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Can biological therapies reduce the use of drugs and metal prostheses?
To understand the concept of Regenerative Medicine, we need only recall the myth of Prometheus, where Zeus sent an eagle every morning to eat his liver, but every time the next morning the liver was reformed.
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Cover of "Regenerative Medicine", National Institute of Health, 2006, USA.
The idea of finding an element from the body itself with regenerative, healing and anti-inflammatory effects on the body's damaged tissues is quite old in the history of medicine. This idea led to the emergence of Regenerative Medicine as a special, new field of medical science for the purpose of treating tissue destruction due to degenerative diseases or injuries. Regenerative Medicine is concerned with the regeneration of tissues and organs of the body that have undergone degeneration or damage, through the stimulation of the process of autophagy.
To achieve this, regenerative medicine uses the body's own means of self-repair and is based on stem cells, which guide tissue regeneration and have the advantage of not diminishing with age. However, in addition to stem cells, the following have been researched and are widely used as biological therapies: platelet-derived growth factors that are easily isolated from the patient's blood (PRP (Platelet Rich Plasma) method) and proteins that have an anabolic (regenerative) effect on tissues, as well as proteins that inhibit the catabolic (destructive) action of other macromolecules.
In the field of Orthopaedics, although we are surgeons, the vast majority of the cases we treat are conservative. Severe musculoskeletal injuries, such as complete ligament-tendon tears and bone fractures, usually require immediate surgery. However, chronic musculoskeletal conditions are generally treated conservatively at first. In these, symptoms such as pain and loss of function are caused by degeneration - chronic wear and tear of the menisci (degenerative tears), cartilage (chondropathy, osteoarthritis) and tendons (tendinitis, epicondylitis, partial rupture).
In the therapeutic approach, anti-inflammatory drugs are indicated only in recent diseases. In chronic conditions, they only work as painkillers and not therapeutically, and end up in the whole body with a risk of side effects. In contrast, topical injections act directly on the site of the problem, avoiding side effects on the rest of the body's organs. In addition to traditional cortisone injections, with the development of the field of regenerative medicine, biological injections are increasingly being applied.
The efficacy of stem cell application, especially PRP, which has been used for several years, is well documented in the international scientific community, especially in the knee joint. Recently, our team in collaboration with researchers from the USA and Israel published excellent results on the combination of PRP infusion with hyaluronate in the treatment of knee osteoarthritis in the American Arthroscopic Association (AANA) "Journal of Arthroscopy". The use of the methods is safe, with no side effects. In osteoarthritis of the knee that has not progressed to full bone-on-bone contact on radiography, slowing the deterioration of osteoarthritis up to and including improvement of the radiographic image after stem cell therapy has been demonstrated. Limitations in their application clearly exist. In very severe osteoarthritis, the option of arthroplasty is the only definitive treatment. However, even in these cases relief of symptoms has been observed in a large proportion of patients.
The important thing is that the development of regenerative medicine is rapid and is predicted to greatly expand the possibilities of medical science in the non-surgical treatment of many conditions. It is no coincidence that major centers abroad, such as the Mayo Clinic, are incorporating it into their treatment quiver, estimating that Regenerative Medicine will account for 10% of all treatments regardless of specialty within the next decade.
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