The need for tissue and organ replacements cannot be satisfied by autograft and allografts alone. The purpose of this study was to investigate the feasibility of electrospinning a blend of polydioxanone and fibrinogen to produce an engineered tissue scaffold. Fiber diameter and pore size of blends were characterized, as well as mechanical strength. Cell proliferation assays for 1 and 7 day cultures were preformed, and a histological evaluation was performed to determine how favorable the various blends were to cell infiltration and proliferation. Some ratios of blends were identified that contained both acceptable mechanical properties and properties that facilitated cell infiltration. These findings pave the way for future refinement and use of these scaffolds for a variety of tissue engineered targets.

Chronic respiratory diseases affects many people worldwide with little known about the mechanisms diving the pathology, making it difficult to find a cure. Improving the understanding of smooth muscle and extracellular matrix (ECM) interaction is key to developing a remedy to this leading cause of death. With currently no relevant or controllable in vivo or in vitro model to investigate diseased and normal interactions of small airway components, the development of a physiologically relevant in vitro model with comparable cell attachment, signaling, and organization is necessary to develop new treatments for airway disease. The goal of this study is to create a mechanically, biologically and structurally relevant in vitro model of small airway smooth muscle tissue. Synthetic Poly-L-Lactic Acid (PLLA) and decellularized pig lung ECM (DPLECM) were electrospun to form nanofibrous mats that can closely mimic natural bronchial tissue. The addition of DPLECM significantly changed the PLLA scaffold mechanically, biologically, and physically to bring it closer to the characteristics of the human lung. DPLECM scaffolds exhibited a significant decrease in the elastic modulus compared with PLLA alone. Histological staining and SDS-PAGE showed that after scaffold fabrication, essential proteins or protein fragments in natural ECM are still present after processing. Human bronchial smooth muscle cells (HBSMCs) seeded onto PLECM scaffolds formed multiple layers of cells compared to scaffolds composed solely of PLLA. Phenotype of smooth muscle is better maintained when DPLECM is incorporated into the scaffold shown by enhanced contractile protein expression and increased collagen production for normal smooth muscle remodeling of the scaffold. In summary, this research demonstrates that a PLLA/DPLECM composite electrospun mat is a promising tool to produce an in vitro model with the potential to uncover unknown characteristics of bronchiole smooth muscle behavior in diseased or normal states.

Three-dimensional collagen/chitosan scaffolds fabricated by freeze-drying technique in 96-well polystyrene and PDMS plates were optimized during this study. Surface tension is, by and large, one of the most limiting factors in fabricating freeze-dried scaffolds in small format well plates. Traditionally, bowl-shaped top surfaces of collagen/chitosan scaffolds were common in polystyrene 96-well plate; whereas for PDMS 96-well plate, dome-shaped surfaces were formed. These surface tension phenomena are not desirable in cell studies especially during initial cell seeding. A combination of surface treatment and change of freeze-drying regime were developed to mitigate the surface tension problem in PS and PDMS 96-well plates respectively. Collagen/chitosan scaffolds of varying concentration and composition were experimented in both polystyrene and PDMS 96-well plates. Thin water film treatment with UV cross-linking was successfully used to eliminate meniscus in PS well plates; pre-cooling, on the other hand, was utilised to treat scaffold solutions in PDMS well plates. The resultant matrices all had flat top surfaces and average thickness of 1 mm. As expected, scaffolds with lower overall polymer concentration or, from a compositional perspective, scaffolds with high chitosan content generally had larger pores. Microscopic observation by multi-photon microscope was performed and chemical analyses were conducted to characterize the surface-treated scaffolds. In addition, scaffolds were tested in vitro using DLD-1 cells, hMSCs and fibroblasts for their biological performance. The purpose of this study was to address the problem of using small format culture wells for the fabrication of freeze-dried collagen-based scaffolds for studies of cell growth in 3D culture and in microfluidic perfusion bioreactors.

