Module III

LUNGS
ARCHITECTURE OF LUNGS
The lung is an important organ in the human body. It is part of the respiratory system. It is
mainly involved in the process of breathing. The primary function of lungs is to facilitate the
exchange of gases between the air we breathe and the bloodstream.
The architecture of lungs is complex and well organized. Knowledge of the architecture of lung
is essential for understanding the relationship between morphology -functions of the lung
component. This helps to understand the mechanism of gas exchange process.
An overview of the main structures and components of the lungs along with their working
mechanism is described below:
1. Trachea: When we breathe, air enters in to the nose and passes through nasal passages to
wind pipe. This wind pipe is called as the trachea. It is a rigid tube made of cartilage rings that
connects the larynx (voice box) to the bronchi. It serves as the main passageway for air to enter
and exit the lungs.
2. Bronchi: At the entry point of lungs, the trachea divides into two main branches one leading
to each lung called as bronchi.
3. Bronchioles: The bronchi further divide into small, narrow branches known as bronchioles.
This branching network extends throughout the lungs. Bronchioles contain smooth muscle
which can contract or expand easily to regulate airflow.
4. Alveoli: Alveoli are tiny, grape-like sacs at the ends of the bronchioles. They are the primary
sites of gas exchange in the lungs. Each lung contains millions of alveoli. They provide a large
surface area for efficient oxygen and carbon dioxide exchange.
5. Pulmonary Capillaries: Alveolus are surrounded by networks of tiny blood vessel called
as pulmonary capillaries. These capillaries have thin walls which allow the exchange of gases
between the air in the alveoli and the bloodstream.
6. Diaphragm: The diaphragm is a dome-shaped muscle located below the lungs. It plays a
crucial role in respiration. It contracts and flattens during inhalation and hence increases the
volume of the chest cavity. This allows the lungs to expand during inhalation.
Thus, the architecture of the lungs is designed to maximize the surface area available for gas
exchange.
GAS EXCHANGE MECHANISMS IN LUNGS
The lung is the main organ involved in the process of breathing. Breathing is inhaling oxygen-
rich air and exhaling carbon dioxide rich air.
Mechanism of gas exchange during inhaling and exhaling is briefly described here:
1. The first step is contraction of diaphragm. When diaphragm contracts, the muscles in the rib
cage expand the chest cavity. This causes the expansion of lungs also. This expansion lowers
the pressure inside the lungs. Due to difference in pressure, air is drawn in to the respiratory
system.
2. Air enters in to the nose and passes through nasal passages to trachea.
3. Then, air passes through bronchi, bronchioles and diffuses across the thin walls of the alveoli
(tiny air sacs in the lungs) into the surrounding blood capillaries.
4. The concentration of oxygen in the alveoli of the lungs is higher than in the blood. Hence,
oxygen diffuses into the bloodstream. There, oxygen binds to iron of haemoglobin molecules
within red blood cells, forming oxyhaemoglobin.
5. This oxygenated blood is then transported to the heart, which pumps it to various organs and
tissues in the body.
6. Concentration of oxygen within cell is less than in oxygenated blood, thus at cell walls, the
oxygen molecules dissociate from the oxyhemoglobin and diffuse across the cells.
7. In this way oxygen is supplied to each and every cell where it is utilized for cellular
respiration, energy production, and metabolism.
8. At the same time, carbon dioxide, a waste product generated by cellular metabolism binds
to iron of hemoglobin molecules within red blood cells, forming carboxyhemoglobin.
9. This carboxyhemoglobin in blood is transported to the heart, which pumps it back into the
alveoli of lunge and exhaled out.
Thus, gas exchange in the lungs occurs primarily through a process of diffusion. It involves the
movement of gases (oxygen and carbon dioxide) across the thin walls of the alveoli (air sacs)
and the surrounding pulmonary capillaries.

