Why is osteoarthritis cartilage damage so hard to treat… an opportunity for stem cells?

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Why is osteoarthritis cartilage damage so hard to treat… an opportunity for stem cells?



Osteoarthritis is a disease of hyaline cartilage, the tough gristle that caps the ends of long bones.
Cartilage is composed of cells, collagen , proteoglycans, and water
It’s an interesting compound because it is both pliable as well as stiff.
The cells inside of cartilage are called chondrocytes. They sit inside the matrix of proteoglycans, collagen, and water. Picture grapes inside a gelatin mold.
When cartilage is damaged, it has a limited ability to repair itself. Chondrocytes are just not capable of doing it. Also cartilage damage leads to further chondrocyte death.
This leads to osteoarthritis.
Multiple techniques have been used to try and rectify this problem. The first is microfracture. This is a procedure where the surgeon drills multiple holes into the cartilage and underlying bone leading to bleeding and the release of some mesenchymal stem cells from the marrow.
Mosaicplasty is a procedure where plugs of normal cartilage and bone are plugged into the area where cartilage damage has occurred.
Autologous chondrocyte implantation is a technique where a cartilage plug is harvested from a non-weight-bearing part of the knee, digested with enzymes in the lab and chondrocytes are stimulated to multiply. The chondrocytes are then re-implanted into the area of cartilage damage and kept there by a thin membrane that is sewn into place.
All of these attempts have a long recovery, an excessive number of complications, as well as an excessive amount of chondrocyte death around the margins.
So far, the most promising approach has been the use of mesenchymal stem cells. These are adult stem cells that are programmed to become connective tissue such as cartilage.

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