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PURPOSE: Temporomandibular joint osteoarthritis (TMJ-OA) management is complex, and several conservative and minimally invasive protocols have been proposed. Intra-articular injections of medications directed at OA have been performed, but in some cases, these medications do not directly contact the tissue lesion sites. Here, we propose a new real-time ultrasound-guided technique to inject medications directly into the subchondral bone. METHODS: Ultrasound image screening was carried out with the point-of-care Clarius L15 device. Then, with the patient's mouth closed, a stainless-steel cannula with a concentric trocar was US-guided using an in-plane approach until the perforating tip of the internal trocar touched the lateral pole of the mandibular condyle. Then, the trocar was inserted through the medullary bone, where a posterior injection was made. RESULTS: The technique's precision was confirmed by capturing an iodine contrast solution that imaged the medullary condyle of fresh anatomical specimens processed by computed tomography. CONCLUSION: The proposed technique was effective in accessing the mandibular condyle subchondral bone in the inferior TMJ space for the simultaneously intra-articular (IA) and intra-osseous (IO) in-plane US-guided injections. Thus, its implementation may represent an important advance in early TMJ-OA treatment. This may be a promising approach, especially in OA cases in which the cortical bone is still preserved.

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Condylar resorption is an aggressive and disability form of temporomandibular joint (TMJ) degenerative disease, usually non-respondent to conservative or minimally invasive therapies and often leading to surgical intervention and prostheses implantation. This condition is also one of the most dreaded postoperative complications of orthognathic surgery, with severe cartilage erosion and loss of subchondral bone volume and mineral density, associated with a painful or not inflammatory processes. Because regenerative medicine has emerged as an alternative for orthopedic cases with advanced degenerative joint disease, we conducted a phase I/IIa clinical trial (U1111-1194-6997) to evaluate the safety and efficacy of autologous nasal septal chondroprogenitor cells. Ten participants underwent biopsy of the nasal septum cartilage during their orthognathic surgery. The harvested cells were cultured in vitro and analyzed for viability, presence of phenotype markers for mesenchymal stem and/or chondroprogenitor cells, and the potential to differentiate into chondrocytes, adipocytes, and osteoblasts. After the intra-articular injection of the cell therapy, clinical follow-up was performed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and computed tomography (CT) images. No serious adverse events related to the cell therapy injection were observed during the 12-month follow-up period. It was found that autologous chondroprogenitors reduced arthralgia, promoted stabilization of mandibular function and condylar volume, and regeneration of condylar tissues. This study demonstrates that chondroprogenitor cells from the nasal septum may be a promise strategy for the treatment of temporomandibular degenerative joint disease that do not respond to other conservative therapies.

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BACKGROUND: Stem cells from adipose tissue (ADSCs) and platelet-rich plasma (PRP) are innovative modalities that arise due to their regenerative potential. OBJECTIVE: The aim of this study was to characterize possible histological changes induced by PRP and ADSC therapies in photoaged skin. METHODS: A prospective randomized study involving 20 healthy individuals, showing skin aging. They underwent two therapeutic protocols (protocol 1: PRP; protocol 2: ADSCs). Biopsies were obtained before and after treatment (4 months). RESULTS: PRP protocol showed unwanted changes in the reticular dermis, mainly due to the deposition of a horizontal layer of collagen (fibrosis) and elastic fibers tightly linked. Structural analyses revealed infiltration of mononuclear cells and depot of fibrotic material in the reticular dermis. The ADSC protocol leads to neoelastogenesis with increase of tropoelastin and fibrillin. There was an improvement of solar elastosis inducing an increment of macrophage polarization and matrix proteinases. These last effects are probably related to the increase of elastinolysis and the remodeling of the dermis. CONCLUSIONS: The PRP promoted an inflammatory process with an increase of reticular dermis thickness with a fibrotic aspect. On the other hand, ADSC therapy is a promising modality with an important antiaging effect on photoaged human skin.

