ORTHOBIOLOGICS: FROM UNKNOWN UNKNOWNS TO KNOWN KNOWNS: THE STORY SO FAR ...

Dr Vaibhav Bagariambbs ms fcps

Consultant Joint Replacement & Sports SurgeonCARE Hospital, Nagpur

Chief innovation officer- ORIGYN Healthcare

1Wednesday, 4 June 14

ONCE UPON A TIME...

3000 BC : As per Mahabharata, Adi Parva, chapter 114, shloka 17, the Kaurava were created by splitting the single embryo into 101 parts and growing each part in a separate kund or container. It is believed that Kaurva’s birth mentioned here is first reported mention of what could

be possible use of embryonic stem cell.

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UNKNOWN UNKNOWNS

Why some people healed better than others?

Why certain organs regenerated and repaired on their own?

Can human body’s inherent regeneration potential be harnessed?

What would be potential fall outs - cost, ethical and moral issues?

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NOT LONG AGO...

We looked for mechanical solutions to the biological problem.

Over the years we realised that ‘it is Biology Stupid’!

Now we are increasingly looking for Biological solutions to biological problem!

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STEM CELL RESEARCH TIMELINE

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CURRENT KNOWN KNOWNS

Stem cell, growth factor and scaffolds interplay

Mechanism of Repair & Regeneration.

Potential therapeutic Role

Future directions in orthobiologics..

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WHAT ARE STEM CELLS?

… ‘uncommitted’ cells with the capacity for unlimited or prolonged self renewal and the ability to give rise to differentiated cells under appropriate conditions.

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STEM CELL CHARACTERISTICS

Undifferentiated cells with the capacity for unlimited or prolonged self-renewal that can give rise to differentiated cells.

Self renewing for long periods.

Unipotent / pluripotent / multipotent e.g. Intestinal stem cells produce one or more of the 4 classes of mature differentiated cells (absorptive, goblet, Paneth and enteroendocrine cells)

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STEM CELL CHARACTERISTICS

Plasticity : The formation of one differentiated cell type from another.

Slow cycling in cell division.

Specific gene expression

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SOURCES OF STEM CELLS

Adult Tissue: Hematopoeitic SC, Mesenchymal SC, Neural, muscle derived, Pancreatic, Hepatic, Epithelial, Dental.

Fetal Tissue

Cord blood

Embryo’s ( ESC)

!

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BROAD CLASSIFICATION

EMBRYONIC STEM CELLS

ADULT STEM CELLS

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HEALING TRINITY

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THIS TALK

Concentrated Bone marrow products & Applications

Platelet rich plasma product & Application

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BONE MARROW DERIVED CELLS

Hematopoietic stem cell

1.  CD34 “+” Cells

2.  Abundant cells

3.  Progenitors

4.  Non Adherent

Mesenchymal stem cell

1.  CD34 “–” Cells

2.  Rare cells

3.  Total undifferentiated

4.  Adherent

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BONE MARROW CONCENTRATE

Enhances levels of Bone Marrow-Mesenchymal Stem (BM-MS) Cells

BM-MS cells decrease with age

Concentrating mimics the cell load and healing potential of young patients

4-5x progenitor cell increase above baseline

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BONE MARROW COCKTAIL

Endothelial Progenitor Cells: for supporting vasculature. Healing is impaired until the vasculature is restored. Stimulate BM-MS cells

Hematopoietic Stem Cells 

Platelets:  to modulate the regeneration process – MIGRATION HIGHWAYS. Recruit bone marrow progenitor cells to foci of injury, Provide adhesion sites for stem cells

Adhesion Molecules: Mediate cell-to-cell adhesion, Maintenance of tissue integration, wound healing, and cellular migration

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POST PROCESSING RESULTS

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BMAC USES

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BMAC IN NON UNIONS

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BMAC IN AVN

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BMAC FOR CARTILAGE REPAIR

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BMAC IN SPINAL FUSION

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PLATELETS

Specialised type of blood cells

Major role in injury healing

Reservoirs of natural growth factor

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GROWTH FACTORS

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PLATELET CONCENTRATES

Affect mitogenic activity of resident osteoblasts & undifferentiated cells

Act on undifferentiated cells with respect to cell recruitment (chemo-attraction)

Increases the attraction of undifferentiated cells to the wound site but also proliferation of those cells.

Can even allow for a reduction in autograft requirements by accelerating healing

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PRP VS NORMAL PLASMA

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PRP & HEALING

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PRP USES

SPORT INJURIES:Tennis Elbow, ACL Tears, Rotator Cuff Tears, Plantar Fasciitis

SPINE FUSIONS

CARPAL TUNNEL SYNDROME

ARTHRITIC JOINTS

DEGENERATIVE DISC DISEASE

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TRAILER - ROAD AHEAD

Promising

Bumpy

hope vs hype

Use judgement & common sense

Event Horizon: Best way to predict future is to create it!

29Wednesday, 4 June 14

TRAILER - ROAD AHEAD

Promising

Bumpy

hope vs hype

Use judgement & common sense

Event Horizon: Best way to predict future is to create it!

29Wednesday, 4 June 14

THANK YOU...

www.drbagaria.com

30Wednesday, 4 June 14

THANK YOU...

www.drbagaria.com

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