Protecting the regenerative environment: selecting the optimal delivery vehicle for cartilage repair-a narrative review

T Mark Campbell; Guy Trudel

doi:10.3389/fbioe.2024.1283752

Protecting the regenerative environment: selecting the optimal delivery vehicle for cartilage repair-a narrative review

Front Bioeng Biotechnol. 2024 Jan 25:12:1283752. doi: 10.3389/fbioe.2024.1283752. eCollection 2024.

Authors

T Mark Campbell^{1

2

3}, Guy Trudel^{2

3

4}

Affiliations

¹ Elisabeth Bruyère Hospital, Ottawa, ON, Canada.
² Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
³ Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁴ The Ottawa Hospital, Department of Medicine, Division of Physical Medicine and Rehabilitation, Ottawa, ON, Canada.

Abstract

Focal cartilage defects are common in youth and older adults, cause significant morbidity and constitute a major risk factor for developing osteoarthritis (OA). OA is the most common musculoskeletal (MSK) disease worldwide, resulting in pain, stiffness, loss of function, and is currently irreversible. Research into the optimal regenerative approach and methods in the setting of either focal cartilage defects and/or OA holds to the ideal of resolving both diseases. The two fundamentals required for cartilage regenerative treatment are 1) the biological element contributing to the regeneration (e.g., direct application of stem cells, or of an exogenous secretome), and 2) the vehicle by which the biological element is suspended and delivered. The vehicle provides support to the regenerative process by providing a protective environment, a structure that allows cell adherence and migration, and a source of growth and regenerative factors that can activate and sustain regeneration. Models of cartilage diseases include osteochondral defect (OCD) (which usually involve one focal lesion), or OA (which involves a more diffuse articular cartilage loss). Given the differing nature of these models, the optimal regenerative strategy to treat different cartilage diseases may not be universal. This could potentially impact the translatability of a successful approach in one condition to that of the other. An analogy would be the repair of a pothole (OCD) versus repaving the entire road (OA). In this narrative review, we explore the existing literature evaluating cartilage regeneration approaches for OCD and OA in animal then in human studies and the vehicles used for each of these two conditions. We then highlight strengths and challenges faced by the different approaches presented and discuss what might constitute the optimal cartilage regenerative delivery vehicle for clinical cartilage regeneration.

Keywords: cartilage; musculoskeletal health; osteoarthritis; regenerative therapy; stem cells.

Publication types

Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work is supported by funding from the Bruyère Academic Medical Organization Incentive Fund, The Ottawa Hospital Department of Medicine Translational Research Grant and the University of Ottawa Translational Research Grant.