You almost certainly know them: Someone who had to retire from soccer because of a hip problem. A grandmother who can't lift her arm to comb her hair because of shoulder pain. A coworker who had a knee replacement. So often, the cause is osteoarthritis, a wear and tear of the joints that affects one in six people over the age of 30. Osteoarthritis has no cure, and the only remedies are the implantation of a prosthesis or some treatment for pain.
There is reason for optimism, however, because an agency in the US Department of Health and Human Services has allocated millions of dollars to various initiatives investigating a cure for this disease. That agency is the Advanced Research Projects Agency for Health (ARPA-H), and the project that seeks to eradicate osteoarthritis is called NITRO, or Novel Innovations for Tissue Regeneration in Osteoarthritis. The most advanced initiative in this area is being undertaken by a multidisciplinary team at the University of Colorado Boulder, which has received a $33.5 million grant from NITRO to develop an experimental therapy with the potential to reverse joint damage in a matter of weeks through a simple injection.
Osteoarthritis is characterized by the progressive wearing away of cartilage, the tissue that cushions the contact between bones. Over time, this deterioration causes not only pain and inflammation but also joint deformation and loss of mobility. It's the most common type of arthritis in the US and affects as many as 240 million people worldwide.
“At the moment, the options for many patients are either a massive, expensive surgery or nothing. There’s not a lot in between,” Evalina Burger, professor and chair of the Department of Orthopaedics at CU Anschutz, said via a statement. “That's why ARPA-H is so important.”
Against this backdrop, the Colorado team led by biomedical engineer Stephanie Bryant proposes a radically different approach: “Our goal is not just to treat pain and halt progression, but to end this disease.”
Joints That Can Heal Themselves
The breakthrough is based on harnessing the body's natural ability to regenerate itself. Instead of introducing artificial tissues or a prosthesis, the Colorado scientists have designed a system that “recruits” the body's own cells to repair the damage.
One of the strategies involves a single injection that releases an already approved drug in a controlled manner, thanks to a particle system that acts as a vehicle. This system allows small doses to be administered over months directly into the affected joint, stimulating the repair processes.
The second strategy is designed for more advanced cases. It involves a kit of biomaterials and proteins that can be applied through minimally invasive procedures. Once inside the body, this material solidifies and acts as a scaffold, attracting progenitor cells that fill and regenerate damaged areas of cartilage or bone.
Something very important that both approaches have in common is that they seek to transform the diseased joint into an environment conducive to natural regeneration.
Rapid and Positive Progress
In animal studies, the results have been encouraging. Treated joints returned to a healthy state within four to eight weeks. Moreover, in more severe injuries, the researchers observed complete regeneration of the damaged tissue.
“In two years, we were able to go from a moonshot idea to developing these therapies to demonstrating that they reverse osteoarthritis in animals,” said Bryant. Additional experiments with human cells obtained from patients undergoing joint replacement also showed clear regenerative effects, suggesting that the approach could be translatable to humans.
It is important to stress, however, that these results have not been validated in clinical trials. The researchers first intend to publish their findings in an academic journal later this year. They have also founded a startup, Renovare Therapeutics, to begin the commercialization process.
Back in the lab, the next step would be to expand animal studies and analyze key aspects such as toxicity and safety. If all goes according to plan, human clinical trials could begin in approximately 18 months.
This story originally appeared in WIRED en Español and has been translated from Spanish.
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