If your knees sound like a bowl of Rice Krispies every time you stand up, the federal government might just have the fix.
The Advanced Research Projects Agency for Health (ARPA-H), the ‘high-risk, high-reward’ arm of the US health department, just unveiled a trio of futuristic, potentially game-changing treatments designed to turn creaky, aging joints back into smooth movers within months.
We’re talking cartilage-regrowing injections and repair kits that make knee replacements look like antiques!
Okay, so here’s what’s going on: three years ago, ARPA-H, a new federal agency, revealed its first major project. It consisted of a plan to spend tens of millions of dollars over five years to discover a cure for osteoarthritis, a painful condition that causes joint deterioration and impacts 32 million people in the United States.
ARPA-H was first introduced and established under the Biden administration. Proposed in 2021 as part of President Biden’s FY2022 budget request, the agency was formally established in March 2022 to accelerate biomedical innovations.
It looks like the agency has some pretty favorable fixes for arthritis, and they’ve got to start human trials within the next 18 months. Although it’s kicking off with knee studies, researchers think this is destined for every joint.
ARPA-H just greenlit two teams, Duke University & the University of Colorado Boulder CU to grow back bone and cartilage with a simple shot. Meanwhile, Columbia is on track to regrow a whole new knee.
It’s only been tested on animals so far, but experts say these early findings are incredibly promising.
Dr. Scott Rodeo, vice chair of orthopedic research at the Hospital for Special Surgery in New York, was not involved in the studies, but he expressed his enthusiasm and support for the studies. “It’s hugely promising,” he told The New York Times. “Right now, everything we have just modifies symptoms.” He emphasized that treating arthritis by regenerating cartilage and bone “would be a paradigm shift.”
ARPA-H is a part of the Department of Health and Human Services. It is based on a similar initiative from the Defense Department known as DARPA (the Defense Advanced Research Projects Agency), which contributed to the creation of technologies like the internet, GPS and self-driving drones.
According to The Times, the scientists who seek funding for arthritis research at ARPA-H come from various companies, labs and teams, and they commit to addressing the issue through preclinical and clinical studies. If their treatments prove effective in humans, they are required to bring these products to market.
Additionally, researchers must ensure that their arthritis treatments are tested on populations that will benefit most. This means that over half of the participants in clinical trials must be women and the trials must also include Black Americans and other people of color.
Plus, the newly approved treatments have to be 75% cheaper than what’s out there now.
A team at Columbia University, led by biomedical engineers Clark Hung and Nadeen Chahine, has found a way to regrow knees using a 3-D printed artificial joint. This joint acts as a “scaffold” filled with bone and cartilage cells.
Over about a year, these cells grow into healthy bone and cartilage while the scaffold slowly disintegrates. This treatment is aimed at patients who have lost most or all of the cartilage in their knees, commonly known as bone-on-bone patients.
The cells used for the scaffold can be taken from the patient’s own abdominal fat or from donor banks. When sourced this way, researchers can then extract stem cells and use biological agents to help them develop into cartilage and bone cells: this process takes about a month.
On the other hand, cells from donors do not need to transform into bone and cartilage cells, according to Dr. Chahine. That’s because during testing conducted by the team, these donated cells did not cause an immune reaction despite coming from different sources.
To see if the scaffold would act like a real knee – supporting weight and allowing movement—surgeons put their test knees in cadavers and used robots to assess how well the joints performed during walking.
At Duke, Dr. Benjamin Alman, an orthopedic surgeon, explained that the team wanted to find a way to help cartilage cells regrow in patients with osteoarthritis, especially since many of them have some cartilage remaining in their knees, even if it’s very little.
They tested different medications alone and together, which led them to three effective treatments.
The first treatment is an injection that helps cartilage cells grow. The second is another injection that reshapes bone. The third treatment is an infusion that can target several arthritic joints at once and helps promote the growth of cartilage.
“The idea would be, if a patient’s problem is mostly in cartilage, we would target cartilage,” Dr. Alman explained to The Times. “If it is mostly bone, we would target bone.”
The treatments have been effective in rats and mice. “I tend to be very skeptical, but this surprised me,” Dr. Alman said.
Stephanie Bryant, a chemical and biological engineer leading a team at the University of Colorado, Boulder, stated that her aim was “to return the tissue to a healthy state,” ideally with just one injection.
The team discovered a drug, which is an existing medication that has been repurposed, that proved effective in animals. They created a formulation that delivers the drug in bursts over several months. According to her, the drug “resides long-term in the joint.”
Their experiments also included rabbits that experienced injuries similar to human A.C.L. tears. Like people, these rabbits quickly developed osteoarthritis. However, within two months after receiving the injection, their knees showed signs of regeneration.
Another test involved guinea pigs that develop degenerative arthritis similar to what older adults experience. Once again, the treatment appeared to work perfectly for their knees.
And as for people with advanced bone-on-bone arthritis, the Colorado team has created a blend of specially designed proteins that are injected into joints to fill the gaps where cartilage is missing. These proteins draw progenitor cells from the bone underneath and encourage them to create new cartilage. In their study with the rabbits, all the injected material was gone in only three months, resulting in healthy cartilage.
Dr. Bryant mentioned that the team was thrilled. “You do all of this work, have all these hypotheses, but you never know if it will work,” she said. “Very few of us get the opportunity to really push forward things we are working on,” she continued.
“This is an opportunity to really help patients.”
