ePoster #211 - 2013 ISAKOS Biennial Congress

Adipose-Derived Regenerative Cells Form New Hyaline Cartilage in Patients with Osteoarthritis

Hanno Pototschnig, MD, Munich, GERMANY
Rolf Krebs, Dr. med., MD, Munich, GERMANY
Philip B. Schoettle, MD, PhD, Assoc. Prof., Munich, GERMANY
Eckhard Alt, MD, Prof., Munich, GERMANY
ISAR Klinikum, Munich, GERMANY

FDA Status Not Applicable

Summary: Adipose-Derived Regenerative Cells Form New Hyaline Cartilage in Patients with Osteoarthritis

Abstract:
OBJECTIVE:
Cell-based treatments of cartilage defects have shown encouraging results in animal studies and in initial human case reports. Mesenchymal stromal cells provide immune-modulatory, anti-inflammatory and analgesic effects. However, the concept of transdifferentiation to hyaline cartilage is less evidenced and accepted.
With a novel point-of-care (POC) system, a high number of adipose derived regenerative cells (ADRC) (750 000 +- 250 000 cells per g adipose tissue) are obtained without the need for culturing. The resulting fresh autologous ADRC suspension contains a significantly higher amount of pluripotent cells (10%) compared to bone marrow concentrate (0.1%).
The aim of this prospective study was to evaluate the grade of filling of cartilage defects and the quality of the newly formed cartilage after application of this novel cell-based treatment at one year arthroscopic follow-up (FU).

MATERIAL AND METHODS:
Over a period of 12 months 10 female and 15 male patients (PX) suffering from OA of the knee grade 3-4 were operated by the same orthopedic surgeon. All PX were treated by ADRC, arthroscopic abrasion combined with Pridie drillings and, where indicated, by high tibial or supracondylar femoral osteotomy for malalignment correction. 60 ml abdominal adipose tissue was harvested by liposuction at time of arthroscopy. The CE-marked Transpose RTâ„¢ System (InGeneron Inc. Houston TX) was used at POC. An ADRC cell suspension (5-7 ml) was prepared within 60 minutes, and applied to the knee within the same operative procedure. Coverage of cartilage defects and quality of newly formed cartilage were evaluated by the operating surgeon at an arthroscopic one year FU.

RESULTS:
At FU (20/25 PX studied so far), average coverage of the cartilage defect of more than 95% was found in all PX. In one PX, one knee was treated with ADRCs as described above; while no ADRCs were administered to the other knee; otherwise, both knees were treated by the same arthroscopic procedure. At FU, in the knee with ADRC treatment, high quality cartilage arthroscopically appearing to be hyaline-like has been found; whereas, in the other knee where cells were not administered, the known rough fibrous cartilage of limited quality shows at one year FU. The histological assessment of the knee treated with ADRC reveals a normal three-layer hyaline cartilage, the other without cells respectively a fibrous cartilage.

CONCLUSION:
Arthroscopic FU and histological analysis demonstrate that, in the microenvironment of the knee, ADRC have the potential to repair cartilage by differentiation into new, three-layer typical hyaline cartilage. The InGeneron POC system is an easy to use, effective and safe system for POC therapy within one operative procedure. Results are superior to results of PX treated by conventional methods only. Multicenter studies with increased numbers of patients and longer FU time are currently validating those initial encouraging results.