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Regulatory Proteins in dHACM
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The historical use of various clinical applications of amniotic membranes began relatively early in the 20th century.
Myth: I can just use cells from Cord blood or matrix tissue from the placenta. The donor is younger and cells are more vibrant.
Cells from cord blood have an HLA (immune profile). They are transplanted in oncology only with a background of aggressive immune conditioning and a HLA match of 5 or greater.
Transplantation of cells with an immune profile (cord blood cells) that are not HLA matched and with no immune conditioning results in an inflammatory response and rejection.
This need to HLA match and immune conditioning is why not all patients have a marrow match who are in need of a transplant. Placental matrix tissue has growth factors and collagen which can be helpful especially when combined with other biologics.
Amniotic fluid has a variety of homologous uses as in utero it naturally functions to protect and cushion, reduce inflammation and enhance mobility.2,6 It is a dynamically changing biological fluid that changes in both volume and composition throughout the course of gestation and the fluid normally ranges from 25 mL at 10 weeks to about 400 mL at the time of delivery.
Composition of amniotic fluid. Key elements of amniotic fluid include growth factors, carbohydrates, proteins, lipids, electrolytes, and other nutrients, as well as hyaluronic acid (HA), a principle component of viscosity and lubrication in synovial fluid.
An extension of the fetal extracellular compartment.
A connection between the intracoelemic and extracoelemic components of the developinginfant.
A physiologic buffer for various extra-fetal compounds.
Modulation of fluid and electrolyte transport between the mother and fetus across fetal andplacental membranes.
Nutritional support of the fetus.
Provision of a supportive fluid cushion to the developing fetus, allowing fetal movement andgrowth.
Protective functions provided by the inclusion of multiple growth factors and biologicalmolecules.
Provide antimicrobial effectors that protect the fetus
Concentrations of the various composition of amniotic fluid vary over the course of gestation, frequently changing near the time of delivery.
Sozanskii measured the concentrations of various compounds in pregnancy and compared serum and AF concentrations. He found that “in 136 women at various terms of pregnancy…the biochemical composition of amniotic fluid changed as follows: there was a rise of urea, rest nitrogen, and of the total protein; sugar concentration dropped; chloride level remained unchanged.”
Campbell did a similar measurement set and found comparable results. “Levels of sodium, potassium and bicarbonate were significantly higher in amniotic fluid whilst chloride, urea, bilirubin, protein, albumin, glucose, creatinine, calcium and phosphate were present in higher concentrations in extraembryonic coelomic fluid. All differences in concentration were significant (P less than 0.05; unpaired t-test). No relation was demonstrated between electrolyte concentrations in amniotic fluid or coelomic fluid and stage of gestation.”
Amniotic Tissue can be used for homologous use to reduce scar tissue formation, modulate inflammation, enhance surgical wound healing, and act as a barrier membrane.
DO NOT USE human tissue where the product does not meet the American Association of Tissue Banks (AATB) standards. Human amniotic tissue is regulated as a human cell, tissue, or cellular or tissue-based product (HCT/P) under Section 361 of the Public Health Service Act.
Growth factors are powerful agents that our bodies produce to signal cells to come to the target site, help the site to heal, and help your own cells regenerate the damaged tissue. Only the highest quality amniotic tissue products contain the most important growth factors needed for soft tissue healing. The following are some of the most notable growth factors that help enhance healing: • Transforming Growth Factor Beta (TGF-ß) • Fibroblast Growth Factor (FGF) • Platelet Derived Growth Factor A & B (PDGF AA & BB)