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Sains Malaysiana 47(11)(2018): 2757–2767 http://dx.doi.org/10.17576/jsm-2018-4711-18
Strides towards the Realization
of Cure for Cartilage Defects and Osteoarthritis: The Limitation
and Regulatory Challenges (Kemajuan ke Arah Merealisasikan Perubatan
bagi Kecacatan Tulang Rawan dan Osteoartitis: Had dan Cabaran
Pengawalan) UDE CHINEDU
CLETUS1,
AZIZI
MISKON1
& RUSZYMAH BT HJ IDRUS2*
1Bio-artifical Organ
and Regenerative Medicine Unit, National Defence University of
Malaysia, Kem Sungai Besi, 57000 Kuala Lumpur, Federal Territory,
Malaysia 2Department of Physiology,
Medical Faculty National University of Malaysia Medical Center,
Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Federal
Territory, Malaysia Diserahkan: 25
Mac 2018/Diterima: 30 Julai 2018 ABSTRACT Despite remarkable mechanical
durability and strength, hyaline cartilage has very limited capacity
for self-repair when injured and over time, may degenerate to
osteoarthritis. We evaluated the most significant mile stones
attained, in the pursuit of cure for cartilage defects and osteoarthritis.
The basic treatment options include: Natural or physical therapy,
medications, nutritional supplements, nutriceuticals and chondroprotective
agents. Next are repairs and replacements, which include surgical
procedures: Debridement/chondroplasty, microfracturing, mosaicplasty,
periosteum transplantation, osteochondral autografting and allografting,
high tibial osteotomy and total knee arthroplasty. But, current
trend has shifted from repair, replacement, to most recently regeneration.
Regenerations include the cell and gene therapies. While cell
therapy involves the use of cells isolated from different tissues
to cause regeneration of cartilage; gene therapy involves the
selection of appropriate gene and optimal vector to incorporate
cDNA. There has been much positivity reported
with big animal models, which has led to several ongoing clinical
trials. Translations of these findings hold high promises, though
not without inherent regulatory hurdles. Considering the initial
success rates, there are increasing hopes of realizing these treatments
from bench to bedsides. Significant improvements in the treatment
of cartilage degenerations and osteoarthritis have been made so
far, but no gold standard delineated. Keywords: Cartilage defects;
cell therapy; osteoarthritis; tissue engineering ABSTRAK Meskipun mempunyai kekuatan
dan ketahanan mekanik yang luar biasa, rawan hialin mempunyai
kapasiti yang terhad untuk memulih sendiri apabila tercedera serta
akan merosot kepada osteoartitis. Penilaian bagi langkah paling
berkesan telah dilakukan dalam usaha mengubati kecacatan rawan
dan osteoartitis. Rawatan asas termasuk: terapi semula jadi atau
fizikal, ubat-ubatan, pemakanan tambahan, nutriseutis dan agen
kondropelindung. Selepas itu adalah pembaikan dan penggantian
melalui pembedahan: Debridemen/kondroplasti, mikropatah, mozaikplasti,
pemindahan periosteum, autocantuman dan alocantuman osteokondral,
osteotomi tibial tinggi dan jumlah artroplasti lutut. Namun, trend
terbaru beralih daripada pembaikan dan penggantian kepada penjanaan
semula. Penjanaan semula termasuk terapi sel dan gen. Terapi sel
melibatkan penggunaan sel-sel yang diasingkan daripada tisu yang
berbeza untuk penjanaan semula rawan manakala terapi gen pula
melibatkan pemilihan gen yang sesuai dan vektor optimum untuk
menggabungkan cDNA.
Banyak laporan positif telah diperoleh dengan menggunakan model
haiwan yang besar lantas menggalakkan beberapa ujian klinikal
secara berterusan. Penemuan ini menunjukkan potensi yang tinggi,
meskipun terdapat cabaran kawalan yang perlu dihadapi. Berdasarkan
kadar kejayaan awal, rawatan ini perlu dipertimbangkan ke tahap
yang lebih tinggi. Kemajuan yang ketara dalam rawatan penjanaan
semula rawan dan osteoartitis telah dapat dilihat setakat ini,
tetapi tidak ada piawaian emas yang ditandakan. Kata kunci: Kecacatan rawan; kejuruteraan tisu; osteoartitis; terapi
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