EP0989855A1 - Regeneration de cartilage dans l'arthrose a l'aide de cellules souches mesenchymateuses humaines - Google Patents

Regeneration de cartilage dans l'arthrose a l'aide de cellules souches mesenchymateuses humaines

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Publication number
EP0989855A1
EP0989855A1 EP98922211A EP98922211A EP0989855A1 EP 0989855 A1 EP0989855 A1 EP 0989855A1 EP 98922211 A EP98922211 A EP 98922211A EP 98922211 A EP98922211 A EP 98922211A EP 0989855 A1 EP0989855 A1 EP 0989855A1
Authority
EP
European Patent Office
Prior art keywords
cartilage
mesenchymal stem
composition
stem cells
cells
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
EP98922211A
Other languages
German (de)
English (en)
Other versions
EP0989855A4 (fr
Inventor
Victor M. Goldberg
Arnold I. Caplan
Francis P. Barry
David J. Fink
Daniel R. Marshak
James S. Burns
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Case Western Reserve University
Osiris Therapeutics Inc
Original Assignee
Case Western Reserve University
Osiris Therapeutics Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Case Western Reserve University, Osiris Therapeutics Inc filed Critical Case Western Reserve University
Priority to EP09008942A priority Critical patent/EP2110431A1/fr
Publication of EP0989855A1 publication Critical patent/EP0989855A1/fr
Publication of EP0989855A4 publication Critical patent/EP0989855A4/fr
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
    • A61L27/38—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells
    • A61L27/3886—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells comprising two or more cell types
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
    • A61L27/38—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells
    • A61L27/3804—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells characterised by specific cells or progenitors thereof, e.g. fibroblasts, connective tissue cells, kidney cells
    • A61L27/3817—Cartilage-forming cells, e.g. pre-chondrocytes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
    • A61L27/38—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells
    • A61L27/3804—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells characterised by specific cells or progenitors thereof, e.g. fibroblasts, connective tissue cells, kidney cells
    • A61L27/3834—Cells able to produce different cell types, e.g. hematopoietic stem cells, mesenchymal stem cells, marrow stromal cells, embryonic stem cells
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
    • A61L27/38—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells
    • A61L27/3839—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix containing added animal cells characterised by the site of application in the body
    • A61L27/3843—Connective tissue
    • A61L27/3852—Cartilage, e.g. meniscus
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N5/00—Undifferentiated human, animal or plant cells, e.g. cell lines; Tissues; Cultivation or maintenance thereof; Culture media therefor
    • C12N5/06—Animal cells or tissues; Human cells or tissues
    • C12N5/0602—Vertebrate cells
    • C12N5/0652—Cells of skeletal and connective tissues; Mesenchyme
    • C12N5/0655—Chondrocytes; Cartilage
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N5/00—Undifferentiated human, animal or plant cells, e.g. cell lines; Tissues; Cultivation or maintenance thereof; Culture media therefor
    • C12N5/06—Animal cells or tissues; Human cells or tissues
    • C12N5/0602—Vertebrate cells
    • C12N5/0652—Cells of skeletal and connective tissues; Mesenchyme
    • C12N5/0662—Stem cells
    • C12N5/0663—Bone marrow mesenchymal stem cells (BM-MSC)
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/12—Materials from mammals; Compositions comprising non-specified tissues or cells; Compositions comprising non-embryonic stem cells; Genetically modified cells
    • A61K2035/124—Materials from mammals; Compositions comprising non-specified tissues or cells; Compositions comprising non-embryonic stem cells; Genetically modified cells the cells being hematopoietic, bone marrow derived or blood cells
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2430/00—Materials or treatment for tissue regeneration
    • A61L2430/06—Materials or treatment for tissue regeneration for cartilage reconstruction, e.g. meniscus
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2500/00—Specific components of cell culture medium
    • C12N2500/30—Organic components
    • C12N2500/38—Vitamins
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2501/00—Active agents used in cell culture processes, e.g. differentation
    • C12N2501/10—Growth factors
    • C12N2501/15—Transforming growth factor beta (TGF-β)
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2501/00—Active agents used in cell culture processes, e.g. differentation
    • C12N2501/20—Cytokines; Chemokines
    • C12N2501/23—Interleukins [IL]
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2501/00—Active agents used in cell culture processes, e.g. differentation
    • C12N2501/30—Hormones
    • C12N2501/38—Hormones with nuclear receptors
    • C12N2501/39—Steroid hormones
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2501/00—Active agents used in cell culture processes, e.g. differentation
    • C12N2501/70—Enzymes
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
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    • C12N2533/00—Supports or coatings for cell culture, characterised by material
    • C12N2533/50—Proteins
    • C12N2533/54—Collagen; Gelatin

Definitions

  • Arthritis is the most common chronic musculos eletal disorder, affecting nearly 23 million patients or 9% of the U.S. population, with osteoarthritis (OA) comprising about 70% of that patient population. Arthritis is the leading age-related medical condition among women and ranks as the second most common such condition among men over 45 years of age. Deformities or orthopaedic joint impairment rank sixth among chronic disorders causing activity limitations .
  • the continued projected growth of the elderly as a percentage of the total population will increase the prevalence of arthritis. Increasing longevity of the elderly population will further accelerate the incidence of age-related conditions such as arthritis.
  • a significant portion of elderly arthritis sufferers are afflicted seriously enough to be considered disabled.
  • the disabled elderly population is expected to increase to over 7 million (18% of elderly) patients, and more than double to 15-20 million over the subsequent fifty years.
  • Hip osteoarthritis are the two most common forms of joint cartilage degeneration. Both forms of osteoarthritis occur most commonly in patients over 50 years old. Hip osteoarthritis is characterized by movement pain, joint stiffness and eventually deformity of the hip.
  • Osteoarthritis can be a primary degenerative process, result from childhood hip disorders, or as secondary to adult injury, infection, endocrine/metabolic disorders or bone dysplasia. Depending on the patient's age, their range of hip motion and clinical presentation, current operative procedures range from arthrodesis in young patients and osteotomy in patients under 60 years with reasonable hip motion, to hemi-, total, resection and cup arthroplasty. Knee osteoarthritis is characterized by pain, joint swelling, stiffness, motion loss and eventually deformity. As with the hip, knee osteoarthritis may be a primary degenerative process or result from a single or repeated knee injuries.
