Stem Cells in Orthopaedics

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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