Tailoring and Testing New Treatment Options through Regenerative Medicine
Over the past few years, sports medicine has benefitted enormously from the use of injectable biologics to delay or even avoid the need for knee replacement surgery. Among the growing list of promising therapeutic options, NYU Langone is using growth factors derived from platelet-rich plasma and stem cells derived from bone marrow aspirate to treat osteoarthritis (OA) and is testing the treatments on a range of other conditions.
“Biologics will certainly play a major role in the future in the management of patients with musculoskeletal disease,” says Laith Jazrawi, MD, Professor of Orthopedic Surgery and Chief of the Division of Sports Medicine. Dr. Jazrawi is leading plans for the department’s Center for Regenerative Medicine that would include a dedicated procedure room for injectable therapeutics.
NYU Langone researchers are conducting multiple projects to help determine which biologics may have the brightest future. In one multicenter randomized controlled trial, investigators are comparing the effectiveness of platelet-rich plasma to dry needling for treating patellar tendinopathy. Other researchers are pursuing a randomized controlled trial in collaboration with Birmingham, Alabama-based NuTech Medical, Inc., to compare the effectiveness of the company’s ReNu amniotic stem cell allograft to a hyaluronic acid injection or saline control for treating knee OA. A third study is examining whether hyaluronic acid injections improve the symptoms of patients with the earliest stages of OA, compared with physical therapy alone.
Dr. Jazrawi says that although preliminary, results of clinical trials have been encouraging. Pending FDA approval, he and colleagues also hope to investigate the OA-treating potential of adipose tissue-derived stem cells, which could be harvested by liposuction in collaboration with the Department of Plastic Surgery. The cells, Dr. Jazrawi says, might even help reestablish cartilage in an OA-afflicted knee.
Research Synergy with Synovial Fluid Registry
The current and upcoming clinical research projects, he says, fit well with the work of the department’s Joint Preservation and Arthritis Center. Synovial fluid samples collected as part of the Joint Preservation Registry, for instance, are helping to match patients’ therapeutic responses to unique biomarkers. “We’re beginning to tailor our medical care toward a specific patient profile,” Dr. Jazrawi says. In this case, he says, the biomarker-based profile can help determine which patients will respond best to which cellular therapy.
“There may be a specific cohort of patients that have better regenerative potential,” he says. Asking why they improve with stem cell injections while others don’t can lead to a better alignment of treatments based on patients’ molecular characteristics identified via blood, urine or joint fluid samples. “By getting that information, it will help us determine if a patient will benefit more from an injection, from physical therapy, or by going right to total knee replacement,” he says.
Similarly, the researchers, led by Dr. Eric Strauss, are harvesting synovial fluid from young patients with ACL tears to assess which parts of their biomarker profiles might contribute to successful surgical outcomes. Finally, they’re collecting fluid from patients undergoing knee arthroscopy to likewise help determine who is more likely to do well or poorly.
The decision-aiding information, in turn, can prevent treatment delays and streamline patient care. “They’re getting the best treatment possible for them, not for all patients in general,” Dr. Jazrawi says. “So we’re looking for this tailored, personal medicine concept based on the data from this registry to help us answer some of these questions.”
Sidebar: Superior Results with Superior Capsular Reconstruction
NYU Langone’s expanding use of a new procedure called superior capsular reconstruction is helping patients with a deficient and non-repairable rotator cuff injury avoid a traditional reverse shoulder replacement and its complications. Younger patients may not need the full replacement and muscle transfers haven’t always led to good outcomes in older patients.
“The concept of a superior capsular reconstruction, where we’re using a dermal allograft, anchoring it into the glenoid and then re-attaching it to the humeral head at the rotator cuff insertion, has really allowed patients to avoid a shoulder replacement and lift their arm up,” Dr. Jazrawi says. By helping patients regain their strength and mobility, he says, the new rotator cuff-focused alternative could yield an “exciting” change in the field of orthopaedics and especially within sports medicine.