Obtención de plasma rico en plaquetas (PRP) en el Laboratorio de Terapia Celular para uso como herramienta terapéutica en medicina regenerativa / Obtaining platelet rich plasma (PRP) in the Cell Therapy Laboratory for use as a therapeutic tool in regenerative medicine

Platelet rich plasma (PRP) is used to speed up tissue repair. Despite its widespread use, the therapeutic application of PRP generates controversies in clinical results due to the variability in methods of obtaining the different preparations and differences between the components of different types of PRP, so it's recommended to mention the type of platelet preparation used. In this article, we describe technical and biologics characteristics of our platelet product, and we compare them to different commercial preparations described in order to validate their clinical use. Our results determine that the preparation can be considered a platelet rich plasma with biological activity in vivo and in vitro, which supports its use as a valid therapeutic tool, alternative to products currently available in Regenerative Medicine. (AU)

Terapia con células madre e insuficiencia cardiaca: aspectos éticos / Ethics of stem cell therapy for heart failure

Heart failure is one of the first diseases in which stem cells were used for regenerative medicine. Since 2001, many publications have shown that stem cell therapy has the potential to mitigate heart diseases, but there is no solid scientific evidence to fully support its clinical application at present. The future of regenerative medicine requires validated clinical trials with standardized platforms and transdisciplinary efforts to enable the development of safe and effective regenerative therapies to protect patients and to promote the ethical application of this new and highly promising therapy. Doctors and scientists have a responsibility to discuss with patients the current reality of regenerative therapies. They also have a responsibility to discourage the indiscriminate and commercial use of these therapies, which are sometimes based on false hopes, since their inappropriate use can harm vulnerable patients as well as research efforts. Although regenerative medicine may be the medicine of the future and might bring the hope of cure for chronic diseases, it is not yet ready for its wide clinical application.

Produção da proteína recombinante humana TGF-ß1 (fator do crescimento transformante beta 1) em células de mamífero / Production of recombinant human protein TGF-ß1 (Transforming Growth Factor Beta 1) in mammalian cells

O fator de crescimento transformante beta tipo 1, TGF-ß1, é uma proteína extracelular homodimérica secretada por vários tipos celulares, que pode ter ação parácrina ou endócrina. Essa proteína está envolvida em processos celulares de diferenciação, proliferação, mobilidade e formação de matriz extracelular. Além disso, é parte importante dos processos de regeneração tecidual, atuando, de maneira decisiva, no reparo, atraindo macrófagos e fibroblastos para o local da injúria e estimulando a angiogênese. Assim, considerando o papel desse peptídeo no processo regenerativo, o uso de TGF-ß1 como proteína terapêutica na área de Bioengenharia Tecidual é bastante promissor. Apesar disso, a venda dessa proteína, para fins terapêuticos, é inexistente no mercado e a proteína recombinante vendida, que só pode ser utilizada em pesquisas científicas, não é produzida nacionalmente e chega a custar R$200.000,00/mg. Nesse contexto, o objetivo do presente trabalho é desenvolver uma metodologia de produção do fator recombinante TGF-ß1 em células de ovário de hamster chinês (CHO), visando à obtenção de níveis altos de rendimento, e, futuramente, a transferência da tecnologia de produção para a iniciativa privada, tornando possível seu uso na Medicina Regenerativa, sozinho ou em combinação com outros fatores de crescimento. O cDNA de TGF-ß1 foi amplificado a partir de um banco de cDNA humano e clonado no vetor proprietário pNU1 de expressão de mamífero. A construção pNU1/TGF-ß1 foi utilizada para transfectar estavelmente células CHO DG44 e uma estratégia de co-amplificação foi utilizada para selecionar células transfectantes com maior número de cópias da sequência correspondente a TGF-ß1. Estas culturas foram submetidas ao processo de amplificação gênica com concentrações crescentes de metotrexato. Ensaios de Western Blot e ELISA foram realizados utilizando-se o meio condicionado pelas populações selecionadas e por clones superprodutores. Entre os 41clones obtidos, cinco apresentaram maiores níveis de produção de TGF-ß1, entre 1.000 e 2.000 ng/mL. Estes clones foram selecionados para a realização de testes de atividade in vitro utilizando-se células A549, que permitem avaliar a transição epitélio-mesênquima. Um ensaio de cicatrização de feridas em peles do dorso de camundongos foi padronizado e utilizado para avaliar a atividade in vivo do clone que apresentou melhor resultado in vitro. A proteína TGF-ß1 foi parcialmente purificada por HPLC em uma coluna de afinidade. Portanto, a proteína TGF-ß1 humana recombinante foi produzida, apresentando atividade biológica in vitro e in vivo, sendo capaz de reparar eficientemente feridas cutâneas. Essa iniciativa pode oferecer aos pacientes uma alternativa para o tratamento de lesões teciduais, acelerando a cicatrização de feridas e o reparo de tecidos