LUNGS AS PURIFICATION SYSTEM

The lungs have certain built-in mechanisms to filter out larger particles and foreign substances
present in the inhaled air. This mechanism helps to filter the air and protect the respiratory
system from harmful substances. The role of lungs in purification mechanism is briefly
described here:
1. When we breathe, the nose and nasal passages act as the first line of defence. They trap larger
particles such as dust, pollen, and pollutants.
2. The mucus lining of the respiratory tract also helps to trap and remove particles, preventing
them from reaching deeper into the lunge.
3. The cilia, tiny hair-like structures lining the airways, then work in coordination with the
mucus to move trapped particles upward, where they can be expelled by coughing or
swallowing.
4. The respiratory system, including the lungs, has an immune defence system that helps protect
against pathogens such as bacteria, viruses, and fungi.
5. The mucus in the respiratory tract contains antibodies and enzymes that can neutralize or
destroy pathogens.
6. The lungs plays main role in removing carbon dioxide from blood. Carbon dioxide can act
as an acid when dissolved and can reduce pH of blood.
7. The lungs help regulate the pH balance of the blood by controlling the levels of carbon
dioxide. Lungs remove carbon dioxide from blood and helps in maintaining optimal pH level
of blood.
Thus, the lungs are responsible for breathing, gas exchange, oxygenation of blood, removal of
carbon dioxide, acid-base balance regulation, and defense against foreign particles. Hence, the
proper functioning of lungs in crucial for maintaining the body's overall health and well-being.
ABNORMAL LUNG PHYSIOLOGY
The main role of the lungs is to facilitate the exchange of oxygen and carbon dioxide between
the body and the environment. Any deviation from the normal functioning of the lungs is
referred to as abnormal lung physiology. Deviation from normal lung functioning can occur
due to various factors like exposing to dangerous chemicals in the environment, lifestyle
choices like smoking and various infections. These can result in various abnormalities of lungs.
Few of them are given below:
1. Chronic obstructive pulmonary disease (COPD): It is characterized by airway obstruction
that makes it difficult for air to flow in and out of the lungs. Obstruction can be caused by
inflammation, narrowing of the airways, excessive mucus production, or a combination of these
factors. This leads to symptoms like shortness of breath, wheezing, and decreased airflow.
2. Asthma: Asthma is a chronic condition characterized by inflammation and narrowing of the
airways. It leads to recurrent episodes of wheezing. breathlessness, chest tightness, and
coughing. Asthma symptoms are triggered by allergens, weather conditions and respiratory
infections.
3. Respiratory Infections: Pneumonia is an infection of lungs caused by bacteria, viruses, fungi,
or other microorganisms. It results in inflammation in the air sacs of the lungs. Symptoms
associated with pneumonia are fever, cough, chest pain, and difficulty breathing. Bronchitis is
another common infection of lungs. These infections can lead to fluid accumulation in the
lungs, impaired gas exchange, and decreased lung function.
4. Pulmonary Fibrosis: Pulmonary fibrosis results in the scarring and thickening of lung tissue.
This leads to progressive loss of lung function and impaired oxygen transfer. It can be caused
by exposure to environmental toxins, or certain medications.
5. Lung Cancer: Lung cancer can affect lung physiology by causing the growth of abnormal
cells within the lungs. Tumors can obstruct the airways, impair lung function, and interfere
with gas exchange. Lung cancer can also spread to other parts of the body, further impacting
lung function.
These are few examples of conditions that can result in abnormal lung physiology. Each
condition can affect lung function in a different way. Diagnosis and treatment of abnormal lung
physiology require a thorough evaluation by a healthcare professional, typically a
pulmonologist or respiratory therapist, who can conduct tests, interpret results, and develop an
appropriate management plan.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disease that affects the
airways and lungs. It results in breathing difficulty due to the obstruction or narrowing of the
airways. This obstruction is caused by chronic inflammation and damage to the lung tissue.
The airways lose their elasticity, and the walls of the air sacs (alveol) become inflamed and
thickened, leading to reduced airflow, COPD is a chronic disease. A chronic disease refers to a
long-lasting medical condition that generally progresses over time and often has no known
cure.
The main causes of COPD are:
1. COPD is usually caused by long-term exposure to irritants, mainly cigarette smoke.
2. It can also be caused by exposure to occupational dust and chemicals, indoor air pollution.
3. It can also be caused due to genetic factors.
The main symptoms of COPD are:
1. The most common symptoms of COPD include chronic cough, sputum production, shortness
of breath, and wheezing. These symptoms often develop gradually and worsen over time.
2. Individuals with COPD may experience frequent respiratory infections, fatigue, and exercise
intolerance.
COPD can be diagnosed based on a combination of symptoms, medical history, lung function
tests, and imaging studies. Spirometry is a key test used to measure the reduced lung function
and limited airflow in case of COPD patient. There is no cure for COPD. The disease should be
effectively managed to reduce symptoms, slow down disease progression, and improve quality
