Orthopaedic Biomechanics

Together with colleagues of UMC Utrecht, Keita Ito hopes to create a paradigm shift in the field of scoliosis research, that will not only uncover the complex anatomical, biomechanical and mechanobiological causes of AIS, but also identify predictive triggers that can be used for prevention and early treatment.

Adolescent idiopathic scoliosis (AIS) is a 3D deformity of the spine affecting previously healthy children, substantially reducing their quality of life and creating a life-long burden of disease. Although it has been indentified since the time of Hippocrates (400 BC), we have not been able to rationally develop effective treatments and provide a cure for these children suffering from AIS because its cause and mechanism of disease are still unknown. We believe that AIS is caused by a perfect storm of anatomical, biomechanical and mechanobiological processes in the intervertebral disc. My recently awarded ERC-AdG grant, ScoliStorm, will allow us to create a paradigm shift in AIS research by exploring this disease mechanism whereby predictive triggers are identified that can be used for prevention and early treatment.

In the project, we will study human subjects non-invasively through disease initiation and progression, creating for the first time a comprehensive dataset of healthy and scoliotic human spines that can be used for early detection and treatment of juvenile spine conditions. We will create safe non-radiographic accurate imaging of the osseous spine, available in most hospitals, which can become the standard for diagnosis and monitoring of osseous injury and disease in juveniles. We will develop high-throughput creation and use of subject specific in silico models, allowing simulation of organ and tissue function such that morphological imaging data can provide functional analysis of the patient for diagnosis and treatment. Mechanisms affecting tissue adaptation will be mapped and show that normal processes by their coincidence can create an aberrant response and disease, providing an explanation applicable for other multifactorial diseases.

Thus, a unique dedicated and complete multidisciplinary process, combining 1) bioengineering analysis, exploiting imaging, in silico modeling, in vitro and ex vivo approaches in humans, and 2) clinical medicine, will be created. Many of these tools will also be beneficial for investigating treatment methodologies including regenerative medicine, not just in the spine but also for musculoskeletal treatment in general.

Keita Ito, Bert van Rietbergen, Jasper Foolen

More than 1.5 million people in the Netherlands suffer from osteoarthritis – a degenerative joint disease. For many osteoarthritis patients, there is currently no treatment that can slow the disease process or cure it. Therefore, they struggle with pain and movement limitations every day. LS-NeoCarE wants to improve their lives by developing durable regenerative cartilage implants. These living implants are based on revolutionary stem cell, bioreactor, and 3D-printing technologies. Through the active involvement of researchers, industry, doctors, and patient organizations, the project creates support among both patients and doctors for applicability and with industry for marketing the developed implants.

Official secretary on behalf of the consortium: prof. dr. ir. K. (Keita) Ito – Eindhoven University of Technology

Consortium: Eindhoven University of Technology, Leiden University Medical Center, UMC Utrecht, Utrecht University, Leiden University, Fontys University of Applied Sciences, University of Applied Sciences Utrecht, University of Applied Sciences Leiden, Regenerative Medicine Crossing Borders, Purac Biochem BV, Demcon, Scinus Cell Expansion BV, ASR Zorgverzekering, NC Biomatrix BV, Azar Innovations, Poietis France, Dutch Arthritis Foundation (ReumaNederland), patient participation arthritis Leiden LUMC (PPA-Leiden).

Amount awarded: 3.2 million Euros

Keita Ito

The southern Netherlands and Flanders are demographically similar areas. Both are aging areas with relatively many elderly people who are living longer, moving less, developing obesity and thus with increasing joint wear in the process

3D printed personalized and smart implants & orthoses

When joints are severely worn or damaged, in many cases, the only solution is to (partially) replace the joint with an implant. There are also young people struggling with musculoskeletal disorders, where joint replacement implants are not an option. Instead, orthoses, externally worn devices, are used to correct position deviations or abnormal mobility of joints or the spine.

PRosPERoS-II - following in the footsteps of PRosPERoS (2016-2020) - continues its trajectory and aims to develop new patient-specific implants and orthoses that have a long lifespan and accelerate and improve the healing and rehabilitation process. In addition to hip and spine, it now wants to expand its focus to ankle, shoulder and trauma. The project uses cutting-edge research in 3D printing, surface functionality and new biomedical materials. This will allow better prediction of how implants will eventually behave in the body. The project also aims to conduct research on slowing the development of osteoarthritis and accelerating the healing of bone defects.

