Severe types of arthroses, which can heavily affect sufferers’ quality of life and sometimes mean replacing worn-out cartilage with a prosthesis, could be treated by grafting cartilage from the patient's own nasal septum in the future.
A team from the Department of Biomedicine at Basel University, which has been involved in research of this kind for at least four years, together with orthopaedic surgeons and colleagues from hospitals in various countries, has published the results of a trial in a journal entitled Science Translational Medicine, and these results finally offer clear confirmation after several unsuccessful attempts. The study was carried out in partnership with, among others, the Rizzoli Orthopaedic Institute in Bologna and Milan Polytechnic. Case Western Reserve University in Cleveland (USA) also took part in the trial.
After promising results on animals (mice and sheep) the researchers applied their technique to humans. Their first patients were two young boys with severe arthrosis. The Basel scientists first took cartilage cells (chondrocytes) from the nasal septum of the two patients and placed them in cultures in advanced laboratories in order to duplicate them until they formed a uniform layer. They were then re-implanted into their knees.
A powerful anti-inflammatory effect
The first thing to verify, once the cells were transplanted, was how well they could survive in the microenvironment of an arthritic knee. Unlike cartilage damaged by trauma, the joint tissues in a knee of this kind are chronically inflamed, which might have destroyed the Implant.
However, everything went extremely well. Researchers noticed that the new cells had a powerful anti-inflammatory action and withstood mechanical stimuli very well. In other words, they not only replace dead or damaged cells, but also help reduce inflammation and fight arthrosis.
This is probably because certain substances produced by cartilage cells from the nose block the inflammatory circuits (the technical term is WNT signalling pathways) that are chronically active in arthrosis cells. At the same time, they stimulate new cells that take the place of the diseased ones – the embryonic origin of cartilage tissue is the same, whether from the nose or the knee joints – and no significant side effects have been reported.
A congenital defect
Both young people experimented on showed a marked improvement, which was also confirmed – in one of them – by MRI scans. Theysuffered from arthrosis caused by an imperfect alignment of the joints, a congenital defect that can be corrected through surgery. The researchers believe that by implanting nasal cartilage the patients can live a normal, pain-free life without the need for prostheses.
"Our results have allowed us to pave a biological pathway for a new treatment, and we are cautiously optimistic," said Ivan Martin, a researcher at Basel University’s Department of Biomedical Engineering and co-author of the study.
Obviously, the positive outcome in this case will have to be confirmed in a larger number of patients, a study for which the hospital's own Innovation Focus Fund for regenerative surgery has already awarded a grant to researchers and surgeons.
Arthrosis (also known as osteoarthritis) is a degeneration of joint cartilage, most commonly in the knee or hip, but also at base of the thumb and in other parts of the body. It affects a large number of people, especially the elderly, although in many cases it has no symptoms. There are various possible causes, but it is most prevalent in people who have worked in heavy manual labour for long periods of time or have played sports intensely.