A tissue engineering-based approach has become a possible solution for the treatment of chondral lesions. Actually, autologous chondrocytes seeded on biodegradable scaffolds for cell proliferation were successfully developed. However, these techniques promote cartilaginous but not bony regeneration. Therefore a new experimental approach involving mesenchymal stem cells (MSC) has been introduced.

A 31-year-old man affected by massive osteonecrosis of the right femoral head was selected to begin this study. The MSC were isolated from the bone marrow harvested from the patient’s iliac crest. After a 3-week monolayer expansion, cells were seeded and cultured onto hyaluronan-based three-dimensional scaffolds and DBM spongy chips, used to regenerate the cartilaginous and the bony portion, respectively. After a 2-week cultivation, constructs were implanted inside the osteochondral defect using the transtrochanteric approach under arthroscopic control. The patient underwent clinical, X-ray and MRI control during the first 6 months after operation.

Pluripotent MSC may be a promising strategy for osteochondral defect reconstruction due to their capacity to differentiate in vivo along chondrocytic and osteoblastic lineages. This ability, combined with two different kinds of three-dimensional scaffolds, permits simultaneous bone and cartilage tissue regeneration. The preliminary results are encouraging but a more precise judgement of the effectiveness of this method requires longer follow-up.

Aims: The maintenance of the original phenotype by isolated chondrocytes grown in vitro is an important requisite for their use in repairing damaged articular cartilage. The methods to verify the expression of cartilage specific molecules usually involve destructive procedures to recover the cells from the scaffolds for tests. The aim of this study was to find a soluble marker able to attest the occurrence of a differentiation process by chondrocytes grown onto a biomaterial used for cell transplantation. We turned our attention to cathepsin B which is known to be abnormally synthesized in de-differentiated chondrocytes and scarcely produced in the differentiated ones.

Methods: The production of cathepsin B by human articular chondrocytes expanded in vitro and then grown onto a hyaluronan-based polymer derivative (Hyaff“-11) three-dimensional scaffold was evaluated with a specific ELISA and by immunohistochemical analysis at different experimental times (1hour, 1 day, 7, 14, 21 days) together with the expression of mRNA by Real Time PCR.

Results: Cathepsin B is always secreted by the cells grown onto the biomaterial but the protein levels increased from the first day after seeding up to 7 days (p< 0.01), then decreased progressively and significantly until day 21 (p< 0.01). The immunohistological data confirmed those obtained by the ELISA test. Cathepsin B staining was particularly evident at day 7 after cells were seeded onto the biomaterial, and then progressively decreased up to 21 days; at this experimental time point, the totality of cells were negative. Real-time PCR monitoring with the LightCycler using fluorescent dye allowed rapid and sensitive detection of cathepsin B mRNAs from the patient samples. The mRNA levels increased for up to 7 days of culture and slightly decreased until day 21. However, no significant differences were observed.

Conclusions: We can identify in cathepsin B a soluble marker of differentiated chondrocytes phenotype useful in the monitoring of autologous chondrocyte transplantation performed by means of different carriers. Its low concentration in the constructs culture medium could be indicative of a phenotypic stability. The introduction of mature cells inside the chondral defects could help to regenerate damaged hyaline articular cartilage better and faster.