The transforming growth factor beta 1, TGF-ß1, is a homodimeric extracellular protein secreted by several cell types, which may have paracrine or endocrine action. This protein is involved in cellular processes of differentiation, proliferation, mobility and formation of extracellular matrix. In addition, it is an important part of the tissue regeneration processes, acting decisively on repair, attracting macrophages and fibroblasts to the site of injury and stimulating angiogenesis. Therefore, considering the role of this peptide in the regenerative process and the use of TGF-ß1 as a therapeutic protein in the field of Tissue Bioengineering is very promising. Despite this, the sale of this protein for therapeutic purposes is nonexistent in the market and the recombinant protein available in the market, which can only be used in scientific research, is not produced nationally and the costs are in the order of R$ 200,000.00/mg. In this context, the objective of the present work is to develop a methodology for the production of the TGF-ß1 recombinant factor in Chinese hamster ovary (CHO) cells, aiming at obtaining high yields, and, in the future, transfering the production technology to the private initiative, allowing its use in Regenerative Medicine, alone or in combination with other growth factors. The TGF-ß1 cDNA was amplified from a human cDNA library and cloned into the proprietary pNU1 mammalian expression vector. The pNU1/TGF-ß1 construct was used to stably transfect CHO DG44 cells, and a co-amplification strategy was used to select transfectant cells with the largest number of gene copies. These cultures were subjected to the process of gene amplification with methotrexate. Western Blot and ELISA were used to assay the conditioned medium obtained from the selected cell populations and from overproducing cell clones. Among the 41 clones obtained, five presented higher levels of TGF-ß1 production, between 1,000 and 2,000 ng/mL. These clones were selected for in vitro activity testing using A549 cells to evaluate the epithelial-mesenchymal transition. Awound healing assay on mouse dorsal skin was standardized and used to evaluate the in vivo activity of the cell clone which displayed the highest result in vitro. The TGF-ß1 protein was partially purified by HPLC on an affinity column. Therefore, the recombinant human TGF-ß1 protein was produced and shown to display biological activity both in vitro and in vivo, being able to eficiently repair cutaneous wounds. This initiative may provide patients with an alternative treatment for tissue damage, accelerating wound healing and tissue repair

Matrices de tercera generación en la ingeniería de tejidos ósea / Third-generation matrices in bone tissue engineering

Existen numerosas patologías que generan situaciones invalidantes debido a problemas asociados a nivel de defectos óseos. Esto genera, en muchas oportunidades, cuestiones sanitarias de alto impacto. La ingeniería de tejidos óseos pretende generar propuestas novedosas para reparar pérdidas o fracturas óseas, promoviendo regenerar el tejido mediante el implante de matrices biodegradables que puedan actuar como estructuras para la adhesión celular, favoreciendo el crecimiento y la diferenciación hasta formar hueso de novo. El incremento notable de los conocimientos en las áreas biotecnológicas, de síntesis química, así como de biomedicina, permiten el desarrollo de numerosos tipos de matrices de tercera generación, biodegradables y no tóxicas, con características que proponen sean consideradas en la regeneración tisular ósea. Este trabajo intenta resumir los tipos de matrices que mayor impacto han tenido hasta el momento en la medicina regenerativa ósea, mostrando los casos más relevantes de resultados experimentales y clínicos, y propone algunas perspectivas que se deberían considerar para poder aplicarlas a la práctica clínica. Esta es un área que invita a los investigadores a posicionarse en un pensamiento complejo desde el punto de vista científico-filosófico. (AU)