Degenerative conditions of the spine are a major public health problem, leading to severe back pain, reduced quality of life and chronic disablement in a proportion of sufferers. For some of these patients, spinal fusion surgery is a treatment that can alleviate back pain and restore normal function. However, limitations in the availability of graft material mean that alternative grafts are needed and tissue-engineering approaches have been employed. Using a novel self-organising collagen scaffold combined with nano-hydroxyapatite and chondroitin sulphate and by employing the latest materials techniques, I have studied the osteogenic capability of a biomimetic graft for use in spinal fusion surgery. The mineralised collagen scaffold has compressive strength comparable to human cancellous bone and can support the proliferation of viable human mesenchymal stem cells. This porous scaffold can be combined with human mesenchymal stem cells to further promote bone growth, as evidenced by an upregulation in the levels of bone-forming genes and mineralisation of the scaffold. This scaffold can act as a carrier system for BMP-2, with wider application for other growth factors or drugs, providing sustained release when fabricated as a layer-by-layer scaffold. An alternative bone substitute for use in spinal surgery has been designed and characterised, with exciting potential for use in vivo.

Insulin maintains glucose homeostasis through its binding of the insulin receptor and activation of the insulin signalling cascade in insulin sensitive tissues. Skeletal muscle is a major endocrine organ, and is responsible for the majority of post-prandial glucose disposal. The maintenance of glucose homeostasis is a delicate balance and impairments in glucose disposal can have significant physiological effects, resulting in the onset of metabolic diseases such as diabetes mellitus. Insulin stimulated glucose uptake involves a number of signalling proteins to enable uptake to occur. In order to understand the complexities associated with the insulin signalling cascade, cell culture models have provided a controlled and easily manipulated environment in which to investigate insulin stimulated glucose uptake in skeletal muscle. While the majority of these experiments have been conducted in conventional monolayer cultures, the growing field of three-dimensional tissue engineering provides an alternative environment in which skeletal muscle cells can be grown to investigate their physiological function. The purpose of this thesis was to investigate the use of different cell culture models for investigating the effects of acute and chronic insulin exposure on skeletal muscle. Initial investigations aimed to establish glucose uptake in tissue engineering skeletal muscle constructs using tritium labelled (H3) 2-deoxy-d-glucose. Monolayer cultures were used to developed base line conditions. In these cultures, concentrations greater than 0.5 μCi for 15 minutes of insulin stimulation suggested an initial assay window for investigating insulin stimulated glucose uptake. However, the duration of insulin stimulation was not effective in measuring uptake in tissue engineered skeletal muscle constructs based upon western blot experiments of Akt phosphorylation, therefore insulin stimulation in skeletal muscle tissue engineered constructs was increased to 30 minutes. Glucose uptake is mediated via specific glucose transporter protein, GLUT1 and GLUT4. Therefore, the transcriptional profile of these transporters was elucidated in monolayer culture and tissue engineered skeletal muscle constructs. Time course experiments showed an increase in GLUT4 transcription in tissue engineered and monolayer culture systems which is associated with an increase in the transcription of skeletal muscle development and myogenic genes. In two dimensional culture, skeletal muscle cells were exposed to insulin during differentiation and in post-mitotic skeletal muscle myotubes to investigating the potential effects upon metabolic genes and proteins involved in insulin signalling. Chronic exposure to insulin during skeletal muscle differentiation reduced insulin signalling and resulted in an increase in basal glucose uptake and ablated insulin stimulated glucose uptake. In contrast, post-mitotic skeletal muscle myotubes did not shown similar changes and were not as responsive to acute insulin exposure. Therefore future experiments exposed skeletal muscle to insulin during differentiation. Using the previous findings as a basis for experimentation, the effects of chronic and acute insulin exposure upon three dimensional skeletal muscle constructs were investigated. Fibrin and collagen constructs were grown for a total period of 14 days. Constructs were exposed to insulin during differentiation and acutely stimulated for 30 minutes at day 14. Although there was a mean increase in Akt protein phosphorylation in both types of tissue-engineered constructs, these changes were not significant following acute insulin stimulation. In addition, glucose uptake in fibrin skeletal muscle constructs increased as a result of acute insulin stimulation however was not significantly difference to unstimulated constructs. The work presented in this thesis provides initial experimental data of the use of different skeletal muscle cell culture models for investigating insulin signalling and glucose uptake. Further research should further characterise these in vitro models for investigating skeletal muscle metabolism.

