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Biocartilage
This document discusses biocartilage as a potential treatment for cartilage damage and diseases. Biocartilage is made of micronized allogeneic cartilage that has been dehydrated. It is implanted along with platelet rich plasma over a microfractured cartilage defect. This allows mesenchymal stem cells to attach to the cartilage extracellular matrix scaffold. Research in baboons found biocartilage implants led to hyaline-like new cartilage formation within 9 weeks. Biocartilage may provide a lower-cost and more effective alternative to other cartilage treatments like microfracture alone or products using minced juvenile cartilage. Further clinical studies in humans are still needed but biocartilage shows promise as a cartilage repair
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Biocartilage
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- 2. CONTENTS • INTRODUCTION • DISEASESAND TREATMENT • WHAT IS BIOCARTILAGE? • MICRONISED CARTILAGE ECM • MICRONISED CARTILAGE MATRIX • DENOVO NT (ZIMMER) • MICROFRACTURE PLUS • HOW SHOULD WE DO IT? • DELIVERY SYSTEM • TIPS • CONCLUSION • REFERENCE
- 3. INTRODUCTION • Cartilage isa flexible connective tissue found in many areas in the bodies of humans and other animals, including the joints between bones, the rib cage, the ear, the nose, the bronchial tubes and the intervertrebal discs. It is not as hard and rigid as bone but is stiffer and less flexible than muscle. • Cartilage is composed of specialized cells called chondrocytes that produce a large amount of extracellular matrix composed of collagen fibers, abundant ground substance rich in proteoglycan, and elastin fibers. Cartilage is classified in three types, elastic cartilage, hyaline cartilage and fibrocartilage, which differ in the relative amounts of these three main components. Chondroblasts that get caught in the matrix are called chondrocytes. They lie in spaces called lacunae with up to eight chondrocytes per lacuna.
- 5. DISEASES AND TREATMENTS •Osteoarthritis: affects the joints exposed to high stress and is therefore considered the result of "wear and tear" rather than a true disease. • Traumatic rupture or detachment: The cartilage in the knee is frequently damaged, and can be partially repaired through knee cartilage replacement therapy • Achondroplasia: Reduced proliferation of chondrocytes in the epiphyseal plate of long bones during infancy and childhood, resulting in dwarfism. • Costochondritis: Inflammation of cartilage in the ribs, causing chest pain. • Spinal disc herniation : Asymmetrical compression of an intervertebral disc ruptures the sac-like disc, causing a herniation of its soft content. The hernia often compresses the adjacent nerves and causes back pain. • Relapsing polychondritis: a destruction, probably autoimmune, of cartilage, especially of the nose and ears, causing disfiguration. Death occurs by suffocation as the larynx loses its rigidity and collapses.
- 6. Bioengineering techniques arebeing developed to generate new cartilage, using a cellular "scaffolding" material and cultured cells to grow artificial cartilage. HENCE………..
- 7. WHAT IS BIOCARTILAGE? •BioCartilageTM is a new product containing dehydrated, micronized allogeneic cartilage and is implanted with the addition of platelet rich plasma over a microfractured defect. • Platelet rich plasma is shown to potentiate the cartilage repair process and is chemotactic for mesenchymal stem cells introduced following the microfracture procedure. • BioCartilageTM is also an appropriate allogeneic cartilage scaffold with the proper biochemical makeup, including Collagen Type II and cartilage matrix elements. • The procedure can be performed as a single-stage procedure with instrumentation and skill level consistent with standard microfracture techniques. • The use of BioCartilage may create more hyaline-like tissue at the repair site vs microfracture alone.
- 8. MICRONIZED CARTILAGE ECM Potentialaugment for Microfracture • Provides cartilage ECM scaffold . • Allows for BM MSC attachment and growth . • Stem Cells exposed to ECM will differentiate based on factors present within the matrix – Glycoproteins/Proteoglycans . • Simple / inexpensive.