of life. The main treatment options for COPD are:
1. Lifestyle changes like leaving smoking, reducing exposure to air pollutants and regular
exercises.
2. Regular medications like bronchodilator inhalers which reduce swelling in the airways and
relax the airways to keep them open.
3. Pulmonary rehabilitation programs and oxygen therapy.
4. Vaccinations against respiratory infections.
SPIROMETRY
Spirometry is a breathing test used to assess lung function. This test is performed using a device
called as spirometer. During a spirometry test, a person is asked to breathe in and out through
a mouthpiece connected to the spirometer. The spirometer records the volume and flow rate of
the inhaled and exhaled air. Results are used to evaluate lung capacity and lung function.
Spirometry is used to assess lung function:
1. When a person is having wheezing, shortness of breath, or a cough.
2. To diagnose problems like asthma, COPD, lung cancer, or pulmonary fibrosis.
3. To determine if the disease is improving or worsening and whether medications or inhalers
are working properly.
Few of the key parameters measured in spirometry are:
1. Forced Vital Capacity (FVC); FVC is the maximum amount of air a person can forcefully
exhale after taking a deep breath. It represents the total volume of air that can be expelled from
the lungs.
2. Forced Expiratory Volume in 1 second (FEV1): FEV1 is the volume of air forcefully exhaled
during the first second of the FVC operation. It is an important parameter used to assess airflow
limitation.
3. Peak Expiratory Flow (PEF): PEF is the maximum flow rate achieved during a forced
expiration. It reflects the maximum speed at which a person can exhale air and is useful in
monitoring conditions such as asthma.
4. Forced Expiratory Flow (FEF): FEF measures the flow rate during the middle portion of the
forced expiration. Different FEF values can provide information about airflow at different
points during exhalation.
VENTILATOR
When a patient condition is serious, and unable to breathe adequately on their own. Then,
breathing support to patient is given using a medical device called as a ventilator. It is also
known as a mechanical ventilator or a respirator. Ventilators are life-saving devices. With
ventilators, healthcare providers can control and monitor breathing parameters, adjust oxygen
levels, and support patients until their condition improves.
Ventilators are generally used in the following cases:
1. Ventilators are used in intensive care units (ICUs) to manage critically ill patients who
require advanced respiratory support. They provide support to patients until their condition
stabilizes or improves.
2. Ventilators can provide temporary respiratory assistance to patients with acute respiratory
distress syndrome (ARDS), pneumonia, chronic obstructive pulmonary disease (COPD), or
other conditions. They can maintain vital functions and buy time for the underlying condition
to improve.
3. During certain surgical procedures, general anesthesia can cause the suppression of natural
breathing. Ventilators are used to provide controlled ventilation to patients while they are under
anesthesia.
During ventilation Process, a predetermined volume of air/oxygen mixture humidified and
supplied into the patient's lungs. This is known as the tidal volume. The patient is allowed to
exhale passively. In some cases, a positive pressure is applied to assist with exhalation and
prevent alveolar collapse. Healthcare professionals closely monitor the patient's vital signs and
respiratory parameters using the ventilator's displays and alarms. They make adjustments to
ventilation settings as needed, based on the patient's condition, blood gas analysis, and clinical
assessment.
The four main components of ventilator are a control panel, breath delivery system, sensors
and alarms. A control panel is used to input parameters such as tidal volume, respiratory rate,
and oxygen concentration. Breath delivery system delivers the mixture of air and oxygen to the
patient. Sensors and alarms are used to sense and alert the patient's respiratory parameters, such
as airway pressure, tidal volume, and oxygen saturation levels.
THE HEART-LUNG MACHINE
The heart-lung machine is a medical device which is used temporarily to perform the functions
of the heart and lungs. It is used during complex cardiac surgeries. It acts like a bypass machine.
It allows surgeons to temporarily stop the heart and create a still and bloodless surgical field.
So that, they can perform intricate procedures on the heart and major blood vessels.
The main components and functions of heart-lung machine are;
1. Pump: Pump serves the role of heart. It pumps oxygenated blood through the body and
maintains blood flow to vital organs and tissues. It prevents damage of other organs like brain,
kidney by supplying adequate amount of oxygen during the surgical procedure.
2. Oxygenator: This performs the function of the lungs. It adds oxygen to the blood outside the
body and removes waste gases like carbon dioxide from it. It supplies oxygenated blood to
pump so that it is circulated in the body.
3. Heat exchanger. It regulates the temperature of the blood when it passes through the machine
and ensures that it is appropriate when returned to the patient's body.
4. Filters: They remove any air bubbles, clots, or other debris from the blood before it is
circulated back into the patient's body.
The heart-lung machine has significantly contributed to the advancement of cardiac surgery
and saved countless lives by allowing surgeons to perform complex procedures that were once
considered impossible.
KIDNEYS

