HEALING POWER

The future of medicine




Using glass in advanced medical procedures may seem counter-intuitive, but bioglass is a wonder substance which is starting to be applied to everything from complex fractures to future cancer therapies.
 
‘In the future, surgeons will be able to 3D print a custom-shaped piece of bouncy bioglass, and insert it into a broken leg, allowing the patient to walk without crutches’
 
Sitting in his office at King’s College, London, Dr Ian Thompson is holding up a small packet of crystals. To the naked eye, they almost look like sugar grains, but they’re actually a form of glass, and Thompson, a specialist in facial reconstruction at nearby Guy’s Hospital, is about to use them to heal a particularly complex defect.
 
The patient, a male in his late 40s, has a cyst in his jaw, stemming from an infection that developed following a tooth extraction. The cyst has expanded to such an extent that X-rays reveal a 10cm-wide hole, putting the entire jawbone at risk of fracturing. Thompson has seen hundreds of these cases over the past two decades, but while surgeons would previously attempt to fill the hole using a piece of rib or hip bone from the patient’s body, they now insert a putty of powdered bioglass.
 
Using glass to repair bone may seem odd, but this is no ordinary glass. If you inserted window glass into the body, it would be quickly sealed off by scar tissue before being eventually ejected. Bioglass, a substance first invented in the aftermath of the Vietnam War, actually bonds with the bone and surrounding muscle by dissolving into the body, leaving a substance almost identical to real bone mineral. In addition, it releases calcium ions, which stimulate the body’s own cells to become more active and generate new bone, thus naturally healing the hole over weeks and months.
 
‘The body doesn’t recognise it as foreign,’ Thompson says. ‘As bioglass dissolves it also releases sodium ions which kill off bacteria, so you have this very mild antibiotic nature to the glass. It’s much better than trying to relocate bone from other parts of the patient, which comes with complications.’
 
The most well-known commercial use of bioglass is actually in toothpaste, where it helps heal small cavities as well as fighting bacterial infections, but in recent years surgeons have been using it to mend injuries such as eye socket fractures sustained in traffic accidents.
 
Bioglass is even being applied to the most complex of surgeries, from growing back tiny bones in the ear to allow deaf patients to hear again, to hand reconstruction, healing the fragile metacarpal bones, which connect the fingers to the wrist.
 
‘The bioglass bonds to the soft tissue as well as the bone, providing a good feel and means you don’t have the strange sensation of something moving around in your hand,’ Thompson says.
 
Across London, however, scientists are manipulating the chemical structure of bioglass to create enhanced versions, some of which will be able to regenerate much larger pieces of bone while supporting the patient’s weight, and others that can actually mend cartilage.
 
The first version is known as ‘bouncy bioglass’, a moniker given because it resembles a spongy flexible ball, and when dropped, it keeps bouncing rather than shattering. In the future, surgeons will be able to 3D print a custom-shaped piece of bouncy bioglass, and insert it into a broken leg, allowing the patient to walk without crutches. ‘It’s extremely strong and flexible which allows it to take the cyclic load of walking,’ says Professor Julian Jones of Imperial College, London, its developer. ‘Allowing the patients to walk is extremely helpful in regenerating huge pieces of bone, as those forces are transmitted to the cells in your bone like a signal, encouraging them to grow new bone in the right architecture.’
 
But it’s the prospect of using bioglass to regenerate cartilage which has excited so many surgeons. As many of the world’s greatest athletes have found, even the most advanced surgical techniques can’t fully heal damaged cartilage in the spine or the knees, resulting in crippling arthritis. But Jones has created a form of bioglass with the same soft, rubbery texture as cartilage itself.
 
‘Cartilage looks and feels a bit like squid,’ he says. ‘It’s also very soft and flexible, and we’ve had to synthetically replicate all that, so that when we insert a bioglass disc between the vertebrae in the spine, the body’s cells recognise that as the real thing, and are stimulated to regrow natural cartilage as the bioglass dissolves.’
 
Over the next decade, Jones hopes to prove the efficacy of cartilage bioglass in a series of animal and clinical trials, particularly in patients suffering from chronic pain due to a herniated disc. ‘At the moment surgeons deal with this by replacing the disc with a bone graft which fuses the vertebrae together,’ he says. ‘But then the patients lose a lot of mobility. This could change all of that.’
 
But this isn’t all bioglass can do. In cancer research, some preclinical trials are experimenting with using tiny nanospheres made out of forms of bioglass which can be used to deliver intense, targeted doses of chemotherapy and other drugs directly to tumours, before dissolving away into the body as if they never existed.
 
It may seem like science fiction – man-made glass materials which are assimilated within our own bodies – but bioglass has already changed surgery forever. In the coming decades it will increasingly become part of all aspects of medical care, ranging from curing disease to allowing us to regenerate and strengthen our skeleton and its fragile joints like never before.
 
‘It may seem like science fiction – man-made glass materials which are assimilated within our own bodies – but bioglass has already changed surgery forever’

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