Offer

The diagnosis of a haematological disease and the necessary treatments often mean a serious change in the lives of those affected and their relatives. A stem cell transplant offers great opportunities, but also involves risks. The time before, during and after the stem cell transplant places varying demands on both the patient's body and psyche. The physical problems that may arise during the course of treatment can lead to psychological problems. Feelings of exhaustion, insecurity, anxiety, depression or a lack of perspective can occur. These are initially to be understood as quite normal reactions to the great stress of the treatment.

For most patients, the support of family and friends is most important during this time. It can also be helpful to seek professional psycho-oncological support. The Clinic for Hematology therefore offers you targeted psycho-oncological support as a supplement to medical therapy, both during your inpatient stay and in outpatient aftercare. This offer is also aimed at relatives.

Psycho-oncological support through individual, couple and family discussions:

• In acute crises
• When dealing with the disease and coping with the consequences of the disease
• When dealing with anxiety, depressive reactions, traumatic experiences
• When learning suitable relaxation and imagination techniques
• Referral to psychosocial counseling centers, outpatient psychotherapists, self-help groups

For inpatient stays on the isolation ward:

Milena Jacqueline Ritter, MSc
Psychologist
Phone +41 61 328 52 91
milena.ritter@usb.ch

For further outpatient treatment in the cell replacement outpatient clinic:

Dipl. Psych. Birgit Maier
Psychologist, psycho-oncological psychotherapist WPO
Phone +41 61 556 59 94
birgit.maier@usb.ch
Detailed information

• Diagnostik bei Mangelernährung und Resorptionsstörungen (z. B. Kurzdarmsyndrom)
• Individuelle Ernährungstherapie (inkl. enterale (mit Sonden/Trinknahrung)/parenterale (über die Venen)Ernährung)
• Interdisziplinäre Betreuung mit Chirurgie, Ernährungsberatung und Psychosomatik
• Verlaufskontrollen und langfristige Begleitung

The research focus of the Tissue Engineering Laboratory, which is part of the Institute of Surgical Research and Hospital Management, is on the cultivation of cartilage and bone tissue as well as the development and application of bioreactors, devices for tissue cultivation.

A steadily increasing age means that more and more people are affected by degenerative diseases (signs of wear and tear) such as osteoarthritis or other age-related diseases such as osteoporosis. Middle-aged people are also increasingly affected by degenerative joint problems that cause pain and restrict mobility. Current therapies can often only combat the symptoms (pain relief), but cannot repair the tissue and restore the original mobility.

Tissue engineering is the application of engineering and science principles and methods to develop substitutes (implants) to restore, maintain or improve tissue function. In this process, the desired cells are isolated from a tissue sample (biopsy), multiplied in culture (containers filled with culture media) and then seeded onto a special scaffold. The scaffold colonized with cells is cultivated further until the desired tissue has been created. Depending on the scaffold and the type of cells, various tissues such as cartilage and bone can be produced. For use in humans, autologous (the body's own) cells are used to avoid rejection reactions. The cultured implants can be used in the future for a variety of clinical applications, e.g. joint and bone repair.

A first clinical study approved by Swissmedic on the reconstruction of the nostril after tumor removal using cultured cartilage is currently being carried out in collaboration with the Plastic, Reconstructive, Aesthetic and Hand Surgery Department of the University Hospital.

Cell therapy for bone defects

Implants for bone repair can be produced using stem cells that can be isolated from bone marrow or fatty tissue. In Basel, stem cells from adipose tissue are used because they can be obtained in larger quantities and with less stress for the patient. Adipose tissue also contains endothelial cells, which play an important role in the formation of blood vessels. The vascularization (presence of blood vessels) of bone is important to prevent the cells inside large pieces of bone from dying and to ensure good bone growth. The principle of tissue engineering can be simplified by shortening or eliminating the cell culture phase. In this so-called intraoperative approach, the cells are isolated during the operation, seeded onto the scaffold and implanted immediately. A clinical study on the treatment of osteoporosis-related upper arm fractures using the intraoperative approach has currently been submitted to the ethics committee and is being assessed by them.