REGENERATIVE MEDICINE: VASCULARIZED SKELETAL MUSCLE Tissue engineering is a compelling strategy to create replacement tissues and in this study, skeletal muscle. One major hurdle in the field is how to vascularize large tissue-engineered constructs exceeding the nutrient delivery capability of diffusion. Endothelial colony forming cells and mesenchymal progenitor cells form blood vessels de novo and were co-injected with satellite cells in Matrigel, an extracellular matrix, or PuraMatrix, a synthetic hydrogel. Our approach focused on the ability of bioengineered vascular networks to induce murine and human satellite cells to differentiate and form organized skeletal muscle when injected. We found that perfused human blood vessels were formed in both Matrigel and PuraMatrix and that murine satellite cells differentiated and formed organized myotubes with striations, indicative of adult skeletal muscle. Mesenchymal progenitor cells also induced differentiation of satellite cells in vitro. Human Satellite cells, however, did not show signs of differentiation in either Matrigel or Puramatrix. These data have provided a proof of concept of engineering vascularized skeletal muscle using murine satellite cells. INDUCTION OF CARDIOMYOGENESIS The heart's regenerative capabilities are not robust enough to repair the amount of damaged tissue from myocardial infarction. A novel approach to relieve the ischemia is to deliver cells with vasculogenic ability, endothelial colony forming cells and mesenchymal progenitor cells, to assemble de novo blood vessels and support recovery of cardiomyocytes. In our study, we used an in vitro transwell system that prevent cell contact, but allow diffusion of soluble factors to investigate if endothelial colony forming cells or mesenchymal progenitor cells secrete factors that induce cardiomyogenesis. We found that neonatal rat cardiomyocyte proliferation is enhanced in the presence of endothelial colony forming cells and mesenchymal progenitor cells; however, presence of these cells without fetal bovine serum is not sufficient to initiate cardiomyogenesis. PERSONALIZED THERAPY FOR RENAL CELL CARCINOMA TESTING IN AN ENDOTHEIAL CELL MODEL Sunitinib and Pazopanib are both tyrosine kinase inhibitors with high specificity for vascular endothelial growth factor receptor 2 and are used in the treatment of Renal Cell Carcinoma to inhibit angiogenesis. Recent clinical findings suggest that a subset of the population with a single nucleotide polymorphism in vascular endothelial growth factor receptor 2 respond better to Pazopanib treatment. We used a standard in vitro angiogenesis assay, endothelial cell proliferation, to test the effects of the single nucleotide polymorphism on responsiveness to Sunitinib and Pazopanib. We found that cells containing the polymorphism are more sensitive to Pazopanib than Sunitinib, confirming the clinical finding. We also analyzed the inhibition of phosphorylated vascular endothelial growth factor receptor 2 and confirmed drug activity on the phosphorylated protein. These findings could have personalized clinical implications for the 3% of the population with the polymorphism.

The field of tissue engineering has grown immensely since its inception in the late 1980s. However, currently commercialized tissue engineered products are simple in structure. This is due to a pre-clinical bottleneck in which complex tissues are unable to be fabricated. 3D bioprinting has become a versatile tool in engineering complex tissues and offers a solution to this bottleneck. Characterizing the mechanical properties of engineered tissue constructs provides powerful insight into the viability of engineered tissues for their desired application. Current methods of mechanical characterization of soft hydrogel materials used in tissue engineering destroy the sample and ignore the effect of 3D bioprinting on the overall mechanical properties of a construct. Herein, this work reports on the novel use of a non-destructive method of viscoelastic analysis to demonstrate the influence of 3D bioprinting strategy on mechanical properties of hydrogel tissue scaffolds. 3D bioprinting is demonstrated as a versatile tool with the ability to control mechanical and physical properties. Structure-function relationships are developed for common 3D bioprinting parameters such as printed fiber size, printed scaffold pattern, and bioink formulation. Further studies include effective real-time monitoring of crosslinking, and mechanical characterization of multi-material scaffolds. We envision this method of characterization opening a new wave of understanding and strategy in tissue engineering. / Graduate

