Focsa Mircea Adrian, Florescu Sorin, Gogulescu Armand
Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania.
Medicina (Kaunas). 2024 Dec 27;61(1):24. doi: 10.3390/medicina61010024.
Cartilage repair remains a critical challenge in orthopaedic medicine due to the tissue's limited self-healing ability, contributing to degenerative joint conditions such as osteoarthritis (OA). In response, regenerative medicine has developed advanced therapeutic strategies, including cell-based therapies, gene editing, and bioengineered scaffolds, to promote cartilage regeneration and restore joint function. This narrative review aims to explore the latest developments in cartilage repair techniques, focusing on mesenchymal stem cell (MSC) therapy, gene-based interventions, and biomaterial innovations. It also discusses the impact of patient-specific factors, such as age, defect size, and cost efficiency, on treatment selection and outcomes. This review synthesises findings from recent clinical and preclinical studies published within the last five years, retrieved from the PubMed, Scopus, and Web of Science databases. The search targeted key terms such as "cartilage repair", "stem cell therapy", "gene editing", "biomaterials", and "tissue engineering". Advances in MSC-based therapies, including autologous chondrocyte implantation (ACI) and platelet-rich plasma (PRP), have demonstrated promising regenerative potential. Gene-editing tools like CRISPR/Cas9 have facilitated targeted cellular modifications, while novel biomaterials such as hydrogels, biodegradable scaffolds, and 3D-printed constructs have improved mechanical support and tissue integration. Additionally, biophysical stimuli like low-intensity pulsed ultrasound (LIPUS) and electromagnetic fields (EMFs) have enhanced chondrogenic differentiation and matrix production. Treatment decisions are influenced by patient age, cartilage defect size, and financial considerations, highlighting the need for personalised and multimodal approaches. Combining regenerative techniques, including cell-based therapies, gene modifications, and advanced scaffolding, offers a promising pathway towards durable cartilage repair and joint preservation. Future research should focus on refining integrated therapeutic protocols, conducting long-term clinical evaluations, and embracing personalised treatment models driven by artificial intelligence and predictive algorithms.
由于软骨组织的自我修复能力有限，导致诸如骨关节炎（OA）等退行性关节疾病，因此软骨修复仍是骨科医学中的一项关键挑战。作为回应，再生医学已开发出先进的治疗策略，包括基于细胞的疗法、基因编辑和生物工程支架，以促进软骨再生并恢复关节功能。本叙述性综述旨在探讨软骨修复技术的最新进展，重点关注间充质干细胞（MSC）疗法、基于基因的干预措施和生物材料创新。它还讨论了患者特异性因素，如年龄、缺损大小和成本效益，对治疗选择和结果的影响。本综述综合了过去五年内发表在PubMed、Scopus和Web of Science数据库中的近期临床和临床前研究结果。搜索目标关键词包括“软骨修复”、“干细胞疗法”、“基因编辑”、“生物材料”和“组织工程”。基于MSC的疗法进展，包括自体软骨细胞植入（ACI）和富血小板血浆（PRP），已显示出有前景的再生潜力。像CRISPR/Cas9这样的基因编辑工具促进了靶向细胞修饰，而新型生物材料如水凝胶、可生物降解支架和3D打印构建体改善了机械支撑和组织整合。此外，低强度脉冲超声（LIPUS）和电磁场（EMF）等生物物理刺激增强了软骨生成分化和基质产生。治疗决策受患者年龄、软骨缺损大小和经济因素影响，凸显了个性化和多模式方法的必要性。结合再生技术，包括基于细胞的疗法、基因修饰和先进支架，为持久的软骨修复和关节保留提供了一条有前景的途径。未来研究应专注于完善综合治疗方案、进行长期临床评估以及采用由人工智能和预测算法驱动的个性化治疗模式。
