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(photo credit: Hadassah Medical Organization)
A team at Jerusalem's Hadassah University Medical Center has managed for the first time in the world to separate platelets and adult stem cells from the blood and bone marrow of patients with fractures and inject them - causing the bones to meld in a quarter to third of the time it usually takes to repair bones, and repairing some breaks that without the therapy would fail to heal at all.
Prof. Meir Liebergall, chairman of the orthopedics department on the Ein Kerem campus, gene therapy expert Prof. Eithan Galun and colleagues worked for years on the technique, which he said involves a "breakthrough in concept and overcomes major scientific and logistical problems."
All seven of those who received the experimental cell-based therapy have seen the broken tibias in their legs heal, even though the fractured bone in at least one control group patient who received only conventional treatment of screws or bone grafts failed to meld. Instead of taking six to nine months to heal, the fractures treated with adult stem cells and platelets healed in two months.
Liebergall told The Jerusalem Post on Thursday that the experiment was conducted in patients aged 18 to 60, with most of them toward the younger side of the range; all of them broke their leg bones in sports activities or accidents. He said the technique is most suited for high-impact fractures rather than broken hips in osteoporosis patients, whose fractures usually meld after surgery. Fractured bones do not heal easily in some patients when the anatomical structure of the fracture area is problematic or when there is a relative lack of muscle and ligament.
Under regional or general anesthesia, the patient undergoes a short procedure to remove 50 milliliters of mesenchymal bone marrow cells and 100 milliliters of blood from the hip area, which is often done for bone-marrow transplants on certain cancer patients. Adult mesenchymal stem cells can differentiate into a variety of cell types.
The patient is returned to the orthopedics department, while the cells and blood are taken to a lab approved for good manufacturing practice (GMP) and dedicated only for this purpose. Out of billions of bone marrow cells, millions of mesencymal stem cells were obtained, and platelets were taken from the blood. In principle, Liebergall said, any type of fracture that takes six to nine months to meld or doesn't heal at all can be treated with the technique, however, the team will wait to monitor patients until a year passes before regarding it as a full success or submitting a medical journal article.
"We intervened early and did not wait until we could determine whether the fracture would heal or not," he said, adding that all who participated in the clinical study gave their informed consent. It took three years to get approval from the Helsinki Committees for human medical experimentation before conducting it.
Liebergall said that if the concept is fully proven successful, it could be widely applied for fractures.
Preparations for the study began a full decade ago. The Hadassah team received a grant from Teva Pharmaceutical Industries to perform the study, and though it has run out, Liebergall hopes it will be renewed.