Neural Prolotherapy

One of the newest advances in Regenerative Orthopedic Medicine is the use of Neurofascial Prolotherapy. Neurofascial Prolotherapy also called Neural Prolotherapy. This is not to be confused with traditional “German” Neural injection therapy. Neurofascial Prolotherapy (NPT) was born out of clinical observations and involves the treatment of Neurogenic inflammation. NPT is given just under the skin in or close to subcutaneous nerves at weekly intervals. Research shows 89% of patients satisfied with 6.8 treatments with a mean follow up of 20 months.

Glucose responsive nerves

Glucose responsive nerves have been demonstrated throughout the nervous system. One proposed mechanism of action suggests that dextrose binds to pre synaptic Calcium channels and inhibits the release of substance P and CGRP, thereby decreasing neurogenic inflammation. This allows normal flow of Nerve Growth Factor and subsequent nerve repair and decreased pain.

Hilton’s Law

Another critical concept in NPT is Hilton’s Law. Hilton’s Law states: the nerve supplying a joint also supplies both the muscles that move the joint and the skin covering the articular insertion of those muscles. This concept is very interesting as it can explain the wide reaching affects of NPT on pain control.

I have been using Neural Prolotherapy in my practice for the past year with outstanding results. It has become my first treatment option followed by traditional Prolotherapy and Platelet Rich Plasma as needed. I find that in about 60% of my patients I have complete pain control with only Neural Prolotherapy.

Musculoskeletal Medicine

Neural Prolotherapy is indeed a powerful treatment option that we may choose to use in our field of Musculoskeletal Medicine.

Amniotic Cream for Topical use

Structure and Function of the Amniotic Membrane

The amniotic membrane surrounds and protects the developing fetus in utero and separates mother and fetus. If you were to look closely at the amniotic membrane, you would be able to notice that the membrane is comprised of several layers. The membrane can be easily separated into two distinct layers: the amnion layer and the chorion layer, which are separated by a jelly-like layer. The amnion layer of the membrane, or fetal side, has a layer of epithelial cells which can easily be removed with simple cell scraping, revealing a see-through underlying layer. The chorion layer is the maternal side of the amniotic membrane. Both layers have a basement membrane and a stromal layer (Medscape, 2012).

If you looked at the amniotic membrane under a microscope, you would be able to appreciate three different types of material: collagen and extracellular matrix, biologically active cells and regenerative molecules. The extracellular matrix provides structure and contains a number of specialized proteins, including proteoglycans, fibronectin, laminins and others. Several types of collagen add structural strength to the membrane. The biologically active cells include stem cells, which function to regenerate new cellular materials within the lining of the membrane. Fibroblasts help to strengthen the tissue, and epithelial cells aid in the healing process via receptors on the cell surface. Regenerative molecules, which are important for growth and healing, are present in the amniotic membrane as well. These include numerous types of growth factors such as fibroblast growth factors, platelet-derived growth factors, metalloproteinases and others. Immunosuppressive cytokines prevent the amniotic membrane from being seen as ‘foreign’ by both the mother and infant’s immune systems. There are also a number of other specialized molecules, such as defensins which protect against bacterial infection (Medscape, 2012).

Wound Healing Properties of Amniotic Membrane Patches

Amniotic Patch has a number of characteristics that make it especially suited to wound healing. The amniotic membrane:

  • contains a significant number of cytokines and essential growth factors
  • reduces pain when applied to a wound
  • increases and enhances the wound healing process
  • has antibacterial properties
  • is non-immunogenic (will not be seen as foreign material)
  • provides a biological barrier
  • provides a matrix for migration and proliferation of cells
  • reduces inflammation
  • reduces scar tissue formation

Dehydration of Amniotic Membrane Tissue

In the past, amniotic tissue was sterilized and stored at 4°C. Amniotic tissue could only be used for up six weeks, at which point it was no longer useful. Now, this material can be cleansed, dehydrated and sterilized, which means that the shelf life of amniotic membrane has been greatly increased.

