[Frontiers in Bioscience 14, 4598-4605, January 1, 2009]

Mesenchymal stem cells and tendon healing

Alphonsus KS Chong1, James Chang2, James CH Go 3

1Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore , 2Division of Plastic Surgery, Stanford University Medical Center, Stanford, California, USA, 3Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

TABLE OF CONTENTS

1. Abstract
2. Introduction
3. Tendons - Structure and Function
4. Tendon Disorders
5. Mesenchymal Stem Cells
6. Mechanisms of action of MSCs
7. Enhancing Tendon Healing with MSCs
8. Key Areas for Development
8.1. Use of Allogeneic MSCs
8.2. Optimization of MSC culture
8.3. Gene Therapy
8.4. The Role of Mechanical Stimulation
9. Navigating the regulatory framework for MSC based therapies
10. Perspective
11. References

1. ABSTRACT

Tendons transmit forces generated by muscle to move the joints they cross. Tendon problems are complicated by slow and incomplete healing as well as re-injury. Mesenchymal stem cell based therapies show promise in improving outcomes. Much of the work has been experimental, although early clinical use in equine strain-induced tendon injury supports the efficacy of this strategy. While much has been studied about the mechanisms of action of implanted MSCs, the relative importance of the various mechanisms is still unknown. Key areas of research that could prove pivotal in the clinical use of MSCs include the use of allogeneic cells, optimization of MSC culture, gene therapy, and mechanical stimulation techniques.