Challenges in treating injuries, together with an increased need for repair of damaged tissues and organs, have made regenerative medicine a major research area today. Biomaterials such as silk fibroin (SF) have proven to be excellent tissue scaffolds possessing properties essential in tissue engineering such as biocompatibility, biodegradability and exceptional mechanical properties. SF nanofibres are especially attractive due to their large surface-to-volume ratio and high porosity which is beneficial in regenerative medicine. However, to design biomaterial scaffolds, chemical and physical properties of SF have to be sufficiently known. The thesis aims to contribute to knowledge by characterizing silk fibroin from the African wild silkworm species Gonometa rufobrunnae, Gonometa postica, Argema mimosae, Epiphora bahuniae and Anaphe panda. Moreover, the feasibility of producing nanofibrous biomaterial scaffolds from these fibroins is explored. The chemical composition of degummed fibres was investigated using Capillary electrophoresis whilst Infrared (IR) and Raman spectroscopic techniques were utilized to determine structural characteristics of the fibroin. In addition, thermal behaviour and mechanical properties of the fibroins were also investigated. Nanofibres were fabricated via electrospinning. The effects of solution concentration, voltage, polymer flow rate and tip to collector distance were studied to give optimum electrospinning conditions. IR spectroscopy was also utilized to observe the conformational structure of the degummed and electrospun fibres whilst scanning electron microscopy (SEM) provided information on the size and morphology of the fibres. The use of the nanofibres as biomaterials was evaluated using cytotoxicity tests. Results showed that glycine, alanine and serine constituted over 70% of the amino acid composition of all the fibroins. Gonometa fibroin had more glycine than alanine whilst the opposite was true for Argema mimosae, Epiphora bahuniae and Anaphe panda fibroin. The abundance of basic amino acids in Gonometa rufobrunnae, Gonometa postica, Argema mimosae and Epiphora bahuniae fibroin makes them prime candidates for cell and tissue culture. The amino acid composition of the fibroins influenced secondary structure as the β-sheet structure. Anaphe panda, Argema mimosae and Epiphora bahuniae silks was made up of mostly alanine-alanine (Ala-Ala)n polypeptides whilst Gonometa fibroin had an interesting mixture of both glycine-alanine (Gly-Ala)n and (Ala-Ala)n units. The unique structures impacted the mechanical and thermal properties of the fibroins. Production of Gonometa nanofibres was mainly dependent on fibroin solution concentration. A minimum of 27 % w/v was needed to produce defect free nanofibres. Diameters of the electrospun fibres produced ranged from 300 to 2500 nm. IR spectroscopy data highlighted that the β-sheet conformation of degummed fibroin was degraded during the formation of the nanofibres rendering them water soluble. It was however possible to regenerate the β-sheet structure in the nanofibres by exposing them to various solvents. Cytotoxicity tests using Sulforhodamine B (SRB) assay demonstrated that the nanofibres were not toxic to cells, a major prerequisite for use as a biomaterial. This thesis successfully provides useful data in an area that has been minimally explored. Results suggest that SF from African silkworm species offers diversity in properties and are therefore attractive for use as biomaterials, especially in cell and tissue engineering. As far as we could determine, we are the first to extend the use of fibroin from African silk species by producing Gonometa SF nanofibres that are of potential use as biomaterial scaffolds. / Chemistry / D. Phil. (Chemisty)

