Supplementary MaterialsVideo 1 Cartilage repair in a knee using Wharton’s jellyCderived
June 14, 2019
Supplementary MaterialsVideo 1 Cartilage repair in a knee using Wharton’s jellyCderived mesenchymal stem cells (WJ-MSCs) embedded onto type I/III collagen scaffolding and implanted in a minimally invasive fashion using dry arthroscopy. has been further developed to provide cell-based cartilage repair using MSCs that have the potential to be used in an off-the-shelf manner, without the need for autologous tissue harvest. Precursor MSCs can be isolated in abundance from the Wharton’s jelly of umbilical cord tissue. These cells have been shown to have the desired capacity for proliferation, differentiation, and release of trophic factors that make them an excellent candidate for use in the clinical setting to provide cell-based restoration of hyaline-like cartilage. Although allogeneic in nature, these cells stimulate little or no host immune response and can be stored for long periods while maintaining viability. We present a technique of cartilage repair in the knee using Wharton’s jellyCderived MSCs embedded onto scaffolding and implanted in a minimally invasive fashion using dry arthroscopy. Injury to articular cartilage is often associated with progressive cartilage wear that may result in osteoarthritic changes to the joint and worsening pain and dysfunction. There is limited inherent capacity for self-regeneration of cartilage lesions, and this has been a prominent focus?in the development of treatment strategies. Cell-based cartilage repair techniques such as autologous chondrocyte implantation have shown good to excellent clinical outcomes and hyaline-like cartilage restoration; however, these are 2-step techniques that require the patient GANT61 inhibition to undergo multiple surgical procedures. Cell-based repair using scaffolding embedded with mesenchymal stem cells (MSCs) sourced from bone marrow aspirate concentrate, such as the technique of hyaluronic acid-based scaffold embedded with bone marrow aspirate concentrate (HA-BMAC), is receiving increasing attention by clinicians because of the encouraging medium-term clinical outcomes reported and the capacity to restore hyaline-like cartilage.1, 2 One-stage cell-based cartilage repair techniques using stem cells are highly advantageous, given the potential for achieving clinical success in the setting of a cost-controlled method of treatment that avoids exposing the patient to a second surgical procedure. In addition to a source of precursor cells for cartilage restoration, MSCs provide numerous trophic and anti-inflammatory factors that provide a favorable environment for GANT61 inhibition chondrogenesis. Although these cells may be obtained from an autologous source such as bone marrow or adipose tissue, precursor cells may also be isolated in abundance from allogeneic sources, such as the Wharton’s jelly of human umbilical cords. Wharton’s jelly is a tissue that surrounds umbilical cord blood vessels and contains high concentrations of precursor MSCs that have increased proliferation and differentiation capabilities compared with adult sources of stem cells.3 Use of such allogeneic cells may be performed in a clinical setting without eliciting an immune response from the host,4, 5 and they do not undergo malignant transformation.6 Furthermore, suspensions of MSCs sourced from Wharton’s jelly may be stored for long periods while maintaining cell viability, allowing for off-the-shelf use. Recent developments in cell-based cartilage repair techniques that use dry arthroscopic methods have further advanced this field, given the advantages of a minimally invasive technique that reduces morbidity and optimizes postoperative rehabilitation progression.7, 8 This Technical Note describes a method of cell-based cartilage repair using allogeneic MSCs sourced from Wharton’s jelly (WJ-MSCs) that are embedded onto a type I/III collagen scaffold and implanted under dry arthroscopy (Video 1). Surgical Procedure Cell Culture and Preparation of WJ-MSC Isolate Umbilical cord sections are collected after informed consent is obtained from the donor mother in cases of either cesarean or natural delivery (Fig 1A). The samples of umbilical cord tissue are maintained in a temperature-controlled environment and are processed within 48?hours of procurement. The umbilical cord segment is washed in a sterile solution of saline and antibiotic-antimycotic fluid and then portioned into 2-cm-long pieces, followed by removal of blood vessels to isolate GANT61 inhibition the Wharton’s jelly. The isolated Wharton’s jelly is portioned into 2-cm3 fragments, which are then cultured in xeno-free medium supplemented with antibiotics. After 2 to 3 3?weeks Teriparatide Acetate of culture incubation at 37C, stem cells are collected after reaching 90% confluence (Fig 1C), and the remaining tissue is discarded. These.