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Matrix-Induced Autologous Chondrocyte Implantation (MACI) Using a Cell-Seeded Collagen Membrane Improves Cartilage Healing in the Equine Model.
J Bone Joint Surg Am 2017; 99(23):1987-1998JB

Abstract

BACKGROUND

Autologous chondrocyte implantation (ACI) using a collagen scaffold (matrix-induced ACI; MACI) is a next-generation approach to traditional ACI that provides the benefit of autologous cells and guided tissue regeneration using a biocompatible collagen scaffold. The MACI implant also has inherent advantages including surgical implantation via arthroscopy or miniarthrotomy, the elimination of periosteal harvest, and the use of tissue adhesive in lieu of sutures. This study evaluated the efficacy of the MACI implant in an equine full-thickness cartilage defect model at 1 year.

METHODS

Autologous chondrocytes were seeded onto a collagen type-I/III membrane and implanted into one of two 15-mm defects in the femoral trochlear ridge of 24 horses. Control defects either were implanted with cell-free collagen type-I/III membrane (12 horses) or were left ungrafted as empty defects (12 horses). An additional 3 horses had both 15-mm defects remain empty as nonimplanted joints. The repair was scored by second-look arthroscopy (12 weeks), and necropsy examination (53 weeks). Healing was assessed by arthroscopic scoring, gross assessment, histology and immunohistology, cartilage matrix component assay, and gene expression determination. Toxicity was examined by prostaglandin E2 formation in joint fluid, and lymph node morphology combined with histologic screening of organs.

RESULTS

MACI-implanted defects had improved gross healing and composite histologic scores, as well as increases in chondrocyte predominance, toluidine blue-stained matrix, and collagen type-II content compared with scaffold-only implanted or empty defects. There was minimal evidence of reaction to the implant in the synovial membrane (minor perivascular cuffing), subchondral bone, or cartilage. There were no adverse clinical effects, signs of organ toxicity, or evidence of chondrocytes or collagen type-I/III membrane in draining lymph nodes.

CONCLUSIONS

The MACI implant appeared to improve cartilage healing in a critical-sized defect in the equine model compared with collagen matrix alone.

CLINICAL RELEVANCE

These results indicate that the MACI implant is quick to insert, provides chondrocyte security in the defect, and improves cartilage healing compared with ACI.

Authors+Show Affiliations

Comparative Orthopaedics Laboratory, Department of Clinical Sciences (A.J.N., H.D.S., L.B., and M.S.S.), and Department of Biomedical Sciences, College of Veterinary Medicine (S.M.), Cornell University, Ithaca, New York.Comparative Orthopaedics Laboratory, Department of Clinical Sciences (A.J.N., H.D.S., L.B., and M.S.S.), and Department of Biomedical Sciences, College of Veterinary Medicine (S.M.), Cornell University, Ithaca, New York.Comparative Orthopaedics Laboratory, Department of Clinical Sciences (A.J.N., H.D.S., L.B., and M.S.S.), and Department of Biomedical Sciences, College of Veterinary Medicine (S.M.), Cornell University, Ithaca, New York.Comparative Orthopaedics Laboratory, Department of Clinical Sciences (A.J.N., H.D.S., L.B., and M.S.S.), and Department of Biomedical Sciences, College of Veterinary Medicine (S.M.), Cornell University, Ithaca, New York.Comparative Orthopaedics Laboratory, Department of Clinical Sciences (A.J.N., H.D.S., L.B., and M.S.S.), and Department of Biomedical Sciences, College of Veterinary Medicine (S.M.), Cornell University, Ithaca, New York.Histogenics Corporation, Waltham, Massachusetts.Histogenics Corporation, Waltham, Massachusetts.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29206788