Indications for Use

What types of wounds can amniotic membrane be used on? Traditionally, amniotic membrane has been used on burns; nowadays, however, amniotic membrane can be used on a wide variety of wounds. It is important to note that amniotic membrane should be used only after conservative treatment has failed. In other words, amniotic membrane may be used for wounds that are chronic and non-healing.

Application of Amniotic Membrane

Prior to using amniotic membrane, a thorough initial assessment of the wound is necessary, as is a medical history. Gather information on the history of the wound, including duration, what treatments have been tried and patient comorbidity. Document wound appearance, size, depth, presence of necrotic tissue and note whether bone or other structures are visible. Assess circulatory status, nutrition and other barriers to healing. These are the same steps that you would follow prior to implementing any wound treatment and are not specific to amniotic membrane treatment.

Next, prepare the wound bed by performing any necessary debridement. The wound bed should be clear of any necrotic tissue and should not have any signs of infection. Amniotic membrane is supplied in a sterile container, and sterile scissors may be used to cut a piece of the amniotic membrane to fit the wound. The material may be applied wet or dry. Note that the stromal collagen layer must be facing the wound – read the manufacturer’s recommendations to determine how to apply the material. You can use steri-strips to hold the graft in place. There is no need to suture the material in place. A secondary dressing which promotes moist wound healing should be chosen as a secondary dressing. The graft should not be disturbed for at least one to two weeks.

After one to two weeks the amniotic membrane allograft will be incorporated into the wound. You should begin to see improvement in the wound in terms of size and depth within 2 to 3 weeks, or even sooner. You can apply a second graft once slowing of wound healing has occurred, as typically observed by wound measurements over time (Podiatry Today, 2015).

The use of amniotic membrane in the management of chronic wounds is an exciting new development which provides another option for wounds that fail to heal using traditional wound therapies and dressings.

Sources:
Fetterolf D, Snyder R. Scientific and Clinical Support for the Use of Dehydrated Amniotic Membrane in Wound Management. Wounds. 2012;24(10):299-307.
Zelen C, Serena T. Amniotic Membrane: Can it facilitate healing? Podiatry Today. 2015 Apr;28(4).

Colorblindness Technologies

How Do Colorblindness Glasses Work? Whom Might They Help?

Genetic (if you are born with it) colorblindness is caused by an absence of, or problem in the function of, one or more of the three types of color-sensing cone photoreceptors in the retina. People who have difficulty detecting green light (deuteranomaly) or red light (protanomaly) experience an overlap between some of the light wavelengths that the brain interprets as red or green color which account for over 10% of the population to some degree.

“Colorblindness glasses are made with certain minerals to absorb and filter out some of the wavelengths between green and red that could confuse the brain to help the wearer process colors differently than without.

Some of the light coming through the glasses is blocked so that the remaining red and green light wavelengths don’t overlap as much. With less color overlap, the brain gets a clearer signal to help distinguish between the problem colors.

Colorblindness-correcting glasses will not change color perception for people whose deficiency is caused by a complete absence of red or green photoreceptors. And the positive effects of the glasses last only as long as they are being worn. The glasses don’t in any way modify a person’s photoreceptors, optic nerves or visual cortex to fix colorblindness.

Color perception requires a complete set of optimally functioning equipment, and glasses will not replace or repair missing or broken mechanisms.

Optomitrist

Glasses change what the people who wear them see, enhancing the distinction between red and green. But the experience will vary widely among individuals, and colorblindness-correcting glasses don’t give people a true equivalent of natural color vision.

What to Consider Before Purchasing Colorblindness Glasses

Because they reduce the amount of light getting to the eye, it might not be a good idea to wear colorblindness-correcting glasses at night. Reducing the amount of light getting into the eye might especially be a problem for people who have other eye conditions such as cataracts or macular degeneration. EnChroma, the manufacturer, warns against using the glasses while driving. The company offers an indoor collection that blocks less light, for lower-light conditions.

Cost is also a concern for the average consumer. These glasses may be a luxury item for many individuals, because they can cost several hundred dollars. It’s important for people to have realistic expectations of how much these glasses might or might not help them before they buy. Colorblindness-correcting glasses are generally not covered by insurance because colorblindness doesn’t affect a person’s health, so treatment isn’t medically necessary.

