Self repair of teeth, bone and soft tissue
Teeth are constantly being attacked by acid, which creates small micropores in the enamel, precursors to cavities. A new technique, developed in Leeds, uses specifically designed peptide molecules which are triggered by the conditions inside the micro-pores to join together in three-dimensional scaffold-like structures within these tiny holes. Calcium ions are attracted to the peptides, creating a natural repair to the tooth.
The peptides can be applied in a liquid, either by brush or mouth wash, and will also prevent tooth sensitivity by strengthening areas of root exposed by receding gums.
Discussions are underway to license this technology for commercialisation, and the potential impact is great. It could ensure people are able to retain their own teeth for longer, reduce the need for expensive drilling, filling and other repair and so reduce the cost of dentistry to the NHS overall.
The technology is also being investigated for use in other parts of the body for regeneration and repair of soft and other skeletal tissues. Research is focusing particularly on repair of blood vessels, bone and cartilage.
Heart valve transplants
A technique of stripping cells from human and animal tissue to leave a 'scaffold' into which new cells can grow was patented by the team in 2001. Since that time the technique has been used successfully with human heart valves to overcome some of the problems associated with traditional transplants. Over 5,000 patients benefit from heart valve replacement in the UK each year, but none of the current replacements are adequate for patients with life expectancies beyond 10-15 years. Although donor valves remain the 'gold standard', they are subject to immune reactions in the patient.
The patented technique may, therefore, offer a realistic alternative for many of these patients. The scaffold enables the patients own cells to grow into it and the implanted valve has the potential to act like natural tissue. It doesn't provoke an immune response and it retains flexibility, growing with the patient - a potentially major benefit in surgery on children. Animal trials have now shown these scaffolds are repopulated by cells within six months, though it is expected to take longer in humans.
The technique has been used successfully on human valves during clinical studies in Brazil, with findings showing no revisions or complications related to the valve transplant. This has led to ongoing work in the UK with NHS Blood and Transplant, with a view to introducing the innovation into the UK in the next decade.
Spinal disc replacement
New methods of testing spinal disc replacements to simulate the long-term impacts of this type of device in the human body are currently being developed.
Although still fairly new, disc replacement is being used more and more in the UK to combat spinal disease and degeneration. Innovative mechanical techniques to test joint replacements are being developed by the team at Leeds, together with partners at the University of Iowa in the USA who are working on computer simulations. Although this research builds on existing knowledge of hip and knee joint replacements it does require some refinement, the spine is a very different and delicate environment, the proximity to the spinal cord means any problem with a replacement disc could prove catastrophic.
The new assessment methods have already identified that wear of the replacement disc is likely to be significant, creating particles that are of a size that could stimulate a reaction by the body. This means that osteolysis is a potential problem, where the bone disappears from around the implant as the body attempts to clean up the particles, causing the disc to loosen.
Continuing development of the models will help scientists and surgeons estimate the timescale within which such problems are likely to occur and identify ways of mitigating their impact.
Low wear hip replacement
A unique hip joint which creates ten times less wear than other designs is now being used across most of the world. The joint's longer lifespan means it can be used with younger patients, enabling them to continue to lead active lives for longer. A traditional replacement hip joint has a metal head in a polyethylene cup, which creates a lot of wear and so has a limited lifespan. Because of this, many patients are advised to wait as long as possible, often in considerable discomfort, before having an artificial hip put in place.
Other options include metal-on-metal or ceramic-on-ceramic joints, which can be used on younger patients. Both are more durable and create less wear than polyethylene, giving the joint a longer lifespan and reducing the need for further surgery.
The new innovation, developed by the team at Leeds, mixes these two materials to create a ceramic-on-metal hip joint. The bearing includes a new type of ceramic ball which fits inside a metal cup. The combination creates ten times less metal wear than the metal-on-metal joint. The ceramic head remains smooth and undamaged, improving movement and lubrication. The new design has been developed under licence by Depuy-Johnson & Johnson. It has been used in most parts of the world since 2006 and a panel recently recommended to the Food and Drug Administration in the USA that it also be approved for use there.
Knee joint replacement
Scientific analysis of how knee joints move has provided two new concepts in engineering design, which are helping companies across the world create better, more durable, knee joint replacements.
The knee has a very complex motion, which is difficult to replicate in a replacement joint. Although a natural knee has a number of moving surfaces, replacements tended to have only one, with the other parts static.
When a new 'mobile bearing knee' with two moving surfaces was put through simulation and analysis by the team at Leeds, an unexpected advantage was discovered. Because the movements were linear, less wear was created than in the traditional design. Companies have now developed designs using linear movement to create low wearing knee replacements.
Most traditional designs also tried to ensure contact between the polyethylene parts of the joint was spread over a large surface area, as this was thought to create less wear. Recent research has shown that in fact, the opposite is true: the less surface area in contact, the less wear. Designers are now able to use this concept to optimise their design to minimise surface wear and extend the predicted lifetime of knee replacements.