NEW BONE: A CT scan of the patient's skull after the stem cell treatment helped him regrow missing cheekbones
Image: CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
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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.
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46 Comments
Add CommentThis looks like a very expensive procedure that is just going to add to the tremendous amounts of money we spend on health care, which is already unaffordable for millions of people. We already spend 16% of GDP on healthcare and this type of care just serves to increase that number. Think of the thousands of people we could provide routine health care for with the same money.
Reply | Report Abuse | Link to thisAnd to top it off, we probably could have aborted a few babies to at least lower the cost of acquiring the stem cells.
@RDH: You're not the one missing your cheek bones. Maybe you should have donated yours, or do you feel that you might miss them?
Reply | Report Abuse | Link to thisWay to dump on medical advances, RDH. Maybe we should go back to the middle ages with rusty knives and no anesthetics. That'd really reduce the cost of healthcare, don't you think?
Reply | Report Abuse | Link to thisWow, I was impressed by the advance of science and happy for the child. I hope we continue to encourage scientific advancement.
Reply | Report Abuse | Link to thisOk , I'm convinced, I have seen the electormagnetic radiation. Complaining about the amount of GDP we spend on health care is a non-sequitor. It makes no sense to think any sector of our economy should be capped when it comes to its percentage of GDP. And thinking in terms of what's good for an individual as opposed to the good of all is quite contrary to the spirit of liberty and freedom this nation was founded on.
Reply | Report Abuse | Link to thisEven my comment about aborting babies is out of line and on reconsideration I believe our last President was correct with his approach to stem cell research, as this article shows that once again science managed to come up with a method where fetal stem cells were not required.
I don't know where I came off thinking that I, or anyone else, has the right to dictate something as personal as health care. In fact, I now think I am totally opposed to the political class injecting itself into my or anyone else's health care. It should remain in the private sector and I will stop spouting Democratic talking points.
Is anyone missing Bush yet?
Reply | Report Abuse | Link to thisWhat a cold hearted statement, all around
Reply | Report Abuse | Link to thisCould this procedure be adapted to repair damaged ligaments?
Reply | Report Abuse | Link to thisRDH...was that your intent? To mimic your version of a Democratic talking point? You are so out of line in so many ways it is hard to calculate. I don't know of ANYONE who would support the view you espoused...left or right.
Reply | Report Abuse | Link to thisCatastrophic care is not being denied except by insurance companies. Alternatives to fetal stem cells are not blocked by anyone. Why do you want to create trouble?
RDH...was that your intent? To mimic your version of a Democratic talking point? You are so out of line in so many ways it is hard to calculate. I don't know of ANYONE who would support the view you espoused...left or right.
Reply | Report Abuse | Link to thisCatastrophic care is not being denied except by insurance companies. Alternatives to fetal stem cells are not blocked by anyone. Why do you want to create trouble?
Many procedures that are now common, and even covered by insurance, started out like this one--very expensive and experimental: think about the first organ transplants. Medicine doesn't get anywhere without the first very expensive treatments that eventually improve health for everyone.
Reply | Report Abuse | Link to thisMany procedures that are now common, and even covered by insurance, started out like this one--very expensive and experimental: think about the first organ transplants. Medicine doesn't get anywhere without the first very expensive treatments that eventually improve health for everyone.
Reply | Report Abuse | Link to thisMany procedures that are now common, and even covered by insurance, started out like this one--very expensive and experimental: think about the first organ transplants. Medicine doesn't get anywhere without the first very expensive treatments that eventually improve health for everyone.
Reply | Report Abuse | Link to thisLet me know when you can regrow my prostate.
Reply | Report Abuse | Link to thisLet me know when you can regrow my prostate.
Reply | Report Abuse | Link to this@Justjean: You don't realize it, but you are just espousing another extreme. "Catastrophic care is not being denied except by insurance companies."? You say this as though insurance companies somehow have limitless resources. What do you mean?
Reply | Report Abuse | Link to thisPretty sure he's saying what a lot of us already know; that private insurance companies are the largest driver of the high costs and limiting of access to medical care.
Reply | Report Abuse | Link to thisSitting here on the other side of the world I cannot believe the tenor of some of the comments on this blog. Especially as the proponents choose to remain anonymous. As an outsider my first reaction was President Bush's blocking of stem cell research could not have helped this type of development. By blocking elements of research in this area with his fundamentalist view of the world I'm sure that research of this type has been held back.
