Gentherapeutische Möglichkeiten in der Knorpeltherapie

Chondral and osteochondral lesions of the articular cartilage are typical injuries in orthopedics. Since a restitutio ad integrum of the articular cartilage does not take place, the initial lesion can lead to premature arthrosis, which is connected with long-term costs for the health system. Adequate therapy of the chondral and osteochondral lesion is therefore an important goal. Although present concepts are promising in the treatment of these injuries, until now these therapeutic options do not lead to a complete regeneration of the hyaline cartilage and the subchondral bone. Gene therapeutic methods especially in combination with tissue engineering offer new therapeutic options in the treatment of these injuries. However, the transduction of therapeutic genes into the tissue and cells is so far afflicted with large problems. Also it is not clear for which time period and in which quantity, related to the defect size, the therapeutic gene must be produced by gene expression to manage the complete regeneration of the defect. A further unresolved problem is still at this time the safety of such a therapeutic approach. In particular, effective retroviral systems contain also an oncogenic potential. Therefore, new gene therapeutic procedures were recently developed for osteochondral lesions, which are assessable pharmacologically. This review describes the fundamental conditions and the current state of research in the field of gene therapy for lesions of the articular cartilage.