関節軟骨再生の現状と将来 ... - yakushi.pharm.or.jp

1 857 545 8585 1 4 3 e-mail: wakitani 126 S4 857 YAKUGAKU ZASSHI127(5) 857 863 (2007) 2007 The Pharmaceutical Society of Japan Reviews Present Status and Perspective of Articular Cartilage RegenerationShigeyuki WAKITANID epartment of Orthopaedic Surgery, osaka City University Graduate School of Medicine,1 4 3 Asahi, Abeno-ku, osaka 545 8585, Japan(Received January 16, 2007)Because the capacity of articular cartilage for repair is limited, defects are a major clinical problem, and there is atpresent no satisfactory clinical technique to regenerate cartilage defects.

2 Current clinical practice involves the bonestimulation technique, which breaks subchondral bone to facilitate cartilage repair from bone marrow derived cells andcytokines. This consists of multiple perforations, abrasions, and micro-fractures. However, with this procedure, car-tilage defects are repaired with brocartilage, which is known to be biochemically and biomechanically di erent fromnormal hyaline cartilage and degeneration occurs in the reparative tissue. Autologous chondrocyte implantation(ACI)for repair of human articular cartilage was reported in 1994, and approved by the USA Food and Drug Associationin1997.

3 This procedure has been performed for more than 20000 people all over the world, but its e ectiveness is stillcontroversial. Mosaic plasty was explored in the 1990s. Using this procedure, we can repair defects with hyaline car-tilage, but the donor site morbidity is unsolved. To explore a new method for cartilage repair, we transplanted autolo-gous culture-expanded bone marrow mesenchymal cells into articular cartilage defects. Clinical symptoms were impro-red but the repair cartilage was not hyaline cartilage.

4 Further improvement is required. Many investigations have beenmade in the search for better means of repair, including gene transduction and the addition of growth factors during cellculture. In addition to bone marrow mesenchymal cells, synovial cells, adipocytes, muscle cells, etc. have been words chondrocyte; progenitor cell; transplantation1. 1 1997 10 2 2.

5 70 858858 Vol. 127 (2007) 3. 1 1990 mosaic plasty 2 3-1.

6 Marrow Stimulation Tech-nique) multiple perforation 1)abrasion 2)microfracture 3) 3 microfracture 4) 3-2. 1 tissuebanking system 2004 5) tissue bank-ing system mosaic plasty 6)

7 7)4. 4-1. 1968 8) 9,10) 1 tissue banking system Advanced Tissue Science 2002 Smith & Nephew 4-2.

8 859859No. 5 1989 Grande 11)1994 Brittberg 12) 1997 Gen-zyme Biosurgery 2 1 1994 13) sham 2000 mosaic plasty 2003 2 randomized controlled trial mosaic plasty 14) 15) letter to the editor 16,17) 2 2004 mosaic plasty microfracture randomized controlled tri-al 2 18)

9 Microfracture 2005 microfracture debridement ran-domized controlled trial 19) 20) 15 FDA 9 5. 5-1.

10 Di usion chamber 20 21) 22,23) 1999 24) 25) 860860 Vol.