Reply | Report Abuse | Link to thisFurthermore the SCIAM website would benefit from the activities of a sensible moderator to screen out fundamentalisttype non-scientific comments. I would suggest these not not to be censored, but to be removed to a separate "scientifically irrelevant comment" area where the fundamentalists can engage in their self obsessed fantasies and leave the real scientific comments to those who are interested in the subject matter.
Greg Angelo
Melbourne, Victoria, Australia
Sitting here on the other side of the world I cannot believe the tenor of some of the comments on this blog. Especially as the proponents choose to remain anonymous. As an outsider my first reaction was President Bush's blocking of stem cell research could not have helped this type of development. By blocking elements of research in this area with his fundamentalist view of the world I'm sure that research of this type has been held back.
Reply | Report Abuse | Link to thisFurthermore the SCIAM website would benefit from the activities of a sensible moderator to screen out fundamentalisttype non-scientific comments. I would suggest these not not to be censored, but to be removed to a separate "scientifically irrelevant comment" area where the fundamentalists can engage in their self obsessed fantasies and leave the real scientific comments to those who are interested in the subject matter.
Greg Angelo
Melbourne, Victoria, Australia
I have a suggestion. Can duplicate posts be removed? It should be possible to detect such automatically. Also, I am pleased that we are learning so much more about how to heal. It's a good thing!
Reply | Report Abuse | Link to thisI agree with the comment on duplicate posts. These seem to occur if you make a comment without initially logging on. If you then log on to post your comment it then seems to post the comment twice. A simple software routine could easily detect and eliminate duplicates. Alternately the authors could be given the option of removing their own duplicates with a simple authentication routine. Is there are a moderator on this site?
Reply | Report Abuse | Link to thisYea the first time I ever commented I didn't think it worked, sent it again and wished I could delete my own comments.
Reply | Report Abuse | Link to thisThis is really amazing. Agreed, I am so happy that we have this knowledge of healing.
In response to the ligament question, hopefully dentistry will soon become obsolete, because it is such a primitive and masochistic practice.
RDH get some help...something is very wrong with your thinking. I can't believe you would even post such a cruel foolish comment. Maybe your bi-polar. Talk to your doctor.
Reply | Report Abuse | Link to thisGreg Angelo,
Reply | Report Abuse | Link to thisThat's a good idea to remove the the fundamentalists non-scientific irrelevant comments. This is for science comments.
I've read some articles that said... High IQ and Common Sense didn't come together in some people. Another article talked about Bushes IQ being "higher than his and common sense" might be true.
Some people will focus ONLY on their point of view. Me, I like to think about lots of ideas...not just mine...it's fun.
About the Double Comments.
Reply | Report Abuse | Link to thisI noticed that it takes about two minutes to post the new comment. If you click on the view: Newest to Oldest you will see your comment just below that. Hope this helps.
Why in the world would insurance companies drive high medical costs? What could you even mean? It is in their business interest for costs to be low. They don't make money on a percentage basis. It is this kind of thinking that prevents health care reform. Contributing to the villinization of the health insurers does not help anyone. Seriously. Do something constructive.
Reply | Report Abuse | Link to thisThe research underlying this procedure HAD to have been done DURING President Bush's terms.
Reply | Report Abuse | Link to thisYou'd be foolish to think that the underlying research was done only in the last 9 months or so.
The other observation is these stem cells came FROM the patient, not from an aborted fetus or some discarded fertilized egg (= living HUMAN being) in a test tube.
So to those of you who either disparage the kindness of Bush in defending ALL Human Life, or who think this kind of aid is too 'expensive', just remember that this patient could have been YOU!!!
And remember that it also could have been YOU who was that living fertilized egg cell that Bush defended.
So much for Obama-ethics.
Thank you. I posted the same comment 3 times yesterday, much to my chagrin.
Reply | Report Abuse | Link to thisThere goes another Rush L. listener. I am so relieved that they are finally being called out for just what they are... Selfish, rude, religious hypocrites who pretend to care about others, but really only worship themselves...sick sick sick
Reply | Report Abuse | Link to thisGRIDLOCK!! GRIIDLOOOOOOOCK!!
Reply | Report Abuse | Link to thisWOW THAT'S A GOOD LOOKIN SKULL! (why not show his face??)
Reply | Report Abuse | Link to thisthe fact that "cost" is the first thing that comes to some peoples mind when reading a "medical breakthrough" is the really scary part.
Reply | Report Abuse | Link to thishow much is your life worth?
