Stem Cells and Gene Therapy for Cartilage Repair

Abstract

<jats:p>Cartilage defects represent a common problem in orthopaedic practice. Predisposing factors include traumas, inflammatory conditions, and biomechanics alterations. Conservative management of cartilage defects often fails, and patients with this lesions may need surgical intervention. Several treatment strategies have been proposed, although only surgery has been proved to be predictably effective. Usually, in focal cartilage defects without a stable fibrocartilaginous repair tissue formed, surgeons try to promote a natural fibrocartilaginous response by using marrow stimulating techniques, such as microfracture, abrasion arthroplasty, and Pridie drilling, with the aim of reducing swelling and pain and improving joint function of the patients. These procedures have demonstrated to be clinically useful and are usually considered as first-line treatment for focal cartilage defects. However, fibrocartilage presents inferior mechanical and biochemical properties compared to normal hyaline articular cartilage, characterized by poor organization, significant amounts of collagen type I, and an increased susceptibility to injury, which ultimately leads to premature osteoarthritis (OA). Therefore, the aim of future therapeutic strategies for articular cartilage regeneration is to obtain a hyaline-like cartilage repair tissue by transplantation of tissues or cells. Further studies are required to clarify the role of gene therapy and mesenchimal stem cells for management of cartilage lesions.</jats:p>

Evaluation of the Early In Vivo Response of a Functionally Graded Macroporous Scaffold in an Osteochondral Defect in a Rabbit Model

“…Although in the shorter term, these techniques improve mobility and alleviate pain, fibrous cartilage does not possess the optimal biological and mechanical properties to provide a long-term solution. 21 More recently, autologous chondrocyte implantation (ACI), a cell-based therapy, which involves the implantation of expanded autologous chondrocytes under a periosteal patch, has demonstrated improvement in function, reduction in pain and some hyaline cartilage regeneration. However, this technique has not been readily adopted due to cost, technical challenges associated with surgery and post-surgical complications with the periosteal patch.…”

Current Applications of Mesenchymal Stem Cells for Cartilage Tissue Engineering

“…The chondrocytes demonstrate distinctive properties such as being metabolically active in order to maintain the renewal of the extracellular matrix (ECM) by synthesizing collagens, proteoglycans, hyaluronic acid, and glycoproteins. Restoration of the cartilage damage is still challenging for orthopedic medicine due to its poor ability to regenerate [1].…”

“…The chondrocytes demonstrate distinctive properties such as being metabolically active in order to maintain the renewal of the extracellular matrix (ECM) by synthesizing collagens, proteoglycans, hyaluronic acid, and glycoproteins. Restoration of the cartilage damage is still challenging for orthopedic medicine due to its poor ability to regenerate [1].Mesenchymal stem cells (MSCs) have potential applications in tissue engineering, and regenerative medicine represents an atractive option for repairing lesions in cartilage. Stem cellbased therapies that harmonize with tissue-engineering technologies, and biomaterials are vital for the continuous advance of cartilage regenerative medicine [2,3].…”

Evaluation of Cartilage Repair by Mesenchymal Stem Cells Seeded on a PEOT/PBT Scaffold in an Osteochondral Defect

“…Current surgical treatments for degenerative wear in the knee joint include microfracture, mosaicplasty, autologous chondrocyte implantation (ACI) or, more recently, matrix induced autologous chondrocyte implantation (MACI) 2 . Although in the shorter term these techniques improve mobility and alleviate pain, in many cases the repair tissue is fibrocartilaginous and lacks optimal biological and mechanical properties for long-term functional recovery 12 . Over the last 20 years, cell therapies and tissue engineering strategies have been investigated and have shown potential for the repair/regeneration of hyaline cartilage 1 .…”