Abstract
Fecal incontinence (FI), caused by damage or weakness of the anal sphincter, is a devastating problem for patients experiencing the symptom. Although injectable bulking agents are accepted as a minimally invasive therapeutic technique to treat FI, their short-term efficacy and inability to enhance the anal sphincter function are considered as challenges in clinical practices. In this study, growth factor [nerve growth factor (NGF) and/or basic fibroblast growth factor (bFGF)]-immobilized polycaprolactone (PCL) microparticles were prepared as an injectable bioactive bulking agent that can provide a bulking effect (by microparticles) and stimulate myoblast differentiation or injured muscles around the anus (by the sustained release of growth factors) to enhance the sphincter function for the effective treatment of FI. Pluronic F127-entrapped PCL microparticles were prepared by an isolated particle-melting method. Two different growth factors (NGF and bFGF) were incorporated on the surfaces of the Pluronic F127-entrapped PCL microparticles via heparin binding. The growth factors immobilized on the microparticles were released in a sustained manner over 4 weeks. From cell cultures on the growth factor-immobilized microparticles, it was observed that the myoblasts adhered on the microparticle surfaces showed differences in differentiation into myotubes depending on the growth factor type. In particular, the dual NGF/bFGF-immobilized microparticle group was effective for myogenic differentiation in comparison with the single growth factor (NGF or bFGF)-immobilized groups. The dual NGF/bFGF-immobilized microparticles are suitable to be applied as an injectable bulking agent for the treatment of FI.
Introduction
Fecal incontinence (FI), defined as involuntary loss or inability to control the passage of fecal matter through the anus, is a devastating problem for patients experiencing the symptom and their families. It is estimated that its prevalence ranges are from 2.6 % (in 20- to 29-year-olds) to 15.3 % (in 70-year-olds and older) in the public community and the average annual cost for fecal incontinence is over US$4000 per person in the US [1, 2]. This symptom is understood to be closely associated with damage and/or weakness of the anal sphincter caused by childbirth, anorectal surgery, neuropathy, or diarrhea-predominant irritable bowel syndrome [3, 4]. The main approaches for the treatment of FI are based on improvement of the sealing property of the anal canal by volume augmentation or functional recovery of the anal sphincter, and they include conservative therapies (dietary therapy, pharmaceutical approach, sphincter training, etc.), surgical options (sphincter repair, sacral-nerve stimulation, sphincter replacement, etc.), and injectable bulking agents [5, 6].
Surgical options have been commonly considered as the first therapy in case the results of conservative methods do not alleviate the symptom satisfactorily; however, the high cost, invasive procedure, need for general anesthesia, and decrement of therapeutic effect over time remain as a clinical challenge [7]. Recently, the injectable bulking agents that are frequently used in urinary incontinence have been suggested as an alternative therapy for surgical options for FI because of low cost and a minimally invasive procedure using local anesthesia. As with urinary incontinence, the bulking agent is injected into the submucosal or intersphincter space for volume augmentation at anal cushions, and thus increases the sealing property of the anal canal, resulting in symptomatic relief [8]. A variety of bulking agents based on natural and synthetic materials [7–17] have been tried for injection therapy for FI. Although the bulking agent is accepted as a therapeutic technique for some patients with mild or moderate FI symptom, many clinicians consider that the technique cannot be an ideal solution for FI because of its short-term efficacy as a result of resorption or particle migration over time and inability to enhance the anal sphincter function [6, 18].
