Current Concepts Cartilage Repair: 2013 Asian Update James H. P. Hui, M.B.B.S., F.R.C.S., F.A.M.S., Deepak Goyal, M.D., Norimasa Nakamura, M.D., Ph.D., and Mitsuo Ochi, M.D., for the Asian Cartilage Society Abstract: Despite financial and regulatory hurdles, Asian scientists and clinicians have made important contributions in the area of cartilage repair. Because it is impossible to include observations on all the published articles in one review, our attempt is to highlight Asian progress in this area during recent years (2005 to the present), reviewing research devel- opment and clinical studies. In the former, our discussion of in vitro studies focuses on (1) potential sources of stem cellsdsuch as mesenchymal stem cells (MSCs) from marrow, cord blood, synovium, and mobilized peripheral bloodd which are capable of enhancing cartilage repair and (2) the use of growth factors and scaffolds with and without cells. Our discussion of animal studies attempts to summarize activities in evaluating surgical procedures and determining the route of cell administration, as well as studies on matrices and scaffolds. It ranges from the use of small animals such as rats and rabbits to larger animals like pigs and dogs. The local adherent technique, enhancement of microfracture with poly(L- lactic-co-glycolic acid) scaffold, adenovirus-mediated bone morphogenic protein (BMP) genes, and MSCsdwhether they are magnetically labeled, suspended in hyaluronic acid, or immobilized with transforming growth factor-b (TGF-b)dhave all been able to engineer a repair of the osteochondral defect. Although published Asian reports of clinical studies on cartilage repair are few, the findings of relevant trials are summarized in our discussion of these investigations. There has been a long history of use of laboratory-derived MSCs for cartilage repair. Recent progress has suggested the potential utility of cord blood and mobilized peripheral blood in this area, as well as more injectable bone marrow (BM)-derived stem cells. Finally, we make a few suggestions on the direction of research and development activities and the need for collaborative approaches by regulatory agencies. A sian scientists and clinicians have been active in the research of cell-based therapy for cartilage damage. They face major hurdles in clinical applicationsd including awareness, cost, and rehabilitation issues; the almost total absence of a regulatory framework in most countries; patchy research activities as well as few publi- cations in regional or national languages; an absence of data sharing; and an absence of multicenter trials. In addition, the unfortunate rise in “stem cell tourism” has compounded the problems, 1,2 making regulatory agencies and institutional review boards even more cautious in their evaluation and approval of legitimate clinical studies and giving patients the wrong impres- sions about the utility of stem cells. 3 These issues were recognized by prominent faculties in Asia and guided them to search for common solutions together. The result was the formation of the Asian Cartilage Repair Society in 2011. At that time it was decided to initiate a basic analysis of various research activities done by different members, for example, laboratory studies, animal trials, clinical studies, case series, and multi- center trials. Despite all the difficulties, the effort by teams of investigators in various Asian countries had resulted in numerous quality publications. Any attempt at a comprehensive review is impossible. The purpose of this article is to discuss some of the important research and clinical activities in chondrocyte and MSC cartilage repair in Asia during recent years. The focus is on the use From the Cartilage Repair Program, Therapeutic Tissue Engineering Laboratory, Department of Orthopaedic Surgery (J.H.P.H.), National University Health System, National University of Singapore, Singapore; Saumya: Center for Advanced Surgeries of the Knee Joint (D.G.), Ahmedabad, India; Department of Orthopaedic Surgery (M.O.), Grad- uate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan; Department of Rehabilitation Science (N.N.), Osaka Health Science University, Osaka, Japan. The authors report the following potential conflict of interest or source of funding in relation to this article: M.O. has received money from J-Tec and Smith & Nephew for consultancy, from Smith & Nephew for payment for lectures including service on speakers bureaus, and payment for manuscript preparation from Esai Co. Received May 8, 2013; accepted June 11, 2013. Address correspondence to James H. P. Hui, M.B.B.S., F.R.C.S., F.A.M.S., Cartilage Repair Program, Therapeutic Tissue Engineering Laboratory, Department of Orthopaedic Surgery, National University Health System, National University of Singapore, 1E, Kent Ridge Road 119288, Singapore. E-mail: james_hui@nuhs.edu.sg Ó 2013 by the Arthroscopy Association of North America 0749-8063/13315/$36.00 http://dx.doi.org/10.1016/j.arthro.2013.06.009 1992 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 29, No 12 (December), 2013: pp 1992-2000