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Biologics > Allografts 101 > Flashcards

Allografts 101 Flashcards

1
Q

What is bone grafting?

A

The healing of two bones to one another.
(Stops motion and thereby pain.)
Or to fill a void (restore bone strength)

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2
Q

What are the two primary types of grafts?

A

Structural-struts, shafts, etc…

And osteobiologics - more regenerative and not structural

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3
Q

What are the reasons for bone grafting? 5

A 
Trauma
Degeneration
Osteolytic Neoplasm - destructive tumor
Iatrogenic - caused by surgery
Implant failure - joint reconstruction failure
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4
Q

Whats the bone graft market in 2017

A

2.3 Billion
80% spine
10-15% foot and ankle
Average age for fusion is 54.2

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5
Q

What 3 characteristics does autograft provide?

A
  1. Scaffold - provides structure to guide the formation of new bone
  2. Signal - Naturally occurring growth factors recruit host cells and guide the formation of new bone
  3. Cells - Host cell population to support bone growth
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6
Q

Why was allostem developed?

A

To approximate the desired qualities of autograft bone

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7
Q

What are the 3 characteristics of allostem?

A
  1. Cells - Replace natural cell population to support bone growth
  2. Scaffold - Allograft bone provides ideal structure to guide the formation of new bone.
  3. Signal - Naturally occurring growth factors present in allograft bone recruit host cells and encourage the formation of new bone
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8
Q

Types of autograft

A

Source: patient
Iliac crest
Spinous process

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9
Q

Types of Demineralized Bone Matrix Putty

A

Source: Allograft donor
AlloFuse
Grafton
DBX

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10
Q

Types of Demineralized Bone Fibers

A

Source: Allograft Donor
3Demin
Vesuvis

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11
Q

Types of Synthetics

A

Source: Various
ViToss
TCP
HA

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12
Q

Types of Bone Morphogenic Protein

A

Source: Grown in mammalian model

InFuse

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13
Q

Types of Cellular Allograft

A

Source: Allograft donor
AlloStem
OsteoCel
Trinity

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14
Q

Types of Bone Marrow Aspirate

A

Source: Patient
ProCuRE
Retrieve

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15
Q

Types of Platelet Rich Plasma

A

Source: Patient
Harvest
Angel

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16
Q

Amniotic Derived Cells

A

Source: Allograft donor
BioD
NuCel

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17
Q

What are Embryonic Stem Cell characteristics?

A

Harvested from human embryos
Pluripotent - can become any type of cell
Uncontrolled growth an issue
Can become liver, spleen, kidney, etc…

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18
Q

What are Adult Stem Cell characteristics?

A

Recovered from adult tissue
Multipotent
Limited growth
Can only differentiate into fat, cartilage or bone

19
Q

What is a mesenchymal stem cell?

A
  1. Capable of repairing and/or differentiating into fat, cartilage/muscle, or bone
  2. Can be transplanted from donor to recipient without stimulating and immune response
  3. Must be able to attach to a viable substrate
20
Q

How are cells and DBM substrate combined?

A

Single donor
Adipose recovery/washing
Enzymatic digestion
Centrifutgation

/

Cancellous bone recovery
Demineralization process

/

Combined cells onto bone grafts
Cell selection and bonding
Rinse
Cryopreservation

21
Q

How many products have a super concentration of mesenchymal stem cells adhered to a demineralized bone scaffold?

A

Only 1 - Allostem

22
Q

How do we know that it’s MSC that are adhering to the DBM?

A

Defined by the International Society of Cellular Therapy to have 3 characteristics

  1. must adhere to scaffold
  2. Must stain positive for certain surface markers
  3. Must be able to differentiate into bone, fat or cartilage cells
23
Q

How many MSC’s per cc in Allostem?

A

66,255k

24
Q

How many MSC’s do you need per cc of cellular allograft?

A

We don’t know

One study suggested 30k per cc

25
Q

Allostem vs. Bone Marrow Aspirate concentration

A

Allostem 66k

Bone-Marrow Aspirate BMAC 2500/cc upon implantation

26
Q

Allostem lacks immunogenic components

A

Our adipose cell concentration, or stromal vascular fraction, contains MSC’s, leukocytes, erythrocites, etc
Allostem combines the SVF onto the bone graft
MSC’s adhere to the substrate
Therefor most immunogenic components wash off in the rinse leaving behind a high concentraiton of MSC’s that adhere to the bone.

27
Q

How do we know MSC’s adhered and the immunogenic components rinsed off?

A

We took a picture under a high powered microscope

28
Q

What are leukocytes?

A

White Blood Cells
are the cells of the immune system that are involved in defending the body against both infectious disease and foreign invaders.

29
Q

What are erythrocytes?

A

Red blood cells, also called erythrocytes, are the most common type of blood cell and the vertebrate organism’s principal means of delivering oxygen to the body tissues via the blood flow through the circulatory system.

30
Q

What do MSC’s on allostem Show?

A

Strong osteogenic proliferative ability

31
Q

Adipose cells vs Bone Marrow Cells

A

Equally good at producing bone
They both contain MSCs
The difference is there are many more MSCs in Adipose tissue when compared to Bone Marrow Cells.
Typical bone marrow will have 250,000 MSCs and Adipose will have 18,000,000 MSCs from Adipose

32
Q

Even in ideal conditions, what needs time to adhere to the scaffold?

A

MSCs

Important when considering irrigation

33
Q

How long is typical graft prep?

A

10-15 minutes

Only 6.2% will stick to the desired scaffold

34
Q

What type of scaffold does Allostem use?

A

Nature’s scaffold

Cells prefer the naturally occuring boney nanostructure to synthetics by nearly 2x the rate of leading synthetics

35
Q

Does Allostem adapt to different cage designs?

A

Yes. Whether you perform cervical, deformity, MIS, lateral, stand-alone, etc, Allostem has a product to fit their needs

36
Q

What does demineralization create?

A

A more biologically active graft with all-natural growth factors in quantities safe for bone growth

37
Q

Where are BMPs found?

A

Naturally in demineralized bone

38
Q

What are the BMPs key in growing new bone?

A

BMP 2 and BMP 7

39
Q

How long has DBM been used?

A

40+ years

40
Q

What type of BMP is InFuse?

A

rhBMP

41
Q

What are the down sides of InFuse?

A

Can create too much bone growth

Linked to a number of cancer, ectopic bone growth and sterility

42
Q

How much more BMP is there in rhBMP than in standard DBM?

A

1,000,000x more

43
Q

What is the Allostem quality process?

A 
Tissue donation
Rigorous donor screening
Rigid recovery procedures
Extensive donor testing
Aseptic processing
Post-processing review
Terminal sterilization - where appropriate 
Allograft distribution

Biologics (2 decks)

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