EFORT PRESS RELEASE

The use of stem cells in orthopaedics and traumatology has been talked about for a long time, but the first research into the utility of undifferentiated cells in areas such as cartilage, nerves and bone began only a very short time ago.

Pridie described and performed a treatment for osteoarthritis, called Pridie-drilling, where he actually had access to stem cells and growth factors.
It is too early to say that molecular biology can provide credible solutions for the treatment of a number of orthopaedic diseases, although it has been recognised that only current randomised studies may be able to make a contribution quite soon.

This is the hope of orthopaedists, who are on the lookout every day for new treatment prospects, as pointed out by Professor Fernando Fonseca, orthopaedist at Coimbra University’s teaching hospitals, drawing attention to the fact that, «in the last two years, the major randomised, double-blind studies, i.e. trials of high scientific value» had not yet produced any of the certainties «that physicians hope for». Indeed, the preliminary conclusions have shown that «when biopsies are performed, the cartilage produced by the implanted chondrocytes is, in most cases, fibrocartilage». This means that the introduction of stem cells places the «chondrocyte but it has difficulty in producing type II collagen, which is the protein that makes cartilage resistant ».

This type of phenomenon has not been considered in previous studies but is now being included in scientific discussion, according to Professor Fonseca, who mentioned another aspect that had to be taken into account, which was the dedifferentiation in which «when the chondrocyte is implanted in highly accelerated growth, it changes its genetic expression and begins to function as a fibroblast».

As the Professor said, this dedifferentiation means that «the cartilage produced is fibrocartilage. In other words, we obtain a cartilage with lower capacity and less resistance», which defeats the purpose of creating resistant cartilages «to absorb shocks and slippage».

« A lack of ethics is what may be a problem»

The results of studies obtained so far represent a new advance but we must be cautious, said Professor Fonseca, stressing that «things are not always what they seem», and so it is necessary to wait for new results from studies being conducted at the best research centres in Europe, including Portugal.

So far, only physicians recognise that molecular biology may be a possible way, as patients, for their part, will only be in favour «if the results obtained make some kind of a contribution to their problems. Otherwise patients do not really care about the importance of molecular biology», explained Professor Fonseca, admitting that molecular biology might «benefit patients, as it may help reduce the intake of analgesics, for example ».

Scientific advances are normally accompanied by ethical decisions and these are two sciences that go hand in hand «which is a good thing» according to Professor Fonseca, who considered «ethics to be an asset in making medical decisions» and reminded us that «a lack of ethics is what may be a problem». He reasserted his position saying that «some of the major disasters that have happened have been due to a lack of ethics». This means that ethics should «express an opinion» in accordance with scientific progress. He drew attention to the fact that «humankind has succeeded in sequencing the human genome, which is a new field that merits special attention». Indeed, «major individuals that we have had and who have made great contributions to humanity had serious deficiencies», said the professor, who classified «ethics as a valuable tool ».

In any case, he stated that molecular biology «will help us to control certain phenomena, especially in reconstructive surgery after large losses of substance and in surgery on tetra-paraplegics and paraplegics in whom most of the nerve cell has died ».

7th EFORT Congress, June 5th, Press Office, AZ