Evaluation of silk as a scaffold for musculoskeletal regeneration - the path from the laboratory to clinical trials

© 2019 Elsevier B.V. All rights reserved. Numerous conditions of the musculoskeletal system could be solved or relieved by the use of engineered tissues. Silk is extraordinary in its versatility, slow degradation rate and incredible mechanical properties, and thus a large number of studies proposed it as a candidate scaffold for repairing failing tissues. Many in vitro and in vivo studies have investigated silk as a scaffold for musculoskeletal regeneration, with promising results. Despite these positive studies, there is still very little information available regarding current clinical trials of silk implants. The aim of this review will be to evaluate the feasibility and requirements for translating silk studies in the laboratory and animal models to clinical trials. The first part of this review briefly summarizes relevant past studies of silk for skeletal tissue engineering, and the second part will evaluate findings from past studies in the context of medical implant assessment and safety, and highlight aspects which merit further research. Overall, the review will compare and call attention to the differences between novel scaffolds of regenerated silk fibroin, native, degummed silk scaffolds and the traditional dyed Bombyx mori silk sutures.