Articular cartilage repair with recombinant human type II collagen/polylactide scaffold in a preliminary porcine study

Abstract

The purpose of this study was to investigate the potential of a novel recombinant human type II collagen/polylactide scaffold (rhCo-PLA) in the repair of full-thickness cartilage lesions with autologous chondrocyte implantation technique (ACI). The forming repair tissue was compared to spontaneous healing (spontaneous) and repair with a commercial porcine type I/III collagen membrane (pCo). Domestic pigs (4-month-old, n ¼ 20) were randomized into three study groups and a circular full-thickness chondral lesion with a diameter of 8 mm was created in the right medial femoral condyle. After 3 weeks, the chondral lesions were repaired with either rhCo-PLA or pCo together with autologous chondrocytes, or the lesion was only debrided and left untreated for spontaneous repair. The repair tissue was evaluated 4 months after the second operation. Hyaline cartilage formed most frequently in the rhCo-PLA treatment group. Biomechanically, there was a trend that both treatment groups resulted in better repair tissue than spontaneous healing. Adverse subchondral bone reactions developed less frequently in the spontaneous group (40%) and the rhCo-PLA treated group (50%) than in the pCo control group (100%). However, no statistically significant differences were found between the groups. The novel rhCo-PLA biomaterial showed promising results in this proof-of-concept study, but further studies will be needed in order to determine its effectiveness in articular cartilage repair. 2,3 However, the original ACI procedure where a periosteal flap covers the repair area has major intrinsic limitations, such as initial mechanical weakness of the repaired site and periosteal hypertrophy. 4A wide variety of biomaterials have been introduced for cartilage repair as periosteal flap substitutes in ACI.5-8 Our research group has developed a novel biomaterial scaffold rhCo-PLA, which is a biodegradable scaffold combining recombinant human type II collagen (rhCo) and polylactide 96/4 felt (PLA). Being free of animal products, rhCo-PLA scaffold eliminates the risk of undesirable immunological responses and transmission of animal-derived pathogens.9,10 We have demonstrated the biocompatibility and neocartilage forming ability of recombinant human type II collagen.11,12 Furthermore, the recombinant technology enables batch consistency and manufacture of high purity collagen. The synthetic polylactide can be fabricated into a 3D scaffold structure that provides the repair site with mechanical support while gradually degrading as neotissue forms. However, PLAs alone have limitations in bioactivity. This is typically seen as a dense connective tissue layer around the PLA. 13 The rhCo, in contrast, is incorporated in the synthetic PLA mesh to improve its physico-chemical and biomechanical characteristics. Collagen enhances hydrophilicity of a scaffold. 6,14 Mechanical loading pumps water out of cartilage tissue, and during unloading, the water is reabsorbed. Thus, the water reabsorbing ability is an essential characteristic of a scaffold. W...

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