AN EVALUATION OF THE SAFETY AND EFFICACY OF AUTOLOGOUS STEM CELLS, CHONDROCYTES OR THE TWO (ASCOT) FOR TREATING KNEE CARTILAGE DEFECTS

Clinical Delivery and Analysis: The late Professor James Richardson, Peter Gallacher, Paul Jermin, Martyn Snow, Bernhard Tins, Paul Harrison, Barbara Linklater-Jones, Jo Wales, Naomi Dugard, Jan Herman Kuiper

Scientific Investigations: Karina Wright, Helen McCarthy, Claire Mennan, Charlotte Hulme, Jade Perry, John Garcia, Lauren Tierney, Abi Jones, Sally RobertsFunded by the Orthopaedic Institute, Versus Arthritis and the Medical Research Council

Autologous Chondrocyte Implantation (or ACI) is a treatment which has been used clinically at the RJAH Orthopaedic Hospital in Oswestry for about 20 years on a select group of patients who have injured or damaged cartilage in their knees or ankles. Instead of using artificial material or the more usual drugs, such as steroids or pain killers, this technique uses cartilage cells called chondrocytes (see picture insert) that have been prepared from the patient’s own cartilage and grown in the RJAH’s cell culture facility, OsCell’s John Charnley Laboratory. The cultured cells are then implanted back into the damaged area in the joint. If left untreated it is believed that these patients would likely go on to develop osteoarthritis with all the changes that this brings in the different parts of the knee, and many would need a joint replacement eventually.

The ASCOT – Autologous Stem Cells, Chondrocytes or the Two? Clinical Trial is comparing chondrocytes with other types of cells which can be obtained from the patient’s bone marrow, called mesenchymal stem or stromal cells (MSCs). These have been used in a similar procedure to ACI in Japan. Stem cells have the potential to develop into many different cell types, including those that form both cartilage and bone. MSCs have now also been shown to produce many other therapeutic factors, some of which seem to reduce inflammation and help reduce pain. The question we want to answer through the ASCOT trial is would these MSCs, either alone or combined with chondrocytes, be better at repairing cartilage and bone defects in the knee joint, compared to chondrocytes alone (the standard ACI treatment).

We have now reached our target recruitment of 114 patients for the ASCOT trial and patients have been randomized into the 3 different treatment ‘arms’ with the 3 different cell populations (MSCs, cartilage cells or a combination of the two). There are 4 patients who are waiting to receive their cells and we aim to treat these remaining patients later in the year.