There are other devices designed to enhance contrast between colors!

inventors understood visual physiology, color deficiency, and had a thorough understanding of the physics of optics and optical filters. With that combined knowledge they were able to select rare earth minerals that exactly matched the filter restrictions needed to enrich the glasses to address this color deficiency. It’s an elegant meld of curiosity and education to address a problem.

Enchroma Glasses Alternatives

Cost of Color Blind Glasses

Wharton Jelly

Practical Applications: Wharton’s Jelly for Diabetic Treatments

Stem cell treatments are exciting. The best way to harvest stem cells has been a matter of research and discussion. Cells for certain treatments have often been tested from bone marrow from healthy patients. However, there are many concerns about bone marrow stem cells. For example, studies have shown mixed results about their efficacy. Furthermore, obtaining bone marrow is a very painful, invasive procedure that has a risk of infection for the donor.

A huge breakthrough in regenerative medicine has been the use of Wharton’s Jelly. Wharton’s Jelly comes from the umbilical cord. The umbilical cord has three vessels. Surrounding these vessels is mucoid connective tissue, which is called Wharton’s Jelly. Wharton’s jelly is easy to obtain from discarded umbilical cords. Many umbilical cords are donated, and the cords are rich in stem cells, making them an excellent source to work with.

Wharton’s jelly has been found in studies to be effective in treating inflammatory and autoimmune diseases. These illnesses include lupus and multiple sclerosis. Wharton’s jelly can reverse partially or totally Graft vs. Host Disease (GVHD), a condition where donated cells attack the patient’s body, in 50% of patients. This article explores various ways Wharton’s jelly can be used in treatment of diabetes mellitus.

Wharton’s Jelly’s immunosuppressive capabilities make it ideal for treating type 1 diabetes. Also known as diabetes mellitus, it is an autoimmune disorder where T cells destroy insulin producing beta cells. In the United States, 1.25 Americans have Type 1 diabetes, and 5 million people are expected to be diagnosed by 2050. Type 1 diabetes results in $14 billion healthcare expenditures and lost income per year. Fewer than a third of people with Type 1 diabetes consistently achieve appropriate blood-glucose levels. The disease is increasingly expensive for individuals, resulting in 1 of 4 diabetics rationing insulin, a dangerous practice in controlling glucose levels. Constant high glucose levels can cause inflammation in organs, causing promoting fibrosis and irreversible damage.

Other potential risks of diabetes are:

  • blindness,
  • kidney failure,
  • cardiovascular disease,
  • stroke,
  • neuropathy,
  • vascular dysfunction.

Symptoms of diabetes include:

  • excessive thirst and hunger,
  • fatigue,
  • blurred vision,
  • weight loss,
  • irritability, and
  • frequent infections.

Even though drugs can work to achieve glycemic control, they don’t prevent the complications. Stem cells have the ability to differentiate into function insulin producing cells. If doctors can eliminate the cause of disease, the pancreas can even regenerate.

Studies have shown that intravenous infusion of allogenic (from a donor) Wharton’s Jelly mesenchymal stromal cells (MSCs) is safe for patients with type 1 diabetes. Furthermore, blood glucose, glycosylated hemoglobin, C-peptide, and incidence of diabetic complications were significantly improved in one study. It is unknown exactly how Wharton’s Jelly MSC leads to these effects, but they are extremely promising.

Wharton’s Jelly treats diabetic wounds

Treatment with Wharton’s Jelly MSCs can help with diabetic wounds. Diabetes affects wound healing in many multivariate ways.  

Diabetic wounds heal slowly, because high blood sugar:

  • prevents nutrients and oxygen from making cells strong and energetic,
  • prevents your immune system from functioning properly,
  • results in a lack of neovascularization, the formation of new blood vessels that is important for new tissue growth;
  • causes reduced collagen production. Collagen helps fibroblasts and keratinocytes to reach the wound to boost tissue growth.
  • leads to malfunctioning macrophages. Macrophages clear cell debris, resolve inflammation, and promote fibrosis.
  • increases inflammation. 

