World Wide Regenerative Medicine Leader?

Regenerative Medicine is exploding worldwide.  There is a healthy debate emerging about who is in the lead.  Is it North America  (USA, Canada), Europe, South America, Australia or Asia?  Could Africa be the place of a monumental discovery discovery much like when Christiaan Barnard did the first heart transplant in Cape Town in 1967?

Countries and continents are taking vastly different approaches to stem cell treatments, genetic engineering and other forms of regenerative medicine.  Regulatory issues are especially different by country and changing rapidly.    It is also difficult to keep track of all the trials that are popping up everyday.

Send in your comments or follow bloodcure on twitter to be part of the conversation.




AM

Regenerative Medicine Treatment Value Equation

Regenerative medicine is a buzz phrase right now.  Patients, providers and politicians are all in favor of "Regenerative Medicine".  There are three major components to evaluate when assessing treatment value (TV).  Treatment value is directly related to overall efficacy (E) of the drug or procedure and inversely related to cost (C) and risk (R).  A simple equation can define it:

TV = E / C x R2

That is Treatment Value = Efficacy divided by Cost times Risk squared.

We need treatments of high value with maximal efficacy that have reasonable costs and minimal risks.  When evaluating new potential "Regenerative Medicine Treatments", consider this equation.

Please post any comments or suggestions.

AM
ApexPRP.com

Level One Two Year Follow Up Paper Supports Use of Platelet Rich Plasma for Tennis Elbow

Dr. Taco Gosens and his team from the Netherlands have just published in the American Journal of Sports Medicine the best paper to date on the use of platelet rich plasma for tennis elbow.  Using the Biomet GPS device to create platelet rich plasma (Type 1A PRP in Mishra's classification system of PRP), they found PRP patients were successfully treated more often than patients treated with corticosteroid injections at two year follow up.  This was highly statistically significant at a p value of < 0.0001. 
Read the entire abstract here.

This paper confirms that a specific type of PRP is better than the often used cortisone injection for chronic lateral epicondylar tendinopathy.  This team of researchers also needs to be congratulated on finishing this important work. 

AM
Total Tendon
http://www.twitter.com/bloodcure

AAOS Now PRP Forum

AAOS Now reported on the recent platelet rich plasma forum in San Diego.


"The participants of the 2011 PRP Forum also endorsed the development of standards in the manufacture of PRP, noted that PRP may be contraindicated in some conditions, and called for the establishment of a study group to follow up on the other recommendations resulting from the session."
  
"At the end of the day, an informal survey of participants found most in agreement that PRP would be an option, particularly if conservative treatments have failed and the next step would be surgery."


The group agreed that PRP needs a classification system.  Dr. Allan Mishra proposed one that is under consideration.


AM

Platelet Rich Plasma Forum at AAOS

The American Academy of Orthopaedic Surgery and AAOS Now will be conducting a Platelet Rich Plasma Forum on February 14, 2011 just prior to the Annual Meeting in San Diego.  Participating in this meeting are an elite group of clinicians and researchers including but not limited to Dr. James Andrews, Dr. Steven Arnoczky, Dr. Terry Canale, Dr. William Clancy, Dr. Freddie Fu, Dr. Taco Gosens, Dr. Elizaveta Kon, Dr. Nicola Maffulli, Dr. Robert Marx, Dr. Allan Mishra, Dr. Pietro Randelli, Dr. Scott Rodeo, and Dr. JR Woodall.

This group along with several others has been tasked with evaluating the state of platelet rich plasma.  It will be the most comprehensive discussion of the topic with regard to orthopedics and sports medicine.  The goal is to hopefully make some sense of how to best evaluate and potentially use PRP.

Stay tuned for details.

AM

RevaTen Platelet Rich Plasma Shows Promise as a Heart Attack Treatment

Researchers at the Stanford University School of Medicine, in collaboration with BioParadox, Inc., have published data supporting the use of RevaTen platelet-rich plasma as a promising biologic treatment for myocardial infarction (heart attack).


The findings were published online in Cardiovascular Revascularization Medicine and will be presented at The Sixth International Conference on Cell Therapy for Cardiovascular Disease at Columbia University Medical Center, New York City, on January 20, 2011.

Platelet-rich plasma (PRP) has been identified as a novel biologic treatment for wound healing and sports-related injuries. Studies indicate PRP stimulates cell repair via growth factor release and by attracting reparative cells. Only recently, however, have scientists begun to study PRP's potential in repairing damaged cardiovascular tissue.

Working with colleagues at Stanford University Medical Center, lead author Allan Mishra, MD, a leading PRP researcher, studied the effects of RevaTen PRP (a proprietary formulation of concentrated platelets and white blood cells) on cardiac function after inducing cardiac ischemia (damage to myocardial tissue caused by blood restriction) in mice. The research was conducted under the direction of Robert Robbins, MD, chairman of the department of cardiothoracic surgery at Stanford University.

In this study of 28 mice, researchers induced ischemia by either permanently occluding the left anterior descending artery (Group A) or temporarily ligating it for 45 minutes (Group B). The hearts were then injected with RevaTen PRP or saline control. In order to assess cardiac function after treatment, magnetic resonance images were taken at seven days post-procedure (Group A) and 21 days (Group B). Tissue from all hearts was collected for histopathologic evaluation.

