25th annual meeting slides - amazon web...
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#SIS25th
25th Annual Meeting Slides
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Stem Cell for Spine Care- From dish to disc
Wenchun Qu, MD, PhD
Mayo Clinic Rochester
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Disclosures
ØConsultant, DePuy SynthesØBoard of Directors, American Academy of Regenerative Medicine
ØBoard of Directors, Society of Chinese American Physician Entrepreneurs
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Goals for Discussion
1. To recognize the activities of stem cells2. To review stem cells based on strategy of preparation3. To familiarize with current regen spine service and
translational research
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Processes of Disc & Cartilage Degeneration•Three processes
•Cellular process• Apoptosis
•Molecular process• Cytokine profile• Matrix degradation
•Painful experience• AP frequency ñ
Molecular:ECM
Degradation
Cellular:CellDeath
Pain:APñ
- Aging- Genetic- MechanicalStress- Obesity
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Processes of Disc & Cartilage Degeneration•Three processes
•Cellular process• Apoptosis
•Molecular process• Cytokine profile• Matrix degradation
•Painful experience• AP frequency ñ
Molecular:ECM
Degradation
Cellular:CellDeath
Pain:APñ
- Aging- Genetic- MechanicalStress- Obesity
#SIS25th
Processes of Disc & Cartilage Degeneration•Three processes
•Cellular process• Apoptosis
•Molecular process• Cytokine profile• Matrix degradation
•Painful experience• AP frequency ñ
Molecular:ECM
Degradation
Cellular:CellDeath
Pain:APñ
- Aging- Genetic- MechanicalStress- Obesity
#SIS25th
Processes of Disc & Cartilage Degeneration•Three processes
•Cellular process• Apoptosis
•Molecular process• Cytokine profile• Matrix degradation
•Painful experience• AP frequency ñ
Molecular:ECM
Degradation
Cellular:CellDeath
Pain:APñ
- Aging- Genetic- MechanicalStress- Obesity
#SIS25th
Source of MSCs
HumantissuesourceCFU-Fyield(perccoftissue)
MSCfrequencyrange(CFU-F/106nucleatedcells)
Bonemarrowaspirate 109–664 10–83
Adipose/lipoaspirate 2058–9650 205–51000
Umbilicalcordblood 0.06 0–0.02
Synovialfluid 4–14 2–250
Amnioticfluid 3 9.2
Peripheralblood 0 0-2
Dermis Notreported 74000– 157000
Murphy,Experimental&molecularmedicine, 45(11),e54.
#SIS25thHunt,2017
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Technique of Bone Marrow Aspiration
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Current Regen Pain Services
- Bone Marrow Aspirate Concentrate Injection
BoneMarrowAspiration
BoneMarrowMesenchymalStemCell(BMSC)
BoneMarrowAspirateConcentration(BMAC)
BMACInjection- Disc- Facet- SIJ
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G1:Bone Marrow Aspirate Concentrate
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Transform the Practice Initiative Trial- AMSCs for discogenic pain- Culture Expanded AMSC Injection
AdiposeBiopsy
AdiposeDerivedMesenchymalStemCell(BMSC)
AMACInjection- Intradiscal- TherapyArm
CultureExpansionofAMSC
ExperimentBMSC
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Industry Trial for Discogenic Pain
- Culture Expanded BMSC Injection
BoneMarrowAspiration
BoneMarrowMesenchymalStemCell(BMSC)
BMACInjection- Intradiscal- TherapyArm- ControlArm
CultureExpansionofBMSC
ExperimentBMSC
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G2: Completed Trials on DiscogenicPain
Author N Design Celltype Dosage Outcomes
Baeetal.2014 100 RCT,3arms AllogeneicMPC,immunoselected 6M
18M+HAcarrierVAS,ODI,SF-36,WPAI
Coric etal.2013 15
Openlabel,singlearm
Allogeneicchondrocytes,cultured
100-200Mwithfibrincarrier NRS,ODI,SF-36,MRI
Orozcoetal.2011 10
Openlabel,singlearm AutologousBMSC,cultured 18-28M VAS,ODI,SF-36,MRI
Pangetal.2014 2 Casestudy AllogeneicHUC-MSCs,cultured 100M VAS,ODI,MRI
Pettineetal.2016 26
Openlabel,2arms AutologousBMSC 2-3ml VAS,ODI,MRI
Pettine2012 14
Openlabel,singlearm Allogeneicchondrocytes 10Mwithfibrinogen
andthrombincarrier NRS,ODI,SF-36,MRI
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G2: On-going Trials for DiscogenicPain
Sponsor N Phase Design Celltype Dosage Outcomes
ReddeTerapiaCelular
24 I-II RCT,2arms AllogeneicBMSC,cultured 25M VAS,ODI,SF-12,MRI,
AEs
Mesoblast 330 III RCT,3arms AllogeneicMPC 6M
6M+HAVAS,ODI
Bioheart 100 II Openlabel,singlearm AutologousAMSC+PRP Willvary VAS,ODI
Biostar 8 I-II Openlabel,singlearm
AutologousAMSC 40M VAS,MRI,AEs
Inbo Han,CHAUniversity 10 I Openlabel,
singlearm AutologousAMSC 20-40M+HA VAS,ODI,SF-36,MRI,DHI,AEs
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#SIS25th JAmCollCardiol. ;61(23):2329
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State of Stem Cell in Spine CareMSC
Generation Source Human Animal Bench Concentrate Culture -Expand
TF Induced Gene modified
1st Gen Auto √ √
2nd Gen Auto √ √ √
Allo √ √ √
3rd Gen Auto √ √ √ √Allo √ √ √
4th Gen Auto √ √ √ +/- √Allo √ √ +/- √
5th Gen iPSC - - +/- +/-