All of these lead to slower wound healing.

Diabetic foot wounds

Diabetics are particularly prone to food ulcers, an open sore that 15% of patients with diabetes get on the bottom of their foot, resulting in 6% of these individuals being hospitalized. Diabetes is the leading cause of lower extremity amputations not caused by trauma, and 14-24% of diabetics developing a foot ulcer will require amputation. Part of the danger is that patients with diabetes can develop neuropathy, or nerve damage, from high glucose levels, which leads to them not being able to feel pain in their feet and the wound getting out of hand. Because of all these dangers, it is particularly important to develop new, effective treatments for diabetic wounds, and Wharton’s Jelly MSC shows great promise.

In one study, patients’ wounds were covered in amniotic membrane seeded with Wharton’s jelly MSCs, and the results appear to demonstrate that significant acceleration occurred in healing. Other studies have shown that Wharton’s Jelly MSCs enhance healing of diabetic wounds. Wharton’s jelly leads to nerve regeneration, neuroprotection, and reduced inflammation. In studies, patients experienced reepithelialization. Repithelialization is how the skin and mucus membranes replace superficial cells damaged or lost in a wound. They also experienced greater neovascularization, which is necessary to form granulation tissue. This is the new connective tissue and microscopic blood vessel that fill wounds. Finally, there was greater fibroproliferation, essential in cutaneous healing.

Other uses of Wharton’s Jelly in Type 1 diabetes

The future of treating Type 1 diabetes might involve Wharton’s jelly. Studies have shown that Wharton’s jelly cells promote insulin formation and can repair renal damage. Cells migrate to damaged organs and contributed lower glucose levels in 30% of treated mice, and these mice showed reduced symptoms.

In another important study, 61 patients were divided into two groups; one was given saline, and one was given an intravenous infusion using Wharton’s Jelly MSCs. During the 36-month follow-up, it was shown that the infusion improved the function of cells, reduced the incidence of diabetic complications, and increased pancreatic function.

Conclusion

Diabetes is a serious and growing public health issue that has significant costs in terms of the economy. The human costs can be devastating. While currently there are options for trying to control glucose levels, there is a need for an overall treatment that prevents type 1 diabetes and leads to repairs of the systems. Wharton’s Jelly and the cells it contains have shown great promise in reducing diabetes, and in treating wounds due to diabetes. To find out more about Wharton’s Jelly, visit www.whartonjelly.com.

References

http://www.clinicaltdd.com/article.asp?issn=2542-3975;year=2018;volume=3;issue=2;spage=32;epage=37;aulast=Carlsson
https://www.ncbi.nlm.nih.gov/pubmed/31127705
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997981/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645864/
https://onlinelibrary.wiley.com/doi/abs/10.1002/jcb.28398
https://www.spandidos-publications.com/etm/12/3/1857

Exosomes

Exosomes for Hair Restoration

What’s more frustrating than hair loss (alopecia)? We use our hair to signal beauty and youth; it is our pride and joy.  Yet new research in China found that people perceive they are going bald earlier than past generations, even in their 20s! In the study 60% of participants self-reported that they were losing significant amounts of hair. In general, 85% of men’s hair will have thinned out significantly by the age of 50.

Not just men experience pattern baldness. More than 50% of women will experience noticeable hair loss, often because of female-pattern hair loss. Because of rigid beauty standards for women, there may be an even greater stigma attached to their hair loss, and greater emotional damage.

What causes hair loss

Age is the obvious cause of hair loss; in fact, 95% of men’s hair loss is caused by male pattern baldness, but hormonal changes, autoimmune diseases, thyroid disorders, and stress can contribute as well. Some assert that vegan diets may contribute to hair loss. Vitamin deficiencies have been indicated too, such as zinc, vitamin D, and other nutrients.

How does stress contribute?

There are multiple stages in hair growth and loss. Stress can move hair out of the growth phase, causing hair to fall out and not regrow. Studies on animals have shown stress to cause this to occur. Millennials report higher levels of stress than older generations, and more difficulty in coping, which may be one reason they report more hair loss.

