Abstract
We demonstrated the safety and efficacy of autologous chondrocyte precursor (CP) cell therapy in repairing Grade 4 cartilage defects of medial femoral condyles. The autologous bone marrow mesenchymal stem cells of each participant were isolated, amplified, and then differentiated into CPs in atelocollagen. Neotissues made of CPs were implanted into cartilage defects with an average cell density of 4.9 ± 2.1 × 106 cells/cm2 through arthrotomy. The knee function was evaluated with the International Knee Documentation Committee (IKDC) subjective knee form. Patients’ knee functions significantly improved by the 28th week (IKDC score = 68.3 ± 12.1), relative to the initial functionality before the CP therapy (IKDC score = 46.1 ± 16.4, p-value = 0.0014). Nine of these twelve patients maintained good knee functions for 9 years post-implantation (IKDC score = 69.8 ± 12.3) at levels higher than the pre-implantation values (p-value = 0.0018). Patients were evaluated with MRI and arthroscopy, and the defective sites exhibited a smooth surface without a gap between the implant and host tissue. This study demonstrates that autologous CPs successfully engraft into the host tissue and result in the re-formation of hyaline-like cartilage, thereby improving the impaired knee functions. Most importantly, no adverse event was reported during this long-term follow-up period.
Highlights
Introduction iationsArthritis is an epidemic group of joint disorders and a leading source of chronic pain and disability in the world [1]
During the chondrogenic differentiation of bone marrow MSCs toward mature chondrocytes, we have identified a unique population of chondrocyte precursors (CPs) that can secrete glycosaminoglycan (GAG) without forming lacunae, which are usually present in mature cartilage tissue
Therapy has been shown to have a positive effect on OA patients [35]. In this case series study, we demonstrated the safety and efficacy of CP therapy for cartilage defects from osteoarthritis or osteonecrosis based on several clinical assessments, including arthroscopy, International Knee Documentation Committee (IKDC) score, MRI, and histology
Summary
Arthritis is an epidemic group of joint disorders and a leading source of chronic pain and disability in the world [1]. By 2040, the number of American adults with diagnosed arthritis is projected to be 78.4 million (25.9% of all the adults) [2] due to increases in life expectancy and body mass index. The most common type of arthritis is knee osteoarthritis (OA), which accounts for >70% of the total arthritis burden [1]. The “wear and tear” of knee articular cartilage usually progresses into OA because cartilage is an avascular tissue with a limited capacity of self-repair. In 1743, Hunter described the impossibility of cartilage repair, stating that “once the cartilage is destroyed, it never recovers” [3,4].
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