Zusammenfassung
Studienziel: Die autologe In-vitro-Chondrozytenexpansion ist eine erst seit jüngerer Zeit angewandte Methode zur Behandlung von Knorpeldefekten. Durch zahlreiche Arbeitsgruppen konnte gezeigt werden, dass neben dem Periost und embryonalen Somitenmesoderm im humanen Knochenmark mesenchymale Progenitorzellen existieren, welche unter geeigneten Bedingungen in vitro chondrogen differenzieren. Ziel der Studie ist die Darlegung der gegenwärtigen Möglichkeiten und Grenzen einer chondrogenen Stammzelltherapie unter besonderer Berücksichtigung der verwendeten zellulären Carrier (Biomatrices) sowie die Diskussion der sich hieraus ergebenden Probleme und das Aufzeigen von entsprechenden Lösungsmöglichkeiten. Methode: Zur Erfassung der gegenwärtig vorliegenden experimentellen und klinischen Daten wird eine umfassende Literaturrecherche durchgeführt. Des Weiteren werden eigene zellkulturelle Erfahrungen eingebracht. Ergebnisse: Bei der Behandlung von osteochondralen Defekten existiert bisher kein suffizientes Therapieverfahren, welches Progenitorzellen in ein therapeutisches Konzept im Sinne einer lokalen Chondrozytenregeneration einbindet. Die Gründe hierfür liegen in den Schwierigkeiten, ein längerfristiges, biomechanisch und histologisch stabiles hyalines Gewebe zu kultivieren, welches sich zugleich als In-vivo-Transplantat eignet und in situ eine sichere lokale Verankerung in der Defektzone zulässt. Schlussfolgerung: Die systematische, zellkulturelle Evaluierung eines Biowerkstoffes durch chondrogene Progenitorzell-Linien kann wertvolle Hinweise auf die chondrogene Potenz einer Matrix liefern.
Abstract
Aim: The autologous in vitro expansion of chondrocytes is a new method for the treatment of localized cartilage defect zones in humans. In the past several investigators have shown the occurrence of mesenchymal stem cells (MSC) in human bone marrow, periosteum and somite mesoderm. Moreover it has been shown that these progenitor cells are able to differentiate into chondral tissue under special in vitro conditions. The following study shows current possibilities and borders of a chondrogenetic stem cell therapy. Furthermore advantages and disadvantages of different cellular biomatrix carriers are described, cartilage tissue engineering-related problems are discussed and possible solutions were pointed out. Methods: A literature investigation served for evaluation of the present clinical and experimental data. Furthermore our own cell culture experiences were considered. Results: Until now there exists no clinical concept using the potential of MSC for cartilage tissue engineering. Reasons are the lack of biomechanical and histological stability and handling problems of the cultivated cartilage tissue, especially the difficulties to fix and secure the transplant in the cartilage defect zones in situ. Conclusion: The systematic investigation of biomatrices by chondrogenic progenitor cell culture systems may lead to important data for the evaluation of the chondrogenic potency biomatrices.
Schlüsselwörter
Stammzelle - Chondrogenese - Zelltherapie
Key words
Stem Cell - chondrogenesis - cell therapy
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Dr. med. Marcus Jäger
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