The good results encourage experts to continue researching, as they do from the García Cugat Foundation, and today researches how to obtain better results in the aforementioned cartilaginous, tendon and muscle pathologies.
We can regenerate. Not like sci-fi heroes, but it’s in our hands, or rather in our cells, to repair the damage to our tissues. Although we did not know how to take advantage of this potential until we saw the best athletes, such as Rafa Nadal or Xavi Hernández, among others, touched by the magic injection of Medicine: growth factors.
They are proteins that are located in the platelets and that accelerate the regeneration of the tissue. “Specifically they’re in the Alpha granule of the platelets. They act as mediators in the tissue repair process and with them we cause healing in the face of an injury more quickly”, explains Vicente Díez Vázquez, specialist in orthopedic surgery and traumatology and medical director of the Center of Advanced Medicine at the Virgen del Mar Clinic in Madrid. The expert clarifies that “this treatment is governed by the same principles as the organism to cure. And even though it depends on the ailment to be treated, the advantage is that the patient recovers in about half the time.” Just draw blood from the patient, and the rest falls into the hands of the machinery. The blood is centrifuged, platelet-rich plasma is isolated, activated to release the precious proteins, and is ready to be injected into the area to be treated.
Tendinitis and Osteoarthritis
Its application is associated with ankle, knee injuries, muscle tears or fiber breakage, elbow injuries, patellar chondromalasia… And especially “in the patellar tendon of athletes, because if they infiltrate, we increase the risk of breakage, while with growth factors, no; on the contrary, the tendon is strengthened,” specifies Díez Vázquez.
And it doesn’t end there. As Explained by Ramón Cugat Bertomeu, head of the Hospital Quirón Traumatology Service in Barcelona, and President Catalan Mutuality Medical Teams of Footballers (Spanish Football Federation), “also apply in specialties such as stomatology, cosmetic surgery, regenerative medicine or ophthalmology”.
But, without a doubt, the biggest milestone was reached in the field of the locomotive system. This is the case with osteoarthritis, especially in large load joints such as the knee or hip. Because this ailment is a consequence of the wear and tear of the cartilage and causes alterations in the joint mechanism, inflammation of the synovial, stroke, deformity, pain, loss of function… And on many occasions it leads the affected person to go through operating room to “place” a prosthesis. Jaume Graell and Antonio García, director and deputy director respectively of the Catalan Institute of Rheumatology and Bone Diseases, nuance that “getting the tissue regenerated or not being lost is one of the great achievements, as long as it is realized at a phase where there is still cartilage. In these cases, there is a very high percentage, around 80 per cent, of the chances of slowing developments and deterioration.” Moreover, ‘situations in which the operation was foreseeable, it has been achieved that, for the time being, it is not carried out”, adds Graell. However, experts make this clear: “This is a functional aid and decreases clinical symptomatology. In these cases it is not curative,” Cugat says.
This therapeutic proposal (PRGF-Endoret) was developed based on the research of Eduardo Anitua and Mikel Sánchez of the USP La Esperanza, of Vitoria, and was marketed by BTI Biotechnology Institute. “I designed this technique 15 years ago to regenerate the bone in a tooth extraction and avoid complications. The results were very good and we started using it in bone regeneration in atropic jaws and around dental implants. And we recently completed a multicenter clinical trial for osteoarthritis,” anitua describes. This work shows that it decreases the pain and stiffness of the joint, allowing for greater mobility. ‘It is clear from the trial that the pain, stiffness and functional disability associated with osteoarthritis are improved by 40 per cent,’ Anitua says.
However, in this degenerative ailment it is not enough with a single infiltration, but it is necessary to perform several throughout the year and continue to go to revisions. Graell clarifies that “the extraction process is the same, but it is necessary to make four applications throughout the year, with a time space of two or three weeks the first three injections and subsequently, that is, the fourth, inject it after two months. What we call a reminder. From there, once a year you have to repeat the process to maintain the benefits.”
It can be somewhat “cumbersome” for the patient, so much dated, but nothing further. In addition, anesthesia is regional, not local, as “anesthesia cannot be mixed with growth factors because it is acidic. An anesthetic blockade is put in the area. I mean, we slept, but no anesthetic inside.” The good results encourage experts to continue researching, as they do from the García Cugat Foundation, and today researches how to obtain better results in the aforementioned cartilaginous, tendon and muscle pathologies.
Another novelty in which we work is the ailment of the spine. As the director of the Catalan Institute of Rheumatology and Bone Diseases explains, “especially for problems of insertion of the muscles, such as lumbalgias”. Work is also under way on diabetes, or rather, problems that are derived, such as diabetic or pressure foot ulcers. Recently, work by a group of scientists at Massachusetts General Hospital (USA) has developed a system for the use of these factors in these chronic wounds.
In the study in mice and published in Proceedings of the National Academy of Sciences, the researchers produced “nanospheres” containing keratinocyte growth factor (KGF), a protein that plays a very important role in wound healing, and mixed it with elastin (which brings greater flexibility to tissues). By applying nanoparticles to genetically modified diabetic rodent ulcers, healing accelerated by stimulating the formation of surface epithelial tissues as well as fibrous connective tissue. Piyush Koria, the principal investigator, explained to the media that “it is amazing how after the infiltration of a single dose of this protein was enough to induce tissue regeneration in two weeks”.
Therefore, with the diabetic foot, there are already three groups of beneficiaries, along with traumatic sports pathologies and degenerative pathologies. However, there are sick people who do not enjoy the same luck. Because, although age is not an inconvenience, the same is not true for people who have active or recent tumors. There is no absolute evidence, but it is considered that there may be a remote effect or stimulate proliferation.
Properties aside, what interests many patients is knowing how much their recovery is going to cost them. And while putting a price on health is complicated, the medical director of the Center for Advanced Medicine quantifies that “a treatment, depending on the type of ailment, that is, if you need more or less amount, would range, with three or four sessions, for example, between 1,500 and 3,000 euros. Because it has to be obtained in extreme hygiene conditions and immediately. It is expensive by processing kits and various equipment.”
Also to rejuvenate the skin
The “boom” of the CCs has not only caught the attention of athletes or affected by rheumatological and trauma ailments. The science of beauty has also discovered the benefits of this type of technique, as they regulate skin remodeling and repair. Therefore, in recent years they are applied topically or with subcutaneous injection of growth factors for aged skin. Gema Pérez-Sevilla, head of the Facial Aesthetic Medicine Unit of the Laser Medical Institute (IML), states that “it increases the thickness and elasticity of the skin by inducing so-called neocologenogenesis in fibroblasts and improves microvascularization”. In addition, it stimulates secretions and helps maintain the skin structure. It is from the age of 30, when its application is recommended, that is, as soon as the skin begins to lose some of its restorative potential. “We can do this by stimulating dermal fibroblasts. The results obtained are: an increase in skin tone and smoothness and increased shine. The usual treatment is three sessions spaced monthly and one maintenance session every six months”, the expert said.