Unicamp's Hospital de Clínicas opens this Thursday (21), at 15 pm, the first Tissue and Cellular Therapy Bank in the region and the second in the interior of the State. The new area will allow the processing, storage and availability of biologically safe tissues - bones, cartilage, tendons, ligaments, meniscus and fascia - for use in surgeries in the areas of orthopedics, neurosurgery, otorhinolaryngology, plastic surgery, dentistry, among others. There are three units in the State: HC at USP, at Santa Casa de São Paulo and at the Hospital Universitário de Marília.
The Unicamp HC Tissue Bank is set up in an area of 260 m² with the most modern technologies used in the area. The highlight is the 30 m² clean room intended for tissue processing and cell culture, with four antichambers with pass-through (material passage boxes to avoid cross-contamination). The site has a medical gas network, automatic door interlocking and filter lining with absolute filter. Even the lamps are designed for exclusive use.
The clean room installed at the Tissue Bank is the one with the highest purity classification existing in the institution: Grade A - ISO 5. The technology of filtering lining systems, with a unidirectional flow of very high purity air, is the same as in laboratories that produce medicines or manufacture components for space satellites. "This is an environment where air quality is essential in controlling particle contamination when carrying out procedures sensitive to contamination", explains orthopedist Gustavo Constantino de Campos.
The new Unicamp HC area also has an access chamber, a barrier changing room, a waste shelter, in addition to support rooms. The tissues will be stored in two cryopreservation rooms with -80° frezzers with digital temperature control. Other equipment available on site is a bone freeze dryer, which dehydrates, decontaminates and sterilizes the material, preventing the development of any type of microorganism.
Orthopedists at Unicamp HC explain that sterile bone graft surgery allows an improvement in the quality of life and self-esteem of the recipient patient, in the recovery of simple activities or even in oral health. The main destination of this material is for oncology patients, with polytrauma or iatrogenic diseases. "The absorption of the grafted bone varies depending on the location of the procedure and the primary pathology", informs Campos.
One of the sources of supply of these tissues are patients undergoing arthroplasty surgeries, such as the placement of a hip prosthesis, in which the femoral head is removed. Donation authorization is required. Another type of donor, he says, is the cadaver donor, as long as he or she does not carry any communicable disease such as AIDS, hepatitis B and C, or even bacterial contamination. Factors such as age, medical history and cause of death are also taken into account.
"The preference is for the deceased donor, as this allows the capture of a greater number of bone tissue than from a living donor", emphasizes Campos. Experts say that the biggest problem is still the scarcity of available tissues as families resist donating the bones of the corpse. However, doctors clarify that there is no problem with disfigurement of the body, which is reconstructed with synthetic bones identical to those extracted.
According to Luiz Antônio Sardinha, coordinator of the Organ Procurement Organization (OPO) at Unicamp HC, the control model is the same as that already applied to other types of organs and tissues. Relatives of potential donors are advised in the event of brain death. When there is availability for donation, the information is passed to a center, which contacts the bone bank closest to the extraction site.
Currently, the captured tissues can be used in dental treatments. Patients who experience bone loss due to trauma, infection or periodontal disease have the opportunity to be treated by bone graft surgery. These techniques help patients recover chewing function and improve speech.
Other surgeries are orthopedic, such as revision of hip and knee prostheses, resection of bone tumors, correction of bone defects, spinal surgeries, correction of congenital deformities, ligament surgeries, replacement of menisci and loss of cartilage.
Tissue Bank in Brazil and around the world - In Brazil, there are six Bone and Tissue Banks in five states: Rio Grande do Sul, Paraná (HC-UFPR), São Paulo, Rio de Janeiro (National Institute of Orthopedics and Traumatology - INTO ) and Pernambuco (IMIP). In the State of São Paulo, the University of Marília bank (Unioss) is the largest in Brazil in capturing and processing bone tissue, being responsible for supplying more than 50% of the material used in these surgeries throughout the country.
The Ministry of Health maintains strict control of each material processed with an identification number for traceability until the end of the process. All documentation about the donor and recipient is archived for 25 years.
The unit of the Institute of Orthopedics and Traumatology (IOT) of the HC of the University of São Paulo, a pioneer in the country, benefits orthopedic patients undergoing treatment for bone tumors or lack of certain bone segments. In addition, it promotes activities for teaching undergraduate and postgraduate medical courses and basic and technological research.
“The supply of sterile bones for the reconstruction of tumors and ligaments for use in dentistry are some of the things we intend to follow with the USP model. And in the future, in addition to orthopedics, we want to use other areas of medicine, such as plastic surgery, for cases involving burns, for example”, says Campos.
Abroad, there are renowned musculoskeletal tissue banks in institutions such as Leicester University Hospital, the largest NHS (National Health Service) tissue bank in the United Kingdom. Other renowned reference centers are Harvard University, in Boston, and MD Anderson, in Texas, in the United States.
