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Musculoskeletal Tissue Regeneration Orthopedic Biology and Medicine Musculoskeletal Tissue Regeneration Orthopedic Biology and Medicine SERIES EDITORS: Yuehuei H. An and A. U. Daniels Orthopaedic Research Laboratory Medical University of South Carolina, Charleston, SC Musculoskeletal Tissue Regeneration: Biological Materials and Methods, edited by William S. Pietrzak, 2008 Repair and Regeneration of Ligaments, Tendons, and Joint Capsule, edited by William R. Walsh, 2005 Musculoskeletal Tissue Regeneration Biological Materials and Methods Edited by William S. Pietrzak Ph.D. Department of Bioengineering, University of Illinois at Chicago, Chicago, IL and Biomet, Inc., Warsaw, IN Foreword by Charles A. Vacanti, M.D. Brigham and Women's Hospital, Boston, MA William S. Pietrzak, Ph.D. Department of Bioengineering University of Illinois at Chicago Chicago, IL Biomet, Inc., Warsaw, IN USA [email protected] Series Editors: Yuehuei H. An and A. U. Daniels Orthopaedic Research Laboratory Medical University of South Carolina Charleston, SC ISBN: 978-1-58829-909-3 e-ISBN: 978-1-59745-239-7 DOI: 10.1007/978-1-59745-239-7 Library of Congress Control Number: 2008920308 © 2008 Humana Press, a part of Springer Science+Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Humana Press, 999 Riverview Drive, Suite 208, Totowa, NJ 07512 USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identifi ed as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Cover illustration: Prepared by Terry Armstrong, Warsaw, IN, representing cells, matrices, and signaling molecules - the three essential components of musculoskeletal tissue regeneration. Designed by William S. Pietrzak and Terry Armstrong. Printed on acid-free paper 9 8 7 6 5 4 3 2 1 springer.com About the Editor Originally from Chicago, Dr. William Pietrzak received his Bachelor of Science (1977) and Ph.D. (1988) bioengineering degrees from the University of Illinois at Chicago. His career has spanned several medical disciplines, including opthalmo- logy, cardiovascular, and—for the past 16 years—orthopedics. He has published research on numerous technologies used for musculoskeletal tissue regeneration, including bioabsorbable fixation, bone graft substitutes, bone morphogenetic proteins, platelet rich plasma, and total knee and hip arthroplasty. Several of these publications have been centered around the foot, ankle, knee, hip, shoulder, and craniofacial skeleton. He is an inventor, with four patents in the fields of suture anchors and bioabsorbable fixation. In addition to his role as a reviewer for several biomedical journals, he serves on the Editorial Boards of the Journal of Craniofacial Surgery and the Journal of Applied Research in Clinical and Experimental Therapeutics. He is a member of the Society for Biomaterials and the Orthopaedic Research Society. Dr. Pietrzak is a Chief Research Scientist at Biomet, Inc., with a current emphasis on clinical research. He is also Adjunct Research Professor of Bioengineering at the University of Illinois at Chicago. v I dedicate this book to my wife, Karen, whose love and support helped make it happen; and my children, Brad and Becky, who inspire me to view the world through the eyes of a child—a world with limitless possibilities. Foreword Tissue engineering and regenerative medicine will ultimately have a more profound impact than most of us can fully appreciate. The combination of the principles of engineering with advances in the material sciences, and an increased understanding of developmental biology has the potential to influence developments in medicine and biotechnology more than any single advance in these fields during the last several decades. I would first like to applaud the volume editor, Dr. Pietrzak, and the authors for their efforts in bringing together a group of interrelated topics to create a textbook emphasizing the Tissue Engineered generation of musculoskeletal tissue. The authors of this book are all established experts in their respective fields. The publication of a separate volume dedicated to musculoskeletal tissue regeneration as part of a series focusing on orthopedic biology and medicine is a reflection of the tremendous growth of knowledge and ongoing developments that have occurred in this field over the last decade. Musculoskeletal Tissue Regeneration: Biological Materials and Methods is intended to cover the basic fundamentals and early treatment of musculoskeletal disease, tissue loss and wound healing, as well as provide a comprehensive summary of recent advances in regenerative medicine and tissue engineering as they relate to the musculoskeletal system, and should serve as a reference for researchers and graduate students in this discipline. Since the initial descriptions of the field, the synthesis of new polymers and materials for use in the generation of engineered musculoskeletal tissue has increased dramatically. Cell/biomaterials and biomaterial/host interactions continue to be explored. The tremendous potential for the use of stem cells in tissue engineering and regenerative medicine is now widely appreciated, with some groups focusing on the use of fetal stem cells, and others employing adult stem or progenitor cells, to develop into various specialized tissues. Practicing physicians in many disciplines are now starting to apply the tech- niques of musculoskeletal tissue engineering to patient care. This growing interest has resulted in expansion of the scope of regenerative medicine. The chapters presented in this text represent the multidisciplinary efforts of a mul- titude of scientists and clinicians. Various technologies described here may ultimately make a profound and lasting impact on the way that the healthcare industry functions in the treatment of many disease processes. Any new developments in tissue and organ replacements have the potential to be controversial. Tissue engineering as a science and a medical discipline ix x Foreword may be viewed by some as “unnatural.” It is often difficult for society to reach an opinion on the relative merits and ethics of any new therapeutic. Both pro- fessionals and lay people are likely to examine the ethics of any new endeavor and weigh its relative merits, especially when that endeavor has the potential to employ other controversial techniques, such as stem cell manipulation. When one actually considers what physicians have done for centuries, the similari- ties between “conventional” treatment and tissue engineering become more obvious. If the basic premise of health care is that the body heals itself, then physicians do nothing more than optimize the environment most conducive to healing. Basically, physicians attempt to neutralize hostile factors at the same time that they enhance the supply of oxygen and nutrients that the body needs to heal itself. In Tissue Engineering, the same goal is achieved using a some- what unique approach. Living cells that belong in the injured area are delivered using a scaffold that dictates the shape and function of the desired tissue. The physician then optimizes the local environment by maximizing the delivery of oxygen and the elimination of waste products. Under ideal conditions, this will then enable the body to heal itself. In this respect, the significant difference is that “tissue engineering” efforts are focused on the microenvironment, or the cellular level, as opposed to being focused on the macroenvironment, or the organ level, as is done in “traditional” medicine. One hopeful outcome of this text is to demonstrate the skill and imagination that have been brought to bear to develop revolutionary new approaches to treat patients who are often desperately ill and have no alternative. Finally, it is important to understand the current limitations of the field, and the need for developments in associated fields on which tissue engineering is predicated. Our expectations must be realistic as the field develops and knowl- edge is acquired. Initial applications may reflect the advantages of component therapy to replace lost function(s) of specific organs, rather than replacement of an entire organ. It is certainly possible that many tissue functions can be sufficiently recovered without the need to replace an entire organ. In this fash- ion, advances in human application can parallel advances in the science of the field, rather than generate hopes prematurely. Although I believe that developments in this field will result in a tremen- dous advance in the treatment of many disease processes, the power of tissue engineering as a model to explore changes associated with developmental biology may equal its special applications to human health care. Charles A. Vacanti, M.D. Director of Tissue Engineering Laboratory and Chair of the Department
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