Report for ICRS Newsletter
ICRS UK WORKSHOP ON CARTILAGE TRANSPLANTATION
Professors George Bentley and David Marsh held the second UK ICRS meeting in Stanmore, London on 28-29th January 2009. Mats Brittberg was guest speaker and told us about the good clinical success he is finding with a hyaluronan scaffold which he has a license to use with cells grown in his local laboratory, headed by Anders Lindahl. This can be applied via arthroscopic insertion, with reduced morbidity compared to arthrotomy. He also described other modifications including a membrane technique which helps to hold the layers of graft in place. He also reports increased use of combining these techniques with an osteotomy, which he now describes as his ‘favourite operation’.
Professor Kim from Korea described their product, ChondronTM from CellonTech, as an injectable form of ACI. An excellent lecture by Cosimo de Bari questioned the ability of non-cartilage stem cells as being unlikely to form stable chondrocytes. However, he suggested that if used in combination with other cells, they could be important in providing the trophic factors to drive cartilage formation.
Charlie Archer described his findings that cartilage itself contains progenitors or stem cells. These are cultured in his lab as clones from single cells; they have rapid rates of division and may be an option for cell therapies in the future. Bruce Caterson described the advantage of being old, as the antibodies he developed as a young scientist to chondroitin sulphate epitopes now appear to have the potential to identify stem cells in their niches. Other topics were discussed including legislation and licensing of cell culture facilities (I Swann), histology of repair tissue (S Roberts), characterising cells for implantation (D Suh, W Khan and S Kili) and models for future treatments (D Marsh).
ACTIVE is a prospectively randomised controlled trial of cell therapy in a ‘real world’ pragmatic design that avoids the difficulties of very selective trials. An update was given by James Richardson who reported that 258 patients are now recruited in this trial making it one of the largest trials in the field. Funding for 10 year follow up has been provided by the Medical Research Council, UK. All the surgeons, co-ordinators and independent assessors were congratulated on the hard work of reaching this point. Future trials were discussed and Richard Gray identified the need for (1) an important question to be asked and (2) large numbers to be entered into any trial to provide a reliable answer.
Workshops were held the next day discussing topics such as future basic science and research (led by C Archer & C de Bari), the problems in selecting patients (led by T Briggs & G Bentley), Problems of assessing results and outcomes (led by J Richardson, T Spalding & H Smith) and finally planning future trials (D Marsh & A Price). A consensus of the UK ICRS was to:
1. Establish a trial steering group led by G Bentley and T Briggs of Stanmore
2. Develop a protocol for the management of chondral defects to be led by T Spalding, Coventry
3. Investigate obtaining funding to establish a registry for all chondral defects treated in the UK, led by J Richardson & H Smith, Oswestry.
James B Richardson and Sally Roberts.