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Применение аутологичной кондиционированной плазмы крови в ортопедии доктор Julien Troillet

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Материалы симпозиума "Методы регенеративной медицины в травматологии и ортопедии лошадей". НОИР. 25.02.2012.
Autologous Conditioned Autologous Conditioned Serum
Serum
in the treatment of orthopaedic disease
in the treatment of orthopaedic disease
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Dr.med.vet. J.Troillet; St. Petersburg 24.02.12
•
•
What is Autologous Conditioned Serum (ACS)?
What is Autologous Conditioned Serum (ACS)?
•
•
How does ACS perform?
How does ACS perform?
•
•
How is ACS prepared?
How is ACS prepared?
•
•
Has ACS got clinical relevance?
Has ACS got clinical relevance?
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
What is
What is
From the Patient
For the Patient
Autologous
Autologous
Conditioned Serum (ACS)?
Conditioned Serum (ACS)?
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Exposure
Medical grade “A“glass beads
What is
What is
Autologous
Autologous
Conditioned Conditioned Serum (ACS)?
Serum (ACS)?
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Incubation
37°C Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Exposure
&
Incubation
Stimulation
Leukocytes
&
Thrombocytes
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Monocyte
Makrophage
Lymfocyte
Neutrophile
granulocyte
Immunologic cell
IL-1Ra
Leukocytes
?
Dr.med.vet. J.Troillet; St. Petersburg 24.02.12
-Vascular Endothelial Growth Factor
-Platelet Derived Growth Factor
-Transforming Growth Factor-ß1
-And many more…
Thrombocytes
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
What is Autologous Conditioned
What is Autologous Conditioned
Coagulated
Supernatant
Cell-free
(ACS)?
(ACS)?
Serum
Serum
Dr.med.vet. J.Troillet; St. Petersburg 24.02.12
How does ACS perform?
How does ACS perform?
Pro-inflammatory and destructive cytokines
Biomechanical Factors
Activation of cytokine
network cascade
Destruction of hyaline
Cartilage and it‘s matrix
Imbalance in matrix metabolism
Joint pathology
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
One responsible cytocine
One responsible cytocine
•Pro-Inflammatory cytokine
•Stimulation of collagenase and metallo-proteinase
•Destruction of hyalin cartilage and its matrix Interleukin-1 Receptorantagonist
•Anti-inflammatory and chondroprotectiveInterleukin-1
•Type I and II IL-1 receptors
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Inside a pathologic joint
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
GF‘s such as:
•PDGF
•FGF
•TGF
•IGF
•HGF
•VEGF
Cytokines such as:
•IL-1Ra
•IL-4
•IL-7
•IL-13
•IL-10
•IL-6
Further components of ACS Minimized:
TNFa
IL-1ß
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
How is ACS prepared?
How is ACS prepared?
Medical Device: irap
®
irap
®
50irap
®
10
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Aseptical bloodwithdrawal
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
at 37°C for 6-9 h
Incubation
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
at RCF: 3000g for 10min
Centrifugation
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Seperated serum from cruor
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Harvesting the serum (ACS)
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Ready to use ACS
Storage at <-20°C
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Use sterile-filter (0,22µm) for reinjection!
Reinjection
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Has ACS got clinical relevance?
Has ACS got clinical relevance?Proven trough clinical and experimantal studies
Human medicine: Orthokine
®
Autologous conditioned serum (Orthokine) is an effective
treatment for knee osteoarthritis (Balzer et al. 2009)
Effects significantly superior to HA
Efficacy of Epidural Perineural Injections with Autologous Conditioned Serum for Lumbar Radicular Compression
(Becker et al. 2007)
Encouraging treatment option
Decrease in pain superior to steroid injection
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Veterinary medicine: irap
®
Treatment of Muscle Injuries by local Admisnistration of Autologous conditioned Serum: Animal Experiments using a Muscle Contusion Model
(Wright-Carpenter et al. 2004)
ACSControl
Satelite cell activation at 30/48 h accelerated
Diameter of regenerating myofibres was increased
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Accelerated Healing of the Rat Achilles Tendon in Response to Autologous Conditioned Serum (Majewsky et al. 2009)
Enhanced expression of the Col1A1 gene Thicker
More type I collagen Accelerated recovery
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
ACS generated with the irap
®
device.
A new therapy for dogs?
(Hauri, 2010) •
Lame dogs
•
Ellbow or stifle
•
Radiological signs of OA
•
No surgery of the affected joint (12 months)
•
No signs of ligament rupture
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
0
1
2
3
4
123456789101112
Dog Nr.
Grade of lameness
Before treatment
2 weeks after last Inj.
3 months after last Inj.
Dr. med.vet. S. Hauri, Beinwil am See, CH
Results
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Comparison of the Success of intra-articular treatment with Sodium Hyaluronate and Corticosteroids vs. Autologous Conditioned Serum in horses with positive anaesthesia of the coffin joint (Joestingmeier, 2008)
54 Horses with forelimb lameness
X-Ray with osteoarthritic signs
+ve coffin joint anestesia
Dr. Eric Levy, France
Dr. Eric Levy, France
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Group 1 N27
Bethamethasone(Celestovet
®
)
Na-Hyaluronat (Hylartil
®
)
Group 2 N27
Autologous Conditioned Serum (irap
®
)
Pferdeklinik Bakum Lüsche
Pferdeklinik Burg Müggenhausen
Dr.med.vet. J.Troillet; St. Petersburg 24.02.12
Group 1 (HY and Steroids) 63% success (Ø2,8 treatments)
Group 2 N 27
Lamefree
Group 1 N 27
Lamefree
Group 2 (ACS) 88,9% success (Ø3,3 treatments)
Results
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Clinical, biochemical, and histologic effects of intra-
articular administration of Autologous Conditioned Serum in horses with experimentally induced osteoarthritis (Frisbie et al. 2007)
N16
Group 1 N8
6ml PBS Solution
Day 14,21,28,35
Group 2 N8
6ml ACS
Day 14,21,28,35
Clydevetgroup, UK
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
-No adverse reaction
-Improved lameness
-Decreased synovial membrane hyperplasia
-Less gross cartilage fibrillation
-Less synovial membrane hemorrhage
Results
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Evaluation of Autologous Conditioned Serum
(Österdahl, 2008)
N10
fetlock joint PSGAG (Adequan
®
) failures
N10
fetlock & coffin joints
HY (Hyonate
®
) failures
3 x 2 mL irap ACS
10 of 10 back to work
3 x 2 mL irap ACS
7 of 10 back to work
N20
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Indications for irap
®
–ACS in the tratment of Horses
I) -Diagnosed arthritic condition
-HY and/or Steroid failure II) -Post-surgical application -OCD lesions and cartilage defects III) -Acute inflammation -Joint effusion IV) -Tendon lesions / tendon sheaths Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Highly effective therapy
Long lasting effect
Alternative to NSAIDs and Steroids
Safe : 100% Autologous Owners wish for alternative medicine Take Home Message
Take Home Message
Dr.med.vet. J.Troillet; St. Petersburg 25.02.12
Thank You for Your attention!
Thank You for Your attention!
www.irap.de
Автор
irina.turenko
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применение, доктор, аутологичной, кондиционированной, плазмы, крови, ортопедии_, julien, troillet
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