Granma | 30 January, 2017
Considered one of the most remarkable global scientific advances of the past two decades in the health field, regenerative medicine shows promising prospects for application in the treatment of various conditions.
Based on the same behavior as the human body when repairing itself by replacing damaged cells, with healthy ones, the four fundamental pillars of regenerative medicine lie in treatment using stem cells, the use of proteins capable of regenerating injured tissues, the engineering of tissues that include those produced in a laboratory (in vitro) and that practiced directly on individuals (in vivo), and gene therapy.
Given their greater feasibility, the first two are the most widely used internationally, at times complemented by in vivo tissue engineering, as gene therapy is the most complex of these methods and until now has only been undertaken in a few countries and on a very limited number of patients.
In the specific case of Cuba, stem cell therapies, the use of bioactive proteins and in vivo tissue engineering, are the regenerative medicine procedures that the country has been working on since the beginning of the 21st century.
Despite the promising opportunities offered people suffering from a diverse range of chronic diseases who do not respond to conventional treatments, and the progressive application and extension of these treatments in 2016 across all the country’s 15 provinces and the Isle of Youth special municipality; to date such lines of work have only been conducted as part of research projects in which prospective patients are selected according to the objectives of the study.
A RANGE OF APPLICATIONS
As Dr. Porfirio Hernández Ramírez Sc.D., coordinator of the Ministry of Public Health’s Regenerative Medicine and Cellular Therapy Group explained to Granma International, according to their evolutionary state, stem cells are classified as embryonic, that is those derived from the embryos of mammals, with the possibility of generating any type of cell, and those described as somatic or adult.
To begin with, he noted, there were many questions regarding the most appropriate cell type for treatment, but the limitations posed by the use of embryonic cells, including those of a biological nature, regarding the possibility of inducing tumors, and of an ethical nature, linked to the use and destruction of human embryos, favored the remarkable advance in the use of adult stem cells, with none of the aforementioned drawbacks and the advantage of being sourced from the patient themselves.
According to Dr. Porfirio, an important step that contributed to the application of stem cell therapy in Cuba was the preparation at the Institute of Haematology and Immunology of a simple and practical method of obtaining mononuclear cells (MNC) from bone marrow.
First obtained directly from the bone marrow, these cells were shortly after obtained from the peripheral blood, through the use of a stimulating factor produced in the country by two prestigious scientific institutions belonging to the BioCubaFarma Enterprise Group: the Center of Molecular Immunology and the Center for Genetic Engineering and Biotechnology.
Thus cellular therapy using peripheral blood MNCs is currently the most widely used method in the country.
According to the specialist, mononuclear cells have a great advantage, as they are composed of a mixture of different stem cells and adult progenitor cells, to form a true “cellular cocktail,” capable of increasing the regenerative properties of the MNCs.
Another advantage is that they can be easily obtained from the patient’s own blood. Through the use of this simplified method, very positive results have been achieved in Cuba, in many cases similar to those achieved in other countries with more complex procedures.
By the end of 2016, the number of patients treated with stem cells in the country had risen to 10,473, since its practical introduction for the first time on February 24, 2004. Of this total, 5,173 (49%) patients were treated within the specialty of orthopedics and traumatology, 4,090 (39%) in angiology, and the remaining 1,020 (12%) refer to other medical specialties.
In the opinion of Dr. Porfirio Hernández, the research undertaken until now has provided very encouraging results, mainly in the aforementioned areas.
“Also in angiology, the results in the treatment of patients with severe arterial insufficiency of the lower limbs stand out, avoiding major amputation in the range of 58 to 80% of those with these symptoms.
Likewise, notable recoveries in about 85% of people with less advanced chronic arterial insufficiency of the lower extremities were reported,” he noted.
Other promising applications of cell therapy have been achieved in patients with periodontitis, paraplegia due to trauma to the spine with spinal cord injury, and Duchenne muscular dystrophy in children.
The country is also looking into the use of platelets and their components, given that these constitute biological materials replete with multiple bioactive molecules with regenerative capacities, and contain elements that modulate angiogenesis and inflammation.
The most promising results have been reported in orthopedic and traumatic conditions, diabetic foot ulcers, dry eye syndrome, corneal ulcers and sports-related injuries.