How the body can “grow its own bones”

Many people don’t realize that, after blood, bone is the second most widely transplanted human tissue, resulting in more than 2 million procedures per year worldwide at a cost of over $5 billion.

If you’ve lost a healthy bone to an accident or illness, or if you’re born with bones that aren’t the right shape, what do you do? Historical solutions have included using animal bones or pieces of bone from human donors, but the body is quite picky. Complications abound when the body rejects what it sees as a foreign object, leading to infections or defective transplants.

So, even now, the gold standard treatment for a person like Roger Ebert, the late American film-critic who lost his jawbone to cancer, is autograft, which is basically a euphemism for cutting a piece of bone out of one part of the body and putting it in another.

Autograft is the sort of procedure that needs a euphemism. Though it’s our current best option, it still isn’t that great. The surgery is invasive and destructive. It can leave patients with a whole host of new issues, including multiple surgeries. In Roger Ebert’s case, because doctors cut bone out of his hip and shoulder, he suffered a limp for the rest of his life. And with pediatric cases, autografts are an even worse option – there’s often quite simply not enough bone to go around.

And so millions of patients need a better solution for bone replacement, and as the population ages and the world globalizes, such musculoskeletal solutions must last a lifetime. Inventors are working to meet this need. One emerging technology for skeletal reconstruction are 3D printed synthetic implants made to match the anatomical shape of the patient’s defects, such as those from Mobelife, Oxford Performance Materials and ConforMIS. Others are developing stem-cell therapies, such as those from Stempeutics, Novadip or Bonus Biogroup in which either banked cells or harvested adult stem cells are used to aid in bone regeneration.

At our start-up, EpiBone, we propose a more radical – and dare we say natural – approach that combines both of the above trends: grow your own bone. Why not use the stem cells that grow our bones every day in our bodies to engineer bones in a lab? In order to do this, we take two things from the patient: a CT scan, which is essentially a high-resolution 3D x-ray, so that we can calculate and fabricate a personalized scaffold in the precise three-dimensional shape of the bone we want to engineer; and a fat sample from which we extract the stem cells, then infusing them into the 3D scaffold.

The scaffold and stem cells together go into a special growth chamber, called a bioreactor, which simulates conditions found inside the body. Temperature, humidity, acidity and nutrient composition all need to be just right for the stem cells to transform into bone-growing osteoblasts, colonize the scaffold and remodel it with living tissue. Three weeks later, out comes a piece of living, human bone that’s sized and shaped precisely for the patient. This is an implant that your body hopefully won’t reject, because it’s made from your own cells.

Lots of research remains to be done before we place the first personalized, lab-grown bone into a patient. Lab-grown bones have already been successfully implanted in pigs and other animals, but we still need to demonstrate that this method will work for humans.

EpiBone’s work builds on the discovery from developmental biology that stem cells can transform into any part of the body. Our innovations, in turn, will be the foundation for still more new inventions, many yet to be imagined. If we can work in concert with living cells to grow bone, we might also adapt cells to groundbreaking new uses in other realms of medicine, or even entirely different fields, such as architecture, art and fashion.

What’s most inspiring to me about the evolving science of regenerative medicine is how it recasts the role and potential of our own cells. No longer seen simply as the passive subjects of our treatments, cells are now active agents. They are our collaborators. And they are the kind of naturally powerful actors that you really want on your team.

There’s still a long road ahead, but I would love to look back someday and say that painful, problem-prone bone transplants are statistic from the past. Countless patients, present and future, hope so, too.

Full details on all of the Technology Pioneers 2015 can be found here 

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Author: Nina Tandon, CEO and co-founder, Epibone, a World Economic Forum Technology Pioneer

Image: Belgian Professor Denis Dufrane, coordinator of the centre of tissue and cellular therapy of Brussels’ Saint Luc Hospital, shows how a hole in the tibia of a patient suffering from a disease was treated on an x-ray, in Belgium January 14, 2014. REUTERS/Yves Herman