Zelltherapie zur Knorpelregeneration im Kniegelenk

Zusammenfassung

Die Zelltherapie besitzt einen festen Stellenwert bei der Therapie chondraler Läsionen am Kniegelenk. Die derzeit am häufigsten zur chondralen Regeneration eingesetzten Zellen sind ausdifferenzierte Chondrozyten (autologous chondrocyte implantation, ACI; matrix-induced autologous chondrocyte implantation, MACI). Das enzymatische Herauslösen der Chondrozyten aus dem entnommenen Knorpel durch Kollagenasen sowie die anschließende Zellexpansion führt zu einer zellulären De- bzw. Transdifferenzierung. Um diese zu verhindern, empfehlen einige Autoren die 3-D‐Kultivierung sowie die Zugabe von Wachstumsfaktoren und Zytokinen. Zur Vermeidung von entnahmebedingten, iatrogenen Knorpelschäden bei der Gewinnung von chondrozytärem Gewebe werden gegenwärtig verschiedene Progenitorzellen auf ihre Potenz zur osteochondralen Regeneration untersucht. Insbesondere autologe MSC aus dem Knochenmark weisen zahlreiche Vorteile für die Behandlung von osteochondralen Defekten auf. Neben der guten Verfügbarkeit, der vergleichsweise einfachen Entnahme- und Kultivierungstechnik besitzen nach derzeitigem Kenntnisstand humane MSC ebenfalls ein hohes Maß an biologischer Sicherheit. In der vorliegenden Übersichtsarbeit werden zellbiologische Grundlagen und klinische Ergebnisse der Zelltherapie zur Behandlung chondraler Defekte am Kniegelenk zusammengefasst und diskutiert.

Abstract

The application of autologous cells is a standard procedure for the treatment of chondral lesions of the knee. Here, the most frequently used cells are differentiated chondrocytes (autologous chondrocyte implantation, ACI; matrix-induced autologous chondrocyte implantation, MACI). The enzymatic digestion of cartilage tissue by collagenase and isolation of chondrocytes followed by in vitro cultivation are associated with cellular de- and transdifferentiation. To prevent these effects some authors recommend 3D‐cultures and culture medium supplementation of defined growth factors and cytokines. Another aim is the reduction of donor site morbidity. Therefore, different progenitor cell types were tested towards their potential for osteochondral regeneration. In particular, MSC derived from bone marrow include several advantages for the treatment of osteochondral defects such as unproblematic sampling, cultivation techniques, and a relatively high degree of biological safety. This review summarises the basic cellular principles as well as clinical results of cell therapeutics for the regeneration of osteochondral defects in the knee.

Schlüsselwörter

Knorpel - Zelltherapie - mesenchymale Stammzellen (MSC) - Knie - osteochondrale Regeneration

Key words

cartilage - cell therapy - mesenchymal stem cell (MSC) - knee - osteochondral regeneration

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