For many years, the conventional wisdom regarding osteoarthritis has been as follows: control your discomfort, prevent further damage, and eventually replace the joint completely when conditions worsen. Despite affecting about 32 million Americans and costing the healthcare system more than $130 billion a year, this treatment approach has changed surprisingly little over time. For this reason, it seems worthwhile to pay attention to what is currently emerging from Colorado.
Researchers at Colorado State University, CU Anschutz Medical Campus, and the University of Colorado Boulder have created two experimental treatments that, in animal experiments, not only slowed but also reversed osteoarthritis. Within four to eight weeks, some damaged joints recovered to what the researchers called a healthy state. That isn’t a steady improvement. That is a completely different kind of outcome.
The first treatment uses a patented particle delivery system that is injected straight into the afflicted joint and releases sporadic doses of an FDA-approved medication over a period of several months. Although the concept of repurposing an existing medication is not new in medicine, this instance differs in the way it is delivered. The particles continue to release the medication in controlled bursts rather than a single dose that wears off, providing the joint with prolonged exposure to something that seems to promote bone and cartilage regeneration rather than merely reducing inflammation.
Patients with more severe damage—visible lesions in the cartilage or underlying bone—are the target of the second strategy. A combination of engineered proteins are administered arthroscopically and cured in situ at the site of injury as part of this treatment. Once in place, it attracts the body’s own progenitor cells, which are capable of developing into specialized tissue, to the injured area to carry out the necessary repairs. Principal investigator Stephanie Bryant, a CU Boulder professor of chemical and biological engineering, characterized the outcomes in bone and cartilage defects as “full regeneration and repair.” Researchers do not use that language carelessly.
This has been closely monitored by the federal Advanced Research Projects Agency for Health, or ARPA-H. The Colorado team received funding up to $33.5 million, contingent on outcomes, from the agency’s first program, the Novel Innovations for Tissue Regeneration in Osteoarthritis program, or NITRO. The team finished phase one and made progress after two years. That’s important because ARPA-H doesn’t have a tendency to expedite poorly performing tasks.
That warning has a lot of weight because it’s still early. Thus far, research has been done on animals. Many promising treatments have failed to make the transition from animal models to human biology, and this one hasn’t done so yet. Clinical trials are still pending, but the team has also been testing their materials in human cells from patients who donated tissue during joint replacement procedures, which adds some translational confidence.
The current state of treatment is straightforward, according to Dr. Evalina Burger, chair of the Department of Orthopedics at CU Anschutz: for many patients, it’s either major surgery or nothing. The middle is largely empty. It’s difficult to ignore the weight of witnessing a group of biologists and engineers attempt to close that gap with something minimally invasive and possibly reasonably priced (the researchers have specifically stressed accessible pricing).
To advance the technology’s commercialization, the team has already established Renovare Therapeutics Inc. According to Bryant, human clinical trials may start in 18 months if the next stage of research proceeds as planned.
There’s a real but cautious feeling that something significant is taking place here. This is a serious, well-funded, scientifically based attempt to alter the actual course of treatment for osteoarthritis, but it is not a guaranteed breakthrough—medicine rarely offers those. That possibility alone is worth pursuing for the millions of people who use cortisone shots and anti-inflammatories to manage everyday pain.
