Participating scientists and clinicians:

Prof. Dr. Dr. Martijn van Griensven, Ludwig Boltzmann Institute, Austria 
Prof. Dr. John Jansen, Radboud University, Netherlands, co-editor in chief of TE-journal 
Prof. Dr. Peter C. Johnson, Scintellix, US, co-editor in chief of TE-journal 
Prof. Dr. C. James Kirkpatrick, Johannes Gutenberg University, Germany 
Prof. Dr. Antonios Mikos, Rice University, US, co-editor in chief of TE-journal 
Prof. Dr. Yasuhiko Tabata, Institute of Frontier Medical Science, Japan 
Prof. Dr. Molly Stevens, Imperial College London, UK 
Prof. Dr. Peter ten Dijke, Leiden University Medical Center, NL 
Prof. Dr. Marc Grynpas, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, CA 
Dr. Rita Kandel, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, CA 
Prof. Dr. Dietmar Hutmacher, Queensland University of Technology, Brisbane, Australia 
Prof. Dr. Hae-Ryong Song, University Medical Center, Seoul, Korea 
Prof. Dr. Josep A. Planell, University of Catalonia, Barcelona, Spain 
Prof. Dr. Pierre Layrolle, University of Nantes, France 
Prof. Dr. Clemens A. van Blitterswijk, Twente University, Enschede, NL 
Prof. Dr. Wouter J.A. Dhert, Utrecht University, NL 
Prof. Dr. Peter Fratzl, Max-Planck Insitute, Potsdam, Germany 
Dr. Guak-Kim Tan, University of Queensland, Brisbane, Australia 
Dr. Chanzong Liu, University College London, UK

Scientific fields involved

Our group represents a complex array of interests:

• Skeletal muscles 
• Long bones 
• Spine 
• Cranial and maxillofacial surgery 
• Tendons 
• Cartilage 
• Nerves 
• Nutrition by vascularisation 
• which include
  • Matrices 
  • Signaling molecules 
  • Stem cells 

Scientific rationale: current state of musculoskeletal treatments

There is a significant clinical demand for the treatment of musculoskeletal illnesses, on the one hand the congenital diseases, such as Duchenne Muscular Dystrophy, and on the other hand other acquired illnesses involving tumors or traumata.

The prevalence of fracture injuries is increasing worldwide. This is largely attributed to an aging population and to sports-related and traumatic injuries. The treatment of these injuries will be a major global burden on individuals and national health care systems. For example, in 2007, statistics indicated that more than 15 million cases of fracture injuries were reported per annum in the United States. As a result, bone reconstruction has an immense growth opportunity and is predicted to reach a market potential of $3.3 billion by 2013, with a compound annual growth rate of 13.8% in the United States market alone.

Fundamentally, there are still numerous unanswered questions concerning bone, cartilage and tendon regeneration and remodeling. The transplantation of autogenous bone is to date regarded as the gold standard in the treatment of bone defects. However, autogenous bone grafting is limited in availability and its osteogenic potential is patient-dependent. There have also been concerns with long term resorption of the bone in large defects.

In addition, morbidity at donor and recipient sites has to be taken into account. Current literature shows that, as a result of harvesting at the iliac crest, 20 to 30 % of the patients suffer for the rest of their lives. Furthermore, risks of blood loss in older patients must be taken into consideration.

Recipient risks include the following:

• Infection 
• Necrosis 
• Loss of transplantation volume 

These complications are due to problems of nutrition. The literature also emphasizes the total necrosis of transplanted osteocytes in block transplantation procedures.

Bone tissue engineering (BTE) using both stem cells and growth factors together, or separately, in combination with suitable scaffolds, have resulted in reasonable success. Concerning cartilage and tendons, tissue engineering techniques, to date, are still in a phase of preclinical and clinical trials. BTE has since emerged as an alternative for fracture repair but its clinical introduction is largely hindered by a lack of adequate nutrition which is due to insufficient angiogenesis.

The absence of adequate reconstructive and musculoskeletal tissue replacement solutions highlights an urgent, unmet need for the development of new therapeutic strategies. This includes stem cells, smart scaffold technology, bioreactors, growth factors and clinical know-how procedures.

Proposed objectives

Our main objective is to facilitate swifter clinical application of new technologies. This will be achieved by establishing a network consisting of clinicians, scientists, researchers and engineers. The respective network will ensure a fast and efficient communication between its members and guarantee that new research results reach clinicians and surgeons as well as university students in a short time.

To obtain the best results, it is paramount for all stake-holders to collaborate more closely. This especially applies to the interaction between clinicians, scientists and engineers.

In addition to establishing an efficient network of experts, the focus of research has to be extended. So far, research has predominantly concentrated on scaffolds, stem cells and signaling molecules. Thus more research on biomechanical stimulation and angiogenesis for remodeling of musculoskeletal tissue for long term efficacy and prevention of resorption is urgently required.

Our priority is to promote more research in vascularisation and in understanding the regulation of cytokines during the growth of different types of new tissue. The discontinuous release of cytokines seems to play an important role and has previously been ignored in many publications.

Finally, the time-frame of releasing new research findings has to be condensed. Manuscripts concerning new research results have to be published faster.

In conclusion, to successfully address complex tissue engineering issues and to achieve the regeneration of complete organic systems requires efficient and encompassing interdisciplinary cooperation and collaboration involving all stake- holders.

To ensure a top-level and up-to-date state of research, our group will organize discussions and symposia at various meetings and congresses world-wide. The members of our group will meet regularly to discuss new developments and to ensure that our objectives are achieved. We are convinced that this theme can be regarded as a fundamental element of TERMIS activity worldwide.