Scientists at URMC are researching how to use 3-D printing to create bone replacement. Jamie Germano

University of Rochester Medical Center Scientists Hani Awad, left, and Edward Schwarz explain how they are leading the way in using 3-D printing and stem cells to create bone replacements for patients.(Photo: Jamie Germano/@jgermano1/Staff Photographer)Buy Photo

Imagine getting a made-to-order bone implanted in your body that's composed of your own cells.

Scientists at the University of Rochester Medical Center have been developing a procedure to use3-D printing and stem cells fromthe patient to createbones made of regenerated tissue.

Thismulti-step procedure still has a ways to go before it is tested on humans and can become part of the services provided by URMC's Center for Musculoskeletal Research.Butit's the latest example of how 3-D printing, which isincreasingly finding its place in manufacturing, is leaving its mark in medicine.

It is changing the way we do a lot of things, saidHani Awad, who is associate director of the center and professor of biomedical engineering with aspecialty in tissue engineering.

Biomedical research, as it is being done in this initiative, is an important component of the medical center's identity.

"Part of our mission is that we want to do research that is impactful," said Stephen Dewhurst, vice dean for research at the medical center.

A 3-D replica of a spinal deformity in a child that gives surgeons a hands-on look at a problem before surgery. The replica is made with a 3-D printer at the University of Rochester Medical Center.(Photo: Jamie Germano/@jgermano1/Staff P)

UR is already using 3-D printing to create replicas of human organs to practice on before conducting difficult surgical procedures.

The Center for Musculoskeletal Research is trying to gobeyond this use of3-D printing.

Simulated surgery makes headway at UR Medical Center

Edward Schwarz, director of the center, andAwadare heading up an initiative that not only makes replicas of bones for doctors to better understand and show patients the problems they face, butis alsousing 3-D printing to create the framework for regenerating bone tissue.

Currently, a person with a badly damaged limb that cannot be healed by surgical means faces amputation, followed bythe fitting of an artificial limb.

Bones from cadavers arealso sometimes used as replacement limbs, but there is a high failure rate withcadaver limbs over time. That's because cadaver bonesare not living tissue and thus cannot repair themselves when the limb suffers minor fractures, as they often do.

Bone regeneration offers the prospect of a new alternative.

Thesurgically implanted replica serves as a framework to regenerate bone tissue.

"A big part of the problem is figuring out how to grow a big piece of bone,"said Awad.

With the technology developed, a3-D replicais created by taking a CT scan of the patient's bone. What's recorded by the scan is thenconverted by a computer into a digital modelthat programsthe 3-D printer.

If a leg is too badly damaged tomake a replica, a CTscan can be taken of the patient's other leg. And with the use of computer technology, any needed modification can be made. ACT scan of a left leg could be made to look like it isa right leg in the 3-D printout.

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During a recent demonstration, thestainless steel platform of the 3-D printer,which moves up and down, wasreplenished with a supply of powdered calcium phosphate a materialsimilar to bone.

The printer's inkjets wereprogrammed by computer to spray a binding solution of phosphoric acid in a patternthat formed a thighbone.

Over the course of an hour or so, the 3-D printer creating one thin layer on top of another builtthe artificial human boneabout 1 inch thick and 6inches long.

But that's not where this bone replacement procedure ends.

The next step and one not yet tried on humans is regeneration of tissue using stem cells wrapped around the replacementbone.

Schwarz and Awad have beentesting bone regeneration on mice, without any indicationof rejection and with signs of bone regeneration.

And they are beginning to test regeneration on mini-pigs.

The 3-D replica bones arecoated with sheets ofstem cells, whichregenerate bone tissue. Eventually, the 3-D part of the replacement bones made of calcium phosphate isexpected to be absorbed by new bone tissue.

Awad estimates that this tissue regeneration technology couldbe triedon humans in three to five years.

Research at the University of Rochester uses 3-D printing to create bone replacements. Jamie Germano

UR is among a handful of universitiesdoing research that combines 3-D technologyand tissue regeneration.

"The exact horizon is unclear, but we are certainlyrunning full-speed ahead," said Dr. Paul Rubery, chairman of the Department of Orthopaedics at the UR Medical Center.

3-D printing, Rubery noted, makes possible the reproduction of intricate shapes, including those in the human body.

"What is the science one might say what is the magic that will make a person's body take on a new part and make it a living part?" said Rubery about the possibility of bone regeneration using stem cells and 3-D technology.

The Medical Center is well positioned to figure this out.

"We havea long tradition of understanding the molecular processes that lead to healing and repair of the skeleton," said Rubery.

The Musculoskeletal Center, which is inRubery'sdepartment, last fiscal year received the second highest amount of funding for such centers fromthe National Institutes of Health roughly $10 million. About65 researchers and technicians are on staff.

The other half of the equation is the Medical Centers Upstate Stem Cell cGMP Facility, where stemcells are grown in accordance with strict Food and Drug Administration regulations.

Located in the Medical Center's Ernest J. Del Monte Neuromedicine Institute, the cGMP was established in 2012, with the help of a $3.5 million grant from the Empire State Stem Cell Board.

In bone regeneration, the stem cells are usually taken by syringe at the hip, where such cells are plentiful, and then grown in petri dishes atthecGMP Facility.

Schwarz, who is a professor of orthopaedics, said what's mostneeded before the procedure can beused on humans is work on how the stem cells are transferred from the cGMP facility to the 3-D replicas.

"Youbasically have to demonstrate that you can harvest the cells, grow the cells andre-implant the cells in a safe and effective manner," said Schwarz.

Currently, the alternative to an artificial leg is one from a cadaver, but that is done only in limited situations.

"If the bone is not alive, it eventually becomes structurally weakened," said Dewhurst.

Bone grafts are also done, buthere, too,the graftcomesfrom cadavers in thevast majority of cases, said Awad.

Regenerating bone tissue would provide a different dynamic creating live bone tissue that replenishes itself.

Rejection is not expected to be an issue because the stem cellswould come from the patient.

Unlike other cells, stem cells have the capability to divide indefinitely, so they can grow new bone tissue.

Awad and Schwarz are among the authors of studies in scientific journals that show the effectiveness of stem cells in healing damaged bones in mice.

In a laboratory at the Musculoskeletal Center is a tabletop full of replicas of human bones and bone structures made by the 3-D printer in the room.

The replica of the spine is that of a childwho suffered from a severe curvature.

Having such a model enabled a doctor to figure out what kind of steps could be taken to address the problem.

The 3-D skull on the table is a replica of a human skulland provides a way researchers can study howinjuries can be treated.

A hole was made in the cheekbone to resemble a bullet wound. Another replicawas missing part of a jaw.

Inboth cases, the goalis to have stem cells regenerate bone tissue.

The body can naturally healitself in the normal course of injuries, but can't do so when the bone is damaged beyond repair.

Implanting a 3-D bone coated withhuman stem cells would offer an alternative to existing choices.

"It is really going to be part of UR Medicine and its health care system," said Schwarz.

JGOODMAN@Gannett.com

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Bones made to order at University of Rochester, thanks to 3-D printers - Rochester Democrat and Chronicle