Cell-based partial pulp regeneration in a porcine preclinical model

Abstract : The dental pulp is a connective tissue, which is highly innervated and vascularized, encapsulated in a mineralized inextensible structure formed by enamel, dentin and cementum, ensuring the homeostasis and sensibility of the tooth. The pulp is often damaged by caries and trauma, resulting in infection or necrosis. In such situations, the routine clinical treatment is a root canal therapy, which consists in the elimination of the affected tissue and filling of the endodontic canal system with bioinert synthetic materials. In spite of satisfactory clinical outcomes, none of the original functions is restored and the lack of sensitivity as well as natural defence may lead to tooth fracture and reinfection. Cell-based pulp regeneration could provide a valid alternative to traditional endodontic treatment of damaged teeth. This strategy focuses, in fact, on the preservation of the healthy pulp tissue and the regeneration of the damaged one, by combining stem cells, scaffolds and growth factors. In case of trauma or carious lesion, as the pulp inflammatory reaction is compartmentalized in first instance, such conservative approach could be indicated. Regarding non-rodent animal model, to our knowledge, only Iohara et al. (2009) reported the achievement of partial pulp regeneration in canine tooth by implantation of subfractions of autologous pulp cells; however, in the perspective of a transfer to the human clinic, larger animal models should be developed to test the feasibility and the success of the therapy mimicking the clinical conditions of pulpotomy. Due to dental anatomical and physiological similarities with human, the minipig constitutes a model of choice for preclinical pulp engineering studies. The aim of this study was to develop a preclinical model of partial dental pulp regeneration in minipig, by implanting a pulp construct, made by self-assembling nano-peptide injectable hydrogel and porcine minipig dental pulp cells (pDPCs), in artificially created pulp defects. Secondarily, in the context of this preclinical model, two different techniques of analysis of the regeneration process have been developed. In particular, an in vivo 3D subtraction angiography has been set for the visualization of dental pulp vascular network. Indeed, further developments of this modality open promising perspectives of its application for the morphometric characterization of angiogenesis process in newly formed dental tissues and bone defects. Moreover, using specific morphometric parameters, initially developed to characterize bone, a micro-CT morphometric analysis of the mineralized reparative tissues, obtained by the partial pulp regeneration protocol, has been elaborated. By split mouth model, pulp constructs made with self-assembling injectable nano-peptide hydrogel with and without porcine dental pulp cells (pDPCs) were implanted, after pulp chamber amputation in premolars and molars. At day 21 after surgery, three-dimensional morphometric characterization, Masson’s trichrome and immunolabeled for DSP and BSP were performed on treated teeth. 3D subtraction angiographies have been performed before and after partial pulp regeneration procedure. Regardless of the presence of pDPCs, the implantation of pulp construct induces the formation of an osteodentin bridge, whose microarchitecture sensibly differs from the native dentin. Furthermore, the presence of pDPCs in the construct slightly impairs this reparative process. The latter was led the remaining pulp cells, instead of the pDPCs in the scaffold. Angiographies could show entire vascularization of jaws and continuously growing teeth but blood supply of treated mature permanent teeth could not be displayed. The failure of partial pulp regeneration cell based strategy, in these near-real clinical conditions, highlights the importance of preclinical models, to identify the factors promoting a favourable regenerative environment, in the perspective of a transfer to the human clinics.
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Francesca Mangione. Cell-based partial pulp regeneration in a porcine preclinical model. Human health and pathology. Université Sorbonne Paris Cité, 2017. English. ⟨NNT : 2017USPCB046⟩. ⟨tel-02117873⟩

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