For Farshid Guilak, Ph.D., the human body and its joints is a feat of engineering genius. Millions of times annually, our joints and their cartilage cushions endure thousands of pounds of pressure, and they don’t wear out. Except when they do.

It’s this orthopedic inevitability that Guilak, Duke University Medical Center vice-chair of orthopedic surgery and the director of orthopedic research, is fighting. By fusing his biomedical engineering background with stem cell science advancements, he and his team are perfecting a joint replacement option that trades in metal and plastic for the body’s own tissues.

“Through several different studies with stem cells, we’ve started to look at how to regenerate the entire joint. A lot of people have worked to fix the small hole in cartilage, but that’s like fixing a pothole,” said Guilak, the Laszlo Ormandy professor. “If the whole road is destroyed, you need to repave the entire surface.”

Using stem cells, he said, removes immunity or rejection issues. But researchers had to identify a stem cells source that was both easily accessible and plentiful enough to cover the entire joint. By accident, they discovered subcutaneous fat cells – fat cells lying just under the skin – are a rich source of stem cells that can be reprogrammed and redirected to become cartilage, bone, and other tissues. Even a small liposuction procedure, Guilak said, could foster 1 billion stem cells in only a few weeks.

This finding launched Guilak’s team on the path to founding Cytex Therapeutics, Inc. in 2006. To maximize their discovery, the team used tissue engineering techniques to create a woven fabric scaffold for stem cells to latch onto and grow. They also developed a 3D weaving technology that lets them control how new joint layers are constructed to mimic the old joint’s shape. Over time, the scaffolding dissolves, leaving only the new tissue behind.

Recently, the team received grants to fund preclinical studies, and they’re partnering with the North Carolina State University School of Veterinary Medicine to test their technology in dogs.

“There’s a large market in veterinary medicine – a lot of hip replacements in dogs and other pets,” Guilak said. “It’s a great application for the technology and to study the outcomes of hip replacements in dogs compared to humans. Of all the large animals, the dog hip is the closest to humans – it’s a similar shape, only smaller.”

The next step, Guilak said, is to test whether bone marrow stem cells can be used in a similar way to create large pieces of cartilage for use in patients with arthritis.

Overall, Guilak credits much of his team’s success with Cytex to Duke’s early support. Not only did his team receive a Duke-Coulter Translational Partnership Grant, but they also garnered financial support from the Duke Translational Medicine Institute’s seed funding program.

“This support really enabled us to take our research from the bench and basic science to a concept that can go to the next level and spin out,” Guilak said. “What was really great, though, was the infrastructure that came with these two programs in terms of helping us think about regulatory issues and connecting us with other investigators who could provide ideas on how to form a start-up and take things to the next level.”

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Written by Whitney L.J. Howell