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BACKGROUND: Upon orthognathic mandibular advancement surgery the adjacent soft tissues can displace the distal bone segment and increase the load on the temporomandibular joint causing loss of its integrity. Remodeling of the condyle and temporal fossa with destruction of condylar cartilage and subchondral bone leads to postsurgical condylar resorption, with arthralgia and functional limitations. Patients with severe lesions are refractory to conservative treatments, leading to more invasive therapies that range from simple arthrocentesis to open surgery and prosthesis. Although aggressive and with a high risk for the patient, surgical invasive treatments are not always efficient in managing the degenerative lesions. METHODS: We propose a regenerative medicine approach using in-vitro expanded autologous cells from nasal septum applied to the first proof-of-concept patient. After the required quality controls, the cells were injected into each joint by arthrocentesis. Results were monitored by functional assays and image analysis using computed tomography. RESULTS: The cell injection fully reverted the condylar resorption, leading to functional and structural regeneration after 6 months. Computed tomography images showed new cortical bone formation filling the former cavity space, and a partial recovery of condylar and temporal bones. The superposition of the condyle models showed the regeneration of the bone defect, reconstructing the condyle original form. CONCLUSIONS: We propose a new treatment of condylar resorption subsequent to orthognathic surgery, presently treated only by alloplastic total joint replacement. We propose an intra-articular injection of autologous in-vitro expanded cells from the nasal septum. The proof-of-concept treatment of a selected patient that had no alternative therapeutic proposal has given promising results, reaching full regeneration of both the condylar cartilage and bone at 6 months after the therapy, which was fully maintained after 1 year. This first case is being followed by inclusion of new patients with a similar pathological profile to complete an ongoing stage I/II study. TRIAL REGISTRATION: This clinical trial is approved by the National Commission of Ethics in Medical Research (CONEP), Brazil, CAAE 12484813.0.0000.5245, and retrospectively registered in the Brazilian National Clinical Trials Registry and in the USA Clinical Trials Registry under the Universal Trial Number (UTN) U1111-1194-6997 .

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BACKGROUND: Mesenchymal stromal cells (MSC) can be obtained from potentially any tissue from the human body, but cells purified from different sources are undoubtedly different, and for each medical application, the MSC with the best regenerative potential should be chosen. RESULTS: Bone marrow-derived mesenchymal stromal cells (BM-MSC), adipose tissue-derived mesenchymal stromal cells (AT-MSC) and Wharton's Jelly-derived mesenchymal stromal cells (WJ-MSC) were isolated from human tissues and were cultured under differentiation media supplemented with fetal bovine serum. We quantified the expression of stem cell and adipocyte genetic markers using quantitative real time PCR, as well as the secretion of cytokines, extracellular matrix components and growth factors using Luminex and ELISA. All three MSC differentiated into adipogenic cells. AT-MSC showed the highest shift in ADIPOQ, CEBPA and PPARG mRNA expression. BM-MSC kept high expression levels of stem-cell markers SOX2 and POU5F1. WJ-MSC showed the lowest increase in mRNA expression when cells were induced to differentiate into adipocytes. Regarding protein secretion, adipocyte-like cells generated from WJ-MSC secreted the highest chemokine levels. AT-MSC-derived adipocyte-like cells secreted the lowest cytokine amounts and the highest quantity of collagen types I and III. Adipocyte-like cells obtained from BM-MSC secreted high amounts of most angiogenic factors, growth factors TGF-ß1 and TGF-ß2, collagens type II and IV, heparan sulfate, laminin and aggrecan. CONCLUSION: Mesenchymal stromal cells purified from different tissues have a different behavior when induced to differentiate into adipocyte-like cells.

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BACKGROUND: Platelet-rich plasma (PRP) is increasingly used as a cell culture supplement, in order to reduce the contact of human cells with animal-derived products during in vitro expansion. The effect of supplementation changes on cell growth and protein production is not fully characterized. METHODS: Human mesenchymal stromal cells from bone marrow, adipose tissue and Wharton's Jelly were isolated and cultured in PRP-supplemented media. Proliferation, in vitro differentiation, expression of cell surface markers, mRNA expression of key genes and protein secretion were quantified. RESULTS: 10% PRP sustained five to tenfold increased cell proliferation as compared to 10% fetal bovine serum. Regarding cell differentiation, PRP reduced adipogenic differentiation and increased calcium deposits in bone marrow and adipose tissue-mesenchymal stromal cells. Wharton's Jelly derived mesenchymal stromal cells secreted higher concentrations of chemokines and growth factors than other mesenchymal stromal cells when cultured in PRP-supplemented media. Bone marrow derived mesenchymal stromal cells secreted higher concentrations of pro-inflammatory and pro-angiogenic proteins. Mesenchymal stromal cells isolated from adipose tissue secreted higher amounts of extracellular matrix components. CONCLUSIONS: Mesenchymal stromal cells purified from different tissues have distinct properties regarding differentiation, angiogenic, inflammatory and matrix remodeling potential when cultured in PRP supplemented media. These abilities should be further characterized in order to choose the best protocols for their therapeutic use.

