TED2010
Kevin Stone: The bio-future of joint replacement
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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
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
Double-click the English transcript below to play the video.
00:16
So let me just start with my story.
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So I tore my knee joint meniscus cartilage
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playing soccer in college.
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Then I went on to tear my ACL, the ligament in my knee,
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and then developed an arthritic knee.
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And I'm sure that many of you in this audience have that same story,
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and, by the way, I married a woman
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who has exactly the same story.
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So this motivated me to become an orthopedic surgeon
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and to see if I couldn't focus on solutions for those problems
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that would keep me playing sports and not limit me.
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So with that, let me just show you a quick video
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to get you in the mood of what we're trying to explain.
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Narrator: We are all aware of the risk of cancer,
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but there's another disease
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that's destined to affect even more of us: arthritis.
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Cancer may kill you, but when you look at the numbers,
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arthritis ruins more lives.
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Assuming you live a long life, there's a 50 percent chance
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you'll develop arthritis.
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And it's not just aging that causes arthritis.
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Common injuries can lead to decades of pain,
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until our joints quite literally grind to a halt.
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01:16
Desperate for a solution, we've turned to engineering
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to design artificial components
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to replace our worn-out body parts,
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but in the midst of the modern buzz
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around the promises of a bionic body,
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shouldn't we stop and ask if there's a better, more natural way?
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Let's consider an alternative path.
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What if all the replacements our bodies need
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already exist in nature,
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or within our own stem cells?
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This is the field of biologic replacements,
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where we replace worn-out parts with new, natural ones.
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01:45
Kevin Stone: And so, the mission is:
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how do I treat these things biologically?
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And let's talk about both what I did for my wife,
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and what I've done for hundreds of other patients.
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First thing for my wife,
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and the most common thing I hear from my patients,
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particularly in the 40- to 80-year-old age group, 70-year-old age group,
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is they come in and say,
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"Hey, Doc, isn't there just a shock absorber you can put in my knee?
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I'm not ready for joint replacement."
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And so for her, I put in a human meniscus allograft donor
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right into that [knee] joint space.
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And [the allograft] replaces [the missing meniscus].
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And then for that unstable ligament,
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we put in a human donor ligament
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to stabilize the knee.
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And then for the damaged arthritis on the surface,
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we did a stem cell paste graft,
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which we designed in 1991,
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to regrow that articular cartilage surface
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and give it back a smooth surface there.
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So here's my wife's bad knee on the left,
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and her just hiking now
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four months later in Aspen, and doing well.
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And it works, not just for my wife, but certainly for other patients.
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The girl on the video, Jen Hudak,
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just won the Superpipe in Aspen
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just nine months after having destroyed her knee,
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as you see in the other image --
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and having a paste graft to that knee.
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And so we can regrow these surfaces biologically.
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So with all this success,
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why isn't that good enough, you might ask.
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Well the reason is because there's not enough donor cycles.
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There's not enough young, healthy people
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falling off their motorcycle
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and donating that tissue to us.
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And the tissue's very expensive.
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And so that's not going to be a solution
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that's going to get us global with biologic tissue.
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But the solution is animal tissue
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because it's plentiful, it's cheap,
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you can get it from young, healthy tissues,
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but the barrier is immunology.
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And the specific barrier
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is a specific epitope
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called the galactosyl, or gal epitope.
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So if we're going to transplant animal tissues to people,
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we have to figure out a way to get rid of that epitope.
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So my story in working with animal tissues
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starts in 1984.
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And I started first
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with cow Achilles tendon,
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where we would take the cow Achilles tendon,
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which is type-I collagen,
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strip it of its antigens
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by degrading it with an acid and detergent wash
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and forming it into a regeneration template.
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We would then take that regeneration template
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and insert it into the missing meniscus cartilage
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to regrow that in a patient's knee.
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We've now done that procedure,
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and it's been done worldwide in over 4,000 cases,
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so it's an FDA-approved and worldwide-accepted way
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to regrow the meniscus.
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And that's great when I can degrade the tissue.
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But what happens for your ligament when I need an intact ligament?
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I can't grind it up in a blender.
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So in that case,
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I have to design -- and we designed with Uri Galili and Tom Turek --
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an enzyme wash
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to wash away, or strip,
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those galactosyl epitopes
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with a specific enzyme.
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And we call that a "gal stripping" technique.
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What we do is humanize the tissue.
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It's by gal stripping that tissue
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we humanize it (Laughter),
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and then we can put it back
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into a patient's knee.
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04:53
And we've done that. Now we've taken pig ligament --
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04:55
young, healthy, big tissue,
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put it into 10 patients in an FDA-approved trial --
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and then one of our patients went on to have
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three Canadian Masters Downhill championships --
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on his "pig-lig," as he calls it. So we know it can work.
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And there's a wide clinical trial of this tissue now pending.
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So what about the next step?
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What about getting to a total biologic knee replacement,
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not just the parts?
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How are we going to revolutionize artificial joint replacement?
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Well here's how we're going to do it.
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So what we're going to do is take
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an articular cartilage
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from a young, healthy pig,
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strip it of its antigens,
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load it with your stem cells,
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then put it back on to that
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arthritic surface in your knee,
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tack it on there, have you heal that surface
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and then create a new biologic surface for your knee.
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So that's our biologic approach right now.
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We're going to rebuild your knee with the parts.
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We're going to resurface it with a completely new surface.
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But we have other advantages from the animal kingdom.
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There's a benefit of 400 million years
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of ambulation.
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We can harness those benefits.
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We can use thicker, younger, better tissues
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than you might have injured in your knee,
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or that you might have when you're 40, 50 or 60.
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We can do it as an outpatient procedure.
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We can strip that tissue very economically,
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and so this is how we can get biologic knee replacement
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to go global.
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And so welcome to super biologics.
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It's not hardware.
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It's not software.
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It's bioware.
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It's version 2.0 of you.
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And so with that, coming to a --
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06:37
(Laughter)
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coming to an operating theater near you soon, I believe.
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06:41
Thank you very much.
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06:43
(Applause)
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ABOUT THE SPEAKER
Kevin Stone - Surgeon, inventorKevin 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.
Kevin Stone | Speaker | TED.com