Regenerative Medicine Annu Navani, MD Medical Director, - - PowerPoint PPT Presentation

S

Regenerative Medicine

Annu Navani, MD Medical Director, Comprehensive Spine and Sports Ctr Advisor, Le Reve Regenerative Wellness www.cssctr.com

Disclosures

S None relevant to this talk

Regenerative Medicine in News

http://www.foxsportsnor th.com/07/03/12/Platel et-rich-plasma-therapy- big-with- at/landing_timberwolves. html

History of Stem Cell Research

1908: The term Stem Cell was coined by Russian Scientist Alexander Makriso. 1963: McCulloch and Till illustrated the presence of self renewing cells in mouse bone marrow. 1968: Bone marrow transplant between 2 siblings treated SCID 1981: Mouse embryonic cells were derived from inner cell mass. 1992: Neural stem cells were cultured in vitro as neurospheres. 1995: Dr Mataparkar pioneers in adult stem cell research with clinical utilization of research in body. 2001: Scientists at Advanced Cell Technology cloned early stage Embryo. 2006: Scientist at UI Chicago find stem cell characteristics in umbilical cord blood cells. 2008: Robert Lanza & Colleagues find first human embryonic cells w/o the destruction of an Embryo.

Mistakes

S

“I have not failed, I have just found 10,000 ways that won’t work”

• Thomas A. Edison

S

Stem cells can revolutionize medicine, more than anything since antibiotics

• Ronald Reagan

Why the Need?

S Limitations of surgical solutions S Limited life span of current spine and orthopedic interventions S Trend towards natural holistic solutions S Interest in repair and restoration S Positive animal, in vitro and in vivo studies

Publication is growing

Stem cell: Market Growth

Comprehensive Spine and Sports Center

https://www.pewtrusts.org/en/research-and-analysis/reports/2019/10/17/

Autologous

S BM- MSCs S AD- MSCs S IPSCs

Allogenic

S Growing human cells outside the body S Many tissues have some undifferentiated cells that will reproduce

and grow in the right environment, and nutrients in the culture media

S Researchers are designing equipment to simulate the normal

environment of the body

S Laboratory devices that do this are referred to as bioreactors

iPSCs

Induced Pluripotent Stem cells are adult cells that have been genetically reprogrammed to an embryonic stem cell

S

Mouse iPSCs were first reported in 2006, and human iPSCs were first reported in late 2007

S

Human iPSCs also express stem cell markers and are capable of generating cells characteristic of all three germ layers

S

iPSCs are useful tools for drug development and modeling of diseases especially cancer and transplantation

S

Tissues derived from iPSCs are identical match to donor and thereby no rejection by the immune system.

S

Additional research is needed and is underway.

Common Clinical Biologics

S Platelet-rich Plasma S BMC- MSCs S ADC- MSCs S Amniotic tissue

PRP

Comprehensive Spine & Sports Center

BMAC vs. ADSC

Properties of PRP and MSCs

PRP

S Macrophage activation S Wound healing S Collagen Proliferation S Cellular differentiation S Vasodilation S Vascularization

MSCs

S Secretion of growth

factors

S Cell proliferation S Vascularization S Anti-inflammatory S Anti-apoptic S Immunomodulatory

Applications: MSK and Spine

MSK/Ortho S Joints S Ligaments S Muscles and

Tendons

S AVN S Non union Spine S Discs S Facets S Epidural S Sacro-iliac

joint

S Sacro-

coccygeal joint/bursa

Disc PRP-BMC evidence

Comprehensive Spine and Sports Center

Intradiscal Biologic Injection

09/10/18

Comprehensive Spine & Sports Center

Demographics: VAS and Years of Pain

09/10/18

Comprehensive Spine & Sports Center

Efficacy and Sustainability

S20 patients start, 18 patients at 6 months and

15 at 18 months

S>50% relief in VAS up in 93% of patients at 18

months (n=14/15) and in 94% of patients (n=17/18) at 6 months

SImprovement in SF 36 up in 93% of patients at

18 months (n=14/15) compared to 100% (n=18/18) at 6 months

S 77% patients reported significant flare up

after injection that lasted 2-4 weeks (n= 14) at 6 months

SMedication use decreased in 80% of patients

at 18 months (n=12/15) compared to 89% of patients (n=16/18) at 6 months

SNo adverse events SNo hospitalization or spine surgery in 100% of

patients.

Comprehensive Spine & Sports Center

Secondary Outcomes: Disc Biologics

Comprehensive Spine & Sports Center

Advantages of Biologics

S Autologous S Readily available and easily accessible S Cost effective S Minimal regulatory barriers- PRP and BM S Contains multiple growth factors: PDGF, TGF-beta, FGF, IGF-1,2,

VEGF, EGF, Il-8, KGF, CTGF

S Contains potential healing cells S Contains autologous plasma S Pre-clinical studies show positive effects on tissue repair and restoration

Essence

Regenerative Medicine is complicated, unfamiliar, unregulated Precise and Systematic

Success Criterion

Success

Patient Selection Indication Provider Skill Level Procedure Quality of Product

S35 chapters S> 50 authors S> 400 figures

and tables

S> 675 pages

Our Experience

S Long lasting and often with resolution S Significant improvements in function and pain S Structural improvements in many S No report of serious complications

Future of RM

S 3D Bioprinting S Biologic-Device

combination

S Precision Medicine S Gene therapy S Nanotechnology S Artificial Intelligence

Thank You

Annu Navani, MD

anavani@cssctr.com