(CBS) This story was originally published on Dec. 13, 2009. It was updated on July 25, 2010.

Thousands wait in vain for organ transplants; soldiers return from battle horribly maimed. There is only so much medicine can do, but we may be on the path to a new technology in which quite literally, we will be growing new body parts.

It’s called “regenerative medicine,” where cells in the human body are manipulated into regrowing tissue.

As we first reported last December, researchers have so far created beating hearts, ears and bladders. Biotech companies and the Pentagon have invested hundreds of millions of dollars in research that could profoundly change millions of lives.

Wake Forest Institute for Regenerative Medicine
McGowan Institute for Regenerative Medicine
Web Extra: Making Body Parts
Web Extra: Growing and Ear
Web Extra: Kaitlyne’s Story

Dr. Anthony Atala runs the Wake Forest Institute for Regenerative Medicine in North Carolina. You name the body part, chances are Dr. Atala is trying to grow one.

“Currently at the institute we’re working on over 22 different tissues and organs,” Dr. Atala told 60 Minutes correspondent Morley Safer.

According to Atala, they are working on regenerating bladders, kidneys, lungs and more. “The possibilities really are endless,” he said.

“Are you suggesting a remarkable future when organs fail, we simply replace them and live to 120? 150?” Safer asked.

“Well, the hope for the future is that if you do have a patient who has organ failure, you don’t want that patient to die because you’re waiting for an organ,” Atala said. “People are dying every day on the transplant wait list. So the hope of the field is that some day we can provide replacement tissues and organs that can be used to help them survive.”

Atala presides over the world’s largest lab devoted to bioengineering body parts. He has made everything from components of fingers to kidneys – it’s enough to make Dr. Frankenstein jealous.

Atala says every organ in our body contains special stem cells that are unique to each body part. The key to regeneration, he says, is to isolate and then multiply those cells until there are enough to cover a mold of that particular body part.

Atala showed Safer a bladder that was growing in the lab. “And you can see here that we actually create the three dimensional mold first. This is actually coated with cells and it’s done one layer at a time. It’s very much like baking a layer cake.”

It’s sort of surgery as pastry making.

“But, how do those cells know – it’s a really stupid question, I understand – but how do the bladder cells know they should be functioning as bladder cells?” Safer asked.

“The cells know exactly what to do. Every single cell in your body has all the genetic information to create a whole new you. So if you place that cell in the right environment, it’ll be programmed to do what it’s supposed to do,” Atala explained.

He says some body parts are simpler to make than others.

“And you can see here the mold shaped like an ear. And then what we do is we start seeding these with cells. And then this is actually the fully engineered ear,” he said. “The molds are designed to degrade over time. So as the tissue forms the mold goes away.”

“If that was for a child, would that grow with the child?” Safer asked, looking at the mold.

“Yes,” Atala said. “The body does recognize them as their own and it does grow with the child.”

Depending on the body part, Atala says the whole process can take six to eight weeks.

Atala showed Safer a beating, engineered heart valve. He says that human testing of heart valves and blood vessels will begin within five years. He has already grown and transplanted livers in mice.

Asked if the mouse livers are functioning, Atala said, “Yeah. And the tissue actually starts making what you’re supposed to see. Like for the liver, we actually are able to see the functionality that you would expect from the liver.”

And there’s Kaitlyne McNamara, a college student who was born with Spina bifida which caused her bladder to fail. Nine years ago, Kaitlyne, along with eight other patients, received new bladders grown from their own cells outside the body.

She says the procedure changed her life. “I never even knew I could get this far. I’m just living a normal adult life.”

(CBS) In Pittsburgh, researchers are taking a different approach: at the McGowan Institute for Regenerative Medicine they are trying to trick the body into actually repairing and regenerating itself.

“I would imagine when people ask you what you do for a living, it’s not the easiest thing in the world to explain,” Safer asked Dr. Steven Badylak, the institute’s deputy director.

“No, it’s not. So, now, I just say we, I make body parts. It gets their attention,” Dr. Badylak replied with a chuckle.

He and his team are convinced that the key to regeneration is finding the switch in our bodies that tells our cells to grow when we are still in the womb.

“The accepted wisdom is that we’re born with what we have and that’s it. You know, the body doesn’t grow new parts,” Safer remarked.

“Well the human body. ‘Cause there certainly are examples of species that regrow their arms and legs like a newt or a salamander. But, as a human early enough in gestation, we can do the same things. We can regrow major body parts. Limbs even, if it’s early enough,” Badylak explained.

“In essence, is what you’re doing trying to find the key to turning that process back on?” Safer asked.

“Yeah,” Badylak said. “If we could make the body or at least the part of the body that’s missing or injured think that it’s an early fetus again. That’s game set and match.”

Badylak says he now has the material that might be a step towards that. It is called ECM (Extra Cellular Matrix), which he gets, from of all places, pig bladders.

Badylak told Safer ECM exists in all of us and in all species. “It’s loaded with signals that instruct cells to do things, as well as serving as a structural support.”

“And where do pig bladders come into it?” Safer asked.

“They are a convenient source because it’s a throwaway product for the agricultural community. And so, we can get rid of the cells. And the remaining Extra Cellular Matrix is proven to be very instructive to the body,” Badylak said.

Asked if humans are closely related to pigs, the doctor said, “Probably closer than we’d like to admit.”

He says that ECM could regrow virtually every tissue in the body.

When doctors at the University of Pittsburgh were treating a patient with cancer of the esophagus who was too weak to face complicated surgery, they turned to Dr. Badylak and his ECM.

“Our therapy of choice right now is to remove the esophagus and pull the remaining stomach up through the chest and attach it to what’s left in the throat,” Badylak explained. “So, the treatment’s as bad as the disease. So, what we have done is said, ‘Can we take a regenerative medicine approach to allow surgeons and go in and just resect the cancer? And instruct the remaining esophagus to regrow itself as opposed to respond to injury and form a scar?’”

(CBS) Dr. Blair Jobe operated on 76-year-old Erwin Schmidt last April.

Jobe removed the cancerous lining of the esophagus and inserted a sleeve of ECM. Instead of forming a scar that would block his esophagus, doctors believe the ECM instructed his cells to regrow a new lining.

Today Schmidt is cancer free. “I’m eating real good, I feel terrific, and I’m starting to put weight on. No pain, no nothing,” Schmidt told Dr. Jobe.

“So essentially you gave him a new esophagus,” Safer remarked.

“We’re very excited by this. And I think, you know, in my heart I feel that this will change the way we do things ultimately,” Jobe said. “But I think right now it’s too early to claim victory.”

Based on that success, Jobe and his colleagues hope to start a full clinical trial soon.

And then there is the military. The Pentagon has invested $250 million in regenerative research aimed at helping soldiers with severe battle injuries, regrowing muscle and skin for burn injuries, as well as transplant technology for lost limbs.

Dr. Steven Wolf is the chief of clinical trials at the Army’s Institute for Surgical Research.

“I would imagine that the patient group that you’re dealing with are a particularly positive one. They’re young, eager men who suffer these horrible losses and want to get as much of their lives together as they can,” Safer remarked.

