The California Institute for Regenerative Medicine (CIRM) has awarded a $2.7 million research grant to Scripps Health to investigate the use of stem cells to engineer rotator cuff tendons in the lab that can then be used to repair common shoulder injuries.
The rotator cuff is a group of four muscles and their attached tendons, which hold the upper arm in place in the shoulder socket. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate the arm.
Most rotator cuff tears result from natural degeneration of the tendon over time, frequently causing pain and possibly limited use of the arm. As the condition progresses and worsens, the shoulder can become weaker, more painful, and less useful.
The use of pluripotent stem cells to develop lab-grown tendon tissue to repair rotator cuffs could benefit older patients with significant tears due to age-related degeneration.
“For this group of patients, the failure rate for conventional repair surgery is about 40%,” said Dr. Darryl D’Lima, director of orthopedic research for the Shiley Center for Orthopaedic Research and Education (SCORE) at Scripps Clinic and the initiative’s lead investigator. “This is a common injury, and as our population ages, there’s a pressing need to find new solutions.”
Annually, over 100,000 Californians sustain tendon injuries, the majority of which require surgical repair. Failure rates for shoulder rotator cuff tendon repairs vary between 20% and 90%. Failed rotator cuff tendons lead to early development of osteoarthritis, for which the only effective treatment is total joint replacement. Preventing disability offers significant socioeconomic benefits and reductions in healthcare costs also are likely to be significant.
The funding from CIRM will support the initiative’s three-year discovery phase at Shiley Center for Orthopaedic Research and Education (SCORE) on Torrey Pines Mesa. Researchers plan to develop a series of lab tests called assays to assess and measure the makeup of the tendon cells and develop the tendon material in the lab.
SCORE researchers intend to explore the possibility of transforming pluripotent stem cells into tendon-like cells, which would be embedded into a scaffold structure of “electrospun” fibers and grown into tendon tissue using bioreactors.
The lab-engineered tendon tissue also would be stretched to help stimulate the cells to produce more tissue, and to help align the electrospun fibers so they mimic the intricate alignment of fibers in native tissue. Lining up the tendon fibers in the same direction that stretching occurs is needed to resist tensile force, or the stretching force experienced during motion.
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The Stem Cellar 
The rotator cuff consists of four muscles. These are the subscapular is, the supraspinatus, the infraspinatus and the teres minor muscles. These muscles end in short, flat, broad tendons which fuse intimately with the fibrous capsule to form the musculatendinoes cuff.
Stem cell therapy is an effective therapeutic treatment to treat rotator cuff injury. Pluripotent stem cell technology require to develop pluripotent stem cells into four different types of tendon-like cells which would be embedded into scaffold structure of electrospun fiber and grown into tendon tissues using bioreactor.
To note that, stem cells require growth factors for growth and differentiations. The growth factors have important roles to induce maturation and gene expression of adhesion molecules on progenitors. As the formation of rotator cuff requires four different muscles organized in correct conformation. Hence, the organization of four differentiated tendon cells is dependent on cell-suface interaction both with molecules on the surface of other cells and the extracellular matrix. Localization of cells can thus in principle be driven by the interplay between interaction with surface and matrix molecules that regulate adherence, and chemoatractant gradients that direct cell migration. These principle operate throughout the biology of multicellular organisms.