Tissue engineering: cartilage grown in test tubes

Interview with Dr. Justus Gille, Head of the Department of Trauma Surgery, Traumatology and Sports Traumatology at the University Hospital Schleswig-Holstein, Campus Lübeck

15/11/2016

It is very difficult for surgeons to regenerate cartilage tissue after an accident. There has been extensive research on this subject for decades. Though there are many therapeutic options available, first resultsare only available after years of testing.

Image: Dr. Justus Gille; Copyright: beta-web/Lormis

Dr. Justus Gille at MEDICA; © beta-web/Lormis

On Monday, Dr. Justus Gille gave a lecture on tissue engineering in orthopedics and trauma surgery at the MEDICA EDUCATION CONFERENCE, which addresses this issue.

Dr. Gille, what was the subject of your lecture?
Dr. Gille: My lecture addressed an issue that has always existed in medicine. The body doesn't have enough capacity to build high-quality cartilage replacement tissue in case of cartilage injury. Gradually, damages can increase and end in arthritis. My lecture focused on how we can improve the existing treatment approaches and prevent osteoarthritis. Cartilage injuries are among the diseases of civilization and treatment is very complex. A lot has happened in this area but we still don't have the ultimate solution for it.

There are many different treatment options; one of them is tissue engineering which aims to regenerate cartilage tissue. There are different versions of tissue engineering. One option is to stimulate the body's own regenerative capacity to create replacement tissue for cartilage damage. Another option is where we create a cell-matrix construct in a test tube which is inserted into the damaged cartilage via surgery. To do this, tissue is extracted beforehand from it. This process takes several weeks and has been researched and improved upon for many decades. Swiss researchers already managed to take cartilage tissue from the nose and used it to treat knee injuries. This only requires one surgery. The treatment options are currently only suited for limited cartilage damage caused by accidents for example. Extended damage such as osteoarthritis cannot be treated this way.

What should be some possibilitiesin trauma surgery ten years from nowusing tissue engineering?
Gille:
The body needs to be stimulated to where it is able to produce replacement tissue on its own. This is currently not yet possible but we are working on it.

What are the major obstacles to these developments in your opinion?
Gille:
If you want to use targeted growth factors in cartilage repair to create premium cartilage replacement, you need to try out and monitor many things. We are currently in the process of carefully approaching this subject. It is difficult to assess the effects of new treatments since it takes many years before we are able to determinereliable results. We have to monitor the successes over a long period of time before we can say with one hundred percent certainty that the treatment was successful. That’s why time is one of our biggest problems. If we manage to produce high-quality cartilage tissue, we might also be able to prevent subsequent osteoarthritis. Given this context, theterm known as bioprosthesis was coined.

Will we get body parts from the 3D printer or the lab in the future?
Gille: It will likely be a combination of both. The 3D printer provides a construct but there is no "life" in it yet.I can definitely envision for the printer to createa matrix that the body needs to fill with biology, with living human tissue so to speak. Technology and biology must collaborate to accomplish this.

Image: Lorraine Dindas; © B. Frommann

© B. Frommann

This interview was conducted by Lorraine Dindas and translated from German by Elena O'Meara..
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