The impact of hair loss on self-image

Studies have shown that women are drawn to men with hair, and some have pointed to hair as a factor in success in politics (Eisenhower is the only bald man to be elected to the White House in modern times. Men respond to this prejudice with body dysmorphia and other psychological problems that are difficult to talk about.

What remedies for hair loss have traditionally been used?

While in older times, herbs like lavender, rosemary, and thyme were used to treat hair loss, in modern times more people try methods like hair regrowth pharmaceuticals. Some of these drugs can cause rapid heart rate, unwanted hair growth and even sexual dysfunction. So far, there are hair restoration    like hair transplant surgery. This is only implicated when only the top of the head is affected. Skin is transplanted from the back to the top. Multiple surgeries may be need, and hereditary hair loss will still occur. The surgery can be expensive and painful. No one wants to be forced to use a product every day or lose their benefits (their hair) again. Who doesn’t dream about simply regrowing their own hair?

Exosomes are the next frontier in hair restoration

Exosomes, which ethically come from birth tissues (see http://amnioticdoctors.com/top-uses-of-amniotic-membrane-to-heal-the-eyes for a more detailed explanation), contain RNA and mRNA, which is the initiator of protein manufacture. They produce signals that create bodily function including cellular growth. Basically, they send messages and direct cells how to act.

Exosomes are released by cells when they fuse together.

The technical stuff

Exosomes are extracted from mesenchymal stem cells and contain growth factors SCF, and melanocyte. Exosomes are trophic, or regenerative, therapies. They are naturally bioactive amnion-based products that act as paracrine effectors. The stimulating effect is by the transfer of information. Exosomes provide excellent nutrition to cells. Collectively, exosomes and microvesicles are known as EVs.

They contain TGFB3, which converts inflammatory cells into anti-inflammatory regularly cells. VEGF and MIP-1 stimulate the formation of blood vessels and recruits mononuclear cells to the scalp. Exosomes contain FGF, a potent growth factor that affects many kinds of cells. When they tell a cell to deliver mRNA, it stimulates other cells to generate proteins that repair damage.

Where do these cells come from? They largely come from amniotic cells or Wharton’s Jelly (insert link).

(Insert link for exosomes for cancer once it’s posted) They might be used to treat Lyme disease and RA.

How do exosomes for hair loss work?

In Spring of 2019, physicians and researchers began to agree that exosomes have great potential in hair restoration. Studies are still investigating how exosomes work to regrow hair. Hair follicles have mature cells called HFSCs and dermal papilla cells (DPCs) and exosomes act on these.

There are two methods for inserting exosomes for hair loss. A serum is manufactured and filtered to isolate exosomes. The serum is injected with local anesthetic into the superficial dermis of the scalp. The patient returns to most normal activities the next day but is encouraged to avoid sweating. Some soreness may exist for around a week.

Second, like micro-needling, the scalp is punctured to deliver exosomes with tiny needles. So far in the research, this appears to be the faster method to regrow hair.

With exosome therapy for hair loss, the hair growth cycle remains and hair strands become thicker and healthier

Conclusion

Exosomes are an aspect of regenerative treatment, and these cells heal, repair, stimulate, and restore cells and tissues. Do exosomes, with time and research, have the potential to beat all existing forms of hair transplantation? Time will tell! Use the contact form below to find a doctor who can tell you if exosomes for hair loss is right for you.

References

https://my.clevelandclinic.org › health › diseases › 16921-hair-loss-in-women

https://www.healthline.com/health-news/why-millennials-losing-hair-earlier#4
https://www.ncbi.nlm.nih.gov/pubmed/30924959

Ocular Care 2020 with Amniotic Patches

Structure and Function of the Amniotic Membrane

The amniotic membrane surrounds and protects the developing fetus in utero and separates mother and fetus. If you were to look closely at the amniotic membrane, you would be able to notice that the membrane is comprised of several layers. The membrane can be easily separated into two distinct layers: the amnion layer and the chorion layer, which are separated by a jelly-like layer. The amnion layer of the membrane, or fetal side, has a layer of epithelial cells which can easily be removed with simple cell scraping, revealing a see-through underlying layer. The chorion layer is the maternal side of the amniotic membrane. Both layers have a basement membrane and a stromal layer (Medscape, 2012).

