Research Article: PTH decreases in vitro human cartilage regeneration without affecting hypertrophic differentiation

Date Published: April 4, 2019

Publisher: Public Library of Science

Author(s): Marijn Rutgers, Frances Bach, Luciënne Vonk, Mattie van Rijen, Vanessa Akrum, Antonette van Boxtel, Wouter Dhert, Laura Creemers, Gianpaolo Papaccio.


Regenerated cartilage formed after Autologous Chondrocyte Implantation may be of suboptimal quality due to postulated hypertrophic changes. Parathyroid hormone-related peptide, containing the parathyroid hormone sequence (PTHrP 1–34), enhances cartilage growth during development and inhibits hypertrophic differentiation of mesenchymal stromal cells (MSCs) and growth plate chondrocytes. This study aims to determine the possible anabolic and/or hypertrophic effect of PTH on human articular chondrocytes. Healthy human articular cartilage-derived chondrocytes (n = 6 donors) were cultured on type II collagen-coated transwells with/without 0.1 or 1.0 μM PTH from day 0, 9, or 21 until the end of culture (day 28). Extracellular matrix production, (pre)hypertrophy and PTH signaling were assessed by RT-qPCR and/or immunohistochemistry for collagen type I, II, X, RUNX2, MMP13, PTHR1 and IHH and by determining glycosaminoglycan production and DNA content. The Bern score assessed cartilage quality by histology. Regardless of the concentration and initiation of supplementation, PTH treatment significantly decreased DNA and glycosaminoglycan content and reduced the Bern score compared with controls. Type I collagen deposition was increased, whereas PTHR1 expression and type II collagen deposition were decreased by PTH supplementation. Expression of the (pre)hypertrophic markers MMP13, RUNX2, IHH and type X collagen were not affected by PTH. In conclusion, PTH supplementation to healthy human articular chondrocytes did not affect hypertrophic differentiation, but negatively influenced cartilage quality, the tissues’ extracellular matrix and cell content. Although PTH may be an effective inhibitor of hypertrophic differentiation in MSC-based cartilage repair, care may be warranted in applying accessory PTH treatment due to its effects on articular chondrocytes.

Partial Text

Autologous chondrocyte implantation (ACI) is an effective treatment in patients with medium-sized cartilage defects [1]. Chondrocytes isolated from healthy non weight-bearing cartilage and re-transplanted after in vitro expansion ideally fill the void with hyaline neocartilage [2]. Variable results have, however, been found regarding the obtained cartilage quality, with fibrous or even hypertrophically differentiated tissue instead of healthy cartilage [3]. Similarly, MSC-based regeneration either as part of microfracture procedures or as exogenous cell source has been shown to result in hypertrophic differentiation [4]. A possible tool to prevent this unfavorable differentiation pathway may be the co-administration of parathyroid hormone related-peptide (PTHrP).

Although ACI is effective at treating medium-sized cartilage defects [1], the newly formed cartilage can be of reduced (e.g. hypertrophic) quality [3]. PTH and PTHrP have the ability to inhibit hypertrophic differentiation of MSCs [14–18] and growth plate chondrocytes [19,20]. Therefore, the first aim of this study was to determine whether PTH could also inhibit hypertrophic differentiation in healthy human chondrocytes, the cell source used for ACI.

Continuous PTH treatment inhibited regeneration of healthy human articular chondrocytes, while hypertrophic differentiation was not influenced, indicating that articular chondrocytes respond differently to PTH compared with MSCs. Therefore, PTH may be more suitable for cartilage repair based on MSCs than on articular chondrocytes.




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