“Absolutely. They want to go back. Most of these guys do. They say, ‘Hey, fix me up so I can go back,’” Dr. Wolf replied.

Beginning this month, Wolf is leading a clinical trial that could one day make that possible. Army surgeons will implant ECM in the limbs of severely injured soldiers in hopes of restoring muscle lost to roadside bombs.

“What we’re doing with this project is putting this ECM, in there, and then hoping that it populates and then it becomes muscle,” Wolf explained.

“It also, in a place like this, goes by the name of pixie dust, correct?” Safer asked.

“Right. Well, it is somewhat magical, isn’t it?” Wolf remarked. “The whole notion of, well, we’re gonna put this powder in there. And it’s gonna make a new thing. And there is a lot of biological support of that whole notion, so it’s not magic, you know. But it certainly seems that way.”

Asked what he is hoping to achieve with this research, Wolf said, “Well, we’re not gonna, you know, just show up and go, ‘Hey, okay, here’s your leg. We’ll stick it on.’ What we hope is that we can replace certain tissues that can improve function. That’s the first thing to do is make ‘em function as well as possible.”

(CBS) Which is what Isais Hernandez says ECM did for him: he was so severely wounded by a mortar round that amputation of his leg seemed likely.

Wolf operated on Hernandez last year as a first test of ECM in this type of injury. He placed ECM in Hernandez’ thigh, which grew entirely new muscle in a wound that had once exposed the bone.

His physical therapist Johnny Owens says the muscle growth is clear.

Asked if he feels the difference, Hernandez told Safer, “Yeah, I mean, it doesn’t feel, it doesn’t get as tired as quickly or shaky before. After doing some other workouts, I’d have to break. And now I don’t have to break anymore.”

“Must be giving you a lot of pleasure to see that kind of progress?” Safer asked Owens.

“It does, yeah,” he replied. “And this is one, early on, I think there’s a lot of potential to see bigger and better things.”

“When you saw that this, to some extent, worked, were you surprised?” Safer asked Dr. Steven Wolf.

“Part of my job is to be a scientist and to be somewhat objective, right?” Wolf replied.

“You’re also a human being,” Safer pointed out.

“Exactly. Exactly,” Wolf agreed, laughing. “Of course we were excited. You know, and that ‘Did it fail miserably?’ No. In fact, it seemed to work. Eureka!”

“If this works it could really change trauma medicine, yes?” Safer asked.

“In terms of muscle loss. Now all right, what happens if we put that by a nerve? What happens if we put that by bone? What happens if we put that by your heart? What happens by so? You see, it opens a lot of doors if it actually works,” Wolf said.

The military is also using regenerative techniques in hand replacements for amputees. Doctors at the University of Pittsburgh have successfully transplanted a hand taken from a cadaver onto the arm of Marine Josh Maloney who lost his right hand working with dynamite.

Using cell therapy and a bone marrow transplant from the donor, doctors were able to get Josh’s body to accept the new hand without many of the anti-rejection drugs that are almost always toxic.

Maloney says the surgery has given him his life back. To Dr. Wolf, it’s the least medicine can do.

“These guys, they were protecting us. They took the hit for us, and they deserve our respect for that reason,” Wolf said. “And from my perspective, they deserve our very best effort to do the best we know how to do, and then further, to do the best that we don’t even know yet how to do.”

Click Here to Watch the 60 Minutes Video, ‘Growing Body Parts.’

Stem cells so far have been used to mend tissues ranging from damaged hearts to collapsed tracheas. Now the multifaceted cells have proved successful at regrowing bone in humans. In the first procedure of its kind, doctors at Cincinnati Children’s Hospital Medical Center replaced a 14-year-old boy’s missing cheekbones—in part by repurposing stem cells from his own body.

The technique, should it be approved for widespread use, could benefit some seven million people in the U.S. who need more bone—everyone from cancer patients to injured war veterans.

“This is sort of the holy grail for a number of different surgeons,” says Jesse Taylor, a surgeon and researcher in the hospital’s Division of Plastic Surgery and one of the procedure’s lead physicians. The procedure could be used in plastic, orthopedic and neural surgeries, he notes. Some bone tissue had previously been generated from stem cells in the lab, but this marks hope for a surgical solution for those who need additional bone.

“We often find ourselves in the operating room saying, ‘Man, I wish we had a little more bone,’” Taylor says. In adult patients plastic and metal have often subbed in, in the absence of bone, but as Taylor notes: “What happens if someone gets a fracture? It’s another surgery.” In contrast, a natural bone regrown from stem cells should heal on its own. Another alternative, bone transplants—either repurposed from the patient’s body or from cadavers—have high rejection and absorption rates, leading to many unsuccessful attempts.

To create the new bones, which have become part of the patient’s own skull structure and have remained securely in place for four and a half months, the medical team used a combination of fat-derived stem cells, donated bone scaffolds, growth protein, and bone-coating tissue.

No culturing required
After honing the bone-growth technique in laboratory pigs for more than two years, Taylor and his team were ready to attempt it in a person.

Their first patient was Brad Guilkey, who had been born with Treacher Collins syndrome (TCS), a rare genetic defect, which in Guilkey’s case resulted in the absence of some of his facial bones. Guilkey, who was 14 at the time of the surgery, had been born without either zygomatic bone—the two upper cheekbones that protect the eyes and form the normal cheek contours. “We were basically able to make new ones for Brad,” says Taylor of the bones. Before the surgery, Guilkey’s face sloped slightly inward—and his eyes downward—and a lack of protective bone left his eyes vulnerable, especially when he played his favorite sports, basketball and baseball.

Unlike many other stem cell treatments, such as heart patches, the procedure Taylor and his colleagues used did not require any advance culturing or growth in the lab. The intensive, daylong surgical procedure included every step—from the stem cell harvesting through liposuction to bone implantation.

The group chose fat stem cells over those from bone marrow largely because of the ease of access. “One of the neat things about adipose-derived stem cells is they’re very easy to harvest,” Taylor says. They also exist in just about the same proportion as bone marrow stem cells, which can be more difficult to obtain.

For the surgery, Taylor and his team shaped donor bone—from cadaver-donated femurs—to resemble zygomatic bones and act as a biological scaffold for the bone to grow on. Mesenchymal stem cells, harvested from Guilkey’s fat, and growth-encouraging morphogenetic protein-2 (BMP-2), were injected into holes drilled into the scaffolds. Before implanting the bone sections into Guilkey’s face, Taylor and his team wrapped them in periosteum tissue, which covers bone surfaces and was harvested from Guilkey’s leg. The surrounding material, especially the periosteum and the growth protein, helped to cue the stem cells to produce bone tissue.

New bones for all?
The new technique may have applications across the board for those who need bone regeneration, but it may not be as successful—or as simple—in every case.

Some of the procedure’s effectiveness may be due to Guilkey’s youth. “The periosteum, which is probably the most important component, changes as you get older,” Taylor says. This membrane, which covers healthy bones, helps to supply bones with blood and nutrients, encouraging growth and healing. So new bone may not generate as quickly in a 70-year-old as someone in his or her teens, he notes. The team is performing tests on pigs of different ages to see how much of a role senescence plays in the growth and healing process.

