Hype, Promise and Reality: Orthopaedic Use of Biologics in 2020 (AANA20)-Hype, Promise, and Reality_ Orthopaedic Use of Biologics in 2020-Dr. Scott Rodeo

Hype, Promise, and Reality_ Orthopaedic Use of Biologics in 2020-Dr. Scott Rodeo

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In his 2020 lecture, Dr. Scott A. Rodeo examines the current state and future prospects of biologic therapies in orthopaedics, highlighting a significant gap between the promise of these treatments and their clinical reality. The widespread clinical use of “biologics” like platelet-rich plasma (PRP), cell-based therapies, and blood derivatives has outpaced rigorous scientific validation, partly due to regulatory gaps and aggressive marketing in the U.S.<br /><br />Currently available biologic options include PRP, autologous conditioned serum, mesenchymal stem cell preparations from bone marrow and adipose tissue, as well as emerging therapies like allogeneic cells, induced pluripotent stem cells (iPSCs), purified cytokines, extracellular matrix materials, gene therapy, and small molecules. However, clinical evidence supporting their effectiveness remains limited.<br /><br />Dr. Rodeo emphasizes the critical need to define the precise “biologic targets” of treatment — such as reducing inflammation, enhancing vascularity, or stimulating cell migration — and to tailor biologic formulations accordingly. He cautions against a “one size fits all” approach given patient and tissue variability.<br /><br />Next-generation advances in PRP involve modifying its composition to remove detrimental factors like TGF-β1 and myostatin, enhancing anti-inflammatory mediators, or combining PRP with antifibrotic agents or standardized growth factor doses for improved muscle and tendon healing.<br /><br />For cell-based therapies, he differentiates current minimally manipulated heterogeneous preparations from purified, culture-expanded mesenchymal stem cells, favoring the term “connective tissue progenitor” cells. Limitations include the low stem cell numbers and challenges with cell behavior post-transplantation. Future directions focus on harnessing intrinsic stem cell niches and using biomarkers and machine learning to better characterize and personalize cell therapies.<br /><br />The lecture also highlights molecular mechanisms underlying tendinopathy, involving complex interactions of immune cells, cytokines (e.g., IL-17A, IL-21R), and signaling pathways like Wnt that drive tendon degeneration or repair. Targeted therapies such as IL-17A blockers and Wnt inhibitors (e.g., SM04755) show promise in preclinical and early clinical studies.<br /><br />Dr. Rodeo advocates for integration of developmental biology and immunology insights, refinement of biomarkers for early diagnosis, and standardized potency tests to improve translational success. The overall message: biologic augmentation holds great potential but requires further research, standardization, and precision medicine approaches before its full clinical benefit can be realized.

Keywords

biologic therapies

orthopaedics

platelet-rich plasma (PRP)

cell-based therapies

mesenchymal stem cells

tendinopathy

cytokines

gene therapy

precision medicine

biomarkers