Effects of Cell Seeding and Cyclic Stretch on the Fiber Remodeling in an Extracellular Matrix-Derived Bioscaffold

The porcine small intestine submucosa, an extracellular matrix-derived bioscaffold (ECM-SIS), has been successfully used to enhance the healing of ligaments and tendons. Since the collagen fibers of ECM-SIS have an orientation of +/- 30 degrees, its application in improving the healing of the parallel-fibered ligament and tendon may not be optimal. Therefore, the objective was to improve the collagen fiber alignment of ECM-SIS in vitro with fibroblast seeding and cyclic stretch. The hypothesis was that with the synergistic effects of cell seeding and mechanical stimuli, the collagen fibers in the ECM-SIS can be remodeled and aligned, making it an improved bioscaffold with enhanced conductive properties. Three experimental groups were established: group I (n=14), ECM-SIS was seeded with fibroblasts and cyclically stretched; group II (n=13), ECM-SIS was seeded with fibroblasts but not cyclically stretched; and group III (n=8), ECM-SIS was not seeded with fibroblasts but cyclically stretched. After 5 days' experiments, the scaffolds from all the three groups (n=9 for group I; n=8 for groups II and III) were processed for quantification of the collagen fiber orientation with a small-angle light scattering (SALS) system. For groups I and II, in which the scaffolds were seeded with fibroblasts, the cell morphology and orientation and newly produced collagen fibrils were examined with confocal fluorescent microscopy (n=3/group) and transmission electronic microscopy (n=2/group). The results revealed that the collagen fiber orientation in group I was more aligned closer to the stretching direction when compared to the other two groups. The mean angle decreased from 25.3 degrees to 7.1 degrees (p<0.05), and the associated angular dispersion was also reduced (37.4 degrees vs. 18.5 degrees, p<0.05). In contrast, groups II and III demonstrated minimal changes. The cells in group I were more aligned in the stretching direction than those in group II. Newly produced collagen fibrils could be observed along the cells in both groups I and II. This study demonstrated that a combination of fibroblast seeding and cyclic stretch could remodel and align the collagen fiber orientation in ECM-SIS bioscaffolds. The better-aligned ECM-SIS has the prospect of eliciting improved effects on enhancing the healing of ligaments and tendons.