Implantation power: custom-made prescription implants will save patients from rejection

Russian scientists have proposed a way to change the composition of implants depending on the immunity of patients. This will reduce risks and allow operations to be performed by people who are deprived of such an opportunity due to health restrictions. For example, with allergies, autoimmune disorders, or latent inflammations. At the same time, experts point out that the human immune system is dynamic, so in the long run, not only the adaptation of the implant, but also the management of the patient's condition may be more effective.

How do implants affect living tissues with inflammation

Changing the composition of implants depending on the patient's health status will reduce the risks of rejection and postoperative complications in people with chronic inflammation, allergies, and autoimmune diseases. This conclusion was reached by Russian scientists who studied how various bone-substituting materials affect model organisms with pathologies.

Photo: IZVESTIA/Tatiana Ulemskaya

In the study, they showed that the reaction to foreign structures in the body is largely determined by the state of the patient's immune system. In particular, in the presence of latent inflammatory processes, allergies, or autoimmune diseases, even implants that are well compatible with healthy patients can cause rejection, tissue necrosis, and other complications. This is due to the fact that in a significant part of patients, the immune system is in an activated state, and immune cells are the first to interact with foreign materials that trigger the body's defensive reactions.

In the course of the study, samples from calcium phosphate ceramics were synthesized, the scientists said. It is the main material for replacing bone defects after injuries, tumors, and inflammatory lesions. It is similar in composition and structure to natural bone tissue.

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The resulting constructs were tested when implanted into the tissues of healthy laboratory animals (Wistar rats) and in a model with artificially induced inflammation. The results showed that artificial materials did not cause problems in the normal state of the body. However, in the presence of a latent pathological process, the picture changed significantly. In particular, some implantable materials led to the formation of scar tissue around foreign elements. Another type of ceramic provoked necrotic changes and the formation of a dense capsule of dead cells around the bone prosthesis, which was accompanied by attempts by the body to reject it.

— We are used to testing materials on healthy animals. But in real life, patients are often susceptible to chronic inflammation, allergies, and autoimmune problems. And our work has shown that what behaves well in a healthy body can cause bone rejection and destruction when inflamed. This means that in preclinical tests of bone—plastic materials, it is necessary to evaluate their immunomodulatory properties and use models with weakened or altered immunity," Vladimir Komlev, one of the authors of the study, director of the A.A. Baykov Institute of Metallurgy and Materials Science of the Russian Academy of Sciences, told Izvestia.

Photo: IZVESTIA/Sergey Lantyukhov

In the future, the researchers plan to expand the range of materials used as implants and study different types of chronic immune disorders. This will make it possible to select the implant individually, depending on the patient's immune system.

Specialists from the A.A. Baykov Institute of Metallurgy and Materials Science of the Russian Academy of Sciences, the Institute of Theoretical and Experimental Biophysics of the Russian Academy of Sciences, and the M.M. Shemyakin and Yu.A. Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences took part in the work.

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How to choose the right bone prosthesis

The presented work is a path to personalized medicine. This approach will reduce the risks of surgical intervention and accelerate the rehabilitation of patients, Vladimir Komlev added. Also, accurate prediction of the impact of the implant will allow the installation of bone prostheses for people who are deprived of such an opportunity due to health restrictions.

Photo: IZVESTIA/Anna Selina

— The methods when the patient's immunological and resistant response is checked are the main ones in preparation for operations. But to work them out, long-term animal studies are needed. These approaches involve consistent repeated study of the same objects, which will allow us to build a picture of changes over time and create a database that will help surgeons reduce the risks of negative reactions," Konstantin Sergatsky, MD, Professor of the Department of Surgery at Penza State University, told Izvestia.

In the future, in the development of this area, it will be possible to identify such areas as the use of AI to predict the degree of wear and shelf life of an implant in order to replace it in a timely manner, he added. It is also possible to consider the use of neural networks to calculate the optimal shape of the implant, taking into account the biomechanical parameters of a particular patient.

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Other solutions are the creation of AI—assisted rehabilitation protocols with the direct participation of a doctor and using telemedicine. Undoubtedly, developments in the field of bioprinting with living cells are interesting. Such approaches will allow implants to take root faster and integrate with the body, which will solve the problem of the body's tolerance to artificial substitutes, the expert said.

— Creating a "universal" implant that is ideal for all patients is unrealistic. It is better to talk not about "selecting the composition for the patient", but about understanding the interaction of the material with the immune system. This means that it is often more effective to manage the patient's condition (for example, to reduce inflammation or adjust the immune response) than to radically change the material itself," says Albert Rizvanov, head of the Center for Excellence "Personalized Medicine" at Kazan (Volga Region) Federal University, corresponding member of the Academy of Sciences of the Republic of Tatarstan.

Photo: IZVESTIA/Anna Selina

Taking into account changes in the patient's condition over time is a difficult task, since a person's immune status is dynamic, he continued. Therefore, after surgery, a controlled inflammatory response is necessary for healing, but its excess leads to fibrosis and rejection.

According to the scientist, a combined approach looks the most promising, including preliminary preparation of the patient for surgery, the use of drugs to modulate the immune response and the use of materials capable of gently interacting with the body's immune system. It is important to take into account that excessive suppression of the immune response also carries risks: it can increase the likelihood of infectious complications, which is especially critical in surgical practice.