- 9. BIOCARTILAGE ECM MICRONIZEDCARTILAGE MATRIX. In vivo supportive evidence: • – Baboon osteochondral defects filled with micronized cartilage particulate • 15 mm diameter, 10 mm depth • By 9 weeks had gross appearance of hyaline like cartilage • Histo: Newly formed cartilage cells, normal appearing proteoglycan content • Control group remained open or contained uneven patches of tissue • Malinin T et al. Induction of regeneration of articular cartilage defects by freeze dried particulate cartilage allografts. ICRS 2009 Meeting; poster presentation. 12 weeks
- 11. BIOCARTILAGE ECM MICRONIZEDCARTILAGE MATRIX. Future In vivo support: • Full thickness cartilage defects • Microfracture vs. BioCartilage • Cole, Fortier, Cook• Future clinical support: • Post market release study for femoral condyle lesions • Post market release study for talar lesions
- 12. DENOVO NT (ZIMMER) DeNovoNT • Juvenile, allograft cartilage minced into 1 mm cubes • Priced around $4,500 • BioCartilage = $750 Shelf life less than 1 month • BioCartilage = 4 years Arthroscopic application is difficult • BioCartilage has paste like consistency when mixed with autologous blood , allowing for delivery through a needle
- 13. MICROFRACTURE “PLUS” BST CarGelModel • Piramal Healthcare • Chitosan based scaffold mixed with blood • • Shrimp exoskeleton Microfractur Chitosan + e Blood • Received CE mark approval April 2012 • Conducting randomized pivotal trial in Canada Gross
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- 15. HOW SHOULD WEDO IT? • Easy • Inexpensive • Quick • Cannulas • Double lumen applicator for fibrin covering
- 16. MIXING AND DELIVERYSYSTEM
- 18. MIXING AND DELIVERYSYSTEM
- 19. TIPS Overlay fibrin glue(Evicel) to adhere to native cartilage • Use a double lumen syringe system • Don’t overuse fibrin, add slowly & carefully • Tisseel has own double lumen syringe avail Use cannula • Easier, more reliable instrument insertion • Not to disturb fibrin clot or sculpted biocartilage Make good vertical margins • Prefer curette with microfracture • BEWARE making divots with burrs
- 20. TISSUE ENGINEERS REPORTKNEE CARTILAGE REPAIR SUCCESS WITH NEW BIOMATERIAL • An illustration of the cartilage repair surgical procedure. • A mini-incision exposes the cartilage defect (top left-hand panel), and any dead tissue is removed from the edges. (B) The adhesive is then applied to the base and walls of the defect, followed by microfracture. (C) Lastly, the hydrogel solution is injected into the defect. (D) Bleeding from the microfracture holes is trapped in and around the hydrogel.
- 21. CONCLUSION • Cartilage haslimited repair capabilities • Over the last years, surgeons and scientists have elaborated a series of cartilage repair procedures that help to postpone the need for joint replacement. • Thus it led to the discovery of biocartilage. Researchers at Columbia Engineering announced that they have successfully grown fully functional human cartilage in vitro from human stem cells derived from fat tissue. Scope of biocartilage is tremendous and the healthy utilisation will seriously pave way as an aid for many treatments………………….
- 22. REFERENCE • https://in.news.yahoo.com/fully-functional-human-cartilage-grown-lab-first-time-055805895.html+ • http://en.wikipedia.org/wiki/Articular_cartilage_repair •Behrens P., P. (2005). "Matrixgekoppelte Mikrofrakturierung". Arthroskopie 18 (3): 193–197. doi:10.1007/s00142-005-0316-0. • Jump up^ Saw, KY; Anz A; Merican S; Tay YG; Ragavanaidu K; Jee CS; McGuire DA (Epub 2011 Feb 19). "Articular cartilage regeneration with autologous peripheral blood progenitor cells and hyaluronic Acid after arthroscopic subchondral drilling: a report of 5 cases with histology". Arthroscopy 27 (4): 493–506. doi:10.1016/j.arthro.2010.11.054. PMID 21334844. • Wey Wen, Lim. "Generating New Cartilage". The Star. Retrieved 6 May 2011. • Jump up^ Solheim E, Hegna J, Øyen J, Austgulen OK, Harlem T, Strand T. Osteochondral autografting (mosaicplasty) in articular cartilage defects in the knee: results at 5 to 9 years. Knee. 2010 Jan;17(1):84–7. • Jump up^ Knutsen G, Drogset JO, Engebretsen L, Grøntvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am. 2007 Oct;89(10):2105–12. • Jump up^ Centeno CJ, Schultz JR, Cheever M, Robinson B, Freeman M, Marasco W. (2010). "Safety and Complications Reporting on the Re- implantation of Culture-Expanded Mesenchymal Stem Cells using Autologous Platelet Lysate Technique". Current Stem Cell Research and Therapy. 5 (1): 81–93. doi:10.2174/157488810790442796. PMID 19951252.
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