There are several pathologies that generate disability due to complications associated with bone defects. This often generates high impact health troubles. Bone tissue engineering aims to generate novel means to repair bone loss or bone fractures, promoting tissue regeneration through the implantation biodegradables scaffolds, which can act as structures for cell adhesion, that promts cell growth and differentiation for the novo bone formation. The remarkable for the novo bone formation in biotechnology, chemical synthesis, and biomedical knowledge allows the development of numerous types of third generation scaffolds, applied to promote bone tissue regeneration. This brief report aims to review the scaffolds that have had more impact in bone regenerative medicine so far, describing the most relevant experimental and clinical results. This is an area that invites researchers to situate themselves in a complex thought of scientific-philosophical point of view. (AU)

Cardiac Regeneration using Growth Factors: Advances and Challenges / Regeneração Cardíaca com Fatores de Crescimento: Avanços e Desafios

Abstract Myocardial infarction is the most significant manifestation of ischemic heart disease and is associated with high morbidity and mortality. Novel strategies targeting at regenerating the injured myocardium have been investigated, including gene therapy, cell therapy, and the use of growth factors. Growth factor therapy has aroused interest in cardiovascular medicine because of the regeneration mechanisms induced by these biomolecules, including angiogenesis, extracellular matrix remodeling, cardiomyocyte proliferation, stem-cell recruitment, and others. Together, these mechanisms promote myocardial repair and improvement of the cardiac function. This review aims to address the strategic role of growth factor therapy in cardiac regeneration, considering its innovative and multifactorial character in myocardial repair after ischemic injury. Different issues will be discussed, with emphasis on the regeneration mechanisms as a potential therapeutic resource mediated by growth factors, and the challenges to make these proteins therapeutically viable in the field of cardiology and regenerative medicine.

Resumo O infarto do miocárdio representa a manifestação mais significativa da cardiopatia isquêmica e está associado a elevada morbimortalidade. Novas estratégias vêm sendo investigadas com o intuito de regenerar o miocárdio lesionado, incluindo a terapia gênica, a terapia celular e a utilização de fatores de crescimento. A terapia com fatores de crescimento despertou interesse em medicina cardiovascular, devido aos mecanismos de regeneração induzidos por essas biomoléculas, incluindo angiogênese, remodelamento da matriz extracelular, proliferação de cardiomiócitos e recrutamento de células-tronco, dentre outros. Em conjunto, tais mecanismos promovem a reparação do miocárdio e a melhora da função cardíaca. Esta revisão pretende abordar o papel estratégico da terapia, com fatores de crescimento, para a regeneração cardíaca, considerando seu caráter inovador e multifatorial sobre o reparo do miocárdio após dano isquêmico. Diferentes questões serão discutidas, destacando-se os mecanismos de regeneração como recurso terapêutico potencial mediado por fatores de crescimento e os desafios para tornar essas proteínas terapeuticamente viáveis no âmbito da cardiologia e da medicina regenerativa.

Hard tissue regeneration using bone substitutes: an update on innovations in materials

Bone is a unique organ composed of mineralized hard tissue, unlike any other body part. The unique manner in which bone can constantly undergo self-remodeling has created interesting clinical approaches to the healing of damaged bone. Healing of large bone defects is achieved using implant materials that gradually integrate with the body after healing is completed. Such strategies require a multidisciplinary approach by material scientists, biological scientists, and clinicians. Development of materials for bone healing and exploration of the interactions thereof with the body are active research areas. In this review, we explore ongoing developments in the creation of materials for regenerating hard tissues.

