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TED2010

Kevin Stone: The bio-future of joint replacement

February 11, 2010

Arthritis and injury grind down millions of joints, but few get the best remedy -- real biological tissue. Kevin Stone shows a treatment that could sidestep the high costs and donor shortfall of human-to-human transplants with a novel use of animal tissue.

Kevin Stone - Surgeon, inventor
Kevin Stone's clinic treats joint injury using the latest in bio-medicine: reconstructing damaged tissue, even replacing whole joint parts, with lab-grown cartilage and ligament. Full bio

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Double-click the English subtitles below to play the video.
So let me just start with my story.
00:16
So I tore my knee joint meniscus cartilage
00:18
playing soccer in college.
00:20
Then I went on to tear my ACL, the ligament in my knee,
00:23
and then developed an arthritic knee.
00:26
And I'm sure that many of you in this audience have that same story,
00:28
and, by the way, I married a woman
00:31
who has exactly the same story.
00:33
So this motivated me to become an orthopedic surgeon
00:36
and to see if I couldn't focus on solutions for those problems
00:39
that would keep me playing sports and not limit me.
00:42
So with that, let me just show you a quick video
00:46
to get you in the mood of what we're trying to explain.
00:49
Narrator: We are all aware of the risk of cancer,
00:52
but there's another disease
00:54
that's destined to affect even more of us: arthritis.
00:56
Cancer may kill you, but when you look at the numbers,
00:59
arthritis ruins more lives.
01:01
Assuming you live a long life, there's a 50 percent chance
01:03
you'll develop arthritis.
01:05
And it's not just aging that causes arthritis.
01:08
Common injuries can lead to decades of pain,
01:10
until our joints quite literally grind to a halt.
01:13
Desperate for a solution, we've turned to engineering
01:16
to design artificial components
01:18
to replace our worn-out body parts,
01:20
but in the midst of the modern buzz
01:22
around the promises of a bionic body,
01:24
shouldn't we stop and ask if there's a better, more natural way?
01:26
Let's consider an alternative path.
01:31
What if all the replacements our bodies need
01:33
already exist in nature,
01:36
or within our own stem cells?
01:38
This is the field of biologic replacements,
01:40
where we replace worn-out parts with new, natural ones.
01:42
Kevin Stone: And so, the mission is:
01:45
how do I treat these things biologically?
01:47
And let's talk about both what I did for my wife,
01:49
and what I've done for hundreds of other patients.
01:51
First thing for my wife,
01:53
and the most common thing I hear from my patients,
01:55
particularly in the 40- to 80-year-old age group, 70-year-old age group,
01:57
is they come in and say,
02:00
"Hey, Doc, isn't there just a shock absorber you can put in my knee?
02:02
I'm not ready for joint replacement."
02:04
And so for her, I put in a human meniscus allograft donor
02:06
right into that [knee] joint space.
02:09
And [the allograft] replaces [the missing meniscus].
02:11
And then for that unstable ligament,
02:13
we put in a human donor ligament
02:15
to stabilize the knee.
02:17
And then for the damaged arthritis on the surface,
02:19
we did a stem cell paste graft,
02:22
which we designed in 1991,
02:24
to regrow that articular cartilage surface
02:26
and give it back a smooth surface there.
02:29
So here's my wife's bad knee on the left,
02:32
and her just hiking now
02:34
four months later in Aspen, and doing well.
02:36
And it works, not just for my wife, but certainly for other patients.
02:39
The girl on the video, Jen Hudak,
02:42
just won the Superpipe in Aspen
02:44
just nine months after having destroyed her knee,
02:46
as you see in the other image --
02:49
and having a paste graft to that knee.
02:51
And so we can regrow these surfaces biologically.
02:53
So with all this success,
02:57
why isn't that good enough, you might ask.
02:59
Well the reason is because there's not enough donor cycles.
03:02
There's not enough young, healthy people
03:05
falling off their motorcycle
03:07
and donating that tissue to us.
03:09
And the tissue's very expensive.
03:12
And so that's not going to be a solution
03:15
that's going to get us global with biologic tissue.
03:17
But the solution is animal tissue
03:20
because it's plentiful, it's cheap,
03:22
you can get it from young, healthy tissues,
03:24
but the barrier is immunology.
03:27
