#SIS25th. 25th Annual Meeting Slides

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1 25th Annual Meeting Slides

2 Stem Cell for Spine Care - From dish to disc Wenchun Qu, MD, PhD Mayo Clinic Rochester

3 Disclosures ØConsultant, DePuy Synthes ØBoard of Directors, American Academy of Regenerative Medicine ØBoard of Directors, Society of Chinese American Physician Entrepreneurs

4 Goals for Discussion 1. To recognize the activities of stem cells 2. To review stem cells based on strategy of preparation 3. To familiarize with current regen spine service and translational research

5 Processes of Disc & Cartilage Degeneration Three processes Cellular process Apoptosis Molecular process Cytokine profile Matrix degradation Painful experience AP frequency ñ Cellular: Cell Death - Aging - Genetic - Mechanical Stress - Obesity Pain: AP ñ Molecular: ECM Degradation

6 Processes of Disc & Cartilage Degeneration Three processes Cellular process Apoptosis Molecular process Cytokine profile Matrix degradation Painful experience AP frequency ñ Cellular: Cell Death - Aging - Genetic - Mechanical Stress - Obesity Pain: AP ñ Molecular: ECM Degradation

7 Processes of Disc & Cartilage Degeneration Three processes Cellular process Apoptosis Molecular process Cytokine profile Matrix degradation Painful experience AP frequency ñ Cellular: Cell Death - Aging - Genetic - Mechanical Stress - Obesity Pain: AP ñ Molecular: ECM Degradation

8 Processes of Disc & Cartilage Degeneration Three processes Cellular process Apoptosis Molecular process Cytokine profile Matrix degradation Painful experience AP frequency ñ Cellular: Cell Death - Aging - Genetic - Mechanical Stress - Obesity Pain: AP ñ Molecular: ECM Degradation

9 Source of MSCs Human tissue source CFU-F yield (per cc of tissue) MSC frequency range (CFU-F/10 6 nucleated cells) Bone marrow aspirate Adipose/lipoaspirate Umbilical cord blood Synovial fluid Amniotic fluid Peripheral blood Dermis Not reported Murphy, Experimental & molecular medicine, 45(11), e54.

10 Hunt, 2017

11

12 Technique of Bone Marrow Aspiration

13 Current Regen Pain Services - Bone Marrow Aspirate Concentrate Injection Bone Marrow Aspiration Bone Marrow Mesenchymal Stem Cell (BMSC) Bone Marrow Aspirate Concentration (BMAC) BMAC Injection - Disc - Facet - SIJ

14 G1:Bone Marrow Aspirate Concentrate

15

16 Transform the Practice Initiative Trial - AMSCs for discogenic pain - Culture Expanded AMSC Injection Experiment BMSC Adipose Biopsy Adipose Derived Mesenchymal Stem Cell (BMSC) Culture Expansion of AMSC AMAC Injection - Intradiscal - Therapy Arm

17 Industry Trial for Discogenic Pain - Culture Expanded BMSC Injection Experiment BMSC Bone Marrow Aspiration Bone Marrow Mesenchymal Stem Cell (BMSC) Culture Expansion of BMSC BMAC Injection - Intradiscal - Therapy Arm - Control Arm

18 G2: Completed Trials on Discogenic Pain Author N Design Cell type Dosage Outcomes Bae et al RCT, 3 arms Allogeneic MPC, immunoselected 6M 18M + HA carrier VAS, ODI, SF-36, WPAI Coric et al Orozco et al Pang et al Pettine et al Open label, single arm Open label, single arm Allogeneic chondrocytes, cultured M with fibrin carrier NRS, ODI, SF-36, MRI Autologous BMSC, cultured 18-28M VAS, ODI, SF-36, MRI 2 Case study Allogeneic HUC-MSCs, cultured 100M VAS, ODI, MRI 26 Open label, 2 arms Autologous BMSC 2-3 ml VAS, ODI, MRI Pettine Open label, single arm Allogeneic chondrocytes 10M with fibrinogen and thrombin carrier NRS, ODI, SF-36, MRI

19 G2: On-going Trials for Discogenic Pain Sponsor N Phase Design Cell type Dosage Outcomes Red de Terapia Celular 24 I-II RCT, 2 arms Allogeneic BMSC, cultured 25M VAS, ODI, SF-12, MRI, AEs Mesoblast 330 III RCT, 3 arms Allogeneic MPC 6M 6M + HA VAS, ODI Bioheart 100 II Open label, single arm Autologous AMSC + PRP Will vary VAS, ODI Biostar 8 I-II Open label, single arm Autologous AMSC 40M VAS, MRI, AEs Inbo Han, CHA University 10 I Open label, single arm Autologous AMSC 20-40M + HA VAS, ODI, SF-36, MRI, DHI, AEs

20

21 J Am Coll Cardiol. ;61(23):2329

22

23

24 State of Stem Cell in Spine Care MSC Generation Source Human Animal Bench Concentrate Culture - Expand 1 st Gen Auto 2 nd Gen Auto Allo TF Induced Gene modified 3 rd Gen Auto Allo 4 th Gen Auto +/- Allo +/- 5 th Gen ipsc - - +/- +/-

25 Thank you!

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