Many leading orthopedic companies are researching bone cell therapies and are trying to open up possibilities of incorporating stem cells in this regard. According to the study ‘Osteonecrosis Global Clinical Trials Review, H1, 2018’, Bone Therapeutics is a leading cell therapy company addressing high unmet needs in orthopedics and bone diseases. The Belgium based company operates a diversified portfolio of bone cell therapy products in clinical development across a number of disease areas targeting markets with large unmet medical needs and limited innovation.
Avascular necrosis also called osteonecrosis or bone infarction is the death of bone tissue caused by interruption of blood supply. It is a focal infarct of bone that may be caused by specific etiologic factors or may even be of idiopathic nature, meaning it can arise out of unknown reasons spontaneously. It may lead to pain, limitation in motion, joint collapse and osteoarthritis. Diagnosis is done by X-ray and MRI with the latter being more sensitive and specific. In early stages, surgical procedures may slow or prevent progression. In later stages, joint replacement may be required for relief of pain and maintenance of function. It is often suspected in patients with unexplained non-traumatic pain in the hip, knee or shoulder.
Osteonecrosis is most often a complication of displaced hip fracture but factors that compromise bone blood flow such as chronic corticosteroid use and excessive alcohol consumption tend to increase risk of non-traumatic osteonecrosis. The hip (femoral head) is most commonly affected followed by the knee and shoulder. The wrist and ankle are less often involved. Since osteonecrosis affects mostly the joints and bones, the most widely used treatment is via surgery carried out by orthopedic surgeons. Core decompression and bone grafting are popular in this respect. Various surgical procedures are helpful to relieve pain and improve function of the affected femoral head in the early stages; however, the secondary trauma caused by surgical intervention remains an inevitable clinical problem where surgical procedures are unable to prevent deformity and collapse in deteriorating cases of osteonecrosis of femoral head.
Currently the attention of researchers is focused on three key points that will help maximize the efficiency of existing resources. The first, enhancing the sensibility and accuracy of diagnosis to raise the rate of early diagnosis, the second, improving surgical operation technology or developing minimally invasive surgery to avoid the secondary trauma caused by surgical intervention and the third, exploring drugs or grafting products to promote reparative bone remodeling thereby obtaining a good prognosis. Following advances in basic science, many new insights focus on bone tissue engineering to optimize therapies and facilitate prognosis of osteonecrosis.
Research is also attempting to answer the question on how to reverse the early stage of osteonecrosis and promote reparative bone remodeling as the key for maintaining the undestroyed joint adjacent to lesion areas and making available therapies to facilitate a good prognosis. In this review, disease classifications, current treatment options, potential therapies and the relevant translational barriers are being reviewed in the context of clinical application and preclinical exploration, which would provide guidance for preferable treatment options and translation into novel therapies.
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