Some investigators have demonstrated that regenerative cell therapy based on myogenic cells, including bone marrow-derived mesenchymal stem cells, muscle-derived stem cells, muscle progenitor cells, and myoblasts can have a positive effect in treating FI [18–22]; however, their long-term results are still not promising, probably because of cell loss (migration or apoptosis) from the applied site owing to the absence of a matrix for cell attachment [23], resulting in low integration in and thus insufficient functional recovery of the anal sphincter. On the basis of the literature, we expected that a combination of a bulking agent (as a matrix for bulking effect) and regenerative cell therapy (for functional recovery of the anal sphincter) would be a promising therapeutic tool for the treatment of FI; therefore, the main aim of this study is the development of a bioactive bulking agent that can allow stable myoblast delivery, differentiate myoblasts into myotubes, and thus stimulate regeneration of the anal sphincter. At a muscle injury site, myoblasts may fuse with each other to form new immature fibers called myotubes, which participate in muscle regeneration [24]. We prepared growth factor [nerve growth factor (NGF) and/or basic fibroblast growth factor (bFGF)]-immobilized polycaprolactone (PCL) microparticles as an injectable bulking agent.
The growth factor-immobilized microparticles can act as a cell (myoblast) carrier, provide a bulking effect (by microparticles), and stimulate myoblast differentiation or injured muscles around the anus (by the sustained release of growth factors) to enhance the sphincter function for the effective treatment of FI. Both NGF and bFGF, which are members of the heparin-binding growth factor family, are well-known as growth factors that regulate muscle differentiation [25–27], as well as neurogenesis (NGF) and angiogenesis (bFGF). The behavior of growth factor release from the NGF or bFGF-immobilized microparticles and their myoblast differentiation into more mature muscle (i.e., myotubes) were investigated.
Experimental
Materials
PCL (Mw 43 000∼50 000 Da; Polysciences, Warrington, PA, USA) and Pluronic F127 (EG99 PG65 EG99, Mw 12 500 Da; Sigma, St. Louis, MO, USA) were used to fabricate microparticles. Heparin and growth factors (NGF and bFGF) were purchased from R & D Systems (Minneapolis, MN, USA) and Celsus Laboratories (Cincinnati, OH, USA), respectively. All other chemicals were of analytical grade and were used as received. Water was purified using a Milli-Q purification system (Millipore Co., Billerica, MA, USA). For in vitro cell culture, the microparticles were sterilized by ethylene oxide (EO).
Fabrication of PCL microparticles
PCL microparticles were prepared by an isolated particle-melting method, described elsewhere [28]. Briefly, PCL pellets were cryo-pulverized into random-shape microparticles using a freezer mill (SPEX 6750, Metuchen, NJ, USA). The crushed particles with a size range of 100∼200 μm were separated by micro-sieving using standard testing sieves (Chunggye Industrial Co., Korea), and then the microparticles were evenly dispersed in a cold Pluronic F127 aqueous solution (20 wt %; sol-gel transition temperature, ∼20 °C) and the gelation of Pluronic F127 solution induced by treatment at ∼25 °C for 1 h [PCL microparticles/Pluronic F127 solution, 1/50 (w/v)]. The PCL microparticles dispersed in the gel matrix were then located in a water bath at 65 °C for 30 min. With this procedure, the random-shape PCL microparticles melted (melting point of PCL, ∼60 °C) and transformed into spherical shapes. After this procedure, the PCL microparticles/Pluronic F127 gel mixture was cooled to ∼4 °C and then centrifuged. After removing the supernatant, the Pluronic F127-entrapped PCL microparticles were freeze-dried. The morphology of the prepared microparticles was observed by a scanning electron microscope (SEM; Model S-3000N, Hitachi, Japan).
Growth factor immobilization and release test
Two different growth factors (NGF and bFGF) were incorporated on the surfaces of the Pluronic F127-entrapped PCL microparticles via heparin binding. Schematic diagrams show the binding mechanism of heparin and subsequent growth factors onto the surface of the Pluronic F127-entrapped PCL microparticles (Fig. 1). To introduce heparin onto the surface of the microparticles, the microparticles were immersed in heparin solution [1 mg/mL (in 2 wt % NaCl solution)] at 4 °C for 3 h. The heparin-immobilized microparticles were rinsed successively with 2 wt % NaCl solution and water, and then freeze-dried. The amount of immobilized heparin was determined using a Toluidine blue assay [29]. To investigate the Pluronic F127 effect on heparin binding on the surface of the microparticles, the heparin was also immobilized on the PCL microparticles without Pluronic F127 and the heparin immobilization amount compared with that of the Pluronic F127-entrapped PCL microparticles.

