Speaker highlights new findings in biologics research
Click Here to Manage Email Alerts
KOLOA, Hawaii — In a presentation at Orthopedics Today Hawaii, Jason L. Dragoo, MD, discussed different types of biologics and how these can be used in the treatment of orthopedic conditions.
When it comes to platelet-rich plasma, Dragoo noted that research has shown it is a stronger biologic compared with hyaluronic acid in the treatment of osteoarthritis, and that leukocyte-poor PRP tends to work better than leukocyte-rich PRP. Additional research has shown that the combination of hyaluronic acid and leukocyte-poor PRP yielded better results than hyaluronic acid alone, according to Dragoo.
However, he added a study from JAMA did not support the use of PRP for the management of osteoarthritis. Despite these results, Dragoo noted that the conclusion should state that the particular formulation used in the study did not improve the symptoms of OA.
“The problem is that this particular formulation wasn’t PRP,” Dragoo said in his presentation here. “It did not contain the minimum criteria with regard to the platelets and so, therefore, cannot be classified as PRP in the first place.”
Cell therapy, bone marrow aspirate
In progenitor cell therapy, Dragoo said adipose tissue has been found to decrease pain and inflammation in patients.
“Why do you want to choose adipose tissue? The answer is the amount of cells. These [mesenchymal stem cells] MSCs that we are looking for are hundreds or thousands of times greater than the other tissues that we have as a choice,” he said. “That is why adipose treatments are skyrocketing in the clinics, because of how many MSCs are available.”
In the past, the FDA said using syringe emulsification to prepare fat tissue for delivery was not approved for use due to it being a procedure that more than minimally manipulated the tissues. However, Dragoo said that the 9th U.S. Circuit of Appeals recently ruled against the FDA, stating that what the surgeon performs at a patient’s bedside is up to his or her discretion and is not under FDA jurisdiction.
“This is a huge ruling because what it does is validate the same surgical procedure exemption that says you can do what you need to do to treat your patient with regard to being a surgeon,” Dragoo said.
While bone marrow aspirate could be doubled with the use of a concentration system, Dragoo said physicians should be careful about which machine is used for concentration.
“They all do a reasonable job of concentrating cells, but the question is what kind of cells do you want to concentrate. And you see that these different manufacturers give you different results,” Dragoo said.
He added that physicians may not need to use bone marrow aspirate concentration as long as they use a good technique in removing the bone marrow from the iliac crest.
Juvenile chondrocytes, xenografts
Juvenile chondrocytes, which early data have shown are able to remodel cartilage on the lateral facet and the talus, have 250 genes that are upregulated and common to MSCs and a different gene profile from that of adult cartilage, according to Dragoo.
“[Juvenile chondrocytes] are not stem cells, but they are not progenitor cells,” he said. “They are one step further down the line, yet their genes are producing different things than the adult cells.”
Although human allografts and xenografts have good clinical data in rotator cuff scaffolds, Dragoo noted that xenografts have not had a good track record in musculoskeletal medicine because xenografts can be recognized as foreign material by the body.
“For the most part, you saw the good data for the xenografts. I’m not refuting that whatsoever,” Dragoo said. “But I am saying there is some data out there that says that some patients can react to it. So just be prepared for that. You just have to know that with xenografts there is this chance that you’d have some inflammation, quite possibly some drainage. This is a low percentage of patients but, nonetheless, it is out there.”
Collapse
Dragoo JL. Orthobiologics: Now and in the future. Presented at: Orthopedics Today Hawaii. Jan. 8-12, 2023; Koloa, Hawaii.
Read more about
Click Here to Manage Email Alerts