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 Researchers tested a new technique for repairing what’s known as
articular cartilage, the tissue that covers the ends of bones where
they come together to form joints. When articular cartilage is
damaged by injury or normal wear and tear, it can result in joint
pain and limited mobility.
Because the experiment only included 10 adults who were followed for
just two years, it’s impossible to say for sure whether this
procedure would be safe or effective with widespread use. But the
results are promising enough to merit more testing, said study
co-author Ivan Martin of the University of Basel in Switzerland.
“We have developed a new promising approach to the treatment of
articular cartilage injuries,” said Martin said by email. “Before
this can be offered to patients as a standard treatment, obviously
it needs to be tested in larger patient cohorts and in randomized
and controlled trials with long-term assessment of clinical
outcome.”
Previous research has found cells extracted from the septum,
cartilage tissue in the nose, can be used to grow new cartilage in a
lab, Martin said. With the current experiment, researchers
successfully implanted this lab-grown tissue into knee joints for
the first time, he said.
To do this, researchers first performed a minimally invasive
procedure using local anesthesia to harvest a small specimen, about
6 millimeters or a quarter of an inch, of tissue from the nasal
septum.
Next, they grew the harvested cells in a lab for two weeks, then
cultured them for another two weeks on a scaffold made of what’s
known as collagen membrane to grow thin sheets of cartilage
measuring 30 mm by 40 mm, or about 1.2 inches by 1.5 inches.
Researchers trimmed these grafts to the right shape to replace the
damaged cartilage removed from each patient’s knee joint, then
implanted the replacement tissue.
Two years after reconstructive surgery, most recipients reported
improvements in pain, knee function and quality of life, researchers
report in The Lancet.
MRI scans at two years also showed the growth of new tissue similar
to native knee cartilage around where the replacement tissue was
implanted, the study found.
Researchers didn’t see any adverse reactions or dangerous side
effects.
Every year, around 2 million people in the U.S. and Europe alone are
diagnosed with damage to articular cartilage because of injuries or
accidents, the researchers note.
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Because the tissue doesn't have its own blood supply, it has limited
capacity to repair itself once damaged, leading to degenerative
joint conditions like osteoarthritis.
Traditional methods to prevent or delay onset of cartilage
degeneration don't create the healthy cartilage needed to endure the
forces of everyday movement, the authors contend.
Efforts to use patients’ own healthy articular cartilage cells from
a healthy joint to repair damaged knee tissue haven’t been able to
reliably restore function over the long term, the researchers argue.
“In my eyes, the major advantage (of the experimental procedure
using nasal tissue) is that there is no need to obtain cartilage
from within a healthy joint,” said Dr. Nicole Rotter of Ulm
University Medical Center in Germany, author of an accompanying
editorial.
“Potential harms include side effects to the new donor site, the
nose, such as deformities of the nose and functional problems such
as nasal obstruction,” Rotter added by email. “These negative side
effects can be avoided with an appropriate surgical technique to
obtain the biopsy, meaning this is a surgery that should be done by
a person with expertise in nasal surgery such as an
otorhinolaryngologist.”
Beyond that, more research is needed to see how this procedure works
in the knee joint over a longer period of time, Rotter added by
email.
“Long term stability and integrity need to be investigated, as a
potential risk could be that these transplants are not stable in the
long run,” Rotter said.
SOURCE: http://bit.ly/2f3A2vI and http://bit.ly/2eQCxib The Lancet,
online October 22, 2016.
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