  • Osteoarthritis is a progressively degenerative disease, resulting in increasing pain, impairment and ultimately disability. While the available treatments seek to ameliorate pain or improve mobility, these treatments rarely modify the course of the disease, but rather attend to its consequences.
  • treatment is largely limited to addressing the symptoms of inflammation with non-steroidal anti-inflammatory drugs, steroids for acute exacerbation and some use of the more toxic Disease-Modifying Arthorheumatic Drugs (DMARDS, e.g. gold salts, penicillamine, and methotrexate) .
  • DMARDS Disease-Modifying Arthorheumatic Drugs
  • Clinical reports indicate that even the newest DMARDS, such as tenidap, will not materially improve the clinical outcomes. None of these treatments stop the progression of the condition nor regenerate damaged cartilage .
  • Evolving treatment procedures include arthroscopic debridement, abrasion/drilling of chondral defects and articular cartilage allografts .
  • chondrocytes Various groups have initiated cell seeding-absorbable matrix projects using mature differentiated chondrocytes .
  • One such group is developing a cell-seeded absorbable matrix for non-weight bearing cartilage, while another is using a purified bovine collagen matrix for meniscal repair .
  • tissue progenitor cells human mesenchymal stem cells or human mesenchymal stem cells
  • cartilage, bone, muscle, bone marrow stroma, ligament, tendon and connective tissue prenatally, and applying the same technology to the regeneration of injured and diseased tissue in adults.
  • Human mesenchymal stem cell technology provides not only multiple opportunities to regenerate cartilage, but other mesenchymal tissue as well, including bone, muscle, tendon, marrow stroma and dermis .
  • the regeneration of cartilage and other injured or diseased tissue is achieved by administration of an optimal number of human mesenchymal stem cells to the repair site in an appropriate biomatrix delivery device, without the need for a second surgical site to harvest normal tissue grafts.
  • opportunities also exist to use human mesenchymal stem cell technology for gene therapy, cancer treatment, bone marrow transplantation, and for the treatment of osteoporosis and osteoarthritis .
  • the present inventors have found that the human mesenchymal stem cell approach makes it possible to: (1) regenerate both shallow cartilage chondral defects and full thickness cartilage defects (osteochondral lesions) ; (2) broaden the suitable clinical population to routinely include middle-aged patients; (3) eliminate the use of autologous tissue grafts (mature cartilage and the periosteal covering) to repair an articular cartilage injury,- (4) regenerate other types of injured cartilage such as patellar and spinal disk cartilage; (5) regenerate articular joint cartilage in older patients with osteoarthritis; and (6) form new cartilage and subchondral bone which fully integrate into the adjacent normal tissue.
  • the process of developing the present invention focused on the use of autologous mesenchymal stem cells for the regeneration of stable hyaline cartilage in affected joints.
  • the articular cartilage of the knee and hip joints was the target of initial focus because the greatest morbidity and debilitating conditions in osteoarthritis arise from degeneration or degradation of these joints in the leg.
  • mesenchymal stem cells which are osteochondral precursors .
  • Mesenchymal stem cells for articular cartilage repair are combined with a controlled-resorption biodegradable matrix, preferably collagen-based products .
  • These mesenchymal stem cell-matrix implants initiate, de novo, tissue formation, and maintain and stabilize the articular defect during the repair process.
  • the types of biomatrix materials include sponges, foams or porous fabrics that form a three-dimensional scaffold for the support of mesenchymal stem cells .
  • These materials may be composed of collagen, gelatin, hyaluronan or derivatives thereof, or may consist of synthetic polymers, or may consist of composites of several different materials.
  • the different matrix configurations and collagen formulations will depend on the nature of the cartilage defect, and include those for both open surgical and arthroscopic procedures .
  • Several formulations of autologous, culture-expanded mesenchymal stem cells that serve as the basis of therapies for osteoarthritis are contemplated, depending on the stage, joint location, and severity of the disease.
  • a gel formulation that can be applied to osteochondral defects during arthroscopy
  • an injectable cell suspension for delivery directly to the synovial space
  • a molded mesenchymal stem cell-biomatrix product to re-surface joint surfaces in advanced cases.
  • the methods, compositions and implant devices of the invention are particularly suited for established conditions where superficial chondral or osteochondral defects can be diagnosed, but prior to the point where there is widespread joint instability and bone destruction.
  • a characteristic indicator of chondral defect is a visibly altered gait or use of the joint to accommodate the discomfort or stiffness resulting from tissue damage, and the objective of treatment is to regenerate full thickness articular cartilage at the site of the defects to thereby prevent the joint destabilization and rapid joint destruction which are common sequelae of advanced osteoarthritis .
  • Administration is by application of culture-expanded (preferably autologous) human mesenchymal stem cells in a biodegradable collagen and/or fibrin matrix implant and/or blood serum clots to the affected joint.
  • Application typically involves an arthroscopic procedure, which may include debridement of the defect prior to implantation of the human mesenchymal stem cell matrix.
  • the graft develops into full thickness cartilage with complete bonding to the subchondral bone.
  • a bone marrow aspirate (e.g. , approximately 10-20 ml) is obtained from the patient's medial posterior iliac crest using standard aseptic techniques in an outpatient procedure.
  • a Bone Marrow Collection and Transport Kit described herein, provides most or all of the material needed for safe and efficient collection, identification, and transportation of the collected bone marrow.
  • the double-sealed collection vessel is refrigerated until ready for human mesenchymal stem cell processing.
  • a single aspirate sample can be culture-expanded sufficiently to provide material for multiple lesions (4-6) during one or several arthroscopic procedures .
  • the cryopreservation techniques described herein permit retention of that portion of the aspirate that is not needed currently until it is required.
  • the implant is a two-- component product consisting of a culture-expanded human mesenchymal stem cell suspension or cryopreserved human mesenchymal stem cells in one sterile transport device and a flowable collagen matrix in another sterile transport device.
  • the contents of the two transport devices are admixed in a combined or third separate sterile implant chamber (closed system) which attaches by means of custom couplers (supplied with the procedure tray) to fit standard arthroscopes .