Articular cartilage defects are still one of the major challenges in orthopedic and trauma surgery. Today, autologous chondrocyte transplantation (ACT), as a cell-based therapy, is an established procedure. However, one major limitation of this technique is the loss of the chondrogenic phenotype during expansion. Human mesenchymal stem cells (hMSCs) have an extensive proliferation potential and the capacity to differentiate into chondrocytes when maintained under specific conditions. They are therefore considered as candidate cells for tissue engineering approaches of functional cartilage tissue substitutes. First in this study, hMSCs were embedded in a collagen type I hydrogel to evaluate the cartilaginous construct in vitro. HMSC collagen hydrogels cultivated in different culture media showed always a marked contraction, most pronounced in chondrogenic differentiation medium supplemented with TGF-ß1. After stimulation with chondrogenic factors (dexamethasone and TGF-ß1) hMSCs were able to undergo chondrogenesis when embedded in the collagen type I hydrogel, as evaluated by the temporal induction of cartilage-specific gene expression. Furthermore, the cells showed a chondrocyte-like appearance and were homogeneously distributed within a proteoglycan- and collagen type II-rich extracellular matrix, except a small area in the center of the constructs. In this study, chondrogenic differentiation could not be realized with every hMSC preparation. With the improvement of the culture conditions, e.g. the use of a different FBS lot in the gel fabrication process, a higher amount of cartilage-specific matrix deposition could be achieved. Nevertheless, the large variations in the differentiation capacity display the high donor-to-donor variability influencing the development of a cartilaginous construct. Taken together, the results demonstrate that the collagen type I hydrogel is a suitable carrier matrix for hMSC-based cartilage regeneration therapies which present a promising future alternative to ACT. Second, to further improve the quality of tissue-engineered cartilaginous constructs, mechanical stimulation in specific bioreactor systems are often employed. In this study, the effects of mechanical loading on hMSC differentiation have been examined. HMSC collagen hydrogels were cultured in a defined chondrogenic differentiation medium without TGF-ß1 and subjected to a combined mechanical stimulation protocol, consisting of perfusion and cyclic uniaxial compression. Bioreactor cultivation neither affected overall cell viability nor the cell number in collagen hydrogels. Compared with non-loaded controls, mechanical loading promoted the gene expression of COMP and biglycan and induced an up-regulation of matrix metalloproteinase 3. These results circumstantiate that hMSCs are sensitive to mechanical forces, but their differentiation to chondrocytes could not be induced. Further studies are needed to identify the specific metabolic pathways which are altered by mechanical stimulation. Third, for the development of new cell-based therapies for articular cartilage repair, a reliable cell monitoring technique is required to track the cells in vivo non-invasively and repeatedly. This study aimed at analyzing systematically the performance and biological impact of a simple and efficient labeling protocol for hMSCs. Very small superparamagnetic iron oxide particles (VSOPs) were used as magnetic resonance (MR) contrast agent. Iron uptake was confirmed histologically with prussian blue staining and quantified by mass spectrometry. Compared with unlabeled cells, VSOP-labeling did neither influence significantly the viability nor the proliferation potential of hMSCs. Furthermore, iron incorporation did not affect the differentiation capacity of hMSCs. The efficiency of the labeling protocol was assessed with high resolution MR imaging at 11.7 Tesla. VSOP-labeled hMSCs were visualized in a collagen type I hydrogel indicated by distinct hypointense spots in the MR images, resulting from an iron specific loss of signal intensity. This was confirmed by prussian blue staining. In summary, this labeling technique has great potential to visualize hMSCs and track their migration after transplantation for articular cartilage repair with MR imaging. / Gelenkknorpeldefekte stellen immer noch eine der großen Herausforderungen in der Orthopädie und Unfallchirurgie dar. Als zellbasiertes Verfahren ist die Autologe Chondrozytentransplantation (ACT) heute in der klinischen Routine etabliert. Ein großer Nachteil dieser Methode ist jedoch der Verlust des chondrozytären Phänotyps während der Expansion der Zellen. Humane mesenchymale Stammzellen (hMSZ) verfügen über ein ausgeprägtes Proliferationspotential und besitzen die Fähigkeit, unter spezifischen Bedingungen