Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.
Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.
Adv Healthc Mater. 2022 Dec;11(24):e2201305. doi: 10.1002/adhm.202201305. Epub 2022 Nov 22.
Human articular cartilage has a poor ability to self-repair, meaning small injuries often lead to osteoarthritis, a painful and debilitating condition which is a major contributor to the global burden of disease. Existing clinical strategies generally do not regenerate hyaline type cartilage, motivating research toward tissue engineering solutions. Prospective cartilage tissue engineering therapies can be placed into two broad categories: i) Ex situ strategies, where cartilage tissue constructs are engineered in the lab prior to implantation and ii) in situ strategies, where cells and/or a bioscaffold are delivered to the defect site to stimulate chondral repair directly. While commonalities exist between these two approaches, the core point of distinction-whether chondrogenesis primarily occurs "within" or "without" (outside) the body-can dictate many aspects of the treatment. This difference influences decisions around cell selection, the biomaterials formulation and the surgical implantation procedure, the processes of tissue integration and maturation, as well as, the prospects for regulatory clearance and clinical translation. Here, ex situ and in situ cartilage engineering strategies are compared: Highlighting their respective challenges, opportunities, and prospects on their translational pathways toward long term human cartilage repair.
人关节软骨自我修复能力差,这意味着小的损伤常常导致骨关节炎,这是一种痛苦且使人虚弱的疾病,也是导致全球疾病负担的主要原因之一。现有的临床策略通常不能再生透明软骨,这促使人们研究组织工程解决方案。潜在的软骨组织工程疗法可以分为两大类:i)离体策略,其中在植入前在实验室中设计软骨组织构建体,以及 ii)原位策略,其中将细胞和/或生物支架递送到缺陷部位以直接刺激软骨修复。尽管这两种方法有共同之处,但核心区别点——软骨发生主要是“在体内”还是“在体外”(身体之外)——可以决定治疗的许多方面。这种差异影响到细胞选择、生物材料配方和手术植入程序、组织整合和成熟的过程,以及监管批准和临床转化的前景。在这里,离体和原位软骨工程策略进行了比较:强调了它们各自在向长期人类软骨修复转化途径上的挑战、机遇和前景。