Therapeutic potentials of regenerative medicine and tissue engineering in the field of orthopedics
Therapeutic potentials of regenerative medicine and tissue engineering in the field of orthopedics
bakhtyar abdolahzadeh,1,*negar abdolahzadeh,2Mohammadreza Chehrassan,3Amir Amani,4
1. Iran University of Medical Sciences - Shafa Yahyaian Hospital 2. Bojnourd University of Medical Sciences, Faculty of Medicine, Novel Technologies, North Khorasan, Iran. 3. Iran University of Medical Sciences - Shafa Yahyaian Hospital 4. Department of Advanced Sciences and Technologies, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
Introduction: The goal of orthopaedic joint therapies is to restore pain-free function with minimally invasive procedures. Stem cells have the potential to revitalise damaged ligaments, cartilage and bone. However, regenerative medicine has not yet achieved clinical acceptance in orthopaedics. Stem cells have the potential to revolutionize orthopaedic practice, and this article aims to provide a complete overview of the clinical advances in this field. Stem cells can be obtained from various sources, but bone marrow, adipose tissue and muscle-derived MSCs are most commonly used. Mesenchymal stem cells (MSCs) have the potential to develop into any mesodermal tissue, including bone. Biologic augmentation can help heal nonunion/delayed union and bone defects following trauma, tumor or infection. Autologous cancellous graft is the "gold standard," but limited supply and donor site morbidity limit their use. Allografts and bone graft substitutes are routinely used, but poor graft integration and osteonecrosis of the graft remain primary issues. Bone marrow aspirates have been successfully used to enhance healing of non-unions.
Methods: In order to review the studies of regenerative medicine and tissue engineering in the field of orthopedics, articles with keywords regenerative medicine, tissue engineering, orthopedics, stem cell, platelet-rich plasma, stem cell isolation methods, types of stem cells, growth factors, scaffold in Time period from 2010 to 2023 in the database Pubmed and google scholar reviewed.
Results: Stem cells can be administered through various routes, and they have the ability to differentiate and secrete growth factors and cytokines that play a role in angiogenesis, repair, cell survival and proliferation. Genetically modified MSCs are being developed for long-term release of growth factors. Tissue engineering with stem cells and scaffolds have been found to be useful for bridging bone defects. MSCs alone have not proven to be beneficial for filling defects caused by simple/aneurysmal bone cysts, but healing rates are enhanced when used with scaffolds such as HA, DBM and TCP.
Currently, among the new treatment methods for osteoarthritis and tendonopathy diseases, using the reconstructive medicine method, including injection:
Platelet-rich plasma.
Mesenchymal stem cells: stem cells obtained from adipose tissue, bone marrow, and pregnancy-associated sources like the umbilical cord, amniotic fluid, and the placenta.
Biomaterials - organic substances such as autologous chondrocytes (cells procured from the patient that generate cartilage), bovine collagen, bone matrix, and proteins.
Regenerative medicine techniques, specifically orthobiologic injections, provide solutions for clinical issues like tendinopathies and degenerative arthritis that have previously shown limited response to medication, rehabilitation, surgery, or joint replacement surgery, with biological therapies emerging as promising treatment options for musculoskeletal disorders in young adults and the elderly. Regenerative Medicine and Tissue Engineering (TE) have raised the hopes and expectations in medicine and created the hope of repairing or replacing the human tissues damaged by disease or trauma.
Conclusion: Regenerative medicine and biological methods are recognized as the next-generation advances in treating musculoskeletal conditions. Exciting options include autologous blood derivatives, cytokines, and cell-based therapy. Biological therapies using PRP and BMC are commonly used in orthobiology for various clinical problems such as osteoarthritis, tendon repair, chondral lesions, and soft tissue repair. Additionally, there is potential for treating nerve conditions and injuries.
Cell therapy appears to have the most potential for tissue healing and regeneration. Musculoskeletal tissues like cartilage and ligaments do not heal well due to poor vascularity. Regenerating these tissues requires cells, morphogenetic signals, scaffolds, and a suitable mechanical environment. Treatment strategies could involve stimulating healing response, genetic alteration, cellular signaling changes, and exogenous augmentation with scaffolds.
Regenerative medicine offers the potential to postpone and potentially minimize the need for surgical procedures in individuals experiencing degenerative joint ailments and musculoskeletal traumas. In the imminent future, there is a possibility that orthobiologics could be employed as an intermediate approach for ailments like arthritis, occupying a position that lies between conservative treatments (such as steroid injections) and surgical intervention.