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Highlights in Pathophysiology and Treatment of Osteoarthritis

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Co-Guest Editor
Department Experimental and Clinical Medicine, Division of Rheumatology, Careggi University Hospital, University of Florence, 50141 Florence, Italy
Interests: autoimmune diseases; systemic sclerosis; interstitial lung disease; rheumatoid arthritis; inflammatory rheumatic diseases
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Special Issue Information

Dear Colleagues,

Osteoarthritis is a highly common and disabling condition worldwide. Growing evidence shows that osteoarthritis is a complex condition in which the whole joint is involved; the degradation of articular cartilage, subchondral sclerosis, and the hyperplasia of the synovial tissue are hallmarks of the disease. Unfortunately, its pathophysiology is not yet fully understood, and multiple factors ranging from aging to biomechanical and biochemical stimuli contribute to the development and progression of osteoarthritis. The pathological changes in the joint structure are mediated by a plethora of factors, such as proteases, proinflammatory cytokines and chemokines, adipokines, prostaglandins, nitric oxide, and reactive oxygen species. Current data suggest that aberrant epigenetic modifications, as well as the gut microbiome, play key roles in the pathophysiology of this disease.

Our incomplete knowledge of the pathophysiology of this disease and the complexity of the pathogenic mechanisms pose a challenge in its management. In fact, current pharmacological treatments are mostly related to the relief of symptoms; disease-modifying osteoarthritis drugs, aimed at reducing symptoms in addition to slowing or stopping disease progression, are not currently available. The discovery of crucial pathways characterizing this disease could offer new opportunities to identify compounds potentially able to reduce or stop osteoarthritis progression.  

Our aim in launching this Special Issue is to provide an overview of emerging studies designed to identify the complex pathological mechanisms that characterize the disease and that test different pharmacological and non-pharmacological approaches to the treatment of osteoarthritis.

Research articles, review articles, and communications are welcome.

Dr. Antonella Fioravanti
Guest Editor

Prof. Dr. Serena Guiducci
Co-Guest Editor

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Keywords

  • osteoarthritis
  • pathophysiology (cytokines, adipokines, chemokines, epigenetics, microbiome)
  • cartilage
  • synovial membrane
  • subchondral bone
  • treatment
  • disease-modifying osteoarthritis drugs
  • non-pharmacological treatment

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Published Papers (2 papers)

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27 pages, 832 KB  
Review
Infrapatellar Fat Pad in Knee Osteoarthritis: A Comprehensive Review of Pathophysiology and Targeted Therapeutic Strategies
by Ilenia Mallia, Antonella Fioravanti and Serena Guiducci
Int. J. Mol. Sci. 2025, 26(21), 10408; https://doi.org/10.3390/ijms262110408 - 26 Oct 2025
Viewed by 3525
Abstract
Osteoarthritis (OA) is the most common joint disorder globally, affecting approximately 595 million individuals and representing the first cause of chronic pain and disability. Recently, the infrapatellar fat pad (IFP), an intracapsular adipose tissue in the human knee joint, was recognized as an [...] Read more.
Osteoarthritis (OA) is the most common joint disorder globally, affecting approximately 595 million individuals and representing the first cause of chronic pain and disability. Recently, the infrapatellar fat pad (IFP), an intracapsular adipose tissue in the human knee joint, was recognized as an active and metabolically significant contributor to the pathophysiology of OA through the release of pro-inflammatory cytokines, adipokines, and growth factors that sustain inflammatory response, fibrotic remodeling, and neurogenic pain. The present review provides an overview of the pathophysiological significance of the IFP in OA and current and promising therapeutic strategies targeting this adipose structure. We summarize the available preclinical and translational evidence on conservative therapies, minimally invasive interventions, and surgical options as well as IFP-derived mesenchymal stromal cells as a potential cell source for cartilage repair. Overall, preclinical research indicates that the modulation of IFP inflammation and fibrosis could alleviate pain and delay the progression of the disease. The superficial location and its central role in the pathogenesis of OA make the IFP a promising therapeutic target in knee OA (KOA). Full article
(This article belongs to the Special Issue Highlights in Pathophysiology and Treatment of Osteoarthritis)
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17 pages, 3069 KB  
Article
Development of an Ex Vivo Osteochondral Biomimetic Platform for Mechanistic Investigation of Cartilage Regeneration
by Johanna Brobeil, Dorothea Alexander, Felix Umrath and Marina Danalache
Int. J. Mol. Sci. 2025, 26(23), 11759; https://doi.org/10.3390/ijms262311759 - 4 Dec 2025
Viewed by 796
Abstract
Articular cartilage possesses limited intrinsic healing capacity due to its avascular and aneural nature, posing a significant challenge for treating focal chondral defects. While regenerative strategies employing biomaterials and stem cells have progressed, their mechanistic evaluation is hindered by the lack of physiologically [...] Read more.
Articular cartilage possesses limited intrinsic healing capacity due to its avascular and aneural nature, posing a significant challenge for treating focal chondral defects. While regenerative strategies employing biomaterials and stem cells have progressed, their mechanistic evaluation is hindered by the lack of physiologically relevant in vitro models. This study aimed to establish and characterize a human ex vivo osteochondral explant model to assess cellular and extracellular matrix responses to cartilage repair strategies. Osteochondral explants (10 mm diameter, n = 61) were harvested from femoral condyles of patients undergoing knee arthroplasty. Standardized full-thickness chondral defects (4 mm) were created and assigned to six treatment groups: native control, untreated defect, fibrin glue, collagen type I hydrogel (ChondroFiller®), fibrin glue + MSCs, and ChondroFiller® + MSCs. Explants were cultured for 7, 14, or 21 days, followed by metabolic, biochemical, and histological assessments. Explants remained viable for 21 days. Notably, the ChondroFiller® group showed a 2.4-fold increase in DNA content by day 14, while MSC-treated groups enhanced collagen deposition and GAG production. Significant correlations between DNA and collagen levels were observed in scaffold-based treatments. This ex vivo model offers a reproducible and translational platform to investigate cartilage regeneration with temporal resolution, supporting preclinical testing of emerging therapeutic approaches. Full article
(This article belongs to the Special Issue Highlights in Pathophysiology and Treatment of Osteoarthritis)
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