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Bone Healing from Within
New discoveries in orthobiologics are speeding up bone repair and regeneration

People are living longer than ever before because of advancements in medical technology and the public's increased understanding of how to live healthier. The United Nations estimates that by 2050, at least two in every five persons will be aged 60 years or older. East Asian countries are leading this segment, followed by Southeast Asia and South Asia. And, as economically advanced countries like Japan deal with increasingly steeper healthcare expenditures per capita (four times more is spent on its elderly than on the rest of the population), other Asian nations, too, can expect to face challenges in financing and delivering healthcare that best meets the needs of ageing populations afflicted by chronic illnesses and declining health.

Market analysts expect that in the next few years, growth in the geriatric population will create a higher demand for regenerative medicine, namely orthobiologics-related technology such as bone grafting, spinal infusions and cartilage implants. Obesity has a direct bearing on bone health, and is known to expedite the occurrence of conditions such as osteoarthritis and rheumatoid arthritis. Other factors such as sedentary lifestyles and spurts in the number of sports-related injuries are also contributing to higher demand in the orthobiologics market.

Orthobiologics is a rapidly advancing field that uses cell-based therapies and biomaterials to promote healing. By empowering the body to repair and regenerate itself, orthobiologic treatments offer exciting alternatives to traditional orthopedic options. Compared to the implantation of foreign hardware made of plastic and metal, orthobiologic procedures are often less invasive and more effective at restoring patients to their normal, active lives.

“The field of orthobiologistics is one of the most exciting advances in modern medicine that’s being used to heal injuries. The novel idea behind these treatments is to heal damage, rather than cutting it out or prescribing medication to cover the pain,” says Adeline Tan, Country Manager, Netherlands Foreign Investment Agency (NFIA). A key focus of the NFIA is the life sciences and health sector, designated by the Dutch Ministry of Economic Affairs, as one of the top sectors to address global societal challenges in terms of disease prevention, improving quality of life, and restraining healthcare costs for at-risk populations.

While North America and Europe dominate the orthobiologics market, the highest growth is expected in Asia-Pacific. In view of Asia’s impending demographic transition, companies in the industry will have to focus on introducing solutions that address age-related orthopaedic disorders that will plague a region slated to be the oldest in the world in the next half-century.

Emerging Technologies

The efficacy of orthobiologics has made it a dynamic and transformative force in medical science. Various innovations have been introduced in recent years, presenting themselves as viable alternatives to the ways in which orthopaedic conditions have been managed or treated. Products based on stem cell are gaining broad acceptance, while the use of synthetic bone substitutes will become a key trend as it minimises risks of infection transmission to a negligible level. Patients are also shifting from autografts and allografts to the use of orthobiologics to avoid the double surgeries involved in the first two methods.

The applications of orthobiologics are varied, and continue to expand in different areas of medicine such as cardiothoracic surgery, wound healing, sports medicine, orthopaedic surgery, urology, cosmetic surgery and dentistry. Utilising higher concentrations of naturally occurring bodily substances such as bone tissue, autologous blood, platelet-rich plasma, growth factors and stem cells, orthobiologics help expedite tissue and skeletal healing, especially in fractures and injured muscles, tendons and ligaments.

With the implementation of cutting-edge technologies like 3D printing, bone grafts and ultrasound waves, orthobiologics companies continue to improve on ways to harness the restorative capabilities of the body’s cells and redirect their use for quickened bone repair. Beyond reducing the need for highly invasive procedures, these innovations also offer patients greater customisation of treatments, minimal side effects, fewer hospital visits and shorter recovery times. For surgeons and patients, these bone healing options have become attractive considerations as clinically proven and less expensive orthopaedic therapies and tools.

3D Bone Implants

Last year, Japanese firm Next21 signed a deal with Xilloc, Dutch medical company, to bring CT-Bone® into European hospitals. What this means is that doctors can now offer their patients customised bone implants, made from calcium phosphate, to assist in bone regeneration. In this instance, a CT scan of a patient’s body is taken to determine the size and shape of the bone to be replaced. From the measurements, a bone-like implant, made from calcium phosphate is printed, using an inkjet 3D printing process.

Maikel Beerens, CEO at Xilloc explains, “3D Printing with CT-Bone allows us to help even more patients with a tailor-made solution. After taking a CT-scan of the patient, a patient-specific implant is designed by our biomedical engineers in collaboration with the surgeon. This design perfectly fits on the anatomy of the patient, ensuring good bone-to-implant contact and facilitating bone ingrowth.”