The kidneys are two bean-shaped organs. They are located just below the rib cage, one on each
side of the spine. The primary function of the kidneys is to filter waste products from blood
stream, while maintaining electrolyte balance. The filtered waste and excess fluids form urine.
Healthy kidneys filter about a half cup of blood every minute, removing wastes and extra water
to make urine. Blood circulates through kidneys many times a day and each time waste products
are filtered out. Apart from filtration of waste materials from blood stream, kidneys have other
important functions as given below:
1. Blood Pressure Regulation: The kidneys produce a hormone called renin. Renin activates a
series of reactions that help control blood pressure. And also, kidneys regulate the volume of
blood plasma by adjusting the amount of water and sodium in blood.

2. Red Blood Cell Production: The kidneys produce a hormone called erythropoietin, which
stimulates the bone marrow to produce red blood cells. Red blood cells are essential for oxygen
transportation throughout the body.

3. Vitamin D Activation: The kidneys play a role in activating vitamin D, which is important
for calcium absorption in the intestines. Vitamin D helps maintain proper bone health and plays
a role in several other physiological processes.

4. Kidneys also remove excess acid produced by the cells and maintain acid-base balance in
the body. Without this balance, nerves, muscles, and other tissues in your body may not work
normally.

5. The kidneys maintain electrolyte balance in the body by filtration and reabsorption
mechanism. This electrolyte and acid-base balance is highly required for proper functioning of
nerves, muscles, and other tissues.

Thus, kidneys play a critical role in overall health and proper functioning of the body.

ARCHITECTURE OF KIDNEYS AND MECHANISM OF FILTRATION

The main role of kidney is to filter out waste products from blood stream. Hence, it is
considered as a filtration system. The main components of kidney and their role in filtration
mechanism are briefly described below:

1. Renal artery: The renal artery is a blood vessel through which oxygenated, unfiltered blood
is supplied to the kidneys. Upon entering the kidney, the renal artery branches into smaller
arteries, which further divide to form a complex network of blood vessels throughout the
nephron. These branches ensure a rich blood supply to the nephrons for filtration.

2. Nephron: A nephron is the functional filtering unit of the kidney. It is responsible for filtering
blood, reabsorbing essential substances, and producing urine. Each kidney contains millions of
nephrons. Each nephron contains two main parts, one is the glomerulus which performs
filtration, and other a tubule. The tubule reabsorbs and returns needed substances to blood and
removes wastes.
3. Glomerulus: The glomerulus is present in the initial part of a nephron. It is a network of
specialized capillaries (tiny blood vessels) with small pores or openings in their walls. These
small pores allow the passage of small molecules and fluid while preventing the passage of
larger particles like blood cells and proteins. They are mainly responsible for filtration of blood.

As blood flows into each nephron, it enters in to the glomerulus with high pressure. Under high
pressure, smaller molecules, wastes, and fluid are forced out through small pores and pass into
the tubule. While, only larger molecules, such as proteins and blood cells, stay in the blood
vessel. Thus, waste materials are filtered out of blood and moved to filtrate. Along with waste,
other essential small molecules like electrolytes, and water are also removed and passed on to
filtrate.

