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Protease Inhibitors: A ‘New Dawn’ in Treating Early Osteoarthritis of the Basal Joint

Scientists writing in a 2017 issue of European Medical Journal predicted that new, more effective therapeutic agents to stop the progressive destruction of joint cartilage in osteoarthritis are “on the close horizon.” Well, that day may already have dawned, says Miami-based hand and upper limb orthopedic surgeon Alejandro Badia, MD, founder and chief medical officer of the Badia Hand to Shoulder Center and OrthoNOW®, who is using advanced techniques, including natural biomaterials, to treat osteoarthritis of the thumb.

An expert in orthobiologics, Dr. Badia is harnessing the power of protease inhibitors to slow, and potentially halt, destruction of joint cartilage in the basal -- carpometacarpal (CMC) – joint at the base of the thumb in patients with early osteoarthritis of the hand.

Orthobiologics involves utilizing a patient’s own biologic substances, or those of a donor, including blood platelets (PRP therapy) and adult (mesenchymal) stem cells, to mitigate inflammation, relieve chronic musculoskeletal pain and repair orthopedic injuries.

Dr. Badia explains that inflammation is a response to age-related wear-and-tear or injury to a joint and is believed to support the transition to pathological osteoarthritis. Although many factors can contribute to the development of osteoarthritis, nobody knows the primary cause of the debilitating disease. Many sedentary people develop this as they age, and both occupational and genetic factors play a part. It is certain however that repetitive and acute injuries, if untreated, will worsen the symptoms of underlying arthritis and accelerate its development and progression.

Researchers have determined that cartilage degradation is accelerated by chronic inflammation through the excessive activity of proteases, enzymes that normally function to clear damaged tissue after an injury but when they persist in chronically-inflamed joints they lead to degradation of cartilage and subsequent joint pain. Cartilage serves as a cushion for joints; its breakdown leads to joint stiffness and pain, Dr. Badia explains. Proteases are vital to many biological functions, such as digestion and cellular repair, but over-activity of these enzymes in the joint can speed the degradation of cartilage’s extracellular matrix.

But, protease inhibitors, like alpha 1-antitrypsin and alpha 2-macroglobulin, are molecules that can be harvested from blood plasma and other tissues to inhibit inflammatory proteases and clear them from the joint.

“Injection of these inhibitors into the basal joint is proving successful in some patients for relieving the debilitating pain of osteoarthritis of the thumb and potentially helping rebuild some of the lost cartilage,” says Dr. Badia. He and his team at OrthoNOW have treated arthritic patients using a variety of advanced surgical, non-surgical and orthobiologic approaches.

Osteoarthritis is the most common joint disease overall. Basal joint osteoarthritis, a specific form of the disorder, is the second most common arthritic condition of the hand, Dr. Badia says. The thumb disorder can result in severe pain, loss of grip function, strength and restricted range of motion and even deformity – to the point where a patient has difficulty holding a can or glass, opening a jar lid or buttoning a shirt, Dr. Badia notes.

Until now, effective treatments for stopping the progression of osteoarthritis have been limited but increasing studies of the biological basis of the disorder are leading to new therapies, including application of protease inhibitors.

Dr. Badia credits scientists like Shawn Browning Ph.D., vice president of research and development at Holding Technologies, who has studied the biology of joint cartilage degeneration in osteoarthritis, and medical innovators, such as Ziad Hamandi, chief executive officer of ABT Medical, for progress in treating osteoarthritis with protease inhibitors and other orthobiologics. Under Hamandi’s leadership, ABT Medical and their physician collaborators have designed advanced processes for separating blood and other fluid biologics into needed therapeutic components.

“The mission ABT Medical is to be innovative in the development of comprehensive blood management programs that are both responsive and reliable,” Hamandi states.

Orthobiologic therapies are not without risk, according to the federal Food and Drug Administration (FDA). Side effects can include reactions at site of injection, failure of biomaterials to perform as intended, and migration of injected cells away from treatment areas, potentially changing into unwanted cell types, multiplying, and negatively affecting other tissues.

Dr. Badia advises caregivers to exercise caution when administering biomaterials and exhorts patients to be especially careful when seeking medical help in the area of orthobiologics, a specialization in which practitioners often lack necessary training and expertise. It is imperative for patients who are considering regenerative medicine options to seek a clinician who can offer multiple remedies and solutions depending on the patient’s needs and stage of disease. In many cases, clinicians who have stem cell clinics are limited in what they can offer. OrthoNOW provides autologous access to stem cell therapies as well as other conservative therapies that the patient may benefit from, including anti-inflammatory mediators, physical therapy, procedures such as a joint arthroscopy, or even joint replacement for more severe cases. Dr. Badia worries that sometimes patients are being misled by practitioners who are not fully qualified to do regenerative medicine.

“Better than the best therapies for osteoarthritis, of course, is prevention,” states Dr. Badia. “You cannot stop joints from growing older, but you can reduce your risk for joint problems.” He offers the following recommendations:

  • Maintain an appropriate weight.
  • Keep joints heathy through exercise.
  • Control blood sugar.
  • Avoid joint injuries by wearing the proper protective gear when engaged in sports.

See an orthopedic specialist as soon as possible for diagnosis and treatment if a joint injury fails to heal. Injured joints are seven times more likely to develop osteoarthritis, according to the Arthritis Foundation.

Bio: Alejandro Badia, MD, FACS, internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW®, a walk-in orthopedic care clinic. He is a member the American Society for Surgery of the Hand, American Association for Hand Surgery, and the American Academy of Orthopedic Surgeons. He is a specialist in treating all problems related to the hand and upper extremity including trauma, sports injury, joint reconstruction, nerve injuries and arthroscopic surgeries. and

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