Islamabad - Doctors harvested cells from their noses to engineer new cartilage tissue and transplant it into their damaged knees, reported a recent research study.

In a paper, the Swiss team describes how 2 years after transplant, most of the patients had developed new tissue similar to normal cartilage and reported improvements in knee function, pain, and quality of life. They note that the observational study only involved a small number of patients, there was no control group, and the follow-up was quite short.

Lead author Ivan Martin, professor of tissue engineering at the University of Basel and University Hospital Basel in Switzerland, adds:

“Moreover, in order to extend the potential use of this technique to older people or those with degenerative cartilage pathologies like osteoarthritis, a lot more fundamental and pre-clinical research work needs to be done.”

Joint or articular cartilage is the layer of smooth tissue at the ends of bones that eases movement, and protects and cushions the surfaces of the joint where the bones meet.

As this tissue has no blood supply, if it gets damaged it cannot regenerate. Eventually, as the cartilage wears away, the bones become exposed and inflamed from rubbing against each other, leading to painful joint conditions like osteoarthritis.

There are medical techniques - such as microfracture surgery - that can prevent or delay the onset of cartilage degeneration following injury or accident, but they do not regenerate healthy cartilage to protect the joints.

There have also been attempts to use cartilage cells or chondrocytes from the patients’ own joints to make new cartilage in the joint, but these have not been very successful at creating the right structure and function of the cushioning tissue.

The team then took the cultured new cells and seeded them onto “scaffolding” made of collagen and grew them for another 2 weeks. The result was a 2-millimeter thick graft of new cartilage measuring about 30-40 millimeters.

In an accompanying comment article, Dr. Nicole Rotter, from Ulm University Medical Center, and Dr. Rolf Brenner, from the University of Ulm - both in Germany - say the trial “represents an important advance towards less invasive, cell-based repair technologies for articular cartilage defects.”

The main reason they give is that the cells were not taken from healthy tissue near the site of injury but from a completely unaffected part of the body, which avoids the risk of harvesting affecting the damaged joint.

They also mention the promising result that patient age does not appear to affect the success of the procedure.

However, like the trial authors, they conclude that only longer-term randomized, controlled trials - that among other things test the quality of the repair tissue - will be needed before we can say whether this approach is likely to gain regulatory approval and reach clinical use.

Prof. Ivan Martin said that “Our findings confirm the safety and feasibility of cartilage grafts engineered from nasal cells to repair damaged knee cartilage . But use of this procedure in everyday clinical practice is still a long way off as it requires rigorous assessment of efficacy in larger groups of patients and the development of manufacturing strategies to ensure cost effectiveness.”




Brain volume may help diagnose dementia



Dementia with Lewy bodies is not an easy condition to diagnose, making it difficult to treat in a timely fashion. New research measuring brain volume may be the key to recognizing this disease early on and starting medication earlier.

DLB is characterized by a buildup of Lewy bodies - protein deposits - in the brain. Lewy bodies also appear in other diseases, including Parkinson’s disease. Depending on where the Lewy bodies appear, symptoms vary.

If they arise in the base of the brain, they can create motor symptoms similar to Parkinson’s. When they appear in the outer layers of the brain, they produce cognitive symptoms, similar to Alzheimer’s. Diagnosing DLB is primarily a case of watching symptoms develop and gradually ruling out other, similar conditions; there are no reliable diagnostic tests.

Researchers from the Mayo Clinic in Rochester, MN, set out to investigate whether brain volume could be useful in diagnosing DLB at an earlier stage. Their findings are published this week in the journal Neurology.

“Being able to identify people who are at risk for dementia with Lewy bodies is important so they can receive the correct treatments early on. Early diagnosis also helps doctors know what drugs to avoid - up to 50 percent of people with dementia with Lewy bodies have severe reactions to antipsychotic drugs.”

Study author Dr. Kejal Kantarci

The research utilized 160 participants from the Mayo Clinic Alzheimer’s Disease Research Center. All of the individuals had mild cognitive impairments - a slight but measurable reduction in cognitive abilities. People with mild cognitive impairments are known to be at a greater risk of developing Alzheimer’s or other types of dementia.

Individuals with other neurological conditions, epilepsy, brain tumors, and substance abuse were excluded.

Once the data were analyzed, patients with no measurable shrinkage were 5.8 times more likely to develop DLB when compared with those who did display hippocampal shrinkage.

Seventeen out of the 20 participants (85 percent) who developed DLB had normal hippocampus volumes. Conversely, 37 out of the 61 individuals (61 percent) who went on to develop Alzheimer’s disease did show shrinkage.

DLB does not always affect memory, so when the researchers only looked at the data from those whose cognitive deficits did not include memory problems, the results were even more pronounced. As the authors explain, “we demonstrated that those with preserved hippocampal volumes are at an increased risk for probable DLB.”

Although the study is on a relatively small scale, the results are encouraging. Dr. Kantarci hopes that the research will be duplicated and followed up with studies that include a postmortem autopsy to confirm DLB diagnoses.