Greg,
Reply | Report Abuse | Link to thisPresident Bush did NOT block any type of stem cell research. If you are truly interested in the science instead of the politics, you'd be aware that he merely restricted government FUNDING to already existing lines of embryonic stem cells. This was the FIRST federal funding ever for ESC research. You would also realize that, to date, ESC research (which continues all over the world) has produced NO treatments and has caused uncontrolled tumor growth. Every dollar that funds an unpromising area of research is a dollar less for promising research. So far, adult stem cells have produced MANY treatments and are way ahead in the "game". By comparison, ESCs aren't even on the playing field. There is a reason that private, for profit companies are paying for ASC research while ESC research must depend on the government for funds. There are NO laws prohibiting any type of stem cell research. It's all about funding, not restricting. Check this link: http://www.stemcellresearch.org/facts/treatments.htm
In 10 years they'll be growing complete arm bones in vitro. In 20 they'll be mounting muscle tissue and skin on artificially-grown limbs to replace those lost in accidents or war.
Reply | Report Abuse | Link to thisWell, if it isn't in the Bible, thee must be something wrong with it. Surely, if God had wanted man to be able to do these things He would have created minds capable of doing such things.....er.....oh,.....did I just contradict myself?
Reply | Report Abuse | Link to thisSigh...Schmice, did you know the universe has a reset button?
Reply | Report Abuse | Link to thisDon't make me push it.
hello- why do you think abortion was made legal?? they have been harvesting stem cells and doing umbilical cord research since at least the late seventies-I worked in all of the OR's in a County Hospital
Reply | Report Abuse | Link to thisThese are ADULT stem cells: cells harvested from the donor himself. Embryonic stem cells, harvested from fetal material, has had a lot of problems with rejection and tumor growth and is likely on its way out in favor of the new procedures for manufacturing/harvesting adult stem cells.
Reply | Report Abuse | Link to thisThe room os dicussion is open for any opinion or thought, So no hard feelings , what i think strongly is that the field of stem cell biology and cell develoment is striking so high and in a vary short time so if you want to thaink of the future you should lit go of the money issuses and what the 2 docotrs helpples the boy with is wounderful and fasinating i wish them the best of luck and too the front
Reply | Report Abuse | Link to thisThe room os dicussion is open for any opinion or thought, So no hard feelings , what i think strongly is that the field of stem cell biology and cell develoment is striking so high and in a vary short time so if you want to thaink of the future you should lit go of the money issuses and what the 2 docotrs helpples the boy with is wounderful and fasinating i wish them the best of luck and too the front
Reply | Report Abuse | Link to thisIn 1997 Dr Roger Amar, a French plastic surgeon corrected a frontal bone defect with what was called preadipocytes which became un the 2000 the mesenchymal stem cells. His technique FAMI helped hundred of patient for rejuvenation, accidents or birth defect as cleft lip. visit www.rogeramar.com
Reply | Report Abuse | Link to thisRDH
Reply | Report Abuse | Link to thisperhaps your just jealous because you seem to be missing a brain and a heart, maybe someday they'll be able to grow those things for you!
Very well said Greg Angelo! My thoughts exactly, from my position North of the USA! And NO! Neither I nor the world in general miss Bush!
Reply | Report Abuse | Link to thisWell first off, the stem cells came from his own fat, those are adult stem cells,not embryonic stem cells from a fetus. Maybe if we spent less on the industrial military complex and trying to control parts of the world that don't want us there, we could have money for health care and for important research into what can actually fix us instead of covering up the problem with drugs, but maybe you like big pharma and all their fuzzy feelings commercials to take this and that pill to fix your problem because our health insurance companies won't pay for real solutions to our health problems.
Reply | Report Abuse | Link to thisSome places are injecting tendons and ligaments into people with stem cells now and I plan to try this within couple weeks on myself, but what worries me is that this procedure in the article at least had a growth protein bmp2 and the periosteum along with the stem cells to help the stem cells specifically grow into new bone. I think all I'm getting injected is blood platelets and the stem cells with no specific growth factor that would specifically direct the stem cells into becoming new tendon tissue that I desperately need to grow so I have a lot of reservations about how helpful this will be. It is very costly treatment too so it upset me to think that it's possibly missing a key component of what would make it really work right. I wish I was having some sorta bmp groth protein thingy injected with the stem cells.
Reply | Report Abuse | Link to thisThis will be beneficial for people who have had empty nose syndrome, because wacky ent had decided to mess up their inferior and middle turbinates, which these ent's thought they're useless. But in fact, they have ruined many lives because of a terrible surgery they call "turbinectomy" or "partial turbinectomy", or "turbinates reduction surgery".
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