Overcoming genetic diseases, such as Guilkey’s TCS, can be challenging, Taylor notes, as repurposing that person’s biological material does not eliminate the mutations that caused a lack of bone in the first place. Although Taylor gives Guilkey’s procedure better than a 50–50 chance of long-term success, he remains cautious. “The real proof of the pudding of this concept will be whether it’s there in five years,” he says. If it is, “that will be really amazing.” Other, more traditional bone grafts for similar patients often start to come loose within a few months of the procedure. But, he says, Guilkey’s new bones remain “rock steady.”

Using the procedure in cancer patients may prove to be the most difficult due to intensive scarring and the fact that the growth protein, BMP-2, is not approved for use in people with cancer. Traumatic injuries will likely be the easiest to fix, provided the patient can wait six months to a year for scars to heal, says Taylor.

by Jocelyn Kaiser on June 29, 2010

The decision could have implications far beyond stem cell research. It seems to invite disgruntled scientists whose proposals to the National Institutes of Health aren’t funded to argue in court that NIH is at fault for funding a new research area.

The suit was filed last August by Christian groups that argued that NIH’s stem cell guidelines violate a federal ban on using federal funds to create or destroy human embryos. A U.S. District Court rejected the suit for several reasons, including that none of the plaintiffs had legal standing to sue. But on Friday, the U.S. Court of Appeals in Washington, D.C., found (pdf) that two doctors on the suit do have standing.

The doctors, who include James Sherley, an adult stem cell researcher at the Boston Biomedical Research Institute, had argued that by opening up federal funding for research on human embryonic stem cells (ESCs), the NIH guidelines made them less likely to win funding to study adult stem cells (ACSs). The court agreed:

Because the Guidelines have intensified the competition for a share in a fixed amount of money, the plaintiffs will have to invest more time and resources to craft a successful grant application. That is an actual, here-and-now injury.

The Doctors will suffer an additional injury whenever a project involving ESCs receives funding that, but for the broadened eligibility in the Guidelines, would have gone to fund a project of theirs. They are more likely to lose funding to projects involving ESCs than are researchers who do not work with stem cells because ASCs and ESCs are substitutes in some uses. The Doctors illustrated this point in a post-argument letter in which they report Dr. Sherley recently submitted a grant for a project in which ASCs will be used to create a surrogate for a human liver and suggest his “chief competitor” will be a company that “engages in similar research using [ESCs].” Although no one can say exactly how likely the Doctors are to lose funding to projects involving ESCs, having been put into competition with those projects, the Doctors face a substantial enough probability to deem the injury to them imminent.

The decision “seems to challenge core principles of priority setting, funds allocation, and competition” at NIH, says Anthony Mazzaschi of the Association of American Medical Colleges in Washington, D.C. That is, if NIH expands funding for any new research area, or creates a new type of grant program, a researcher could claim the agency is taking money away from his or her related area, Mazzaschi suggests. But he’s not sure if the court’s reasoning would have weight in cases involving projects other than stem cells.

The suit now goes back to the lower court, which must reconsider its rejection of the plaintiffs’ request for a motion to block federal funding of ESC research. The federal government seems ready to counter the appeals court’s reasoning. In a response to Friday’s decision, NIH spokesperson John Burklow said NIH doesn’t set aside fixed amounts of money for studying adult or embryonic stem cells, but instead makes award decisions based on scientific merit and relevance to NIH’s priorities. “As a result, adult and [ESCs] projects are not in direct competition for funding,” Burklow said in a statement.

By Salynn Boyles

WebMD Health News Reviewed by Laura J. Martin, MD

June 23, 2010 — A regenerative treatment that uses stem cells taken from the patient’s own eyes is helping some blind patients see again.

Italian researchers report that the stem cell procedure resulted in successful corneal transplantation in three-fourths of patients with blindness in one or both eyes, caused in most patients by chemical or thermal burns.

Vision was at least partially restored in patients who did not have major damage to other parts of the affected eye, says study researcher Graziella Pellegrini, PhD, of the University of Moderna’s Center for Regenerative Medicine.

Pellegrini and colleagues have performed corneal transplants in around 250 patients over the last decade using the stem cell technique, but it remains experimental and is not being done in the U.S.

Their latest study is published in the New England Journal of Medicine. The findings were also reported last week in San Francisco at a meeting of the International Society for Stem Cell Research.

“We followed the patients in this study for an average of three years and as long as a decade,” she tells WebMD. “We have shown that the results can last for many years.”

Regeneration of Corneas
The study included 112 patients with damaged corneas who received the stem cell treatment between 1998 and 2006.

The procedure involved extracting healthy stem cells from the limbus, which is located between the colored and white part of the eye.

Pellegrini says the procedure can be done even when only a tiny portion of the limbus remained undamaged.

Stem cells taken from the biopsied limbus tissue grew into healthy corneal tissue in a little over two weeks, she says, and the healthy tissue was then grafted onto the damaged eye.

When the procedure was successful, the damaged, opaque cornea became clear again and the eye looked normal.

In all, 77% of patients had a successful first or second graft, while the procedure was considered a partial success or failure in 13% and 10% of cases, respectively.

People with corneal damage from chemical and thermal burns often have symptoms including light sensitivity, itching, and pain. These symptoms went away or were much less severe in the successfully treated patients.

Following successful transplant, about half of the patients had further surgeries to improve visual acuity and most showed at least some improvement in vision. One patient achieved normal vision with the stem cell grafting alone.

Regenerative Treatments for Heart and Liver
University of California, Davis ophthalmology professor Ivan Schwab, MD, was among the first to perform the stem cell transplant procedure, based on Pellegrini’s early work, almost a decade ago.

He treated about 15 patients, and while many showed early responses, the benefits did not last.

“This study is remarkable because these researchers have shown not only that this technique works, but that it works for up to 10 years in some cases,” he tells WebMD.

He adds that regenerative treatments show promise for a wide range of illnesses, including those involving the bladder, liver, and the heart.

“We are not talking about regenerating the entire liver or heart,” he says. “The concept that you have to grow a whole liver or a whole heart is not correct.”

He points out that researchers are already working on a heart “patch” that can help a damaged heart function better.

