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Cartilage repair: past and future – lessons for regenerative medicine
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Journal Article
Cartilage repair: past and future – lessons for regenerative medicine
2009
Overview
• Introduction: the impaired repair capacity of cartilage and the beginning of cell therapy ‐ Autologous chondrocyte implantation ‐ Combination products ‐ Randomized controlled studies • Choice of cell types • Regulating cellular activities ‐ Influence of growth factors on chondrogenic differentiation ‐ Influence of growth factors on matrix deposition ‐ Supportive effect of biomaterials • Interference of inflammation with cartilage repair • Tracking of transplanted cells in vivo • Conclusion and future directions Since the first cell therapeutic study to repair articular cartilage defects in the knee in 1994, several clinical studies have been reported. An overview of the results of clinical studies did not conclusively show improvement over conventional methods, mainly because few studies reach level I of evidence for effects on middle or long term. However, these explorative trials have provided valuable information about study design, mechanisms of repair and clinical outcome and have revealed that much is still unknown and further improvements are required. Furthermore, cellular and molecular studies using new technologies such as cell tracking, gene arrays and proteomics have provided more insight in the cell biology and mechanisms of joint surface regeneration. Besides articular cartilage, cartilage of other anatomical locations as well as progenitor cells are now considered as alternative cell sources. Growth Factor research has revealed some information on optimal conditions to support cartilage repair. Thus, there is hope for improvement. In order to obtain more robust and reproducible results, more detailed information is needed on many aspects including the fate of the cells, choice of cell type and culture parameters. As for the clinical aspects, it becomes clear that careful selection of patient groups is an important input parameter that should be optimized for each application. In addition, the study outcome parameters should be improved. Although reduced pain and improved function are, from the patient's perspective, the most important outcomes, there is a need for more structure/tissue‐related outcome measures. Ideally, criteria and/or markers to identify patients at risk and responders to treatment are the ultimate goal for these more sophisticated regenerative approaches in joint surface repair in particular, and regenerative medicine in general.
Publisher
Blackwell Publishing Ltd,John Wiley & Sons, Inc
Subject
/ Adult Stem Cells - transplantation
/ Adult Stem Cells/cytology/transplantation
/ Animals
/ autologous chondrocyte implantation
/ Biopsy
/ Cartilage, Articular - pathology
/ Cells
/ Chondrocytes - transplantation
/ Chondrocytes/cytology/transplantation
/ Collagen
/ Defects
/ Embryonic Stem Cells - transplantation
/ Humans
/ Joint Diseases/pathology/therapy
/ Kirurgi
/ Knee
/ Mesenchymal Stem Cell Transplantation
/ Patients
/ Randomized Controlled Trials as Topic
/ Reviews
/ Studies
/ Surgery
/ Tissues
