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Questions and Answers

What are the three essential components of regenerative medicine?

Genes, cells, and matrix.

Explain the role of the extracellular matrix (ECM) in tissue regeneration.

The ECM provides structural support, regulates cell behavior, and influences the processes of tissue regeneration.

What significant advancement was highlighted by Sir Peter Medawar in the 20th century?

The importance of immune rejection in transplantation.

What are stem cell niches and why are they important?

<p>Stem cell niches are microenvironments that support stem cells and regulate their behavior.</p> Signup and view all the answers

Identify the three embryonic layers formed during gastrulation.

<p>Ectoderm, mesoderm, and endoderm.</p> Signup and view all the answers

What are the four phases of the organ-genetic period of embryonic development?

<p>Growth, morphogenesis, differentiation, and maturation.</p> Signup and view all the answers

What types of proteins are categorized as fibrous proteins in the ECM?

<p>Collagen, elastin, and fibronectin.</p> Signup and view all the answers

How does the interaction between cells and ECM influence tissue regeneration?

<p>The interaction mediates cell adhesion and regulates signaling pathways crucial for tissue repair and development.</p> Signup and view all the answers

What is the primary origin of the epidermis in skin development?

<p>The epidermis is derived from the surface ectoderm.</p> Signup and view all the answers

How does intramembranous ossification differ from endochondral ossification?

<p>Intramembranous ossification forms flat bones, while endochondral ossification forms long bones.</p> Signup and view all the answers

What type of mesoderm is responsible for developing skeletal muscle?

<p>Skeletal muscle develops from the myotome regions of the somites in the mesoderm.</p> Signup and view all the answers

In cardiac muscle development, from which embryonic tissue does it primarily arise?

<p>Cardiac muscle arises from lateral splanchnic mesoderm.</p> Signup and view all the answers

What role do neural crest cells play in the development of the peripheral nervous system?

<p>Neural crest cells give rise to cranial, spinal visceral nerves and ganglia in the PNS.</p> Signup and view all the answers

What process allows cells to lose epithelial characteristics and become more mobile?

<p>Epithelial-Mesenchymal Transition (EMT) allows cells to lose epithelial characteristics.</p> Signup and view all the answers

How does Mesenchymal-Epithelial Transition (MET) contribute to tissue repair?

<p>MET is crucial for tissue repair as it reverses EMT, aiding in kidney development.</p> Signup and view all the answers

What are Bone Morphogenetic Proteins (BMPs) essential for in development?

<p>BMPs are essential for regulating tissue development and organ specification.</p> Signup and view all the answers

What are cadherins and what role do they play in tissue formation?

<p>Cadherins mediate cell-cell adhesion and are crucial for maintaining tissue integrity.</p> Signup and view all the answers

How do integrins function in relation to the extracellular matrix (ECM)?

<p>Integrins act as receptors for ECM, facilitating cellular communication with their environment.</p> Signup and view all the answers

Why is the skin crucial in protecting the body from external threats?

<p>The skin acts as a waterproof barrier and protects against environmental hazards.</p> Signup and view all the answers

What are the complications associated with severe burns?

<p>Complications can include infection, scarring, and sepsis, which can be fatal.</p> Signup and view all the answers

How does skin's ability to self-repair change after severe injuries?

<p>After severe injuries, skin's ability to self-repair is compromised and can struggle.</p> Signup and view all the answers

What is the significance of using REIMS/i-knife in burn treatment?

<p>REIMS/i-knife helps differentiate between healthy and necrotic tissue in real-time, guiding surgeons during debridement.</p> Signup and view all the answers

What is a primary disadvantage of split-thickness skin grafts?

<p>Split-thickness skin grafts can result in donor site morbidity, including pain and scarring.</p> Signup and view all the answers

How do autologous cell treatments reduce the risk of rejection in skin grafts?

<p>Autologous cell treatments use cells sourced from the patient's own body, eliminating the risk of immune rejection.</p> Signup and view all the answers

What role does bromelain play in burn wound debridement?

<p>Bromelain acts as an enzyme to assist in the removal of dead tissue, especially in hard-to-reach areas.</p> Signup and view all the answers

What limitations does a xenograft have in burn treatment?

<p>Xenografts are limited to temporary use due to vigorous immune rejection and are often derived from animals.</p> Signup and view all the answers

Why is timing crucial when using Cultured Epithelial Autografts (CEAs) for skin coverage?

<p>Precise timing in CEAs is essential to ensure optimal healing and to minimize scarring.</p> Signup and view all the answers

What is a potential risk associated with receiving an allograft for burn treatment?

<p>Allografts carry a risk of rejection and cross-contamination, often necessitating immunosuppressive therapy.</p> Signup and view all the answers

Describe the composition of skin grafts from the dermal-epidermal junction in ReCell Spray-on Skin treatment.

<p>ReCell Spray-on Skin includes keratinocytes for skin barrier, fibroblasts for matrix production, and melanocytes for pigmentation.</p> Signup and view all the answers

What cell types play a crucial role in the healing of skin wounds?

<p>Keratinocytes, fibroblasts, and melanocytes are essential for skin healing.</p> Signup and view all the answers

How do Cultured Epithelial Autograft (CEA) sheets facilitate wound healing?

<p>CEA sheets are cultured from a full-thickness biopsy and provide a layer of keratinocytes that help restore the epidermis.</p> Signup and view all the answers

What risk is associated with delayed surgical intervention after skin injury?

<p>Delaying treatment beyond 10 days increases the scar risk, rising to 78% if healing takes more than 21 days.</p> Signup and view all the answers

Why is the extracellular matrix (ECM) significant beyond mere structural support in skin regeneration?

<p>The ECM actively influences healing through the release of growth factors and its physical properties.</p> Signup and view all the answers

What are two types of matrices mentioned for burn treatment and their key characteristics?

<p>Integra is collagen-based and biodegradable, while BTM has a non-biodegradable top layer for water loss prevention.</p> Signup and view all the answers

How does Apligraf differ from other skin substitutes?

<p>Apligraf is a bilayered cultured graft composed of both dermal and epidermal components.</p> Signup and view all the answers

What role do stem cells play in future innovations for skin regeneration?

<p>Stem cells are being explored for their potential in enhancing skin regeneration and immune modulation.</p> Signup and view all the answers

What are the benefits of 3D bioprinting in tissue engineering?

<p>3D bioprinting allows for the customization of tissues' matrix properties and can print complete structures for transplantation.</p> Signup and view all the answers

What is a major challenge related to the use of dermal scaffolds in skin regeneration?

<p>Vascularization into new templates is critical yet often limited in achieving adequate epidermal coverage.</p> Signup and view all the answers

How do adjunct therapies enhance the outcomes of skin treatments?

<p>Adjunct therapies, like laser scar modulation, improve the appearance of scars post-healing.</p> Signup and view all the answers

What unique feature of cultured allogeneic grafts limits their use?

<p>Cultured allogeneic grafts lack blood vessels, hair follicles, and certain immune cells.</p> Signup and view all the answers

What is the role of fibroblasts in skin regeneration?

<p>Fibroblasts are essential for forming the dermal matrix and supporting tissue integrity during healing.</p> Signup and view all the answers

Why is early treatment crucial for skin wounds?

<p>Early treatment reduces scar formation risk and promotes a more effective healing process.</p> Signup and view all the answers

What is the significance of utilizing autologous keratinocyte preparations in skin therapy?

<p>Autologous keratinocyte preparations provide a tailored approach to healing, utilizing the patient's own cells.</p> Signup and view all the answers

What has been identified as an emerging area of focus for improving skin regenerative therapy?

<p>Research is focusing on induced pluripotent stem cells and their potential roles in regeneration.</p> Signup and view all the answers

What is the role of multipotent stem cells (MSCs) in tissue regeneration?

<p>MSCs have the ability to differentiate into various cell types and form connective tissue scaffolding, crucial for tissue repair and regeneration.</p> Signup and view all the answers

How do MSCs contribute to the immune response during inflammation?

<p>MSCs respond to inflammation by homing to affected tissues and modulating immune responses through direct cell contact and paracrine mechanisms.</p> Signup and view all the answers

What was the founding mission of FACT in the field of cellular therapies?

<p>FACT was founded to improve the quality of cellular therapies through peer-developed standards, education, and voluntary accreditation.</p> Signup and view all the answers

What is the significance of accreditation in the BMT field as promoted by FACT?

<p>Accreditation minimizes the burden of regulatory oversight and enhances collaboration between clinical units and laboratories.</p> Signup and view all the answers

In what ways do MSCs support the haematopoiesis niche in bone marrow?

<p>MSCs form a supportive niche that enables hematopoietic stem cell proliferation and differentiation by secreting vital cytokines, chemokines, and growth factors.</p> Signup and view all the answers

What are the primary characteristics that distinguish ATMPs from other biological products?

<p>ATMPs are characterized by substantial manipulation or a different essential function from donor cells, unlike other biological products used for the same purpose.</p> Signup and view all the answers

Explain the regulatory role of the Office of the Gene Technology Regulator (OGTR) concerning GMOs in ATMPs.

<p>The OGTR ensures that dealings with GMOs in ATMPs comply with the Gene Technology Act, overseeing monitoring and compliance activities.</p> Signup and view all the answers

Define biologicals according to the Australian Regulatory Guidelines for Biologicals.

<p>Biologicals are products made from human cells or tissues used to treat diseases, diagnose conditions, or replace body parts.</p> Signup and view all the answers

What types of products are classified as biological medicines, and how do they differ from biologicals?

<p>Biological medicines include recombinant and plasma-derived products, as well as vaccines without viable human cells, distinguishing them from biologicals that contain human cells or tissues.</p> Signup and view all the answers

Why is it significant that some ATMPs contain genetically modified organisms (GMOs)?

<p>The presence of GMOs in ATMPs necessitates specific regulatory scrutiny to ensure safety and compliance with genetic manipulation laws.</p> Signup and view all the answers

How does substantial manipulation of cells or tissues play a role in classifying a product as an ATMP?

<p>Substantial manipulation changes the biological characteristics or intended function of the cells or tissues, which qualifies the product as an ATMP.</p> Signup and view all the answers

What is the primary purpose of administering products that include recombinant nucleic acids?

<p>These products aim to regulate, repair, replace, or modify genetic sequences within human beings.</p> Signup and view all the answers

Can you provide an example of a combination product within the ATMP category?

<p>An example of a combination product would be a cell therapy that is delivered using a medical device.</p> Signup and view all the answers

What is the purpose of the Gene Technology Regulator in managing ATMPs containing GMOs?

<p>The Gene Technology Regulator assesses and approves ATMPs containing GMOs for clinical use to ensure safety and compliance with regulations.</p> Signup and view all the answers

Identify two key facilities or services provided by the Cell and Tissue Therapies WA (CTTWA).

<p>CTTWA provides services for manufacturing licensed cell therapies and conducting cell processing for hematopoietic stem cell transplants (HSCT).</p> Signup and view all the answers

What primary skill set is required for staff handling ATMPs in a cleanroom facility?

<p>Staff must demonstrate expertise in Good Manufacturing Practices (GMP), aseptic cell processing, and handling of GMOs.</p> Signup and view all the answers

What is the significance of Major Histocompatibility Complex (MHC) matching in hemopoietic stem cell transplantation?

<p>MHC matching is critical to reduce the risk of graft-versus-host disease (GVHD) and improve transplant success.</p> Signup and view all the answers

Explain the role of CAR T-cell therapy in treating cancer.

<p>CAR T-cell therapy modifies a patient's T-cells to specifically target and destroy cancer cells, providing a novel treatment approach.</p> Signup and view all the answers

What challenges are presented by the global shortage of corneal transplant materials?

<p>The shortage of transplant-grade cadaveric donor corneal tissue leads to an annual gap between demand and available transplants.</p> Signup and view all the answers

What are mesenchymal stem cells (MSCs) and where can they be found?

<p>MSCs are a type of stem cell found in bone marrow, adipose tissue, umbilical cord, and other tissues.</p> Signup and view all the answers

How did the National Marrow Donor Program (NMDP) impact stem cell donations?

<p>The NMDP established a coordinated registry to increase the availability of stem cell donors for patients needing transplants.</p> Signup and view all the answers

What is the current standard of treatment for loss of corneal endothelial cells?

<p>The current gold standard treatment is a corneal transplant, which addresses visual impairment due to cell loss.</p> Signup and view all the answers

Describe the importance of quality systems and Standard Operating Procedures (SOPs) in ATMP facilities.

<p>Quality systems and SOPs ensure consistent, safe practices in the manufacturing and delivery of ATMPs to patients.</p> Signup and view all the answers

What role do scaffolds play in tissue engineering?

<p>Scaffolds act as templates that support cell growth and guide tissue formation.</p> Signup and view all the answers

Name two types of signals that influence cell behavior in tissue engineering.

<p>Growth factors and hormones are two types of signals that influence cell behavior.</p> Signup and view all the answers

What is a primary challenge faced in the development of tissue engineering solutions?

<p>Developing reliable and cost-effective scaffolds is a primary challenge.</p> Signup and view all the answers

How do biomaterials contribute to the function of scaffolds?

<p>Biomaterials provide the necessary mechanical properties and biocompatibility for scaffold function.</p> Signup and view all the answers

What are the three sources of cells commonly used in tissue engineering?

<p>Cells can be sourced from autologous, allogeneic, or xenogeneic origins.</p> Signup and view all the answers

Describe the significance of the extracellular matrix (ECM) in tissue engineering.

<p>The ECM provides structural and biochemical support essential for cell function and tissue integrity.</p> Signup and view all the answers

What are the key characteristics that scaffolds must have for successful tissue regeneration?

<p>Scaffolds must have adequate mechanical properties, be biocompatible, and be biodegradable.</p> Signup and view all the answers

How does mechanotransduction influence tissue engineering?

<p>Mechanotransduction refers to how cells convert mechanical stimuli into biochemical signals.</p> Signup and view all the answers

What are bioinks and why are they significant in bioprinting?

<p>Bioinks are soft hydrogels used in bioprinting that can absorb large amounts of water and provide a true 3D environment for cells. They are significant because they resemble the extracellular matrix (ECM) and can support cell suspension and drug delivery.</p> Signup and view all the answers

Name two challenges associated with extrusion-based bioprinting.

<p>Two challenges include the potential sinking of cells during printing and the risk of needle clogging due to high cell density. Additionally, materials might dehydrate or collapse if the bioink lacks structural integrity.</p> Signup and view all the answers

What role does collagen play in tissue biomechanics?

<p>Collagen is the most abundant protein in the body and acts as a fibrous reinforcement within the extracellular matrix, providing structural support. It is crucial for maintaining the mechanical properties and stiffness of tissues.</p> Signup and view all the answers

Describe the importance of tailoring scaffold size and shape in tissue engineering.

<p>Tailoring scaffold size and shape is important as it can enhance tissue attachment and promote regeneration by mimicking the natural environment. It allows for improved cell migration and integration within the scaffold.</p> Signup and view all the answers

What distinguishes biodegradable synthetic polymers from natural polymers in scaffold fabrication?

<p>Biodegradable synthetic polymers are generally easier to manipulate and process compared to natural polymers, which can be challenging to isolate. Synthetic polymers can also be engineered to meet specific mechanical and biological requirements.</p> Signup and view all the answers

Explain what Melt Electrowriting (MEW) is and one of its benefits.

<p>Melt Electrowriting (MEW) is a high-resolution 3D printing technique used to create detailed scaffolds for bone or soft tissues. One of its benefits is that it offers high control over the mechanical properties and microarchitectures of the printed structures.</p> Signup and view all the answers

What is the significance of cell contractility in tissue engineering?

<p>Cell contractility influences how cells interact within the extracellular matrix and respond to mechanical forces. It is significant because proper mechano-sensing can enhance tissue regeneration and integration.</p> Signup and view all the answers

In tissue engineering, what are the implications of using 3D scaffolds?

<p>3D scaffolds in tissue engineering allow for complex tissue structures that can better mimic natural tissue architecture and function. They also facilitate nutrient and waste exchange between cells within the scaffold.</p> Signup and view all the answers

What are two primary types of heart valves in current clinical use, and one characteristic of each?

<p>The two primary types are mechanical valves, which require lifelong anti-coagulation therapy for durability, and bio-prosthetic valves, which often do not require such therapy but have a shorter lifespan. Mechanical valves can last around 20 years, while bio-prosthetic valves last about 5 years in younger patients.</p> Signup and view all the answers

How do scaffolds influence cellular responses in tissue engineering?

<p>Scaffolds influence cellular responses by providing structural support, guiding cell behavior, and delivering biochemical cues. The material type and design of the scaffold significantly affect cell attachment, growth, and differentiation.</p> Signup and view all the answers

What is the primary advantage of matrix-induced autologous chondrocyte implantation (MACI) over traditional cartilage repair methods?

<p>MACI utilizes a patient's own cells and a collagen scaffold for direct implantation, resulting in better integration and quality control of cell density.</p> Signup and view all the answers

Why is cartilage injury often asymptomatic initially?

<p>Cartilage lacks blood supply and nerve endings, so defects often do not produce symptoms until significant damage occurs.</p> Signup and view all the answers

How does the use of fibrin glue enhance the MACI procedure?

<p>Fibrin glue secures the collagen scaffold without the need for sutures, which reduces surgery time and minimizes trauma to the joint.</p> Signup and view all the answers

What role do stem cells play in cellular engineering therapies like MACI?

<p>Stem cells can provide a source of chondrocytes for the repair of damaged cartilage, enhancing the body's regenerative capacity.</p> Signup and view all the answers

What is the significance of developing tissue constructs in the field of cellular engineering?

<p>Tissue constructs are immature but functional matrices that can offer local effects for effective repair and integration in damaged areas.</p> Signup and view all the answers

How does the cost of cartilage injuries impact healthcare in Australia?

<p>Cartilage injuries cost patients around $30 million yearly in Australia due to their high prevalence and challenges in effective treatment.</p> Signup and view all the answers

What are the limits of current treatment options for cartilage damage?

<p>Current treatments mainly manage symptoms and do not effectively restore cartilage, often leading to inferior repair tissue.</p> Signup and view all the answers

In which joints is MACI currently being utilized, and what is its primary method of implantation?

<p>MACI is used for the knee, ankle, shoulder, and hip, primarily utilizing direct chondrocyte seeding on the collagen scaffold during surgery.</p> Signup and view all the answers

What are the main advantages of using MACI for cartilage repair?

<p>MACI is less invasive, offers better quality control in cell density, and can be performed arthroscopically.</p> Signup and view all the answers

What significant clinical outcomes have been observed from MACI within two years post-surgery?

<p>Significant improvements in pain and joint function have been observed within two years.</p> Signup and view all the answers

How does MACI address the complications associated with microfracture techniques?

<p>MACI avoids complications like bone cysts by providing a cell-loaded scaffold that promotes natural repair without bone damage.</p> Signup and view all the answers

What is the purpose of using a collagen membrane in the MACI procedure?

<p>The collagen membrane replaces the periosteal membrane and facilitates the direct integration of chondrocytes.</p> Signup and view all the answers

Which aspects are considered challenges and innovations in current cartilage repair strategies?

<p>Challenges include complications from synthetic materials, while innovations focus on collagen-based scaffolds and stem cell-based therapies.</p> Signup and view all the answers

What is the future goal for joint repair beyond cartilage repair with MACI?

<p>The goal is to repair the entire osteochondral region, including both bone and cartilage.</p> Signup and view all the answers

Why is MACI considered an advancement over traditional autologous chondrocyte implantation (ACI)?

<p>MACI represents a second-generation improvement that addresses some of ACI's limitations by enhancing the quality of repair.</p> Signup and view all the answers

What role do regulatory considerations play in the application of stem cell therapies?

<p>Regulatory frameworks help define appropriate uses for stem cells, ensuring safety and effectiveness in regenerative medicine.</p> Signup and view all the answers

How does the clinical application of MACI in Australasia compare to that in the USA?

<p>Australia is approximately 15 years ahead in developing and adopting MACI compared to the USA.</p> Signup and view all the answers

What are key recommendations for clinicians when employing stem cell therapies?

<p>Clinicians should establish boundaries for stem cell practices and improve patient access to clinical trials.</p> Signup and view all the answers

What triggers the activation of hepatic non-parenchymal cells in liver disease?

<p>The activation of hepatic non-parenchymal cells is triggered by liver disease, which leads to the release of tumor necrosis factor (TNF) and interleukin (IL)-6.</p> Signup and view all the answers

Where do oval cells reside in the liver and what is their primary function?

<p>Oval cells reside in the canal of Herring and primarily function to differentiate into hepatocytes and cholangiocytes.</p> Signup and view all the answers

What effect does transforming growth factor (TGF) have on hepatocyte DNA synthesis?

<p>Transforming growth factor (TGF) inhibits hepatocyte DNA synthesis.</p> Signup and view all the answers

How do hepatic progenitor cells (HPCs) contribute to liver regeneration?

<p>HPCs are bi-potential stem cells that can differentiate into both hepatocytes and cholangiocytes, aiding in liver regeneration.</p> Signup and view all the answers

What are some genetic liver diseases that can be treated using gene therapy?

<p>Examples of genetic liver diseases treated with gene therapy include Hemophilia B, Crigler-Najjar Syndrome, and Wilson Disease.</p> Signup and view all the answers

What role do Kupffer cells play in the liver's immune response?

<p>Kupffer cells are liver resident macrophages that migrate from the blood and are involved in the local immune response.</p> Signup and view all the answers

What is the significance of isolating oval cells from the liver?

<p>Isolating oval cells is significant because they can be cultured to produce both hepatic cells and cholangiocytes for research and therapy.</p> Signup and view all the answers

Describe the contribution of hepatic stellate cells (HSCs) to liver pathology.