June 24, 2010

GALVESTON, Texas A– For someone with a severe, incurable lung disorder such as cystic fibrosis or chronic obstructive pulmonary disease, a lung transplant may be the only chance for survival. Unfortunately, it’s often not a very good chance. Matching donor lungs are rare, and many would-be recipients die waiting for the transplants that could save their lives.
Such deaths could be prevented if it were possible to use stem cells to grow new lungs or lung tissue. Specialists in the emerging field of tissue engineering have been hard at work on this for years. But they’ve been frustrated by the problem of coaxing undifferentiated stem cells to develop into the specific cell types that populate different locations in the lung.
Now, researchers from the University of Texas Medical Branch at Galveston have demonstrated a potentially revolutionary solution to this problem. As they describe in an article published electronically ahead of print by the journal Tissue Engineering Part A, they seeded mouse embryonic stem cells into “acellular” rat lungs A— organs whose original cells had been destroyed by repeated cycles of freezing and thawing and exposure to detergent.
The result: empty lung-shaped scaffolds of structural proteins on which the mouse stem cells thrived and differentiated into new cells appropriate to their specific locations.
“In terms of different cell types, the lung is probably the most complex of all organs A— the cells near the entrance are very different from those deep in the lung,” said Dr. Joaquin Cortiella, one of the article’s lead authors. “Our natural matrix generated the same pattern, with tracheal cells only in the trachea, alveoli-like cells in the alveoli, pneumocytes only in the distal lung, and definite transition zones between the bronchi and the alveoli.”
Such “site-specific” cell development has never been seen before in a natural matrix, said professor Joan Nichols, another of the paper’s lead authors. The complexity gives the researchers hope that the concept could be scaled up to produce replacement tissues for humans A— or used to create models to test therapies and diagnostic techniques for a variety of lung diseases.
“If we can make a good lung for people, we can also make a good model for injury,” Nichols said. “We can create a fibrotic lung, or an emphysematous lung, and evaluate what’s happening with those, what the cells are doing, how well stem cell or other therapy works. We can see what happens in pneumonia, or what happens when you’ve got a hemorrhagic fever, or tuberculosis, or hantavirus A— all the agents that target the lung and cause damage in the lung.”
The researchers have already begun work on large-scale experiments, “decellularizing” pig lungs with an eye toward using them to produce larger samples of lung tissue that could lead to applications in humans. They’re also taking on the challenge of vascularization A— stimulating the growth of blood vessels that will enable the engineered tissues to survive outside the special bioreactors that the researchers now use to keep them alive by bathing them in a life-sustaining cocktail of nutrients and oxygen.
“People ask us why we’re doing the lung, because it’s so hard,” Cortiella said. “But the potential is so great, and the technology is here. It’s going to take time, but I think we’re going to create a system that works.”
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Other authors of the Tissue Engineering Part A paper (”Influence of Acellular Natural Lung Matrix on Murine Embryonic Stem Cell Differentiation and Tissue Formation”) are UTMB research associate Jean Niles, associate professor Gracie Vargas, medical student Sean Winston, graduate student Shannon Walls, summer research fellows Andrea Brettler and Jennifer Wang, Andrea Cantu of Stanford University and Dr. Anthony Pham of Brown Medical School.
ABOUT UTMB: Established in 1891, Texas’ first academic health center comprises four health sciences schools, three institutes for advanced study, a research enterprise that includes one of only two national laboratories dedicated to the safe study of infectious threats to human health, and a health system offering a full range of primary and specialized medical services throughout Galveston County and the Texas Gulf Coast region. UTMB is a component of the University of Texas System.
The University of Texas Medical Branch at Galveston
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Contact: Jim Kelly
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University of Texas Medical Branch at Galveston

Platelet-Rich Plasma (PRP) Utilized To Promote Greater Graft Volume Retention in Autologous Fat Grafting

Kevin S. Sadati, DO; Anthony C. Corrado, DO; Robert W. Alexander, MD, DMD

Objectives: Autologous fat theoretically provides one of the most ideal mediums for soft-tissue augmentation and reconstruction, although its clinical applications have been marked with skepticism because of its documented unreliable survival. Over the years, numerous unsuccessful efforts have set forth to elucidate modifications in the application process of autologous fat grafts to allow the medium greater clinical predictability. This study aims to investigate the effects of platelet-rich plasma (PRP) on autologous fat grafts when used in conjunction with each other in soft tissue augmen- tation and reconstruction.
Study Design: Retrospective review, over a 30-month period, of consecutive patients with results greater than 6 months in duration.
Methods: This study is based on clinical experiences representing 2033 grafts in 448 consecutive patients using PRP additives and in the previous 132 patients who had syringe harvest without use of PRP. All PRP isolates were harvested via the Smart Prep system. Harvest and augmen- tation techniques are discussed and representative results are presented.
Results: Results were based on clinical observations and patient satisfaction. Of the 580 patients in the experimental group, essentially all showed greater graft volume retention over extended time intervals compared with control subjects (nongraft areas). Patients in the PRP-added experimental group displayed less postoperative ecchymosis and edema, which also led to greater patient satisfaction in this group.
Conclusion: Adding PRP to autologous fat aids in graft volume retention and survival when used clinically for soft- tissue augmentation and reconstruction.

Received for Publication July 5, 2006.

Dr Sadati is in private practice in Costa Mesa, Calif. Dr Corrado is from the Department of Otolaryngology and Facial Plastic Surgery, University of Medicine and Dentistry of New Jersey. Dr Alexander is in private practice in Washington and Montana.
Corresponding author: Kevin S. Sadati, DO, Cosmetic and Reconstruc- tive Surgery, 720 Paularino Ave, Suite 200, Costa Mesa, CA 92626 (e-mail: ksadati@galleryofcosmeticsurgery.com).

The selection of autologous graft materials is widely accepted as one of the most fundamental mediums for use in most soft-tissue augmentation and re- construction dilemmas. It provides a very versatile augmentation medium for cosmetic and reconstructive surgeons. Adipose tissue provides a readily available, autologous graft medium for which use in human autotransplantation has been documented for more than a century.1,2 Autologous fat affords a medium that is soft, pliable, and readily available in abundant stores; can be harvested with minimal morbidity; has low antigenicity; and lacks risk of disease trans- mission.2,3–5 In light of the aforementioned benefits, the use of autologous fat as a graft medium has been fraught with skepticism by the cosmetic surgery community. This skepticism lies in the relatively inconsistent and unpredictable survival rates of autologous fat grafts to date. These results frequently necessitate the need for overcorrection of soft-tissue volume defects and increase the possibility of multiple procedures to achieve the desired volume of augmen- tation and symmetry. Because of these unpredictable outcomes, many studies have focused on modifying various parts of this procedure to achieve greater graft survival rates.6,7 Several studies have sought to modify and standardize the harvest procedures, whereas others have tried to provide additives that might improve graft survival. Unfortunately, many of these attempts have fallen short of their goals. Over the past decade, a better understanding of the biochemical milieu of the wound-healing process has enhanced the ability to assist healing.