Cell therapy for cartilage defects

Implants for the healing of cartilage or osteochondral (bone-cartilage) defects are produced using cartilage cells that can be taken from the nose or joints, for example. In Basel, cartilage cells from the nose are used due to their better quality and easier removal. An initial clinical study on the reconstruction of the nasal wing using cultured cartilage has been approved by Swissmedic and is currently being carried out.

Use of bioreactors for tissue engineering

Important factors in the application of tissue engineering in clinical routine are above all safety and costs. Bioreactors, special computerized devices that provide a controlled environment for tissue engineering while automating the process, enable reproducible, controlled, cost-efficient and safe production of artificial tissues by avoiding manual steps. The development of these devices is another focus of research at the University Hospital Basel. In the future, a clinical study on the reconstruction of articular cartilage in the knee is planned, which will use bioreactors to grow cartilage implants instead of conventional tissue engineering methods.

Status of the studies

Study I

In the clinical phase I study: "Tissue engineered nasal cartilage for reconstruction of the alar lobule" (Nose to Nose), a piece of cartilage grown in the laboratory from nasal cartilage cells is used to reconstruct the nostril after tumor removal. The last of the 5 patients in the cartilage study was successfully transplanted on 6.2.12. The study was completed on January 24, 2013 with the 1-year follow-up of the last patient. No adverse reactions occurred during the study. The clinical results are good for all patients.

Study II

In the second clinical phase I study: "Tissue engineered nasal cartilage for the regeneration of articular cartilage in the knee after traumatic injury" (Nose to Knee), a piece of cartilage grown in the laboratory from nasal cartilage cells is being used to treat a cartilage defect in the knee. A total of 10 patients with a grade III-IV cartilage injury of 2-8 cm2 will be recruited. The aim of the study is to demonstrate the safety and feasibility of this technique and to potentially improve cartilage regeneration. The study was started on August 29, 2012 with the inclusion of the first patient. Three patients have been included so far.

Study III

The third clinical study (Robust - Regeneration of osteoporotic bone using stem-cell transplantation) is investigating whether secondary failures and thus the reoperation rate in the surgical treatment of proximal humeral fractures in osteoporotic patients can be reduced if fat-derived mesenchymal stem cells are used instead of a bone substitute material. This blind study consists of a pilot study with 20 patients and a main study with approximately 270 patients divided into a control group (bone graft substitute only) and a treatment group (bone graft substitute + mesenchymal stem cells). The study is currently recruiting patients. So far, three patients have been treated.

Study IV

As part of the EU project "BIO-COMET", a Phase I clinical trial is planned in which patients similar to those in Study II (Nose to Knee) will be treated. However, in this study the cartilage construct will be produced in an automated manner using a bioreactor. Bioreactors are essential to bring cultured grafts into clinical applications, as they could enable automated, standardized, cost-efficient and GMP-compliant production of grafts in the future. The aim of this study is to demonstrate the safety and feasibility of bioreactor-based cartilage transplants.

Status of GMP laboratories

For the N2K study, the GMP laboratory of the hematology department will be used to produce the cartilage transplants. The cooperation with and support from Hematology is very good. The room is used jointly by Hematology and Tissue Engineering, but only sequentially, not in parallel. Hematology is currently planning 5-6 patients/year. This would allow TE to treat a further 5 patients per year in an optimal case with sequential treatment. Parallel use would require a high cleaning effort and cleaning validation and is currently not desired by Swissmedic. Parallel processing of two patients would be possible, but is currently not planned for capacity reasons.
The establishment of a GMP room in the ZLF is currently being planned. To this end, evaluations are currently being carried out with regard to the requirements of the various users and the planned clinical studies are being compiled. The planning of the rooms is based on the concept implemented in haematology.