Human Amniotic Membrane: Sprouting Life

Abstract

Commentary: The human amniotic membrane (hAM) is an absorbable, biocompatible collagen-based matrix procured from the human placenta1. Over the previous decade, the advancement of tissue designing, alongside new acellularization conventions; reworked this biomaterial into a modulatory matrix for regenerative medicine2. The hAM possesses a wide array of properties namely anti-microbial, anti-fibrotic, and anti-inflammatory pertaining to the presence of various growth factors and mesenchymal stem cells which decreases the secretion of proinflammatory cytokines3-4. Another essential property of this extracellular matrix for tissue designing applications is its capacity of cellular multiplication, differentiation, and cell attachment5. This exceptional arrangement of natural and biochemical properties along with its boundless accessibility and diminished cost have formed hAM into a biomaterial of choice. In the field of medicine, it is widely used in ophthalmology for ocular surface reconstruction, in dermatology for the biological dressing of wounds and ulcers, as a scaffold in tympanoplasty, arthroplasty, other organ reconstruction procedures, and it was recently used in oncology since it can block the oxygen and nutrient supply to the tumor cells, therefore, inhibiting its growth6. Tissue protection and preservation provides a consistent supply of this scaffold for clinical applications. A few conventions developed for the protection of intact hAM, namely cryopreservation in glycerol, air-drying, lyophilization, acid treatment (peracetic acid, and ethanol), and gamma irradiation has also been described without affecting its composition7. Over the past decade, hAM has paved its way into the field of dentistry, it is widely used in diverse branches like in periodontal root coverage procedures, vestibuloplasty, bone reconstruction procedures, it is also used in oral mucous reconstruction after the treatment of lesions caused by carcinoma or leukoplakia or recurrent mouth ulcers8. The amniotic membrane is a compound semipermeable layer comprising of cellular components having pluripotential capacity. The amniotic membrane is an immunotolerant and foundational structure having the pluripotential capacity of transdifferentiation to other cell components of the periodontium making it a reasonable contender for guided tissue regeneration (GTR) and they are broadly utilized in the field of regenerative dentistry as a scaffold in immature non-vital pulp regeneration and revitalization cases9. The inherent properties of angiogenesis, release, and entrapment of endogenic growth factors, induction of collagen synthesis, and maintenance of structural and anatomical configuration of regenerated tissues make the amniotic membrane an ideal base for rapid healing, reduction in post-operative scarring, pain, and loss of function. It is a biomodulator that allows both hard and soft tissue healing, making its application widespread. Although dental pulp stem cells are accessible autologously or probably allogeneically; it faces numerous scientific, regulatory, and commercialization barriers creating transplantation of these cells to be a research exercise as opposed to clinical reality. In-progress work on the application of hAM in various healing, reconstructive and regenerative protocols, that helps organize the orienting of host endogenous cells, represents a shift from standard cell transplantation approaches and thus hasten clinical translation. Hence, the application of hAM is pacing up in numerous fields of tissue engineering, regenerative biology, and stem cell researches. Even though, further investigation and long haul clinical preliminary trials, probing the maximum capacity of this stem cell reservoir are required to undoubtedly acknowledge the reality of the human amniotic membrane as a repository for recovery and regeneration.