This project is focused on studying the effects of enhancing fat-graft survival by augmenting the bio-chemical healing potential of the graft material with the addition of platelet-rich plasma (PRP, also known as autologous platelet concentrate). PRP maintains a high concentration of bioactive proteins and growth factors that are shown to precipitate and augment tissue repair and regeneration processes.8–19 Results of clinical trials have suggested that growth factors not only influence the viability of transferred cells but also may play a bioactive role in influencing the differentiation of precursor adipocytes within the graft into their mature form.4,20–24 Clinical trials have documented the efficacy and safety of the use of such concentrates in hard- and soft-tissue augmentation by stimulating and enhancing the native repair and regeneration of osseous and soft tissues.3,14,15,17,25,26 That evidence has already been clinically reviewed, so this study seeks to further report on the clinical improvements noted in the effects of autologous platelet concentrates with regards to the predictability and effective viability of autologous fat as a soft-tissue augmentation medium.
Definition of PRP
PRP describes a volume of autologous plasma that has a platelet concentration typically 5 or 6 times the normal baseline levels. PRP is isolated from an autologous whole blood sample by a process of differential centrifugation.27 PRP can be applied to wound sites directly in its isolated form or in form of a platelet gel created by initiation of the coagulation process and adding thrombin and calcium chloride. PRP is defined as 100 3 109/L platelets/[mu] in a 5 mL volume of plasma, which is the concentration at which bone and soft-tissue healing enhancements have been scientifically reported.16,27 This high concentration of platelets, as well as the component parts, is what allows PRP to become a strong bioactive element, providing high concentrations of growth factors contained pre- dominantly within the alpha granules of its platelets to enhance wound healing.16,17 The major documented growth factors contained in PRP include platelet- derived growth factor (PDGF) aa, PDGFbb, PDGFab, transforming growth factor b-1, transforming growth factor b-2, vascular endothelial growth factor, and epithelial growth factor.16,17
Materials and Methods
Isolation of PRP
Isolation of autologous platelet concentrates was once a cumbersome process, requiring expensive equipment and technical staff to isolate and prepare such materials for use in surgery. With the advent of affordable equipment and kit development, perioper- ative isolation of PRP is easily and safely completed at outpatient bases, using an automated dual-spin process (SmartPreP, Harvest Technologies, Inc, Plymouth, Mass).
Closed Syringe Harvest of Autologous Fat
Most surgeons who are experienced at fat transfer have adopted use of low pressure, syringe harvesting of fat-graft materials. In the authors’ practice, harvesting is carried out using tumescent fluid infiltration of the donor sites composed of 0.05% xylocaine with 1:1,000,000 epinephrine. In this study, use of tumes- cent volume of infiltration was at a ratio of 2:1 (fluid to supranatant graft), and there was an attempt to gently extract the graft materials via Cell Friendly (Tulip BioMed, San Diego, Calif) microcannulas using a technique that was as minimally traumatic as possible. Efforts were made to minimize graft trauma including using polished blunt cannulas of a somewhat larger diameter (2.0–3.0 mm), displacing air from the system before use with sterile saline or Ringer lactated solution. During harvest, low pressure is applied by limiting the plunger movement to half or less of the syringe being used. The Tulip Cell Friendly System was selected based on the internal superpolished lumens and smoothed exterior for graft collection with minimal trauma. In the authors’ experience, use of slightly larger harvest tubes, minimal-extraction vacuum pressures, and superpolished titanium cannulas pro- vides the most atraumatic means for graft harvest.
After fat harvesting, the graft was serially rinsed to reduce the residual intracellular lidocaine and debris (including cellular remnants, blood products, free lipids). At this point the graft is ready for the addition of autologous platelet concentrates in a 10% concen- tration PRP to rinsed graft.
Closed Syringe Harvest of Autologous Fat
Autologous Fat Graft Preparation with PRP

The PRP is first added to the prepared fat graft in a ratio of 1:9 (10%), and after gentle agitation it is left undisturbed for 10 minutes to permit release of the platelet-concentrate component elements. After the 10- minute interval the graft material is ready for injection. The prepared fat-graft material is then placed in various size injection syringes (1–10 cm3 luer-loc syringe) with polished Cell Friendly transfer needles ranging from 1 mm to 2.1 bore cannulas for most small volume transfers, and 1.7–3.0 bore for large-volume grafting procedures. In all instances, gentle pretunneling of the recipient sites should be performed in layers to prepare a recipient bed to accept the small micrografts laid in the developed space under minimal pressures.

Results
This study is based on clinical experiences represent- ing 2033 grafts in 580 consecutive patients treated from January 2002 through June 2004 (Table 1); PRP additive was used in 448 patients, and 132 patients had no PRP additive (Table 2). Each group used low- pressure closed syringe harvest with cell friendly cannulas, a minimum of 2 saline rinses, no centrifuga- tion, and no use of osmotic stabilization agents (such as albumin) in either group.
Clinical observations and patient satisfaction review of cases using autologous platelet concentrate (PRP) as an additive to autologous fat grafts suggests that this method of soft-tissue augmentation may have clinically significant advantages over conventional fat-grafting techniques (Table 3). PRP-enhanced grafts appear to show a greater potential for graft acceptance and retention over some existing conventional techniques as documented by physician findings and patients’ clinical satisfaction levels. Clinical results have been very encouraging from the standpoint of greater graft- volume retention. It has also been noted that there appears to be less swelling and bruising at the donor sites after injection compared with patients who underwent conventional techniques without addition of PRP.
Figure 3 displays a female patient 1 year after autologous fat grafting with PRP to the nasolabial folds and lips. This patient continues to display marked rejuvenation in the areas noted. There continues to be noticeable improvements: continued fullness of the lips, some reduction of perioral rhytids, enhanced definition of the cupid’s bow, and reduced prominence of the nasolabial folds. Furthermore, there are no palpable nodules at the recipient sites, and the patient has not required further follow-up procedures.
Figure 4 displays a female patient 1 year after rhytidectomy and autologous fat grafting with PRP to the malar fat pads and nasolabial folds. One year after treatment the patient continues to display noticeable fullness and definition of the malar fat pads with continued reduction of the nasolabial folds.
Similar results can be seen in Figure 5, which shows a woman 1 year after rhytidectomy and autologous fat grafting with PRP to the malar fat pads and nasolabial folds. This patient also continues to display youthful definition in the cheeks and continued reduction of the nasolabial folds.
Figure 6 shows a woman 6 months after autologous fat grafting to the lips. The patient displays a continued fullness of the upper and lower lips. Although this is only a 6-month follow-up, the patient will likely continue to be observed to mark progress and effects.
Figure 7 shows a woman 2 years after autologous fat grafting to the breast. The patient displays a continued fullness. Although there was much improvement in breast fullness, she is receiving more fat graft for slightly larger breast at a second stage. Mammogra- phies preoperatively, at 6 months, and then annually have revealed no abnormalities or cystic calcifications.
Although the current results were based on qualita- tive, clinical findings, efforts are being set forth to further study the procedure from a quantitative, cellular level.

