The University of Basel, which has developed an innovative technique to repair joint wear and tear, is coordinating a major international project that has received 11.8 million Swiss francs in funding from the EU and Switzerland.
The University of Basel’s Department of Biomedicine and the Swiss city’s University Hospital are recruiting researchers all over the world to expand their studies on cartilage transplantation, as part of a large-scale project that has received a massive 11.8 million Swiss francs (around 12 million euros) in funding from the European Union and the Swiss National Science Foundation [Click here to read the article by Basel University].
Coordinated by the team from Basel, the project is ‘designed’ to treat the most severe cases of knee osteoarthritis, avoiding the need for prosthetic implants (which require complex surgery and need replacing every 15-20 years). The technique used to replace worn cartilage will be the particularly innovative one developed in Basel: N-TEC, which stands for Nasal Chondrocyte Tissue-Engineered Cartilage. The N-TEC technique will be used in hospitals in several countries, including Germany, Italy, Croatia, Austria, Poland and Sweden.
As the name suggests, N-TEC is based on the transplantation of cells — chondrocytes — harvested from the cartilage of the nasal septum. It has been tested in more than 100 patients so far, with very positive results. Chondrocytes are ‘extracted’ by the surgeon in 7x7 mm segments, without harming the patient’s nose in any way, and are cultured on a collagen (a fibrous protein) membrane in the laboratory. These cells are able to multiply, creating ‘grafts’ — each one measuring 40 cm2 — in just four weeks. The grafts can then be transplanted into the knee joint to replace the worn cartilage.
Ivan Martin, Professor of Tissue Engineering at the Department of Biomedicine of the University of Basel said: “Thanks to generous public funding and cooperation with other outstanding teams, we will now extend clinical trials to investigate N-TEC in more challenging conditions so that someday it can become a mainstream bed-side procedure”. However, the N-TEC technique cannot be used to treat rheumatoid arthritis.
Good results in older patients too
Cells from the nasal septum multiply quickly and are particularly ‘valuable’ because they originate from the area of the embryo called the neural crest, which also gives rise to highly complex organs such as the eye and brain. These cells are superior to those in other parts of the body, including in terms of their so-called environmental plasticity, in other words the ability to adapt to different environments and conditions. What’s more, chondrocytes of the nasal septum are able to perform effective repair in older people, too: this is an important advantage, since many of the people who need an operation are in fact older.
However, ‘repairing’ the cartilage with fresh cells wouldn’t be sufficient in itself, because in osteoarthritis the entire joint is compromised by the wear and tear caused by chronic inflammation. Thankfully, in the N-TEC technique, the transplanted cells also have an anti-inflammatory effect, promoting the natural restoration of damaged tissues, which explains why the experimental therapy is showing such promising results.
Three months of physiotherapy
Once the graft has been transplanted into the area of the knee joint to be treated, the new cells have been found to integrate very well. The patient is asked to stay in the hospital for three to five days to rest their leg, and then to walk with crutches for six weeks, to avoid subjecting the knee to overexertion, which could damage the graft itself. They then need approximately three months of physiotherapy. Eventually, if there are no setbacks, the patient can resume their normal activities, including sports.