  • the implant chamber provides the means to freshly mix human mesenchymal stem cells with biomatrix at the time of the operative procedure .
  • the implant chamber is maintained for a sufficient gelation time for the cell-matrix to achieve the proper viscosity, and allows the orthopaedist or the rheumatologist to adjust the procedure and/or implant volume to conform to the actual lesion configuration.
  • Figures 1A-1F show the effect of TGF ⁇ on in vi tro chondrogenesis of human bone marrow-derived mesenchymal stem cells.
  • Figure 1A shows a cross-section of the human mesenchymal stem cell pellets as described in Example 1, at 10X magnification.
  • Figure IB shows a cross-section of the human mesenchymal stem cell pellets, maintained in culture in the presence of dexamethasone and TGF-E3 as described in Example 1, at 2OX magnification.
  • Figure IC shows a cross-section of the human mesenchymal stem cell pellets maintained in culture in the presence of dexamethasone and TGF- ⁇ 3 as described in Example 1 at 4OX magnification.
  • Figure ID shows a section of the same pellets, stained in control reactions without the addition of primary antibody, at 10X magnification.
  • Figure IE shows a section of the same pellets , stained in control reactions without the addition of primary antibody, at 2OX magnification.
  • Figure IF shows a section of the same pellets, stained in control reactions without the addition of primary antibody, at 4OX magnification.
  • Figures 2A-2F show the in vi tro chondrogenesis of human bone marrow-derived mesenchymal stem cells.
  • Figure 2A shows a cross-section of the human mesenchymal stem cell pellets maintained in culture without TGF- ⁇ 3 as described in Example 2 at 10X magnification.
  • Figure 2B shows a cross-section of human mesenchymal stem cell pellets maintained in culture without TGF-S3 as described in Example 2 at 2OX magnification.
  • Figure 2C shows a cross-section of the human mesenchymal stem cell pellets maintained in culture without TGF- ⁇ 3 as described in Example 2 at 4OX magnification.
  • Figure 2D shows a section of the same pellets, stained in control reactions without the addition of primary antibody, at 10X magnification.
  • Figure 2E shows a section of the same pellets, stained in control reactions without the addition of primary antibody, at 2OX magnification.
  • Figure 2F shows a section of the same pellets, stained in control reactions without the addition of primary antibody, at 4OX magnification.
  • Figures 3A-3C show an analysis of aggrecan GI domain by MALDI-TOF.
  • Figure 3A shows the MALDI-TOF mass spectrum of pig aggrecan GI domain collected using sinapinic acid matrix.
  • the peak labeled 1 corresponds to monomeric pig aggrecan GI domain.
  • Peaks 2,3 and 4 correspond to the dimer, timer and tetramer, respectively, of the molecule.
  • Figure 3B shows the spectrum obtained for an aggrecan GI isolated from human osteoarthritic tissue.
  • the peak labeled 1 corresponds to human aggrecan GI fragment generated in the cartilage tissue in vivo.
  • Peak 2 corresponds to link protein.
  • Figure 3C shows the same sample after reduction and carboxymethylation and removal of keratan sulfate chains by treatment with keratanase .
  • Peak 1 corresponds to aggrecan GI after removal of keratan sulfate chains .
  • Peak 2 corresponds to link protein.
  • Figures 4A-4G show serial sections of an mesenchymal stem cell implant after 4 weeks .
  • Figure 4A shows the implant stained with toluidine blue, at low magnification (2X) .
  • Figure 4B shows the implant stained with toluidine blue at 10X magnification.
  • Figure 4C is a section of the mesenchymal stem cell implant stained with chondroitin-4-sulfate (antibody 3B3) (10X) .
  • Figure 4D is a section of the mesenhymal stem cell implant stained with chondroitin-6-sulfate (ZB6) (10X) .
  • Figure 4E is a section of the mesenchymal stem cell implant stained with keratan sulfate (5D4) (10X) .
  • Figure 4F is a section of the mesenchymal stem cell implant stained with link protein (8A4) (10X) .
  • Figure 4G is a section of the mesenchymal stem cell implant stained with collagen type II (C4F6) (10X) .
  • Figures 5A-5B show (a) control tissue without cells or matrix carrier both stained with toluidine blue .
  • Figure 5B is a higher magnification of Figure 5A.
  • Figures 6A-6B show Dil-labeled cells in a standard 3 mm defect 6 days post-implantation.
  • Figure 6A shows fluorescence staining;
  • Figure 6B shows gross appearance.
  • the implants of the present invention include a suspension of purified fibrillar collagen or modified collagen and culture-expanded human mesenchymal stem cells (human mesenchymal stem cells) . These cells are the naturally occurring progenitors which give rise to multiple structural and connective tissues, including normal cartilage.
  • the devices or implants of the invention unlike preparations of cultured mature chondrocytes, have significantly more cartilage regeneration potential to restore hyaline cartilage which has degenerated at the site of a patient's osteoarthritic lesion (s). The ability to restore normal functional articular hyaline cartilage is due to the inclusion of cartilage progenitor cells .
  • a 10-20cc marrow aspirate is harvested from the patient which yields 1,000-5,000 human mesenchymal stem cells.
  • Approximately 10-50 million culture-expanded autologous human mesenchymal stem cells are then returned in the form of an implant .
  • Most implants can be administered arthroscopically.
  • the implants of the invention are indicated for use in regenerating articular cartilage which has been lost through degenerative osteoarthritis . They are particularly suitable for treating patients with ongoing joint swelling, pain, stiffness and motion loss resulting from degenerative cartilage fissuring, pitting and erosions.
  • Implants containing autologous human mesenchymal stem cells are chondrogenic and, as such, regenerate hyaline cartilage directly at the graft site where they are able to differentiate into cartilage-forming chondrocytes. This process is referred to as "regenerative tissue therapy".
  • the direct chondrogenic activity of human mesenchymal stem cells is superior to harvesting mature cartilage cells or other surgical techniques because human mesenchymal stem cells are able to recapitulate the original morphogenic (tissue-forming) events.
  • Harvested chondrocytes are not able to replenish the pool of newly formed chondrocytes which have differentiated from mesenchymal progenitor cells .