[Show as slideshow]

Discussion: The Fat-Graft Healing Model
The literature contains numerous studies that have sought to elucidate a biochemical additive or agent that can improve the acceptance and outcome of autologous fat grafts. Numerous additives, such as heparin, cal- cium, thyroid hormone, bezafibrate, and vitamin E have been studied with little or no evidence supporting greater graft acceptance.1,3,7,22 Growth factors are the biologically active signal peptides released from local tissue or blood products that play a critical role in influencing the initiation and progression of the normal wound-healing process.3,12–14,16,17,25,27,28 Growth factors coordinate the processes of epithelialization, angiogenesis, and collagen/matrix formation, which are the key steps in wound healing.13 Growth factors function in paracrine, endocrine, and autocrine manners to guide the dynamic stages of wound healing.13 No single growth factor appears to maintain a specific physiologic task; instead, these peptides work in a coordinated fashion to orchestrate the normal wound-healing process.13 A substantial amount of research has displayed the efficacy of these bioactive peptides with regards to healing in both soft and osseous tissue.11,12,25,26,29 In a randomized, prospec- tive, double-blind, placebo-controlled study of 118 patients with chronic, full thickness, lower extremity diabetic neurotrophic ulcers of at least 8 weeks, there was a statistically significant difference in numbers of patients healed and healing rates after daily application of topical recombinant growth factor.30 Forty-eight percent of the patients randomized to the growth factor application group achieved complete wound healing, compared with only 25% who achieved wound healing in the placebo group. Knighton et al18 displayed 93% re-epithelialization in 41 patients displaying a total of 71 chronic wounds after receiving daily treatments with autologous platelet concentrate. In a second study, Knighton et al19 reported the re-epithelialization of 17 of 21 chronic lower extremity ulcers that were treated with an 8-week course of twice daily autologous platelet concentrate. Of the patients in the placebo group, only 2 of 13 their wounds displayed the same results. Upon crossover treatment of the placebo group with autologous platelet concentrate, all previously unresponsive wounds displayed re-epithelialization. Ganio et al15 displayed a 78% limb salvage rate among a series of 171 patients with a total of 355 wounds of average 75 weeks’ duration after daily treatment with a platelet-derived wound-healing factor concentrate for an average of 10 weeks. In the field of oromaxillofacial surgery, Marx et al. reported enhancement of bone formation on bone biopsy specimens in mandibular bone grafts after treatment with PRP.17 Relevant to facial plastic surgery, Powell et al reported trends that may suggest enhancement of recovery with decreases in postoperative edema and ecchymoses in a pilot, randomized, prospective, controlled clinical trial in- volving 8 female patients treated with autologous platelet gel during standard deep-plane facelift.25 The effect of growth factors on enhancement of neo- vascularization was studied by Khouri et al.31 This study demonstrated that after the application of basic fibroblast growth factor to ischemic flaps in rat models, the experimental group displayed greater flap survival rates, as well as a greater increase in the number of new blood vessels upon histologic examination.31
PRP, a clinically documented promoter of the wound-healing process, contains supraphysiologic con- centrations of growth factors. It is the intention of the present study to extrapolate the basic wound-healing model with respect to the transplantation of autologous fat and to study the effects of autologous platelet concentrates within this environment. It is postulated that the effects of PRP, with regard to enhancement of normal tissue healing processes, can be safely used as an additive in autologous fat transplantation to promote increased graft volume retention and return to meta- bolic activity. Adding PRP (and the attendant addition of high concentrations of growth factors and cytokines) may increase the retention of the transplanted fat cells, increase the rate of revascularization of the graft, and aid in the differentiation of preadipocyte precursor cells into mature adipocytes to further augment graft volumes. Use of mesenchymal stem cells derived from fat is the current subject of study, as they appear to be able to undergo induction differentiation and are more prevalent and easier to obtain than bone marrow cells.
In the case of autologous fat transplantation, the recipient bed represents the basic model of soft tissue injury. The authors believe there is clinical enhance- ment of wound repair in the recipient bed, through the effects of adding PRP, that appear to favorably aid in graft-volume retention and graft acceptance at site. Autologous fat cells are injected into a created potential space that has been subjected to tissue injury as a result of pretunneling at the recipient site. After grafting, this site consists of transplanted cellular elements, clotted blood containing platelets, exposed endothelial cells, interstitial collagen, fibroblasts, and undifferentiated stem cell elements.3
It is suggested that this model represents the initiation of the wound-healing process. With the oc- currence of tissue injury, the damaged recipient bed cells (native) release growth factors (notably PDGF and transforming growth factor).13,32 Concurrently, activa- tion of the clotting cascade results in the transformation of fibrinogen to fibrin, a potent stimulus for the release of growth factor from the alpha granules within the aggregated platelets.13,32 These growth factors then activate their target cells (polymorphonuclear neutro- phil leukocytes, macrophages, lymphocytes, fibro- blasts, endothelial cells, epithelial cells) to proliferate and migrate.32 Macrophages secrete growth factors that induce fibroblast proliferation and collagen synthesis, endothelial cell replication and mobilization, and epidermal cell mobility and proliferation.13,32 Angio- genic growth factors are released by the injured cells, platelets, macrophages, and extracellular matrix, in- ducing vascularization.13 It is evident that growth factors play a key role in initiating, expediting, and coordinating the phases involved in wound healing.
The investigators of this study believe adding PRP, which contains supraphysiologic concentrations of the growth factors necessary for normal wound healing, may help to markedly augment and improve the healing process at the recipient bed. This enhancement of heal- ing rate and graft survival may result in more favorable and reliable results with regards to success in trans- planting autologous fat.
It is postulated that the growth-factor enhancement seen in general wound healing may play a key role in allowing greater survival of transplanted adipocytes. Evidence in the literature suggests that growth factors may play a role in initiating the differentiation of adi- pose precursor cells into mature adipocytes.3,4,20–24 Eppley et al,20 in a later study, observed the effects of basic fibroblast growth factor on fat grafts at up to 1 year after grafting. The results showed near complete graft-weight maintenance, larger adipocyte volume, increased numbers of intact cells, and the presence of numerous smaller adipocyte-like cells compared with controls 1 year after grafting.20 These results suggest that growth factors may enhance graft retention volumes and increase the number of adipocytes within the grafted tissue as evidenced by the increase in mean adipocyte area percentages in the experimental groups.20 These studies suggest that adding growth
factor to autologous fat grafts before transplantation may aid in improving fat-graft survival by influencing differentiation of pre-adipocyte cells contained in the graft tissue. Thus, adipocytes that may be lost in the transplantation process may be replaced by new cells, which allows the overall graft volume to be maintained. Further, many conflicting reports estimating volume survival in fat grafting seem to ignore the fact that the harvest and transfer processes involve a fat cell suspension including 20–40% fluid components. In determining clinically successful graft volume, the fluid component should be expected to be gradually reduced during the healing processes. Claims that fat grafting does not work, or that it shows categoric loss of 30– 50%, should be evaluated carefully, while accounting for the extracellular fluid carrier volumes in final volume retention estimates.