<p>Hepatic stellate cells (HSCs) synthesize components of the extracellular matrix, contributing to cirrhosis and fibrosis.</p> Signup and view all the answers

What role do activated hepatic stellate cells (HSCs) play in liver fibrosis?

<p>Activated HSCs transform into myofibroblast-like cells, producing excess collagen and extracellular matrix (ECM), leading to liver fibrosis.</p> Signup and view all the answers

How do mesenchymal stem cells (MSCs) contribute to the treatment of liver disease?

<p>MSCs can modulate immune cell functions and attenuate liver inflammation, thereby reducing hepatocyte injury and promoting healing.</p> Signup and view all the answers

What limitations exist when generating hepatocyte-like cells from pluripotent stem cells?

<p>Limitations include incomplete gene expression, difficulties in scaling up the process, and heterogeneity in cell culture.</p> Signup and view all the answers

What are liver organoids and what potential do they have?

<p>Liver organoids are mini-liver structures derived from various cell types that can spontaneously form small blood vessels and show potential for transplantation.</p> Signup and view all the answers

What is the main challenge associated with using stem cell therapies for treating liver diseases?

<p>The main challenge includes addressing immune rejection and ensuring complete cell differentiation to prevent tumor risks.</p> Signup and view all the answers

What factors contribute to the activation of HSCs in the liver?

<p>HSCs are activated by liver injury or chronic inflammation, which are influenced by cytokines and growth factors.</p> Signup and view all the answers

Why are liver buds considered promising for transplantation?

<p>Liver buds closely resemble natural liver tissue and have exhibited therapeutic potential in animal models for liver disease.</p> Signup and view all the answers

What types of clinical trials have been conducted using MSCs for liver cirrhosis?

<p>As of 2020, there are 29 registered clinical trials specifically focusing on using MSCs for liver cirrhosis treatment.</p> Signup and view all the answers

How do small molecules aid in improving the function of hepatocyte-like cells?

<p>Small molecules can induce rapid proliferation and enhance the differentiation of hepatocyte-like cells derived from stem cells.</p> Signup and view all the answers

What is a significant concern regarding the transplant of cells in regenerative medicine?

<p>A key concern is the possibility of tumorigenicity, where transplanted cells may form tumors instead of integrating effectively.</p> Signup and view all the answers

What is the function of CRISPR/Cas9 in gene therapy?

<p>CRISPR/Cas9 edits faulty genes to treat genetic diseases such as AATD and Wilson's disease.</p> Signup and view all the answers

How are induced pluripotent stem cells (iPSCs) generated?

<p>iPSCs are derived from adult cells that are reprogrammed back into an embryonic-like pluripotent state using defined factors like Oct4 and Sox2.</p> Signup and view all the answers

What is the main challenge associated with liver transplantation?

<p>The main challenge is the organ shortage and the increasing demand for suitable donor livers.</p> Signup and view all the answers

What is the purpose of a Bio-Artificial Liver Device (ELAD)?

<p>The ELAD mimics liver function by filtering toxins, using human liver cells to facilitate appropriate transfer of metabolites.</p> Signup and view all the answers

What are the roles of mesenchymal stem cells (MSCs) in liver disease treatment?

<p>MSCs are used to treat fibrosis and cirrhosis by reducing liver inflammation and modulating immune responses.</p> Signup and view all the answers

What is Non-Alcoholic Steatohepatitis (NASH), and how does it differ from Non-Alcoholic Fatty Liver Disease (NAFLD)?

<p>NASH involves inflammation and liver cell damage alongside fat accumulation, while NAFLD is primarily fat buildup without inflammation.</p> Signup and view all the answers

What are the challenges facing hepatocyte transplantation as a treatment option?

<p>Challenges include immune rejection, poor donor availability, and the need for a significant percentage of liver cells to be replaced.</p> Signup and view all the answers

How do viral vectors contribute to gene therapy?

<p>Viral vectors, especially Adeno-associated virus (AAV), are refined to carry corrected genes into cells for therapeutic purposes.</p> Signup and view all the answers

What is the significance of using patient-specific iPSCs in gene therapy?

<p>Patient-specific iPSCs allow for personalized therapy by being tailored to an individual's genetic makeup.</p> Signup and view all the answers

What metabolic factors contribute to lifestyle-related liver diseases?

<p>Alcohol consumption, obesity, and intravenous drug use are significant lifestyle contributors to metabolic liver diseases.</p> Signup and view all the answers

How does the process of regenerative medicine apply to liver disease treatment?

<p>Regenerative medicine aims to restore normal liver function by engineering or regenerating liver cells and tissues.</p> Signup and view all the answers

What is the role of hepatic stellate cells (HSCs) in liver injury?

<p>Hepatic stellate cells are activated during liver injury, contributing to the development of fibrosis.</p> Signup and view all the answers

What is the therapeutic approach using ex vivo gene therapy for genetic liver diseases?

<p>Ex vivo gene therapy involves altering genes in cells outside the body before returning them for treatment.</p> Signup and view all the answers

What are the potential benefits of using immunotherapy in cancer treatment for liver disease?

<p>Immunotherapy can enhance the body's immune response to combat liver cancers, potentially improving survival rates.</p> Signup and view all the answers

What is the main consequence of fibrosis in affected tissues?

<p>The main consequence of fibrosis is the loss of normal tissue function due to excessive scar tissue formation.</p> Signup and view all the answers

How does the intrinsic cellular capacity influence tissue repair?

<p>Intrinsic cellular capacity influences tissue repair by determining how well cells can proliferate and regenerate damaged structures.</p> Signup and view all the answers

What role does the location of injury play in the healing process?

<p>The location of injury is crucial as it affects the intrinsic capacity to heal and the type of tissue involved.</p> Signup and view all the answers

What factors can delay the healing process in tissues?

<p>Factors such as infection, poor perfusion, and nutritional status can delay the healing process.</p> Signup and view all the answers

Describe how stable cells differ from labile and permanent cells regarding injury response.

<p>Stable cells divide when necessary to repair tissue, unlike labile cells that continuously divide, and permanent cells that cannot regenerate.</p> Signup and view all the answers

What is the significance of the excessive scar tissue in the context of myocardial infarction?

<p>Excessive scar tissue formation in myocardial infarction reduces heart contractile function and hampers overall cardiac efficiency.</p> Signup and view all the answers

How do chronic injuries affect the tissue repair process?

<p>Chronic injuries lead to continuous inflammation and eventual fibrosis, impairing the normal healing response.</p> Signup and view all the answers

What potential consequences arise from a prolonged injurious agent's exposure on tissue repair?

<p>Prolonged exposure can lead to significant damage and may result in chronic fibrosis, hampering the healing process.</p> Signup and view all the answers

What role do fibroblasts play in the development of fibrosis?

<p>Fibroblasts proliferate and increase collagen production in fibrosis.</p> Signup and view all the answers

Which signaling pathway is known to increase fibrosis in mouse models?

<p>The STAT3 signaling pathway is known to increase fibrosis.</p> Signup and view all the answers

What are some models used to investigate lung fibrosis?

<p>Models include bleomycin-induced lung fibrosis in mice and human cell cultures.</p> Signup and view all the answers

How are small molecule inhibitors relevant to fibrosis research?

<p>Small molecule inhibitors targeting STAT signaling, like AZD1480, are being developed to reduce fibrosis.</p> Signup and view all the answers

What autoimmune-like features are present in idiopathic pulmonary fibrosis (IPF)?

<p>IPF is characterized by high levels of circulating autoantibodies and increased B cells.</p> Signup and view all the answers

What is the significance of the 'scar in a jar' model in fibrosis research?

<p>The 'scar in a jar' model helps assess collagen deposition and macromolecular crowding.</p> Signup and view all the answers

What effect does the treatment targeting plasma cells have on lung fibrosis?

<p>Targeting antibody-producing plasma cells may reduce lung fibrosis.</p> Signup and view all the answers

What are the challenges in finding effective treatments for idiopathic pulmonary fibrosis?

<p>Current treatments slow disease progression but do not cure fibrosis and have side effects.</p> Signup and view all the answers

How do immune cells contribute to the fibrosis process?

<p>Immune cells, particularly B cells, play a critical role in the inflammatory response associated with fibrosis.</p> Signup and view all the answers

What method is used to quantify fibrosis in mouse lung tissue?

<p>Ex Vivo μCT imaging is used to quantify fibrosis in mouse lung tissue.</p> Signup and view all the answers

How do systemic factors like diabetes influence wound healing?

<p>Diabetes can compromise wound healing by impairing vascular function and reducing collagen synthesis.</p> Signup and view all the answers

What impact do steroids have on wound healing and scar formation?

<p>Steroids can reduce collagen production, leading to weaker scar tissue due to their anti-inflammatory effects.</p> Signup and view all the answers

What role do fibroblasts play in the formation of scar tissue?

<p>Fibroblasts are the major source of extracellular matrix components, essential for collagen deposition in scar tissue.</p> Signup and view all the answers

What is described as a pathological response to injury characterized by excessive collagen deposition?

<p>Fibrosis is the pathological response involving excessive deposition of collagen and other matrix components.</p> Signup and view all the answers

How does the extracellular matrix (ECM) influence cellular behavior during tissue repair?

<p>The ECM provides a scaffold that controls cell proliferation, migration, differentiation, and apoptosis.</p> Signup and view all the answers

What are the clinical implications of excessive collagen deposition in conditions like pulmonary fibrosis?

<p>Excessive collagen deposition in pulmonary fibrosis leads to loss of lung function and is usually fatal.</p> Signup and view all the answers

What sequential processes occur during wound healing?

<p>Wound healing includes inflammation, cell proliferation, ECM synthesis, remodeling, and scar formation.</p> Signup and view all the answers

How do foreign bodies affect the wound healing process?

<p>Foreign bodies can perpetuate chronic inflammation, which interferes with normal healing and can contribute to fibrosis.</p> Signup and view all the answers

What is the primary function of growth factors in tissue repair?

<p>Growth factors stimulate cell populations to enter the cell cycle, promoting tissue regeneration and repair.</p> Signup and view all the answers

What is the significance of collagen synthesis starting 3-5 days after injury?

<p>This timing is crucial for ensuring a scaffold forms as part of the healing process, leading to effective scar tissue formation.</p> Signup and view all the answers

Explain how mechanical stress affects wound healing.

<p>Mechanical stress on a wound can impede healing by inducing tension that disrupts collagen alignment and ECM formation.</p> Signup and view all the answers

What role do autocrine and paracrine signaling play in tissue repair?

<p>Autocrine signaling influences cells to respond to their own factors, while paracrine signaling allows nearby cells to communicate and coordinate healing.</p> Signup and view all the answers

What characteristics define idiopathic pulmonary fibrosis (IPF)?

<p>IPF is characterized by progressive collagen deposition, abnormal tissue remodeling, and significant loss of lung function.</p> Signup and view all the answers

How does the regulation of healing depend on signaling factors?

<p>Healing regulation depends on a balance of stimulatory and inhibitory factors released in response to injury.</p> Signup and view all the answers

What distinguishes the interstitial matrix from the basement membrane in ECM?

<p>The interstitial matrix comprises various connective tissues, while the basement membrane is a specialized structure produced by epithelial and mesenchymal cells.</p> Signup and view all the answers

What is the primary function of killer T cells in the immune system?

<p>Killer T cells hunt and destroy infected or cancerous cells.</p> Signup and view all the answers

Define 'tolerance' in the context of T cell immunity.

<p>Tolerance is the mechanism that prevents self-reactive T cells from causing autoimmunity.</p> Signup and view all the answers

What are the three types of dendritic cells mentioned?

<p>The three types are circulating, lymphoid-resident, and migratory dendritic cells.</p> Signup and view all the answers

How do dendritic cells contribute to cancer immunotherapy?

<p>Dendritic cells can be targeted to enhance T cell responses against tumors once their antigen presentation is understood.</p> Signup and view all the answers

What is cross-presentation in relation to dendritic cells?

<p>Cross-presentation is the process whereby dendritic cells present antigens to CD8+ T cells.</p> Signup and view all the answers

What is the significance of stage 0 in melanoma development?

<p>Stage 0 indicates that melanoma is confined to the epidermis.</p> Signup and view all the answers

Explain the importance of dendritic cells in maintaining immune homeostasis.

<p>Dendritic cells help orchestrate T cell immunity and ensure tolerance to self and harmless antigens.</p> Signup and view all the answers

What is an example of a study involving dendritic cells in skin cancer?

<p>Studies show that both epidermal-derived Langerhans cells and dermal-derived DCs are involved in the immune response in melanoma.</p> Signup and view all the answers

What role do XCR1+ dendritic cells play in tumor immunity?

<p>XCR1+ dendritic cells specialize in cross-presenting tumor antigens, promoting CD8+ T cell responses.</p> Signup and view all the answers

How do tissue-resident memory T cells (TRM) contribute to controlling melanoma?

<p>TRM cells reside in tissues and maintain immune equilibrium, preventing melanoma relapse.</p> Signup and view all the answers

What is the significance of the adoptive cell therapy approach?

<p>Adoptive cell therapy transfers activated CD8+ T cells to eliminate tumors, aiming to improve treatment efficacy.</p> Signup and view all the answers

Explain the importance of Flt3L in dendritic cell biology.

<p>Flt3L expands XCR1+ dendritic cells, enhancing their ability to present antigens and activate CD8+ T cells.</p> Signup and view all the answers

What are the three phases of tumor interaction with the immune system?

<p>The three phases are elimination, equilibrium, and escape.</p> Signup and view all the answers

What are the implications of tumor heterogeneity on cancer treatment?

<p>Tumor heterogeneity complicates treatment by introducing various cell types that may respond differently to therapies.</p> Signup and view all the answers

What is the epicutaneous model of melanoma used for?

<p>The epicutaneous model is used to study melanoma progression and immune responses in mice.</p> Signup and view all the answers

How does the concept of immune equilibrium relate to melanoma?

<p>Immune equilibrium refers to a state where tumor growth is controlled, preventing both progression and immune evasion.</p> Signup and view all the answers

What is the role of IL-10 and TGF-β in cytokine therapy for myoblasts?

<p>IL-10 and TGF-β promote Treg activity and suppress the immune response, creating a favorable environment for myoblast survival.</p> Signup and view all the answers

How can bacterial vectors like pMP6a be used in cytokine therapy?

<p>The pMP6a vector can be expanded in bacteria and is designed to express cytokines in eukaryotic cells using a cytomegalovirus promoter.</p> Signup and view all the answers

Explain the process of in vivo electroporation in muscle tissue.

<p>In vivo electroporation involves injecting a plasmid into muscle tissue and applying an electrical current to increase membrane permeability, allowing plasmid uptake.</p> Signup and view all the answers

What is the significance of using ampicillin resistance in bacterial selection?

<p>Ampicillin resistance allows researchers to selectively grow bacteria that have successfully taken up the plasmid by growing them in the presence of the antibiotic.</p> Signup and view all the answers

Why is long-term gene expression critical in gene therapy?

<p>Long-term gene expression is essential to ensure sustained therapeutic effects and address the underlying causes of genetic diseases.</p> Signup and view all the answers

What challenges remain in the field of gene therapy according to the key takeaways?

<p>Challenges include selecting the right delivery system, managing immune responses, and achieving long-term gene expression.</p> Signup and view all the answers

Describe one advantage of non-viral methods of gene therapy.

<p>Non-viral methods, such as electroporation, generally have a better safety profile compared to viral vectors due to reduced risk of insertional mutagenesis.</p> Signup and view all the answers

How do cytokine levels relate to immune response in the context of muscle regeneration?

<p>Increased levels of cytokines like IL-10 and TGF-β help modulate the immune response, potentially leading to improved myoblast survival and muscle regeneration.</p> Signup and view all the answers

What is gene therapy and what kind of diseases can it potentially treat?

<p>Gene therapy aims to correct or replace defective genes to treat diseases such as Duchenne Muscular Dystrophy, Severe Combined Immunodeficiency, and Sickle Cell Disease.</p> Signup and view all the answers

Describe the process of normal gene insertion in gene therapy.

<p>In normal gene insertion, a healthy copy of the gene is introduced into a nonspecific location in the genome to replace a nonfunctional gene.</p> Signup and view all the answers

How does homologous recombination facilitate gene therapy?

<p>Homologous recombination allows for an abnormal gene to be swapped out for a normal gene by utilizing the natural recombination process in cells.</p> Signup and view all the answers

What role do viral vectors play in gene therapy?

<p>Viral vectors are used to deliver therapeutic genes into target cells because they can effectively insert their genetic material into host cells.</p> Signup and view all the answers

Explain how gene repair functions in the context of gene therapy.

<p>Gene repair works by inducing selective mutations that correct the defective gene, such as using techniques like CRISPR to restore its normal function.</p> Signup and view all the answers

What method is used to test the integration and expression of transfected genes in gene therapy?

<p>Transfected genes are tested for integration and expression through assays performed on the bone marrow cells used in therapies like X-SCID treatment.</p> Signup and view all the answers

What is gene regulation alteration in gene therapy?

<p>Gene regulation alteration involves changing how much a gene is expressed, either by turning it on or off or adjusting its expression level to manage disease.</p> Signup and view all the answers

What type of virus is commonly used in gene therapy and what is its characteristic?

<p>Adenoviruses are often used in gene therapy and are characterized by their double-stranded DNA genomes.</p> Signup and view all the answers

What is the main advantage of adeno-associated viruses (AAVs) in gene therapy?

<p>AAVs can integrate their genetic material at a specific site on chromosome 19, providing stable gene expression.</p> Signup and view all the answers

Explain how retroviruses contribute to gene therapy.

<p>Retroviruses can convert their RNA genome into DNA and integrate it into the host's genome, allowing for long-term gene expression.</p> Signup and view all the answers

What challenge do immune responses pose in myoblast transfer therapy for Duchenne Muscular Dystrophy (DMD)?

<p>The immune system often attacks and destroys transplanted donor cells, leading to treatment ineffectiveness.</p> Signup and view all the answers

How does the technique of exon skipping work in gene therapy for DMD?

<p>Exon skipping uses modified RNA molecules to bypass defective exons in the dystrophin gene, allowing functional protein production.</p> Signup and view all the answers

What are the primary sources of genes delivered via non-viral methods?

<p>Non-viral methods can deliver genes through direct injection, electroporation, and liposomal delivery systems.</p> Signup and view all the answers

Describe what DMD is and its primary cause.

<p>Duchenne Muscular Dystrophy is a severe muscle-wasting disease caused by mutations in the dystrophin gene.</p> Signup and view all the answers

What role do regulatory T cells (Tregs) play in gene therapy?

<p>Tregs help regulate the immune response, potentially reducing the rejection of transplanted cells.</p> Signup and view all the answers

Why are mini dystrophin genes utilized in gene therapy for DMD?

<p>Mini dystrophin genes are smaller and can be delivered effectively, while still providing key functional capabilities.</p> Signup and view all the answers

Explain the significance of the dystrophin protein in muscle cells.

<p>The dystrophin protein links muscle cell cytoskeletons to the surrounding matrix, providing stability during contraction.</p> Signup and view all the answers

How do non-viral delivery systems compare to viral ones in gene therapy?

<p>Non-viral delivery systems are less efficient but reduce the risks associated with viral vectors, such as immune responses.</p> Signup and view all the answers

What is unique about herpes simplex viruses in the context of gene therapy?

<p>Herpes simplex viruses can infect neurons and evade the immune system, making them suitable for targeting nervous system disorders.</p> Signup and view all the answers

What is the result of a nonsense mutation in the dystrophin gene?

<p>A nonsense mutation leads to premature termination of protein synthesis, resulting in a non-functional dystrophin protein.</p> Signup and view all the answers

Discuss a limitation of the direct injection method for gene delivery.

<p>Direct injection is often inefficient because very little DNA successfully enters the target cells.</p> Signup and view all the answers

What is gene therapy and how does it differ from traditional treatment methods?

<p>Gene therapy is an experimental technique that uses genes to treat or prevent disease, as opposed to traditional methods like drugs or surgery.</p> Signup and view all the answers

Why are viral vectors used in gene therapy, and what is a common example?

<p>Viral vectors are used because they can effectively deliver genes into cells while being modified to be non-pathogenic; a common example is Adeno-Associated Virus (AAV).</p> Signup and view all the answers

List two reasons why the eye is considered an ideal target for gene therapy.

<p>The eye has immune privilege, leading to reduced rejection rates, and its small size allows for the administration of smaller treatment doses.</p> Signup and view all the answers

What is the first key step in developing a gene therapy strategy?

<p>Understanding the biology of the disorder, including affected cells and gene function, is the first key step in developing a gene therapy strategy.</p> Signup and view all the answers

What role do biological models play in gene therapy development?

<p>Biological models, such as animal models or human-derived cells, are used to assess the effectiveness and safety of the gene therapy before clinical trials.</p> Signup and view all the answers

How do the immune properties of the eye benefit ocular gene therapy?

<p>The immune privilege of the eye lowers the risk of immune rejection, making it easier for gene therapy to be accepted and function effectively.</p> Signup and view all the answers

What is the significance of selecting the correct vector in gene therapy?

<p>Selecting the correct vector is vital for ensuring effective delivery of the therapeutic gene to the appropriate cells and maximizing treatment efficacy.</p> Signup and view all the answers

What are the primary focuses during the initial clinical trials of gene therapy?

<p>Initial clinical trials primarily focus on evaluating safety aspects before progressing to therapeutic efficacy assessments in later trials.</p> Signup and view all the answers

What genetic mechanism leads to anticipation and severity increase in certain dominant disorders like Huntington's disease?