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BACKGROUND: Quantitative real time polymerase chain reaction (qPCR) is an extremely powerful technique for monitoring gene expression. The quantity of the messenger ribonucleic acids (mRNA) of interest should be normalized using a reference gene, in order to avoid unreliable results originated by the obtained RNA quality and quantity, manipulation errors and inhibitory contaminants. A reference gene is any gene that is stably and consistently expressed under the conditions being studied. Completely false data can be generated if a reference gene is not chosen adequately. RESULTS: In the present study, we compared expression levels of five putative reference genes (HPRT1, ACTB, GAPDH, RPL13A and B2M) in primary cultures of four different human cells: mesenchymal stromal cells obtained from bone marrow, adipose tissue or umbilical cord Whartons Jelly, and dermal fibroblasts, under different expansion and differentiation conditions. We observed that reference genes are not the same for different cells under the same culture conditions. CONCLUSION: Most stable reference genes under our experimental conditions were: RPL13A for adipose tissue- and Whartons Jelly-derived mesenchymal stromal cells, and HPRT1 for bone marrow-derived mesenchymal stromal cells and dermal fibroblasts. ACTB was the most unstable gene when evaluating adipose tissue- and Whartons Jelly-derived mesenchymal stromal cells, whilst GAPDH and B2M were the most unstable genes for bone marrow-derived mesenchymal stromal cells and dermal fibroblasts, respectively.

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OBJETIVO: Testar o efeito das c élulas tronco mesenquimais (CTM) de tecido adiposo no preenchimento cutâneo de rítides na região naso-labial. MÉTODOS: Foram coletados 50 cc de gordura da região infra-umbilical e 20 mL de sangue periférico de 15 voluntárias do sexo feminino para obtenção das CTM e de plasma autólogo, respectivamente. As voluntárias foram agrupadas de acordo com as estratégias de injeções intra-dérmicas: grupo (1) somente o ácido hialurônico; grupo (2) somente as CTM; grupo (3) CTM associadas ao ácido hialurônico. Tratando-se de um estudo prospectivo e qualitativo o acompanhamento das voluntárias era mensal através de fotografias. RESULTADOS: No grupo (1) foi observado um efeito de preenchimento imediato ao contrário do grupo (2) onde o efeito de preenchimento pleno foi alcançado aproximadamente após dois meses. No grupo (3) o preenchimento ocorreu de maneira mais efetiva e também progressiva, devido à combinação dos efeitos de curto e de longo prazo gerados pelo ácido hialurônico e pelas CTM, respectivamente. CONCLUSÃO: As CTM quando associadas ao ácido hialurônico foram capazes de promover o preenchimento de sulcos profundos, com melhora progressiva do tônus da pele e diminuição das linhas de expressão.

OBJECTIVE: To test the effect of mesenchymal stem cells (MSC) from adipose tissue on the dermal filling for nasolabial rhytids correction. MEHTODS: 50 cc of infraumbilical fat and 20 ml of peripheral blood were harvested to isolate MSC and autologous plasma from 15 female volunteers, respectively. The volunteers were grouped in according to the following strategies of intra-dermal injection: Group (I) only hyaluronic acid; Group (II) only MSC; Group (III) MSC combined with hyaluronic acid. For this qualitative and prospective study photographic monitoring was done monthly. RESULTS: In the group (I) we observed an immediate effect of filling; in the group (II) the effect of filling was reached after approximately two months. In the group (III) filling occurred more efficiently and progressively, probably due to the combination of the short and long-term effects generated by the hyaluronic acid and MSC, respectively. CONLCUSION: MSC when combined with hyaluronic acid were able to fill in deep folds, with progressive improvement of skin tone and decreasing lines of expression.

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OBJECTIVE: To test the effect of mesenchymal stem cells (MSC) from adipose tissue on the dermal filling for nasolabial rhytids correction. METHODS: 50 cc of infraumbilical fat and 20 ml of peripheral blood were harvested to isolate MSC and autologous plasma from 15 female volunteers, respectively. The volunteers were grouped in according to the following strategies of intra-dermal injection: Group (I) only hyaluronic acid; Group (II) only MSC; Group (III) MSC combined with hyaluronic acid. For this qualitative and prospective study photographic monitoring was done monthly. RESULTS: In the group (I) we observed an immediate effect of filling; in the group (II) the effect of filling was reached after approximately two months. In the group (III) filling occurred more efficiently and progressively, probably due to the combination of the short and long-term effects generated by the hyaluronic acid and MSC, respectively. CONCLUSION: MSC when combined with hyaluronic acid were able to fill in deep folds, with progressive improvement of skin tone and decreasing lines of expression.

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