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The use of mesenchymal stem cells for cartilage repair and regeneration: a systematic review.

Goldberg, A; Mitchell, K; Soans, J; Kim, L; Zaidi, R (2017) The use of mesenchymal stem cells for cartilage repair and regeneration: a systematic review. J Orthop Surg Res, 12 (1). p. 39. ISSN 1749-799X https://doi.org/10.1186/s13018-017-0534-y
SGUL Authors: Kim, Unchung Louise

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Abstract

BACKGROUND: The management of articular cartilage defects presents many clinical challenges due to its avascular, aneural and alymphatic nature. Bone marrow stimulation techniques, such as microfracture, are the most frequently used method in clinical practice however the resulting mixed fibrocartilage tissue which is inferior to native hyaline cartilage. Other methods have shown promise but are far from perfect. There is an unmet need and growing interest in regenerative medicine and tissue engineering to improve the outcome for patients requiring cartilage repair. Many published reviews on cartilage repair only list human clinical trials, underestimating the wealth of basic sciences and animal studies that are precursors to future research. We therefore set out to perform a systematic review of the literature to assess the translation of stem cell therapy to explore what research had been carried out at each of the stages of translation from bench-top (in vitro), animal (pre-clinical) and human studies (clinical) and assemble an evidence-based cascade for the responsible introduction of stem cell therapy for cartilage defects. This review was conducted in accordance to PRISMA guidelines using CINHAL, MEDLINE, EMBASE, Scopus and Web of Knowledge databases from 1st January 1900 to 30th June 2015. In total, there were 2880 studies identified of which 252 studies were included for analysis (100 articles for in vitro studies, 111 studies for animal studies; and 31 studies for human studies). There was a huge variance in cell source in pre-clinical studies both of terms of animal used, location of harvest (fat, marrow, blood or synovium) and allogeneicity. The use of scaffolds, growth factors, number of cell passages and number of cells used was hugely heterogeneous. SHORT CONCLUSIONS: This review offers a comprehensive assessment of the evidence behind the translation of basic science to the clinical practice of cartilage repair. It has revealed a lack of connectivity between the in vitro, pre-clinical and human data and a patchwork quilt of synergistic evidence. Drivers for progress in this space are largely driven by patient demand, surgeon inquisition and a regulatory framework that is learning at the same pace as new developments take place.

Item Type: Article
Additional Information: © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Autologous chondrocyte implantation, Matrix-induced autologous chondrocyte implantation, Mesenchymal stem cells, Animals, Cartilage, Articular, Chondrocytes, Humans, Mesenchymal Stem Cell Transplantation, Regeneration, Regenerative Medicine, Tissue Engineering, Tissue Scaffolds, Translational Medical Research, Wound Healing, Matrix-induced autologous chondrocyte implantation, Autologous chondrocyte implantation, Mesenchymal stem cells, Orthopedics, 1103 Clinical Sciences
Journal or Publication Title: J Orthop Surg Res
ISSN: 1749-799X
Language: eng
Dates:
DateEvent
9 March 2017Published
13 February 2017Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 28279182
Web of Science ID: WOS:000396985500001
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109911
Publisher's version: https://doi.org/10.1186/s13018-017-0534-y

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