4. Tubule: The blood filtrate from glomerulus enters in to tubule. Tubule has highly coiled and
convoluted structure with a large surface area. As the filtrate moves through the tubule, water
and essential electrolytes, such as sodium, potassium, and calcium, are re-absorbed back. These
essential small molecules are passed into the bloodstream through blood vessel which runs
alongside the tubule. Thus, the tubule returns needed substances to blood and removes wastes.
This process helps maintain proper hydration and electrolyte levels in the body. The remaining
fluid and wastes in the tubule becomes urine.

5. Collecting Ducts: The collecting ducts receive urine from multiple nephrons.

6. Ureter: Urine is passed from the kidneys to the urinary bladder through two muscular tubes
called ureters. Each ureter connects one kidney to the urinary bladder. Kidneys, ureters, and
bladder are part of your urinary system.

Overall, the architecture of kidneys allows the efficient filtration of waste products and
reabsorption of necessary electrolytes and fluid in to blood stream.

CHRONIC KIDNEY DISEASE

The main role of kidneys is to filter waste products and excess fluids from the blood stream.
Due to various reasons, kidneys may gradually and progressively loose their ability to filter
wastes from blood. This condition is called as chronic kidney disease. It is a serious health
issue that can lead to many other complications. It is referred to as “chronic” because it is a
progressive disease that lasts for a long duration.
In the early stages, CKD may not show noticeable symptoms. But, as the disease progresses,
symptoms like fatigue, weakness, loss of appetite, weight loss, dry itchy skin, changes in urine
output (increased or decreased), fluid retention, swelling (particularly in the legs and ankles),
difficulty and increased or decreased urination at night are observed.

Chronic kidney disease can result in:

a) Building up of toxic wastes in blood.

b) Imbalance in the concentration of electrolytes.

c) Improper production of hormones that regulate blood pressure.

d) Improper production of hormones that produce red blood cells resulting in anemia.

e) CKD can result in a sudden loss of kidney function and may finally progress to end-stage
renal disease (ESRD).

Main causes which may result in chronic kidney disease are:

a) Diabetes: High blood sugar levels over time can damage the small blood vessels in the
kidneys.

b) Hypertension (high blood pressure): Uncontrolled high blood pressure can strain the
kidneys, leading to damage.

c) Certain kidney conditions like glomerulonephritis and polycystic kidney disease.

d) Recurrent kidney infections, urinary tract obstructions, and

e) Prolonged use of certain medications.

Kidney's filtering ability is measured in terms of estimated glomerular filtration rate (eGFR).
Based on the eGFR values, Chronic kidney disease can be classified into five stages. Stage 1
(mild kidney damage with normal eGFR) to Stage 5 (severe kidney damage with low eGFR).
Stage 5 is the end-stage renal disease, where the kidneys are no longer functioning adequately
to sustain life. This condition requires requiring dialysis or kidney transplantation.

The following are the treatment options for CKD:

a) Taking prescribed medications as directed.

b) Controlling underlying conditions like diabetes and hypertension.

c) Lifestyle modifications, such as a healthy diet, regular exercise, staying hydrated, avoiding
excessive alcohol consumption and quitting smoking.

d) Avoiding substances that can further damage the kidneys (such as certain medications and
excessive use of painkillers).evaluating kidney function through blood tests, urine tests,
imaging studies, and kidney biopsy in some cases.

In advanced stages of CKD, when kidney function is severely impaired, main treatment options
are dialysis or kidney transplantation. Kidney transplantation is the replacing of the damaged
kidneys with a healthy kidney from a donor. Dialysis is using a machine to filter waste and
excess fluid from the blood.

DIALYSIS SYSTEMS

Dialysis is the main treatment option for the people in advanced stages of chronic kidney
disease (CKD) like end-stage renal disease (ESRD) or kidney failure. At this stage, kidneys
can function at around 10% to 15% of their normal function. Even though, kidney
transplantation is the major solution to these problems, dialysis serves as a life-sustaining
treatment.

Dialysis system is used to remove waste products, excess fluids, and toxins from the blood
when the kidneys are unable to perform these functions adequately.

Dialysis systems help to maintain the balance of fluids and electrolytes in the body, control
blood pressure, and manage other complications associated with kidney failure.

The main components and operation principle of dialysis unit is given below:

1. The core part of dialysis unit is the hemodialysis machine. This machine is responsible for
filtering and purifying the blood during the dialysis process.