zu Knorpelzellen zu differenzieren. Sie werden daher als alternative Zellen für das Tissue Engineering von funktionellem Knorpelersatzgewebe in Betracht gezogen. In der vorliegenden Arbeit wurden erstens hMSZ in ein Kollagen Typ I Hydrogel eingebracht und zunächst der Grad der chondrogenen Zelldifferenzierung im Konstrukt evaluiert. HMSZ-Kollagenhydrogele zeigten in allen Kultivierungsmedien eine deutliche Kontraktion, welche am stärksten im chondrogenen Differenzierungsmedium unter Zugabe von TGF-ß1 ausgeprägt war. Nach Stimulation mit chondrogenen Faktoren (Dexamethason und TGF-ß1) differenzierten hMSZ zu Knorpelzellen, nachgewiesen durch die Induktion von knorpelspezifischer Genexpression. Die Zellen wiesen eine Chondrozyten-ähnliche Morphologie auf und waren bis auf einen kleinen Bereich in der Mitte des Konstrukts homogen in einer Proteoglykan- und Kollagen Typ II-haltigen extrazellulären Matrix verteilt. Eine chondrogene Differenzierung konnte in der vorliegenden Arbeit jedoch nicht mit jeder hMSZ-Präparation realisiert werden. Durch die Verbesserung der Kulturbedingungen, z.B. durch die Verwendung einer anderen Serumcharge im Gelherstellungsprozess, konnte eine Steigerung der knorpelspezifischen Matrixsynthese erzielt werden. Nichtsdestotrotz spiegeln die großen Schwankungen in der Differenzierungskapazität die hohe Variabilität zwischen verschiedenen Spendern wider, welche die Entwicklung eines knorpelartigen Gewebes beeinflussen. Zusammengefasst zeigen die Ergebnisse, dass das Kollagen Typ I Hydrogel eine geeignete Trägermatrix für hMSZ darstellt, um in Stammzell-basierten Knorpelregenerationstherapien zukünftig als vielversprechende Alternative zur ACT eingesetzt zu werden. Um die Qualität eines in vitro generierten knorpelartigen Gewebes weiter zu verbessern, wird häufig eine mechanische Stimulation in spezifischen Bioreaktorsystemen durchgeführt. In der vorliegenden Arbeit wurden daher zweitens die Effekte von mechanischer Belastung auf die Differenzierung von hMSZ untersucht. HMSZ-Kollagenhydrogele wurden im chondrogenen Differenzierungsmedium ohne TGF-ß1 kultiviert und einem kombinierten mechanischen Stimulationsprotokoll, bestehend aus Perfusion und zyklischer uniaxialer Kompression, ausgesetzt. Die Kultivierung im Bioreaktor hatte weder einen Einfluss auf die Zellvitalität noch auf die Anzahl der Zellen im Kollagen Typ I Hydrogel. Die mechanische Beeinflussung steigerte im Vergleich mit den unbelasteten Kontrollgelen die Genexpression von COMP und Biglykan und führte zu einer Hochregulation von Matrix Metalloproteinase 3. Diese Ergebnisse belegen, dass hMSZ mechanosensitiv sind, jedoch konnte keine Differenzierung zu Knorpelzellen induziert werden. Hierfür sind weitere Studien notwendig, um spezifische Stoffwechselwege zu identifizieren, welche durch die mechanische Stimulation beeinflusst werden. Drittens, für die Entwicklung von neuen zellbasierten Therapien für die Gelenkknorpelrekonstruktion ist eine zuverlässige Bildgebung auf zellulärer Ebene erforderlich, um die Zellen in vivo wiederholt nicht invasiv zu detektieren. Die vorliegende Arbeit hatte zum Ziel, systematisch die Effizienz und die biologischen Auswirkungen einer einfachen und dauerhaften Markierung für hMSZ zu untersuchen. Superparamagnetische Eisenoxidnanopartikel (VSOPs), ein Magnetresonanz (MR)-Kontrastmittel, wurden für die Markierung eingesetzt. Die Aufnahme der Eisenoxidnanopartikel wurde histologisch mittels eisenspezifischer Berliner-Blau-Färbung nachgewiesen und durch Massenspektroskopie quantifiziert. Im Vergleich zu unmarkierten Zellen beeinträchtigte die VSOP-Markierung weder die Vitalität noch das Proliferationspotential der hMSZ. Weiterhin war durch die Aufnahme der Eisenoxidnanopartikel keine Beeinflussung der Differenzierungskapazität der hMSZ zu verzeichnen. Die Effizienz der Zellmarkierung wurde mittels hochauflösender MR-Bildgebung bei 11,7 Tesla beurteilt. VSOP-markierte hMSZ im Kollagen Typ I Hydrogel erschienen als hypointense Punkte in den MR-Bildern, hervorgerufen durch die typische, VSOP-bedingte Signalauslöschung. Histologische Untersuchungen dieser Konstrukte bestätigten die MR-Ergebnisse. Zusammenfassend lässt sich festhalten, dass diese Zellmarkierungsmethode in Verbindung mit der MR-Bildgebung über das Potential verfügt, nach einer Gelenkknorpelrekonstruktion Aufschluss über die Lokalisation und Migration der transplantierten hMSZ zu liefern.

