Abstract

Bone marrow concentrates for knee arthritis have received much attention over the last decade as a viable treatment for osteoarthritic knee pain and disability [1]. In spite of the availability of these bone marrow concentrates, few authors have suggested a gold standard treatment protocol [2]. We first introduced our signaling cell procedure to orthopedic surgery in 2006 [3]. The procedure has undergone multiple iterations since that time. In this article, we introduce our seventh-generation technique for signaling cell treatment in the setting of osteoarthritis of the knee and discuss the role of tumor necrosis factor stimulated gene six protein in our signaling cell product.
We identified TSG-6 as an important chondroprotective biomolecule that is critical for the assembly and maintenance of the cartilage extracellular matrix. TSG-6 is an inflammation-induced protein that is produced at pathological sites, like synovial joints during arthritic degeneration. TSG-6 protects against joint damage through anti-plasmin activity and de-activation of serine protease during inflammation [4]. TSG6 also limits neutrophil migration and has an anabolic, immunomodulatory effect in synovial joints [5].
Modern signaling cell techniques are unable to capture or concentrate TSG-6 due to its small molecular size, that is coincident with the undesirable pro-inflammatory molecules. These molecules are on the order of 30 kD in comparison with anti-inflammatory molecules that typically are greater than 600 kD in size. Hyaluronic acid typically has a molecular weight of 3000 - 4000 kD and is bound by one of the domains of TSG-6, causing biological activation of the complex [6].
We combine our cell concentration product and a commercially prepared hyaluronic acid to formulate a growth factor concentrate that is activated as a scaffold for signaling cells we harvest from autologous bone marrow aspirate taken at the anterior gluteal pillar during immunobiologic procedures. We believe that by concentrating TSG-6 and including it as a component of our signaling cell transplant procedures, a biologically superior injectate is able to be assembled that may favor cellular and tissue anabolism. In addition, we harvest autologous clotting proteins (Thrombin/factor 2) to lock the product in the subchondral bone after micro core of the stiff, subchondral bone using a commercially available device.

Keywords: TSG-6; Cartigram®; Bone Marrow

References

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Citation

Citation: Austin Yeargan III., et al. “Is TSG-6 the Most Important Biomolecule in Orthopedic Molecular Immunobiologics in the Setting of Orthopedic Surgical Immunobiologics? Scientific Concepts and Case Report with Cartigram® Imaging".Acta Scientific Orthopaedics 3.8 (2020): 14-25.

Copyright

Copyright: © 2020 Austin Yeargan III., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.