<p>Repeat expansion of unstable noncoding regions causes anticipation and greater severity with each generation.</p> Signup and view all the answers

How does gene replacement therapy differ from molecular therapies in treating genetic disorders?

<p>Gene replacement therapy replaces faulty genes entirely, while molecular therapies target gene expression at various stages.</p> Signup and view all the answers

What is the role of Antisense Oligonucleotides (AOs) in treating genetic diseases?

<p>AOs can alter mRNA splicing, block translation, or induce RNA degradation to offer precise treatment options.</p> Signup and view all the answers

What challenges do rare diseases present in terms of treatment availability?

<p>Over 6000 rare diseases affect millions, with 95% having no treatment and a long diagnostic process.</p> Signup and view all the answers

What is the significance of dystrophin in muscular dystrophies such as Duchenne Muscular Dystrophy (DMD)?

<p>Dystrophin acts like a protective mesh around muscle fibers, and its absence leads to muscle weakness and damage.</p> Signup and view all the answers

How do frame-shifting mutations in the dystrophin gene contribute to DMD?

<p>Frame-shifting mutations result in truncated dystrophin proteins, which fail to provide necessary muscle support.</p> Signup and view all the answers

What is the role of SMN1 gene in Spinal Muscular Atrophy (SMA)?

<p>The SMN1 gene provides survival signals to motor neurons, and its deletion leads to motor neuron death.</p> Signup and view all the answers

In the context of muscular dystrophies, how does the presence of some dystrophin impact disease severity?

<p>Some dystrophin is better than none; carriers of dystrophin with variable quality can have milder symptoms.</p> Signup and view all the answers

What therapeutic approach was approved by the FDA for treating DMD in 2016, and how does it work?

<p>Exondys51, a Morpholino nucleic acid analogue, targets dystrophin exon 51 to restore the reading frame during splicing.</p> Signup and view all the answers

How do infections and organ failure relate to complications in muscle degenerative disorders?

<p>Muscle degeneration can lead to complications like impacted bowel and respiratory failure, resulting in organ failure.</p> Signup and view all the answers

What demographic changes are influencing the prevalence of rare diseases across different regions of the world?

<p>Migration patterns have led rare diseases to become a concern in both third-world and first-world countries.</p> Signup and view all the answers

What is the significance of the creatine kinase levels in assessing muscle damage in dystrophinopathies?

<p>Increased creatine kinase levels in blood indicate muscle fiber damage due to the lack of protective dystrophin.</p> Signup and view all the answers

What role do satellite cells play in muscle repair following damage in muscular dystrophies?

<p>Satellite cells proliferate to fuse and form new muscle fibers after muscle damage, aided by growth factors.</p> Signup and view all the answers

What outcomes are associated with the use of gene therapy in treating Retinitis Pigmentosa?

<p>Gene therapy aims to downregulate harmful transcripts to help preserve vision in this degenerative eye disease.</p> Signup and view all the answers

What is the primary advantage of subretinal injection compared to intravitreal injection in gene therapy?

<p>Subretinal injection delivers the gene therapy directly under the retina, which is more specific for targeting photoreceptor cells.</p> Signup and view all the answers

Why is AAV considered effective for gene delivery in both dividing and non-dividing cells?

<p>AAV is replication-deficient and can integrate into the host cell's genome, making it suitable for a variety of cell types.</p> Signup and view all the answers

What are the potential risks associated with the creation of a local bleb during subretinal injection?

<p>If the bleb does not reattach after the injection, it can lead to tissue loss.</p> Signup and view all the answers

Identify one challenge that gene therapy faces regarding AAV's genome packaging capacity.

<p>AAV can only carry small genes, limiting the size of therapeutic genes that can be delivered.</p> Signup and view all the answers

How does pre-existing immunity affect the effectiveness of AAV-based gene therapy?

<p>Pre-existing antibodies to AAV can neutralize the viral vector before it delivers the therapeutic gene.</p> Signup and view all the answers

What role does alternative splicing play in gene expression?

<p>Alternative splicing allows a single gene to produce multiple protein isoforms, increasing protein diversity.</p> Signup and view all the answers

Which specific cells are effectively targeted by AAV2, AAV8, and AAV9 in the retina?

<p>These serotypes target photoreceptors and ganglion cells within the retina.</p> Signup and view all the answers

What is the significance of RPE65 gene therapy for Leber Congenital Amaurosis?

<p>It involves replacing a defective gene with a healthy copy to restore vision.</p> Signup and view all the answers

In the context of Age-Related Macular Degeneration (AMD), what therapeutic approach is being developed using AAV vectors?

<p>AAV vectors are being used to deliver genes encoding soluble VEGF receptor 1 (sFlt-1) to inhibit abnormal blood vessel growth.</p> Signup and view all the answers

What problems can arise from the delivery method chosen for gene therapy, such as subretinal vs. intravitreal injection?

<p>The delivery method can affect how effectively the therapy reaches its target cells, influencing treatment outcomes.</p> Signup and view all the answers

What recent advancements are being explored in ongoing trials for ocular conditions using AAV-based therapies?

<p>Trials are investigating different AAV serotypes and injection methods for conditions like wet AMD.</p> Signup and view all the answers

Describe one way splicing disruptions can contribute to disease development.

<p>Disruptions can lead to the production of non-functional or deleterious protein isoforms, causing various diseases.</p> Signup and view all the answers

What can be inferred about the role of AAV's low immunogenicity in gene therapy?

<p>Low immunogenicity reduces the immune response against AAV vectors, enhancing the likelihood of successful gene delivery.</p> Signup and view all the answers

What is the impact of mutations on gene function in the context of missense and nonsense mutations?

<p>Missense mutations can alter protein structure and function, while nonsense mutations create truncated, non-functional proteins.</p> Signup and view all the answers

What therapeutic target does gene therapy aim to influence in the case of genetic defects?

<p>Gene therapy aims to correct or replace defective genes that contribute to various inherited disorders.</p> Signup and view all the answers

What does CRISPR stand for and what is its primary function in bacteria?

<p>CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats, and its primary function is to provide a bacterial immune system by allowing bacteria to 'remember' and target invading viruses.</p> Signup and view all the answers

What role does the PAM sequence play in the CRISPR-Cas9 system?

<p>The PAM (Protospacer Adjacent Motif) sequence is essential for Cas9 to differentiate between self and non-self DNA, enabling precise targeting and cleavage of foreign DNA.</p> Signup and view all the answers

Describe the function of guide RNA (gRNA) in the CRISPR-Cas9 system.

<p>Guide RNA (gRNA) directs the Cas9 protein to the specific target DNA sequence, combining crRNA, which is sequence-specific, and tracrRNA, which acts as a scaffold.</p> Signup and view all the answers

What are the differences in delivery methods for CRISPR components, and why are they significant?

<p>CRISPR components can be delivered via plasmids, ribonucleoprotein (RNP) complexes, or mRNA; RNP complexes are preferred for clinical applications due to their rapid turnover and reduced risk of off-target effects.</p> Signup and view all the answers

Explain how the CRISPR system allows bacteria to defend against viral infections.

<p>The CRISPR system enables bacteria to capture snippets of viral DNA, which they store as spacers, and uses this information to recognize and cut the DNA of future viral invaders using Cas9.</p> Signup and view all the answers

What is the significance of the Cas9 protein in gene editing?

<p>Cas9 is the enzyme that induces double-stranded breaks in DNA, which is a critical step for gene editing as it allows the DNA to be modified at specific locations.</p> Signup and view all the answers

Identify one limitation of CRISPR technology in clinical applications.

<p>One limitation of CRISPR technology is the potential for off-target effects, where the system may inadvertently modify unintended parts of the genome.</p> Signup and view all the answers

What role do spacers play in the CRISPR system?

<p>Spacers are sequences derived from viral and plasmid DNA that allow bacteria to remember past infections, providing a template for recognizing and targeting the same or similar invaders in the future.</p> Signup and view all the answers

What are the two main pathways for repairing DNA damage in eukaryotic cells, and how do they differ?

<p>The two main pathways are Non-Homologous End Joining (NHEJ), which is error-prone and can lead to insertions or deletions, and Homology Directed Repair (HDR), which is precise and uses a template for repair.</p> Signup and view all the answers

How does the timing of DNA repair processes differ between NHEJ and HDR?

<p>NHEJ operates throughout the cell cycle, while HDR predominantly occurs during the S/G2 phases.</p> Signup and view all the answers

What is one advantage and disadvantage of using plasmids for CRISPR components delivery?

<p>An advantage is their longer persistence in cells; a disadvantage is the potential for off-target effects.</p> Signup and view all the answers

What are Ribonucleoprotein Complexes (RNPs), and how do they differ from plasmids in CRISPR applications?

<p>RNPs provide immediate action and have less persistence compared to plasmids, making them preferred for clinical applications.</p> Signup and view all the answers

What role does dCas9 play in gene manipulation?

<p>dCas9 is a catalytically inactive version of Cas9 that can be fused with effectors to activate or repress target genes without causing DNA cleavage.</p> Signup and view all the answers

How can CRISPR be utilized to study the function of new genes?

<p>CRISPR can knock out genes, model disease-causing mutations, and create gene knock-ins to investigate genetic functions.</p> Signup and view all the answers

What is the main challenge associated with editing high turnover rate cells in vivo?

<p>The main challenge is that changes made to the cells may be lost over time due to constant cell replacement.</p> Signup and view all the answers

Describe a therapeutic potential of CRISPR for monogenic diseases.

<p>CRISPR can correct mutations in disease-causing genes, such as those involved in cystic fibrosis, providing a permanent cure.</p> Signup and view all the answers

What is the significance of using iPSCs in CRISPR-based therapies?

<p>iPSCs allow for the correction of patient-derived cells, which can then be differentiated and transplanted back to patients.</p> Signup and view all the answers

What common mutation causes cystic fibrosis, and what impact does it have?

<p>The most common mutation is a 3 bp deletion (ΔF508) in the CFTR gene, which impairs protein folding and transport, leading to severe symptoms.</p> Signup and view all the answers

Identify one method that can improve the specificity of nanoparticle delivery in CRISPR applications.

<p>Using peptide conjugates can enhance the specificity of nanoparticle delivery systems.</p> Signup and view all the answers

What is a primary advantage of using nanoparticle delivery systems for CRISPR?

<p>Nanoparticles can reduce Cas9 recognition and clearance by immune cells, enhancing the effectiveness of gene editing.</p> Signup and view all the answers

What ethical considerations arise in the context of CRISPR technology?

<p>Ethical considerations include potential off-target effects, implications of germline editing, and regulatory issues surrounding genetic modifications.</p> Signup and view all the answers

What complicates gene therapy for most common diseases?

<p>Most common diseases are caused by multigene disorders, complicating therapy targeting a single gene mutation.</p> Signup and view all the answers

What is a major challenge regarding the efficacy of gene therapy in non-stem cells?

<p>In non-stem cells, gene therapy often results in short-lived corrections or temporary results.</p> Signup and view all the answers

How can gene therapy lead to unwanted effects in the genome?

<p>Gene editing in therapy may cause off-target effects, leading to unintended mutations and genomic instability.</p> Signup and view all the answers

What issues are associated with the use of vectors in gene therapy?

<p>Challenges include effective delivery of genes into somatic cells and possible immune responses from vector types like adenoviruses.</p> Signup and view all the answers

What are the implications of immune responses in repeated gene therapy treatments?

<p>Gene therapy can provoke immune reactions, which may limit the viability of repeated treatments.</p> Signup and view all the answers

What is the primary function of the Cas9 enzyme in the CRISPR system?

<p>The Cas9 enzyme cuts DNA at specific locations when guided by gRNA.</p> Signup and view all the answers

What role do PAM sequences play in the CRISPR-Cas9 system?

<p>PAM sequences are required for Cas9 to distinguish between self and non-self DNA.</p> Signup and view all the answers

What are the two main pathways for gene editing using CRISPR-Cas9?

<p>The two main pathways are Non-Homologous End Joining (NHEJ) and Homology Directed Repair (HDR).</p> Signup and view all the answers

How do base editors improve the CRISPR technology?

<p>Base editors modify DNA without making cuts, which reduces the risk of errors during editing.</p> Signup and view all the answers

What is one therapeutic example where CRISPR-Cas9 has potential benefits?

<p>CRISPR-Cas9 has potential benefits for treating Cystic Fibrosis by correcting the ΔF508 mutation.</p> Signup and view all the answers

What are some limitations of CRISPR technology in clinical applications?

<p>Limitations include delivery to non-dividing cells, immune reactions, and high costs.</p> Signup and view all the answers

What is the primary source of spacers in the CRISPR system?

<p>The spacers in the CRISPR system are derived from nucleic acids of viruses and plasmids.</p> Signup and view all the answers

What distinguishes the Type I and II systems in CRISPR?

<p>Type I and II systems rely on the presence of a PAM sequence for effective DNA targeting.</p> Signup and view all the answers

What are the two main repair pathways used by eukaryotic cells after DNA cleavage induced by CRISPR?

<p>Non-Homologous End Joining (NHEJ) and Homology Directed Repair (HDR).</p> Signup and view all the answers

What is the significance of the protospacer adjacent motif (PAM) in CRISPR technology?

<p>PAM is essential for Cas9 to recognize and bind to the target DNA sequence before inducing cleavage.</p> Signup and view all the answers

How does the use of dead Cas9 (dCas9) differ from active Cas9 in CRISPR applications?

<p>dCas9 lacks cleavage activity and is used for gene activation or repression without cutting DNA.</p> Signup and view all the answers

What are some common delivery methods for CRISPR components to cells?

<p>Adeno-associated virus (AAV), microinjection, electroporation, and lipid nanoparticles.</p> Signup and view all the answers

In CRISPR therapy, what advantage does using ribonucleoprotein (RNP) complexes have over plasmids?

<p>RNP complexes have a rapid turnover, reducing off-target effects compared to long-lived plasmids.</p> Signup and view all the answers

Why are induced pluripotent stem cells (iPSCs) considered valuable for gene therapy?

<p>iPSCs can differentiate into nearly all cell types and have a high self-renewal rate.</p> Signup and view all the answers

What outcomes can CRISPR be used to achieve in gene manipulation?

<p>CRISPR can achieve DNA cleavage and repair, leading to gene knockout or precise edits.</p> Signup and view all the answers

What challenges are associated with editing cells in vivo compared to in vitro?

<p>Editing cells in vivo is often harder due to limited uptake and the potential loss of edits over time.</p> Signup and view all the answers

How does the effectiveness of Non-Homologous End Joining (NHEJ) compare to Homology Directed Repair (HDR)?

<p>NHEJ is more efficient, with about 75% success, while HDR has only about 25% efficiency.</p> Signup and view all the answers

What role do nanoparticle deliveries, such as CRISPR Gold, play in CRISPR applications?

<p>Nanoparticle deliveries enhance uptake of CRISPR components into cells.</p> Signup and view all the answers

What mutation causes Hemophilia B, and what main factor is affected in the blood coagulation cascade?

<p>Mutations in the coagulation factor IX (FIX) gene cause Hemophilia B, affecting the ability to form blood clots.</p> Signup and view all the answers

What type of viral vector showed promise for long-term phenotypic correction of Hemophilia B in mice?

<p>Adenoviral vectors demonstrated long-term phenotypic correction of Hemophilia B in mouse models.</p> Signup and view all the answers

What are the limitations associated with current CRISPR-based gene editing therapies?

<p>Limitations include delivery efficiency, off-target effects, and potential immune responses.</p> Signup and view all the answers

What is the primary therapeutic strategy currently used to manage HIV/AIDS?

<p>The main therapeutic strategy for HIV/AIDS is highly active antiretroviral therapy (HAART).</p> Signup and view all the answers

How did the first CRISPR attempt to cure HIV infection, published in September 2019, function?

<p>It involved electroporation of CRISPR into hematopoietic stem cells to disable the CCR5 co-receptor.</p> Signup and view all the answers

What challenge remains after stopping HAART in HIV patients?

<p>HIV symptoms typically return within weeks after halting HAART due to latent viral reservoirs.</p> Signup and view all the answers

What is the significance of using AAV vectors in gene therapy for Hemophilia B?

<p>AAV vectors enable persistent expression of FIX after administration.</p> Signup and view all the answers

What type of genetic editing technology was first applied to prevent HIV-1 infection in 2013?

<p>CRISPR/Cas9 technology was applied to disrupt latent HIV-1 provirus.</p> Signup and view all the answers

Why is the delivery method a key limitation in CRISPR gene editing?

<p>Delivery methods can vary in their efficiency and may provoke immune responses.</p> Signup and view all the answers

What evidence supports the safety and feasibility of CRISPR technology observed in clinical trials?

<p>The intended target was edited with no off-target effects, and modified cells persisted for over 19 months.</p> Signup and view all the answers

What ethical concerns are associated with CRISPR technology?

<p>Concerns include eugenics, regulation, equitable access, and the implications of embryo modification.</p> Signup and view all the answers

What was identified as a significant barrier to the widespread use of CRISPR therapies?

<p>The high cost of current gene editing therapies, approximately $1 million per patient, is a major barrier.</p> Signup and view all the answers

What role does the monogenic nature of Hemophilia B play in gene therapy research?

<p>The monogenic nature allows for targeted gene therapy approaches to potentially correct the disorder.</p> Signup and view all the answers

What is the primary genetic cause of Cystic Fibrosis (CF)?

<p>Mutations in the CFTR gene, particularly the ΔF508 deletion, cause Cystic Fibrosis.</p> Signup and view all the answers

What major challenge exists in the gene therapy for Cystic Fibrosis?

<p>The difficulty in transducing basal cells, which are necessary for long-term functional restoration of airway epithelium, is a major challenge.</p> Signup and view all the answers

What genetic alteration is responsible for Sickle Cell Disease (SCD)?

<p>Sickle Cell Disease is caused by a specific point mutation in the HBB gene that encodes the beta chain of hemoglobin.</p> Signup and view all the answers

What is the role of BCL11A in treating Sickle Cell Disease?

<p>BCL11A regulates the switch from fetal to adult hemoglobin; targeting its enhancer can increase fetal hemoglobin levels.</p> Signup and view all the answers

What notable achievement was reached with Casgevy, a CRISPR-based therapy?

<p>Casgevy was the first approved CRISPR-based therapy and has shown significant results in reducing transfusion dependency in patients.</p> Signup and view all the answers

How does increasing fetal hemoglobin (HbF) levels affect patients with SCD or TDT?

<p>Increasing HbF levels helps in reducing sickling of red blood cells and alleviating symptoms of both SCD and transfusion-dependent beta-thalassemia.</p> Signup and view all the answers

What is Duchenne Muscular Dystrophy (DMD) primarily caused by?

<p>DMD is caused by loss-of-function mutations in the dystrophin gene located on the X chromosome.</p> Signup and view all the answers

What innovative technique has been used to correct the dystrophin gene in DMD patients?

<p>Techniques such as TALEN and CRISPR-Cas9 have been employed to achieve precise correction of the dystrophin gene.</p> Signup and view all the answers

What is a significant benefit of gene therapies like those developed for CF or SCD?

<p>Gene therapies can potentially provide long-lasting cures or significant improvements in quality of life for genetic disorders.</p> Signup and view all the answers

What therapeutic strategy has been highlighted for ameliorating symptoms of Sickle Cell Disease?

<p>Enhancer targeting to reactivate fetal hemoglobin production is a key therapeutic strategy for Sickle Cell Disease.</p> Signup and view all the answers

What was the patient response in terms of transfusion independence after the Casgevy treatment?

<p>25 out of 27 individuals were no longer transfusion dependent following Casgevy treatment.</p> Signup and view all the answers

What kind of mutations lead to ineffective red blood cell development in TDT?

<p>Point mutations in the HBB gene lead to an imbalance in alpha and beta globins, causing ineffective RBC development.</p> Signup and view all the answers

What is 'hereditary persistence of fetal hemoglobin' (HPFH) and its significance?

<p>HPFH is a rare condition where individuals continue to produce high levels of fetal hemoglobin throughout life, protecting them from SCD.</p> Signup and view all the answers

How does CRISPR-mediated gene editing impact patients with SCD or TDT?

<p>CRISPR-mediated gene editing can enhance the levels of fetal hemoglobin in patients, thus managing their condition more effectively.</p> Signup and view all the answers

What are the main components of allorecognition during transplant rejection?

<p>Allorecognition involves T cells and antibodies (B cells and plasma cells) responding to transplanted HLA molecules.</p> Signup and view all the answers

What is the difference between homologous and heterologous transplants?

<p>Homologous transplants involve individuals of the same species, while heterologous transplants are between different species.</p> Signup and view all the answers

Which types of cells primarily express HLA class II molecules?

<p>HLA class II molecules are primarily expressed by antigen-presenting cells (APCs) such as dendritic cells, macrophages, and B cells.</p> Signup and view all the answers

Why is HLA matching important in transplantation?

<p>HLA matching is crucial to increase compatibility between donors and recipients, reducing the risk of transplant rejection.</p> Signup and view all the answers

What role do CD8 T cells play in the immune response during acute rejection of a transplant?

<p>CD8 T cells recognize HLA class I-peptide complexes on infected or transplanted cells, triggering cytotoxic effector mechanisms.</p> Signup and view all the answers

How does HLA diversity affect transplantation success in different populations?

<p>HLA diversity can complicate finding compatible donors for specific populations, as some unique alleles may not be present in others.</p> Signup and view all the answers

What types of biological materials can be transplanted besides solid organs?

<p>Bone marrow, stem cells, blood transfusions, and tissues such as skin and corneas can also be transplanted.</p> Signup and view all the answers

What is the primary function of Major Histocompatibility Complex (MHC) molecules in adaptive immunity?

<p>MHC molecules present pathogen-derived peptides to T cells, facilitating the recognition and response to infections.</p> Signup and view all the answers

What role do HLA mismatched molecules play in transplant rejection?

