The role of adult bone marrow derived mesenchymal stem cells, growth factors and carriers in the treatment of cartilage and bone defects.

Abstract

Human mesenchymal stem cells, which reside in adult bone marrow, have an excellent regeneration potential for tissue repair. These cells can expand in culture into lineages of mesenchymal tissues and they are able to differentiate into cartilage, bone and other tissues. This regenerative process is assisted by application of bioactive molecules, specific growth factors, signaling molecules and biomaterials (scaffolds). An articular cartilage defect has only limited capacity for healing. Presently no methods have successfully repaired cartilage. The result of preclinical in vitro and in vivo investigations using mesenchymal stem cells, inductive biomolecules or carriers is encouraging for the future clinical applications. Bone defects can be treated with traditional methods using autologous bone grafting, but these procedures are often material limited and can cause donor side morbidity. The formation of bone in small or large defects after injury requires mesenchymal stem cells capable of differentiation in osteoblasts, moreover growth factors that direct these cells into the defect. According to in vitro and in vivo animal investigations and some clinical experiments with the application of cultured mesenchymal cells, growth factors, first of all bone morphogenetic proteins (BMP-s), successful reparative results can be achieved. The application of recombinant human BMP-s is a novel therapy using osteoinductive signaling of a number of gene expression pathways involving differentiation of mesenchymal progenitor cells. The aim of this review is to study the results of preclinical investigations during the last two decades and to deal with the potential clinical application.