2. The patient is connected to hemodialysis machine using the appropriate vascular access site.
The blood from patient's body is pumped to the machine for purification.

3. The main working part of hemodialysis machine is the dialyzer, also known as an artificial
kidney. It contains a semi-permeable membrane.

4. Patient's blood is supplied to one side of the semi-permeable membrane and to the other side
of the membrane a specially formulated solution called as dialysate is circulated.

5. The dialysate is a carefully formulated solution with lower concentration than blood sample.
6. Due to this difference in concentration, waste products and excess fluid from the patient's
blood move across semipermeable membrane to the dialysate solution.

7. The dialysis unit has a system for preparing and delivering dialysate. The dialysate is mixed
accurately and delivered at the appropriate temperature and flow rate.

8. The dialysis unit is equipped with various monitoring devices to track the patient's vital
signs, such as blood pressure, heart rate, oxygen saturation, and temperature. And also, alarms
and safety mechanisms are in place to detect and respond to any issues or emergencies during
the dialysis treatment.

Thus, the dialyzer unit filters the blood, mimicking the natural functioning of the kidneys. It
filters waste products, excess fluid, and toxins from the blood, while retaining essential
substances. By removing these substances, dialysis prevents their harmful buildup in the body.

Dialysis can alleviate various symptoms associated with kidney failure, such as fatigue, nausea,
vomiting, loss of appetite, itching, and difficulty breathing. By removing waste products and
excess fluids, dialysis can improve the overall well-being and quality of life for individuals
with kidney failure. Dialysis can be used as a temporary measure while awaiting a kidney
transplant. It helps maintain the individual's health and stability until a suitable donor organ
becomes available.

MUSCULAR AND SKELETAL SYSTEMS

The muscular and skeletal systems are two interconnected and interdependent systems in the
human body. They work together to provide support to the body, enable its movement, give
protection to vital organs, and carry out various physiological functions essential for human
life.

The muscular and skeletal systems are briefly described below:

1. The Skeletal System: The skeletal system is composed of bones, cartilage, ligaments, and
other connective tissues. The main functions of skeletal system are :

a) Support: The skeleton provides a framework which supports the body, and gives shape and
structure.

b) Protection: Bones serve as protective coverings for vital organs. The skull protects the brain,
the ribcage safeguards the heart and lungs and the vertebrae safeguard the spinal cord.
c) Movement: The bones, along with joints, muscles, and tendons are responsible for
movement of body and body parts.

d) Blood Cell Production: Within certain bones, the bone marrow produces red blood cells,
white blood cells, and platelets.

e) Mineral Storage: Bones store minerals, particularly calcium and phosphorus, which are
essential for various bodily functions. These minerals can be released into the bloodstream as
needed to maintain mineral balance.

2. The Muscular System: The muscular system is made up of muscles, tendons A tendon is a
fibrous connective tissue that attaches muscle to bone, and ligaments. Its main functions
include:

a) Movement: Muscles are responsible for the movement in the body. They contract and relax,
producing the mechanical energy, and generate force for the movement of bones and joints.
Skeletal muscles are attached to bones via tendons, and allow voluntary movements like
walking, running, and lifting objects.

b) Posture and Stability: Muscles help maintain proper posture and stability by providing
support to the skeleton. They work in coordination to keep the body balanced and aligned.

c) Heat Generation: Muscles generate heat as a byproduct of their metabolic processes. This
heat production helps maintain body temperature and contributes to the regulation of body heat.

d) Protection: Some muscles, such as the abdominal muscles, help protect internal organs and
provide support to delicate tissues.

e) Metabolism: Muscles are highly metabolically active tissues. They require energy in the
form of calories, and their activity contributes to the overall energy expenditure and metabolism
of the body.

Overall, the muscular and skeletal systems work together to enable movement, provide support
and protection, maintain posture, and facilitate various physiological functions necessary for
human life.

MUSCULAR AND SKELETAL SYSTEMS AS SCAFFOLDS

The muscular and skeletal systems in the human body can be considered as structural
frameworks that support and shape the body. They provide support to the body's tissues and
organs, allowing for coordinated movement and protection. In this way they play the role of
scaffolds in the human body.