<p>HLA mismatched molecules trigger the host immune response, leading to transplant rejection.</p> Signup and view all the answers

Name the type of rejection that occurs due to preformed ABO isohaemogglutinins.

<p>Hyperacute rejection.</p> Signup and view all the answers

What is a key predictor of transplant outcome related to HLA matching?

<p>HLA matching is a predictor of graft survival and patient survival.</p> Signup and view all the answers

Describe the general consequences of acute rejection in renal allografts.

<p>Acute rejection causes tubulointerstitial damage and can lead to graft dysfunction.</p> Signup and view all the answers

What are the long-term changes associated with chronic rejection of kidney transplants?

<p>Chronic rejection leads to vascular narrowing, interstitial fibrosis, and tubular atrophy.</p> Signup and view all the answers

How does a positive crossmatch test influence organ donation?

<p>A positive crossmatch test excludes donors for recipients with high levels of HLA antibodies.</p> Signup and view all the answers

What factors are considered in the Australian National Organ Matching Program for kidney allocation?

<p>HLA matching, waiting time, and clinical need are considered for kidney allocation.</p> Signup and view all the answers

What is the effect of repeated HLA mismatches on transplant outcomes?

<p>Repeated HLA mismatches are particularly harmful and increase the risk of rejection.</p> Signup and view all the answers

What complications may arise from the use of immunosuppressive drugs post-transplant?

<p>Immunosuppressive drugs can lead to an increased risk of infections and non-Hodgkin's lymphoma.</p> Signup and view all the answers

Identify a significant impact of HLA-DR mismatching in transplant patients.

<p>HLA-DR mismatching is associated with increased immunoreactivity one year post-transplant.</p> Signup and view all the answers

What solution is used to perfuse organs until they become transparent during retrieval?

<p>UW solution</p> Signup and view all the answers

What is the maximum acceptable warm ischemic time (WIT) for liver donation?

<p>The maximum acceptable WIT for liver donation is 30-60 minutes.</p> Signup and view all the answers

What should be done if a donor kidney is too small for transplantation?

<p>Combine two kidneys for transplantation.</p> Signup and view all the answers

Why are cardiac donors typically less preferred for liver transplant?

<p>Cardiac donors are less preferred due to longer WIT, which can compromise organ viability.</p> Signup and view all the answers

What is the purpose of using argon during the blood vessel sealing in liver transplantation?

<p>To seal the blood vessel without direct contact.</p> Signup and view all the answers

What device is used to elevate the ribcage if the transplanted liver is too large?

<p>A mechanical device to push the ribcage up.</p> Signup and view all the answers

What is the preferred cold ischemic time (CIT) for a liver transplant, and why is it important?

<p>The preferred CIT for a liver transplant is within 6-9 hours, as it preserves organ viability.</p> Signup and view all the answers

When preparing organs for transport, what are the three layers of packaging typically used?

<p>Three bags: UW solution, ice chips, and extra protection.</p> Signup and view all the answers

Identify two common causes of death that lead to organ donation.

<p>Two common causes of death leading to organ donation are aneurysm and stroke.</p> Signup and view all the answers

What is the purpose of using UW solution in liver perfusion?

<p>UW solution is used to minimize cell metabolism and maintain cell membrane stability during liver perfusion.</p> Signup and view all the answers

What anatomical structures must be reconstructed along with a liver transplant?

<p>IBC top, IBC lower, and portal vein.</p> Signup and view all the answers

What problem is addressed by performing a cavaplasty when the recipient inferior vena cava (IVC) is damaged?

<p>To join the IVC on top of itself.</p> Signup and view all the answers

What anatomical structures are assessed to ensure successful liver transplantation?

<p>Anatomical structures such as accessory vessels and surrounding anatomy are assessed for successful transplantation.</p> Signup and view all the answers

How is portal vein thrombosis typically managed during organ transplantation?

<p>By removing the clot or establishing a bypass.</p> Signup and view all the answers

What is the significance of the bile in the gallbladder during the organ donation process?

<p>Bile in the gallbladder acts as a chemical stimulus to the biliary system, influencing bile duct function.</p> Signup and view all the answers

Describe the ‘marginal liver’ and its implications for liver transplants.

<p>A marginal liver is one that is neither too good nor too bad, often declining over 50% fatty liver.</p> Signup and view all the answers

What legal requirements must be met for organ donation under the Human Tissue and Transplant Act 1982?

<p>Death certification, donor consent, and next of kin consent are required.</p> Signup and view all the answers

What are the two conditions that establish a definition of death according to the guidelines?

<p>Irreversible cessation of circulation of blood or irreversible cessation of all brain function.</p> Signup and view all the answers

Identify two common causes of brain death in potential organ donors.

<p>Trauma and spontaneous intracranial hemorrhage.</p> Signup and view all the answers

What is the importance of having two medical practitioners certifying death in the context of organ donation?

<p>It ensures the accuracy and legitimacy of the death certification process.</p> Signup and view all the answers

What roles do designated officers play in the organ donation process?

<p>They are responsible for obtaining consent and facilitating the donation process.</p> Signup and view all the answers

What are the two main methods to certify brain death?

<p>Clinical testing and radiological imaging.</p> Signup and view all the answers

What is required for the certification of brain death?

<p>Two medical practitioners must declare it.</p> Signup and view all the answers

What is the process involved in Donation after Circulatory Death (DCDD)?

<p>It involves declaring death after the cessation of circulation, followed by planned withdrawal of treatment.</p> Signup and view all the answers

What factors determine whether organs can be donated?

<p>How and where death occurs are critical factors.</p> Signup and view all the answers

What does the decision to withdraw cardiorespiratory support (WCRS) entail?

<p>It is made independently before considering donation.</p> Signup and view all the answers

What is the primary focus of Family Donor Conversations (FDC)?

<p>To provide families with the necessary information to make informed decisions about donation.</p> Signup and view all the answers

How is organ donor eligibility assessed?

<p>Through collection of donor information including medical history and tests.</p> Signup and view all the answers

What is the significance of the Designated Officer in organ donation in WA?

<p>The Designated Officer ensures the death determination and consent processes are followed.</p> Signup and view all the answers

What is the difference between neurological death and circulatory death?

<p>Neurological death occurs with catastrophic brain injury, while circulatory death involves cessation of circulation.</p> Signup and view all the answers

What are some conditions that warrant consideration for DCDD?

<p>Severe irreversible brain injury or ventilator-dependent quadriplegia.</p> Signup and view all the answers

What role does consent play in organ donation?

<p>Consent is required from the senior next of kin or the donor’s prior wishes.</p> Signup and view all the answers

Why must families be approached for organ donation in an informed manner?

<p>Families have the right to receive complete information for making enduring decisions.</p> Signup and view all the answers

What happens if a death is referred to the coroner?

<p>Deaths from unnatural or unknown causes can still allow organ or tissue donation once resolved.</p> Signup and view all the answers

What criteria can affect organ allocation in transplants?

<p>Criteria include blood type, size match, and recipient's urgency of need.</p> Signup and view all the answers

What is a significant aspect of the operating theatre during organ donation?

<p>The atmosphere is to be respectful, dignified, and professional.</p> Signup and view all the answers

What constitutes the logistics of organ donation?

<p>It involves consent, investigations, organ offers, and follow-up with families.</p> Signup and view all the answers

What are the two primary components of bone morphology?

<p>Bone morphology consists of 60% inorganic material (calcium and phosphorus) and 30% organic material (collagen and non-collagenous proteins).</p> Signup and view all the answers

How do osteoblasts and osteoclasts contribute to bone remodelling?

<p>Osteoblasts are responsible for bone formation, while osteoclasts aid in bone resorption, creating a balance essential for bone health.</p> Signup and view all the answers

What is the significance of BMPs in osteogenesis?

<p>Bone Morphogenetic Proteins (BMPs) are growth factors that stimulate the differentiation of osteoprogenitor cells into osteoblasts, promoting bone growth.</p> Signup and view all the answers

List two ideal properties of bone substitutes.

<p>Bone substitutes should be osteoconductive and biologically safe with minimal risk of disease transmission.</p> Signup and view all the answers

What role does autograft play in bone regeneration?

<p>Autografts use the patient's own bone, which is considered the gold standard for bone regeneration due to its compatibility and low risk of rejection.</p> Signup and view all the answers

What are the two forms of osteoinduction and their importance?

<p>Osteoinduction can be active, involving growth factors, or passive, relying on environmental factors; both stimulate undifferentiated cells to become osteoprogenitor cells.</p> Signup and view all the answers

What impact does the surface area of a bone graft have on osteoconduction?

<p>A high surface area enhances osteoconduction, promoting better cell adhesion and growth.</p> Signup and view all the answers

What is the difference between cancellous and cortical bone in terms of grafting?

<p>Cancellous bone provides great osteoconduction but less structural support, while cortical bone offers strong support but has a slower incorporation rate.</p> Signup and view all the answers

What is the primary difference between DBM and OP-1 in terms of their use as graft options?

<p>DBM has variable osteoinductivity and is demineralized, while OP-1 is exclusively osteoinductive and combines collagen with BMP-7.</p> Signup and view all the answers

In what context is xenograft usage most commonly seen?

<p>Xenografts are commonly used for dental implants, heart valves, and skin grafts.</p> Signup and view all the answers

What is the significance of PlusLife's donor programs?

<p>PlusLife's donor programs facilitate the retrieval and distribution of human tissue and bone for transplant, ensuring a significant number of allografts for medical use.</p> Signup and view all the answers

What specific regulations must PlusLife adhere to in their processing facilities?

<p>PlusLife must adhere to TGA licensing and Good Manufacturing Practice (GMP) to ensure the highest quality and safety of human tissues.</p> Signup and view all the answers

Describe the purpose of microbial testing in tissue processing.

<p>Microbial testing ensures that tissue donations are free from harmful pathogens, thereby safeguarding recipient health.</p> Signup and view all the answers

What is a major challenge associated with using coralline hydroxyapatite in grafting techniques?

<p>A major challenge includes compatibility issues and efficacy concerns regarding bone growth.</p> Signup and view all the answers

What are the exclusion criteria during donor screening for tissue donation?

<p>Exclusion criteria include past or present malignancy, autoimmune disorders, and infections like HIV or hepatitis.</p> Signup and view all the answers

How does terminal irradiation contribute to the safety of grafts?

<p>Terminal irradiation reduces bioburden by killing pathogens, ensuring that the grafts are safer for recipient use.</p> Signup and view all the answers

What role does the Cleanroom environment play in tissue processing?

<p>The Cleanroom environment minimizes contaminants and ensures that all processing is done in a sterile and controlled setting.</p> Signup and view all the answers

What type of graft is indicated for periprosthetic fractures?

<p>Allografts are typically indicated for periprosthetic fractures to aid in bone healing.</p> Signup and view all the answers

What defines an allograft and provide two examples of commonly transplanted allografts?

<p>An allograft is a graft donated from a genetically distinct individual of the same species. Examples include organs like the kidney and musculoskeletal tissues like bone.</p> Signup and view all the answers

What are the two primary modes of transmission for allograft-transmissible infections?

<p>Transmission can occur from donor infections, either acute or chronic, and from contamination, such as normal microflora or environmental sources.</p> Signup and view all the answers

Explain the concept of lookback (or traceback) in allograft transmission.

<p>Lookback is the investigation and additional testing of donor-recipient pairs and groups when an infection is identified in one member to trace possible transmission paths.</p> Signup and view all the answers

How might the presence of infections like HIV, HBV, or HCV in a donor not necessarily contraindicate donation?

<p>Such infections may not contraindicate donation if there is informed consent, the recipient's clinical factors are considered, and effective treatment options are available.</p> Signup and view all the answers

What is the significance of understanding transmissibility criteria for allograft-transmissible agents?

<p>Understanding the transmissibility criteria helps in assessing the risks of infection transmission from donors to recipients and aids in making informed clinical decisions.</p> Signup and view all the answers

What is the primary purpose of biovigilance in the context of biological product safety?

<p>The primary purpose of biovigilance is to detect and respond to adverse events related to the donation or receipt of biological products.</p> Signup and view all the answers

Explain the term 'window period' in relation to infectious disease screening.

<p>The window period refers to the time between infection and the first detection of the infectious agent in the bloodstream.</p> Signup and view all the answers

What does the 'healthy donor effect' imply in blood donation studies?

<p>'Healthy donor effect' suggests that first-time donors generally have lower prevalence rates of infections compared to the general population.</p> Signup and view all the answers

What factors influence the risk tolerability of allografts?

<p>Factors include the sufficiency of graft supply, costs of interventions, effectiveness of risk mitigation strategies, and urgency of graft requirements.</p> Signup and view all the answers

Why is donor selection critical in the context of allograft transplantation?

<p>Donor selection is critical to ensure the safety of both the living donor and the recipient while minimizing risks associated with the graft.</p> Signup and view all the answers

How does globalization impact the risks associated with allograft transmission?

<p>Globalization increases risks due to the ease of travel and the spread of infectious diseases across borders.</p> Signup and view all the answers

What role does education play in the donor screening process?

<p>Education aims to inform potential donors about common eligibility criteria to prevent ineligible individuals from donating.</p> Signup and view all the answers

What are the consequences of not addressing residual risks in allograft transmission?

<p>Not addressing residual risks can lead to increased transmission of infections, jeopardizing recipient health and safety.</p> Signup and view all the answers

Explain how effective treatments contribute to the decreasing risk associated with allografts.

<p>More effective treatments reduce the transmission rates of infectious agents and improve patient outcomes post-transplant.</p> Signup and view all the answers

Why is precise HLA matching crucial for bone marrow donations?

<p>Precise HLA matching is essential to reduce the risk of rejection and complications following bone marrow transplantation.</p> Signup and view all the answers

How does the availability of blood differ from organs in terms of transplantation?

<p>Blood supply is relatively plentiful and donors can be interchangeable, while organ availability is scarce and often timesensitive.</p> Signup and view all the answers

What is the importance of traceability in biovigilance?

<p>Traceability is vital for monitoring the quality of biological products, managing recalls, and ensuring donor safety.</p> Signup and view all the answers

What underlying issues contribute to vaccine hesitancy affecting allograft safety?

<p>Vaccine hesitancy leads to lower immunization rates, increasing the risk of outbreaks of vaccine-preventable diseases among vulnerable transplant recipients.</p> Signup and view all the answers

In terms of risk competency, what are the challenges faced during donor screening?

<p>Challenges include translating extensive eligibility criteria into manageable questions and ensuring the accurate assessment of potential donors.</p> Signup and view all the answers

What criteria must products meet to receive RMAT designation from the FDA?

<p>Products must treat a serious or life-threatening condition and provide preliminary clinical evidence of their efficacy.</p> Signup and view all the answers

How does MiMedx's AmnioFix Injectable address an unmet medical need?

<p>AmnioFix Injectable provides an alternative treatment for osteoarthritis pain, reducing reliance on opioids.</p> Signup and view all the answers

What constitutes a therapeutic good according to its definition?

<p>A therapeutic good is any product used in healthcare to treat, prevent, or diagnose diseases and ailments, influence physiological processes, or test for diseases.</p> Signup and view all the answers

How can the classification of garlic change depending on its form and claims?

<p>Garlic is a food in its natural state but becomes a therapeutic good when concentrated, marketed in capsules, and making claims to relieve cold symptoms.</p> Signup and view all the answers

Explain the significance of the 'pathway of innovation' in product approval.

<p>It involves demonstrating scientific excellence, clinical efficacy, risk evaluation, and cost-effectiveness for regulatory approval.</p> Signup and view all the answers

What makes Ortho-ATI's approach to RMAT designation similar to that of AmnioFix Injectable?

<p>Both aim to address serious conditions with significant clinical needs, utilizing preliminary evidence for treatment efficacy.</p> Signup and view all the answers

What regulatory authority oversees the standard for foods in Australia?

<p>Food Standards Australia New Zealand (FSANZ) regulates foods.</p> Signup and view all the answers

Why is scientific excellence alone insufficient for regulatory approval in the context of RMAT?

<p>Regulatory approval also requires clinical evidence of efficacy, risk evaluation, and cost-effectiveness beyond scientific excellence.</p> Signup and view all the answers

What is a key factor that determines whether a product is classified as a cosmetic or a therapeutic good?

<p>The principal use of the product is a key factor in determining its classification as either a cosmetic or a therapeutic good.</p> Signup and view all the answers

What types of goods are explicitly excluded from regulation as therapeutic goods?

<p>Excluded goods include hair dyes, dental whiteners, and equipment for measuring alcohol in body fluids.</p> Signup and view all the answers

In the context of therapeutic goods, why is the method of administration significant?

<p>The method of administration can influence whether a product is classified as a therapeutic good, based on its intended use and claims.</p> Signup and view all the answers

Why might a moisturizer be classified as a therapeutic good?

<p>A moisturizer may be classified as a therapeutic good if it contains sunscreen agents and claims to help protect skin from UV radiation.</p> Signup and view all the answers

What legislative act provides the legal definition of therapeutic goods in Australia?

<p>The legal definition of therapeutic goods is found in the Therapeutic Goods Act 1989.</p> Signup and view all the answers

What main issues are considered to determine if a product is a 'therapeutic good'?

<p>The product's purpose, its use in humans, its classification under the Food Standard, and its history as a food are key considerations.</p> Signup and view all the answers

Why is regulation of therapeutic goods important, referencing thalidomide?

<p>Regulation is crucial to prevent tragedies like thalidomide, which caused severe birth defects in the 1950s due to lack of oversight.</p> Signup and view all the answers

Who is responsible for regulating therapeutic goods in Australia?

<p>The Therapeutic Goods Administration (TGA) is responsible for ensuring quality, safety, and efficacy of therapeutic goods.</p> Signup and view all the answers

What essential data is reviewed during the pre-market evaluation of biotherapeutic products?

<p>Safety and quality data, manufacturing data, and clinical data are essential during the pre-market evaluation.</p> Signup and view all the answers

List two components of safety data evaluated in pre-market evaluation.

<p>Toxicology studies and immunogenicity assessments are two components of safety data evaluated.</p> Signup and view all the answers

What are the three major categories of therapeutic goods?

<p>The three categories are medicines, medical devices, and biologicals.</p> Signup and view all the answers

What is RMAT Designation and its significance?

<p>RMAT Designation stands for Regenerative Medicine Advanced Therapy Designation and it facilitates expedited development and review for regenerative therapies.</p> Signup and view all the answers

How is the safety of therapeutic goods monitored after they enter the market?

<p>The TGA monitors therapeutic goods post-marketing to ensure ongoing safety and efficacy.</p> Signup and view all the answers

What role does the Excluded Goods Order play in regulating therapeutic goods?

<p>It provides a full listing of goods that are excluded from the definition of therapeutic goods.</p> Signup and view all the answers

Identify one key criterion for a drug to receive RMAT Designation.

<p>The drug must be intended to treat, modify, reverse, or cure a serious or life-threatening disease or condition.</p> Signup and view all the answers

In what scenario might a biotherapeutic product be excluded from regulation?

<p>Fresh, viable human organs and certain autologous cells used in specific treatments can be excluded.</p> Signup and view all the answers

What are 'unmet medical needs' as defined by the FDA?

<p>'Unmet medical needs' refer to conditions whose treatment or diagnosis is not adequately addressed by available therapies.</p> Signup and view all the answers

Name one problem associated with one-size-fits-all stem cell clinics.

<p>They often lack sufficient pre-clinical evaluation.</p> Signup and view all the answers

What are the core pillars of the regulation of therapeutic goods?

<p>The four core pillars include premarket regulation, classification, evaluation of safety and efficacy, and post-market monitoring.</p> Signup and view all the answers

What kind of manufacturing data is crucial during the pre-market evaluation?

<p>Details of the manufacturing process, including process controls and microbial control measures, are crucial.</p> Signup and view all the answers

What is the significance of classifying a therapeutic product correctly?

<p>Correct classification influences the regulatory requirements and oversight necessary for the product.</p> Signup and view all the answers

Why is donor evaluation critical in the production of biotherapeutic products?

<p>Donor evaluation helps ensure the safety of biological starting materials and minimize the risk of contamination.</p> Signup and view all the answers

How does the TGA support the regulation of therapeutic goods?

<p>The TGA classifies and evaluates goods before marketing, inspects manufacturers, and monitors products in the market.</p> Signup and view all the answers

What was a significant financial implication related to the drug Vioxx?

<p>Vioxx resulted in $4.85 billion in legal claims due to health issues associated with its use.</p> Signup and view all the answers

What does non-clinical safety data include in the pre-market evaluation?

<p>Non-clinical safety data may include biological dynamics, toxicology studies, and pharmacology assessments.</p> Signup and view all the answers

What type of regulatory oversight do biotherapeutic products typically require?

<p>Biotherapeutic products generally require oversight at multiple stages, including premarket evaluation and post-market monitoring.</p> Signup and view all the answers

Describe the significance of traceability in biotherapeutic products.

<p>Traceability ensures that the origin of every component can be tracked for safety and compliance purposes.</p> Signup and view all the answers

What impact did unapproved stem cell therapies have on the reputation of stem cell research?

<p>Unapproved therapies have damaged the reputation of stem cell research and development by causing severe patient harm.</p> Signup and view all the answers

Why is it important for consumers to have timely access to therapeutic goods?

<p>Timely access ensures that consumers benefit from effective treatments while maintaining safety and quality standards.</p> Signup and view all the answers

Identify one type of medical device mentioned in the context of therapeutic goods.

<p>Examples include blood pressure monitors and cardiac pacemakers.</p> Signup and view all the answers

What are critical manufacturing steps in the context of biotherapeutic products?

