Could nose cartilage help repair worn out knees? | Health Info

By Amy Norton Health Day Reporter

THURSDAY, September 2, 2021 (HealthDay News) – When people suffer from arthritis of the knee, the cartilage cushioning the joint gradually breaks down. Now, a first study suggests a possible solution: replace it with cartilage from the nose.

The researchers tested the approach on just two patients with arthritis of the knee and said there was still a lot of work to be done.

But the first results, published on September 1 in Science Translational Medicine, indicate that the cartilage cells of the nose can be used safely to generate replacement cartilage for the knee.

And months after the procedure, both patients reported less pain and better knee function.

However, it is not known whether this relief can be attributed to the replacement cartilage.

“We are a long way from possibly claiming efficacy,” said researcher Ivan Martin, professor at the University of Basel in Switzerland.

More studies, he said, are needed to rigorously test the procedure as a treatment for osteoarthritis of the knee.

Osteoarthritis refers to the common form of “wear and tear” of arthritis where joint cartilage – the protective tissue at the ends of bones – gradually deteriorates. Over time, this causes changes in the bone itself, leading to inflammation, joint stiffness, and pain.

There are treatments for arthritis of the knee, such as physiotherapy and cortisone injections, but no way to stop its progression. At some point, joint replacement surgery may be necessary.

Currently, there are ways to repair some degree of damage to the cartilage in the knee, including moving the cartilage from a part of the knee that is not carrying weight to fill in the damaged cartilage defect.

But these treatments are used when there is a limited area of ​​cartilage damage, such as a tear from a sports injury, explained Dr Andreas Gomoll, an orthopedic surgeon who was not in the study.

Gomoll, who is based at the Hospital for Special Surgery in New York City, explained it this way: If a road has a single pothole, but the pavement around it is healthy, you can just fill in the pothole. But if the road is riddled with potholes, it won’t work.

Osteoarthritis of the knee is akin to the latter scenario, Gomoll said.

Beyond that, he explained, the arthritic knee is full of inflammation, which would expose any transplanted cartilage to a “toxic environment.”

For the new study, Martin’s team looked at whether cartilage cells in the nose might be a possible alternative. Research has suggested that the cartilage there has a greater capacity for regeneration and may be more adaptable to harsh conditions. It is also easy to remove cells from the nose.

Researchers started in the lab. First, they used nasal chondrocytes (cartilage cells) to grow new cartilage, which they then exposed to inflammatory factors similar to those found in arthritic knees. The cartilage resisted – and even seemed to calm the “inflammatory profile” of cells in arthritic joints.

Next, the researchers showed that the transplanted cartilage could be successfully integrated into arthritic joints in laboratory animals.

Next come the two patients with osteoarthritis of the knee. Both patients, in their 30s, suffered from knee pain and other symptoms that did not respond to non-surgical treatments.

The patients underwent an osteotomy, a surgical procedure in which the bones of the knee joint are cut and realigned to relieve pressure on the damaged area of ​​cartilage. They also received replacement cartilage made from their own nasal cells.

MRI scans later showed that the nasal cartilage had filled in the cartilage defects in the patients’ knee. And three to 14 months after the procedure, patients reported less pain and better knee joint function.

Gomoll warned, however, that symptom relief could come from the osteotomy.

Martin agreed that it’s not clear whether nasal cartilage itself was an effective treatment. He said larger studies are needed not only to prove its effectiveness, but also to determine which patients are good candidates.

Gomoll said it would be interesting to see if the cartilage in the nose “actually knows a few tricks” that allow it to thrive in the arthritic knee.

He also warned that osteoarthritis is more complicated than a simple cartilage defect. There is inflammation and damage to other joint structures. Plus, there are patient-related factors that contribute to the disease, Gomoll said, such as being overweight or “bow-legged” (as the two patients in the study were), and even genetics.

Because of this complexity, Martin doesn’t think of nasal cartilage as a quick fix. “Ultimately I think combination therapy will be necessary,” he said.

Physiotherapy, Martin added, would be essential in preventing the deterioration of new cartilage, as “native” cartilage did.

SOURCES: Ivan Martin, PhD, professor, department of biomedicine, University of Basel, Switzerland; Andreas H. Gomoll, MD, associate orthopedic surgeon, Hospital for Special Surgery, and associate professor, orthopedic surgery, Weill Cornell Medical College, New York City; Scientific translational medicine, Septum. 1, 2021, online

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