Concepts in regenerative medicine: Past, present, and future in articular cartilage treatment

Abstract

Regenerative medicine is emerging with great interest and hope from patients, industry, academia, and medical professionals. Cartilage regeneration, restoration, or repair is one of the prime targets that remains largely unsolved, and many believe that regenerative medicine can possibly deliver solutions that can be widely used to address the current gap(s) in treatment. In the United States, Europe, Australia, and India the regulation of regenerative based treatments has become a big debate. Although the rules and regulations remain unclear, clinicians that are interested should carry-on with the best available guidelines to ensure safety and compliance during delivery in clinical practice to avoid regulatory infraction. Many have made significant investment of time, resources, and facilities in recent years to provide new regenerative treatment options and advance medical care for patients. Instead of reinventing the wheel, it would be more efficient to adopt currently accepted standards and nomenclature borrowed from transplantation science, and cord blood storage industries. The purposes of this article are to provide some historical background to the field of regenerative medicine as it applies to cartilage, and how this field has developed. This will be followed by a separate discussion on regulatory oversight and input and how it has influenced access to care. Furthermore, we discuss current clinical techniques and progress, and ways to deliver these treatments to patients safely, effectively, and in a cost sensitive manner, concluding with an overview of some of the promising regenerative techniques specific to cartilage.

An MRI Evaluation of Patients Who Underwent Treatment with a Cell-Mediated Gene Therapy for Degenerative Knee Arthritis: A Phase IIa Clinical Trial

“…These hurdles may prevent the implementation of such therapies in everyday practice. 20 Furthermore, the process of stem cell procurement, gene transfection, and development of these treatment injections often come with considerably costs, which have yet to be justified for widespread clinical use. 21 However, in Tan et al's evaluation of the cost of tissue engineering, it was found that these methods may actually be associated with lower costs than using material from donors.…”

Regenerative Medicine for Axial and Radicular Spine‐Related Pain: A Narrative Review

“…Eligible articles were written in English and analyzed the therapeutic injection effects of PRP, prolotherapy, or MSCs via intradiscal, facet joint, epidural, or SIJ delivery on human patients diagnosed with spine‐related pain. PRP, prolotherapy, and MSCs were the 3 orthobiologic agents chosen to include within this review because they are the most common agents used for regenerative injection‐based therapy in musculoskeletal medicine and are the most well studied . Exclusion criteria were case reports and studies in which spine‐related pain was not the principal diagnosis.…”

“…PRP, prolotherapy, and MSCs were the 3 orthobiologic agents chosen to include within this review because they are the most common agents used for regenerative injection-based therapy in musculoskeletal medicine and are the most well studied. 22 Exclusion criteria were case reports and studies in which spinerelated pain was not the principal diagnosis. Three authors (D.R., J.T.M., B.M.)…”

Emerging potential of gene silencing approaches targeting anti-chondrogenic factors for cell-based cartilage repair

“…Ideally, this is achieved by implanting a sufficient number of mature chondrocytes or undifferentiated progenitor cells with a high chondrogenic potential [6]. Recently, experimental therapies using mesenchymal stem cells (MSCs) have been receiving an increasing amount of interest, mostly due to the ease of isolation and their regenerative potential [7][8][9]. Unfortunately, the use of native unaltered chondrogenic cells, either chondrocytes or MSCs, has not fulfilled expectations, with the underlying mechanisms of tissue regeneration still poorly understood [10].…”