Evaluation of two human dental pulp stem cell cryopreservation methods / Evaluación de dos métodos de criopreservación de células troncales de pulpa dental humana

La pulpa dental es una fuente promisoria de células madre mesenquimales para ser utilizadas en terapia celular y medicina regenerativa. El desarrollo de métodos que permitan almacenar las células madre con mínimo compromiso de la viabilidad celular, capacidad de diferenciación y función es necesario para aplicaciones clínicas e investigación. El objetivo de este estudio fue evaluar si las células troncales depulpa dental humana (hDPSCs) aisladas y criopreservadas durante 1, 7 y 30 días conservan la viabilidad y expresiónde marcadores específicos de células troncales pos crio-preservación. Para esto, las hDPSCs se aislaron de 23pacientes sanos entre 18 y 31 años. La pulpa dental se disoció enzimáticamente, y las células CD105+ se separaron mediante el sistema Miltenyi™. Posteriormente, las hDPSCs se criopreservaron utilizando el método de Kamath y de Papaccio, se evaluó la viabilidad pos crio-preservación porcitometría de flujo (7AAD) y la expresión de marcadores CD105+/ CD73+, CD34-/CD45-. El método de Papaccio, mostró mayor viabilidad celular a los 30 días (59,5 por ciento)comparado con el método de Kamath, a 1 día (65,5%) y 7 días (56%) respectivamente. Se observó mayor expresión de los marcadores CD105+/CD34- a 1 y 7 días pos-criopreservación con el método Kamath y CD105+/CD45- a los 3 tiempos decriopreservación. CD73+ presentó mayor expresión en las hDPSCs a las 24 horas y 7 días con el método de Kamath, y al mes con el método Papaccio. Estos resultados sugieren que las hDPSCs expresan marcadores de células troncales mesenquimales postcriopreservación. Sin embargo el tiempo de criopreservación podría modificar la expresión de los marcadores probablemente por alterarla configuración espacial de las proteínas de membrana celular; o por comprometer a las células a cierto grado de diferenciación.

Dental pulp is a promising source of mesenchymal stem cells for use in cell therapy and regenerative medicine. Methods for storing stem cells with minimum compromise of cell viability, differentiation capacity and function should be developed for clinical and research applications. The aim of this study was toevaluate whether human dental pulp stem cells (hDPSCs)isolated and cryopreserved for 1, 7 and 30 days maintain viability and expression of specific stem cell markers. Human dental pulp stem cells were isolated from 23 healthy patients aged 18 to 31 years. Dental pulp was enzymatically dissociated, and CD105+ cells were separated using the Miltenyi™ system.The hDPSCs were cryopreserved using the Kamath andPapaccio methods. Post-cryopreservation viability wasmeasured by flow cytometry (7AAD) and by the expression of the phenotype markers CD105+/ CD73+, CD34-/CD45-. The Papaccio method showed greater cell viability for cells that had been frozen for 30 days (59.5%) than the Kamath method (56.2%), while the Kamath method provided better results for 1 day (65.5%) and 7 days (56%). Post-cryopreservation expression of the markers CD105+/CD34- was greater after 1 and 7 days with the Kamath method and CD105+/CD45- were expressed after all 3 cryopreservation times. There was greaterexpression of CD73+ in the hDPSCs after 1 and 7 days with the Kamath method, and after 30 days with the Papaccio method. These results suggest that hDPSCs express mesenchymal stem cell markers after cryopreservation. However, cryopreservationtime may affect marker expression, probably by altering the spatialconfiguration of cell membrane proteins or by compromising cells at a certain level of differentiation.

Políticas internacionais em ciência e saúde: a pesquisa celular e a medicina regenerativa / International policies in science and health: cellular research and regenerative medicine

O desenvolvimento de medicamentos e terapias baseados nos princípios científicos das biociências e das biotecnologias da saúde - com base em células vivas e difíceis de serem estandardizadas - tem sido um tema de amplos debates públicos em nível global. A área tem sido recentemente demarcada como medicina regenerativa, que inclui as pesquisas e terapias com células-tronco (PCT e TC), foco deste estudo. No presente artigo, apresentam-se os principais eventos históricos na área de pesquisa celular, descreve-se o estágio atual na evolução da medicina regenerativa e as características das principais políticas desenvolvidas, em especial pelos países de liderança global, e em relação à regulamentação dos direitos de propriedade intelectual. Desenvolve-se análise quantitativa e qualitativa com dados secundários coletados em nível internacional, revisão bibliográfica e de informações em arquivos das instituições de regulamentação globais, resenhas jornalísticas atualizadas, assim como de artigos especializados publicados em revistas internacionais. A revisão da informação é guiada pelas seguintes perguntas: quais são as trajetórias principais de inovação em ciência e saúde nessa área? Quais fatores incidem principalmente na sua evolução? Conclui-se com reflexões específicas sobre os impactos dos desenvolvimentos associados na Saúde Coletiva...

