A basic presentation on the role of orthobiologics, PRP, Bone marrow aspirate concentrate in orthopaedics. Insights, and future research directions in a rapidly evolving field.

1. ORTHOBIOLOGICS: FROM
UNKNOWN UNKNOWNS
TO KNOWN KNOWNS:
THE STORY SO FAR ...
Dr Vaibhav Bagaria
mbbs ms fcps
Consultant Joint Replacement & Sports Surgeon
CARE Hospital, Nagpur
Chief innovation officer- ORIGYN Healthcare
1Wednesday, 4 June 14

2. ONCE UPON A TIME...
3000 BC : As per Mahabharata, Adi Parva, chapter
114, shloka 17, the Kaurava were created by splitting the
single embryo into 101 parts and growing each part in a
separate kund or container. It is believed that Kaurva’s
birth mentioned here is first reported mention of what could
be possible use of embryonic stem cell.
2Wednesday, 4 June 14

3. UNKNOWN UNKNOWNS
Why some people healed better than others?
Why certain organs regenerated and repaired on their own?
Can human body’s inherent regeneration potential be
harnessed?
What would be potential fall outs - cost, ethical and moral
issues?
3Wednesday, 4 June 14

4. NOT LONG AGO...
We looked for mechanical solutions to the biological
problem.
Over the years we realised that ‘it is Biology Stupid’!
Now we are increasingly looking for Biological solutions to
biological problem!
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5. STEM CELL RESEARCH TIMELINE
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6. CURRENT KNOWN KNOWNS
Stem cell, growth factor and scaffolds interplay
Mechanism of Repair & Regeneration.
Potential therapeutic Role
Future directions in orthobiologics..
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7. WHAT ARE STEM CELLS?
… ‘uncommitted’ cells with the capacity for unlimited or
prolonged self renewal and the ability to give rise to
differentiated cells under appropriate conditions.
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8. STEM CELL CHARACTERISTICS
Undifferentiated cells with the capacity for unlimited or
prolonged self-renewal that can give rise to differentiated
cells.
Self renewing for long periods.
Unipotent / pluripotent / multipotent e.g. Intestinal stem
cells produce one or more of the 4 classes of mature
differentiated cells (absorptive, goblet, Paneth and
enteroendocrine cells)
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9. STEM CELL CHARACTERISTICS
Plasticity : The formation of one differentiated cell type
from another.
Slow cycling in cell division.
Specific gene expression
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10. SOURCES OF STEM CELLS
Adult Tissue: Hematopoeitic SC, Mesenchymal SC, Neural,
muscle derived, Pancreatic, Hepatic, Epithelial, Dental.
Fetal Tissue
Cord blood
Embryo’s ( ESC)
!
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11. BROAD CLASSIFICATION
EMBRYONIC STEM CELLS ADULT STEM CELLS
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12. HEALING TRINITY
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13. THIS TALK
Concentrated Bone marrow products & Applications
Platelet rich plasma product & Application
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14. BONE MARROW DERIVED CELLS
Hematopoietic stem cell
1. CD34 “+” Cells
2. Abundant cells
3. Progenitors
4. Non Adherent
Mesenchymal stem cell
1. CD34 “–” Cells
2. Rare cells
3. Total undifferentiated
4. Adherent
14Wednesday, 4 June 14

15. BONE MARROW CONCENTRATE
Enhances levels of Bone Marrow-Mesenchymal Stem (BM-
MS) Cells
BM-MS cells decrease with age
Concentrating mimics the cell load and healing potential of
young patients
4-5x progenitor cell increase above baseline
15Wednesday, 4 June 14

16. BONE MARROW COCKTAIL
Endothelial Progenitor Cells: for supporting vasculature.
Healing is impaired until the vasculature is restored. Stimulate
BM-MS cells
Hematopoietic Stem Cells
Platelets: to modulate the regeneration process –
MIGRATION HIGHWAYS. Recruit bone marrow progenitor
cells to foci of injury, Provide adhesion sites for stem cells
Adhesion Molecules: Mediate cell-to-cell adhesion, Maintenance
of tissue integration, wound healing, and cellular migration
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17. POST PROCESSING RESULTS
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18. BMAC USES
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19. BMAC IN NON UNIONS
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20. BMAC IN AVN
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21. BMAC FOR CARTILAGE REPAIR
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22. BMAC IN SPINAL FUSION
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23. PLATELETS
Specialised type of blood cells
Major role in injury healing
Reservoirs of natural growth factor
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24. GROWTH FACTORS
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25. PLATELET CONCENTRATES
Affect mitogenic activity of resident osteoblasts &
undifferentiated cells
Act on undifferentiated cells with respect to cell
recruitment (chemo-attraction)
Increases the attraction of undifferentiated cells to the
wound site but also proliferation of those cells.
Can even allow for a reduction in autograft requirements by
accelerating healing
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26. PRP VS NORMAL PLASMA
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27. PRP & HEALING
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28. PRP USES
SPORT INJURIES:Tennis Elbow, ACL Tears, Rotator Cuff Tears, Plantar
Fasciitis
SPINE FUSIONS
CARPAL TUNNEL SYNDROME
ARTHRITIC JOINTS
DEGENERATIVE DISC DISEASE
28Wednesday, 4 June 14

29. TRAILER - ROAD AHEAD
Promising
Bumpy
hope vs hype
Use judgement & common sense
Event Horizon: Best way to predict future is to create it!
29Wednesday, 4 June 14

30. TRAILER - ROAD AHEAD
Promising
Bumpy
hope vs hype
Use judgement & common sense
Event Horizon: Best way to predict future is to create it!
29Wednesday, 4 June 14

31. THANK YOU...
www.drbagaria.com
30Wednesday, 4 June 14

32. THANK YOU...
www.drbagaria.com
30Wednesday, 4 June 14