">27</xref>,<xref ref-type="bibr" rid="B28-jfb-03-00023">28</xref>]. In addition, the C<sub>t</sub> values for GAPDH remained stable with no changes detected under all culture conditions, suggesting its suitability as a reference gene.</p>
      </sec>
      <sec>
        <title>2.6. Biochemical Analysis</title>
        <p>The production of nitrite was determined in media samples and assayed spectrophotometrically at 540 nm using the Griess reaction. sGAG content was measured in media and constructs digested overnight at 37 °C with 10 U mL<sup>−1</sup> agarase followed by 1 h at 60 °C with 2.8 U mL<sup>−1</sup> papain (both Sigma Chemical Co., Poole, UK) using the DMMB assay [<xref ref-type="bibr" rid="B25-jfb-03-00023">25</xref>,<xref ref-type="bibr" rid="B26-jfb-03-00023">26</xref>]. Total DNA content which remained stable throughout the culture conditions was assayed using the Hoescht dye 33258 in agarase/papain digests.</p>
      </sec>
      <sec>
        <title>2.7. Mechanical Properties</title>
        <p>NP/agarose constructs were tested in unconfined compression with a mechanical test system (MTS Bionix 100, Billingshirt, UK) using stainless steel platens which were larger compared with the 5 mm diameter constructs. Samples were initially subjected to a 0.02 N tare load followed by a strain rate of 0.05% strain/s up to a maximum strain of 15%. This constant strain was maintained while the constructs relaxed until an equilibrium stress was reached. From the stress-strain response a tangent modulus was estimated, while an equilibrium modulus was calculated following stress relaxation [<xref ref-type="bibr" rid="B29-jfb-03-00023">29</xref>].</p>
      </sec>
      <sec>
        <title>2.8. Statistics</title>
        <p>For<italic/>free-swelling experiments, data represent the mean and SEM values of 12 replicates from three separate experiments. For the mechanical loading experiments, data represent the mean and SEM values of 15 replicates from four separate experiments. Statistical analysis was performed by a two-way analysis of variance (ANOVA) and the multiple <italic>post hoc</italic> Bonferroni-corrected <italic>t</italic>-tests to compare differences between the various treatment groups. In all cases, a level of 5% was considered statistically significant (<italic>p</italic></p>
      </sec>
    </sec>
    <sec sec-type="results">
      <title>3. Results and Discussion</title>
      <p>Growth factors may contribute to disc regeneration by regulating cell-mediated remodeling events and matrix synthesis. Mechanical loading will additionally influence the cellular response and regulate downstream effects such as gene expression and protein biosynthesis. Bioreactors are therefore valuable tools for evaluating the effects of mechanical loading on signal transduction pathways in 3D culture systems. The present study therefore utilized the agarose/bioreactor model to examine its potential as an <italic>in vitro</italic> system for disc regeneration. This is the first study to examine the combined effect of TGFβ and dynamic compression on gene expression and protein synthesis in NP/agarose constructs.</p>
      <sec>
        <title>3.1. The effect of Agarose Concentration on NP Protein Synthesis and Resulting Mechanical Properties </title>
        <p>The effect of culturing NP cells in constructs of different agarose types and concentrations on protein synthesis and the resulting mechanical properties are illustrated in Figure 1. GAG synthesis was significantly enhanced over the 48 h culture period (<italic>p</italic>p 30,<xref ref-type="bibr" rid="B31-jfb-03-00023">31</xref>]. In particular, long term culture of NP cells in agarose constructs increased cell proliferation and GAG synthesis and enhanced gene expression of aggrecan and collagen type II [<xref ref-type="bibr" rid="B32-jfb-03-00023">32</xref>,<xref ref-type="bibr" rid="B33-jfb-03-00023">33</xref>]. In addition, 3D cultures of NP cells were previously described in alginate beads or in fibrin/hylauronan and were shown to maintain cell phenotype and matrix synthesis [<xref ref-type="bibr" rid="B32-jfb-03-00023">32</xref>,<xref ref-type="bibr" rid="B34-jfb-03-00023">34</xref>,<xref ref-type="bibr" rid="B35-jfb-03-00023">35</xref>,<xref ref-type="bibr" rid="B36-jfb-03-00023">36</xref>]. Accordingly, subsequent experiments were limited to examining the effect of mechanical conditioning of NP cells cultured in 3% agarose type VII.</p>
        <fig id="jfb-03-00023-f001" position="anchor">
          <label>Figure 1</label>
          <caption>
            <p>Effect of culture period on NP/agarose constructs. (<bold>A</bold>) GAG synthesis; (<bold>B</bold>) nitrite release; (<bold>C</bold>) equilibrium modulus (<bold>D</bold>) tangent modulus (<italic>n</italic> = 12). (***) indicates significant comparisons for the different treatment conditions (<italic>p</italic>p &gt; 0.05).</p>
