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Contenu archivé le 2024-06-10

Autologous implantation of de novo cartilage as a therapy for joint cartilage defects

Objectif

Evaluation of the quality of the in vitro cartilage graft before implantation by mechanical tests, MRI, histology and biochemistry/molecular biology. Evaluation of graft quality after different periods of implantation in the rabbit and minipig by mechanical tests, MRI, histology and biochemistry/molecular biology including long term survival. Assessment of arthroscopic graft implantation, longitudinal observation of graft performance.

The only predictably effective treatment for cartilage lesions arising from trauma or degenerative disease is early osteotomy and replacing the joint with a prosthesis. However total joint arthroplasties have a limited life span and will not support unlimited heavy loading or vigorous use required to provide a quality of life demanded by younger patients. Local repair of cartilage lesions has so far not been successful. The use of synthetic, materials has been tried to enhance the quality of the repair tissue but no method has achieved reliable re-growth of normal hyaline cartilage with adequate biomechanical properties and bonding to surrounding tissue. We have developed a culture methodology that allows retention of the chondrocyte phenotype by keeping the cells in a truly three dimensional cartilage-like polyanionic matrix. Using this method, we intend to isolate chondrocytes from the patient himself to grow a de novo cartilage that can be used as an implant to replace the damaged tissue. We have shown that cartilage from donors other than the patient himself elicits an immune response.

To achieve a sufficient mechanical strength to withstand the initial loading we might have to reinforce the implant with a felt of a synthetic fibrous polymer. The implant will be inserted into the prepared defect by a novel arthroscopic press fitting procedure and possibly covered by a periosteal graft. We plan extensive animal experimentation before we in a later phase of the project apply the procedure to humans. Implants will be studied by a variety of methods to evaluate and improve the procedure. These will include in situ and ex situ magnetic resonance imaging biomechanical testing, quantitative electron and light microscopy, and analysis of the extracellular matrix composition by the means of biochemistry and molecular biology.

The expected benefits are several. We expect to relieve pain and improve physical functioning of patients without necessarily increasing their life span. This should also result in decrased direct and indirect medical costs. In addition, our procedure would lead to at least two novel industrial products. One would be the implant itself and a second would be the arthroscopic instruments needed for the implantation. They would have considerable commercial potential because of the large number of patients that would profit from our treatment. Further, the magnetic resonance techniques developed for cartilage imaging could have a future industrial potential. The economical benefits would be twofold. Clearly a local treatment for cartilage lesions would be less costly than joint replacement and as it would be an arthroscopic procedure it would probably require only a short hospitalisation. Further economical benefits would come from the involved industries.

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Coordinateur

UNIVERSITAET KOELN
Contribution de l’UE
Aucune donnée
Adresse
52,Joseph-Stelzmann-Srasse 52
50931 KOELN
Allemagne

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