Issue link: https://beckershealthcare.uberflip.com/i/1425344
45 Executive Briefing The perspective offered by Dr. Osorio was that any linkage between the immune and skeletal systems was viewed as a "negative effect" from the various medications that affected the immune system, because the blunting of the immune system was detrimental to bone formation and healing. In fact, as part of their preoperative planning in advance of a spine fusion procedure, these surgeons look carefully at a patient's overall health and prescribed medications. If a patient's immune system is modulated by chemotherapy or radiation, a fusion is unlikely to be attempted; if a patient has diabetes and their hemoglobin A1C is greater than 7.5, the surgery may be postponed. However, in addition to paying much more attention to how the immune system could negatively affect spinal fusion, these leading spine surgeons are now leveraging the immune system to aid in the healing process. "Ultimately, I think we can make the immune system our ally to elicit a faster healing response and improve our outcomes in spine fusion," Dr. Braxton said. Dr. Patel described this mindset shift as moving from a focus on "overpowering the immune system" to "augmenting the biology" and "harnessing the immune system" to help patients heal faster. The emergence of innovative bone grafts In the last few years, Dr. Patel has seen increased market adoption of concepts around surface technology and implants where the surface technology can drive a host bone response. "The fact that surface technology can drive a host bone response," Dr. Patel said, "that's pretty well accepted now." Dr. Osorio concurred. "The field has embraced this concept of surface technology and to the macrophage response that really promotes bone formation." There is also increased attention paid to the idea of immunomodulation, which is the mechanism by which an agent suppresses or stimulates the immune response. Dr. Patel continued by raising a question he believes many spine surgeons are now contemplating: "Is there a way to take advantage of that same surface technology effect in bone grafts?" Dr. Patel sees the moment as "an opportunity to look at a bone graft not just as an osteoconductive scaffold, but as something that can be an active player in the fusion process." According to clinical research, bone grafts are a highly effective way to maximize fusion rates, outperforming additional surgical training and improved techniques in the clinical setting. 4 5 Leveraging the most effective bone grafts, such as those that modulate human immune response, can improve fusion outcomes by up to 60 percent. 5 6 7 The next evolution in spinal fusion — biologics Dr. Braxton sees the role of implants as stabilizing the spine, but noted, "Ultimately there needs to be a biological solution, which is a fusion between spinal elements." Dr. Osorio agreed. "I'm focusing a lot on surface technology and that goes hand-in-hand with biologics." These surgeons are encouraged by MagnetOs' proven ability to modulate human immune response. According to Dr. Braxton, there is great value in bone graft technologies that are faster, safer and easier to use, improve outcomes and are less costly. They also result in less pain, shorter hospital stays and less use of narcotics. In addition, he sees the potential of Kuros' MagnetOs to result in fewer revision surgeries, which will save costs. From Dr. Osorio's perspective, most spine surgeons already have a fairly good understanding of surface technology, but he sees less knowledge about bone grafts. These surgeons are optimistic about the future of surface technologies and particularly bone grafts. "The science behind this product [MagnetOs] is going to lead us into some really cool places," Dr. Patel said. Getting to these cool places will be aided by use of NeedleGrip™, which is Kuros Biosciences' unique sub- micron needle-shaped surface. Conclusion "This concept of osteoimmunology will feel like a new idea, but it's really the evolution of a number of ideas that have existed in spine surgery for years in terms of the interplay between host biology and bone healing," Dr. Patel said. "These are concepts that already exist and have been well adopted by many surgeons." He concluded, "This is that next natural evolution to marry those concepts together to get better bone healing, better fusion rates for our patients. It seems like a brand-new concept, but it's really just the next evolution." Among all of the steps that spine surgeons can take right now to improve fusions, selecting innovative bone graft technology may be the most important. Disclaimer: The views, opinions and positions expressed by surgeons in this article are those of the surgeon alone and do not represent those of Kuros Biosciences. In the US, MagnetOs is cleared for standalone use in the extremities and as an autograft extender in posterolateral spine. MagnetOs is not cleared by FDA as an osteoinductive bone graft. Please refer to the product instructions for use for a full list of indications, contradications, warnings, and precautions. 1 Medtech 360 report "Orthopedic Biomaterials Market Analysis 2017". 2 Hsu, et al. GSJ. 2012;2:239–248. 3 Mabud, et al. Clin Spine Surg. 2017;30:E1376–E1381. 4 Epstein, et al. SNI. 2017;8:61.Hsu, et al. 5 Chun, et al. Neurosurgical Focus. 2015;39(4):E10. 6 GSJ. 2012;2:239–248. 7 Morris, et al, ESJ. 2018;27:1856–1867. Spine-related pain is taking a huge toll on our society: more bed days, more days off work, and at a greater financial cost to westernized healthcare than any other condition. Kuros Biosciences is on a mission to ease this burden through superior biologics for better spinal fusions. They believe that a greater quality and quantity of science holds the key to easing the burden of back surgery. Their flagship product, MagnetOs, isn't like other bone grafts. It grows bone even in soft tissue thanks to its unique NeedleGrip™ surface technology which provides traction for our body's vitally important 'pro-healing' immune cells (M2 macrophages). The latest candidate in their pipeline is based on proprietary controlled-release technology that combines the well-established mechanism of the bone growth factor parathyroid hormone (PTH) with the natural healing matrix, fibrin. Fibrin-PTH is the first ever investigational drug-biologic candidate to be evaluated for spinal fusion. Visit www.kurosbio.com for additional information on Kuros Biosciences, its people, science and product pipeline.