Scientists use lab-grown cartilage to reconstruct cancer patients’ noses

Researchers in Switzerland have successfully reconstructed the noses of five skin cancer patients – using cartilage grown from the patients’ very own tissue.

Utilizing a technique called tissue engineering, scientists at the University of Basel extracted very small amounts of cartilage from the patients’ noses, and then amplified the tissue in the lab.  The resulting product: A relatively large mass of white, glossy cartilage – which could be easily shaped to fit each patient’s individual nose.

According to lead researcher Dr. Ivan Martin, this method of nasal reconstruction could be very appealing for those suffering from non-melanoma skin cancer, which commonly occurs on the nose because of its cumulative exposure to sunlight.  Currently, surgeons must treat this condition by completely removing tumors from the nose, often cutting away at vital areas of cartilage in the process.

"From isolated tissues we grow a batch of cartilage, which performs as good as native cartilage for construction.”

— Dr. Ivan Martin, lead researcher

And to fill these gaps, large amounts of cartilage must be taken from other areas of the body.

“Now, a patient has to take [grafts from] his or her own cartilage tissue – taken from the ears, lips or from the nasal septum. But this requires an additional surgical site, so there’s a risk of infection… And from an aesthetic standpoint, you have a piece missing from your ear or lips,” Martin, professor of tissue engineering at the department of biomedicine at the University of Basal, told “As opposed to using native analogous tissue, you only are taking a small biopsy. From isolated tissues we grow a batch of cartilage, which performs as good as native cartilage for construction.”

To create their lab-grown cartilage, Martin and his team took small biopsies from the nasal septum of five patients between the ages of 76 and 88, all of whom had severe nasal defects following skin cancer surgery.  The extracted tissues were only a few millimeters in diameter.

The researchers then isolated the cartilage cells and multiplied them, using a combination of growth factors.

“We use first of all an extract from the patient’s own blood. We need an autologous serum as a concentrate that [spurs growth], so we added some synthetic protein that further boost the growth velocity and also maintain the cartilage’s capacity of regeneration in the future,” Martin said.

After around two weeks, the amplified cells were seeded onto a collagen membrane scaffold and cultured for two additional weeks.  After this four week period, the pieces of cartilage had expanded 40 times the size of the original biopsy.

With such large amounts of tissue to work with, the surgeons could then shape the cartilage to fit the exact specifications of each patient.

“The same surgical procedure is continued, and the patient is allowed to breath normally,” Martin said. “The outcome of the procedure was to determine safety and feasibility, which is measured in terms of adverse events and in terms of stability.  In all the five cases, there were no adverse events, and the patients could breathe as well in both nostrils, indicating complete satisfaction.”

Martin said tissue engineering has significant promise for the future, not just in treating skin cancer, but for other cartilage-related injuries as well.

“We are testing the same procedure in cartilage of the knee…We’re running a clinical study where the same patches of engineered cartilage are applied onto the particular surface of injury, and the results are already very promising.  We can address a condition where there is no satisfactory treatment… especially for younger patients and athletes who are affected.”

Though the results of this research have been promising, clinical application of tissue engineering is still a long way off, especially until researchers and companies can find a way to make it cost effective.  Currently, many smart materials and artificial implants can heal and regenerate tissues just like engineered tissue can – but at much lower rates.

“For some indications, I think of smart materials that do not require the use of cells and can be much cheaper and bring into our bodies some signals that can activate the cells at the site to regenerate themselves,” Martin said. “But for each tissue, I’m convinced there are different approaches, and some will be relying on tissue engineering.”

The research was published in the current edition of the academic journal The Lancet.