Schematic diagrams showing the binding of heparin and growth factors onto the surface of the Pluronic F127-entrapped PCL microparticles.
To incorporate growth factors onto the heparin-bound PCL microparticles, the microparticles were immersed in growth factor solutions of either NGF or bFGF (each 200 ng/mL)] at room temperature for 5 h. The growth factor-immobilized microparticles were washed three times with phosphate buffered saline (PBS; pH ∼7.4) and the amount of immobilized growth factors was determined by a direct ELISA technique [30]. The growth factor-immobilized microparticles were blocked in Reagent diluent [1 % bovine serum albumin (BSA) in PBS] in a 96-well polystyrene (PS) plate (Corning) for 1 h, and then was washed with 0.05 % Tween 20 in PBS three times. The microparticles were then immersed in a detection antibody in Reagent diluent for 2 h, and it was washed repeatedly. Then the microparticles were immersed in Strept Avidin-HRP for 20 min, after which it was washed repeatedly. The microparticles were positioned at the bottom of the wells in a 96-well plate. Finally, 1:1 mixture of Color reagent A (H2 O2) and Color reagent B (tetramethylbenzidine) substrate solution was added to each well and the color development was monitored concurrently with a series of soluble NGF and bFGF standards. After 20 min, Stop solution (2 N H2 SO4) was added to each well, and the absorbance was measured at 450 nm ultraviolet (UV) plate reader along with standards. To examine the effect of heparin bound on the surface of the microparticles on growth factor immobilization and release behavior, growth factor (NGF or bFGF)-adsorbed PCL microparticles without heparin binding were also prepared using the same procedure as above. The growth factor (NGF and/or bFGF)-immobilized microparticles (10 mg) were incubated in 1 mL PBS supplemented with 1 % bovine serum albumin (BSA; Sigma) at 37 °C for up to 35 days under mild shaking (∼50 rpm) to investigate the release behavior of the growth factors. At preset time intervals, the whole incubation medium was collected and replaced with fresh PBS. The amount of released growth factors from the microparticles in the collected medium was determined by the ELISA kit.
In vitro culture of myoblasts on growth factor-immobilized microparticles
In order to investigate the differentiation potential of myoblasts into myotubes, myoblasts were cultured onto the growth factor (NGF and/or bFGF)-immobilized PCL/Pluronic F127 microparticles. To isolate myoblasts, a muscle biopsy (∼1 cm3) was taken from the hind limb of dog. All biopsies were minced mechanically with scissors into small pieces of <1 mm3. The myoblasts were collected as previously described [31, 32] and were grown in tissue culture polystyrene (PS) dishes (Corning, Lowell, MA, USA) with skeletal muscle growth medium (SkGM-2; Lonza, Switzerland). For seeding of the myoblasts (after three passages) onto the PCL microparticles, the microparticle groups (w/o growth factors; single NGF or bFGF loading, each 10 mg; dual NGF/bFGF loading, 5 mg/5 mg) were placed in a 500 μL cell suspension (cell density, 1.0×107 cells/mL) in the above growth medium and shaken mildly under 50 rpm for 2 h and then 100 rpm for 24 h for even cell adhesion onto the microparticles. Next, the microparticles were carefully transferred to non-treated 24-well PS dishes (Corning), and the growth medium was added into each well (500 μL) and cultured in an incubator at 37 °C in a 5 % CO2 atmosphere for 28 days with mild shaking (∼50 rpm). The cell culture on the non-treated PS dishes with mild shaking may minimize migration of cells attached on the microparticles to the dish surfaces. The culture medium was exchanged with fresh medium every 3 days. Cell proliferation on the microparticles during the cell culture periods was estimated by measurement of the DNA content. For this, the cells of each microparticle group at predetermined time intervals (0, 7, 14, 21, and 28 days) were digested overnight in a Papain buffer at 60 °C. The DNA content was determined using a DNA-binding fluorochrome, Hoechst 33258 (Sigma-Aldrich), and purified calf thymus DNA as the standard.