If you looked at the amniotic membrane under a microscope, you would be able to appreciate three different types of material: collagen and extracellular matrix, biologically active cells and regenerative molecules. The extracellular matrix provides structure and contains a number of specialized proteins, including proteoglycans, fibronectin, laminins and others. Several types of collagen add structural strength to the membrane. The biologically active cells include stem cells, which function to regenerate new cellular materials within the lining of the membrane. Fibroblasts help to strengthen the tissue, and epithelial cells aid in the healing process via receptors on the cell surface. Regenerative molecules, which are important for growth and healing, are present in the amniotic membrane as well. These include numerous types of growth factors such as fibroblast growth factors, platelet-derived growth factors, metalloproteinases and others. Immunosuppressive cytokines prevent the amniotic membrane from being seen as ‘foreign’ by both the mother and infant’s immune systems. There are also a number of other specialized molecules, such as defensins which protect against bacterial infection (Medscape, 2012).

Wound Healing Properties of Amniotic Membrane Patches

Amniotic Patch has a number of characteristics that make it especially suited to wound healing. The amniotic membrane:

  • contains a significant number of cytokines and essential growth factors
  • reduces pain when applied to a wound
  • increases and enhances the wound healing process
  • has antibacterial properties
  • is non-immunogenic (will not be seen as foreign material)
  • provides a biological barrier
  • provides a matrix for migration and proliferation of cells
  • reduces inflammation
  • reduces scar tissue formation

Dehydration of Amniotic Membrane Tissue

In the past, amniotic tissue was sterilized and stored at 4°C. Amniotic tissue could only be used for up six weeks, at which point it was no longer useful. Now, this material can be cleansed, dehydrated and sterilized, which means that the shelf life of amniotic membrane has been greatly increased.

Indications for Use

What types of wounds can amniotic membrane be used on? Traditionally, amniotic membrane has been used on burns; nowadays, however, amniotic membrane can be used on a wide variety of wounds. It is important to note that amniotic membrane should be used only after conservative treatment has failed. In other words, amniotic membrane may be used for wounds that are chronic and non-healing.

Application of Amniotic Membrane

Prior to using amnioticmembrane, a thorough initial assessment of the wound is necessary, as is a medical history. Gather information on the history of the wound, including duration, what treatments have been tried and patient comorbidity. Document wound appearance, size, depth, presence of necrotic tissue and note whether bone or other structures are visible. Assess circulatory status, nutrition and other barriers to healing. These are the same steps that you would follow prior to implementing any wound treatment and are not specific to amniotic membrane treatment.

Next, prepare the wound bed by performing any necessary debridement. The wound bed should be clear of any necrotic tissue and should not have any signs of infection. Amniotic membrane is supplied in a sterile container, and sterile scissors may be used to cut a piece of the amniotic membrane to fit the wound. The material may be applied wet or dry. Note that the stromal collagen layer must be facing the wound – read the manufacturer’s recommendations to determine how to apply the material. You can use steri-strips to hold the graft in place. There is no need to suture the material in place. A secondary dressing which promotes moist wound healing should be chosen as a secondary dressing. The graft should not be disturbed for at least one to two weeks.

After one to two weeks the amniotic membrane allograft will be incorporated into the wound. You should begin to see improvement in the wound in terms of size and depth within 2 to 3 weeks, or even sooner. You can apply a second graft once slowing of wound healing has occurred, as typically observed by wound measurements over time (Podiatry Today, 2015).

The use of amniotic membrane in the management of chronic wounds is an exciting new development which provides another option for wounds that fail to heal using traditional wound therapies and dressings.

Sources:
Fetterolf D, Snyder R. Scientific and Clinical Support for the Use of Dehydrated Amniotic Membrane in Wound Management. Wounds. 2012;24(10):299-307.
Zelen C, Serena T. Amniotic Membrane: Can it facilitate healing? Podiatry Today. 2015 Apr;28(4).

