Nano-technologies in new reconstructive surgery

Professor Stefano Zanasi is a Surgeon specialized in Orthopedics with a particular interest in minimally invasive primary and reconstructive prosthetic surgery, in revision surgery with the use of nano- and bio-technology and advanced systems (robotics, navigation) and in surgery and regenerative medicine using stem cells processed from bone marrow and adipose tissue.

Professor Zanasi is the President of a Foundation dedicated to science and the arts, and he has always been involved in international research and development projects on: infection in prosthetic surgery, design, implementation and first user of new implants, application of new bio- and nano-technologies in reconstructive and regenerative surgery for treatment of arthrosis and arthritis. In particular, he has been working for more than 15 years on the study and clinical use of stem cells for the reconstruction of musculoskeletal tissues, especially cartilage, in arthritic patients, in order to extend the lifespan of prosthetic implants or avoid them altogether.

Regenerative medicine and surgery: what are they and what do they offer?
The term regenerative medicine is commonly used to refer to medical or research strategies that make use of the extraordinary potential of a particular type of stem cells. Regenerative Medicine is a rapidly growing multi-disciplinary field that involves not only the medical sciences but also the human sciences as well as engineering, with the aim of developing functional cells, tissues, or organ substitutes, in order to repair or improve any biological functions lost because of congenital diseases, trauma, and the consequences of aging. Stem cells offer unprecedented hope for the treatment and perhaps the cure of severely damaged tissues that would not otherwise be saved even by the most advanced pharmacological or surgical treatments. This perspective has paved the way for a new paradigm in the management of complex diseases, called “Regenerative Medicine“, which has the potential to cure chronic diseases and to favour a healthy and active aging process, with exceptional socio-economic consequences.

Professor, you have mentioned the social consequences of your work, can you explain what they are?
The increase in the average lifespan requires an increase of the working age and an improvement of the physical and mental efficiency of elderly people, hence, the need to develop therapies that can help to replace or regenerate damaged organs. Using stem cells, we can offer unprecedented hope for the treatment and perhaps the cure of severely damaged tissues, hardly manageable with even the more advanced pharmacological or surgical treatments.

Where do mesenchymal stem cells used in reconstructive surgery come from?
The main sources of mesenchymal stem cells (MSC) are bone marrow, peripheral blood, umbilical cord, and adipose tissue. Adipose tissue, especially, allows for a greater ease of access, less pain during the explant (mini-liposuction), and minimal invasiveness; it can be used without depending on hematology centers and, above all, it is richer in MSCs. The application of stem cells promotes the regeneration of degenerated or damaged tissue: it has a trophic, anti-inflammatory, anti-infective and revascularization effect.

What is cell therapy?
Cell therapy is the administration to humans of autologous or heterologous living human cells that have undergone any kind of ex vivo manipulation, including in vitro propagation, for therapeutic, diagnostic and prophylactic purposes. Autologous refers to the use of cells and / or tissues from the same patient, while allogenic refers to the use of cells and / or tissues derived from donors; xenogenic refers to cells and / or tissues derived from animal origin.

Tell us about your tissue reconstruction technique, and how it is used to treat the cartilage of patients suffering from arthrosis. 
I developed this innovative technique to allow the reconstruction of large cartilaginous areas after serious lesion caused by osteoarthritis of the lower limb, Kellgren stage I, II and III, in particular injuries of the knee and ankle, using the combined transplantation of human bone marrow and the product derived from processed lipoaspirate. Both are loaded on nanofabric scaffolds with patient-specific fiber diameter and architecture. In patients affected by mono or bi-compartment arthritis of the knee or ankle, with the aim to avoid or delay prosthesis implantation, this approach allows a much more significant cartilage regeneration compared to the use of simple bone marrow or adipose tissue. Therefore, the combined use of non-expanded autologous tissue products consisting of bone marrow and of white adipose tissue derivatives, such as microfractured products, can be considered an autologous / homologous strategy to improve the natural self-healing ability of the damaged osteoarticular tissues.

Are there any other fields of application for this technique?
Of course, fortunately there are: conserving the vasculo-stromal niche with high concentrations of mesenchymal stem cells (and, therefore, with pericytes) can allow for many other applications in the treatment of ulcers, as well as in the fields of gynecology, urology, proctology, otorhinolaryngology, reconstructive plastic surgery as well as in orthopedics and sports medicine.

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