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      American Society for Bone and Mineral Research‐Orthopaedic Research Society Joint Task Force Report on Cell‐Based Therapies

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          Abstract

          Cell-based therapies, defined here as the delivery of cells in vivo to treat disease, have recently gained increasing public attention as a potentially promising approach to restore structure and function to musculoskeletal tissues. Although cell-based therapy has the potential to improve the treatment of disorders of the musculoskeletal system, there is also the possibility of misuse and misrepresentation of the efficacy of such treatments. The medical literature contains anecdotal reports and research studies, along with web-based marketing and patient testimonials supporting cell-based therapy. Both the American Society for Bone and Mineral Research (ASBMR) and the Orthopaedic Research Society (ORS) are committed to ensuring that the potential of cell-based therapies is realized through rigorous, reproducible, and clinically meaningful scientific discovery. The two organizations convened a multidisciplinary and international Task Force composed of physicians, surgeons, and scientists who are recognized experts in the development and use of cell-based therapies. The Task Force was charged with defining the state-of-the art in cell-based therapies and identifying the gaps in knowledge and methodologies that should guide the research agenda. The efforts of this Task Force are designed to provide researchers and clinicians with a better understanding of the current state of the science and research needed to advance the study and use of cell-based therapies for skeletal tissues. The design and implementation of rigorous, thorough protocols will be critical to leveraging these innovative treatments and optimizing clinical and functional patient outcomes. In addition to providing specific recommendations and ethical considerations for preclinical and clinical investigations, this report concludes with an outline to address knowledge gaps in how to determine the cell autonomous and nonautonomous effects of a donor population used for bone regeneration. © 2019 American Society for Bone and Mineral Research.

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          Most cited references83

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          Concise review: the surface markers and identity of human mesenchymal stem cells.

          The concept of mesenchymal stem cells (MSCs) is becoming increasingly obscure due to the recent findings of heterogeneous populations with different levels of stemness within MSCs isolated by traditional plastic adherence. MSCs were originally identified in bone marrow and later detected in many other tissues. Currently, no cloning based on single surface marker is capable of isolating cells that satisfy the minimal criteria of MSCs from various tissue environments. Markers that associate with the stemness of MSCs await to be elucidated. A number of candidate MSC surface markers or markers possibly related to their stemness have been brought forward so far, including Stro-1, SSEA-4, CD271, and CD146, yet there is a large difference in their expression in various sources of MSCs. The exact identity of MSCs in vivo is not yet clear, although reports have suggested they may have a fibroblastic or pericytic origin. In this review, we revisit the reported expression of surface molecules in MSCs from various sources, aiming to assess their potential as MSC markers and define the critical panel for future investigation. We also discuss the relationship of MSCs to fibroblasts and pericytes in an attempt to shed light on their identity in vivo. © 2014 AlphaMed Press.
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            Regenerative effects of transplanted mesenchymal stem cells in fracture healing.

            Mesenchymal stem cells (MSC) have a therapeutic potential in patients with fractures to reduce the time of healing and treat nonunions. The use of MSC to treat fractures is attractive for several reasons. First, MSCs would be implementing conventional reparative process that seems to be defective or protracted. Secondly, the effects of MSCs treatment would be needed only for relatively brief duration of reparation. However, an integrated approach to define the multiple regenerative contributions of MSC to the fracture repair process is necessary before clinical trials are initiated. In this study, using a stabilized tibia fracture mouse model, we determined the dynamic migration of transplanted MSC to the fracture site, their contributions to the repair process initiation, and their role in modulating the injury-related inflammatory responses. Using MSC expressing luciferase, we determined by bioluminescence imaging that the MSC migration at the fracture site is time- and dose-dependent and, it is exclusively CXCR4-dependent. MSC improved the fracture healing affecting the callus biomechanical properties and such improvement correlated with an increase in cartilage and bone content, and changes in callus morphology as determined by micro-computed tomography and histological studies. Transplanting CMV-Cre-R26R-Lac Z-MSC, we found that MSCs engrafted within the callus endosteal niche. Using MSCs from BMP-2-Lac Z mice genetically modified using a bacterial artificial chromosome system to be beta-gal reporters for bone morphogenic protein 2 (BMP-2) expression, we found that MSCs contributed to the callus initiation by expressing BMP-2. The knowledge of the multiple MSC regenerative abilities in fracture healing will allow design of novel MSC-based therapies to treat fractures.
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              Use of mesenchymal stem cells in a collagen matrix for Achilles tendon repair.