Quantitative real time polymerase chain reaction (real-time PCR) analysis
At initial cell seeding (0 day) and after 28 days of cell culture in each microparticle group, RNA was extracted using an RNAspin mini kit (GE Healthcare, Piscataway, NJ, USA) according to the manufacturer’s instructions. The extracted RNA specimens were converted into cDNA using a reverse transcriptase (Superscript III®; Invitrogen, Carlsbad, CA, USA) with oligo (dT) primers. Polymerase chain reactions were performed using an ABI Prism Sequence Detection System 7500 (Applied Biosystems, Foster City, CA, USA) with a Taqman® gene expression assay (Applied Biosystems). RT-PCR analysis was conducted in a 25 μL reaction mixture containing 1.25 μL of 20X FAM TM dye-labeled Taqman® MGB probe and two PCR primers, 1 μL of template. Expression of the following genes was examined: myogenic factor 5 (MyF 5) and Pax 7 (early markers in myoblast phase [33, 34]), myogenin (MyoG) and myosin heavy chain (MHC) (late (myotube-specific) markers in myoblast differentiation [35]), and glyceraldehyde-3-phosphate dehydrogenase (GAPDH, a housekeeping gene). The data were analyzed using Sequence Detection Software. To quantify the gene expression level, the cyclic threshold method (user bulletin #2, Applied Biosystems) of relative quantification was adapted to estimate the number of copies. The data was normalized with GAPDH values. RT-PCR was performed with the following primers: MyF 5 (F: 5′-CTGTCTGGTCCCGAAAGAAC-3′; R: 5′-GAGAGGGAAGCTGTGTCCTG-3′); Pax 7 (F: 5′-GAGTTCGATTAGCCGAGTGC-3′; R: 5′-CGGGTTCTGATTCCACATCT-3′); MyoG (F: 5′-CAGTGAATGCAACTCCCACA-3′; R: 5′-GGCGTCTGTAGGGTCAGC-3′); MHC (F: 5′-AGAGAAACCACATTCGAGTCGTG-3′; R: 5′-TTGATCCTGATGGCGTCATTC-3′); GAPDH (F: 5′-TGTGTCCGTCGTGGATCTGA-3′; R: 5′-TGTGTCCGTCGTGGATCTGACCTGCTTCACCACCTTCTTGA-3′).
Western blot
At initial cell seeding and after 28 days of cell culture in each microparticle group, the total protein was extracted from each group using a cell lysis buffer (50 mM Tris-HCl, 150 mM NaCl, 0.1 % NP-40, 5 mM EDTA, 10 % glycerol) (Cell signaling, Beverly, MA, USA). Lystates were resolved by 12 % SDS-polyacrylamide gel electrophoresis 50 mmol/L Tris (pH 6.8), 10 mmol/L dithiothreitol (freshly added), 2 % SDS, 0.1 % bromophenol blue, and 20 % glycerol (SDS-PAGE) and transferred onto nitrocellulose membranes (Amersham, UK). The membranes were blocked with 5 % skim milk (in 20 mM Tris-HCl, 150 mM NaCl, and 0.1 % Tween 20). Then, the membranes were probed with antibodies against anti-Pax 7, anti-myosin heavy chain (anti-MHC), and anti-GAPDH (anti-glyceraldehyde-3-phosphate dehydrogenase; Sigma), reacted with the bound antibody, and then visualized with horseradish peroxidase-conjugated secondary antibody (GenDEPOT, Barker, TX, USA). Immunoreactivities were detected using enhanced chemiluminescence (ECL). Images were obtained using an X-ray developer (Daesung, Korea).
