Friday, July 30, 2010

Trial of Embryonic Stem Cells for Spinal Cord Injury

The FDA lifted a hold on Geron's trial of embryonic stem cells to treat spinal cord injuries.  Geron hopes to begin the trial by the end of the year.  The specific cell line in use for this trial is GRNOPC1 which contains cells called oligodendrocyte progenitor cells. 

This is an interesting development.  Geron's stock popped 17% ($80-90 million in market cap) today on the news.  That speaks to the importance of a regulatory pathway for novel biologic treatments.  With the value in their stock, they can fund at least part of the trial.

Any thoughts out there on how to best fund new biologic treatments through the early clinical stages?


Thursday, July 29, 2010

Personalized Medicine

We are at the beginning of Personalized Medicine.  This concept can take many forms.  It can mean an evaluation the DNA of a breast cancer that predicts a poor prognosis.  (Overexpression of the human epidermal growth factor receptor type 2, HER2)  It can also mean a diagnostic test to determine if a patient will response to a specific type of cancer treatment like Gleevec (imatinib).  Recently, several companies have started offering over the counter DNA tests.  These are presently being evaluated by the FDA because of concerns for consistently and how they will be interpreted. 

On the horizon are also various autologous (your own) engineering treatments such as stem cells from your bone marrow or fat to treat heart disease.  Platelet rich plasma is another form of personalized medicine that has evolved rapidly in orthopedics and sports medicine.

An important question is who will pay for the continued development of these diagnostic tools and treatments?  The present macro health care environment is all about covering more patients with less money.  The micro enviroment (patients coming into the office) are demanding access to these new tests and treatments without regard to cost.  We will have to solve this fundamental conflict sooner than later.  It is not possible to have both.


Monday, July 26, 2010

How to Grow an Ear...

Regnereative medicine is simply exploding.  New body parts are now being grown in the lab.

See a video of Dr. Tony Atala in his lab at Wake Forest growing an ear.  Simply amazing.

Video of how to grow an ear


Sunday, July 25, 2010

Platelet Rich Plasma used to treat Nadal's Knees

It appears as if Nadal has had his creaky knees treated with platelet rich plasma.  He has described it himself but only incompletely.  What we do not know is what type of PRP was used,  how it was injected and how he is being treated after the procedure.  These are all critical issues.  Presently, PRP with platelet concentrations around 5x baseline combined with concentrated white blood cells has the best published data supporting its use. 

It is clear that Nadal has chronic, severe tendonitis also know as tendinopathy.  It will help all of us who are studying how to best use PRP we knew more about his specific treatment.  Does anyone out there know any of the details?

Total Tendon

Saturday, July 03, 2010

Orthopedics Article

Dr. Allan Mishra recently had his commentary about the state of platelet rich plasma published in Orthopedics. 

Allan Mishra, MD
Allan Mishra
Is PRP a better solution than cortisone for treating tendon injuries? If so, why? 

"Platelet-rich plasma is clearly a better treatment for tendon injuries than cortisone. A recent double-blind randomized trial found significantly better outcomes in the treatment of tennis elbow in patients who received PRP when compared to cortisone.3,4 There is also a risk of dermal atrophy or even tendon rupture when using cortisone. For these reasons, I rarely, if ever, use cortisone in the treatment of a tendon problem in my practice."

Read more of the article...

Total Tendon

Orthopedics Today PRP Discussion

Orthopedics Today recently published a discussion about platelet rich plasma.  Dr. Allan Mishra, Dr. Steven Arnoczky, Dr. Freddie Fu and Dr. Nicolas Sgaglione commented about the state of PRP. 

“The lay press does not understand the complexity of PRP,” Allan Mishra, MD, said. “As more data emerge, it will become clear to both physicians and surgeons that the specific formulation of PRP matters significantly in terms of bioactivity.” 

“The thing I would emphasize is that we have got to get a better understanding of the formulations in order to figure out whether PRP is valuable or not,” he added. “What is missing in the lay press – but also in the medical literature – is the discussion of what PRP is.”
Mishra pointed out that a formulation of PRP containing only concentrated platelets differs greatly from a formulation composed of concentrated platelets and white blood cells. 

Read more of the artilcle.... 

Total Tendon

Tennis Elbow PRP Discussion at ESSKA in Oslo, Norway

Dr. Pietro Randelli moderated an excellent discussion of the treatment of tennis elbow (lateral epicondylitis) at the recent ESSKA meeting in Oslo, Norway.  Presentations about conservative care, platelet rich plasma injections and surgical treatment were given, including a debate about open versus arthroscopic techniques.  It is clear there are a variety of treatment options for this problem.  Platelet rich plasma is now considered a viable non-operative option.  Further data is presently being developed about the value of PRP vs surgery.  Stay tuned.

Total Tendon
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