<p>Critical manufacturing steps are essential procedures that ensure the quality and safety of the final product.</p> Signup and view all the answers

What is a significant characteristic of medicines under the regulatory framework?

<p>Medicines are defined by their pharmaceutical, immunological, or metabolic effects on the human body.</p> Signup and view all the answers

Why is long-term outcome data important for FDA approval?

<p>Long-term outcome data helps in demonstrating the sustained efficacy and safety of a biotherapeutic product.</p> Signup and view all the answers

Explain one reason why the evaluation of biotherapeutic products is complex.

<p>The evaluation is complex because it involves different types of data, including safety, manufacturing, and clinical effectiveness.</p> Signup and view all the answers

How does pharmacovigilance contribute to the safety of biotherapeutic products?

<p>Pharmacovigilance monitors adverse effects and ensures ongoing patient safety after product approval.</p> Signup and view all the answers

Study Notes

Regenerative Medicine

  • Genes, cells, and matrix are essential components for regenerative medicine.
  • Genes control cell growth and differentiation.
  • Cells produce matrix molecules and enable tissue function.
  • Matrix (ECM) acts as a scaffold for cells to grow and differentiate.
  • Regenerative medicine mimics embryonic development by involving cell transformation and interaction with ECM.
  • Combining genes, cells, and matrix is essential for developing regenerative therapies, such as engineered tissues or organ replacements.

Historical Milestones

  • Gasparo Tagliacozzi (16th century) used skin grafts for reconstructive surgery.
  • John Hunter (18th century) performed early experiments with tissue grafts.
  • 20th century saw advancements in transplantation and the understanding of immune rejection, highlighted by the work of Sir Peter Medawar.

Extracellular Matrix (ECM)

  • Provides structural support, regulates cell behavior, and influences tissue regeneration.
  • Engineering stem cell niches (microenvironments where stem cells reside)
  • Studying disease environments (e.g., tumor microenvironments)
  • Recapitulating tissue physiology for research

Stem Cell Niches

  • ECM interaction within the stem cell niche is crucial.

Tissue-Specific Niches

  • Engineering ECM in diseased environments, such as tumor microenvironments.
  • Engineering and characterization of CD-ECM to study ECM physiology:
    • Biological and biomechanical aspects.

Matrix Components

  • Fibrous proteins: Collagen, elastin, and fibronectin.
  • Growth factors: BMP (Bone Morphogenetic Proteins), Wnt signaling.
  • Cell adhesion molecules: Integrins mediate interactions between cells and ECM.

Cell-Derived ECM (CD-ECM)

  • Technologies for:
    • Generation
    • In vitro deposition
    • Decellularization and processing

Cell and Tissue Development

Embryogenesis and Primitive Streak

  • Gastrulation (around 14 days after fertilization) forms the trilaminar embryonic disc.
  • Embryonic layers:
    • Ectoderm: Forms the nervous system and skin.
    • Mesoderm: Forms muscles, connective tissues, and the cardiovascular system.
    • Endoderm: Forms the digestive and respiratory tracts.

Organ-genetic Period of Embryonic Development

  • 3rd week to 5 weeks after the first day of the last normal menstrual period.
  • Four phases:
    • Growth
    • Morphogenesis
    • Differentiation
    • Maturation

Development of Specific Tissues

Skin

  • Epidermis from ectoderm; dermis from mesoderm.
  • Melanocytes from neural crest.
  • Development of the skin:
    • Four to five weeks
    • Epidermis - derived from surface ectoderm
    • Dermis - derived from mesoderm

Cartilage and Bone

  • Mesoderm forms cartilage, which later ossifies into bone.
  • Cartilage development:
    • Five weeks

Bone

  • Development of bone:
    • Paraxial mesoderm forms somites.
    • Intramembranous ossification (flat bones)
    • Endochondral ossification (long bones)
    • Osteoblast, haversian system, osteocyte, osteoclast

Muscle Types

  • Skeletal, smooth, and cardiac muscles develop from the mesoderm.

Skeletal Muscle

  • Development of skeletal muscle:
    • Seven weeks
    • Myotome regions of the somites (mesoderm)
    • Mesenchymal cells

Smooth Muscle

  • Development of smooth muscle:
    • Somatic mesoderm - vessels smooth muscle
    • Mesenchymal cells - myoepithelial cells in glands
    • Splanchnic mesenchyme - other smooth muscle around endoderm
    • Remain mononuclear

Cardiac Muscle

  • Development of cardiac muscle:
    • Four weeks
    • Lateral splanchnic mesoderm
    • Cardiac muscle fibers arise from single cells.

Neural Tissue

  • Development of the peripheral nervous system (PNS)
    • Neural crest cells
    • Cranial, spinal visceral nerves and cranial, spinal and autonomic ganglia
    • Bipolar sensory cells
    • Satellite cells
    • Schwann cells
    • Connective tissue outside the capsule

Key Molecules in Morphogenesis and Regeneration

  • Morphogenesis of tissue and organ involves complex interactions, cell movement, cell transformation (EMT, MET), and programmed cell death.

Cell Transformation: EMT and MET

  • Epithelial-Mesenchymal Transition (EMT):
    • Cells lose epithelial characteristics (organized and tightly connected) and gain mesenchymal properties (more mobile).
    • Occurs in cancer metastasis and embryonic development.
  • Mesenchymal-Epithelial Transition (MET):
    • Reversal of EMT, crucial in kidney development and tissue repair.

Bone Morphogenetic Proteins (BMPs)

  • Regulate tissue development and are critical for organs like the heart and kidney.
  • Functions:
    • Binds to heparin sulfate, heparin, type IV Collagen.
    • Regulates cell type specification, maturation, apoptosis, chemotaxis, mitosis, differentiation, and ECM production.

Cadherins

  • Mediate cell-cell adhesion.
  • Loss of function can disrupt tissue formation (e.g., N-Cadherin in the neural tube).

Integrins

  • Act as receptors for ECM, facilitating communication between cells and their environment.
  • Heterodimeric transmembrane protein αβ subunits.
  • 15 subtypes of α and 8 β.
  • Arginin-glycine-aspartate (RGD) sequence and the neighboring modulatory site.

Cell and Matrix Molecule Interaction; Organogenesis & Regeneration

  • Matrix proteins:
    • Fibrous structural proteins: collagen, laminis, fibrinectin, vitronectin, and elastin.
    • Specialized proteins: growth factors, small matricellular proteins, small integrin-binding glycoproteins (SIBLINGD).
    • Proteoglycans
  • Matrix degrading enzymes: MMP; serine protease; cysterine protease
  • Cells:
    • Cell proliferation
    • Survival
    • Shape
    • Migration
    • Differentiation
  • Interaction:
    • Growth factors: BMP/TGFβ, Wnt Signaling
    • Cell adhesion molecules
    • Cell-ECM interactions: Integrin and receptors;
    • Cell-Cell interactions: Eph/ephrin family;
    • Matrix molecules and their ligands

Key Points

  • Morphogenesis of tissues and organs starts from cell and matrix molecule interactions.
  • Morphogenesis is a sequential multi-step cascade.
  • Tissue morphogenesis relies on cells exchanging their neighbors.
  • Regeneration recapitulates embryonic development.
  • Genes, cells, and matrix are essential components for engineering regenerative medicine.

Skin Reconstruction and Dermal Equivalents

  • Skin serves as a waterproof barrier, sunshield, and armor.
  • Skin cells:
    • Epithelial layer: Keratinocytes (90%), melanocytes (pigmentation), immune cells
    • Dermal layer: fibroblasts (matrix), endothelial cells (vascular supply), hair follicle cells

Why Treat Skin Injuries?

  • Skin's Importance: Acts as a waterproof barrier, sunshield, and armor.
  • Self-repair but can struggle after severe burns.
  • Complications of Burns:
    • Infection, scarring, and sepsis (potentially fatal).
    • Goal is to reduce inflammation and cover the wound quickly to prevent complications.
  • Healing time matters.

Wound Debridement

  • Removal of dead tissue promotes healing.
  • Traditional surgical removal is a method.
  • Bromelain, an enzyme from pineapple, can be used for hard-to-reach areas.
  • REIMS/i-knife differentiates between healthy and dead tissue in real-time using diathermy and mass spectrometry.

Skin Grafts

  • Split-thickness skin grafts (STSG) are commonly used.
    • Limited expansion (1:3 to 1:5).
    • Donor site morbidity includes pain, discolouration, scarring, and risk of infection.
    • Mesh pattern of healed skin.
  • Xenografts are temporary, derived from animals (pigs, cats, rabbits, pigeons, or mice).
    • Usually not cultured.
    • Vigorous rejection limits them to temporary biological dressings.
  • Allografts are from human donors (cadaveric or neonatal).
    • May or may not be cultured.
    • Eventual rejection due to HLA-DR antigens.
    • Immunosuppressive therapy is required to prevent early rejection.
    • Risk of cross-contamination.
  • Autologous Cells (from the patient) are the gold standard due to eliminating rejection risk.

Autologous Keratinocyte-Based Treatments

  • Cultured Epithelial Autografts (CEAs):
    • Cells are grown from a full-thickness biopsy over 3-5 weeks.
    • Provides good coverage but requires precise timing to reduce scarring.
  • ReCell Spray-on Skin:
    • Uses cells from the dermal-epidermal junction in a spray form.
    • Contains keratinocytes, fibroblasts, melanocytes, and endothelial cells.

Role of the Extracellular Matrix (ECM) and Dermal Scaffolds

  • ECM's importance: Initially seen as passive support, it's now recognized for actively influencing healing through physical and biological properties.
  • Types of Matrices for Burn Treatment:
    • Integra: Collagen-based matrix that supports healing and is biodegradable.
    • BTM: Synthetic matrix with two layers: one non-biodegradable, and the other biodegradable to integrate with tissue.
    • Apligraf: Bilayered cultured graft containing both dermal and epidermal layers.

Future Innovations in Skin Regeneration

  • Stem Cells:
    • Moving from skin-derived cells to multipotent stem cells (like mesenchymal or adipose-derived).
    • Induced pluripotent stem cells (iPSCs) and reprogrammed cells are being explored for better regeneration.
  • Improved Scaffold: Scaffold type (material, design) has a significant impact on guiding cellular responses.
  • 3D Bioprinting:
    • Uses bioinks (a mixture of cells and matrix) to print layers of tissues.
    • Allows customization of matrix stiffness and biological activity.
    • Goal: Print complete tissue structures ready for transplantation.

Understanding the regenerative cells and matrix required

  • Vascularisation
  • Timing – to be connected surgically to replacements? Designed within the bioengineered replacements?
  • Timeline of skin repair methods

Future Development

  • Single stage replacements
  • Integrated cellular/matrix guided regeneration

Advanced Therapy Medicinal Products (ATMPs)

  • ATMPs are therapeutic goods including cell-based products, immunotherapy products, combination products, products containing live animal cells, tissues or organs, and autologous human cells and tissue products (including stem cells).
  • ATMPs are distinct from biological medicines which include recombinant products, plasma derived products, vaccines (that do not contain viable human cells), and gene-therapy vectors alone.
  • ATMPs have been substantially manipulated or not intended for the same essential function in the recipient and the donor.
  • ATMPs containing Genetically Modified Organisms (GMOs) are regulated by the Office of the Gene Technology Regulator (OGTR) in Australia.
  • The OGTR ensures compliance with the Gene Technology Act 2000, Gene Technology Regulations 2001 and corresponding state and territory legislation.
  • ATMPs require specialized and accredited cleanroom facilities for receipt, processing, manufacturing, storage and dispensing.
  • Staff must demonstrate expertise in GMP, GCP, EMP, EMS, QC testing, thaw and infusion, aseptic cell processing, gene therapy formulation, and specialized equipment and materials.

ATMPs – Cell Therapies

  • Hematopoietic stem cell transplant (HSCT) is a vital cell therapy for various blood cancers, such as multiple myeloma, Hodgkin and Non-Hodgkin lymphoma, acute myeloid leukemia, acute lymphocytic leukemia, myelodysplastic syndrome, myelofibrosis, essential thrombocytosis, polycythemia vera, and sickle cell disease & thalassemia.
  • Cell and Tissue Therapies WA (CTTWA) at Royal Perth Hospital (RPH) is a state-of-the-art facility for receiving, storing, manufacturing, and dispensing ATMPs.
  • CTTWA offers clinical services for blood cancers, serum eye drops for dry eye syndrome, and autologous gene modified cell therapies.

Autologous Gene Modified Cell Therapies

  • CAR T-cell therapy is used for treating cancer patients by modifying their immune system to target and destroy cancer cells.
  • Chimeric Antigen Receptor (CAR) T-cells are engineered immune cells that specifically recognize and bind to cancer cells.
  • CAR T-cells are currently used for treating acute lymphoblastic leukemia (ALL) and diffuse large B-cell lymphoma (DLBCL).

Clinical Trials

  • Clinical trials for treating solid cancers, specifically melanoma, using tumor infiltrating lymphocytes are underway.
  • Clinical trials for treating corneal endothelial cell loss, a leading cause of visual impairment and blindness, using injected corneal endothelial cells are ongoing.
  • Clinical trials are investigating the use of mesenchymal stem cells (MSCs) for tissue regeneration, specifically cranial reconstruction.
  • MSCs are multipotent stem cells found in various tissues like bone marrow, adipose tissue, umbilical cord, placenta, amniotic fluid, blood, and fetal tissue.
  • MSCs have immunosuppressive and immunomodulatory properties, playing a crucial role in supporting tissue repair and controlling inflammatory reactions.
  • CTTWA offers contract research and GMP manufacturing services for cell, tissue, and gene therapy products.

FACT Accreditation (Foundation for the Accreditation of Cellular Therapy)

  • FACT was established to promote minimum standards and collaboration in the field of cellular therapy.
  • FACT promotes quality patient care and laboratory practices, improves treatment outcomes, and fosters research and development of cellular therapies.
  • Accreditation under FACT is voluntary but highly valued by BMT programs, hospital administrators, third party payers, and cooperative groups conducting clinical trials.

Tissue Engineering

  • The field of tissue engineering aims to create substitutes for tissues that have been damaged or lost, aiming to restore or enhance tissue function.
  • Key components of tissue engineering include cells, biomaterials/scaffolds, and growth cues.

Challenges in Tissue Engineering

  • Technical challenges include developing reliable scaffolds.
  • Commercial challenges involve making tissue engineering solutions cost-effective and translating them into practical therapies.
  • Regulatory and ethical challenges include navigating approval processes and ethical concerns, particularly with animal or donor cells.

Native Tissues

  • Native tissues rely on:
    • Cells: Building blocks and maintainers of organs.
    • Extracellular Matrix (ECM): Provides structural and biochemical support.
    • Vessels: Supply oxygen and nutrients to keep cells alive.

Tissue Engineering Paradigm

  • The approach involves the use of cells, biomaterials (scaffolds), and growth cues to mimic the structure and function of native tissues.
  • Cell sources include autologous, allogeneic, and xenogeneic cells.
  • Allogeneic and xenogeneic cells often lead to immune rejection.
  • The choice of biomaterial influences scaffold design, which guides cell behavior, morphology, adhesion, and motility through biophysical and biochemical cues.
  • Biological factors such as hormones, cytokines, growth factors, ECM molecules, cell surface molecules, and nucleic acids play a significant role in regulating cell fate.
  • The physical and chemical nature of the scaffold also play a crucial role in cell fate regulation.
  • Mechano-chemical factors contribute to the temporal and spatial coordination of cellular processes via signals from the ECM.

Cell-Environment Interactions

  • Cells interact with their environment through various biochemical, mechano-chemical, and physical mechanisms.
  • Cell-extracellular matrix (ECM) interactions are essential for cell function.
  • Mechanotransduction involves the conversion of mechanical forces into biochemical signals.
  • Integrins, cell adhesion receptors, play a crucial role in mechanotransduction and cell adhesion.
  • Cellular processes, such as shape changes in epithelial cells and geometry of tubules, are influenced by mechanical cues.

Biomaterials in Tissue Engineering

  • Scaffolds serve as templates for tissue regrowth, providing physical structure and cues for cell attachment and growth.
  • Scaffolds must possess adequate mechanical properties, be biocompatible (not rejected by the body), biodegradable (degrade as natural tissue regenerates), and porous to allow for tissue regeneration and attachment.
  • The fabrication process of scaffolds is crucial for precision, reproducibility, compatibility with cells and signals, tailored size and shape, and cost-efficiency.
  • The mechanical properties of scaffolds are a critical factor in guiding tissue regeneration and influencing cell behavior.

Types of Scaffolds

  • Bioinks: Soft hydrogels used in bioprinting, suitable for suspension of cells, drugs, and biologically active materials.
  • Biomaterial Inks: Harder polymers used to create solid structures in bioprinting.
  • Both bioinks and biomaterial inks contain cells.
  • Hydrogels, a common bioink material, are 3D hydrophilic polymer networks that can absorb large amounts of water and possess biocompatibility and biodegradability.

Design Considerations for Bioprinting

  • Bioprinting technologies offer precise control over scaffold design, enabling the creation of complex and intricate structures.
  • Different bioprinting technologies include extrusion-based bioprinting, hydrogel bioprinting, and melt electrowriting (MEW), each with its own set of advantages and limitations.
  • Challenges in extrusion-based bioprinting include cell sinking, cartilage changes, cell stress, needle clogging, material dehydration, and collapsing structures.
  • Hydrogels are widely employed as biomaterials in bioprinting due to their resemblance to the ECM and their ability to create a true 3D environment for cells.
  • Strategies to enhance shape fidelity in bioprinting often involve the use of supporting structures.

Scaffolds for Soft Tissues

  • Scaffolds for soft tissues are often designed to mimic the microarchitecture and mechanical properties of the target tissue.
  • Collagen, a key structural protein in the ECM, is frequently used in soft tissue scaffolds due to its biocompatibility and biodegradability.
  • The use of micrometre-sized collagen bundles in 3D bioprinting aims to emulate the properties of soft tissues, promoting the formation of tissue-like structures.

3D Bioprinting

  • 3D Printing, including techniques like Melt Electrowriting (MEW), allows for the creation of complex scaffolds with high resolution and precision.
  • MEW offers control over the mechanical properties of printed scaffolds, making it suitable for both bone and soft tissues.
  • MEW enables the fabrication of scaffolds with fine structures and precise mechanical properties.

Scaffolds for Heart Valves

  • Heart valve replacement is a critical procedure for patients with aortic stenosis, congenital valve diseases, and other cardiovascular conditions.
  • Current clinical solutions for valve replacement include mechanical valves, bio-prosthetic valves, and tissue-engineered heart valve solutions.
  • Tissue-engineered heart valve solutions, such as those developed by Xeltis, aim to provide a more biocompatible and durable alternative to existing valve replacement options.

Optimised Biomimetic Scaffold Design

  • The development of scaffolds for heart valves requires careful consideration of design factors including cell recruitment, tissue integration, biocompatibility, biodegradability, and mechanical properties.
  • Spatially heterogeneous scaffolds, mimicking the complex structure of heart valves, can be achieved through bioprinting techniques like MEW.
  • Bio-inspired MEW design incorporates insights from the natural structure and function of heart valve tissues to create optimized scaffolds.