Through these patient-specific implants, Next21 and Xilloc’s combined technologies promise tremendous benefits for patients undergoing bone restoration treatments. Given the 3D printer’s ability to print with an accuracy down to 0.1mm, patients can expect bone implants of a perfect fit. The precise geometry and controlled porosity of the implant not only enable easy insertion with no further reshaping of bone or implant required, they also ensure enhanced fusion to a patient’s own bone.

Tests done on animals suggest that this method of bone healing could be further accelerated with the added application of commonly used collagen, stem cells, and growth factors. Thus, as the likes of bio-printing technology take flight, surgeons and clinicians can look forward to incorporating new innovations into existing practices to make orthobiologics devices and treatments even more robust.

Repair and Regeneration

Similarly recognising the limitations of current standard treatments for bone defects and fractures is Kuros Biosciences, a Swiss company focusing on bone healing innovation, namely tissue repair and regeneration. Among its most advanced products are the KUR-111 and KUR-113, both of which can easily be applied to fracture sites and left to polymerize in situ without significant bio-compatibility concerns.

Specially designed as an easy-to-use device that safely restores bones, KUR-111 consists of a natural matrix (fibrin), a targeted bone growth factor and a structural ceramic component that form a paste to be directly administered into fracture voids. When left to polymerize in situ, the material takes on the shape of the defect and forms a perfect graft substitute that is capable of resisting compression while effectively augmenting the healing process. The KUR-113 is also applied directly into fracture gaps and then allowed to form a gel-like material that infiltrates fracture sites without disturbing the surrounding tissue. Decreased surgery durations and lowered risks of infection after operation are just several of the advantages that these minimally disruptive innovations offer.

For even less invasive bone healing treatments, patients can now look to devices used externally. Developed by Bioventus, headquartered in the Netherlands, the EXOGEN® Ultrasound Bone Healing System uses ultrasound waves to promote bone growth. As the machine sends ultrasound waves through skin and soft tissue to reach the fracture, cells near the site are activated, thus triggering the processes critical to bone repair. Daily use of the system has demonstrated the healing of 86% of stubborn-to-heal non-union bone fractures and accelerated mending of an indicated broken tibia or radius by 38% (equivalent to several weeks of recovery time).

Each 20-minute session with the EXOGEN® is a safe, painless experience. As the machine can be operated at home, this therapy can easily be fitted into a patient’s daily schedule and ensures minimal visits to the doctor’s office. Through this method of active healing, Bioventus’ technology diminishes the need for invasive procedures and offers a more cost-effective, more convenient and less painful alternative than previously possible.

Holy Grail of Treatments

The emergence of orthobiologics signals a paradigm shift amongst clinicians, encouraging mindsets which focus on delaying or deterring the onset of diseases as opposed to merely providing temporary and symptomatic relief. As Asia prepares for an unprecedented rise in its geriatric population and their associated orthopaedic problems, innovative technologies that ensure ongoing care and the sustained prevention of further bone debilitation amongst the elderly are crucial.

“In the Netherlands, innovative technologies in biotech and medical engineering are being piloted frequently. Initiatives that have already proven successful can be expanded and applied in Asia,” Ms Tan says.

With exciting prospects clearly in sight, it should be interesting to see how quickly these new technologies can be adopted and integrated into operating rooms and homes all across Asia. Orthobiologics may just turn out to be the holy grail of restorative treatments.

Under the purview of the Dutch Ministry of Economic Affairs, the Netherlands Foreign Investment Agency (NFIA), provides complimentary advice and consultations to foreign companies planning to establish, expand or diversify their business interests in the Netherlands and Europe. For more information, contact: Ms Adeline Tan, Country Manager at Tel: +65 6739 1137, Email: tan@nfia-singapore.com or visit www.investinholland.com.

This article and its photos are contributed by Corporate Media Services P/L, Singapore

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APBN Editorial Calendar 2018
January:
Obesity / Outlook for 2018
February:
Searching for the fountain of youth
March:
Women in Science - Making a difference
April:
Digestive health in the 21st century - Trust your guts
May:
Dental health - The root to good health
June:
Cancer - Therapies and strategies for better patient outcomes
July:
Water management- Technologies for biotech and pharmaceutical industries
August:
Regenerative medicine / Biotech start ups
September:
Digital healthcare / 3D printing
October:
Bones / Breast cancer
November:
Liver health / Top science research nations & institutions
December:
AIDS / Breakthrough of the year/Emerging trends
Editorial calendar is subjected to changes.
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