Are stem cells the future of medicine? TOBI Faculty studies new strategy to tackle severe knee osteoarthritis

Mar 27

Are stem cells the future of medicine? TOBI Faculty studies new strategy to tackle severe knee osteoarthritis

Mikel Sanchez et al – Expert Opin Biol Ther (2016) A new strategy to tackle severe knee osteoarthritis Combination of intra-articular and intraosseous injections of Platelet Rich Plasma.

This recent review by Dr. Sanchez & his team at the BTI Biotechnology Institute in Vitoria, Spain address current controversies in treating knee osteoarthritis (OA) with Platelet Rich Plasma (PRP). The central thesis of this paper rests on the concept that subchondral bone pathology has been overlooked by the research community for many years as a potential target for OA treatment. Several emerging studies have shown how alterations in subchondral bone (by vascular or mechanical stress) can initiate the catabolic process of the articular cartilage and synovial membrane. Indeed, the articular cartilage may simply be the “victim” of catabolic cytokines originating in the synovium and subchondral tissues.

Standard methods to introduce PRP into the intraarticular tissues of the knee joint adequately exposes the articular cartilage and synovial membrane to the the anti-inflammatory effects of PRP-released cytokines, but the deeper cartilage layers and subchondral bone are not addressed. A dys-regulated TGF-1 signaling pathway is implicated in the conversion of normal subchondral bone marrow into fibrovascular tissue, and Sanchez et al hypothesize that PRP delivered intraosseously into the subchondral bone can have a pro-regulatory effect on this process, and they provide an extensive and well-cited biochemical rationale for this treatment in their review paper. The Sanchez group  has studied the intraosseous infusion of PRP into the femoral condyle and tibial plateau subchondral bone using sedation and fluoroscopically guided trocars. They highlight some promising preliminary data on safety and efficacy for this procedure, and hypothesize that the combination of intrasseous PRP infusion followed by intraarticular PRP infusion over several weeks may provide the arthritic knee joint the best opportunity to resist ongoing catabolic degeneration, as well as clinical pain and dysfunction.


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The Orthobiologic Institute (TOBI)
7th Annual PRP & Regenerative Medicine Symposium with Workshops & Cadaver Labs (TOBI 2016)
June 10-12, 2016
Wynn, Las Vegas, NV


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  • Lipoaspirate & Bone Marrow Aspirate
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