Sarah Pressman Lovinger, MD

From the American Association of Orthopedic Surgeons 

     CHICAGO&#8212;The field of orthopedic surgery is      moving beyond casting, pinning, and mechanical joint replacement to treat      musculoskeletal conditions, such as fractures and arthritis. With new      treatments on the horizon, a panel of orthopedic surgeons at the annual      meeting of the American Association of Orthopedic Surgeons explained      how advances in gene therapy and stem cells are improving treatment of      joint and bone ailments.   

     Some surgeons are using stem cells instead of      autografts in patients with slowly healing fractures. Autografts require an      incision over the pelvis to remove part of the patient&#8217;s own pelvic      bone, which can cause discomfort. This procedure also introduces the risk      of infection and bleeding. The use of a patient&#8217;s own stem cells can      eliminate these potential problems.    

     Matthew L. Jimenez, MD, an orthopedic surgeon at the      Illinois Bone and Joint Institute, Morton Grove, Ill, reported on the      results of an ongoing phase 2 trial to determine      the safety of using stem cells in patients with      nonunion fractures that typically heal poorly. In this trial,      stem cells are first removed from a      patient&#8217;s iliac crest by using      a bone marrow aspirate and are then combined with sterilized allograft      fragments in a lab. This mixture, which has the consistency of wet sand, is      then applied to the fracture nonunion site during surgery to enhance      healing. Dr Jimenez reported good healing and no adverse events at 24 weeks      in 7 of the 32 patients initially enrolled in the trial.   

"I believe that tissue engineering is the future." 

     This is the first advanced trial of stem cells in      nonunion fractures in North America, but Dr Jimenez postulates that many      patients will ultimately benefit from this treatment. &#8220;I      believe that tissue engineering is the future,&#8221; he said.   

     Orthopedists are also using gene therapy to improve      fracture management and decrease the need for multiple surgical      procedures. Regis J. O&#8217;Keefe, MD, PhD, director, Center for      Musculoskeletal Research, University of Rochester Medical Center, New York,      investigates how to introduce genes into bone-forming mechanisms. The new      procedure could improve the functions of bone-forming cells, thereby      increasing bone formation.    

     When injured bone is replaced with conventionally      donated bone, the donor bone is dead and tends to fracture in as many as      one third of cases. But the placement of genes that can induce bone      formation on the surface of the dead bone can signal the surrounding tissue      to bring the bone back to life. Currently gene therapy uses viruses as      vectors to bring the gene inside the cell. Dr O&#8217;Keefe is looking for      safer alternatives to deliver the gene to the cell.    

     Currently 2 clinical trials are underway that evaluate      gene therapy to decrease musculoskeletal inflammation in disorders such as      arthritis. 	  

Sarah Pressman Lovinger, MD

Articles

Orthopedists Consider Gene Therapy, Stem Cells for Bone Injuries