Bert van Rietbergen, Chris Arts

TriAnkle is an innovative medical application that aims to improve the junctions and cartilages (and therefore, the overall movement) of the ankle by introducing a tailored, 3D bioprinted collagen- and gelatin-based structure in the affected area. Why TriAnkle? In the past 30 years, the progress in the fields of tendon, ligament and cartilage regeneration has not been very impressive. Together with muscle injuries, the damages to these connective tissues are still the main causes long-term sick leave in elite athletes and one of the main causes of loss of mobility in elderly people. How is it going to work? Collagen is not only the most abundant protein in the human body, but it is also an integral component in the structure of the connective tissues. By introducing a collagen based implant with regenerative factors, these connective tissues can heal vastly faster, reducing the recovery time down to 50%, as well as increasing the recovery ratios of ankle joints up to 15%. A personalized approach for a patient-centered vision: TriAnkle seeks to fill a critical gap in treatment as well as a faster and enhanced healing process. With that objective, the project will develop therapies that adapt to different types of patients. Their needs will be assessed through workshops to guide the innovation process. To satisfy the patients’ needs TriAnkle will use 3D Printing technologies that can allow creation of patient-specific tissue constructs. Additionally, the project will use biomaterials functionalized with with growth factors and/or stem cells in order to make the tissue healing/integration process even more efficient. Elite athletes or osteoarthritic patients will have very different healing needs that translate into different products. The project, financed by the EU and aimed at improving the quality of the life of millions, is made possible thanks to a vast number of partners. Viscofan BioEngineering and Cellink are the industry partners, and various associates, such as FC Barcelona Innovation Hub, Osteoarthritis Foundation International (OAFI), Fraunhofer IGB, University of Stuttgart, Universidad del País Vasco (UPV), Eindhoven University of Technology, Leitat technological center, Cambridge Nanomaterials Technology (CNT), Gradocell and Fundació Clinic per a la Recerca Biomèdica.

Jasper Foolen

Miguel Castilho awarded MIT Lockheed Martin Seed Fund. Along with fellow researcher Professor Markus Buehler of MIT (Massachusetts Institute of Technology), BmE researcher Miguel Castilho was recently awarded the MIT-Netherlands Lockheed Martin Seed Fund (https://misti.mit.edu/faculty-funds/past-seed-fund-winners) for their project "Unlocking mechanical limitations of synthetic heart stents with auxetic, silk-based fiber tubular scaffold." Project supports the exchange between MIT and Miguel's team to investigate a new printing process on natural polymers.

Miguel Castilho is the recipient of the 2023 Jean Leray Award of the European Society for Biomaterials for outstanding research contribution to the field of biomaterials by a young scientist. https://esb2023.org/esb-awards/

Miguel Castilho

OA is a chronic disease leading to progressive damage of joint tissues. Knee OA is the most disabling and also the most frequently occurring form of OA. OA has a multifactorial pathogenesis and there are considerable patient specific differences in disease progression. Biomechanical factors have been demonstrated to play an important role in OA development and progression but their contribution on the individual level as well as the interaction with other risk factors such as inflammation and genetics are unknown. Furthermore, psychosocial factors such as fear of movement, self-efficacy, coping strategies and resilience influence how and how much people move. Specific movement advice remains amongst the most frequently asked questions by OA patients to healthcare professionals. However, personalised advice based on scientific data cannot yet be provided to the individual patient.  

Given the progressive nature of the disease and the large number of patients affected, early pro-active interventions targeting self-management will be the most effective treatment strategy to decrease the burden of disease for patient and society. Therefore, we will investigate how physical activity affects the progression of knee OA at the level of an individual patient and used these insights to develop personalised guidelines and a supportive eHealth platform, providing individualised feedback and coaching on physical activity for knee OA patients. 

This is a large national project with different aspects and many partners. TU/e collaborates in the workgroup which investigates the mechanisms by which different physical activities affect joint loading and influence the degradation or maintenance of cartilage. Specific objectives are: (1) to develop methodology to determine the loading on a person’s cartilage during different physical activities; (2) to understand how the type and level of loading on cartilage tissue influence cartilage degenerative processes; (3) to establish the “bandwidth of healthy loading” for an individual patient. 

Keita Ito, René van Donkelaar

The Orthopaedic Biomechanics groups collaborates with different partners in academia and industry. Collaborations are within the Netherlands, but also go beyond borders.