The muscular and skeletal systems are able to regenerate when there is a minor injury from
incidents like motor vehicle accidents, sport-related injuries. The regenerative ability of these
systems is due to constant flow of nutrients and metabolites through complex three-
dimensional capillary network of the muscle fibers.

However, in the case of severe injury, when muscle mass loss is greater than 20%, tissue repair
response is incapable of adequate tissue regeneration. This may lead to extensive and
irreversible fibrosis, scarring, and loss of muscle function.

When a natural muscle repair mechanisms is not working, we need to search for new muscle
regenerative strategies. One such strategy is using scaffolds made of biomaterials as temporary
templates or frameworks to facilitate the regeneration and formation of new tissue.

Scaffolds are three-dimensional structures made of biomaterials. They are used in tissue
engineering for tissue regeneration. They are designed and used to support and guide the
growth of cells, tissues, or organs in human body. The structure of the scaffold is designed to
mimic the native structure of the tissue. The orientation and alignment of regenerated muscle
cells are guided by the structure of scaffold. The structure of regenerated muscle fibers will be
similar to structure of scaffold.

Scaffolds are porous structures with interconnected pore networks. The porosity allows for the
diffusion of nutrients, oxygen, and waste products. It also allows the infiltration of new cells
and integration of regenerated tissue with the previous one. The surface properties of scaffolds
are modified to incorporate seed cells, bioactive molecules and growth factors. They provide a
temporary support structure for seed cells to adhere, proliferate, and differentiate. This
enhances the availability of regenerative cells at the injury site and supports their integration
into the damaged muscle tissue. Thus, scaffolds create a favorable microenvironment for
muscle regeneration, by stimulating cell proliferation, formation of new blood vessels and by
tissue remodeling. Scaffolds are made from natural polymers like collagen, fibrin and
bioplastics like poly lactic acid (PLA). They are biocompatible and biodegradable. This
prevents generation of harmful immune responses and eliminates the need for scaffold removal
through additional surgeries after tissue regeneration. Scaffolds are used in a wide range of
tissue engineering applications, including the regeneration of bone, cartilage, skin, nerves, and
organs.
MUSCULAR DYSTROPHY

Muscular dystrophy is a group of diseases that cause progressive weakness and loss of muscle
mass. It is a genetic disorder. It is caused by a mutation in the dystrophin gene. This gene is
responsible for production of the dystrophin protein which plays a crucial role in maintaining
the structural integrity of muscle fibers.

Mutation of dystrophin gene interferes with the production of proteins needed to form healthy
muscle and results in muscular dystrophy. The main sign of muscular dystrophy is progressive
muscle weakness. It results in difficulty walking, frequent falls, difficulty rising from a lying
or sitting position, trouble running and jumping etc.

Presently, there is currently no cure for muscular dystrophy. The treatment focuses on
managing symptoms, improving quality of life, and maintaining mobility and function.
Research into gene therapy, stem cell therapy, and other therapeutic approaches is ongoing to
develop potential treatments for muscular dystrophy.

BIOENGINEERING SOLUTIONS FOR MUSCULAR DYSTROPHY

Bioengineering is playing an important role in finding new solutions for muscular dystrophy.
They aim to improve muscle function, slow down disease progression, and enhance the quality
of life. Bioengineering solutions for muscular dystrophy are briefly given below:

1. Gene Therapy: In Gene therapy mutated gene responsible for muscular dystrophy is replaced
by a functional gene. Gene therapy can also be used to modify the expression of genes with the
genetic defect causing muscular dystrophy. Various strategies are being investigated to
introduce corrected genes into muscle cells. This approach can restore the production of
essential muscle proteins.

2. Cell Therapy: In cell therapy, the damaged cells of muscle tissue are transplanted by healthy
muscle cells. Stem cells can be differentiated into muscle cells and implanted into affected
muscles. These cells have the potential to regenerate muscle fibers and improve muscle strength
and function.

3. Tissue Engineering: In this approach, stem cells or muscle precursor cells are seeded onto
bioengineered scaffolds. These scaffolds are then implanted into the affected muscle tissue.
The scaffold provides structural support and guidance for new tissue growth and their
integration into the host tissue.
Tissue engineering strategies can also be used to create functional muscle tissue in the
laboratory and transplant it into individuals with muscular dystrophy.

