The Center for the Advancement of Science in Space (CASIS) has been sending rodents to the International Space Station (ISS) since 2015 on a research mission to test a potential new therapy for accelerating human bone growth.

Lead by UCLA orthopaedic surgeon and professor of Plastic and Reconstructive Surgery Dr Chia Soo, is also research director for UCLA Operation Mend, which provides medical care for wounded soldiers. The study is to test the ability of NELL-1 – a naturally produced bone-forming protein molecule – to instruct stem cells to both induce bone formation, and prevent degeneration.

Dr Kang Ting, Professor of Dentistry discovered NELL-1, with the molecule modified by Professor of Bioengineering Dr Ben Wu, for its suitability in treating osteoporosis. Dr Ting had been examining children with a condition of bone overgrowth in the skull, and wondered whether the gene expression of these patients could reveal a bone-growing protein.

The hope is that the study will provide new insights into the prevention of osteoporosis, and the regeneration of bone for the massive array of skeletal defects in wounded military personnel. Significantly, osteoporosis is a world health problem associated with conditions of immobility such as stroke, cerebral palsy, muscular dystrophy, and spinal cord injury.

Jaw resorption after tooth loss is also focussed to benefit from the findings of the study. Numerous studies have shown that after tooth extraction, approximately 30% of the alveolar ridge is lost as a result of resorption. Studies have shown that during the first three months after extraction, approximately two-thirds of the affected hard and soft tissues undergo some degree of resorption. This is why this study is of particular interest to the dental industry.

NELL-1 holds tremendous hope for not only for preventing bone loss, but to one day restore healthy bone. For those who are bed-bound from bone loss, it would be life changing.

Prolonged space flights generate extreme change in bones and organs that can’t be replicated on Earth. The unique microgravity environment will test innovative hypotheses of the robustness of NELL-1’s bone-producing effects, and offer new insight into the biology and behaviour of bone cells.

The remarkability of the space station is that with the process of bone loss considerably increased in microgravity, the perfect opportunity and environment is presented to test the osteo-inductivity of NELL-1. Under the entirely rigorous conditions of conducting an experiment in space assists the therapeutic development of feasible systemic delivery, translatable to clinics.

Current osteoporosis medications only to slow down bone breakdown, not form new bone. NELL-1 has been shown to prevent further bone loss, and also build new bone – therapy of tremendous benefit to people with severe osteoporosis.

By 2018, Dr Soo and her team had begun developing a novel, systemic osteoporosis therapy injection based on NELL-1 findings.

The use of NELL-1 as a successful osteoporosis treatment is demonstrable; however, use of the protein as a therapy is possible only via the protein directly injected into a patient’s affected bone during surgery. Therapy with a 14-day injection interval is one of the greatest technical challenges the team faces, but successfully extending the dosing interval will be of substantial benefit to patients.

Patients would need fewer injections and the therapy becomes more accessible, and more affordable.

Modifications of NELL-1 as a treatment approach have come far, and there’s still a journey ahead before it’s included as a medical option for osteoporosis patients and those suffering bone damage.

New nanotechnology developed by scientists at King Abdullah University of Science & Technology (KAUST) could transform regenerative medicine with its acceleration of stem cells into bone.

Designed to lead to new treatments for degenerative bone diseases such as TMJ, the temporomandibular joint disorder, the technique relies on iron nanowires bending in response to magnetic fields. The degenerative changes in the TMJ are believed to result from dysfunctional remodeling, due to a decreased host-adaptive capacity of the articulating surfaces and/or functional overloading of the joint that exceeds the normal adaptive capacity.

The bone-forming stem cells grown on the mesh of these tiny wires are strengthened by the moving substrate. Subsequently, they grow into adult bone considerably faster: the differentiation protocol lasts only a few days, rather weeks.

It is a remarkable achievement. Efficient bone cell formation over shorter time. Potentially, it paves the way for more efficient regeneration of bone.

Researchers analysed the bone-producing capability of the nanowire scaffold with, and without magnetic signals. The tiny wires were patterned in an evenly spaced grid, and layered with bone marrow-derived human mesenchymal stem cells.

Adding a low-frequency magnetic field greatly augmented the bone development process.

Through this mechanical stimulation, within 48-hours of incubation, genetic markers of bone development were detected. Genes linked to stemness and self-renewal quickly became inactive. Under a microscope the team witnessed cells rebuilding at a rapid rate to become more bone-like.

The expectation is for seeded nanowire scaffolds being safely implanted into injury sites to promote the speedy healing process of tissue repair, with the aid of an external magnetic field.

It has potential application in other medical fields besides human bone growth, with the customisation the nanowire mesh itself or the base material. Nanowires could be coated with biomolecules.

By varying the matrix stiffness through increasing or decreasing nanowire length and diameter there are different responses. For example, stem cells to promote neuronal growth and brain repair after a stroke or head injury.

It seems that the mission, should you decide to accept it, is to make no bones about making bones to ultimately benefit human life on Earth.

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