  • Cartilage loss resulting from osteoarthritis cannot be regenerated via "harvested chondrocytes or "site-directed matrix implants” because these methods either cannot regenerate the normal pattern of cartilage extracellular matrix formation or they rely on the availability of suitable reserves of human mesenchymal stem cells in surrounding tissue to infiltrate the matrix implant.
  • Patients over the age of 20-25 are generally unable to recruit or generate sufficient cartilage-forming progenitor cells to heal an osteoarthritic lesion.
  • nominal cartilage can be restored, together with subchondral bone, using the body's own natural repair mechanism.
  • the implant is formed of a biodegradable matrix (biomatrix) which is combined aseptically with the culture-expanded autologous human mesenchymal stem cells at the time of surgery.
  • the resulting mixture is then extruded through the mixing chamber either into the pre-drilled graft site directly, or into one of several other disposable implant molds.
  • the implant material human mesenchymal stem cells and biomatrix contracts, either within the implant site or for subsequent implantation in an arthroscopic or open procedure.
  • the rate at which the implant contracts may be varied by adding different amounts of contracting agent at the time human mesenchymal stem cells and biomatrix are combined.
  • a slower contracting implant is easily administered by percutaneous methods such as traditional arthroscopy, fluorography-guided direct injection, or through the disposable implantation device provided by the invention.
  • Mesenchymal stem cells regenerate new cartilage and subchondral bone which conforms to the shape of the graft site.
  • New cartilage and new subchondral bone is fully integrated with the surrounding mature host tissue and the collagen biomatrix components are eventually resorbed. Because the density of cartilage-forming units is uniform in the implant, the overall rate of new osteochondral tissue forms at similar rates regardless of the implant size .
  • Substantial new cartilage and bone is formed by 12-16 weeks after implantation, articular cartilage extracellular matrix continues to form and the subchondral bone remodeling process is already well underway.
  • tissue morphogenesis has taken place, only traces of the biomatrix remain, and the neotissue is nearly indistinguishable from surrounding host tissue.
  • the regenerated osteochondral tissue is thus incorporated into the patient's host cartilage and bone. Recapitulating the events of original endochondral tissue formation in the implant remodeling process ensures long-term structural integrity at the site of the previous osteoarthritic lesion. Only by starting with cartilage progenitor cells can the normal architecture of extracellular matrix molecules be formed.
  • the implants of the invention are prepared at the time of surgery using biomatrix material and the patient's own cells which have been previously harvested.
  • the cells are culture-expanded for approximately 3-6 weeks after harvest, until 1-2 days prior to the scheduled regenerative tissue therapy surgery .
  • a bone marrow aspirate from the medial posterior iliac crest is obtained by standard aseptic techniques in an out-patient procedure.
  • a minimum sample size of 10-20cc which may vary depending on patient age, is required to assure an adequate concentration of human mesenchymal stem cells in the primary cultures. Since human mesenchymal stem cells decline with age, it is important to obtain the proper starting stem cell concentration .
  • Nucleated cells are harvested from the bone marrow and subsequently processed in individual batches under sterile tissue culture conditions which promote selective attachment of the rare mesenchymal stem cells. Typically, only 100 to 500 human mesenchymal stem cells per 10-50 million nucleated marrow cells (or fewer in the case of elderly patients) attach and grow in tissue culture. This translates to approximately 5,000 human mesenchymal stem cells per lOcc marrow aspirate. The remainder of the cell population contains various types of non-adherent hematopoietic and stromal cells which are removed early in the cell culturing procedure.
  • Adherent marrow-derived human mesenchymal stem cells have homogeneous morphology, almost all being fibroblastic, with rare, polygonal cells. The adherent cells are seen as individual cells or small colonies of only a few cells on day 3; however, they replicate rapidly and form colonies of 50-200 cells within the first week of culture. By 10-14 days , the colonies of mesenchymal stem cells have expanded in size with each colony containing several hundred to several thousand cells .
  • each primary human mesenchymal stem cell culture is passaged into new culture vessels when the culture becomes about 80-90% confluent.
  • Cells in newly passaged cultures attach to form a uniformly distributed layer of cells which are 25-35% confluent at the time they are passaged.
  • Cells continue to divide and are again passaged when cell density reaches about 80-90% confluence, yielding an average of 5 million cells per T-flask culture vessel .
  • the human mesenchymal stem cell preparations are preferably culture-expanded in a chemically-defined medium which does not require the addition of fetal calf serum or other serum supplements.
  • This medium is the subject of copending, commonly assigned U.S. patent application serial no. 08/464,599 entitled “Chemically Defined Medium for Human Mesenchymal Stem Cells, filed June 5, 1995.
  • Cells from each culture vessel can be replated many times without a loss in the osteochondrogenic potential of the cells. Therefore, a single primary culture starting with 100 to 500 adherent human mesenchymal stem cells can be expanded to well over one billion (10 9 ) cells. Typically, however, a small l0-20cc marrow aspirate provides 25 primary culture vessels of up to 5 million cells, and consequently, sufficient cells for most implants can be obtained in fewer than 2-3 passages.
  • the present invention is directed, inter alia , to the evolution of a regenerative tissue therapy using human mesenchymal stem cells to regenerate cartilage lost due to osteoarthritis .
  • This effort is aimed at developing a truly osteochondral therapy; that is, to create cartilage and subchondral bone tissue at critical sites rather than simply treating the symptoms of osteoarthritis .
  • This approach to the problem is novel because it utilizes the replacement of the early progenitors of bone formation at the cellular level.
  • the cell-based regeneration of bone will be designed to be effective in conjunction with diet, exercise, and other preventative therapies.
  • the implant preparation and regenerative tissue therapy of the invention are envisaged to improve significantly the quality of life for the osteoarthritic patient .
  • the mesenchymal stem cells are maintained in a sterile liquid suspension at between 2°C and 8°C (36°F and 46°F) until the time of the implant procedure. All aspects of the human mesenchymal stem cell implant procedure should be performed in accordance with accepted standards for joint arthroscopy management .
  • the premeasured biomatrix and contracting catalyst are combined with the autologous mesenchymal stem cells by gently passing them through the mixing chamber. Once mixing is complete, the viscous slurry of material may be extruded through the implant injector into the defect site using any one of the accepted delivery systems.
