Musculoskeletal disease and injury are highly prevalent, painful and associated with considerable disability. The poor intrinsic capacity for repair of some components of the musculoskeletal system, and in other cases imperfect healing of the affected tissue, can lead to chronic impairment. The management of musculoskeletal disorders remains a challenge for clinicians, and surgery and symptomatic therapies do not address the underlying causes of these disorders. However, basic research across a range of disciplines is translating into clinical applications to regenerate the musculoskeletal system.
A number of promising approaches to the repair of musculoskeletal tissues, including cartilage, bone, tendon, skeletal muscle, intervertebral disc, meniscus and ligament, are at various stages of preclinical and clinical development. The articles in this Focus issue highlight progress and promise in the field, from new insights into musculoskeletal biology and novel technologies to identifying and overcoming the barriers to translation of these developments into clinical success.
RESEARCH HIGHLIGHTS
Growth plate or articular: whatever your cartilage type, thyroid hormones are in control!
Jenny Buckland
doi:10.1038/nrrheum.2015.25
Nature Reviews Rheumatology 11, 198 (2015)
NEWS & VIEWS
A new in vivo stem cell model for regenerative rheumatology
Dennis McGonagle & Elena A. Jones
doi:10.1038/nrrheum.2015.21
Nature Reviews Rheumatology 11, 200-201 (2015)
REVIEWS
Origin and function of cartilage stem/progenitor cells in osteoarthritis
Yangzi Jiang & Rocky S. Tuan
doi:10.1038/nrrheum.2014.200
Nature Reviews Rheumatology 11, 206-212 (2015)
Despite having a poor intrinsic capacity for repair, articular cartilage has been shown to contain a population of self-renewing, multipotent cells that express stem-cell-related surface markers. In this article, Jiang and Tuan review what is known about these cartilage-derived stem/progenitor cells, with a focus on their origin, function and therapeutic potential in osteoarthritis.
The current state of scaffolds for musculoskeletal regenerative applications
Benjamin D. Smith & Daniel A. Grande
doi:10.1038/nrrheum.2015.27
Nature Reviews Rheumatology 11, 213-222 (2015)
In the field of musculoskeletal tissue replacement, scaffold-based tissue engineering is evolving rapidly, in preclinical studies as well as clinical applications. In this article, the authors discuss the core concepts of this approach and provide an overview of the use of scaffolds in engineering various musculoskeletal tissue types.
Tendon injury: from biology to tendon repair
Geoffroy Nourissat, Francis Berenbaum & Delphine Duprez
doi:10.1038/nrrheum.2015.26
Nature Reviews Rheumatology 11, 223-233 (2015)
Tendon disorders are common and are a major cause of musculoskeletal pain, but the development of effective therapies requires detailed knowledge of the biology of this mechanosensitive musculoskeletal tissue. As well as providing an overview of tendon physiology and pathology, this article reviews the mechanical and biological factors that contribute to tendon development, homeostasis and repair, drawing on evidence from experimental models and developmental biology.
Gene therapy approaches to regenerating the musculoskeletal system
Christopher H. Evans & Johnny Huard
doi:10.1038/nrrheum.2015.28
Nature Reviews Rheumatology 11, 234-242 (2015)
Gene therapy can produce nascent therapeutic proteins in specific sites in vivo, a powerful tool that could revolutionize treatment for many diseases. However, this potential has not yet been translated into restoration of the musculoskeletal system in patients with rheumatic diseases. Here, the technology, barriers to translation, and clinical trials are reviewed.
Stem cell therapy for intervertebral disc regeneration: obstacles and solutions
Daisuke Sakai & Gunnar B. J. Andersson
doi:10.1038/nrrheum.2015.13
Nature Reviews Rheumatology 11, 243-256 (2015)
After outlining the rationale for injecting viable cells into the degenerating intervertebral disc (IVD), Sakai and Andersson provide an overview of basic and preclinical studies as well as ongoing clinical trials of cell therapies for IVD degeneration. Consideration is also given to various barriers to the development of these therapies and possible solutions to overcome such obstacles.
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