Immunohistochemical analysis
At initial cell seeding and after 28 days of cell culture in each group, immunohistochemical staining was conducted to visualize Pax 7 and MHC. For this, the cell-adhered microparticles embedded in an optimal cutting temperature (OCT) compound (Triangle Biomedical Sciences, Durham, NC, USA) were frozen (–20 °C) and cut into 10 μm transverse sections. The sections were mounted on positively charged slides and then were fixed in 4 % paraformaldehyde in PBS for 10 min and permeabilized with PBS containing 0.1 % Triton X-100 (0.1 % PBST). Next, they were incubated with Pax 7 antibody (diluted to 1:200) and MHC antibody (diluted to 1:1000) for 12 h (4 °C) and then with Texas Red-conjugated anti-mouse IgG (Pax 7) and fluorescein-conjugated anti-rabbit IgG (MHC) second antibodies (Invitrogen) for 1 h at room temperature. The nuclei were stained with 4′6-diamidino-2-phenylindole (DAPI; Vector Laboratories, Burlingame, CA, USA). Images were visualized with confocal microscopy (LSM510 META, Carl Zeiss, Germany).
Statistical analysis
The data obtained from each microparticle group were averaged and expressed as mean ± standard deviation. The Student’s t-test was used to determine the significance of the differences between the microparticle groups. The differences were considered statistically significant at p< 0.05.
Results
Characterization of growth factor-immobilized PCL microparticles
The PCL microparticles were fabricated by the isolated particle-melting method. During the procedure, the random-shape (cryo-pulverized) microparticles were transformed into spherical-shape microparticles with similar sizes (Fig. 2). From the amount of heparin immobilized on the surfaces of PCL microparticles with and without Pluronic F127 entrapment as determined by Toluidine blue assay (Fig. 3), it was observed that the Pluronic F127-entrapped PCL microparticles (+ F127) provide much larger heparin binding on the surfaces of the microparticles (0.31 ± 0.08 μg/mg) compared with the microparticles without Pluronic F127 (- F127; 0.08 ± 0.01 μg/mg), suggesting efficient interaction between Pluronic F127 and heparin. Consequently, the Pluronic F127-entrapped PCL microparticles were used for the heparin and subsequent growth factor immobilizations.

SEM photographs of random-shape (cryo-pulverized) and spherical-shape PCL microparticles.

Amount of heparin immobilized on the PCL microparticles with and without Pluronic F127 entrapment (Toluidine blue assay; n = 3, *p < 0.05).
The amount of growth factors immobilized on the heparin-bound PCL microparticles was determined by the direct ELISA technique [30]. The growth factor immobilizations were significantly higher on the surfaces of the heparin-bound PCL microparticles [NGF (+ Hep), 3.85 ± 0.63 ng/mg; bFGF (+ Hep), 4.50 ± 0.80 ng/mg] than on those of the microparticles without heparin [NGF (- Hep), 1.18 ± 0.18 ng/mg; bFGF (- Hep), 1.48 ± 0.15 ng/mg] (Fig. 4a). The release behavior of the growth factors from the heparin-bound PCL microparticles (Fig. 4b) showed sustained release of growth factors from the microparticles, regardless of growth factor type, over 4 weeks (more than 90 % release of loading amount), probably because of ion exchange in the medium. On the contrary, the microparticles without heparin binding showed an initial burst release of growth factors for 7 days, and then the amount of both growth factor releases was not significant.

(a) Loading amount and (b) cumulative released amount of NGF and bFGF from the PCL microparticles with and without heparin immobilization (n = 3; *p < 0.05).
