Virtual Castellvi Spine Week 2: Living Cells and Therapies

Last week, the Castellvi Spine—Advances in Spine Surgery was dedicated to stem cells, or as Moderator Ira Fedder, M.D. preferred to call it, regenerative therapies. Talks were given by several of the leading experts in the field of regenerative therapies. These leaders discussed cell populations and therapies to treat degenerative disc disease (DDD), disc herniations and stenosis, and the legal and regulatory issues in regenerative medicine.

The use of intradiscal treatment with progenitor cells was presented by Domagoj Coric, M.D. from Carolina Neurosurgery & Spine Associates in Charlotte, North Carolina. Coric outlined several studies that were underway such as those from NuQu, Mesoblast, and Discgenics, which are studying the use of allogeneic progenitor cells of various types that are directly injected into diseased discs.

A major take away from his talk was that the evidence shows efficacy of the injections, but that saline placebo is much more effective than would be expected, suggesting it is actually providing treatment for DDD through an unknown mechanism.

A biofiltration method to isolate chondrogenic and osteogenic progenitor cells was discussed by Farhan Siddiqi, M.D., from Trinity Spine Center in Odessa, Florida. The negative cell selection method involves column filtration using antibodies specific to undesired cell types, resulting in a sample that is 87% pure (compared with 0.02% in a typical sample). A study conducted using the concentrated cells found an over 50% reduction in pain and nearly 48% improvement in disability, compared with 35.7% and 38.1% improvements of the same metrics using a buffy coat only cell population as control.

Gregory Lutz, M.D., from Hospital for Special Surgery in New York City, shared his experiences as a physiatrist and his use of platelet rich plasma (PRP) injections to treat DDD. He compared back pain to an unhealed wound, which PRP has been shown to recruit cells specialized for treating those wounds. Lutz showed radiographs from patients who maintained the restoration of disc health years after receiving PRP injections.

Chief Medical Officer of Regenexx, Chris Centeno, M.D., presented data on the use of platelet cell lysate, which has the benefit of delivery all of the growth factors contained in platelets immediately. He showed the benefits of using platelet lysate to treat disc herniations and stenosis. He showed that the treatment, when targeted to components of the entire spinal unit, including ligamentum flavum, supraspinous ligament, and epidural and facet injections where needed helps to reduce the buckling which is often associated with stenosis.

Finally, Andrew Ittleman, Esq., Founder and Partner of Fuerst Ittleman David & Joseph, discussed the regulations on Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/P), what constitutes minimal manipulation, homologous use, and more. He also briefly discussed the rise of state laws governing HCT/Ps.

All-in-all, the second week of discussion was fascinating.

Agenda and Registration can be found here.