          </caption>
          <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jfb-03-00023-g001.tif"/>
        </fig>
        <fig id="jfb-03-00023-f002" position="anchor">
          <label>Figure 2</label>
          <caption>
            <p>Confocal fluorescence images of viable NP cells cultured in 3% agarose type VII (<bold>A</bold>) and 4% agarose type IX (<bold>B</bold>) for 48 h. White bar represents 10 µm.</p>
          </caption>
          <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jfb-03-00023-g002.tif"/>
        </fig>
      </sec>
      <sec>
        <title>3.2. The Effect of Dynamic Compression on Protein Synthesis in NP/Agarose Constructs</title>
        <p>The effect of two distinct dynamic compression regimens on NP protein synthesis is illustrated in Figure 3. In both cases, nitrite levels were significantly reduced by dynamic compression in NP/agarose constructs (<italic>p</italic>p 16,<xref ref-type="bibr" rid="B37-jfb-03-00023">37</xref>]. In addition, a single load for 30 min or daily for four weeks increased anabolic gene expression in human NP cells cultured in collagen gels [<xref ref-type="bibr" rid="B38-jfb-03-00023">38</xref>,<xref ref-type="bibr" rid="B39-jfb-03-00023">39</xref>]. Conversely, compression applied at high frequencies (&gt;3 Hz) and magnitude (&gt;1 MPa) for extended periods (&gt;48 h) reduced matrix synthesis and increased gene expression of catabolic factors, such as nitric oxide (NO), matrix metalloproteinase-3 (MMP-3), matrix metalloproteinase-13 (MMP-13) and a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS-4) [<xref ref-type="bibr" rid="B16-jfb-03-00023">16</xref>,<xref ref-type="bibr" rid="B37-jfb-03-00023">37</xref>]. The deleterious effects were shown to cause cell death and were similar to murine studies in which static compression was applied at high magnitudes (&gt;1 MPa) for 6 hours [<xref ref-type="bibr" rid="B16-jfb-03-00023">16</xref>,<xref ref-type="bibr" rid="B37-jfb-03-00023">37</xref>].</p>
        <p>In a separate study, stimulation by static compression for one week was associated with degenerative changes involving cell death, decreased aggrecan and collagen type II expression and elevated protease gene expression in murine disc tails [<xref ref-type="bibr" rid="B40-jfb-03-00023">40</xref>,<xref ref-type="bibr" rid="B41-jfb-03-00023">41</xref>,<xref ref-type="bibr" rid="B42-jfb-03-00023">42</xref>,<xref ref-type="bibr" rid="B43-jfb-03-00023">43</xref>]. Interestingly, these effects were not found at low magnitudes of static compression (</p>
        <fig id="jfb-03-00023-f003" position="anchor">
          <label>Figure 3</label>
          <caption>
            <p>Effect of dynamic compression (15%, 1Hz) on protein synthesis in NP/agarose constructs (3%, type VII) cultured for 48 h.</p>
          </caption>
          <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jfb-03-00023-g003.tif"/>
        </fig>
      </sec>
      <sec>
        <title>3.3. The Effect of TGFβ on Protein Synthesis in NP/Agarose Constructs</title>
        <p>The autocrine and paracrine production of growth factors is considered to be a major regulatory mechanism in IVD tissues [<xref ref-type="bibr" rid="B5-jfb-03-00023">5</xref>]. We therefore examined the effect of TGFβ on protein synthesis in NP/agarose constructs. The presence of TGFβ significantly increased GAG synthesis and inhibits nitrite release in a dose-dependent manner (<xref ref-type="fig" rid="jfb-03-00023-f004">Figure 4</xref>). These data are in agreement with previous studies which showed dose-dependent upregulation of proteoglycan synthesis and gene expression of aggrecan and collagen type II by TGFβ in the agarose or alginate model [<xref ref-type="bibr" rid="B10-jfb-03-00023">10</xref>,<xref ref-type="bibr" rid="B32-jfb-03-00023">32</xref>]. At 1 ng/mL, TGFβ increased cell proliferation and proteoglycan synthesis in canine NP cells and the response was further increased with 20% FCS [<xref ref-type="bibr" rid="B8-jfb-03-00023">8</xref>]. In rodent organ culture, TGFβ (5 ng/mL) maintained phenotype and proteoglycan synthesis when cultured in insulin-transferrin-selenium (ITS) containing media with 20% FCS [<xref ref-type="bibr" rid="B47-jfb-03-00023">47</xref>]. At 10 ng/mL, NP cells cultured in collagen or hylauronan scaffolds with TGFβ results in the production of several types of proteoglycans and collagens [<xref ref-type="bibr" rid="B48-jfb-03-00023">48</xref>]. However, matrix integrity could not be maintained during long term culture, highlighting the importance of choosing an optimal environment for TGFβ stimulation in 3D models. Furthermore, the expression of TGFβ and the TGFβ Type II receptor (TGFβRII) were found to be low in human herniated IVDs. In rat and murine models, TGFβ and its receptors were shown to decrease with age [<xref ref-type="bibr" rid="B49-jfb-03-00023">49</xref>,<xref ref-type="bibr" rid="B50-jfb-03-00023">50</xref>]. These findings support the potential of TGFβ in promoting matrix synthesis and maintaining tissue integrity and imply its absence may be a risk factor for IVD degeneration.</p>
