CoreBone Featured in Hamodia

Editor’s note: Article reprinted with permission.

Growing New Bones

By Rhona Lewis, Hamodia (10 May 2017)

Make no bones of two innovative technologies that are changing the face of dental and orthopedic procedures: Hamodia spoke to Dr. Ohad Schwartz of CoreBone, a company based in the Arava desert region, which generates a bone-graft product made from corals grown in a closed system.


Corals for Bone Grafts

CoreBone featured in Hamodia magazingTwo factors inspired Ohad Schwartz to find a way to grow corals on land for medical purposes, especially, bone substitutes. The first was the belief that many of today’s problems can be solved by turning to the sea. “We have cataloged 98 percent of land organisms, but we know only 2 percent of the sea organisms,” says Schwartz. Today, thanks to algaculture, algae fuel can become an alternative to fossil fuels. Bacteria found in the depths of the ocean are being used to treat prostate cancer. Research has shown that the sea cucumbers, a soft, cylindrical marine animal, can be used to kill cancer cells and stimulate the immune system. And corals? Schwartz sees coral as today’s answer to bone implants.

The second factor was the 1997 Kyoto Convention, which called on countries to reduce greenhouse gas emissions. “Aside from the global warming issues, the convention also brought to light the threat to sea corals,” says Schwartz. “Wild harvesting of sea corals to satisfy customers, such as aquarium owners, means that by 2029, there will be no more corals left in the sea,” he says. With this prediction in mind, the Convention issued sanctions to forbid the harvesting of coral. Schwartz’s idea for using corals for bone grafts isn’t an innovation. Since the structure of coral is very similar to human bone structure, for the past 20 years, companies have been harvesting coral and hundreds of thousands of bone grafts using coral have been carried out. However, the sanctions of the Kyoto Protocol had put a stop to wanton harvesting. “In addition, with the increase of pollution in the sea and the difficulty in monitoring the source of the corals, the quality of the material began to deteriorate,” says Schwartz.

But Schwartz’s idea held an innovative kernel. the harvesting of corals banned, why not grow on land? “Today, sources used for bone grafting include cadaver, bovine, porcine and synthetics. Coral is the perfect, kosher, alternative to these sources,” says Schwartz. “By growing corals in closed system on land, we preserve nature and offer patients an effective solution.”

In order to turn his idea into reality, in December 2011, Schwartz teamed up with Professor Yitzchak Binderman, former head of the Oral and Maxillofacial Surgery Department the Tel Aviv Sourasky Medical Center (Ichilov Hospital) and researcher at the Weizmann Institute and at the National Institute of Health Bethesda, Maryland. Today, Schwartz, former of two med-tech companies, Vaica Medical AI, is the CEO of CoreBone, a start-up that coral bone graft.

The Coral Connection

In 1988, a professor by the name of Eugene White first noticed coral’s similarities to bones while diving in the South Pacific. He went on to discover that sea coral naturally possesses the similar porous structure and calcium carbonate of human bones. Professor White thought coral would make great bone grafts. Over the years, researchers tried developing coral as a bone grafting material. But sometimes the coral didn’t biodegrade; it stayed in the body, creating problems for the patient.

Zhidao Xia, a lead researcher in coral bone grafting found a way to make coral more compatible with human bone, also solving the biodegradability problem. Today CoreBone grafts are made from corals that are grown in closed, controlled aquatic (aquarium) systems. The systems eliminate a number of the challenges facing wild corals: sea pollution, biological marine contamination and endangerment.

CoreBone corals are bred from selected species with strength and porosity appropriate for different clinical indications.

A Good Bone Graft

“A good bone graft has five features,” explains Schwartz. “It must be biocompatible so that the body won’t reject it. It must be strong enough to provide sufficient support. It must allow vascularity, meaning that it must be porous enough to allow new blood vessels to grow through it. It must be bioactive, meaning that it must attract new cells and integrate them into the graft. The graft is essentially like scaffolding upon which new bone grows. Finally, a good graft must also be resolvable (biodegradable) so that it can be replaced by the new bone,” he says.

Some organic grafts offer some of the necessary features, but they pose the risk of rejection and bacterial infection and in some countries, for example, Switzerland and Turkey, they are forbidden. In addition, some organic implants have a second drawback. “Bovine implants are treated to dispel the threat of mad cow disease (a.k.a, variant Creutzfeldt-Jakob disease or vCJD). Unfortunately, the treatment turns them into ceramic-like substance that the body has difficulty in ridding itself of,” says Schwartz. While synthetic grafts avoid these risks, they are much weaker than natural bone. Enter CoreBone — a strong, biocompatible, bioactive, and resolvable solution.

CoreBone’s products are undergoing clinical trials at Baruch Padeh Medical Center in Poriya, near Tiberias. CE approval, which has recently been received, allows CoreBone to launch its products in Europe. By the middle of this year, CoreBone plans to apply for approval from the Food and Drug Administration. “This approval is expected by the middle of 2018,” says Schwartz. And the good news is that the coral-based bone grafts will be priced comparably with average bovine-based bone grafts, which sell for about $100 per 1cc in United States.

Corals in the Arava Desert

Let’s start with a closer look at coral. In nature, free-swimming coral larvae attach themselves to submerged rocks or other hard surfaces along the edges islands or continents to begin the process of forming coral reefs. The coral polyps then secrete skeletons from the underside of their skin. These skeletons, made from calcium carbonate, protect the coral animals from predators. The process of growing the skeleton consumes a lot of energy, which is conveniently provided by the algae living in the corals’ tissues. Different species of coral grow at different rates depending on water temperature, salinity, turbulence, and the availability of food. Some grow between 5 and 25mm a year; others can annually add as much as 20 centimeters their length.

“Very few places in the world have the conditions necessary to grow corals,” explains Schwartz. CoreBone provides the corals with the necessary conditions in large, closed aquarium systems filled with laboratory manufactured sea water which ensures quality and safety and is monitored regularly. Each pool is an independent ecosystem to prevent any cross-contamination.

“Instead of sea water, we use drinking water to which we add sea salts. The water is enriched with silica and strontium to add bioactive (bone-cell-attracting) properties,” says Schwartz. “Because we aren’t treating the corals chemically, but rather giving them a food supplement, the effect is rather like taking vitamins,” he says.

In addition, temperature and light levels need to be monitored. Strong sunlight is needed to enable the symbiotic algae to photosynthesize so that they can provide the energy that the corals need in order to grow. And the Arava desert has plenty of that. “Many corals follow a six-month cycle of growth followed by six months of rest. At CoreBone, since the corals aren’t competing for food and since we provide optimum light and temperature levels, the corals grow 10 times faster than in nature. “We are the only coral farm with CE (European Conformity) approval,” says Schwartz. The growth process used on the farm has been patented in Israel and the United States.

Different Corals for Different Tasks

“Our products originate from natural corals that were purchased with certification. Since they have reproduced in our pools, we actually have family trees for all of our products. We grow different corals with different shapes, strengths and porosities for different indications,” Schwartz explains.

One of the most common dental procedures today is socket preservation after tooth extraction. In order to prevent bone loss and to provide a platform for the new implant, the cavity is usually filled with bone graft granules.

“One of the corals grown at CoreBone has the exact shape and dimensions of tooth roots,” says Schwartz. So Schwartz was right — the answer for bone grafts, or at least part of the answer, has indeed been found in the sea.

Read the full article (PDF).

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