Citation

Nixon, Alan J., et al. "Matrix-Induced Autologous Chondrocyte Implantation (MACI) Using a Cell-Seeded Collagen Membrane Improves Cartilage Healing in the Equine Model." The Journal of Bone and Joint Surgery. American Volume, vol. 99, no. 23, 2017, pp. 1987-1998.
Nixon AJ, Sparks HD, Begum L, et al. Matrix-Induced Autologous Chondrocyte Implantation (MACI) Using a Cell-Seeded Collagen Membrane Improves Cartilage Healing in the Equine Model. J Bone Joint Surg Am. 2017;99(23):1987-1998.
Nixon, A. J., Sparks, H. D., Begum, L., McDonough, S., Scimeca, M. S., Moran, N., & Matthews, G. L. (2017). Matrix-Induced Autologous Chondrocyte Implantation (MACI) Using a Cell-Seeded Collagen Membrane Improves Cartilage Healing in the Equine Model. The Journal of Bone and Joint Surgery. American Volume, 99(23), pp. 1987-1998. doi:10.2106/JBJS.16.00603.
Nixon AJ, et al. Matrix-Induced Autologous Chondrocyte Implantation (MACI) Using a Cell-Seeded Collagen Membrane Improves Cartilage Healing in the Equine Model. J Bone Joint Surg Am. 2017 Dec 6;99(23):1987-1998. PubMed PMID: 29206788.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Matrix-Induced Autologous Chondrocyte Implantation (MACI) Using a Cell-Seeded Collagen Membrane Improves Cartilage Healing in the Equine Model. AU - Nixon,Alan J, AU - Sparks,Holly D, AU - Begum,Laila, AU - McDonough,Sean, AU - Scimeca,Michael S, AU - Moran,Nance, AU - Matthews,Gloria L, PY - 2017/12/6/entrez PY - 2017/12/6/pubmed PY - 2017/12/9/medline SP - 1987 EP - 1998 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 99 IS - 23 N2 - BACKGROUND: Autologous chondrocyte implantation (ACI) using a collagen scaffold (matrix-induced ACI; MACI) is a next-generation approach to traditional ACI that provides the benefit of autologous cells and guided tissue regeneration using a biocompatible collagen scaffold. The MACI implant also has inherent advantages including surgical implantation via arthroscopy or miniarthrotomy, the elimination of periosteal harvest, and the use of tissue adhesive in lieu of sutures. This study evaluated the efficacy of the MACI implant in an equine full-thickness cartilage defect model at 1 year. METHODS: Autologous chondrocytes were seeded onto a collagen type-I/III membrane and implanted into one of two 15-mm defects in the femoral trochlear ridge of 24 horses. Control defects either were implanted with cell-free collagen type-I/III membrane (12 horses) or were left ungrafted as empty defects (12 horses). An additional 3 horses had both 15-mm defects remain empty as nonimplanted joints. The repair was scored by second-look arthroscopy (12 weeks), and necropsy examination (53 weeks). Healing was assessed by arthroscopic scoring, gross assessment, histology and immunohistology, cartilage matrix component assay, and gene expression determination. Toxicity was examined by prostaglandin E2 formation in joint fluid, and lymph node morphology combined with histologic screening of organs. RESULTS: MACI-implanted defects had improved gross healing and composite histologic scores, as well as increases in chondrocyte predominance, toluidine blue-stained matrix, and collagen type-II content compared with scaffold-only implanted or empty defects. There was minimal evidence of reaction to the implant in the synovial membrane (minor perivascular cuffing), subchondral bone, or cartilage. There were no adverse clinical effects, signs of organ toxicity, or evidence of chondrocytes or collagen type-I/III membrane in draining lymph nodes. CONCLUSIONS: The MACI implant appeared to improve cartilage healing in a critical-sized defect in the equine model compared with collagen matrix alone. CLINICAL RELEVANCE: These results indicate that the MACI implant is quick to insert, provides chondrocyte security in the defect, and improves cartilage healing compared with ACI. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/29206788/Matrix_Induced_Autologous_Chondrocyte_Implantation__MACI__Using_a_Cell_Seeded_Collagen_Membrane_Improves_Cartilage_Healing_in_the_Equine_Model_ L2 - http://Insights.ovid.com/pubmed?pmid=29206788 DB - PRIME DP - Unbound Medicine ER -