Regenerative Treatments in Sports & Orthopedic MedicineChapter 9: Amniotic and Umbilical Cord Products, Alpha-2 Macroglobulin, and Interleukin-1 Receptor Antagonist ProteinAmniotic and Umbilical Cord Products, Alpha-2 Macroglobulin, and Interleukin-1 Receptor Antagonist Protein
Marko Bodor, together with colleagues Sean Colio and Ryan Dregalla, is contributing an important chapter in the forthcoming book, “Regenerative Treatments in Sports & Orthopedic Medicine”, to be published by Springer Publishing in September 2017.
In this chapter we review three emerging areas in regenerative medicine for orthopedic conditions:
amniotic products, interleukin- 1 receptor antagonist protein ( IRAP ), and alpha- 2 macroglobulin (A2M ). Amniotic fluid and membranes contain numerous growth factors, cytokines, anti-inflammatory proteins, collagen, fibronectin, mesenchymal stromal cells, epithelial cells, and hyaluronic acid. These components are appealing for their utility in treating various acute and chronic musculoskeletal pathologies. IRAP is a naturally occurring analog and a competitor of interleukin- 1 (IL-1) and binds to the interleukin- 1 receptor (IL-1R) causing suppression of inflammation typically caused by IL-1. By suppressing the IL-1 inflammatory cascade, it may be possible to prevent the activation of macrophages, monocytes, and stimulation of osteoclasts that break down bone and cartilage matrix in orthopedic injuries and degenerative processes. A2M is a plasma glycoprotein with
a unique ability to inhibit metalloproteinases (MMP) involved in degrading cartilage and inflammatory cytokines production. Similar to IRAP , A2M may help reduce the catabolic process in degenerative and inflammatory orthopedic conditions. Throughout this chapter we also review the current clinical evidence regarding the use of these techniques.
The majority of studies investigating the use of amniotic products, IRAP , and A2M are limited to in vitro and animal studies with few human clinical trials. Additional randomized clinical trials including other musculoskeletal pathologies along with larger sample sizes and longer term follow- ups are needed to understand their future potential. Furthermore, most of the trials have compared their efficacy versus corticosteroids and saline rather than other orthobiologics. Corticosteroids have known
dose- dependent side effects with risks, including osteoporosis, osteonecrosis, deterioration of articular cartilage and tendon or ligament weakening or rupture leading to minimizing their chronic usage and in some cases avoiding them altogether. Intra- articular saline injections have been shown to yield a statistically and clinically meaningful improvement in knee OA symptoms for up to 6 months, which exceed a placebo effect (102). Therefore, a more logical comparison would be evaluating these products versus other regenerative medicine techniques, such as HA, platelet- rich plasma, or MSC. Nonetheless, improvements have been made in the production and isolation of these products allowing this research to advance, a great stride forward when compared with the early use of bovine amniotic fluid in the joints of patients described in 1938.
ABOUT THE BOOK
Regenerative medicine offers physicians new tools to help repair damaged tissue, alleviate pain, accelerate healing, and improve function for patients with degenerative conditions or sports injuries. Regenerative Treatments in Sports and Orthopedic Medicine is the first comprehensive book devoted to orthobiologic treatments for orthopedic conditions. Authored by experts in regenerative medicine, this evidence- and experience-based guide is written for clinicians looking to understand and effectively implement these treatments in their practices.
Broad yet focused coverage of the scientific underpinnings, regulatory issues, staffing and equipment, nutritional and rehabilitation concerns, and orthobiologic interventions for specific clinical problems make this the ideal procedural reference for anyone working to restore function to athletes or other patients with musculoskeletal pathologies.
- Unparallelled coverage of clinical science and practical applications
- Written by pioneering leaders at the forefront of an emerging standard of care
- Evidence-based indications for initiating orthobiologic therapies
- Includes a review of important nomenclature for the novice
- Covers both Platelet Rich Plasma (PRP) and stem cell procedures
- A must-read guide for practitioners in academic and private practice settings
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Reduce Pain. Increase Mobility + Function. Improve Quality of Life.
All the research conducted through the Napa Medical Research Foundation, a 501(c)(3) nonprofit organization, is fully funded through generous donations received from individuals and family foundations.