And the specific barrier
03:29
is a specific epitope
03:31
called the galactosyl, or gal epitope.
03:33
So if we're going to transplant animal tissues to people,
03:35
we have to figure out a way to get rid of that epitope.
03:37
So my story in working with animal tissues
03:40
starts in 1984.
03:42
And I started first
03:44
with cow Achilles tendon,
03:46
where we would take the cow Achilles tendon,
03:48
which is type-I collagen,
03:50
strip it of its antigens
03:52
by degrading it with an acid and detergent wash
03:54
and forming it into a regeneration template.
03:57
We would then take that regeneration template
04:00
and insert it into the missing meniscus cartilage
04:02
to regrow that in a patient's knee.
04:05
We've now done that procedure,
04:08
and it's been done worldwide in over 4,000 cases,
04:10
so it's an FDA-approved and worldwide-accepted way
04:12
to regrow the meniscus.
04:15
And that's great when I can degrade the tissue.
04:17
But what happens for your ligament when I need an intact ligament?
04:20
I can't grind it up in a blender.
04:23
So in that case,
04:25
I have to design -- and we designed with Uri Galili and Tom Turek --
04:27
an enzyme wash
04:30
to wash away, or strip,
04:32
those galactosyl epitopes
04:34
with a specific enzyme.
04:36
And we call that a "gal stripping" technique.
04:38
What we do is humanize the tissue.
04:41
It's by gal stripping that tissue
04:43
we humanize it (Laughter),
04:45
and then we can put it back
04:47
into a patient's knee.
04:49
And we've done that. Now we've taken pig ligament --
04:53
young, healthy, big tissue,
04:55
put it into 10 patients in an FDA-approved trial --
04:57
and then one of our patients went on to have
05:00
three Canadian Masters Downhill championships --
05:02
on his "pig-lig," as he calls it. So we know it can work.
05:05
And there's a wide clinical trial of this tissue now pending.
05:07
So what about the next step?
05:12
What about getting to a total biologic knee replacement,
05:14
not just the parts?
05:16
How are we going to revolutionize artificial joint replacement?
05:18
Well here's how we're going to do it.
05:21
So what we're going to do is take
05:23
an articular cartilage
05:25
from a young, healthy pig,
05:27
strip it of its antigens,
05:29
load it with your stem cells,
05:31
then put it back on to that
05:34
arthritic surface in your knee,
05:36
tack it on there, have you heal that surface
05:39
and then create a new biologic surface for your knee.
05:42
So that's our biologic approach right now.
05:48
We're going to rebuild your knee with the parts.
05:52
We're going to resurface it with a completely new surface.
05:54
But we have other advantages from the animal kingdom.
05:57
There's a benefit of 400 million years
06:00
of ambulation.
06:02
We can harness those benefits.
06:04
We can use thicker, younger, better tissues
06:06
than you might have injured in your knee,
06:09
or that you might have when you're 40, 50 or 60.
06:11
We can do it as an outpatient procedure.
06:13
We can strip that tissue very economically,
06:15
and so this is how we can get biologic knee replacement
06:18
to go global.
06:21
And so welcome to super biologics.
06:23
It's not hardware.
06:25
It's not software.
06:27
It's bioware.
06:30
It's version 2.0 of you.
06:32
And so with that, coming to a --
06:35
(Laughter)
06:37
coming to an operating theater near you soon, I believe.
06:39
Thank you very much.
06:41
(Applause)
06:43

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Kevin Stone - Surgeon, inventor
Kevin Stone's clinic treats joint injury using the latest in bio-medicine: reconstructing damaged tissue, even replacing whole joint parts, with lab-grown cartilage and ligament.

Why you should listen

Orthopedic surgeon Kevin Stone knows mobility means more than just where you go -- it's the foundation for a fulfilling daily life. (True whether you're an athlete or not.) His Stone Clinic specializes in "biologic knee replacement": replacing damaged joint parts, not with artificial components, but with lab-grown tissue and parts from human donors. He and team are spearheading new techniques that use animal tissue but avoid the complications associated with animal-to-human transplantations.

Stone has consulted publications such as The Wall Street Journal and Newsweek as a medical expert; he has contributed to TV programs such as ESPN's "Treating Athletes in the New Millennium" and The Discovery Channel.

The original video is available on TED.com
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