ACS / Orthokine Antiinflammatory Cytokines and Growth factors in the treatment of orthopedic diseases

Role of Cytokines, IL-1β,Growth Factors: Stimulation of the biologic repair processes Shifting cellular metabolism to the anabolic state Structural modifying (does this affect symptoms?) = Capacity to induce proliferation: PDFG, IGF,FGF, TGFβ, GDF5,probably many others

Original Basis for ACS Most frequently, the problem in orthopedic diseases is a cytokine imbalanceand the loss of regenerative and repair processes. Interleukin-1(IL-1)is a pivotal mediator of tissue destruction and pain in OA, RA and spine diseases. IL-1 receptor antagonist (IL-1Ra)is a naturally occurring inhibitor of IL-1.

AIM of a new Therapy To supply with nutrients as in human blood serum IL-1Ra Growth factors as in specially Autologous Conditioned Serum (ACS) Therapeutic Target One Solution: to use the bodies´own repair mechanisms to use patients own blood to produce the desired proteins = Autologous Conditioned Serum / ACS

Original Basis for ACS a real „biologic“treatment option suggested from the observations of Meijer et al. that exposure of blood to pyrogen free surfaces (e.g. glass beads in a syringe) elicises a vigorous, rapid increase in the synthesis of several anti-inflammatory cytokines,including IL-1Ra, IL-4, IL-10 and several growth factors(IGF, TGF-β, PDGF, FGF).

PREPARTION OF ACS ACS is generated by incubated veinous patient blood in a special syringue for 6 to 9 hours. Following centrifugation and extraction the ACS is portioned and stored in a fridge at -18 celcius

Indications and dosages The ACS is injected locally in a series of injections given once or twice weekly.

ORTHOKINE The Orthokine Therapy a unique way to treat osteoarthritis and back pain biologically, a unique way to treat osteoarthritis and back pain biologically, without the use of any foreign substances. without the use of any foreign substances. The Orthokine Therapy uses individual autologous proteins(receptor anti IL1 and growth factors) derived from the patient's blood, then applied(under imaging control) as a medication. This kind of therapy is a complete autologous form of treatment. uses individual autologous proteins(receptor anti IL1 and growth factors) derived from the patient's blood, then applied(under imaging control) as a medication. This kind of therapy is a complete autologous form of treatment.

Orthokine therapy methods

The blood samples are taken from the arm vein with a special syringe. The glass beads in the syringe induce the blood cells to synthesize increased amounts of protective proteins that inhibit osteoarthritis. The temperature of 37°C in the incubator mimics normal body temperature and creates an optimum environment for protein synthesis. A centrifuge separates the amber serum from the blood clot; the serum contains high concentration of protective and regenerative proteins.

The serum is filled into several syringes. Generally the patient receives six injections into the afflicted joint and three injection into the afflicted spine area

Male patient 63yo. Low back pain and left L5 radiculopathy. No deficit motor. Inflammatory symptoms Orthokine therapy : two procedures under CT control (one procedure every week) Orthokine therapy : two procedures under CT control (one procedure every week) follow up MRI 6 months after the end of the treatment follow up MRI 6 months after the end of the treatment

L5 sagital CT scan L4L5 left postero lateral disk herniation

פריצת דיסק לאחור משמאל התופסת 2/3 של התעלה. חתך אקסיאלי.

Needle tip around the disc herniation

MRI AXIAL L4-L5 Follow up 6 months after ORTHOKINE therapy

Clinical Follow up at 6month,1year and 18 months: no more pain or radiculopathy, normal full life style

Discussion Cervical and lumbar radiculopathy treated non surgically / ideal outcomes in 80-90% (1) Surgery/ unremitting pain; progressive weackness or cervical myelopathy.(2) cervical foraminal injections with antero-lateral approach under CT control Ellenberg Arch Phys Med Rehab 1994

CT Guidance helps avoiding: surgery in many cases (cervical thoracic and lumbar disc herniation, cyst facet joint)1,2,3 complications usually due to lack of precision when using conventional fluoroscopy for guidance; anaesthesia and sedation: most of the procedures are performed without any type of anaesthesia. 1-RSNA 2005 CT GUIDED TECHNICS for chronic cervico-brachialgia 2-AJNR Mars2004 Open study on Percutaneus Periradicular Foraminal steroid Infiltration under CT control in 30 patients 3-CARDIOVASCULAR AND INTERVENTIONAL radiology :CT-Guided Epidural/perineural Injections in Painful Disorders of the lumbar Spine

CT advantages Accuracy Safety (Preventing of harming delicate anatomic structures). More accuracy under CT control between 30 to 40% than under fluoroscopy control.1 The possibility to approach the endocanalar lesions by trans ligamentary pathway.

Discussion ACS/Orthokine is enriched in growth factors and anti- inflammatory cytokines, but honestly, the mode of action is not fully known. ACS reduces pain und increases function, mobility and health-related-quality-of-life. The potential risk of side effects from ACS is small due to its autologous origine

Conclusion CT -guidance increases the precision of the procedure and help confirm needle placement. Periradicular corticosteroid injections under CTimage-guided, complementarity step before more invasive treatment an alternative to surgery.