Cellular Engineering in Surgical Intervention

  • Milestone: Organ transplant -> Material Implant -> Cellular Engineering
  • Material implants: Breast implants, total knee replacements, with limited lifespan (around 15 years) and require replacement
  • Delivery systems of cellular engineering: Stem cells, tissue progenitor cells, cell suspension
    • Cell suspension: Single cells requiring homing, local or systemic impact; immunomodulatory disease; host vs graft disease. Example: CAR-T
    • Cell cluster: Cell carriers with no matrix production, local effect, good integration
    • Tissue construct: Immature but functional matrix, local effect, poor integration. Example: Organ-on-a-chip for drug screening
  • Joint and osteochondral structure: Joint lining is made of cartilage, lacking blood supply and nerves. Defects are asymptomatic
  • Cartilage tissue does not regenerate

Cartilage Injury

  • Irreversible damage leading to Osteoarthritis (OA)
  • 30,000 to 40,000 cartilage injuries annually in Australia, costing $30 million
  • Current treatments (pharmaceuticals, arthroscopy, marrow perforation techniques, osteochondral allo/autografting) only treat symptoms or produce inferior repair tissue.
  • Microfracture can cause bone cyst formation

Matrix-Induced Autologous Chondrocyte Implantation (MACI)

  • Advanced technique for repairing damaged cartilage
  • Involves:
    • Harvesting patient’s own chondrocytes (cartilage cells)
    • Seeding the cells onto a collagen membrane scaffold
    • Implanting the scaffold back into the joint to repair the damaged area.
  • Autologous chondrocyte implantation using collagen membrane as scaffold:
    • Less invasive
    • Non-periosteal harvesting
    • Non-suturing
    • Better quality control of cell density
  • MACI in Australia:
    • Direct chondrocytes seeding on collagen scaffold at the time of surgery
    • 70% mini-surgery, 30% arthroscopic implantation
    • Used in knee, ankle, shoulder, and hip
  • How MACI works:
    • Cell seeding on scaffold: Chondrocytes loaded onto collagen membrane
    • Fibrin glue secures the scaffold without sutures, reducing surgery time
    • Implanted cells integrate into the damaged area, creating hyaline-like cartilage
  • Advantages:
    • Less invasive (no periosteum harvesting)
    • Better quality control of cell density
    • Can be performed arthroscopically or through mini-surgery

Clinical Outcomes of MACI

  • Significant improvements in pain and joint function within 2 years, benefits lasting up to 10 years
  • Post-surgery assessments show sustained recovery over time
  • Long-term outcome study (N=60) in Perth, Australia

Key Technique Aspects

  • Collagen membrane replaces periosteal membrane
  • Direct integration of chondrocytes onto the collagen membrane through loading
  • Fibrin glue replaces suturing, shortening the surgical procedure and preventing graft hypertrophy

Challenges and Innovations

  • Microfracture can lead to bone cysts, avoided by MACI's cell-loaded scaffold
  • Synthetic materials used in the past failed due to complications, MACI focuses on collagen-based scaffolds for better integration

Future Directions for Joint Repair

  • Goal is to repair the entire osteochondral region (bone + cartilage)
  • Techniques under exploration:
    • Bioactive scaffolds with growth factors (TGF-β, BMPs) to enhance cell growth
    • Stem cell-based therapies (concerns about unapproved stem cell treatments harming research)

Key Takeaways

  • MACI is a second-generation improvement over traditional autologous chondrocyte implantation (ACI)
  • Australia leads in developing and adopting MACI, 15 years ahead of the USA
  • MACI is expensive and only targets cartilage repair, not full joint restoration

Regulatory Considerations

  • Clinicians must define appropriate uses for stem cells to protect regenerative medicine credibility
  • Regulatory frameworks are needed to ensure safe and effective therapies

Conclusions

  • MACI produced improved clinical outcomes and functional hyaline-like repair tissue infill up to 10 years
  • MACI is still a very expensive cell therapy technology
  • MACI only repairs cartilage
  • Future of joint repair is to repair the full osteochondral region with barrier or memory structures

Future Regenerative Therapies

  • Osteochondrogenesis
  • Chondroconduction

Recommendations

  • Establish boundaries for stem cell therapy practice
  • Improve community engagement and awareness of stem cell research and therapy
  • Improve patient access to clinical trials
  • Facilitate cross-disciplinary collaboration
  • Specialist use only
  • GMP manufacture / Process characterization

Liver Progenitor Cells

  • Liver disease has increased significantly, activating hepatic non-parenchymal cells (Kupffer) and releasing factors like TNF and IL-6.
  • Other factors are secreted from various glands, including the pancreas (insulin), duodenum, salivary gland (EGF), adrenal gland (norepinephrine), and thyroid gland (T3).
  • Stellate cells release HGF, enabling hepatocytes to overcome cell cycle checkpoints.
  • Transformation Growth Factor (TGF) inhibits hepatocyte DNA synthesis but is blocked during regeneration.
  • Regeneration of liver cells:
    • Cholangiocytes: Derived from embryonic hepatoblasts/oval cells in mice, peaking in proliferation shortly after hepatocytes.
    • Liver Sinusoidal Endothelial Cells (LESCs): Proliferation lasts for days to weeks, with precursor migration from bone marrow.
    • Kupffer Cells and Immune Cells: Local Kupffer cell proliferation, migrating as mononuclear cells from the blood to become liver resident macrophages.
    • Hepatic Stellate Cells (HSCs): Contribute to fibrosis and cirrhosis but also produce signaling molecules essential for regeneration.
  • Hepatic Progenitor Cells (HPC):
    • Bi-potential stem cells in human and animal liver that differentiate into hepatocytes and cholangiocytes.
    • Located in the canal of herring, HPCs grow as extensions of terminal biliary ductules.
    • Oval cells form ductular structures connecting the biliary system and terminating at a hepatocyte-forming blind end.
    • Induced by liver damage, oval cells can be isolated and cultured to produce both hepatic cells and cholangiocytes.

Liver Diseases

  • Genetic liver diseases:
    • Examples include Hemophilia B, Crigler-Najjar Syndrome, Wilson Disease, and Alpha-1 Antitrypsin Deficiency (AATD).
    • Treatment options often involve gene therapy using AAV vectors and CRISPR/Cas9 technology.
    • Gene therapy tools include:
      • AAV vectors: Deliver corrected genes into liver cells.
      • CRISPR/Cas9: edits faulty genes.
    • Induced pluripotent stem cells (iPSCs):
      • Derived from adult cells and reprogrammed to an embryonic-like pluripotent state.
      • Promising for ex vivo gene therapy and cell therapy applications.
  • Metabolic liver diseases:
    • Lifestyle causes include:
      • Alcohol
      • Obesity
      • Viral infections (HCV, HBV)
      • Intravenous drug use

Regenerative Medicine and Liver Disease

  • Regenerative medicine: Replacing, engineering, or regenerating human cells, tissues, or organs to restore normal function.
  • Cell therapy: Introduction of cells into an organism's tissues to treat a disease.
  • Liver transplantation:
    • Donor shortage and unsuitability of donated livers: Increasing demand and poor donor rates lead to limited availability for transplantation.
    • Current treatment for metabolic liver disease:
      • Early stage: Liver disease resection.
      • End-stage: Liver transplant.
    • Cancer (HCC):
      • Treatment options include:
        • Radiofrequency/cryoablation, radiotherapy
        • Partial hepatectomy
        • Transplantation
        • Sorafinib (5-year survival rate 17% in Australia)
        • Immunotherapy (Atezolizumab, combination of Atezolizumab/Bevacizumab).
  • Devices:
    • ALDs (Artificial Liver Device): Mechanical devices that have not proven clinically beneficial.
    • BLDs (Bio-artificial Liver Device):
      • Use human liver cells to filter toxins and mimic liver function.
      • Used as a bridge to transplantation for severe cases.
      • Clinical trials (VTI-208) showed no significant improvement in patient outcomes.

Cell and Gene Therapy for Liver Disease

  • Hepatocyte Transplantation:
    • Challenges: Immune rejection and poor donor availability.
    • Animal models demonstrate: Transplanted hepatocytes can replace damaged liver tissue and restore function, correcting enzymatic, receptor, and transport defects.
    • First human HTx in 1992: Unclear benefits.
    • Limitations:
      • Rejection: Improved immunosuppressive regimens are needed.
      • Donor availability: Good quality cells and suitable donors are required.
      • Engraftment: High-grade cell engraftment is essential.
      • Preconditioning: Regimens have been tried to give transplanted cells an advantage over the recipient's cells, such as partial hepatectomy.
  • Stem Cell Therapy:
    • Mesenchymal Stem Cells (MSCs):
      • Used to treat fibrosis and cirrhosis by reducing liver inflammation.
      • Possess immunomodulatory properties, affecting immune cell activity and HSC behavior.
    • Induced Pluripotent Stem Cells (iPSCs):
      • Reprogrammed adult cells that behave like embryonic stem cells.
      • Can be genetically corrected for personalized therapy.
    • Challenges:
      • Incomplete gene expression.
      • Scale-up issues for therapeutic use.

Hepatic Stellate Cells (HSCs) and Fibrosis

  • Role in Fibrosis:
    • Activated during liver injury or chronic inflammation.
    • Transform into myofibroblast-like cells, producing excessive collagen and extracellular matrix (ECM).
    • Release pro-inflammatory cytokines (e.g., TGF-β, PDGF), promoting further fibrosis.
  • Targeting HSCs for Treatment:
    • Focus on reducing their activation to prevent fibrosis progression.

Mesenchymal Stem Cells for Metabolic Liver Disease

  • MSCs: Candidate stem cell types for treating liver fibrosis/cirrhosis.
  • Clinical trials: 59 registered clinical trials using MSCs for liver disease, 29 focusing on liver cirrhosis (2020).
  • Initial therapeutic interest: MSCs' ability to differentiate into hepatic cells.
  • Accumulating evidence suggests: MSCs' therapeutic mechanisms are due to immunomodulatory effects, attenuating acute or chronic liver inflammation and hepatocyte injury through modulation of immune cell function, including HSCs.

Using Pluripotent Stem Cells to Treat Disease

  • Hepatocyte-like cells: Generated from pluripotent stem cells using various growth factors such as FOXA2, HNF1a.
  • Hepatocyte characteristics:
    • Cytochrome p450 enzyme activity
    • LDL uptake
    • Glycogen storage
    • Urea synthesis
  • Limitations:
    • Incomplete gene expression
    • Scale-up limitations
    • Heterogeneous culture

Improving Hepatocyte-like Cell Function and Cell Number

  • Chemically defined conditions: Used to optimize cell culture.
  • Substrates and matrix: Laminin used for embryonic stem cells and mesenchymal stem cells.
  • Small molecules: Induce rapid proliferation.
  • TGFb-induced proliferation and GSK3b inhibition: Promote cell growth.
  • ESC/iPSC transduction: With transcription factors to promote differentiation and proliferation.

Liver Organoids and Buds

  • Organoids:
    • Mini-liver structures grown from multiple cell types for transplantation.
    • Use a liver-specific gel and fat-derived cells to support growth.
    • Can spontaneously form small blood vessels.
  • Liver Buds:
    • Resemble natural liver tissue and show potential in animal models.
    • Consist of liver progenitor cells and liver endothelial cells.
    • Growing multi-cellular liver organoids for transplantation:
      • Liver progenitor cells differentiate into main liver cells.
      • Liver endothelial cells form blood vessels.
      • A unique liver gel, fat-derived cells, and a 3mm scaffold are used to maintain organoid integrity.

Growing Liver Buds for Transplantation

  • Generating multi-cellular liver organoids from iPSCs:
    • Resemble liver tissue.
    • Show therapeutic potential in a mouse model.
    • Clinically defined with animal-origin free media and supplements.

Summary and Future Directions

  • Liver disease is a major health problem with no real solution.
  • Cell therapy or a combination of cell therapy and gene therapy holds great promise.
  • A range of cell types and procedures are available.
  • The biological properties and outcomes of transplanting such cells need to be exhaustively defined before use in humans due to potential tumorigenicity.
  • More research is needed to better understand the mechanisms of stem cell growth and development.
  • Combination therapies using stem cells, gene therapy, and hepatocyte transplantation hold promise for treating liver diseases.
  • Further research is required to address challenges like immune rejection, tumor risks, and incomplete cell differentiation.
  • Advanced technologies like iPSCs, liver organoids, and bio-artificial devices offer new possibilities for treating severe liver conditions.

Fibrosis: A Pathological Wound Healing Response

  • Fibrosis is a process where damaged tissue is replaced with excessive fibrous (scar) tissue.
  • This leads to loss of normal tissue function and can occur in conditions like Idiopathic Pulmonary Fibrosis (IPF), liver fibrosis, and myocardial infarction.

Healing and Repair Processes

  • Healing: Restoration of normal function, often involves scar formation.
  • Regeneration: Replacement of damaged structures requiring intact tissue scaffolding and stem cells.
  • Fibrosis: Excessive scar tissue formation, negatively impacting organ function.

Factors Influencing Tissue Repair

  • Intrinsic cellular capacity to proliferate:
    • Labile cells: Continuously divide (e.g., epithelial, bone marrow cells).
    • Stable cells: Divide when necessary (e.g., liver, kidney cells).
    • Permanent cells: Cannot regenerate (e.g., cardiac myocytes, neurons).
  • Severity, duration, location, infection, perfusion, nutrition, and stress also influence tissue healing.

Extracellular Matrix (ECM) and Its Role

  • The ECM acts as a scaffold for cell proliferation, migration, and differentiation during tissue repair.
  • Controls cell behavior and acts as a reservoir for growth factors.
  • Composed of polysaccharides, glycoproteins, proteoglycans, and various types of collagen.
  • Fibroblasts are a major source of ECM components during tissue repair.

Wound Healing Process

  • Inflammation: Removal of damaged tissue.
  • Cell proliferation: New connective tissue and blood vessel formation.
  • ECM synthesis: Tissue remodeling and wound contraction.
  • Scar formation: Collagen deposition leads to mature scar tissue.

Fibrosis in Clinical Conditions

  • Fibrosis is the excessive deposition of matrix components, replacing normal tissue with dense scar tissue, leading to functional impairment.
  • Clinical examples: Liver fibrosis, post-operative adhesions, keloids, systemic sclerosis, and IPF.

Idiopathic Pulmonary Fibrosis (IPF)

  • A progressive, usually fatal lung disease with a median survival of 3 years post-diagnosis.
  • Characterized by abnormal tissue remodeling, collagen deposition, and loss of lung function.
  • Potential causes: Dysregulated immune responses, increased TGF-β1, PDGF, and fibroblast activation.

Key Molecular Pathways

  • Fibroblast proliferation and collagen production are increased in fibrosis.
  • Signaling pathways like STAT3 and growth factors (e.g., IL-6, TGF-β) play crucial roles in fibrosis development.
  • STAT3 signaling has been shown to increase fibrosis in pre-clinical models.

B Cells in Idiopathic Pulmonary Fibrosis

  • Abnormal adaptive immune response in IPF.
  • B cell aggregates are present in the lungs, similar to patients with SLE and RA.
  • IPF patients have high circulating autoantibodies, increased B cells (CD19, CD20), BAFF, and immune complexes.
  • Increased plasmablast and plasma cells suggest an autoimmune-like feature.

Mechanisms Driving Fibrosis Leading to New Therapeutics

  • 2023 Research projects focus on understanding fibrosis in the inner ear as a complication of cochlear implant surgery and infection.
  • This fibrosis can cause loss of residual hearing and function of the implant.

2023 Lung Fibrosis Research Projects

  • Current therapies for IPF are limited.
  • Focus on developing treatments that slow disease progression and improve quality of life.
  • Research involves:
    • Macromolecular crowding assay to test suitable drugs.
    • Investigating differential responses of human IPF fibroblasts to drug treatment in vitro.
    • B cell phenotyping and auto-antigen screening to tailor treatments for specific patient populations.
    • Testing immunotherapy for lung fibrosis in mouse models.

Therapeutic Approaches

  • Targeting immune cells: Research on depleting B cells and plasma cells shows potential in reducing fibrosis, particularly in IPF.
  • STAT inhibitors: Small molecule inhibitors targeting STAT3 signaling are being tested for reducing fibrosis.
  • Plasma cell depletion: Therapies targeting antibody-producing plasma cells (e.g., bortezomib) show promise in reducing lung fibrosis.

Immune Regulation

  • Immune regulation ensures the immune system differentiates between self and non-self antigens and harmful and innocuous foreign antigens.
  • T cell immunity involves killer T cells, tolerance, and activation.
  • Tolerance prevents self-reactive T cells from causing autoimmunity.
  • Activation generates effector T cells to fight cancer and infections.
  • Dendritic cells play a crucial role in orchestrating T cell immunity.

Dendritic Cells (DCs)

  • DCs are specialized antigen-presenting cells that activate T cells.
  • They are categorized into three groups: circulating, lymphoid-resident, and migratory.
  • DCs specialize in cross-presentation and play a vital role in presenting antigens to CD8+ T cells, crucial for anti-tumor immunity.
  • It is unknown how antigens are presented to CD8+ T cells in cancer.
  • Studies in melanoma highlight the involvement of Langerhans cells and dermal-derived DCs in the immune response.

Melanoma Progression

  • Melanoma development progresses in stages, from epidermal confinement to spreading to lymph nodes and other organs.
  • Epicutaneous inoculation models are used to study melanoma progression in mice.

Adoptive Cell Therapy

  • Transfers activated CD8+ T cells to combat tumors
  • Tumors are heterogeneous, making them difficult to treat uniformly.

Flt3L and Dendritic Cell Expansion

  • Flt3L (Fms-like tyrosine kinase 3 ligand) expands XCR1+ dendritic cells.
  • XCR1+ DCs specialize in cross-presentation and promoting CD8+ T cell responses.
  • Targeting DCs through Flt3L can enhance immune responses against tumors.

Tissue-Resident Memory T Cells (TRM)

  • TRM cells reside in tissues and play a critical role in controlling tumor growth.
  • TRM accumulate in human cancers and are essential for long-term immune control of melanoma.
  • TRM cells promote an immune equilibrium in the skin, preventing melanoma relapse.

Summary

  • XCR1+ DCs specialize in cross-presentation of tumor antigens and promote CD8+ T cell responses.
  • This knowledge can be utilized to develop novel therapies.
  • TRM CD8+ T cells promote melanoma-immune equilibrium in the skin.

Conclusion

  • XCR1+ dendritic cells and TRM CD8+ T cells are crucial for anti-tumor immunity.
  • Targeting these cells could enhance immune responses against cancers.

Gene Therapy Overview

  • Gene therapy aims to correct or replace faulty genes.
  • It is used to treat diseases caused by mutations in specific genes, such as Duchenne Muscular Dystrophy, Severe Combined Immunodeficiency, and Sickle Cell Disease.
  • The most common approach is to insert a normal copy of a gene into a nonspecific location in the genome to replace its defective counterpart.

Common Approaches to Gene Therapy

  • Normal Gene Insertion: A functional copy of the gene is inserted into the genome to replace the non-functional one.
  • Gene Replacement through Homologous Recombination: The faulty gene is swapped for a normal version using the natural process of recombination.
  • Gene Repair: The faulty gene is corrected by inducing a selective mutation that restores its function, potentially using tools like CRISPR.
  • Gene Regulation Alteration: Gene expression can be adjusted to manage the disease by regulating the extent to which a gene is turned on or off.

How Gene Therapy Works

  • A normal gene is inserted into the target cell using a vector (e.g., a virus).
  • Example: Correction of X-SCID in bone marrow cells.
    • Bone marrow cells are isolated.
    • Cells are transfected in vitro with a retrovirus carrying the "normal" version of the X-SCID gene.
    • The retrovirally-transfected genes are tested for integration and expression.
    • The transformed bone marrow cells are returned to the patient.

Viral Vectors in Gene Therapy

  • Viruses are effective at inserting their genetic material into host cells, making them suitable for gene therapy.
  • Adenoviruses: Double-stranded DNA viruses that cause respiratory, intestinal, and eye infections. They can carry large genes but do not integrate permanently into the host's genome, making their effects temporary.
  • Adeno-associated Viruses (AAVs): Small, single-stranded DNA viruses that can insert their genetic material at a specific location on chromosome 19. They can integrate into the host's genome, providing stable gene expression and are often used for long-term gene therapy.
  • Herpes Simplex Viruses: Double-stranded DNA viruses that infect neurons. They can remain in the body for long periods, making them ideal for gene therapy targeting nervous system diseases.
  • Retroviruses: Convert their RNA genome into DNA, which can then integrate into the host cell’s genome permanently. An example is HIV.
  • Example:
    • X-SCID correction:
      • Bone marrow cells are isolated from a patient.
      • They are transfected in vitro with a recombinant retrovirus carrying a "normal" version of the X-SCID gene.
      • The retrovirally transfected genes are tested for integration and expression.
      • The transformed bone marrow cells are returned to the patient.

Non-Viral Gene Delivery Systems

  • Less efficient but offer an alternative to viral vectors.
  • Direct Injection: Injecting DNA directly into tissues, but with a low efficiency of DNA uptake by cells.
  • Electroporation: Using an electrical current to make cell membranes more permeable, increasing the efficiency of DNA uptake.
  • Gene Gun: Shoots DNA-coated particles into cells, mainly used in plant research.
  • Liposomal Delivery: DNA is packaged in fat bubbles that fuse with cell membranes, allowing DNA to enter cells.

Duchenne Muscular Dystrophy (DMD)

  • A severe, muscle-wasting disease caused by mutations in the dystrophin gene.
  • Primarily affects boys as it is an X-linked recessive disorder.
  • Patients are typically wheelchair-bound by age 12 and die in their 20s or 30s due to cardiac or respiratory failure.
  • The dystrophin gene produces a protein responsible for muscle stability and function.
  • Mutations in the dystrophin gene can be nonsense, frameshift, or in-frame.

Therapeutic Approaches for DMD

  • Mini Dystrophin Gene Delivery: Uses shortened versions of the dystrophin gene, inspired by Becker Muscular Dystrophy, which are small enough for viral delivery and retain functionality.
  • Transcriptional Read-Through: Some antibiotics, like gentamicin, can help cells read through premature stop codons in the dystrophin gene, potentially restoring protein production.
  • Exon Skipping: Uses modified RNA molecules to skip over defective exons, allowing the production of a shorter but functional dystrophin protein. This approach has shown promise and is in clinical trials.
  • Homologue Induction: Increases the expression of utrophin, a protein similar to dystrophin present in embryonic muscles, to compensate for the lack of dystrophin.
  • Myoblast Transfer Therapy (MTT): Transplants myoblasts, muscle precursor cells, from healthy donors into DMD patients. The goal is to have these cells fuse with the patient's muscle cells and provide functional dystrophin.

Challenges in Gene Therapy for DMD

  • Immune Response Issues: The immune system often rejects myoblasts transplanted in myoblast transfer therapy.
  • Regulatory T Cells (Tregs): Immune cells that help regulate the immune response and could potentially reduce myoblast rejection. Researchers are investigating ways to boost the number of Tregs in muscle tissue to protect donor myoblasts.
  • Cytokine Therapy: Experimented with to enhance Treg activity and suppress the immune response.

Key Takeaways

  • Gene therapy is a rapidly evolving field with potential for treating genetic diseases, but challenges remain.
  • Viral vectors are common but non-viral methods are gaining traction due to safety concerns.
  • New approaches offer hope for treating DMD, including exon skipping and cytokine-enhanced myoblast transfer.
  • Success requires the right delivery system, addressing immune system challenges, and ensuring long-term gene expression.

What is Gene Therapy?

  • Gene therapy aims to treat or prevent disease by inserting genes into a patient's cells.
  • It offers an alternative to traditional drug or surgical treatments.
  • Gene therapy applications include:
    • Replacing faulty genes with healthy copies.
    • Deactivating mutant genes.
    • Introducing new genes to treat complex diseases or generate essential proteins.

Viral Vectors in Gene Therapy

  • Modified viruses, known as vectors, deliver genes into cells.
  • These vectors are engineered to infect cells but lack disease-causing genes.
  • Viruses are chosen as vectors due to their ability to efficiently enter cells.
  • Common viral vectors include Adeno-Associated Virus (AAV), Lentivirus, and Retrovirus.

