Researchers in joint and tissue repair have mastered the art and science of harvesting skeletal tissue in vitro.
The next challenges to be faced are developing the best repair strategies and making the technologies cost effective, according to Dr. Francesco Dell'Accio and colleagues, who spoke at a translational science session on joint and tissue repair at the annual European Congress of Rheumatology in Amsterdam.
“Cell-based tissue repair is progressively exiting the experimental, 'proof of principle' phase,” said Dr. Dell'Accio of King's College London in an interview.
“Obtaining skeletal tissues in vitro from a variety of mature or stem cell populations is not a big challenge anymore. However, for cell-based repair strategies to reach the routine clinical applicability, we should develop cell preparations that consistently and reproducibly differentiate into the desired tissues in the diseased microenvironment.” Another important issue is to make such technologies cost effective. Allogeneic stem cell technologies or in situ recruitment of resident cells are important opportunities.
“Finally, biodegradable matrices and scaffolds that allow at the same time delivery (ideally arthroscopically) and containment of the cell preparation and control on tissue formation, patterning and maturation may prove of crucial importance,” Dr. Dell'Accio said.
New technologies may soon allow rheumatologists to perform procedures that traditionally have been the exclusive realm of orthopedists, he noted. “For many years, skeletal tissue repair has been predominantly of orthopedic interest because the inflammatory environment of rheumatic joints has been an obstacle for effective tissue regeneration and for the difficulty of the surgery required. Recently, however, the development of potent tools to control inflammation and the potential of these technologies to be delivered arthroscopically may allow the clinical rheumatologist not only to control inflammation but also to achieve tissue repair and reduce the disability of many rheumatic patients.”
It was noted that major new trial data are coming soon, as well as important changes in the regulatory path in Europe to allow development of these treatments into products—notably, a central route through the European Medicines Agency's Committee for Advanced Therapies.
Cell-based tissue repair could relieve the pain of superficial osteochondral defects. Courtesy Dr. Frank P. Luyten