In vitro differentiation of myoblasts on growth factor-immobilized microparticles
To investigate the in vitro cell proliferation and differentiation potential of myoblasts by continuously releasing growth factors from the PCL microparticles, the myoblasts were seeded onto the microparticle groups (w/o G. F., single NGF, single bFGF, and dual NGF/bFGF loading). The cell proliferation on the microparticles was estimated by the DNA contents at the predetermined time intervals (0, 7, 14, 21, and 28 days) after seeding. The cells are shown to have proliferated for up to 7 days, and then the cell growth for all groups was not significantly different in the culture (Fig. 5). Higher cell growth patterns were observed in the presence of growth factors, probable because of stimulation for cell growth and protection of cell apoptosis by the growth factors [36]; however, differences of cell proliferation among the growth factor (NGF, bFGF, and dual bFGF/NGF)-immobilized microparticle groups were not significant.

Total DNA content with time after in vitro myoblast culture on the PCL microparticles with and without growth factor immobilization (n = 3; *p < 0.05).
To investigate the differentiation potential of myoblasts into myotubes on the growth factor-immobilized PCL microparticles, a quantitative RT-PCR analysis for several genes was conducted at 0 and 28 days after seeding. Differentiation of myoblasts was monitored using four specific markers, MyF 5, Pax 7, MyoG, and MHC [33–35]. The RT-PCR results showed decreased MyF 5 and Pax 7 (early markers in myoblast differentiation) expression and increased MyoG and MHC (myotube-specific markers in myoblast differentiation) expression on the growth factor-immobilized PCL microparticles over time, indicating the differentiation of myoblasts into the more mature cell type (myotubes) to regenerate muscles (Fig. 6a). The single bFGF- and dual NGF/bFGF-immobilized microparticle groups produced significantly higher myotube-specific genes (MyoG and MHC) than the other groups (w/o G.F. and single NGF) at 28 days. In particular, the dual NGF/bFGF group showed notably greater MHC gene expression compared with the single bFGF group. This suggests that the dual NGF/bFGF-immobilized microparticles can provide a better environment for the differentiation of myoblasts into myotubes than the other groups.

(a) RT-PCR and (b) Western blot analyses after in vitro myoblast culture on the PCL microparticles with and without growth factor immobilization at 0 and 28 days (n = 3; *p < 0.05).
In the Western blot analysis, it was also observed that Pax 7 expression on the growth factor-immobilized PCL microparticles decreased dramatically between the initial stage (0 day) and after 28 days, while MHC expression showed the opposite trend (Fig. 6b). The increase in MHC expression at 28 days was in the sequence as follows: Dual NGF/bFGF group > single bFGF group > single NGF group > w/o G. F. group.
From immunohistochemical observations of myoblasts cultured on the PCL microparticles with and without growth factor immobilization (Fig. 7), it was observed that the cells (blue color, cell nucleus) were uniformly distributed on the microparticles, indicating that the PCL microparticles can be an appropriate cell carrier. Pax 7 expression (red color) was detected at 0 day in all microparticle groups, but the expression almost disappeared at 28 days, suggesting that the cells at 0 day are undifferentiated myogenic cells and those at 28 days are differentiation-committed cells [37]. MHC expression was not detected at 0 day, regardless of the presence of growth factors; however, the growth factor-immobilized microparticle groups at 28 days showed greater levels of MHC expression (green color) than the w/o growth factor group, indicating the greater differentiation of myoblasts into myotubes. In particular, the dual NGF/bFGF group had the highest expression of MHC. This observation was consistent with the results of RT-PCR and Western blot analyses (refer to Fig. 6).
![Fig. 7 Immunohistochemical observations after in vitro myoblast culture on the PCL microparticles with and without growth factor immobilization at 0 and 28 days [x 100; blue, cell nucleus (DAPI); red, Pax 7; green, MHC].](/document/doi/10.1515/pac-2014-0209/asset/graphic/pac-2014-0209_fig7.jpg)
Immunohistochemical observations after in vitro myoblast culture on the PCL microparticles with and without growth factor immobilization at 0 and 28 days [x 100; blue, cell nucleus (DAPI); red, Pax 7; green, MHC].
