November 30, 2008
Patient Cells To Create New Knee Cartilage

Does your knee hurt? We need better methods for the repair of worn and aging body parts. With better ways to repair we could keep bodies running far beyond their original design life just like antique cars. The best knee cartilage repair surgery helps some but far from enough.

ďA small hole is going turn into a big hole eventually, given enough time," says Riley Williams, M.D., orthopedic surgeon, Sports Medicine and Shoulder Service, Hospital for Special Surgery in New York, and director of the Institute for Cartilage Repair at HSS.

After an initial injury that has caused damage to a specific area of the cartilage, there are few options that can repair the damage which is likely to lead to severe osteoarthritis. The most popular current treatment for such lesions is called the microfracture procedure. In this surgery, a tiny 'pick' spikes holes into the base of the damaged cartilage area to promote bleeding. This allows the patientís bone marrow cells to come to the surface of the damaged tissue. As a result, the cells then change into fibrocartilage cells and heal the defect.

While microfracture is minimally invasive and very quick, research has found that the defect may not always be fully repaired. The fibrocartilage does not hold up as well under everyday wear and tear as normal cartilage and has a much higher risk of breaking down again. As a result, surgeons in this area continue to pursue new methods of repairing cartilage injuries.

Some improvements in tissue engineering using a patient's own cells might produce a far more lasting layer of replacement cartilage.

A new multi-center clinical trial led by Dr. Williams at Hospital for Special Surgery uses a patientís own cells to heal damaged cartilage, but in a much different way. First, a small piece of the patientís healthy cartilage is taken and then the cells are grown in a laboratory. These cells are put into a piece of protein matrix, called NeoCartģ, which has an internal structure shaped like a honeycomb. The cells use the NeoCartģ as a scaffold and begin to grow over and around the structure. This creates a piece of new cartilage which is then, through a tiny incision, implanted into the patientís joint over the damaged area, much like a living patch. The hope is that the new cartilage will repair the damage and integrate seamlessly with the surrounding cartilage.

Cell manipulation and tissue engineering technologies will produce much better results in the coming years. Some of the more mechanical parts of the body such as joints are lower lying fruit for repair and rejuvenation.

My biggest concern with the clinical trial above has to do with the age of the patients. Will the cells of older patients grow vigorously enough to create enough replacement cartilage? Will we need to wait for rejuvenating therapies for cells before an elderly patient's own cells can build replacement parts? The odds of success might be higher the younger you are.

Share |      Randall Parker, 2008 November 30 06:43 PM  Biotech Repair Joints

TH said at December 1, 2008 3:55 PM:

Isn't it ironic that adult stem cells are showing huge results, yet the intelligentsia seem to be obsessed with embryonic stem cells, any idea why they are dead wrong again as usual?

Engineer-Poet said at December 2, 2008 6:03 PM:

Um, maybe because most of the work which has demonstrated the difference between stem cells and other cells and shown how to identify and transform them required embryonic stem cells?

Of course, the lack of therapies using embryonic stem cells just might have something to do with the Bush prohibition on the use of Federal funds to create new cell lines that are e.g. not contaminated with animal cells and unsuitable for transplants, not to mention the prohibition on "human cloning" which could create pluripotent cells with the patient's own genome.

TH said at December 3, 2008 5:14 AM:

Its all bush's fault, never heard that before. I wish you had your sixty seat senate, then you'd have no excuses to hide behind. Your beloved liberal state governments going bankrupt have been funding embryonic research, I assume European and Asian scientists are well funded, whats their excuse? Too much CO2?

Engineer-Poet said at December 3, 2008 3:44 PM:

My home state just passed an initiative to override pro-liar restrictions on stem cell research, despite a hysterical opposition ad campaign claiming things like the creation of half-human, half-animals.  And I'm not a Dem.

If the best researchers wind up going to Asia to be able to get funding, you'll see exactly that.  However, in the short term we'll just see the whole area get starved as researchers shift their focus.

th said at December 3, 2008 4:52 PM:

So you're from missouri and want to go to jurassic park. Have they cloned Mark Twain yet? I would imagine a new Hank Williams would be good for Branson, keep up the good fight, pissing in the soup is a noble cause.

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