  • the implant contracts and conforms to the shape or contours of the graft bed directly, or it can contract and be molded ex vivo .
  • the implant is then removed, trimmed to fit the precise dimensions of the defect site, and implanted directly in the graft bed. Coverage of the implant and graft bed with soft tissue should then be achieved to complete the procedure.
  • the implants of the present invention are contraindicated (1) in sites with significant vascular impairment proximal to the implant site, (2) in the presence of systemic bone or cartilage disorders, (3) where substantial joint destabilization has occurred, including extensive osteophyte formation (4) where a substantial portion of the weight-bearing articular cartilage surface has eroded, (5) in an infected wound site, or (6) in femoral neck fractures or fractures of the epiphyseal plate.
  • Bone marrow collected with the bone marrow collection and transport kit described herein should be processed according to the protocol described herein.
  • Prep Tray povidone iodine swab sticks (1% available iodine) (3) ; paper towel; fenestrated drape; and hospital drape .
  • Procedure Tray Jamshidi bone marrow biopsy/aspiration needle, 4"; Illinois sternal/iliac aspiration needle, 15GA; bone marrow transport vessel, 20cc; syringe (lOcc) , Luer slip; syringe (20cc) , Luer slip; syringe (5cc) , with 20GA x 1 1/2" needle; syringe (lOcc) , Luer slip; 21 GA x 1 1/2" needle; 25 GA x 5/8" needle; lidocaine hydrochloride USP, 1%, 5ml (2); Heparin USP, 10,000 U/ml, 5ml; scalpel blade with handle; gauze sponges (5) ; elastic bandage; probe; and plastic bags, (2) ;
  • Stem Cell Transport Container protective wrap for transport vessel; plastic bag for ice; three (3) cold blocks; contents of unopened, undamaged package are sterile and nonpyrogenic .
  • the implant kit contains : biomatrix in premeasured sterile matrix container; human mesenchymal stem cells preferably autologous, in premeasured sterile cell culture chamber or syringe (10 million, 25 million, 50 million human mesenchymal stem cells or custom implants) ; mixing chamber; arthroscopic graft site preparation instruments; and arthroscopic graft site implantation instruments; contents of unopened, undamaged packages are sterile and nonpyrogenic . Kits should be stored at refrigerated conditions between 20°C and 80°C (36°F and 46°F) .
  • Regenerative therapy in accordance with the invention is envisaged to be useful in the presence of other symptomatic treatments , such as chronic analgesic or anti-inflammatory medicines.
  • symptomatic treatments such as chronic analgesic or anti-inflammatory medicines.
  • osteoarthritis therapy contemplated include those described in more detail below.
  • This aspect focuses on the identification of molecules regulating mesenchymal stem cells during chondrogenic differentiation, including factors controlling the development of articular hyaline cartilage.
  • vi tro it has been possible to culture human mesenchymal stem cells as "pellets" or aggregates under conditions that promote chondrogenesis in serum-free, defined media. This system permits the screening of molecules for chondrogenic potential in vi tro .
  • Molecules that regulate gene expression are useful for monitoring chondrogenesis in vi tro, and make it possible to demonstrate, for each batch of cells, that 1) the mesenchymal stem cells are maintained in an undifferentiated state and, 2) once committed, the mesenchymal stem cell-derived progeny cells are capable of progressing towards articular chondrocytes.
  • Molecules that are secreted from the developing chondrocytes are helpful in monitoring the chondrogenic process in vivo .
  • model systems such as cultured articular chondrocytes, fibroblastic cell lines, and cultured fragments of cartilage in attempts to discover factors influencing chondrocyte formation, maintenance, and degradation.
  • These models are best at showing the static profile of chondrocytes, that is, observing the expression of type II collagen and aggrecan molecules, for example, and screening factors that might up-regulate metalloproteinases or inappropriate collagens .
  • the human mesenchymal stem cells represent a cellular model system that permits examining the dynamic commitment and differentiation of the cells down the chondrogenic lineage, replicating the events that occur during fetal development .
  • Figure 1 shows a cross section of such a pellet culture after three weeks in defined media.
  • the basal media of the culture must contain sufficient sulfate and proline content to fuel the formation of sulfated proteoglycans and collagen, respectively.
  • Ascorbic acid is also added to ensure proper collagen synthesis. Oxygen tension in the media is likely to be important to the selectivity and rate of differentiation, as chondrogenesis appears to be preferred at lower p0 2 .
  • TGF-j33 causes more rapid induction of the phenotypic changes as defined by metachromatic staining with toluidine blue, morphology, and collagen H expression.
  • TGF- / 33 induces expression of type II collagen and link protein more rapidly than TGF- / 31, and causes suppression of type I collagen. This suggests that TGF- 3 might be useful to accelerate chondrogenesis in vivo in an implant, or to help mesenchymal stem cells commit quickly to the chondrocyte lineage in the manuf cturing culture system, prior to implantation.
  • cytokines have been implicated in the degradation of the extra-cellular matrix and the suppression of the chondrocytic phenotype expressed by articular chondrocytes in culture.
  • IL-1 (7) , IL-6, and TNF- ⁇ (8) appear to enhance the degradation of cartilage matrix by up regulating expression of metalloproteases with specificity for aggrecan and type R collagen. They also suppress the expression of type H collagen, aggrecan, and other proteoglycans (10) .
  • Other cytokines, such as IL-4 and IL-10 appear to have a chondroprotective effect (11) . Therefore, it is of interest to understand the effects of cytokines, such as IL-1, on human mesenchymal stem cells .
  • mesenchymal stem cells produce several cytokines constitutively, including M-CSF and stem cell factor (SCF, also known as c-kit ligand) .
  • M-CSF mesenchymal stem cells
  • SCF stem cell factor
  • the mesenchymal stem cells produce a variety of hematopoietic cytokines , such as G-CSF, GM-CSF, IL-6, IL-11, among others. This has been interpreted to reflect the differentiation of the mesenchymal stem cells down the lineage of bone marrow stromal fibroblasts, the cells that form the microenvironment in the marrow for hematopoiesis .