Ocular Gene Therapy

  • The eye is a suitable target for gene therapy due to several factors:
    • It is a small, compartmentalized organ, requiring smaller treatment doses.
    • The eye enjoys immune privilege, reducing the risk of rejection.
    • Contralateral control allows for comparison between treated and untreated eyes.
    • Its accessibility enables easy monitoring of gene therapy effects.
    • Certain AAV serotypes demonstrate effectiveness in eye delivery.

Developing a Gene Therapy Strategy

  • Key steps in developing an ocular gene therapy include:
    • Understanding the biology of the targeted disorder.
    • Selecting the appropriate gene and vector for delivery.
    • Testing the therapy in biological models (animal models or human-derived retinal cells).
    • Ensuring safety through animal trials before human trials.
    • Conducting clinical trials to assess therapeutic efficacy.

Types of Gene Delivery in the Eye

  • Subretinal Injection:
    • Involves injecting the gene therapy directly beneath the retina, targeting photoreceptor cells.
    • Highly specific but requires delicate surgery.
    • Essential for diseases affecting light-sensing cells, such as Leber Congenital Amaurosis (LCA).
    • Creates a local bleb (detached retinal area) that reattaches after injection.
    • Risk of tissue loss if the bleb does not reattach.
  • Intravitreal Injection:
    • A less invasive procedure where the vector is injected into the vitreous cavity.
    • Easier to perform and often used for treating ganglion cells (e.g., in glaucoma).
    • Less effective targeting for outer nuclear layer (ONL) cells, including photoreceptors.
    • Generates a stronger immune response due to widespread distribution.
  • AAV Properties:
    • Small (25 nm) with a single-stranded DNA genome (~5 kb).
    • Non-pathogenic.
    • Replication-deficient, requiring a helper virus like adenovirus.
    • Effective in both dividing and non-dividing cells.
    • Exhibits high-level, stable expression and low immunogenicity.
    • Limited genome packaging capacity restricts the size of therapeutic genes that can be delivered.

AAV Tropism in the Retina

  • Different AAV serotypes vary in their ability to target specific retinal cells.
  • AAV2, AAV8, and AAV9 are effective in the retina, but some are better suited for specific retinal layers.
  • Subretinal delivery typically targets photoreceptors, while intravitreal injections are better for ganglion cells.

Gene Therapy Examples: Bench to Bedside Pipeline

  • Leber Congenital Amaurosis (LCA):
    • Inherited eye disease caused by RPE65 gene mutations.
    • Symptoms appear at birth or in early childhood, leading to severe visual impairment or blindness.
    • The first FDA-approved gene therapy for LCA.
    • Involves replacing the defective RPE65 gene with a healthy copy via AAV-mediated delivery.
    • Animal studies (dogs and mice) showed remarkable improvement in visual function.
    • Over 11 clinical trials resulted in FDA approval in 2017.
    • Treatment demonstrated long-term vision restoration and improved retinal function.
  • Age-Related Macular Degeneration (AMD):
    • A progressive vision loss condition caused by abnormal blood vessel growth in the retina (wet AMD).
    • High levels of vascular endothelial growth factor (VEGF) contribute to the disease.
    • Current treatments involve frequent anti-VEGF injections to block VEGF activity.
    • Gene therapy solution: AAV vectors deliver genes encoding soluble VEGF receptor 1 (sFlt-1), inhibiting VEGF activity.
    • Preclinical studies:
      • Tested in the Kimba mouse model of chronic retinal degeneration.
      • Non-human primate studies showed safety, long-term efficacy, and lack of toxicity.
    • Clinical trials:
      • A trial at the Lions Eye Institute demonstrated promising results, with fewer injections and maintained visual acuity.

Challenges in Gene Therapy

  • Limited genome capacity: AAV can only carry small genes (~4.7 kb), limiting the deliverable gene size.
  • Pre-existing immunity: Many individuals have anti-AAV antibodies from previous infections, neutralizing the viral vector.
  • Delivery method: The choice of delivery method (subretinal vs. intravitreal) impacts the therapy's effectiveness.

Current and Future Trials

  • AAV-based gene therapies are being tested for various ocular conditions.
  • Trials for wet AMD are ongoing, using different AAV serotypes and injection methods.
  • New therapies are being explored for complex conditions like diabetic retinopathy and glaucoma.

Introduction to Molecular Therapies

  • Molecular therapies manipulate gene expression to treat rare inherited disorders.
  • This involves altering transcription, splicing, and translation processes.
  • Over 10,000 single-gene disorders are identified, but only 600 have available treatments.
  • All genetic mutations implicated in diseases present targets for molecular intervention.

Gene Expression Overview

  • Humans have approximately 42,000 genes, half of which are protein-coding.
  • Many genes undergo alternative splicing, resulting in over 30 million transcripts and complex protein products.
  • Alternative splicing is crucial in determining gene expression patterns.
  • Splicing can produce diverse protein isoforms with varying functions.
  • Disruptions in splicing can cause various diseases, making splicing an important therapeutic target.

Mechanisms of Genetic Mutations

  • Types of Mutations:
    • Missense Mutation: Alters protein structure, leading to loss or gain of function.
    • Nonsense Mutation: Introduces a premature stop codon, resulting in truncated and non-functional proteins.
    • Repeat Expansion: Seen in diseases like Huntington’s, with increased repeats leading to earlier onset and more severe symptoms with each generation.
  • Genetic modifications and diseases are influenced by factors such as non-coding RNAs, trans-acting factors, and epigenetics.

Therapeutic Approaches

  • Gene Replacement: Gene therapy replaces faulty genes entirely, while molecular therapies target gene expression at various stages (e.g., splicing, transcription).
  • Antisense Oligonucleotides (AOs): Synthetic molecules modulate mRNA splicing, block translation, or induce RNA degradation, providing precise treatment options for genetic diseases.

Challenges in Rare Diseases

  • Rare Diseases Stats: Over 6,000 rare diseases affect 300 million people worldwide, with a high fatality rate and 95% lacking treatment.
  • Diagnosis often takes years, and many conditions remain unexplained.
  • They collectively affect more people than cancer.
  • The changing demographics due to migration make rare diseases a global concern.

Opportunities for Intervention

  • Molecular therapies offer potential for treating diverse genetic disorders through various mechanisms.
  • The text highlights specific examples, including:
    • Duchenne Muscular Dystrophy (DMD):
      • Caused by mutations in the dystrophin gene, leading to progressive muscle degeneration.
      • Antisense oligonucleotide therapies are being studied to skip exons and restore a functional reading frame, potentially reducing disease severity.
    • Spinal Muscular Atrophy (SMA):
      • Caused by deletion of the SMN1 gene, resulting in motor neuron death.
      • Antisense therapies like "Nusinersen" promote exon expression and improve survival rates in affected infants.
    • Retinitis Pigmentosa:
      • Antisense therapies are being investigated to downregulate harmful transcripts and preserve vision in this degenerative eye disease.

DMD

  • DMD is a fatal X-linked muscular wasting disorder affecting 1 in 3,500 boys.
  • Frame-shifting or nonsense mutations in the dystrophin gene cause the disease.
  • Progressive disease leads to eventual respiratory or cardiac failure.
  • Protein truncation due to mutations leads to a severe phenotype.
  • BMD (Becker Muscular Dystrophy) is a milder allelic disorder with in-frame deletions that result in dystrophin levels greater than 3% of normal.
  • BMD phenotypes can be variable, with large deletions sometimes associated with mild or asymptomatic disease.

Muscle Damage in DMD

  • Dystrophin acts as a mesh around muscle fibers.
  • Lack of dystrophin weakens muscles, leading to muscle fiber tears and contraction-induced damage.
  • Damaged tissue attracts calcium, making the membrane leaky and allowing creatine kinase to leak out.
  • Elevated creatine kinase levels in the blood indicate muscle damage.
  • Proteases digest muscle fibers, leaving behind satellite cells (muscle stem cells) which proliferate under growth factor influence (like IGF) and fuse to form new muscle fibers.
  • The repair process is limited, and muscle regeneration often fails, leading to scar tissue formation.
  • Antisense oligonucleotide therapies target specific exon 50-51 to block splice sites and restore a functional reading frame.
  • Clinical studies from 2008 to 2016 involved morpholino nucleic acid analogues like AVI 4658, eteplisen, and Exondys51.

Exondys51

  • Ten years of preclinical studies using treatment of neonatal mdx (dystrophic) mice showed the ability to prevent the onset of dystrophy.
  • Exondys51 was approved by the FDA on September 19, 2016.

Spinal Muscular Atrophy (SMA)

  • Caused by homozygous deletion of the SMN1 gene.
  • SMN provides survival signals to motor neurons.
  • Ongoing motor neuron death leads to respiratory failure between 6-13 months of age.
  • It is the second most common genetic cause of death.
  • The most severe form (Type I) affects 1 in 10,000 births.
  • Less severe forms (Type II and III) affect 1 in 24,000.

AAVmdys

  • Gene therapy producing tiny dystrophins.

CRISPR-Cas9 System

  • CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats
  • It is a naturally occurring genome editing system found in bacteria
  • Bacteria capture snippets of DNA from invading viruses to “remember” them
  • CRISPR-Cas9 system utilizes this mechanism to cut DNA and disable the virus
  • Cas9 is the protein that cleaves DNA
  • Guide RNA (gRNA) directs Cas9 to the specific target DNA sequence
  • gRNA combines crRNA and tracrRNA
    • crRNA (CRISPR RNA) is specific to the target DNA sequence
    • tracrRNA (trans-activating crRNA) acts as a scaffold for Cas9
  • PAM (Protospacer Adjacent Motif) sequence is required for Cas9 to distinguish non-self from self DNA
  • Non-Homologous End Joining (NHEJ): Error-prone repair mechanism leading to insertions/deletions (indels)
  • Homology Directed Repair (HDR): Precise repair mechanism that uses a template and occurs only in dividing cells

CRISPR Delivery Methods

  • CRISPR components can be delivered through various methods:
    • Plasmids: Long-lived but higher risk of off-target effects
    • Ribonucleoprotein Complexes (RNPs): Preferable for clinical applications, rapid turnover
    • mRNA: Cas9 delivered as mRNA that translates into protein
    • Nanoparticles: Can improve delivery efficiency, specificity, and reduce immune cell recognition

CRISPR Applications

  • Gene Editing:
    • Knockout: Disabling a gene to study its function
    • Knock-in: Introducing a specific gene or mutation
    • Base Editing: Precisely altering a single nucleotide using base editors
  • Gene Activation/Repression:
    • dCas9 (dead Cas9): Catalytically inactivated Cas9 fused to effectors to activate or repress target loci

Clinical Applications

  • Monogenic Diseases:
    • Cystic fibrosis
    • Haemophilia
    • Sickle cell disease
    • Duchenne muscular dystrophy (DMD)
  • Other Diseases:
    • Cancer
    • Heart disease
    • HIV infection

Case Study: Cystic Fibrosis

  • Autosomal recessive disease caused by mutations in the CFTR gene
  • Build-up of mucus in lungs and other organs
  • Most common mutation is a deletion of phenylalanine (ΔF508)
  • CRISPR can correct mutations in the CFTR gene

Challenges

  • Delivery to Cells: Viral vectors have size limitations
  • Ethical Considerations: Off-target effects, germline editing, regulatory issues
  • Therapeutic Potential: CRISPR is highly promising for monogenic diseases but faces difficulties targeting non-dividing cells and maintaining long-term corrections.

iPSCs and CRISPR

  • iPSCs (induced Pluripotent Stem Cells): High self-renewal rate and can differentiate into various cell types
  • Ex vivo therapy: Correcting patient-derived cells through gene editing and transplanting them back
  • Disease Modeling and Drug Testing: iPSCs can be used to model human diseases and test drugs in a patient-specific context.

Challenges in Gene Therapy

  • Most common human illnesses are caused by multiple gene mutations, making targeted gene therapy difficult.
  • Gene therapy in non-stem cells often results in short-lived corrections due to cell turnover.
  • The body's immune system can mount a reaction against gene therapy, especially with repeated treatments.
  • Gene editing tools can potentially cause unintended mutations, leading to genomic instability.
  • Delivering genes efficiently into non-dividing somatic cells is a challenge.

Vector Types

  • Adenoviruses are non-integrating, meaning they don't insert their genetic information into the host's genome, resulting in temporary gene expression. They often provoke immune responses.
  • Adeno-associated viruses (AAVs) are generally safe and efficient for gene delivery, but have limited capacity for larger genetic sequences.

What is CRISPR?

  • A bacterial defense mechanism against viruses.
  • Consists of short repeated sequences with unique spacer sequences in between.
  • Spacers are derived from viral or plasmid DNA.
  • Relies on CRISPR-associated (Cas) genes.
  • Functions as a natural immune surveillance system in bacteria.

CRISPR-Cas9 System

  • Adapted from the naturally occurring genome editing system in bacteria.
  • Allows bacteria to "remember" viruses by storing snippets of viral DNA in its genome.
  • Uses the Cas9 enzyme to cut and disable invading viral DNA.
  • Requires a Protospacer Adjacent Motif (PAM) sequence for efficient cutting, which distinguishes non-self from self DNA.

Components of CRISPR-Cas9

  • Cas9 enzyme (or other Cas proteins in different bacteria).
  • Guide RNA (gRNA):
    • crRNA (CRISPR RNA): Sequence-specific, binds to target DNA.
    • tracrRNA (trans-activating crRNA): Scaffold for Cas9 binding.
  • Components can be delivered with plasmids (long-lived) or as ribonucleoprotein (RNP) complexes (rapid turnover).
  • RNP delivery is preferred for clinical application due to reduced off-target effects.

CRISPR Mechanism

  • Cas9 enzyme cuts DNA at specific sites guided by the gRNA.
  • PAM sequence is crucial for Cas9 to induce DNA cleavage, typically 3-5 nucleotides long.
  • The guide RNA (gRNA) directs the Cas9 enzyme to the target site.

CRISPR for Genomic Manipulation

  • CRISPR induces DNA cleavage, initiating repair pathways:
    • Non-Homologous End Joining (NHEJ): Error-prone, often used to knock out genes.
    • Homology Directed Repair (HDR): Allows precise gene editing using a template, but limited to certain cell cycle phases.

CRISPR Delivery Methods

  • Viral Vectors: Adeno-associated virus (AAV)
  • Physical Methods: Microinjection, electroporation.
  • Nanoparticle-based delivery: Lipid particles, nanoparticles.
  • The choice of delivery method affects uptake efficiency and editing success.
  • In vivo editing is generally more challenging than in vitro editing.

CRISPR for Gene Activation or Repression

  • Catalytically inactive Cas9 (dCas9): No DNA cleavage activity but can be fused to effectors to activate or repress gene expression.
  • dCas9 binding to the target site is mediated by the gRNA.

CRISPR Applications

  • Research: Investigate gene function, model disease-causing mutations, create knock-ins.
  • Therapeutic: Correct underlying mutations, delete mutant genes, upregulate alternative gene isoforms.
  • CRISPR therapy holds potential for a permanent cure, eliminating the need for continuous drug dosing.

CRISPR Therapy and iPSCs

  • iPSCs are induced pluripotent stem cells that can be differentiated into several cell types.
  • Ex vivo therapy: Patient cells are corrected using gene editing and transplanted back into the patient.
  • iPSCs enable disease modelling and testing in a patient-specific context.

CRISPR Therapeutic Strategies

  • Allele-specific deletion of disease-causing genes using common single-nucleotide polymorphisms (SNPs).
  • Upregulation of alternative gene isoforms.

Promising Therapeutic Applications

  • Monogenic diseases: Cystic fibrosis, Hemophilia, Sickle cell disease, Duchenne muscular dystrophy.
  • Potential applications in common diseases: Cancer, heart disease, HIV infection.

Case Studies

  • Cystic fibrosis:

    • Challenges: Delivery into basal airway cells.
    • Research focuses on targeting basal cells for sustainable long-term restoration of airway function.
    • Base editing of stem cells from CF patients shows promise.
  • Sickle Cell Disease (SCD) and Transfusion-Dependent Beta Thalassemia (TDT):

    • Mutations in the HBB gene leading to ineffective red blood cell development.
    • CRISPR targeting strategies to increase levels of fetal hemoglobin (HbF).
    • Clinical trials have shown successful editing in hematopoietic stem and progenitor cells, leading to transfusion independence.
  • Casgevy:

    • First clinically approved CRISPR-based therapy for transfusion-dependent beta-thalassemia (TDT).
    • Significant reduction or elimination of transfusion dependency, improving quality of life.
  • Duchenne Muscular Dystrophy (DMD):

    • Mutations in the dystrophin gene leading to muscle degeneration.
    • CRISPR is used to “reframe” the mutated gene by removing or adding specific exons, producing a functional dystrophin protein.
  • Hemophilia B:

    • Mutations in the coagulation factor IX (FIX) gene causing bleeding disorders.
    • CRISPR-mediated gene knock-in of FIX cDNA at the ROSA26 locus in mice achieved long-term correction of bleeding phenotypes.
  • HIV-1/AIDS:

    • CRISPR editing of CCR5 co-receptor to prevent HIV-1 infection.
    • Clinical trials have shown that CRISPR-edited HSCs can resist HIV-1 infection.

Clinical Trials

  • 4 phases of clinical trials to ensure safety and efficacy.
  • Focus on different aspects of the treatment during each phase.

CRISPR Limitations

  • Delivery method: Challenges in in vivo delivery, especially with AAV vectors.
  • Editing efficiency: Varies depending on cell type and tissue.
  • Off-target effects: Unintended consequences that can be difficult to predict.
  • Immune response: Potential for immune reactions against Cas9, gRNA, or viral vectors.
  • Time and cost: Significantly high development costs and expensive treatments.

Ethical Concerns

  • Eugenics: Potential misapplication for genetic manipulation.
  • Misapplication: potential misuse for unethical purposes.
  • Inequitable access: Concerns about unequal access to gene-editing technologies.
  • Regulation: Need for strict regulations to ensure responsible use.
  • Embryo modification: Ethical concerns surrounding gene editing in embryos.

Transplantation

  • Solid organ and haematopoietic stem cell transplantation are common medical procedures.
  • The immune system can recognize and reject transplanted tissues.
  • Allorecognition is mediated by T cells and antibodies.
  • Transplantation can be autologous, isologous, homologous, or heterologous.

Major Organs and Tissues Transplanted

  • Solid Organs:
    • Thoracic: Heart, Lung
    • Abdominal: Kidney, Liver, Pancreas, Intestine, Stomach, Uterus.
  • Cells, Tissues, and Fluids:
    • Bone marrow, Stem cells, Blood transfusion, Blood vessels, Heart valve, Cornea, Limb, Skin, Islets of Langerhans, Bone.

Allograft Rejection

  • Allograft rejection is a complex process involving the immune system.
  • The HLA Complex on chromosome 6 plays a crucial role in allograft rejection.
  • HLA class I and class II genes are involved in tissue compatibility.
  • Class I HLA: Expressed on all nucleated cells.
  • Class II HLA: Expressed on antigen-presenting cells (APCs), B cells, and activated T lymphocytes.

HLA Diversity and Matching

  • HLA alleles are highly polymorphic, contributing to individual differences.
  • HLA matching is crucial for successful transplantation.
  • The MHC presents pathogen-derived peptides to T cells, initiating an immune response.
  • Mismatched HLA molecules can trigger an immune response leading to allograft rejection.

Allograft Rejection and Immune Response

  • Allograft rejection shares features with a normal immune response to pathogens.
  • Evidence of immunologically mediated rejection:
    • Latent period
    • Memory (second-set rejection)
    • Specificity
    • Passive transfer by lymphocytes
    • Production of antibodies

Immune Destruction of Kidney Grafts

  • ABO blood group compatibility is essential for kidney transplantation.
  • Preformed ABO isohaemagglutinins can bind to vascular endothelium causing hyperacute rejection.
  • Hyperacute rejection is antibody-mediated.

Chronic Rejection

  • Chronic rejection occurs months to years after transplantation.
  • Gradual narrowing of vascular arterial lumen due to endothelial cell proliferation and fibrosis.
  • Leads to graft ischemia, interstitial fibrosis, and tubular atrophy.
  • Mechanisms include chronic endothelial damage, ongoing cellular and vascular rejection, and immune complex deposition.

HLA Matching and Renal Transplantation

  • HLA matching is essential for successful kidney transplantation.
  • HLA-A, -B, and -DR matching is considered in the Australian National Organ Matching Program (OrganMatch).
  • Most transplants involve multiple HLA mismatches due to limited donor pool and diverse ethnic backgrounds.
  • HLA mismatching is associated with increased immunoreactivity, leading to higher rates of rejection.

HLA Mismatching and Transplant Outcomes

  • HLA mismatching predicts a higher frequency and potency of rejection treatment, increased serum creatinine, higher immunosuppressive drug dosage, increased risk of infection, and higher incidence of non-Hodgkin lymphoma.
  • HLA mismatching can also lead to sensitization of the recipient.
  • Proper HLA matching significantly influences graft survival and overall transplant outcome.