Researchers are exploring different scaffold materials, growth factors, and bioreactor systems
to optimize the generation of functional muscle tissue for transplantation. Many of these
bioengineering approaches are still in the experimental or early stages of development. Further
research and clinical trials are needed to validate their safety and efficacy before they can be
widely implemented for the treatment of muscular dystrophy.

OSTEOPOROSIS

Osteoporosis is a skeletal disorder in which there is decrease in bone mineral density and bone
mass. This can lead to a decrease in bone strength that can increase the risk of fractures (broken
bones). Osteoporosis occurs when the body fails to form enough new bone, or when existing
bone is reabsorbed more quickly than it is replaced.

It is commonly seen in postmenopausal women and in older men. Fractures happen most often
in bones of the hip, vertebrae in the spine, and wrist.

The main causes of osteoporosis are:

a) Hormonal imbalances, particularly a decrease in estrogen levels in women after menopause.

b) Inadequate calcium and vitamin D intake and physical inactivity,

c) Smoking, and excessive alcohol consumption,

d) Taking certain steroidal medications.

Osteoporosis is a chronic condition that requires long-term management. Early diagnosis,

lifestyle modifications, and appropriate medical interventions can help reduce the risk of
fractures, manage symptoms, and maintain bone health. The main strategies for preventing and
managing osteoporosis are:

a) Adequate calcium and vitamin D intake.

b) Regular weight-bearing and muscle-strengthening exercises.

c) Avoidance of smoking and excessive alcohol consumption.

d) Fall prevention measures, and maintaining a healthy body weight.

e) Taking medications to slow bone loss or stimulate bone formation in certain cases.
BIOENGINEERING SOLUTIONS FOR OSTEOPOROSIS

Bone grafting is a common surgical method used to improve bone regeneration in patients
suffering from osteoporosis. Recently, lot of research and developments are happening in
bioengineering field to find solution to osteoporosis. Bioengineering offers several solutions
for osteoporosis. All these solutions focus on promoting bone formation, enhancing bone
strength, and preventing fractures. Main bioengineering solutions for osteoporosis are briefly
given below:

1. Use of scaffolds.

Bioengineered scaffolds can be used to provide structural support and a three- dimensional
environment for bone regeneration. These scaffolds are made from biocompatible and
biodegradable materials, such as calcium phosphate ceramics. They are porous materials with
well-defined shape and size. Seed cells are attached to scaffolds and allowed proliferate and
differentiate to produce new cells. The scaffolds act as a template for new bone growth and
provide mechanical support. Once the new bone is generated, scaffolds gradually degrade and
dissolved in new bone tissue.

2. Use of Growth Factors and Bioactive Molecules.

Growth factors and bioactive molecules enhance bone formation. Growth factors are the
molecules that can stimulate the proliferation and differentiation of bone- forming cells and
accelerate bone regeneration. Example for growth factors is morphogenetic proteins (BMPs).
Bioactive molecules can also be used to promote bone formation and increase bone mineral
density. Example for a bioactive molecule is parathyroid hormone (PTH).

These molecules can be delivered locally to the bone defect site. They can also be incorporated
into scaffolds.

3. Use of cell therapies: Stem cells or seed cells can be isolated from various sources like bone
marrow and adipose tissue. These cells can be incorporated into scaffolds and implanted into
bone defect sites. At this site, they proliferate and differentiate to produce new cells and
contribute to new bone formation. Mesenchymal stem cells (MSCs) are highly effective for
bone regeneration in osteoporosis.

4. Delivering Drugs to target site: Bio engineering based modern targeted drug delivering
systems can be utilized to delivery drugs directly and specifically to osteoporosis site. These
systems can deliver medications, such as bisphosphonates or teriparatide, directly to the bone
tissue. The drugs are encapsulated within biomaterial carriers and carried to specific site and
released in a controlled manner. These systems enhance the efficacy of drugs and minimizing
side effects.

Many of these bioengineering approaches are still in the experimental or preclinical stages of
development. Before using these treatments for osteoporosis, further research, optimization,
and clinical trials are needed to validate their safety, efficacy, and long-term outcomes.