Discussion
Since the first use of a bulking agent in 1993 [12], various bulking agents, including autologous fat [9, 10], glutaraldehyde cross-linked collagen (Contingen®) [11], polytetrafluoroethylene (Teflon) [12], pyrolytic carbon-coated beads (Durasphere®) [13, 14], dextranomer microspheres (SolestaTM) [7, 15], polydimethylsiloxane particles (PTQ® or Bioplastique®) [16], and calcium hydroxylapatite microspheres (Coaptite®) [17], have been used for injection therapy for FI. Although bulking agents have been shown to be easy, safe, and effective therapy in short-term studies [38–40], they cannot be accepted as a general therapeutic tool to cover the wide spectrum of FI because their simple passive bulking effect
inevitably leads to the decrement of efficacy over time (by resorption or migration). To overcome the limitations of conventional bulking agents, growth factor (NGF and/or bFGF)-immobilized PCL microparticles were prepared in this study as a bioactive bulking agent that can act as a cell carrier, provide a bulking effect (by microparticles), and stimulate damaged muscles around the anus to enhance the sphincter function (by growth factors and myoblasts) for effective treatment of FI. Myoblasts are found in the sphincter and differentiate into multinucleated muscle fibers, and thus may be involved in sphincter regeneration [21]. It was reported that some growth factors, such as NGF, bFGF, and insulin-like growth factor 1 (IGF-1), can improve the proliferation and differentiation of myoblasts in vitro and enhance muscle regeneration in vivo [41].
PCL microparticles were fabricated by an isolated particle-melting method [28]. In this procedure, each random-shape (cryo-pulverized) PCL microparticle isolated by a Pluronic F127 gel matrix is molten above the melting temperature of PCL, and such molten PCL microparticles are transformed into a spherical shape, which minimizes the surface area (surface/volume ratio), by interfacial forces in the hydrogel matrix [42]. Moreover, the Pluronic F127 molecules can be physically entrapped on the molten surface region of the PCL microparticles [43]. The hydrophilic polyethylene glycol (PEG) chains in Pluronic F127 are exposed on the surfaces of the microparticles, and the PEG chains on the surface can act as an intermediator between the PCL surface and heparin, which can interact with growth factors (see the Fig. 1) [44, 45]. From the results in this study (Fig. 3), it can be considered that the PEG chains are sufficiently exposed onto the surfaces of the microparticles and interacted effectively with the heparin. The heparin immobilized on the surfaces of the PCL microparticles allows for interaction with heparin-binding growth factors (e.g., NGF and bFGF), while the small amount of heparin binding on the PCL microparticles without Pluronic F127 may be understood as a nonspecific physical adsorption of heparin on the surfaces.
NGF and bFGF, as stimulators for the differentiation of myoblasts (in vitro) and for the healing of damaged muscles around the anal sphincter (in vivo), were immobilized onto the heparin-bound PCL microparticles. The heparin-immobilized microparticles showed a significantly larger loading amount of both growth factors than microparticles without the heparin immobilization, caused by an ionic interaction between heparin and the growth factors [46, 47]). The lower loading amount of NGF on the heparin-immobilized PCL microparticles compared with bFGF (Fig. 4A) can be explained by the differences of the inherent isoelectric point (pI; pI values of NGF and bFGF, ∼8.53 and ∼9.60, respectively). bFGF has greater positive charges in physiological conditions (pH ∼7.4) than NGF, and this leads to stronger ionic interactions with the negatively charged heparin. The sustained release of NGF and bFGF from the heparin-immobilized microparticles (Fig. 4b), which can prolong their biological effects [41, 48], may be helpful for the differentiation of myoblasts into more mature muscle cells (myotubes) and the functional recovery of damaged anal sphincter for a fundamental treatment for FI.