Liver Transplant

  • Liver transplant is a complex procedure involving a donor and a recipient.
  • Not all organs are suitable for donation, with 50-75% of organs being unusable.
  • 25% of Australians donate organs.
  • A donor cannot donate to a recipient, and a recipient cannot receive from their own donor.
  • A patient is declared dead before organ retrieval, either by brain death (DBD) or circulatory death (DCD).
  • DCD patients require therapy withdrawal, leading to a drop in blood pressure (systolic pressure below 50).
  • A 5-minute waiting period is required after the heart stops beating before organ retrieval.
  • The donor is then transferred to the operating room.
  • Once the abdomen is opened, a catheter is inserted and the organ is perfused with the recipient’s blood.
  • The organ then undergoes warm ischemic time (WIT), which is undesirable, and then cold ischemic time (CIT), which is preferred.
  • WIT is the time between the cessation of blood flow to the organ and the start of perfusion.
  • CIT is the time between the start of perfusion and the transplant.
  • Perfect CIT is 6-9 hours within the state and 9 hours interstate, but up to 14 hours with safe outcomes.
  • Livers have a short WIT limit (30-60 minutes).
  • This is why cardiac donors are not preferred for liver transplants.
  • Kidneys are more tolerant of WIT, with a maximum of 90 minutes.
  • The quality of the liver is assessed using a scoring system based on age and the presence of fatty tissue.
  • Livers with a fatty liver percentage greater than 70% are usually not used.
  • Livers with a 20-40% fatty liver percentage may be acceptable, especially in younger recipients.
  • The anatomy of the surrounding structures is also assessed, including accessory vessels for reconstruction.
  • Variations in the anatomical structure of the liver, such as an accessory hepatic artery, are common.
  • The bile duct is assessed for any damage or complications, as it is particularly sensitive to WIT.
  • The most common reasons for organ donation are aneurysm and stroke.
  • The organ is prepared for transport by perfusion with UW solution, which is a cold preservation solution.
  • The UW solution reduces cell metabolism and maintains cell membrane stability.
  • The donor’s chest is opened and the heart and lungs are perfused with the recipient’s blood.
  • This perfusion is performed at the same time for all organs, marking the start of CIT.
  • The organ is perfused through the abdominal aorta, which has several branches:
    • Celiac artery: supplies blood to the liver, stomach, and spleen.
    • Superior mesenteric artery (SMA): supplies blood to the small and large intestines.
    • Inferior mesenteric artery (IMA): supplies blood to the left side of the colon.
    • Left and right renal arteries: supply blood to the kidneys.
  • The perfusion continues until the liquid in the artery becomes transparent with the UW solution.
  • Topical and central cooling are essential for bringing the organ into CIT.
  • The liver is then packed in iced water and placed within three bags of UW solution for transport.
  • The donor’s kidneys can be retrieved either individually or combined for transplantation into a single recipient, depending on the size of the kidneys.
  • Each organ is transported in a different colored bag.
  • The surgeon carefully examines the donor organ to identify any anatomical variations or abnormalities.
  • The liver is then re-constructed with five key structures, including the portal vein and the hepatic artery.
  • The recipient’s liver is removed and the new liver is inserted.
  • The surgical procedure is complex and requires careful reconstruction of the five main structures.
  • New clinical techniques are being used to test the function of the liver before retrieval.
  • Perfusion on the table is used to assess the organ’s viability and improve its overall quality.
  • The recipient’s blood supply is restored to the new liver, followed by anastomosis (connection) of the bile duct.
  • If the liver is too large, a device can be used to push the recipient’s ribcage up.
  • Different techniques are used to address variations in the inferior vena cava (IVC), including caval replacement and cavaplasty.
  • Common complications include portal vein thrombosis, which may require clot removal or bypass surgery.
  • Reconstructions may involve a conduit to bypass a blocked or compromised hepatic artery.
  • The Roux-en-Y procedure is used to reconstruct the bile duct if it is unusable or incompatible.
  • A single donor can provide organs for two recipients.
  • The entire process requires careful observation of the anatomy and meticulous surgical techniques.

Organ and Tissue Donation: Ethics and Logistics

  • DonateLife: A national program in Australia that enables individuals to choose to become organ and tissue donors at the time of death.
  • Legal Framework: The Human Tissue and Transplant Act 1982 and Coroners Act 1996 provide the legal foundation for organ and tissue donation.
  • Rarity of Donation: Organ and tissue donation remains scarce, while the demand for transplantation continues to increase.
  • Deceased Organ Donation:
    • Criteria: Donation can be considered following neurological death or circulatory death.
    • Neurological Death: Occurs after irreversible cessation of all brain function.
      • Causes:
        • Traumatic Brain Injury: Road traffic accidents, gun shot wounds, falls.
        • Spontaneous Intracranial Haemorrhage: Subarachnoid or intracerebral haemorrhage.
        • Hypoxic Injuries: Cardiac arrest, drowning, hanging, asthma.
      • Determination: Two medical practitioners, one a specialist in neurology, neurosurgery, or general medicine, must certify death.
      • Clinical Testing: Includes assessment of pupil reactivity, motor function, and respiratory effort.
      • Radiological Imaging:
        • Four-vessel Angiography: Visualizes cerebral blood flow.
        • Radionuclide Scan: Measures brain perfusion.
    • Donation After Circulatory Death (DCDD):
      • Organs and tissues are retrieved after cessation of circulation.
      • Decision to withdraw life support is made independently of donation decisions.
  • Pathways to Donation:
    • Neurological Death:
      • Catastrophic neurological injury leads to declared death.
      • Consent is obtained, and donor information collected, including tissue typing and serology.
      • Organs are offered and allocated to potential recipients.
    • Circulatory Death:
      • Catastrophic irreversible injury occurs.
      • End-of-life care, withdrawal of treatment, and consent are managed.
      • Donor information is collected, and organs are offered and allocated.
      • Circulatory death is declared within 90 minutes of withdrawal, with time criteria varying based on organ allocation.
  • Organ Suitability:
    • Organ information is provided to transplant units.
    • Potential recipients are identified and tissue typing is performed for crossmatching.
  • Organ Offers: Prioritized based on:
    • Urgent Listings: Patients facing immediate life-threatening situations.
    • Regional Allocations:
      • Within WA: Based on recipient's location.
      • Interstate: Offers considered if no suitable recipients within WA.
    • Matching: Includes blood type, size match, and recipient's clinical urgency.
  • Logistics of Donation:
    • Consent: Essential from the donor (AODR, No Known Objection), next of kin (if available), and potentially the Coroner.
    • Family Donor Conversations (FDC): Clinicians undergo specialized training to support families in making informed decisions about donation.
    • Donor Information Collection:
      • Comprehensive medical history, physical assessments, and laboratory tests are performed.
      • Bloods for serology, tissue typing, and nucleic acid testing (NAT) are collected.
    • Donor Management:
      • The ICU team manages organ perfusion and ensures vital signs stability.
      • Proactive management includes addressing potential complications like hypotension, hypothermia, and electrolyte imbalances.
  • Ethical Dilemmas in Organ Donation:
    • Balancing Patient's Rights: Ensuring patient autonomy and informed consent while respecting the potential benefits of donation.
    • Minimizing Risk: Ensuring the safety and well-being of both the donor and the recipient.
    • Fair Access: Ensuring equitable distribution of organs to those in greatest need.
  • Ethical Perspectives:
    • Utilitarianism: Emphasizes maximizing overall wellbeing and minimizing harm, which can support organ donation as it benefits both the recipient and society.
    • Deontology: Focuses on moral duties and principles, and may argue that respecting the autonomy and bodily integrity of the deceased is paramount.
  • Cultural and Religious Considerations:
    • It is crucial to be sensitive to cultural and religious beliefs when discussing donation with families.
    • Some religions may permit or prohibit donation, and family preferences should be respected.
  • Future Considerations:
    • Increasing the organ donation rate through education, awareness campaigns, and streamlined donation processes.
    • Exploring novel approaches to organ preservation and allocation.
    • Expanding the use of DCDD, with consideration for patient factors and ethical considerations.

Musculoskeletal Tissue Banking

  • Bone Composition:
    • 60% inorganic (calcium and phosphorus)
    • 10% water
    • 30% organic (collagen type I and non-collagenous proteins)

Osteogenesis

  • Bone formation and resorption:
    • Occurs through a process called remodelling
    • Regulated by osteoblasts (formation) and osteoclasts (resorption)
    • Imbalances can lead to conditions like osteoporosis (excess resorption) or osteopetrosis (excess formation)
  • Factors involved:
    • Growth factors: promote cell growth and differentiation
    • Cytokines: influence bone cell function, including bone morphogenetic proteins (BMPs)
    • Functions:
      • Regulate and differentiate bone cells
      • Provide support for cell adhesion
      • Contribute to bone matrix mineralization

Ideal Bone Substitute Properties

  • Osteoconductive: Ability to serve as a scaffold for bone growth
  • Osteoinduction: Ability to stimulate bone formation
  • Active: Contains growth factors to promote bone formation
  • Passive: Provides a supportive environment for bone growth without growth factors
  • Osteointegration: Ability of the implant to integrate with the recipient's bone
  • Non-immunogenic: Minimizes immune rejection
  • Resorption rate/degradability: Determines how long the implant lasts
  • Availability: Supply meets demand
  • Easy to use: Simple to handle and implant
  • Affordable: Cost-effective for patients
  • Fit for purpose: Meets specific clinical requirements
  • Structural integrity: Maintains shape and strength
  • Biologically safe: Donors undergo rigorous screening to prevent disease transmission
  • High surface area: Enhances osteoconduction
  • Low risk of disease transmission: Crucial for donor screening and processing

Three O’s for Bone Growth

  • Osteogenesis: Normal bone growth requiring osteoblasts and osteoprogenitor cells
  • Osteoconduction:
    • Stimulation of undifferentiated cells into osteoprogenitor cells
    • Induces osteogenesis
    • Growth of bone through a scaffold
  • Osteoinduction (active/passive):
    • Surface contact to conduct ‘growth’
    • Can be achieved through growth factors (BMPs) in the case of active osteoinduction or by other environmental factors
    • Facilitates communication and promotion of bone growth.
  • Osteointegration:
    • Implant to recipient bone contact
    • Anchors the graft
    • Creates a bone-conducive environment for growth
    • Material properties (biocompatibility, degradation) play a crucial role

Bone Graft Types

  • Autograft:
    • Patient's own bone
    • Considered the gold standard
    • Commonly sourced from the iliac crest, but also obtained from the fibula, radius, ulna, hamstring tendons, and patella tendon
  • Allograft:
    • Donated bone from living or deceased donors
    • May include bones and tendons (lower limb)
    • Types:
      • Cancellous bone: Great for osteoconduction but offers less structural support
      • Cortical bone: Provides excellent structural support, but has a limited surface area and can be slow to incorporate into the recipient bone
  • Other attributes of allografts:
    • Immunogenicity
    • Disease transmission risk
    • Structural integrity
    • Depend on how the tissue is processed

Bone Substitute Options

  • Demineralized Bone Matrix (DBM):
    • Allograft with the mineral phase (calcium compounds) removed
    • Tissue is exposed to strong acids
    • Variable osteoinductivity
  • OP-1 Implant (Collagen & BMP-7):
    • A putty-like growth factor (BMP-7)
    • Primarily osteoinductive
    • Potential for adverse effects: infection, immune response, and lack of bone homeostasis
    • Often used in combination with other bone healing products
  • Others:
    • Xenograft: Bone from other species (e.g., bovine, porcine) used in dental implants, heart valves, and skin grafts
    • Coralline hydroxyapatite: Ceramic-based bone substitute
    • Ceramics: Various ceramic materials for bone regeneration

PlusLife

  • A non-profit organization that retrieves, processes, and distributes donated human bone and tissue for transplantation purposes
  • Also involved in research
  • Statistics:
    • 15,000 living donors
    • 350 cadaveric donors
    • 11,000 recipients
    • 18,000 implants

Quality and Regulations

  • TGA Licenced Facility:
    • Adheres to Good Manufacturing Practice (GMP) for Human Blood and Tissues
  • Quality assurance:
    • Ensures product safety, effectiveness, and high quality
    • Implementing controls for processes that can be controlled
    • Assessing risks for processes that cannot be easily controlled

Process Controls

  • Bone donations:
    • Donor screening and medical evaluation
    • Strict criteria for donor eligibility
  • Histopathology:
    • Microscopic examination of all bone tissue
  • Microbial tests:
    • Tissue samples and swaps are tested for microbial contamination
  • X-rays:
    • Performed on deceased donors to assess bone health
  • Terminal irradiation:
    • Bone and tendons are sterilized using gamma irradiation (15kGy for soft tissue, 25kGy for bone)
  • Clean room (Grade-C):
    • HEPA filtered air
    • Low particulate walls
    • Sterile instruments and consumables
  • Pressure gradients:
    • To prevent contamination
  • Rigorous cleaning:
    • Maintain a clean and sterile environment
  • Microbiology monitoring:
    • Regularly assess for microbial contamination
  • Particle counting:
    • Monitoring air quality to minimize particulate matter

Musculoskeletal Graft Applications

  • Orthopaedics:
    • Joint replacement
    • Infection
    • Fracture repair (especially periprosthetic fractures)
    • Fusion procedures
    • Tendon and ligament repair
    • Osteosarcoma
  • Maxillo-facial / Dentistry:
    • Dental implants
    • Craniofacial reconstruction
  • Other Applications:
    • Urology
    • Plastic surgery
    • Neurosurgery
    • Spinal fusion
    • Trauma

Situations Where Bone Loss Occurs

  • Trauma:
    • Fractures, especially open fractures
  • Surgery:
    • Joint replacement surgery
    • Bone tumor resection
  • Infection:
    • Osteomyelitis (bone infection)

PlusLife Donor Programs

  • Living Donor Program:
    • Patients undergoing total hip replacement (THR)
    • Femoral head is typically discarded and replaced with an implant
    • Can be donated
    • ~800 femoral heads donated per year, resulting in 1200 allografts
  • Cadaveric Program:
    • Donation of long bones and tendons from deceased donors
    • Referrals through DonateLife
    • ~12 cadaveric donors per year, contributing to 500 allografts

Exclusion Criteria (Donor Screening)

  • Ultra-conservative approach:
    • Rigorous assessment of all donors
  • TGA Guidance:
    • Strict guidelines for donor screening
  • Medical and Social History:
    • Comprehensive review of medical and social history
  • Face-to-face donor interview:
    • Especially for femoral head donations (FHD)
  • Key exclusion criteria:
    • Past or present malignancy
    • Autoimmune disorders
    • Travel history
    • Hepatitis B & C, HIV, HTLV, Syphilis
    • Medications, previous surgery

Tissue Processing

  • Production planning:
    • Careful planning to customize production sessions
  • Tissue clearance:
    • Microbial results
    • Histology results
    • Physical examination
    • Medical history (e.g., ACL repair)
    • Commercial need
    • Time available
  • Production setup:
    • Conducted in a Class C cleanroom environment
    • HEPA filtered air, non-shedding walls
    • Sterile instruments and consumables
    • Line clearance (remove potential contaminants)
    • Gowned personnel
    • Circulator and scrub person
    • Double gloving
    • Environmental and personnel monitoring
    • Microbial testing

Cadaveric Processing

  • Debridement:
    • Removal of soft tissues and contaminants from bone
  • Graft types:
    • Various types processed from cadaveric bone and tendons, depending on intended use
  • Packaging:
    • Careful packaging to maintain sterility and integrity of the graft
  • X-rays and photos:
    • Documentation of the processed graft

Femoral Head Processing

  • Nibbling and cutting:
    • Bone is shaped and sized for specific applications
  • Milling, washing, and packing:
    • Further preparation and packaging for distribution

Bioburden Reduction - Irradiation

  • Terminal irradiation (gamma):
    • Irradiated to kill any remaining microorganisms
    • 15kGy for soft tissue, 25kGy for bone
  • Dispatched and stored:
    • Graft is stored at a controlled temperature

Allografts

  • A graft - organ, tissue, or cells - donated from one individual of the same species to another.
  • Common allograft types include organs, musculoskeletal tissue, other tissue, and cells.
  • Allografts have a significant therapeutic benefit and can be life saving or enhancing.
  • Allograft transmission refers to the spread of infection from the donor to the recipient.
  • "Allograft-transmissible" infections can be difficult to differentiate from regular infections due to the recipient's vulnerability post-transplant.

Transmission of Infections

  • Transmission can occur via acute or latent/chronic donor infection.
  • A single donor can infect multiple recipients.
  • Lookback investigations involve testing donor-recipient pairs to identify potential infections.
  • Transmission can also occur via contamination of the graft, including from the donor's normal microflora, environmental sources, or during processing.

Transmission Criteria

  • The presence of HIV, HBV, or HCV in a donor does not necessarily contraindicate donation.
  • Decisions about proceeding with donation and transplantation depend on recipient informed consent, the nature of the infection, other recipient clinical factors, and the availability of effective treatment.
  • Reported examples of allograft-transmissible infections include Ehrlichiosis, Chagas disease, Hepatitis B, Hepatitis C, Hepatitis A, Tuberculosis, Legionnaires Disease, Listeriosis.

Prevention of Transmission

  • Biological product safety tiers address both transmission and overall donor/recipient safety.
  • Donor selection guidelines aim to minimize risks to both the donor and recipient and ensure graft functionality.
  • These guidelines encompass a range of factors including medical conditions, medications, risk behaviors, travel history, and graft condition.
  • Comprehensive screening involves a donor questionnaire and various tests to identify potential risks.
  • The "window period" is the time between infection and detectable presence of an infectious agent in the bloodstream, which varies by agent and type of test.

Biovigilance

  • A coordinated system to detect adverse events associated with biological products, encompassing traceability, quality control, and recalls.
  • Passive recipient surveillance involves reporting events as they occur.
  • Biovigilance tracks and monitors infection rates, trends, epidemiology, and non-compliance to identify and address potential issues.

Residual Risk

  • Transmissibility criteria and agents constantly evolve due to factors like travel, climate change, globalization, emerging infectious diseases, vaccine hesitancy, and antimicrobial resistance.
  • Risk reduction measures can include donor education, additional eligibility criteria, deferral from certain donation types, and new screening tests.

Risk Management

  • Managing risk involves balancing the sufficiency of graft supply, cost and availability of intervention, and effectiveness.
  • Risk tolerance and response vary significantly across different sectors due to factors like graft availability, time sensitivity, matching difficulty, graft urgency, and consequences of not receiving the graft.

Risk Comparison

  • Blood donations have a relatively plentiful supply, donors are interchangeable, and transfusions are often indicated for minor reasons.
  • Bone marrow donations require precise matching, donor pools are limited, graft performance varies, and decisions are highly individualized.
  • Organ donations are scarce, timing is unpredictable for deceased donors, recipients may experience health decline or death while waiting, and transmitted infections can be serious, leading to individualized decisions.

Therapeutic Goods

  • Therapeutic Goods Act 1989 defines ‘therapeutic good’ and ‘therapeutic use’
  • The principal use and presentation of a product are key to determining if it is a food or a medicine
  • Cosmetics are therapeutic goods if they contain sunscreen agents and claim to protect skin from UV radiation
  • Excluded goods: hair bleaches, hair dyes, dental bleaches, dental whiteners, chemicals to harden finger nails, equipment to measure alcohol in body fluids, reproductive tissue for use in assisted reproductive therapy.

Regulation's Importance

  • Thalidomide: Used in 1950s for morning sickness, later discovered to cause severe birth defects.
  • Vioxx: A pain medication from the 1990s, later withdrawn due to serious health risks and led to $4.85 billion in legal claims.
  • ASR Hip implant: Recalled in 2009 due to high failure rates.
  • Poly Implant Prothese (PIP) Breast Implants: Removed from the market in 2010 for non-compliant manufacturing practices and health risks.

Regulatory Framework

  • Therapeutic Goods Administration (TGA): Responsible for the quality, safety, and efficacy of therapeutic goods.
  • The TGA administers the Therapeutic Goods Act 1989 and related regulations.
  • The TGA works with consumers, healthcare professionals, industry, and international counterparts.

Biotherapeutic Goods

  • Some biotherapeutic products are excluded from regulation as therapeutic goods, e.g., fresh human organs, haematopoietic progenitor cells, and autologous tissues and cells manufactured by a medical practitioner for single-indication treatment.
  • Understanding the classification of a biotherapeutic product (medicine, medical device, or biological) is crucial for navigating the regulatory landscape.

Pre-market Regulation

  • Biotherapeutic product evaluation involves reviewing safety, quality, and efficacy data.
  • Safety and quality data: Includes information on donor selection, blood sampling, donor evaluation, and starting material collection.
  • Manufacturing data: Covers manufacturer details, process description, transportation, labelling, storage, and validation.
  • Non-clinical safety data: Includes biological dynamics, proof of concept, physiological effects, pharmacology, toxicology, and immunogenicity.
  • Clinical data: Includes biodynamics, mechanism of action, biokinetics, dose-finding, clinical efficacy, adverse effects, and biovigilance/pharmacovigilance.

Cell Therapies and Regenerative Medicine

  • FDA RMAT Designation (Regenerative Medicine Advanced Therapy Designation): Provides an expedited pathway for cellular and gene therapies intended for serious or life-threatening diseases.
  • RMAT Eligibility Criteria: The therapy must be a regenerative medicine therapy, intended for a serious or life-threatening disease, and have preliminary clinical evidence demonstrating potential to address unmet medical needs.

RMAT Designation

  • Benefits: Expedited approval pathway, increased meeting opportunities, priority review for marketing approval, and facilitated early patient access.
  • Examples: MiMedx’s product AmnioFix Injectable for knee osteoarthritis, Ortho-ATI™ for resistant tendinopathy.
  • FDA Statistics: As of 9th March 2018, 15 RMAT designations were granted.

Pathway to Regulatory Approval

  • Innovation requires: Scientific excellence, clinical evidence of efficacy, risk evaluation, and cost-effectiveness.

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Explore the fundamental concepts of regenerative medicine, focusing on the roles of genes, cells, and the extracellular matrix (ECM). This quiz also delves into the historical milestones that have shaped the field, highlighting key figures and their contributions. Test your knowledge on how these components interact to promote tissue engineering and repair.

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