Two significant projects are being carried out at the University of Oulu with the aim of developing diagnosis and treatment methods for joint cartilage damage. Both projects last three years and are interconnected: MIRACLE project aims to develop a new tool for the diagnostics of joint cartilage damage, while RESTORE project aims at developing artificial extracellular matrix materials using nanotechnology for the treatment of joint cartilage damage.
Both projects are carried out by the Microelectronics Research Unit (MIC) and Research Unit of Medical Imaging, Physics and Technology (MIPT) at the University of Oulu. The main funding source is the EU Research and Innovation Programme Horizon 2020.
Globally, 242 million people suffer from osteoarthritis. Many are elderly, but younger generations can also suffer from joint cartilage damages.
-Young people too have accidents and one risk group is people doing sports and contact sports. Ice hockey and football, among others, are typical risk sports, says Adjunct Professor Gabriela Lorite.
According to Professor Simo Saarakkala, the treatment of joint cartilage damage is a highly challenging field. Treatment methods have been sought for decades. Various projects have tried to develop artificial cartilage but so far they have been unsuccessful. At the moment, the treatment mostly consists of trying to move correctly and pain management.
-There are some options. Very local cartilage damage can be treated by injecting chondrocytes to the damaged area, but in terms of its structural and mechanical properties, the repair tissue does not match intact human cartilage. We talk about osteoarthritis when the illness has progressed further and cartilage damages are widespread within the joint.
According to Lorite, the researchers’ results up to this point are encouraging. The projects require a lot of research and multi-disciplinary co-operation, but the big research team is functional and persevering. These extensive international projects involve several partners besides the University of Oulu.
MIRACLE – a new diagnostic tool for surgeons
The aim of the MIRACLE project is to develop a completely new measuring technique that will provide objective measurement data to the physicians during arthroscopy on the biochemical composition of the patient’s articular cartilage tissue. The current practice involves the surgeon’s visual assessment of tissue inside the joint and sensing its stiffness with the help of a blunt instrument while relying on personal experience. Joint damage can also be examined without arthroscopy with the help of X-rays and magnetic resonance imaging, but these are of little help in milder cases.
The development of diagnostics is especially important, as incorrectly diagnosed and untreated or incorrectly treated joint damage often leads to osteoarthritis at a later stage. This has high impact when young patients have a trauma due accident or sport injury.
The device being developed in the MIRACLE project is based on biophotonics and infrared spectroscopy, i.e. it measures the reflection of infrared light off a surface. “Healthy and damaged areas of tissue provide different measurement results that can be compiled into a colour coded map. They also show local and minor gradations of damage,” Lorite says.
Although the new device still doesn’t allow external examination only, it is hoped that in the future knee examination and treatment procedures will be performed in one single operation.
-If there were a new device developed by MIRACLE and it were to help in discovering joint cartilage damage, a scaffold could be placed as a treatment measure during the same operation. The same device could be used later on to check how well the scaffold was integrated, i.e. merged, in the surrounding tissue, Saarakkala says.
So far, the identification of different patient and risk groups has not been easy. Information would be valuable, for example when assessing who would benefit from a specific form of treatment. In the future, it may become easier to better evaluate those belonging to risk groups and also to give recommendations on exercising and other life-style-related matters. It is essential to develop new ways of predicting the evolution of diverse situations.
RESTORE – working on a better functioning scaffold
In the RESTORE project, researchers are trying to develop a functional scaffold to repair the structure of damaged cartilage by using so-called functional nanomaterials.
-Nanomaterials are chemical substances with a very small particle size. Nano means 10-9. For example, a nanometre is one millionth of a millimetre, i.e. much smaller than the thickness of a single hair. Nanomaterials are commonly used in many fields, such as in electronics and reinforcement of sport materials, but their use in medicine is still quite new, Lorite says.
Nanomaterials suitable for the RESTORE project are materials compatible with the human body. They are either of biological origin or bio-compatible materials that do not cause rejection in the human body. Lorite emphasises that nanomaterials are a large group of different materials that should not be lumped together. Every single one requires vast amounts of research work.
-Today, these materials can be coated depending on their purpose. The idea is to develop a material that can be activated. There could be, for example, a medicinal substance inside it. Such a scaffold could be placed in the damaged joint area and external stimulation would be sent. Within the project, we are studying, among other things, sound pressure wave and ultrasounds to release the medicinal substance present in the nanomaterial to the tissue, Saarakkala says.
The project includes partners that will carefully examine the materials being used and their toxicity. First, it is important to investigate that cells do not die or get damaged. In addition, the surrounding tissues reactions to the materials must be studied. In the final stage, the research will also involve pre-clinical testing carried out by the University of Ulm. If the developed scaffolds prove to be functional within these studies, testing on voluntary human patients could begin in the future.
-In comparison to their other applications, nanomaterial introduction to medicine has been slowed down by the process required to establish their safety and non-toxicity. When this matter progresses, the materials may be of use, for example, with different physical stimulations which could enhance the healing process. Lorite says.
The idea in the RESTORE project is to monitor the area being treated from the outside during the follow-up process and not to reopen the joint. Changes could be monitored, for example, using sound, observing walking or measuring temperature. Researchers have established that the rougher tissue in the damaged area emits different sound compared to the healthy one. Inflammation, for its part generally increases the joint temperature.
Text: Anna Nieminen
Photo: Juha Sarkkinen
Last updated: 27.6.2019