New Osteochondral Plugs for Cartilage repair

Next month I will be using a new type of plug, made from allograft bone and cartilage, to replace damaged areas of the knee joint. Allografts have been available for some time, and are not experimental; the problem has been that in order to get live cartilage cells the grafts have to be fresh- and this has led to contamination problems with both bacteria and viruses.

The new plugs are based upon a new freezing technology that allows us to freeze the graft without ice crystals forming. About 50% of the cartilage cells live, and survive in the recipient. The grafts are prepackaged in the shape of a cylinder. The cost of these plug is far less than the cost of an ACI transplant.

The company making the freezer is Core Dynamics, have a look at their web site.

Stem Cells and the Candidates

Just before 9/11, President Bush made a televised speech about stem cells and how to restrict federal funding based upon existing lines in culture. Amazing how little is heard about this issue now in the debates, particularly on the Republican side, where it seems most people just want the issue to go away. Well it might or it might not. Recent advances in generating stem like cells without using embryos are promising, but not conclusive (see prior post). Like most issues in science, there will be progress and then setbacks. The main lesson from this impasse seems lost; the government does not "control" science, but it sure can makes things difficult.

Stem Cells Redux

Sometimes after a false start- such as the data fiasco in Korea- the science eventually catches up. So the early report of reprogramming skin cells to behave like stem cells has now been confirmed in humans, and then duplicated by another lab-using a slightly different set of genes.
So it looks like it works. This means we may be able to get a supply of cells that act like stem cells without dealing with embryos whatsoever. That would be a leap forward, especially for those reserachers who are dependent upon NIH policy decisions dictated by the White House.
In effect, it will depoliticize the field.
Next on the agenda- make sure the new programming tools do not, for example, make these cells into cancer cells.

Stem Cells from the Skin

This week the headlining news has once again to do with the production of Stem Cells- this time without using any embryos.
Skin cells (in the mouse) have been reprogrammed using a a small number of "transcription factors". These are small proteisn that control the expression of bits of DNA. What is remarkable is that a only a few signals were needed to make a major change in the cells. And the
work was duplicated by several groups- making it far more believable.
Lots yet to be done to make anything similar work in the human. I have personal experience
working with insulin, that clearly showed major differences between mouse & human. So stay tuned.

New Paper on Cartilage Glue

New technology from Johns Hopkins promises to "glue" new cartilage
to the the surrounding cartilage, giving us the prospect for integrating the repair tissue with the good tissue around it.

clipped from clipmarks.com clipped from www.nature.com

The promise of supplements

I get lots of questions from patients with joint disease about nutritional supplements- the type of stuff available at Costco in a large bottle. None of the stuff in these pills has ever been proven to get to the joints- like many vitamins, it just goes out the GI tract. So the issue is, this is probably a waste of money. Even doctors have been taking the stuff- but of course they are people too, and everyone is looking for a free lunch. Remember St. Johns's Wort (for depression)? Someone- I think Osler- once said you have to use a new medicine real soon, before it loses its efficacy. There is a high "placebo effect", be aware of that.
As to safety, I also get concerned that chondroitin in supplements is not from cows that have been tested for mad cow disease- it is not regulated. That is why this material is not sold in a pharmacy etc. So caveat emptor!

California to (Maybe) release Stem Cell Money

California has several years ago voted to fund Stem Cell Research, thanks to lack of support from the Feds (and specifically the White House). But the anti-Stem forces have stymied the funding in every legalistic way they can. A recent ruling from the California Appeals Court has freed up the money, which has been appropriated by the State. The total is 3 B over a period of time; so far the big winners are Stanford and UCSF, no surprise, but the money is disseminated around the State. Stay tuned to see if there is an appeal to the Supreme Court of CA; it ain't over till it's over.