Osteoarthritis is the most common form of arthritis affecting more than 20 million Americans. It is a disease of articular (joint) cartilage.
Normal cartilage consists of a matrix constructed of a mixture of proteins, sugars (proteoglycans), water, and collagen. Inside this matrix sit chondrocytes, cells that actually manufacture the matrix they sit in.
Under normal situation, cartilage is capable of withstanding both compressive forces as well as shear forces. It deforms when loads are placed on it and then expands to its normal contour once the load has been removed.
When cartilage is damaged as a result of trauma, injury, or other means, a change occurs in cartilage. Chondrocytes produce destructive enzymes; the underlying bone deforms, and the lining of the joint, the synovium, produces cytokines, protein messengers that stimulate inflammation.
The end result is wearing away of cartilage accompanied by chronic inflammation, and deformity related to abnormal mechanics of the joint.
To date, the treatment of osteoarthritis has been largely symptomatic using non-steroidal anti-inflammatory drugs (NSAIDS), physical therapy, and joint injections of either corticosteroid or hyaluronic acid.
The rapid development of stem cell science has shown promise as a treatment that may restore joint integrity by regenerating cartilage.
A caveat: The proper application of stem cells is not merely injecting stem cells into a joint and hoping for the best.
Multiple attempts by various laboratories have searched for a method of introducing stem cells along with a scaffold to enable stem cell multiplication and growth in an organized fashion that will best stimulate cartilage regeneration. A whole new branch of basic science, termed “tissue engineering” has been used to describe these ventures.
An excellent review of the current state of the science was published by the Harvard Stem Cell Institute.
(Willerth SM, Sakiyama-Elbert SE. Combining stem cells and biomaterial scaffolds for constructing tissues and cell delivery.)
The authors reviewed the literature regarding types of scaffold materials that had been studied.
These included natural biomaterials such as collagen, fibrin, silk, sugars, algae cell walls, hyaluronan, and chitin as well as synthetic platforms such as various polymers, peptides, and ceramics.
These scaffolds are generally “seeded” with growth factors that stimulate stem cell multiplication and division while protecting the stem cells in the hostile environment of the arthritic joint.
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