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The Seventh UK Cartilage Symposium was held in Oswestry

ICRS (UK) Meeting Report.

The Seventh UK Cartilage Symposium was held in Oswestry on 19-20th November 2009 and included many members of the ICRS, both research scientists and clinicians. Potentials for ‘Universal’ cell lines and progenitor/stem cells were the focus of the meeting. Several speakers defined potential benefits of a Universal Donor cell including:

• Rapid availability compared to current autologous culture.
• Potentially lower cost compared to autologous cells.
• A more standardised and characterised product, rather than traditional ACI, which, by definition, produces a unique product for a single patient.
• The capability of producing a good quality matrix (which some patients’ own chondrocytes might be incapable of, due to genetic defects).

Major obstacles, including immune responsiveness, were discussed. However, umbilical cord lining cell could be of particular importance due to its apparent lack of immune stimulating surface antigens and/or protective effect against the immune response. The ideal cell would not incite an immune reaction, even when differentiated to a chondrocytic phenotype. The necessity for chondrogenic differerentiation was raised as an issue if non-cartilage cells are to be used as the starting point.

There were many excellent presentations on other topics ranging from labelling and keeping track of cells to assessing the plasticity of stem/progenitor cells, preclinical testing and optimisation of preservation techniques for allogeneic cartilage. Using MRI to track cells labelled with supraparamagnetic particles was also discussed and suggested to be feasible only if cells are closely packed, such as in a contained defect.

Recommendations for Clinical Trial Design:

• Future trials of different cell therapies must include Traditional ACI (T-ACI).
• Outcome measures need to assess: - Pain, physical function and structure of the neo-cartilage.

The meeting was small, but this was almost certainly the reason for the exceptionally lively discussion amongst the very knowledgeable attendees. Despite a well informed gathering it became obvious that many unanswered questions remain regarding cartilage repair:

• Do implanted cells provide the best environment for local cells to be activated or do the implanted cells form the new tissue?
• If implanted (allogeneic) cells remain, can cartilage provide protection from an immune response?
• If implanted cells provide local growth factors, can this be manipulated?
• To what extent does remodelling of the subchondral bone influence the overlying cartilage repair (or degeneration)?
• How best to define arthritis? If it is considered failure of the joint as an organ, then how do traumatic and degenerative lesions lead to this?
• What happens inside the treated chondral defect? Do the added cells continue to divide? How do they form matrix? Is there a dose response in terms of the number of cells implanted? Is it more important to keep the cell divisions below 7 to 9 doublings?
• What are the best rehabilitation protocols in cartilage repair? What are the best biomechanical environments to enhance cell function?

One recurring concern was the importance of not allowing the use or development of cell therapy to become suffocated by inappropriate regulation. It was also generally agreed that it is difficult to regulate for best practice in cell therapy when there is little clarity as to which features are best able to predict success. Finding answers to the fundamental questions listed above remains key to further development of Cartilage Repair.