Stem Cells in Orthopaedics - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE -

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Wednesday 31 January 2018

Stem Cells in Orthopaedics


  • stem cells : specialized cells that can self renew indefinitely – also can differentiate into more mature cells with specific functions
  • seen in
    • inner cell mass of embryo
    • some fetal tissues
    • umbilical cord
    • placenta
    • in some adult organs eg. Neural stem cells in brain : can give rise to neurons, glial cells, astrocytes
      • but difficult to purify and culture
      • only used examples are bone marrow – and skin
  • some types give rise to various types of tissues in that organ eg. Neural stem cell
  • some types give rise to multiple types of tissues in more than one organ : multi potent eg. Embryonic stem cells
    • embryonic stem cells are easily culturable
  • some cells can give rise to wide range of tissue types : pluripotent
Mesenchymal stem cells
  • main role in embryo bone formation – and adult fracture repair and remodeling
  • replicate themselves – some parts are committed to colonies of osteoblasts, chondrocytes, adipocytes – result in formation of bone, cartilage, tendon, ligament, muscle
  • this can be induced by certain inducing agents
    • dexamethasone
    • 1.25 dihydroxyvitamin D3
    • osteogenin
    • osteogenic growth peptide
    • cytokines like BMP
    • TGF-beta
  • bone marrow and umbilical cord contains mesenchymal stem cells
Hematopoetic stem cells
  • only stem cells commonly used presently to treat human diseases
  • leukemia, lymphoma, inherited blood disorders
Current therapy advances
  • tissue cultured skin cells : treating burns and ulcers
  • cultured cartilage cells : treating articular defects
Role in fracture repair
  • needs undifferentiated osteochondral progenitor cells – to mature into osteocytes and chondrocytes
  • marrow and periosteal derived progenitor cells – have been shown to differentiate to produce bone and cartilage in many studies
  • but this depends heavily on many cytokines esp.TGF beta super family
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