The amniotic sac is the inner lining of the placenta, and it supports the fetus throughout development, so it needs to be strong, flexible, and adaptable. It’s made of two distinct but conjoined membranes, the amnion and chorion. The structural integrity of the amniotic and chorionic membranes is due to a complex, bioactive ECM that is composed of collagens, fibronectin, laminin, and proteoglycans, which are integral to tissue regeneration and wound healing1. The ECM also has a high concentration of hyaluronic acid, which promotes non-fibrotic healing and minimizes scarring2.
Multipotent amniotic epithelial and mesenchymal stem cells secrete a broad array of growth factors that support fetal development, including epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), keratinocyte growth factor (KGF), transforming growth factors alpha and beta (TGF‐α and TGF‐β), and nerve growth factor (NGF)3. Used therapeutically, these compounds have powerful healing capabilities even in chronic conditions.
The amniotic and chorionic membranes produce a number of paracrine-acting immunosuppressive cytokines, including interleukins 4 and 10 (IL-4 and IL-10) and prostaglandin E2 (PGE2), which inhibit activation and proliferation of CD4+ and CD8+ T cells and B cells and suppress differentiation of monocytes to antigen-presenting dendritic cells4. Amniotic immunosuppressors also upregulate anti-inflammatory M2 macrophage activation5 and block the release of pro-inflammatory IFN-γ from cytotoxic natural killer (NK) cells6.
The amniotic membranes have a long history in regenerative medicine7, and new applications are identified regularly. Amniotic allografts promote re-epithelialization while minimizing inflammation, making them ideal topical treatments for burns8 (even in pediatric populations9), pressure ulcers10, and other dermal wounds. Chronic conditions like diabetic ulcers are also improved with amniotic allografts11.
Other common applications for amniotic allografts include reconstruction of conjunctival and ocular surfaces12, tendon repair13, osteoarthritis14, and neuropathy15. In addition, amniotic tissue contains numerous growth factors and proteins that have been shown to improve bone healing16-17, regenerate nervous tissue15, and prevent fibrogenesis. Dermatologists are using amniotic allografts to restore a youthful appearance18. Ongoing clinical studies are evaluating amniotic tissue allografts for the prevention and treatment of fibrotic diseases that affect the liver19, lungs20, nervous system21-22, and to repair infarcted myocardial tissue23.
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