Clinical and experimental approaches to knee cartilage lesion repair and mesenchymal stem cell chondrocyte differentiation

Katterine Salazar,Carmen Silva-Álvarez,María García-Robles,Viviana Ulloa,Francisco Nualart,Ximena Koch,Fredy Montoya,Carolina Balmaceda-Aguilera,Fernando Martínez,Federico Rodríguez

doi:10.4067/s0716-97602013000400015

Katterine Salazar, Carmen Silva-Álvarez

Open Access

https://doi.org/10.4067/s0716-97602013000400015

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Journal: Biological Research	Publication Date: Jan 1, 2013
Citations: 15	License type: cc-by

Affiliation: University of Concepción

Abstract

Cartilage has poor regeneration capacity due to the scarcity of endogenous stem cells, its low metabolic activity and the avascular environment. Repair strategies vary widely, including microfracture, autologous or allogenic tissue implantation, and in vitro engineered tissues of autologous origin. However, unlike the advances that have been made over more than two decades with more complex organs, including vascular, cardiac or bone tissues, similar advances in tissue engineering for cartilage repair are lacking. Although the inherent characteristics of cartilage tissue, such as the lack of vascularity and low cellular diversity, suggest that it would be one of the more simple tissues to be engineered, its functional weight-bearing role and implant viability and adaptation make this type of repair more complex. Over the last decade several therapeutic approaches and innovative techniques show promise for lasting and functional regeneration of hyaline cartilage. Here we will analyze the main strategies for cartilage regeneration and discuss our experience.

Highlights

Traumatic and chronic focal injuries to articular cartilage are frequent, especially among young athletes; the incidence of chondral lesions in arthroscopies ranges from 60% to 66% (Aroen et al, 2004; Curl et al, 1997; Widuchowski et al, 2007)
The first approach involves stimulation of the bone marrow by inducing perforations or abrasions of the subchondral plate with the aim of generating scar tissue, which induces deposition of fibrocartilage derived from mesenchymal stem cells (MSCs) that is mechanically different from the hyaline cartilage (Steadman et al, 2003b)
The reported problems and complications, including the in vitro dedifferentiation of mature chondrocytes, the presence of graft hypertrophy even in matrix-induced procedures, lack of incorporation, loss of the implant and the requirement for a previous arthroscopy to obtain a biopsy of healthy chondrocytes, have motivated further research to investigate the therapeutic potential of other scaffolds and cellular sources such as heterologous chondrocytes and MSCs (Hwang et al, 2009; Kon et al, 2012; Niethammer et al, 2013)

Summary

INTRODUCTION

Traumatic and chronic focal injuries to articular cartilage are frequent, especially among young athletes; the incidence of chondral lesions in arthroscopies ranges from 60% to 66% (Aroen et al, 2004; Curl et al, 1997; Widuchowski et al, 2007). Long-term follow-up studies reporting the outcomes of knee chondral lesions treated with the primary ACI and more recent techniques to transplant cells have been published, with adequate results (Beris et al, 2012; Filardo et al, 2012a; Pelissier et al, 2013; Rogers et al, 2010). We will review the mid- to long-term follow-up clinical studies, with a focus on the cell-based therapies

REPAIR TECHNIQUES

Experimental approach to evaluate microfracture for knee cartilage repair

Osteochondral autograft and allograft transplantation

Autologous chondrocyte transplantation

STEM CELL THERAPY

Engineering of heterologous MSCs into cartilage

CONCLUSIONS

Findings

MATERIAL AND METHODS