Für die Rekonstruktion von Gelenkknorpeldefekten des Kniegelenkes in Folge eines Traumas oder einer Osteochondrosis dissecans (OD) stehen verschiedene operative Verfahren zur Verfügung. Die Autologe Chondrozytentransplantation (ACT) hat sich als zuverlässiges Rekonstruktionsverfahren erwiesen. In der vorliegenden Arbeit wurde eine prospektive Fallseriestudie für eine neue Form der ACT mit einem Kollagen I Hydrogel (CaReS-Technologie) durchgeführt. Die Vorteile der Technologie liegen zum Einen darin, dass sich die Zellen homogen im Gel verteilen und zum Anderen, dass die Zellen unmittelbar nach dem Herauslösen aus dem Gelenkknorpel in das Gel eingebracht werden und dadurch eine geringere Dedifferenzierung der Chondrozyten stattfindet. Von März 2003 bis Ende 2006 wurden 29 Patienten in die Studie eingeschlossen. Die Ein- und Ausschlusskriterien erfüllten die Kriterien der Arbeitsgruppe ACT und Tissue Engineering der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie. Die Eingangs- und Nachuntersuchungsbögen wurden an die IKDC Form 2000 angelehnt. Insgesamt zeigte sich ein signifikanter Anstieg des IKDC Scores im mittleren follow-up von 30,7 Monaten von 47,3 auf 74,9 bei den 29 Patienten. Bei Aufschlüsselung der Patienten bzgl. Diagnose, Defektgröße, Lokalisation und Defektanzahl zeigte sich bei den Behandlungsgruppen OD, Trauma/degenerativ, > 4 cm2, mediale Femurkondyle und Einzeldefekte eine signifikante Zunahme des IKDC Scores im zeitlichen Verlauf. Der postoperative Schmerz zeigte einhergehend mit dem Anstieg des IKDC Scores eine signifikante Abnahme der Schmerzintensität in den Behandlungsgruppen OD, Trauma/degenerativ, > 4 cm2, mediale Femurkondyle und Einzeldefekte. Nachgewiesen wurde ebenfalls ein Anstieg des SF36 Scores, der den gegenwärtigen Gesundheitszustand sowohl körperlich als auch psychisch beurteilt. Zusammen mit einer globalen Patientenzufriedenheit von 80% und einem IKDC Funktionsstatus von I und II bei 77% der Patienten spiegeln die gewonnenen Daten die Ergebnisse der klassischen ACT bzw. anderer matrixgekoppelten Verfahren wieder. Die CaReS-Technologie stellt somit ein gleichwertiges Verfahren zu den bisher auf dem Markt befindlichen Techniken der ACT dar. / For the reconstruction of articular cartilage defects of the knee resulting from osteochondritis dissecans (OD) or trauma different surgical techgniques are available. Autologous chondrocyte implantation (ACI) has proven to be a reliable reconstructive technique. In this work, we have performed a prospective case control study using a new form of ACI with a collagen type I hydrogel (CaReS-technology). The advantages of the technology are that the cells can be distributed homogeneously within the hydrogel and immidiatly after their release from the cartilage they are brought into the gel, resulting in less dedifferentiation of the chondrocytes. From March 2003 to the end of 2006 we enrolled 29 patients in this study. The inclusion and exclusion criteria were adopted from the criteria of the working group for ACT and Tissue Engineereing of the German Society for Orthopaedic and Trauma Surgery. The inital clinical and follow-up examinations were performed according to the IKDC form 2000. In general, we found a significant increase of the IKDC score at the follow-up of 30.7 months from 47.3 to 74.9 of the 29 patients. When seperating the patients by diagnosis, defect size, defect location and defect number we found in the groups with OD, trauma/degenerativ, > 4 cm2, medial condyle and single defects a significant increase of the IKDC score over the follow-up period. The postoperative pain showed accoring to the increased IKDC score a significant decrease of the pain intensity in the groups with OD, trauma/degenerativ, > 4 cm2, medial condyle and single defects. We also found an increase of the SF36 score, which describes the current physical and mental health status. Together with a global patient satisfaction of 80% and an IKDC functional status of I and II in 77% of the patients our data reflect the results of the classical ACI, as well as other matrix-based technologies. Therefore, the CaReS-technology is comparable to other technologies which are currently on the market.