Stem Cells & Tissue engineering

Tissue engineering is a major topic of research and is one aspect of regenerative medicine when it centers on self-renewal. Tissue engineering is the practicing of combining scaffolds, which are extracellular matrices that support the cells but also relay certain signaling molecules.  Tissue engineering can turn cells, and molecules into functional tissues like bone, blood vessels, muscle to restore, maintain, or improve damaged tissues or whole organs.

Tissue engineering works by understanding how cells respond to signals and interact with their environment in order to “organize” into tissues and organism. In regenerative medicine, the scaffolds are created with proteins with the hopes that tissue will regenerate. Or, the cells of a donor organ are stripped and collagen scaffold is used. Scaffolds must be biodegradable in the sense that once the tissue is grown, the scaffold should be absorbed rather than surgically removed.

One exciting application of tissue engineering is cartilage repair for knees, including cartilage repair for knees that have osteoarthritis.

Knee pain and cartilage issues

60% of patients who have knee arthroscopy exhibit cartilage damage, and a significant number of individuals over 60 years old have some clinical symptoms of such damage. Without improvements in technology, the self-healing of damaged cartilage is limited.

Many of the ways in which bone tissue have been used for repair, such as autografting and allografting, are limited because of the risk of infection, and potential risk to the donor-site. Bone defects are one of the leading causes of morbidity and disability in elderly patients.

Cartilage repair for osteoarthritis

Growing tissue without instability and imperfections that are dangerous to a patient has been shown to be difficult. Scientists believe that eventually they can regrow cartilage to help with osteoarthritis. One exciting breakthrough comes from scientists at Boston University, who have shown that by adding inactive TGF Beta, a growth factor, instead of active TGF Beta, cartilage can be grown without the typical pathologies that show up in bioengineered cells, albeit somewhat slower.

To keep up with the research on cartilage repair for osteoarthritis, sign up here.

FDA Approved Uses of Tissue Regeneration for Knee Cartilage Repair

Currently, the FDA has approved a procedure called Maci, which is the first FDA-approved product applying tissue engineering. Healthy cartilage from the patient’s own knee (“autologous” cartilage) is used to grow cells on scaffolds, in this case, a pig’s collagen membrane. The membrane is then reabsorbed by the body. An implant has 500k-1M cells per cm2. In a study of 144 patients, the safety and long-term efficacy was demonstrated.

Cartilage repair for knees repaired with microfracture surgery

Microfracture surgery is an articular cartilage repair surgical technique used on knees that works by creating tiny fractures in the underlying bone. New cartilage then develops from a “super-clot.” The surgery is quick, minimally invasive, and can have a significantly shorter recovery time than an arthroplasty (the procedure of fixing the surface of a joint through more invasive surgery). 50% of surgeries using “microfracture surgery” in young people with sports injuries have been successful long-term.

Microfracture surgery hasn’t yet been successful with osteoarthritis, but now, a tissue engineer has created a gel that can be injected into cartilage after surgery for regeneration.  Injectable hydrogels have been shown to be usable as three-dimensional cell culture scaffolds in cartilage and bone tissue engineering. They have a porous framework for cell transplantation and proliferation, minimal invasive properties, and they can take different shapes.

The scaffolds of both cartilage and bone tissue engineering should be “porous, highly biocompatible, nontoxic, and capable of promoting cell differentiation and new tissue formation; they should also have stable mechanical properties, degrade in response to the formation of new tissue, facilitate the diffusion of nutrients and metabolites, adhere and integrate with the surrounding native tissue, and properly fill the injured site.” Because hydrogels are increasingly fulfilling these conditions, the potential for successful microfracture surgery for cartilage repair for knees is much more likely to occur in the future.

CONCLUSION

Tissue engineering for treatment of knee injuries and osteoarthritis are increasingly looking possible. Hydrogels will make microfracture surgery tenable for people with osteoarthritis, as well.

References

https://www.fda.gov/news-events/press-announcements/fda-approves-first-autologous-cellularized-scaffold-repair-cartilage-defects-knee
https://www.nature.com/articles/boneres201714
https://www.nibib.nih.gov/science-education/science-topics/tissue-engineering-and-regenerative-medicine