Arthritis Research Centre for Tissue Engineering Partnership with RJAH Orthopaedic Hospital

Nearly two decades ago, The Institute for Science and Technology in Medicine’s (ISTM) Professor James Richardson set up a clinical service in the Keele partner hospital, Robert Jones and Agnes Hunt (RJAH) Orthopaedic Hospital, Oswestry, using tissue engineering to treat patients with damage to the cartilage which lines the surfaces of their knee called Autologous Chondrocyte Implantation (ACI). This has been a cornerstone of regenerative medicine and has been the basis for many additional laboratory research studies with scientists and clinicians funded from the Medical Research Council (MRC) and Arthritis Research UK (ARUK). The unit has now treated over 450 patients successfully.

Two years ago the group, led by Sally Roberts, James Richardson and Alicia El Haj, became part of the ARUK Centre for Tissue Engineering, joining other scientists and surgeons from Cambridge, Newcastle, Aberdeen and York. There are a multitude of projects now being undertaken within this, all with the focus of developing better and more permanent ways of treating the arthritic knee.

These projects address questions such as:
▪ How do we identify the best cell types to use for therapy?
▪ Are some patients more suitable for cell therapy and regenerative medicine generally than others and if so, can we develop predictive tests to identify them?
▪ Is there a way to characterise the cells themselves and measure their ‘potency’ for repair or regeneration?
▪ What happens to the cells when they are implanted – do they remain forever and synthesise new cartilage or do they only do so for a short time and do they release agents which affect other cells?

Until now, the cartilage repair procedure, ACI, has used cells from the patient’s own cartilage, culturing them in the lab for approximately three weeks before implanting them back to the area of the joint which needs to be repaired.

Now a three year trial named Autologous Stem cells, Chondrocytes Or the Two (ASCOT) will compare autologous mesenchymal stromal/stem cells (from the patient’s bone marrow) with chondrocytes, or alternatively a combination of both cell types.

It has taken a long time for the RJAH and its associates to get this trial under way; approximately three years to prepare all the paperwork and licenses. Now the focus is on recruitment as those involved hope to recruit in excessive of 100 patients.