Medicine and therapy developments based upon scientific principles of biosciences and health biotechnologies - with the use of live cells which are difficult to standardize - have been subject of wide public debates at the global level. The area has been recently defined as one of regenerative medicine that includes stem cell research and therapy, the focus of our study. This paper presents the main historical research events in cellular research, describes regenerative medicine's present stage of evolution and the characteristics of the main public policies developed, most especially in the leading countries and in relation to the regulation of intellectual property rights. A quantitative and qualitative analysis is developed, drawing upon different sets of secondary data collected internationally, bibliographic and archival information from global regulatory institutions, updated journal reviews as well as of specialized articles published in international journals. This information is reviewed guided by the following questions: which are the main trajectories in health innovation in this area? Which factors have most highly influenced its evolution? The paper concludes with reflections on the specific impacts of associated developments on collective health...

Medicina regenerativa: posibles aplicaciones de la medicina regenerativa en las afecciones del aparato locomotor. protocolo de investigación clínica. Informe preliminar / Regenerative medicine: possible applications of regenerative medicine in locomotor system diseases. Clinical research protocol. Preliminary report

El deterioro funcional de un órgano o tejido es un problema médico grave y de alto costo, ya que la sustitución de estas estructuras involucra, entre otros, múltiples factores de orden científico, económico y ético. La medicina busca en la actualidad convertir en realidad la regeneración de los tejidos mediante el desarrollo de terapias para restaurar, en el cuerpo humano, las células y los tejidos envejecidos o dañados. En esta comunicación preliminar presentamos una serie de pacientes donde se utilizaron células mesenquimales, mononucleares, autólogas, obtenidas de la médula ósea de la cresta ilíaca del propio enfermo, para tratar distintas afecciones. Desde noviembre de 2005 hasta mayo 2011, tratamos 23 pacientes, con un promedio de edad de 55,39 años. Once pseudoartrosis; 2 retardos de consolidación; 3 alargamientos óseos; 1 defecto osteo-tegumentario de tibia; 3 pacientes con necrosis óseas asépticas; 1 quiste óseo de cuello femoral; 4 artrosis incipientes de rodilla; 1 lesión del manguito rotador del hombro y 1 entesitis crónica aquiliana. El procedimiento se realizó en todos los casos en forma ambulatoria. Todos los procedimientos se realizaron en quirófano bajo anestesia general breve y con rigurosa asepsia. Utilizamos métodos reglados para cosechar células madre mesenquimáticas mononucleares de médula ósea del propio enfermo. Igualmente de manera reglada se cosecha sangre periférica del paciente para obtener, una vez procesada, plasma enriquecido con plaquetas y lisado de plaquetas. Logramos consolidación clínica y radiológica en 10 de los 11 casos de peudoartrosis (90,90 por ciento), en los 2 casos de retardo de consolidación, en los 3 alargamientos óseos y en el defecto osteo-tegumentario de tibia...