In both groups, mice that received PRP after ischemia had significantly better cardiac function as measured by left ventricular ejection fraction on MRI than those that had been injected with saline only. In group A, the RevaTen-treated animals had 38% better ejection fraction compared to saline controls. In group B, the RevaTen-treated animals had 28% improvement in ejection fraction compared to controls. Additionally, less scar tissue was found in RevaTen-treated hearts than in controls.

"Although this is an observational study using an animal model, PRP might someday be employed at the point of care to treat patients who have had a heart attack. This could preserve cardiac function and limit the progression to congestive heart failure," Dr. Mishra says. "Since myocardial infarction remains the leading cause of death in industrial nations, RevaTen PRP may become a powerful biologic tool in fighting heart disease and provide cost savings." The authors caution that this is a preclinical study and that further translational research is needed to understand how RevaTen PRP might work to repair and/or protect cardiovascular tissue.

Platelet Rich Plasma Tennis Elbow Study

Enrollment in the most comprehensive platelet rich plasma study to date was recently completed.  The study is a double blind randomized trial of 230 patients of PRP vs Saline for chronic tennis elbow.  It followed the protocol outlined in the first published study on the topic. 
(American Journal of Sports Medicine--Mishra and Pavelko, 2006)

It will take 8-10 months to finish the follow up and analyze the data but it is a milestone to have simply completed enrollment in this important investigation.  We can all look forward to the results.

AM
TotalTendon

Platelet Rich Plasma 2011

2011 will be the year we begin to figure out how to best use platelet rich plasma.  For almost a decade now, it has been employed as a treatment for a variety of problems.  Last year, level one data was published showing how PRP is better than cortisone for tennis elbow.  Other data revealed that achilles tendionpathy that is mild to moderate and that had NOT been treated did not get significantly better with PRP and exercise compared to a saline injection and exercise.

This year, large specialty organizations have dedicated time to debate the value of PRP.  Via this forums, we will learn from experts.  New formulations and indications will emerge as some will fade.  These changes will be based on presentation and publication of elite data.

AM
Total Tendon

Embryonic Stem Cells used to Treat Spinal Cord Injury Patient

For the first time in history, embryonic stem cells have been used to treat a patient with an acute spinal cord injury.  According to several reports the protocol calls for using the treatment within two weeks of the initial injury.  Geron, the company sponsoring the trial has spent years and tens of millions of dollars just to get to this first patient.  The hope is for this first phase that safety can be demonstrated.

We have officially entered the era of biologic medicine.  For quite some time there has been promise, now there is action.  It is hard to compute the amount of effort that has likely gone into getting to just this point.  It is the researchers and especially this first brave but tragic patient that deserve the credit for this advancement.

In the future, the use of either adult stem cells or induced pluripotent stem cells may become a better option.  For now, regardless of your stance on the ethics of embryonic stem cells this day must be marked as a milestone.

AM
Total Tendon

HalfDome.TV

Sports Illustrated Platelet Rich Plasma Article

Sports Illustrated recently published an article about platelet rich plasma.

"While Galea's use of PRP on Tiger Woods and other athletes has stirred debate, the technique is not particularly new. Allan Mishra, adjunct clinical assistant professor of orthopedic surgery at the Stanford University Medical Center and a pioneer of PRP therapy, has been using it for nearly a decade. In a breakthrough study last year based on work by Mishra, PRP therapy performed significantly better than cortisone -- and with fewer side effects since it makes use of the patient's own blood -- in the treatment of chronic lateral elbow tendinosis, aka tennis elbow. "I can say pretty definitively that PRP is a reasonable choice for tendon [injuries]," Mishra says. "Now it needs to be studied in other applications."


The breakthrough study was actually performed by Dr. Taco Gosens from the Netherlands.  He and his colleagues have published the best clinical data to date on the use of platelet rich plasma for tendinopathy.  
To read more of the SI article, click here


For sports medicine related videos, go to HalfDome.TV

AAOS Discussion about Platelet Rich Plasma

The American Academy of Orthopaedic Surgery recently published a expert panel discussion about platelet rich plasma (PRP).  Its goal was to help clarify the many issues surrounding this novel therapy.  Dr. Allan Mishra, Dr. Freddie Fu, Dr. Steven Arnoczky and Dr. Jo Hannafin participated.  Below is an excerpt from the article:

Dr. Hannafin: I did a Google search and found more than 400,000 citations for PRP treatment, including YouTube videos on how the procedure is performed. Clearly, patients, physicians, and scientists are interested in the use of PRP. What conditions is PRP being used for?

Dr. Mishra: I use it almost exclusively in treating tendinopathy, particularly chronic tendinopathy that has failed to respond to other treatment modalities. That would include conditions such as chronic, recalcitrant lateral epicondylitis, patellar tendinopathy, and Achilles tendinopathy. I think the data—and the work that I have been doing for almost a decade now—provide the greatest support for its use in that area.

To read more of the article, click here.

AM

For PRP and other related videos, go to HalfDome.TV