              This investigation tested the hypothesis that delivering mesenchymal stem cell-seeded implants to a tendon gap model results in significantly improved repair biomechanics. Cultured, autologous, marrow-derived mesenchymal stem cells were suspended in a collagen gel delivery vehicle; the cell-gel composite was subsequently contracted onto a pretensioned suture. The resulting tissue prosthesis was then implanted into a 1-cm-long gap defect in the rabbit Achilles tendon. Identical procedures were performed on the contralateral tendon, but only the suture material was implanted. The tendon-implant constructs were evaluated 4, 8, and 12 weeks later by biomechanical and histological criteria. Significantly greater load-related structural and material properties were seen at all time intervals in the mesenchymal stem cell-treated tendons than in the contralateral, treated control repairs (p < 0.05), which contained suture alone with natural cell recruitment. The values were typically twice those for the control tissues at each time interval. Load-related material properties for the treated tissues also increased significantly over time (p < 0.05). The treated tissues had a significantly larger cross-sectional area (p < 0.05), and their collagen fibers appeared to be better aligned than those in the matched controls. The results indicate that delivering mesenchymal stem cell-contracted, organized collagen implants to large tendon defects can significantly improve the biomechanics, structure, and probably the function of the tendon after injury.
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                Author and article information

                Journal
                Journal of Bone and Mineral Research
                J Bone Miner Res
                Wiley
                0884-0431
                1523-4681
                September 23 2019
                January 2020
                September 23 2019
                January 2020
                : 35
                : 1
                : 3-17
                Affiliations
                [1 ]Department of Orthopaedic SurgerySchool of Medicine, Washington University St. Louis MO USA
                [2 ]The Chinese University of Hong Kong, Institute for Tissue Engineering and Regenerative Medicine Hong Kong SAR China
                [3 ]Department of MedicineUniversity of California Davis CA USA
                [4 ]Department of Biomedical EngineeringDepartment of Orthopaedics and Rehabilitation University of Rochester, Rochester NY USA
                [5 ]Regenerative Medicine InstituteNational University of Ireland Galway Galway Ireland
                [6 ]Department of PharmacologySchool of Medicine, Tulane University New Orleans LA USA
                [7 ]INSERM UMR 1163Imagine Institute Paris France
                [8 ]Department of EndocrinologyMayo Clinic Rochester MN USA
                [9 ]Department of OrthopaedicsEmory Healthcare, Emory University Tucker GA USA
                [10 ]Department of Orthopaedic SurgeryMcKay Orthopaedic Research Laboratory, University of Pennsylvania Philadelphia PA USA
                [11 ]College of Veterinary MedicineCornell University Ithaca NY USA
                [12 ]Phil and Penny Knight Campus for Accelerating Scientific ImpactUniversity of Oregon Eugene OR USA
                [13 ]Mount Sinai HospitalUniversity of Toronto Toronto, ON Canada
                [14 ]Orthopaedic Research and BiotechnologyKids Research Institute Westmead Australia
                [15 ]Center for Biomedical Ethics and HumanitiesUniversity of Virginia Charlottesville VA USA
                [16 ]Division of OrthodonticsCollege of Dental Medicine, Columbia University New York NY USA
                [17 ]Institute for Medical Science in SportsOsaka Health Science University Osaka Japan
                [18 ]Department of Orthopaedic Surgery, Sports Medicine Research Laboratory, Harvard Medical School/Boston Children's Hospital Boston MA USA
                [19 ]Hospital for Special Surgery New York NY USA
                [20 ]Department of Developmental BiologyHarvard School of Dental Medicine, Harvard University Boston MA USA
                [21 ]Department of Orthopedic SurgeryColumbia University New York NY USA
                [22 ]Center for Musculoskeletal ResearchUniversity of Rochester Rochester NY USA
                [23 ]University of Alabama at Birmingham AL USA
                Article
                10.1002/jbmr.3839
                31545883
                4b9eed7b-7fee-4607-99ad-d4fdc76ff2f4
                © 2020

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                http://doi.wiley.com/10.1002/tdm_license_1.1

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