  • IL-1 treatment dramatically up-regulates the production of the IL-1 itself from human mesenchymal stem cells.
  • IL-l treatment appears to be detrimental to the chondrogenesis of human mesenchymal stem cells. This suggests that inhibitors of IL-1 function and suppression of inflammatory reactions would be important parameters to control in mesenchymal stem cell-directed cartilage regeneration .
  • OA osteoarthritis
  • proprietary reagents and advanced biochemical methods are employed to measure the number and distribution of mesenchymal stem cells and molecular markers from OA patient and animal models of OA.
  • Assays are used as outcome measures for the work in vi tro as well as in vivo in animals and humans.
  • the assay measurements provide information as to the state of the extracellular matrix, as well as the cells and cytokines present during OA.
  • the mesenchymal stem cell-based regenerative therapy not only restores functional joints, but also reverses the abnormal levels of the various degenerative markers in the assays .
  • the measurements are preferably made on cultured cells and their products, such as conditioned media in vi tro, and from samples of synovial fluid, in vivo .
  • the synovium represents the most accessible source of material in vivo, although it is possible that other physiological fluids (blood, plasma, serum, urine, or lymph) could provide useful information on more systemic factors.
  • the assays cover: 1) the cellular environment, that is, the phenotype of cells present at the time of testing; 2) the endocrine environment, that is, the cytokines, hormones, and other soluble factors present; and 3) the matrix environment, that is, the materials comprising the insoluble, extracellular compartment, and their by-products . Analysis by NMR and other imaging techniques provides additional information on the joint under examination, as well as gait analysis or other appropriate physical testing.
  • cytokines specifically IL- 1 and TNF- ⁇
  • cytokines have deleterious effects on cartilage by: 1) suppressing collagen H synthesis while stimulating collagen I production (7) ; 2) inducing metalloproteases, such as collagenase-3 , and blocking protease inhibitors (e.g. TIMP-1) (20) ; 3) activating aggrecan breakdown including keratan sulfate release; and 4) inducing other cytokines that support hematopoietic differentiation, such as IL-6, possibly promoting the production of neutrophils, macrophages and other cells harmful to cartilage.
  • IGF- I (21) and TGF-31 (22) have been found to have the opposite effects from IL-1 in cultured articular chondrocytes, and may be able to block the actions of IL-1.
  • IGF- I (21) and TGF-31 (22) have been found to have the opposite effects from IL-1 in cultured articular chondrocytes, and may be able to block the actions of IL-1.
  • Inhibitors of metalloproteases is another promising avenue of drug development to arrest the degeneration of cartilage matrix, but will not produce new chondrogenesis at the OA joint.
  • Mesenchymal stem cell-based regenerative tissue therapy could supplement other modes of treatment. It is of critical importance to understand the cellular, hormonal , and matrix environment that mesenchymal stem cells will encounter in the OA joint.
  • HPLC high performance liquid chromatography
  • CE capillary electrophoresis
  • MS mass spectrometry
  • MALDI-TOF mass spectrometry
  • Patients with diagnosed OA at early, middle, and late stages provide marrow aspirates from the iliac crest and samples of synovial fluid of the knee joint, as well as peripheral blood.
  • long bone marrow e.g. femoral head or knee
  • cartilage biopsy explants are collected as well .
  • the tissue is dissociated to a mononuclear cell fraction and, from this, quantitation of various cell types is performed by flow cytometry.
  • chondrocytes are cultured under various conditions to obtain mesenchymal stem cells (SH2 antibody positive) , synovial fibroblasts, and monocytes/macrophages (CD45 positive) . Colony counts from each population and antibody reactivity are used for further characterization of the cell preparations.
  • articular chondrocytes can be obtained from biopsied cartilage, cells are subjected to a panel of PCR and antibody-based assays using, for example, the ILA marker of chondrocyte de-differentiation (Schwarz et al . , 1993) .
  • Synovial fluid and serum from OA patients are subjected to a battery of immunoassays for cytokines, hormones, and other growth factors.
  • cytokines ⁇ and ⁇
  • IL-6 IL-6
  • TNF-A TGF-0 (1,2, and 3
  • PTH PTH
  • IGF-1 thyroid hormones
  • thyroid hormones T3 and T4 .
  • high throughput robotic systems are used.
  • Synovial fluid and serum samples are screened from OA and aged-matched normal controls for matrix markers that are indicative of OA.
  • Matrix markers from serum include: COW and BSP as has been documented by Heinegard and coworkers (16) and keratan sulfate (KS) as has been shown by Thonar and coworkers (32) .
  • the same markers as well as collagen and other matrix proteins are also measured in synovial fluid.
  • Synovial fluid markers include the C- propeptide of collagen II, as well as other collagen II fragments, collagenase, and other metalloprotease activity .
  • Aggrecan G3 domain is a useful marker for matrix degradation, particularly when measured coordinately with the aggrecan GI domain and the related Link protein (15) .
  • biochemical and cellular markers are correlated with the clinical diagnosis and other parameters, as available, including high resolution NMR images; radiographic imaging, and composition of biopsy cartilage tissue. These techniques give useful information on the thickness of the joint cartilage, the joint space per se and, in cases of joint removal, biochemistry of the diseased tissue itself.
  • Mass spectrometry of osteoarthritic cartilage components Aggrecan, the major aggregating proteoglycan of cartilage, is degraded by proteolytic enzymes as part of the remodeling process. In osteoarthritis, aggrecan degradation occurs in an uncontrolled fashion, resulting in breakdown of the cartilage integrity. While aggrecan structure has been studied, changes between the normal and diseased states are not known in detail . Of particular interest are changes in the extent of glycosylation which may incease aggrecan proteolytic susceptibility. In order to define an aggrecan phenotype typical of osteoarthritic cartilage, a statistically significant number of patients should be studied. A technique capable of generating data rapidly that provides detailed information on the aggrecan structure from small quantities of tissue would be useful for this purpose.
  • MALDI-TOF analysis required sample treatment in guanidine hydrochloride .
  • GuHCl commonly regarded in the mass spectrometric community as a contaminant, is usually removed before protein analysis.
  • the denaturant enabled the analysis by breaking down non- covalent aggregrates of the sample molecules , as cartilage components tend to aggregate.
