Autologous Bone Marrow Transplant Nanoplasty with Intra-Articular Autologous Bone Marrow Concentrate Injections: Where are we now?
I have offered autologous bone marrow transplant nanoplasty with intra-articular injection of bone marrow concentrate in my clinic in Wilmington, North Carolina since 2006. I developed confidence for the treatment application based on the published work of Philippe Hernigou MD in France and Daniel Eglinton MD in Boone, NC, who introduced me to the molecular concepts behind similar treatment modalities they had begun to offer patients outside of traditional treatment algorithms. Building on the work of these other orthopedic surgeons fostered my interest in receptor mediated cell signaling and an appreciation of the work on ‘signaling cells’ done by Arnold Kaplan PhD at Case Western Reserve, who died recently. Dr. Kaplan called the mesenchymal stem cell an “injury drugstore” for its ability to combat injury on-site and was instrumental in helping me establish my own knowledge base on immunobiologic concepts and their potential clinical application in orthopedics.
My search led to me to many textbooks and journal articles and fruitful discussions with bench scientists who endured my curiosity at a time I was shunned by my clinical peers for my non-traditional interests. I wasn’t deterred by the bad press and what my colleagues were saying about my work and there was no rush to monetize the concepts like we have seen, sadly, in recent years. Today, it’s quite a different landscape where orthopedic immunobiologics are concerned. There is not a single orthopedic surgery clinic or pain management clinic in my small town of 115k, where the techniques I originally described, are not offered. There is not a single state in the US where our protocols are not represented in some fashion. All of my peers and colleagues have been forced to admit I was right after all, but this is just the beginning. Every field in medicine will be affected by immunobiologic signaling techniques. Many surgical procedures available today will be looked back on as barbaric in my opinion.
‘Regenerative Medicine’ has evolved as a formally advertised medical specialty (although the FDA frowns on that for good reason in most cases because it has been used as a marketing tool). Formal professional societies and many journals have been established that focus exclusively on what is being called ‘Regenerative Medicine’. In my electronic mailbox, I receive advertisements nearly every day inviting me to ‘interventional orthopedic’ meetings or lectures on ‘orthobiologics’ that are staffed by doctors who I remember mistook me for a fool when I introduced these concepts. Doctors across the country now pay hefty dues to be part of a specialty society that aims to represent all of the doctors who have now classified themselves as ‘interventional orthopedists’, whether or not they have actually completed an orthopedic residency (or any specific training or that matter), which I find misleading at best. Headlining one of the meetings is a well-recognized ‘expert’ in orthopedic immunobiologics from Stanford who I trained with in fellowship and who once scoffed at my ideas. I’m glad that his patients will enjoy the same benefits that mine have. I completed the last year of my training at the world renowned Steadman-Hawkins Clinic in Vail, Colorado. My ideas and concepts were encouraged there and I continue to collaborate with them to push the envelope as far as possible with the goal of providing patients with their best potential options to invasive surgery that they all deserve to know about.
One of our initial goals was to find an alternative solution for patients with osteoarthritis, particularly of the knee, who were considered candidates for total knee replacement, but who wanted to avoid that too often complicated and not completely predictable surgery where there was potential for significant expectation/result mismatch. Don’t get me wrong, total knee replacement has become far more predictable and patient performance following the surgery has improved dramatically to what it once was.
Once I began to accumulate my own patients who I performed what I considered to be a technically excellent total knee replacement procedure on, I realized that the published reports on large volumes of patients accurately reflected what I was seeing in my own practice. Most patients do not know what they are getting themselves into, particularly when a perioperative complication develops. It’s one thing to discuss the possibility of fatal PE, infectious complications and their fallout and even amputation with a patient. It’s quite another when it happens to them and you must take responsibility for your role in the decision making process.
How did it start?
With an undergraduate background in chemistry from Chapel Hill, and keen on receptor biochemistry, I sought to find a way to reverse the rate limiting steps in the development of osteoarthritis and organic joint disease. Early in my orthopedic surgical residency at the University of Hawaii, I began to make notebooks about the development of arthritis. I looked closely at X-rays and imagined what was occurring at the molecular level and the amount of time it took for those changes to occur. Could there possibly be a way to reverse the changes? Realizing that osteoarthritis was a mechanically induced disease due to joint overload was the first critical epiphany. Next came the identification of the rate limiting step in the process, stiffening of the subchondral bone on the concave side of the joint. Following soonafter was the realization that subchondral injury, clearly identifiable on MRI sequences was not only a marker for disease but a pain generator.
We first detailed the anticipated mechanisms of action and constructed clinical protocols to test our hypothesis shortly thereafter. Initially, there was a great deal of resistance to the methods we presented and introduced to the orthopedic surgical community, even at educational conferences. I was mocked and aggressive attempts to discredit my work came from all directions. It is satisfying to see that the protocols for orthopedic immunobiologic applications we developed in those early days have now spread to over 2000 clinics in North America alone. All major universities in the US now offer the treatments that we elaborated over the last 18 years. All major sports medicine clinics offer the techniques and have gone so far as to advertise the procedures on university websites.
Today our autologous bone marrow transplant nanoplasty protocols have undergone 8 iterations to where they are today. We believe that each one represents an advancement in what was offered before. Biotechnology is advancing and it is likely that methods will continue to change and improve as a function of time as biochemical signaling pathways become more clear and nanomolecules become available for widespread clinical application.