The functional impairment of an organ or tissue is a serious and high cost medical problem. The replacement of these structures involves multiple scientific, economical and ethical issues. All medical physicians and researchers are working nowadays to make possible tissue regeneration by developing therapies to restore damaged, aged or dead cells and tissues of the human body. At this preliminary report we present a series of patients, with various pathologies, in which we used autologous mononuclear mesenchymal cells, harvested from the bone marrow of the patient's iliac crest. Since November 2005 until May 2011, 23 patients, with an average age of 55,39 years, were treated: 11 non unions; 2 delayed unions; 3 bone lengthening; 1 tibia severe lesion of soft tissue and loss of bone; 3 aseptic osteo necrosis; 1 femoral neck bone cyst, 4 mild knee osteoarthritis, 1 rotator cuff injury and 1 chronic Achilles enthesitis. All were ambulatory patients. Performed in an operating room, with strict aseptic conditions, under short general anesthesia. The autologous bone marrow with mesenchymal mononuclear stem cells was harvested under predetermined protocols. Also, pre determined protocols were used to collect the patient's peripheral blood to be sent to the laboratory to obtain platelet rich plasma (PRP) and concentrated lyses platelets in plasma. We achieved clinical and radiological osseous union in: 10 of 11 non unions (90, 90 percent), in 2 delayed unions, in 3 bone lengthening and also in the tibia's severe soft tissue and bone defect. Based on this experience we can conclude that the stimulation of bone consolidation with a concentrated autologous mesenchymal stem cells, obtained from the patient's iliac crest, resulted to be a safe, reliable, minimally invasive procedure with a high rate of success...

Regenerative endodontics: A state of the art.

Scientific advances in the creation of restorative biomaterials, in vitro cell culture technology, tissue grafting, tissue engineering, molecular biology and the human genome project provide the basis for the introduction of new technologies into dentistry. Non-vital infected teeth have long been treated with root canal therapy (for mature root apex) and apexification (for immature root apex), or doomed to extraction. Although successful, current treatments fail to re-establish healthy pulp tissue in these teeth. But, what if the non-vital tooth could be made vital once again? That is the hope offered by regenerative endodontics, an emerging field focused on replacing traumatized and diseased pulp with functional pulp tissue. Restoration of vitality of non-vital tooth is based on tissue engineering and revascularization procedures. The purpose of this article is to review these biological procedures and the hurdles that must be overcome to develop regenerative endodontic procedures.

Características fenotípicas y funcionales de las células madre mesenquimales y endoteliales / Phenotypical and functional features of the mesenchymal and endothelial stem cells

Se presentan los conceptos actuales sobre las células madre provenientes de la médula ósea y la importancia de las células estromales en la Medicina Regenerativa. Se describen, en particular, las características fenotípicas de las células madre mesenquimales y endoteliales, así como las de diferentes tipos celulares relacionados, sus propiedades funcionales y la importancia dada al uso de estas células en diversas aplicaciones terapéuticas. Se refieren los resultados de su estudio en distintos estados patológicos, las variaciones por la acción de drogas y de los factores de crecimiento, y su potencialidad futura en el diagnóstico y tratamiento de diferentes enfermedades

The current concepts on the stem cells from bone marrow and the significance of the stromal cells in Regenerative Medicine are showed. In particular, the phenotypical features of mesenchymal and endothelial stem cells are described, as well as the different related types of cells, its functional and the significance properties given to use of these cells in different therapeutic applications. The results of study in different pathologic states, the variations due to drugs action and of the growth factors are recounted as well as its future potential in diagnosis and treatment of different diseases

Science and society: a stem cell technology model.

Stem cell technology has been recognized as an emerging technology that could transform current supportive approach toward curing many chronic disorders and degenerative conditions. Regenerative medicine is the promising area of medical practice in the coming decade. However, stem cell technology also brings up controversial issues from the bioethical perspective such as the destruction of human embryos to derive embryonic stem cells or putting the egg donors at risk when retrieving oocytes used in somatic cell nuclear transfer technique. Recently, scientists have discovered a novel method to derive human embryonic stem cell-like cells (iPS; induced pluripotent stem cells) from human skin cells. This innovative approach would not only be a breakthrough discovery to advance the knowledge of stem cell research and the landmark for future stem cell-based therapy but will also provide viable solutions for social concerns on bioethical issues.

Aplicabilidade terapêutica das células-tronco / Therapeutical applicability of the stem cells

Os autores apresentam nesse artigo uma revisão atualizada sobre aplicação clínica dos resultados obtidos nas pesquisas sobre as células-tronco. O principal objetivo é o esclarecimento a respeito da capacidade de diferenciação dessas células, bem como do potencial de utilização das mesmas na prática médica, tendo em vista o futuro promissor de uma nova linha de raciocínio terapêutico: a medicina regenerativa