In order to evaluate the in vitro differentiation of myoblasts into myotubes, RT-PCR, Western blot, and immunohistochemical analyses were conducted. It was expected that the continuous release of the growth factors (NGF and bFGF) from the microparticles would provide an appropriate environment for the differentiation of myoblasts into myotubes. Rende et al. [27] reported that NGF influences fusion into myotubes and cell morphology during myoblast differentiation. Kudla et al. [25] also demonstrated that bFGF plays a pivotal role in the regulation of myogenesis and muscle proliferation. In our system, the dual NGF/bFGF-immobilized microparticle group induced a better result than the single NGF- or bFGF-immobilized groups, even though the total loading amount of growth factors was similar. This phenomenon may be understood by a synergistic effect of NGF and bFGF. On the basis of our findings, we recognize that the dual NGF/bFGF-immobilized PCL microparticles may be a good injectable bioactive bulking agent system that can enhance the sphincter muscle function around the anus (by stable myoblast delivery and induction of muscle regeneration) and thus effectively treat FI.
Conclusions
We prepared growth factor (NGF and/or bFGF)-immobilized PCL microparticles as an injectable bioactive bulking agent. Both growth factors were easily immobilized onto the surfaces of PCL microparticles via heparin binding without using any toxic chemicals. The growth factors immobilized on the heparin-bound microparticle surfaces were released in a sustained manner over 4 weeks. From the in vitro differentiation of myoblasts into myotubes, it was recognized that the myoblasts are evenly distributed on the microparticles, regardless of the presence of growth factors, and the sustained release of both growth factors from the microparticles has a positive effect on myoblasts differentiation. In particular, the dual NGF/bFGF-immobilized microparticles offer a better environment for the differentiation of myoblasts into myotubes than the single growth factor-immobilized groups and may accelerate the regeneration of damaged anal sphincter muscles, and thereby offering an effective treatment for FI. An in vivo study using a fecal incontinent dog model to evaluate the therapeutic potential of the dual NGF/bFGF-immobilized microparticles, in terms of integration of implanted myoblasts into host muscles and functional recovery of the anal sphincter, is now in progress.
Article note: A collection of invited papers based on presentations at the 12th International Conference on Frontiers of Polymers and Advanced Materials (ICFPAM 2013), Auckland, New Zealand, 8–13 December 2013.
Acknowledgments
This work was supported by a grant from the Korea Ministry of Health and Welfare (Grant No. A120357).
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©2014, by De Gruyter
Artikel in diesem Heft
- Frontmatter
- Preface
- 12th International Conference on Frontiers of Polymers and Advanced Materials (ICFPAM 2013)
- Conference papers
- Light-triggered vesicle formation: important factors for generation of vesicles and possible applications
- Myoblast differentiation on growth factor-immobilized polycaprolactone microparticles: a potential bioactive bulking agent for fecal incontinence
- Structure–activity relationships of guanylated antimicrobial polymethacrylates
- Thienothiophene-benzotriazole-based semicrystalline linear copolymers for organic field effect transistors
- IUPAC Technical Report
- Single-molecule fluorescence imaging by total internal reflection fluorescence microscopy (IUPAC Technical Report)
Artikel in diesem Heft
- Frontmatter
- Preface
- 12th International Conference on Frontiers of Polymers and Advanced Materials (ICFPAM 2013)
- Conference papers
- Light-triggered vesicle formation: important factors for generation of vesicles and possible applications
- Myoblast differentiation on growth factor-immobilized polycaprolactone microparticles: a potential bioactive bulking agent for fecal incontinence
- Structure–activity relationships of guanylated antimicrobial polymethacrylates
- Thienothiophene-benzotriazole-based semicrystalline linear copolymers for organic field effect transistors
- IUPAC Technical Report
- Single-molecule fluorescence imaging by total internal reflection fluorescence microscopy (IUPAC Technical Report)