  • Cartilage was extracted with guanidine hydrochloride, dialyzed, fractionated by associative and dissociative cesium chloride density centrifugation and the aggrecan GI domain was isolated by chromatography.
  • MALDI-TOF mass spectrometry was then used to profile the heterogeneity of the aggrecan molecule and to measure the extent of glycosylation.
  • MALDI-TOF involved diluting the sample in a matrix solution, usually sinapinic acid for large proteins .
  • Isolated aggrecan GI domain was reduced and alkylated, and digested with trypsin.
  • the tryptic digest was separated chromatographically .
  • the digest for a control tissue was throughly characterized using a combination of mass spectrometry and Edman sequencing with respect to position and extent of post-translational modification and with respect to the C-terminus.
  • Experimental tissues were screened by liquid chromatography-mass spectrometry for changes occurring with respect to the control tissue.
  • FIG. 3A The results of the analysis of pig aggrecan are shown in Figure 3A.
  • the peak labeled 1 corresponds to monomeric pig aggrecan GI domain.
  • Peaks 2,3, and 4 correspond to the dimer, trimer, and tetramer, respectively, of the molecule.
  • any protein to show such a pattern was extremely unusual and illustrated the propensity of aggrecan GI domain to aggregate in solution.
  • Figure 3B shows the spectrum obtained for an aggrecan GI isolated from human osteoarthritic tissue .
  • the peak labeled 1 corresponds to human aggrecan GI fragment generated in the cartilage tissue in vivo .
  • the breadth of this peak is substantially greater relative to that observed in Figure 3A for the pig aggrecan GI and provides a measure of molecular heterogeneity.
  • the sharper peak labeled 2 corresponds to link protein.
  • Figure 3C shows human aggrecan GI after reduction and carboxymethylation.
  • the peak labeled 1 corresponds to aggrecan GI after removal of keratan sulfate chains.
  • the peak labeled 2 corresponds to link protein.
  • the peaks between 1 and 2 are believed to be link variants , also observed in Figure 3B.
  • the canine ACL-resection model (Pond-Nuki) (33) is the preferred system because besides human mesenchymal stem cells , the canine mesenchymal stem cells have been the best characterized preparations of the cells, and because canine has been the standard model system used for other mesenchymal stem cell-based products. Canine models are also standards of practice in experimental orthopaedics . As an alternative, the rabbit model developed by Moskowitz and coworkers (34) can be used. Rabbits are smaller and less expensive than dogs, allowing for larger numbers of experimental procedures. However, the biomechanical forces in the rabbit knee are quite different from the canine and human situation, and while freely mobile, the rabbits have restricted room for motion.
  • the canine model of OA develops ten weeks following transection of the anterior cruciate ligament (ACL) of one knee (stifle) joint by means of lateral arthrotomy.
  • ACL anterior cruciate ligament
  • the contralateral side can be used as a control although not ideal because any systemic endocrine changes could affect both sides, and compensatory mechanical forces may alter the joint space of the control side differently than would sham operated control animals.
  • the amount of collagen II and aggrecan protein and mRNA appear to increase dramatically, as if a repair attempt was in progress (37, 38) .
  • the canine ACL (Pond-Nuki) model appears to be the industry standard for OA therapeutics .
  • the rabbit model of OA employs resection of approximately 30% of the anterior aspect of the medial meniscus.
  • deterioration of the cartilage is evident from physical lesions, such as pits, ulcers, fissures and cysts, as well as from decreased matrix proteoglycan content .
  • Studies of the metabolic consequences of partial meniscectomy reveal that at early times following surgery there is increased cell proliferation, proteoglycan production and protein synthesis. However, the long-term effects of this procedure appear to be degenerative, ultimately resulting in loss of cellularity and matrix proteoglycan and increased osteophyte formation.
  • the partial meniscectomy model is representative of the degeneration seen clinically following meniscal injury.
  • the gel formulation of the implant of the invention is tested using skeletally mature, male dogs (>14 months of age, >30 kg) .
  • the animals Prior to surgery, the animals will undergo marrow aspirates from iliac crest, and autologous canine mesenchymal stem cells (cMSCs) are cultured.
  • cMSCs autologous canine mesenchymal stem cells
  • the anterior cruciate ligament is transected by lateral arthrotomy, and a separate cohort is sham operated.
  • the contralateral side can be used as another control .
  • implants are made arthroscopically into one or more lesion sites on the articular surface. While the canine model is different from the rabbit meniscectomy, this gel formulation is most effective early in the progression of the pathology.
  • the implant, device and/or composition of the invention utilizes autologous mesenchymal stem cells in a gel, liquid or molded configuration to regenerate the articular, hyaline cartilage via the developmental course seen during embryonic differentiation. This is fundamentally distinct from other cellular therapies because it harnesses the capacity of the earliest progenitor cells to form the multilayer tissue that has been eroded by disease. Three principal embodiments of implants, devices and compositions containing mesenchymal stem cells have been developed in accordance with the invention.
  • the first embodiment is a gel suspension of mesenchymal stem cells in bovine, acid processed Type I collagen.
  • Chemically cross-linked collagen can be manipulated quite easily and allowed to "gel in place” following arthroscopic injection of the liquid components. All matrix materials used are resorbable over a period of several months .
  • the gel materials include collagen gel alone, cross-linked collagen gel, fibrin glues and alternative formulations , including autologous fibrin gels .
  • the second formulation is a liquid suspension of autologous mesenchymal stem cells either in autologous serum or buffered saline that can be introduced directly into the synovial cavity.
  • the mesenchymal stem cells in the liquid suspension home directly towards the sites of lesions on the articular surface.
  • High doses (>10 8 cells) of mesenchymal stem cells can be infused without clumping and without ectopic tissue formation.
  • a third formulation in accordance with the invention, is in a moldable gel format so that orthopaedic surgeons can apply it directly to the affected surface in an open procedure.
  • IL-1 should be suppressed at the site of introduction of the mesenchymal stem cells, if cartilage is the desired resul .
  • Collagenases and other degradative enzymes should also be blocked to allow proper production of matrix material by the mesenchymal stem cells.