        <fig id="jfb-03-00023-f004" position="anchor">
          <label>Figure 4</label>
          <caption>
            <p>Dose-response effect of TGFβ (0.01 to 10 ng/mL) on GAG synthesis (<bold>A</bold>) and nitrite release (<bold>B</bold>) in NP/agarose constructs cultured for 48 h (<italic>n</italic> = 12). (*) indicates significant comparisons between untreated and TGFβ stimulated constructs.</p>
          </caption>
          <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jfb-03-00023-g004.tif"/>
        </fig>
      </sec>
      <sec>
        <title>3.4. The Effect of TGFβ and Dynamic Compression on Protein Synthesis and Gene Expression</title>
        <p>The combined effect of TGFβ and dynamic compression on protein synthesis and gene expression in NP/agarose constructs are presented in Figures 5 and 6, respectively. Stimulation by TGFβ and dynamic compression significantly enhanced GAG synthesis and reduced nitrite levels in NP/agarose constructs (both <italic>p</italic>Figure 5). In addition, TGFβ and dynamic compression significantly induced gene expression of aggrecan and collagen type II in a time-dependent manner (all <italic>p</italic>Figure 6). This is the first study to show an additive effect of TGFβ and dynamic compression on protein synthesis and gene expression in NP/agarose constructs. The combined effect of growth factors and mechanical loading on IVD metabolism is not known. Moreover, previous studies demonstrate enhanced chondrogenesis with TGFβ and dynamic compression resulting in anabolic gene expression in human mesenchymal progenitor cells cultured in monolayer or alginate [<xref ref-type="bibr" rid="B51-jfb-03-00023">51</xref>,<xref ref-type="bibr" rid="B52-jfb-03-00023">52</xref>,<xref ref-type="bibr" rid="B53-jfb-03-00023">53</xref>]. It is possible that other growth factors such as GDF-5 or IGF-1 could initiate differentiation of MSCs to an IVD phenotype during physiological dynamic loading. However, the anabolic response will be dependent on the exposure time to growth factors and whether loading was applied during early or late stage cultures [<xref ref-type="bibr" rid="B54-jfb-03-00023">54</xref>].</p>
        <fig id="jfb-03-00023-f005" position="anchor">
          <label>Figure 5</label>
          <caption>
            <p>Effect of TGFβ and dynamic compression (15%, 1 Hz) on GAG synthesis (<bold>A</bold>) and nitrite release for 48 h (<bold>B</bold>). NP/agarose constructs were cultured with 0 or 10 ng/mL TGFβ for 48 h (<italic>n</italic> = 15). (*) indicates significant comparisons in unstrained and strained constructs as shown.</p>
          </caption>
          <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jfb-03-00023-g005.tif"/>
        </fig>
        <fig id="jfb-03-00023-f006" position="anchor">
          <label>Figure 6</label>
          <caption>
            <p>Effect of TGFβ and dynamic compression (15%, 1 Hz) on aggrecan (<bold>A</bold>) and collagen type II gene expression (<bold>B</bold>) for 6 and 48 h (B). NP/agarose constructs were cultured with 0 or 10 ng/mL TGFβ for 48 h (n = 6). (*) indicates significant comparisons in unstrained and strained constructs as shown.</p>
          </caption>
          <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jfb-03-00023-g006.tif"/>
        </fig>
      </sec>
    </sec>
    <sec sec-type="conclusions">
      <title>4. Conclusions</title>
      <p>Growth factors and mechanical conditioning are important factors that determine cell behavior and tissue remodeling. This is the first study to show an additive effect of TGFβ and dynamic compression on protein synthesis and gene expression in NP/agarose constructs. Clinical application of TGFβ in combination with a pharmaceutical and physiotherapeutic approach could therefore be used to counteract the pathophysiological pathways for disc regeneration therapy. Further studies are needed to examine further the beneficial effects of mechanical loading and TGFβ on signal transduction pathways in maintaining normal IVD tissue remodeling.</p>
    </sec>
    <sec>
      <title>Conflicts of Interest</title>
    </sec>
  </body>
  <back>
    <ack>
      <title>Acknowledgements</title>
      <p>The authors declare no conflict of interest. </p>
    </ack>
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