Chiang Hongsen, Jiang Ching-Chuan
Department of Orthopedic Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
J Formos Med Assoc. 2009 Feb;108(2):87-101. doi: 10.1016/S0929-6646(09)60039-5.
Articular cartilage defects heal poorly and lead to catastrophic degenerative arthritis. Clinical experience has indicated that no existing medication substantially promotes the healing process and the cartilage defect requires surgical replacement, preferably with an autograft. However, there is a shortage of articular cartilage that can be donated for autografting. A review of previous unsuccessful experiences reveals the reason for the current strategy to graft cartilage defects with regenerated cartilage. Autologous cartilage regeneration is a cell-based therapy in which autogenous chondrocytes or other chondrogenic cells are cultured to constitute cartilaginous tissue according to the principles of tissue engineering. Current studies are concentrating on improving such techniques from the three elements of tissue engineering, namely the cells, biomaterial scaffolds, and culture conditions. Some models of articular cartilage regeneration have yielded good repair of cartilage defects, in animal models and clinical settings, but the overall results suggest that there is room for improvement of this technique before its routine clinical application. Autologous cartilage regeneration remains the mainstay for repairing articular cartilage defects but more studies are required to optimize the efficacy of regeneration. A more abundant supply of more stable cells, i.e. capable of maintaining the phenotype of chondrogenesis, has to be identified. Porous scaffolds of biocompatible, biodegradable materials that maintain and support the presentation of the chondrogenic cells need to be fabricated. If the cells are not implanted early to allow their in vivo constitution of cartilage, a suitable in vitro cultivation method has to be devised for a consistent yield of regenerative cartilage.
关节软骨缺损愈合不良，并会导致灾难性的退行性关节炎。临床经验表明，现有的药物均无法显著促进愈合过程，软骨缺损需要进行手术置换，最好是使用自体移植物。然而，可用于自体移植的关节软骨供体短缺。回顾以往的失败经验，揭示了目前采用再生软骨移植软骨缺损策略的原因。自体软骨再生是一种基于细胞的治疗方法，其中根据组织工程原理培养自体软骨细胞或其他软骨生成细胞，以构成软骨组织。目前的研究集中在从组织工程的三个要素，即细胞、生物材料支架和培养条件，来改进此类技术。在动物模型和临床环境中，一些关节软骨再生模型已实现软骨缺损的良好修复，但总体结果表明，在该技术常规临床应用之前仍有改进空间。自体软骨再生仍然是修复关节软骨缺损的主要方法，但需要更多研究来优化再生效果。必须找到更丰富的、更稳定的细胞来源，即能够维持软骨生成表型的细胞。需要制造出具有生物相容性、可生物降解的多孔支架，以维持和支持软骨生成细胞的表现。如果细胞没有早期植入以使其在体内构成软骨，则必须设计一种合适的体外培养方法，以稳定产生再生软骨。