  • compounds that inhibit IL-1 e.g. IRAP
  • metalloproteinases e.g. Tenidap
  • Some preparation of the articular surface may be necessary via arthroscopic surgery, such as debriding the surface of the lesions and, perhaps, coating with a material suitable for the attachment of mesenchymal stem cells in vivo, such as fibronectin.
  • the concept of this formulation is to allow the mesenchymal stem cells to move directly to the surfaces that require their action.
  • the mesenchymal stem cells may need to be previously committed to the chondrogenic lineage so that they do not form additional bone on the exposed subchondral surfaces .
  • a particularly preferred embodiment is the molded gel matrix for resurfacing the entire condyle in advanced OA.
  • This is a molded gel containing mesenchymal stem cells, which is positioned on a structural support , such as a woven sheet of suture material .
  • An extension of this embodiment is a suture or other fibrous network, either pressed or woven, on which is impregnated and contracted a gel suspension of mesenchymal stem cells .
  • the implant is molded to the shape of the affected condylar surface, and held in place by suturing it to the periosteum or other mechanical means.
  • another material such as autologous fibrin glue can be used to hold the molded material in place .
  • Example 1 Mesenchymal stem cells derived from human bone marrow were cultured in DMEM (low glucose) with 10% fetal bovine serum until confluent, detached by trypsinization and transferred to minimal culture medium without FBS but with 10 M dexamethasone and ascorbic acid-2-phosphate .
  • the cells (0.2 x 10 6 ) were spun at low speed and maintained in the presence of dexamethasone and TGF/3-3 (10 ng/ml) . After 2 days the cells formed a pellet about 1 mm in diameter. They were maintained for 21 days and then stained for the presence of type II collagen using monoclonal antibody C4F6.
  • FIGS. 1A to IF illustrate cross sections of stained pellets .
  • Example 2 Cells were isolated from human bone marrow as described and were cultured under the conditions as described in Example 1 but without the addition of TGF/3-3. After 21 days cells were stained with an anti-collagen II polyclonal antibody (Rockland) . Under these conditions the cells developed a chondrogenic phenotype and synthesized and secreted collagen type II, as well as other cartilage markers such as link protein, keratan sulfate and COMP (cartilage oligomeric matrix protein) . In rabbit cells treated under the same conditions, the chondrogenic phenotype also developed, but in a host-dependent manner. Figures 2A - 2F illustrate cross sections of stained pellets.
  • the cartilage regeneration described in this example is directed toward the repair of focal full -thickness lesions in relatively young adults, generally resulting from sports-related or traumatic injuries.
  • the ultimate goal of the product development program is to regenerate articular cartilage destroyed by osteoarthritis .
  • Articular cartilage has a limited reparative capacity. Full thickness injuries that penetrate the subchondral bone undergo repair by a variety of mechanisms that generally fail to produce hyaline cartilage at the articular surface. In rabbits, repair of such lesions generally leads to fibrocartilaginous tissue. This generally progresses to fibrillated tissue after 6 months (Shapiro et al . , 1993) .
  • Mesenchymal Stem Cell (mesenchymal stem cell) based repair of osteochondral lesions has been investigated in a series of implant studies carried out at both Case Western Reserve University and the inventors in a standardized osteochondral defect model in the rabbit knee.
  • Adherent cells derived from tibia bone marrow aspirates were cultured by standardized procedures and implanted at the end of first passage. Full-thickness defects (6 mm long, 3 mm wide and 3 mm deep) were made on the weight bearing surface of the medial femoral condyle by drilling 2 adjacent holes and curetting the bridge between them. Mesenchymal stem cells were mixed with acid-soluble type I collagen and gelled prior to implantation. The cell-collagen gel was partially dehydrated and manually transferred to the prepared defect . Control defects were left unfilled (i.e., no cells and no vehicle) .
  • cells were labeled by incubation with the membrane-binding dye Dil (Molecular Probes) overnight, mixed with carrier autologous collagen gel, partially dehydrated and implanted into defects of 3 mm diameter. Control defects were left unfilled. Sections of approximately 1 mm were cut from the center of the defect, exposed to full spectrum light on a fluorescence microscope and photographed.
  • Dil membrane-binding dye Dil
  • FIG. 4A An example of autogolous mesenchymal stem cell -mediated articular cartilage repair 4 weeks after implantation is illustrated in Figure 4A, stained with toluidine blue.
  • Figures 4B-4G show serial sections of the same repair tissue at higher magnification.
  • Figures 5A and 5B show control tissue (i.e. empty defects which received no cells and no matrix) .
  • a fibrous layer is formed in most control defects.
  • Figures 6A and 6B illustrate the distribution of Dil-labeled mesenchymal stem cells 6 days pos -implanta ion.
  • TGF beta stimulates DNA synthesis in precartilage cells but depresses alkaline phosphatase activity in chondrocytes and the calcification of the cartilage extracellular matrix in vitro .

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Abstract

La présente invention permet de réparer le cartilage endommagé à la suite des effets dégénératifs de l'arthrose grâce à un procédé faisant appel à des cellules souches mésenchymateuses humaines, lequel procédé permet: (1) de régénérer le cartilage superficiel atteint d'anomalies cartilagineuses ainsi que le cartilage profond atteint d'anomalies telles que des lésions ostéo-cartilagineuses; (2) d'élargir la population clinique indiquée habituelle afin d'y inclure les patients d'âge moyen; (3) d'éviter l'utilisation de greffes de tissus autologues (cartilage mûr et couche périostique) dans la réparation d'une lésion du cartilage articulaire; (4) de régénérer d'autres types de cartilage atteint tel que le cartilage de la rotule et du disque spinal; (5) de régénérer le cartilage des articulations chez les patients âgés souffrant d'arthrose; et (6) de former un nouveau cartilage et os sous-chondral qui s'intègrent parfaitement dans les tissus normaux adjacents.
EP98922211A 1997-05-13 1998-05-13 Regeneration de cartilage dans l'arthrose a l'aide de cellules souches mesenchymateuses humaines Ceased EP0989855A4 (fr)

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US6777231B1 (en) 1999-03-10 2004-08-17 The Regents Of The University Of California Adipose-derived stem cells and lattices
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EP2110431A1 (fr) 2009-10-21

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