Tapping into the Potential of Regenerative Medicine
FastOA initiative explores therapy to delay osteoarthritis progression after an ACL tear.
By Vandana Suresh | July 25, 2024
The remarkable ability of the body to “repair and restore” after an injury is the driving force behind regenerative therapies. But is regenerative medicine the panacea for treating osteoarthritis (OA) where there is progressive cartilage deterioration and inflammation?
Currently, regenerative therapies utilize biomaterials, cells and other bioactive molecules. The most extensively studied regenerative therapy for OA is platelet-rich plasma (PRP), which is injected directly into the affected joint. The platelet concentrate is obtained from the patient's blood through centrifugation. Since the concentrate is rich in cytokines, growth factors and other anti-inflammatory mediators, like IL-1 antagonists, injecting PRP can help manage pain and protect the joint.
On the other hand, therapies like micro-fragmented adipose tissue (MFAT) and bone marrow aspirate concentrate (BMAC) are stem cell-based. The materials extracted from patients contain stem cells and other active cells, potentially forming an effective toolbox to treat inflammation and protect the joint. MFAT also has a high amount of the lubricating protein lubricin, which is a key component of healthy cartilage that is reduced in patients with OA.
“It’s tough to have a single silver bullet to treat OA since it is a disease that involves several different pathways that have gone dysfunctional," said Prathap Jayaram, MD, Director of Regenerative Medicine at Emory University. "Regenerative medicine, such as PRP, BMAC or MFAT, is a strategy that can address multiple pathways."
However, there are many challenges to fully adopting regenerative therapies. These treatments still need to be FDA-approved (although the equipment to produce them has FDA clearance) and, therefore, are not covered by insurance. More importantly, regenerative therapies delay the progression of cartilage loss but do not reverse established disease.
As of now, patients with less advanced OA are poised to have better outcomes. For that reason, through the Arthritis Foundation's FastOA initiative, Dr. Jayaram and Miguel Otero, PhD, associate scientist in the Orthopedic Soft Tissue Research Program at the Hospital for Special Surgery, are investigating whether early treatments with BMAC delay disease progression in patients at a high risk of developing osteoarthritis quickly after an ACL tear.
In reality, for a majority of patients, OA is a slow-developing disease and will need treatment approaches beyond current regenerative therapies.
“It is not just a cartilage disease or a synovium disease or a bone disease; it is all of the above,” said Hicham Drissi, PhD, professor of orthopedics at Emory University. “Adding to the complexity, OA is a disease with many stages that may require different interventions.”
To seek novel treatments for arthritis, the United States Department of Veterans Affairs in April 2024 inaugurated the CReATE Motion Center at the Atlanta VA Medical Center, where Dr. Drissi is the site director. This center’s portfolio spans the continuum from innovative discoveries, including those within regenerative medicine, to pre-clinical proof of concept studies and the implementation of validated therapeutics in clinical practice. The Arthritis Foundation’s Jason Kim, PhD, vice president of OA research programs, is part of CReATE Motion’s advisory committee.
Looking ahead, regenerative medicine has the potential to play an essential part in a multi-pronged solution for OA, but it has yet to reach its full potential. Currently, several small molecules, cells, cell therapies and delivery systems are under investigation. Scaling up the manufacturing of stem cells for allogeneic therapy and creating degradable 3D materials capable of being loaded with medicinal cells and products are other exciting research areas.
As the field progresses, regenerative medical products will need FDA oversight in clinical trials and subsequent approval for OA treatment. If the trials demonstrate safety and efficacy, they can transform the practice of medicine and reach more people living with arthritis.
The remarkable ability of the body to “repair and restore” after an injury is the driving force behind regenerative therapies. But is regenerative medicine the panacea for treating osteoarthritis (OA) where there is progressive cartilage deterioration and inflammation?
Currently, regenerative therapies utilize biomaterials, cells and other bioactive molecules. The most extensively studied regenerative therapy for OA is platelet-rich plasma (PRP), which is injected directly into the affected joint. The platelet concentrate is obtained from the patient's blood through centrifugation. Since the concentrate is rich in cytokines, growth factors and other anti-inflammatory mediators, like IL-1 antagonists, injecting PRP can help manage pain and protect the joint.
On the other hand, therapies like micro-fragmented adipose tissue (MFAT) and bone marrow aspirate concentrate (BMAC) are stem cell-based. The materials extracted from patients contain stem cells and other active cells, potentially forming an effective toolbox to treat inflammation and protect the joint. MFAT also has a high amount of the lubricating protein lubricin, which is a key component of healthy cartilage that is reduced in patients with OA.
“It’s tough to have a single silver bullet to treat OA since it is a disease that involves several different pathways that have gone dysfunctional," said Prathap Jayaram, MD, Director of Regenerative Medicine at Emory University. "Regenerative medicine, such as PRP, BMAC or MFAT, is a strategy that can address multiple pathways."
However, there are many challenges to fully adopting regenerative therapies. These treatments still need to be FDA-approved (although the equipment to produce them has FDA clearance) and, therefore, are not covered by insurance. More importantly, regenerative therapies delay the progression of cartilage loss but do not reverse established disease.
As of now, patients with less advanced OA are poised to have better outcomes. For that reason, through the Arthritis Foundation's FastOA initiative, Dr. Jayaram and Miguel Otero, PhD, associate scientist in the Orthopedic Soft Tissue Research Program at the Hospital for Special Surgery, are investigating whether early treatments with BMAC delay disease progression in patients at a high risk of developing osteoarthritis quickly after an ACL tear.
In reality, for a majority of patients, OA is a slow-developing disease and will need treatment approaches beyond current regenerative therapies.
“It is not just a cartilage disease or a synovium disease or a bone disease; it is all of the above,” said Hicham Drissi, PhD, professor of orthopedics at Emory University. “Adding to the complexity, OA is a disease with many stages that may require different interventions.”
To seek novel treatments for arthritis, the United States Department of Veterans Affairs in April 2024 inaugurated the CReATE Motion Center at the Atlanta VA Medical Center, where Dr. Drissi is the site director. This center’s portfolio spans the continuum from innovative discoveries, including those within regenerative medicine, to pre-clinical proof of concept studies and the implementation of validated therapeutics in clinical practice. The Arthritis Foundation’s Jason Kim, PhD, vice president of OA research programs, is part of CReATE Motion’s advisory committee.
Looking ahead, regenerative medicine has the potential to play an essential part in a multi-pronged solution for OA, but it has yet to reach its full potential. Currently, several small molecules, cells, cell therapies and delivery systems are under investigation. Scaling up the manufacturing of stem cells for allogeneic therapy and creating degradable 3D materials capable of being loaded with medicinal cells and products are other exciting research areas.
As the field progresses, regenerative medical products will need FDA oversight in clinical trials and subsequent approval for OA treatment. If the trials demonstrate safety and efficacy, they can transform the practice of medicine and reach more people living with arthritis.
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