Conclusion
Correction of soft-tissue defects continues to be one of the major challenges for cosmetic and reconstructive surgeons. Autologous fat theoretically provides a near- ideal medium for soft-tissue augmentation. It is a medium that is readily available in abundant quan- tities, has good physical properties, can be harvested with relative ease and low morbidity, and provides a graft medium with little antigenicity.2–5 The one factor that has frustrated many aesthetic surgeons has been the relative 20–50% loss of site volume after transplantation.4 Studies have sought to elucidate new methods or additives that could prevent this loss, although all have provided little scientific evidence to quantitate the successful grafting of autologous fat. The emergence of growth-factor technology and in vitro evidence has shed promising light on autologous fat grafting. Studies have shown results that may support the role of growth factors in providing greater autologous fat graft volume retention.1 It is also be- lieved that adding growth factors to the graft medium may also stimulate differentiation of adipose precursor cells into their mature form, which would further maintain graft volumes after transfer.4,20–22 Additional study in this area is certainly warranted.
The present study has sought to describe a safe and effective protocol to isolate and use autologous platelet concentrates, which contain much greater concentration than normal wound-site concentrations of growth factors, in an effort to potentially improve the survival and clinical outcomes of autologous fat grafting in the body. The rationale for using PRP as an additive in the transfer process was to create an optimal microenvi- ronment in the recipient bed that would help to expedite and enhance the wound-healing process and graft incorporation. The authors believe PRP may provide the ideal additive to autologous fat grafts to enhance their reliability and clinical success. This study suggests that more standardization and investigation is needed in the areas of small- and large-volume transfer. The authors are currently studying the potential of transfer or activation at recipient site from the mesenchymal stem cell components found in the fat matrix. It has been documented that more mesenchymal stem cells are available in fat tissues than in bone.19 With the advent of many investigators reporting successful large-volume micrograft augmentation in the buttock and breast areas, additional interest in large-volume transfers using PRP has been forthcoming. Further investigation is needed in the form of standardization and accumulation of data from a large-scale, multi-institutional study. Research that provides methods to successfully and uniformly quantify survival and metabolic activities of graft tissue will help determine the ideal clinical application of the techniques proposed in this study.
In conclusion, this study suggests that autologous platelet concentrate/PRP may provide great clinical potential for autologous fat transplantation and that there is a safe and economical way to isolate it for use in a wide variety of general, orthopedic, cosmetic, and reconstructive surgeries.
References
1. UllmannY,HyamsM,RamonY,etal.Enhancing survival of aspirated human fat injected into nude mice. Plast Reconstr Surg. 1998;101:1940–1944.
2. Billings E Jr, May JW Jr. Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery. Plast Reconstr Surg. 1989;83:368–381.
3. Abuzeni PZ, Alexander RW. Enhancement of autologous fat transplantation with platelet rich plasma. Am J Cosm Surg. 2001;18:59–70.
4. Yuksel E, Weinfeld AB, Cleek R, et al. Increased free fat-graft survival with the long-term, local delivery of insulin, insulin-like growth factor-I, and basic fibroblast growth factor by PLGA/PEG microspheres. Plast Reconstr Surg. 2000;105:1712–1720.
5. Chajchir A, Benzaquen I. Fat grafting injection for soft tissue augmentation. Plast Reconstr Surg. 1989;84:921–934.
6. Chajchir A, Benzaquen I, Moretti E. Comparative experimental study of autologous adipose tissue processed by different techniques. Aesthetic Plast Surg. 1993;17:113–115.
7. Moscona R, Shoshani O, Lichtig H, Karnieli E. Viability of adipose tissue injected and treated by different methods: an experimental study in the rat. Ann Plast Surg. 1994;33:500–506.
8. Santrach PJ, Willrs EA, McBane RD, et al.
The American Journal of Cosmetic Surgery Vol. 23, No. 4, 2006
211
Laboratory Validation of autologous platelet gel. Transfusion. 2004;44(Supp1):68A–69A.
9. Sacchi MC, Maresca P, Tartufer L, et al. Platelet gel as a new routine method to improve wound healing and regeneration. Transfus Med. 2000;10:325.
10. Appel TR, Potzsch B, Muller J, et al. Compar- ison of three different preparations of platelet concen- trates for growth factor enrichment. Clin Oral Impl Res. 2002;13:522–528.
11. Mazzucco L, Medici D, Serra M, et al. The use of autologous platelet gel to treat difficult-to-heal wounds: a pilot study. Transfusion. 2004;44:1013–1018.
12. Hom DB, Thatcher G, Tibesar R. Growth factor therapy to improve soft tissue healing. Facial Plast Surg. 2002;18:41–52.
13. Hom DB. Growth factors in wound healing. Otolaryngol Clin North Am. 1995;29:933–950.
14. Man D, Plosker H, Winland-Brown JE. The use of autologous platelet-rich plasma (platelet gel) and autologous platelet-poor plasma (fibrin glue) in cos- metic surgery. Plast Reconstr Surg. 2001;107:229–239.
15. Ganio C, Tenewitz FE, Wilson RC, Moyles BG. The treatment of chronic nonhealing wounds using autologous platelet-derived growth factors. J Foot Ankle Surg. 1993;32:263–267.
16. Marx RE, Carlson ER, Eichstaedt RM, et al. Platelet rich plasma: growth factor enhancement for bone grafts. J Oral Maxillofac Surg. 1993;51:1181– 1193.
17. Marx RE. Platelet-rich plasma (PRP): What is PRP and what is not PRP? Implant Dent. 2001;10:225–228.
18. Knighton DR, Fiegel VO, Doucette MM, et al. The use of topically applied platelet growth factors in chronic nonhealing wounds: a review. Wounds. 1989;1:71–78.
19. Knighton DR, Ciresi K, Fiegel VD, et al. Stimulation of repair in chronic, nonhealing, cutaneous ulcers using platelet-derived wound healing formula. Surg Gynecol Obstet. 1990;170:56–60.
20. Eppley BL, Sidner RA, Platis JM, Sadove AM. Bioactivation of free-fat transfers: a potential new approach to improving graft survival. Plast Reconstr Surg. 1992;90:1022–1030.
21. Eppley BL, Snyders RV Jr, Winkelmann T, Delfino JJ. Autologous facial fat transplantation:
improved graft maintenance by microbead activation. J Oral Maxillofac Surg. 1992;50:477–483.
22. Eppley BL, Sadove AM. A physicochemical aproach to improving free fat graft survival: pre- liminary observations. Aesthetic Plast Surg. 1991; 15:215–218.
23. Wabitsch M, Hauner H, Heinze E, Teller WM. The role of growth hormone/insulin-like growth factors in adipocyte differentiation. Metabolism. 1995; 44(suppl 4):45–49.
24. Boney CM, Moats-Staats BM, Stiles AD, D’Ercole AJ. Expression of insulin-like growth fac- tor-I (IGF-I) and IGF-binding proteins during adipo- genesis. Endocrinology. 1994;135:1863–1868.
25. Powell DM, Chang E, Farrior EH. Recovery from deep-plane rhytidectomy following unilateral wound treatment with autologous platelet gel. Arch Facial Plast Surg. 2001;3:245–250.
26. Kassolis JD, Reynolds MA. Evaluation of the adjunctive benefits of platelet rich plasma in subantral sinus sgmentation. J Craniofac Surg. 2005;16:280– 287.
27. Brissett AE, Hom DB. The effects of tissue sealants, platelet gels, and growth factors on wound healing. Curr Opin Otolaryngol Head Neck Surg. 2003;11:245–250.
28. Pierce GF, Mustoe TA, Lingelbach J, et al. Platelet-derived growth factor and transforming growth factor-beta enhance tissue repair activities by unique mechanisms. J Cell Biol. 1989;109:429–440.
29. Brissett AE, Sherris DA. Scar contractures, hy- pertrophic scars, and keloids Facial Plast Surg. 2001; 17:263–272.
30. Steed DL, The Diabetic Ulcer Study Group. Clinical evaluation of recombinant human platelet- derived growth factor for the treatment of lower extremity diabetic ulcers. J Vasc Surg. 1995;21:71–79.
31. Khouri RK, Brown DM, Leal-Khouri SM, et al. The effect of basic fibroblast growth factor on the neovascularization process: skin flap survival and staged flap transfers. Br J Plast Surg. 1991;44: 585–588.
32. Bhanot S, Alex JC. Current applications of platelet gels in facial flastic surgery. Facial Plast Surg. 2002;18:27–33.

