Regenerative Medicine Annu Navani, MD Medical Director, - PowerPoint PPT Presentation

Regenerative Medicine Annu Navani, MD Medical Director, Comprehensive Spine and Sports Ctr Advisor, Le Reve Regenerative Wellness www.cssctr.com S

Disclosures S None relevant to this talk

Regenerative Medicine in News http://www.foxsportsnor th.com/07/03/12/Platel et-rich-plasma-therapy- big-with- at/landing_timberwolves. html

History of Stem Cell Research 2001 : Scientists at Advanced Cell Technology cloned early stage Embryo. 1981 : Mouse embryonic cells were derived from inner 2006 : Scientist at UI cell mass. Chicago find stem cell characteristics 1963 : McCulloch and 1992: Neural stem in umbilical cord Till illustrated the blood cells. cells were cultured in presence of self vitro as neurospheres. renewing cells in mouse bone marrow. 2008: Robert Lanza & Colleagues find 1995 : Dr Mataparkar first human 1908: The term pioneers in adult 1968 : Bone marrow embryonic cells w/o Stem Cell was stem cell research transplant between 2 the destruction of coined by Russian with clinical siblings treated SCID an Embryo. Scientist utilization of Alexander research in body. Makriso.

Mistakes

“I have not failed, I have just found 10,000 ways that won’t work” -Thomas A. Edison S

Stem cells can revolutionize medicine, more than anything since antibiotics -Ronald Reagan S

Why the Need? S Limitations of surgical solutions S Limited life span of current spine and orthopedic interventions S Trend towards natural holistic solutions S Interest in repair and restoration S Positive animal, in vitro and in vivo studies

Publication is growing

Stem cell: Market Growth

https://www.pewtrusts.org/en/research-and-analysis/reports/2019/10/17/ Comprehensive Spine and Sports Center

Autologous S BM- MSCs S AD- MSCs S IPSCs

Allogenic S Growing human cells outside the body S Many tissues have some undifferentiated cells that will reproduce and grow in the right environment, and nutrients in the culture media S Researchers are designing equipment to simulate the normal environment of the body S Laboratory devices that do this are referred to as bioreactors

iPSCs Induced Pluripotent Stem cells are adult cells that have been genetically reprogrammed to an embryonic stem cell Mouse iPSCs were first reported in 2006, and human iPSCs were first reported S in late 2007 Human iPSCs also express stem cell markers and are capable of generating cells S characteristic of all three germ layers iPSCs are useful tools for drug development and modeling of diseases especially S cancer and transplantation Tissues derived from iPSCs are identical match to donor and thereby no S rejection by the immune system. Additional research is needed and is underway. S

Common Clinical Biologics S Platelet-rich Plasma S BMC- MSCs S ADC- MSCs S Amniotic tissue

PRP Comprehensive Spine & Sports Center

BMAC vs. ADSC

Properties of PRP and MSCs PRP MSCs S Macrophage activation S Secretion of growth factors S Wound healing S Cell proliferation S Collagen Proliferation S Vascularization S Cellular differentiation S Anti-inflammatory S Vasodilation S Anti-apoptic S Vascularization S Immunomodulatory

Applications: MSK and Spine MSK/Ortho Spine S Joints S Discs S Ligaments S Facets S Muscles and S Epidural Tendons S Sacro-iliac S AVN joint S Non union S Sacro- coccygeal joint/bursa

Disc PRP-BMC evidence Comprehensive Spine and Sports Center

Intradiscal Biologic Injection 09/10/18 Comprehensive Spine & Sports Center

Demographics: VAS and Years of Pain 09/10/18 Comprehensive Spine & Sports Center

Efficacy and Sustainability S 20 patients start, 18 patients at 6 months and 15 at 18 months S >50% relief in VAS up in 93% of patients at 18 months (n=14/15) and in 94% of patients (n=17/18) at 6 months S Improvement in SF 36 up in 93% of patients at 18 months (n=14/15) compared to 100% (n=18/18) at 6 months S 77% patients reported significant flare up after injection that lasted 2-4 weeks (n= 14) at 6 months S Medication use decreased in 80% of patients at 18 months (n=12/15) compared to 89% of patients (n=16/18) at 6 months S No adverse events S No hospitalization or spine surgery in 100% of patients . Comprehensive Spine & Sports Center

Secondary Outcomes: Disc Biologics Comprehensive Spine & Sports Center

Advantages of Biologics S Autologous S Readily available and easily accessible S Cost effective S Minimal regulatory barriers- PRP and BM S Contains multiple growth factors: PDGF, TGF-beta, FGF, IGF-1,2, VEGF, EGF, Il-8, KGF, CTGF S Contains potential healing cells S Contains autologous plasma S Pre-clinical studies show positive effects on tissue repair and restoration

Essence Regenerative Medicine is Precise and complicated, unfamiliar, Systematic unregulated

Success Criterion Provider Skill Level Indication Procedure Patient Quality of Success Selection Product

S 35 chapters S > 50 authors S > 400 figures and tables S > 675 pages

Our Experience S Long lasting and often with resolution S Significant improvements in function and pain S Structural improvements in many S No report of serious complications

Future of RM S 3D Bioprinting S Biologic-Device combination S Precision Medicine S Gene therapy S Nanotechnology S Artificial Intelligence

Thank You Annu Navani, MD anavani@cssctr.com