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Amnion Matrix Allograft

The entire amniotic/chorionic membrane tissue can be viewed as a complex rich in extracellular matrix (ECM). The extracellular matrix is a three-dimensional network composed of molecules secreted by cells, including components such as collagen, proteoglycans, and glucosamine. This matrix not only provides support and structural stability but also participates in cell signaling, cell-to-cell communication, and the ability to regulate cell behavior. Furthermore, it contains over 190 different growth factors, including PDGF, TGF, EGF, FGF, and VEGF, which play roles in promoting cell proliferation, differentiation, and tissue repair[1].

  • Platelet-Derived Growth Factor (PDGF) contributes to promoting cell proliferation and differentiation, especially playing a significant role in the growth and repair of vascular endothelial cells and smooth muscle cells.

  • Transforming Growth Factor (TGF) is a multifunctional growth factor family involved in processes such as cell proliferation, differentiation, cell communication, and tissue repair, with broad-ranging effects in biology[1].

  • Epidermal Growth Factor (EGF) is a growth factor that regulates cell proliferation and differentiation, particularly crucial for the growth and tissue repair of epidermal cells.

  • Fibroblast Growth Factor (FGF) is a diverse family of growth factors involved in various cell repair processes, including cell proliferation, cell migration, angiogenesis, and more.

Vascular Endothelial Growth Factor (VEGF) is vital for angiogenesis and the growth and development of vascular endothelial cells, ensuring an adequate blood supply to tissues and organs. These growth factors' presence makes the amniotic/chorionic membrane tissue a significant bioactive tissue matrix. They can regulate cell behavior, stimulate cell proliferation, differentiation, and migration, aiding in tissue repair and healing.

Amniotic membrane matrix is also rich in cytokines that regulate the inflammatory response, such as IL-1Ra, IL-6R, Eotaxin, MIP-1, and more. Interleukin-1 receptor antagonist (IL-1Ra) is an anti-inflammatory molecule that can reduce inflammation induced by Interleukin-1 (IL-1), helping to control excessive immune responses and minimize tissue damage. Interleukin-6 receptor (IL-6R) is involved in regulating Interleukin-6 (IL-6) signaling, which is a multifunctional cytokine participating in immune responses and inflammation. Eotaxin is a chemokine that guides eosinophils to migrate to inflamed areas, participating in immune responses and tissue repair. Macrophage Inflammatory Protein-1 (MIP-1) is a cytokine involved in immune cell migration and stimulating macrophages, helping regulate the inflammatory process. These growth factors and cytokines can stimulate cell migration, cell growth, cell replication, cell differentiation, and other cellular behaviors, promoting tissue repair and healing. They help regulate immune responses, reduce inflammation, and facilitate the regeneration of damaged tissues.

Amniotic Membrane Matrix Features and Applications

Medical professionals collect amniotic membrane under sterile conditions from the placenta to ensure the product's sterility and safety. During the collection process, only amniotic matrix allograft containing stem cell functionality, including mesenchymal stem cells (MSCs), is taken. MSCs have the ability to differentiate into different cell types and participate in tissue repair processes. Compared to the chorionic membrane, the amniotic membrane matrix expresses almost no immunogenicity. Immunogenicity is typically associated with the source and composition of the graft. Since the amniotic membrane matrix is derived from human amniotic membranes and undergoes special processing to ensure sterility, its immunogenicity is lower, making it less likely to be recognized as a foreign substance by the immune system and reducing transplantation risks. The amniotic membrane matrix is processed using aseptic techniques to ensure the product is not contaminated with microorganisms, reducing the risk of infection. The dried powdered form of the amniotic membrane is also easier to store and transport. Before use, it can be reconstituted into an injectable solution and adjusted according to specific clinical requirements for injection or application. Research has shown that using the amniotic membrane matrix to wrap around damaged tendon sites can reduce fibrosis reactions and adhesions, and promote healing.

Growth Factors Present in Amniotic Membrane Matrix:

  • Epidermal Growth Factor (EGF)

  • Transforming Growth Factor β (TGF-β)

  • Fibroblast Growth Factor (FGF)

  • Platelet-Derived Growth Factor (PDGF) A&B

  • Vascular Endothelial Growth Factor (VEGF)

Cytokines Present in Amniotic Membrane Matrix:

  • Interleukin-1 Receptor Antagonist (IL-1Ra)

  • Interleukin-6 Receptor (IL-6R)

  • Eotaxin and Macrophage Inflammatory Protein-1 (MIP-1)

Clinical Application

Tendon and Ligament Tears [3]

Anterior Cruciate Ligament (ACL) Rupture [4]

Refractory Plantar Fasciitis [5]

Reference List

  • [1]Ruiz-Cañada C, Bernabé-García Á, Liarte S, Rodríguez-Valiente M, Nicolás FJ. Chronic Wound Healing by Amniotic Membrane: TGF-β and EGF Signaling Modulation in Re-epithelialization. Front Bioeng Biotechnol. 2021;9:689328. Published 2021 Jul 6.

  • [2]Prakash S, Kalra P, Dhal A. Flexor tendon repair with amniotic membrane [published correction appears in Int Orthop. 2020 Aug 25;:]. Int Orthop. 2020;44(10):2037-2045.

  • [3]Prakash, S., Kalra, P., & Dhal, A. (2020). Flexor tendon repair with amniotic membrane. International Orthopaedics, 44, 2037-2045.

  • [4] Levengood, G. A. Arthroscopic-assisted anterior cruciate ligament reconstruction using hamstring autograft augmented with a dehydrated human amnion/chorion membrane allograft: a retrospective case report. Orthop Muscular Syst, 2016; 5,2.

  • [5] Hansen, M. H., & Anderson, J. J. Chronic and Refractory Plantar Fasciitis Treatment With Single-dose Dehydrated Amniotic Allograft Injection. Desert Foot.2017

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