Parkinson’s Disease

This disease attacks the nervous system of the human body, and is caused by a slow, almost imperceptible loss of cells in the brain that produce a chemical necessary for muscles to work normally.  Many people have come to know the main symptom of Parkinson’s as the disease that causes uncontrollable shaking of the hands, arms or legs.

A study by Instituto Brazzini Radiologos Asociados in Lima, Peru, showed considerable improvement in Parkinson’s symptoms after stem cell implants. Doctors registered various degrees of beneficial changes in brains

of all 47 patients within one week of the treatment. A team of Dr. Augusto Brazzini Armestar, the director of the institute, infused autologous stem cells derived from bone marrow into the arteries that supply blood to parts of brain that are typically damaged by Parkinson’s disease. [1]  Dr. Armestar explains: “Stem cells from bone marrow have the ability to differentiate into neurons and other tissues.” About three quarters of the patients achieved more than 50 percent improvement at the one month follow-up. [2] Dr. Armestar concludes that “[the] findings show a clinical recovery of extrapyramidal symptoms, which are maintained over time, as well as function recovery, representing a better metabolism of neurons and better performance in the brain.”[3]

[1] Autologous stem cells are stem cells coming from the same patient.
[2] Assessed by Parkinson’s disease validated tests.
[3] Susman, Ed, “Stem Cell Implant to the Brain Helps Improve Parkinson’s Symptoms: Presented at SIR,”Doctor’s Guide, 24 March 2008. Accessed at:http://www.docguide.com/news/content.nsf/news/852571020057CCF68525741600511A24 ( 17 April 2008 ).

WAKE FOREST INSTITUTE OF REGENERATIVE MEDICINE, WINSTON-SALEM, NC

Wake Forest University School of Medicine
Winston – Salem, N.C. 2 7 I57

Mission :
Our mission is to improve patient care by continuing to develop and disseminate novel clinical therapies for the functional repair and replacement diseased of organs and tissues.

Director:
Anthony Atala , MD
Background of Director:

Anthony Atala, MD, is the W.H. Boyce Professor and Chair of the Department of Urology and Director of the Institute for Regenerative Medicine at Wake Forest University.  Dr. Atala is a surgeon in the area of pediatric urology and a researcher in
the area of regenerative medicine.  His current work focuses on growing new human cells, tissues and organs.

Dr . Atala works with several journals and serves in various roles, such as Editor-in-Chief of Current Stem Cell Research
and Therapy and the Scientific World-Urology; as Associate or Section Editor of the Journal of Urology (lnvestigativeUrology),
Tissue Engineering and Regenerative Medicine, The Journal of Rejuvenation Research and Current Reviews in Urology; and as Editorial Board member of the Journal of the American College of Surgeons, Urology, Current Opinion in Urology, BioMed Central-Urology, the Journal of Laparoendoscopi and Advanced Surgical Techniques, Stem Cells and Development, Expert Opinion on Biological Therapy, and Biomedical Materials.

Dr . Atala is a recipient of the US Congress funded Christopher Columbus Foundation Award, bestowed on a living American who is currently working on a discovery that will significantly affect society, and the Cold C ystoscope Award for advances in his field.  Dr. Atala was named by Scientific American as a Medical Treatments Leader of the Year for his contributions to the fields of cell, tissue and organ regeneration.  In 2006, he was named by Fast Company magazine as one of 50 people who “will change how we work and live over the next l0 years, and his work was listed as Discover Magazine’s Number 1 Top Science Story of the Year in the field of medicine in 2007.
Dr. Atala has led or served several national professional and government committees, including the National Institutes of Health working group on Cells and Developmental Biology, and the National Institutes of Health Bioengineering Consortium. He is currently an NIH “Quantum Grant” awardee.  Dr. Atala heads a team of over 150 physicians and researchers.  Ten applications of technologies developed in Dr. Atala’s laboratory have been used clinically.  He is the editor of 8 books, including Methods of Tissue Engineering, Principles Regenerative of Medicine, and Minimally Invasive Urology, and has published more than 200 journal articles and has applied for or received over 200 national and international patents.

Major Accomplishments:

• The institute is the only research facility in the world to have created wholly laboratory-grown organs, engineered bladders, that have been successfully implanted in patients.

• The institute has identified and characterized a new class o f non-controversial stem cells derived from amniotic fluid and placenta, which show enormous promise for the treatment of many diseases, including diabetes and liver and heart disease.  The cells could be used as an injectable therapy or to grow replacement tissues and organs in the laboratory that could be implanted in patients.

Current Projects:
The Institute for Regenerative Medicine is currently working to engineer more than 20 different tissues and organs in the laboratory, including kidney, muscle, blood vessel, lung, heart and liver.  In some cases, a patient’s own cells are used.  Other
projects use the stem cells from amniotic fluid, which are distinct from human embryonic stem cells, but resemble them in two important ways. They can be easily expanded in the laboratory and can be induced to differentiate into multiple specialized cell types.  However, unlike embryonic stem cells, the A5 cells do not form tumors when they are transplanted. And, because they are easily obtained from afterbirth, ethical concerns are eliminated.

One project is to coax the amniotic stem cells to differentiate into pancreatic insulin-producing cells.  The ultimate goal is to produce cells that are able to regulate insulin levels based on the amount of glucose the cells are exposed to. We are currently assessing function by injecting the cells into a mouse model of diabetes.  Of course, many steps will have to be completed before the therapy could be applied to humans.  The ultimate goal is to engineer cells with the potential to reverse diabetes.

Web Site: www.wfubmc.edu/wfirm/

PITTSBURGH (CBS) ―

While platelet rich plasma therapy treatment is still relatively new, doctors say it can help with sprains, tears and possibly even arthritis, CBS station KDKA-TV reported.

Experts believe the concentration of platelets help speed the healing of the tendons and ligaments, meaning a quicker recovery for occasional athletes as well as professional ones.

During the procedure, a patient’s own plasma is injected into an injury site. Plasma is the liquid portion of the blood. In order to separate plasma from the blood, doctors put it in a centrifuge and spin it around very fast.

Two Pittsburgh area doctors are using the procedure to treat athletes. Ordinary patients are also seeing the benefits, however.

“What it’s called is autologous platelet rich plasma and simply what that means is we take the patients own blood,” said Dr. DeMeo, the chairman of orthopedic surgery.

“And then the needle enters into the diseased or torn site, and then you inject the platelet in,” says Dr. Snell.

Patient Jodi Matthews knows all about the therapy after injuring his back lifting weights. He had trouble walking, getting dressed and especially doing his job as a physical education teacher.

“I was feeling 50 percent better on the first shot,” Matthews said. “By the second shot, I was completely pain free.”