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16 DEVICES & INNOVATION The Role of Biologics in the Next 5 to 10 Years: 6 Spine Specialists Weigh In By Anuja Vaidya Here six spine specialists discuss the role of biologics in the future of the spinal care industry. Question: How will biologics grow over the next five years? Brian R. Gantwerker, MD, The Craniospinal Center of Los Ange- les: I believe biologics will actually stagnate or evolve very slowly. Sili- con-based technologies sound interesting, but I think most pa- tients would not like the idea of "glass" being put in their spines. Also, the ef- forts of payers to classify standard cell- based biologics as stem cell therapy will thwart its ultimate growth. However, I think the use of biologics themselves will diminish, as more data supporting techniques such as arthroplasty be- come accepted and easier to apply in more advanced disease states. J. Brian Gill, MD, MBA, Nebraska Spine Hos- pital, Omaha: Min- imally invasive sur- geries are fueling this growth as alternatives are sought for bone grafting materials to reduce operative time, pain, hospital stays [and] cost. As the minimally invasive market grows, so will biologics. Srdjan Mirkovic, MD, NorthShore Orthopaedic Institute, Evanston, Ill.: Interest in biologics is high but I anticipate the growth to be slow over the next five years, mainly due to it be- ing such a complex field. The possibilities of bone growth are exciting. Osteoinductive biologics re- search into bone morphogenetic pro- teins, stem cells, disc regeneration and gene therapy will continue to progress. But much research is yet to be done. The majority of the research has to ad- vance well beyond the animal stage when determining dosage, delivery systems and efficacy. There are a lot of unanswered questions and this type of research is expensive. Advancements in these areas are filtered by cost and benefit of care. Osteoconductive biologics are likely to continue to be used. Their efficacy, safe- ty and cost compared to the safe and less expensive use of allograft remains to be determined. The use of a patient's own harvested bone will remain the gold standard for spinal fusions. Over the next five years, it will be an ex- citing but challenging time with biolog- ics in spine care. I anticipate real change in this area will come closer to 10 to 20 years from now. Luga Podesta, MD, director, sports med- icine, St. Charles Orthopedics, E. Se- tauket, N.Y.: Over the past 10 years, there has been significant increasing interest in cell-based ther- apies and biologic treatments includ- ing platelet-rich plasma and stem cells to treat sports-related and other mus- culoskeletal injuries involving soft tis- sue tendons, ligaments, muscle, bone and articular cartilage. Advancement in cell, molecular and developmental biology have helped to discover the signaling molecules responsible for specific cell lineages — that is, muscle, tendon, ligament and articular cartilage — involved in tissue formation and regeneration. Further research and acquired knowl- edge into how these particular biologic therapies, cell components and bioac- tive proteins participate and affect the tissue repair response will aid in the basic understanding of their desired mechanisms of action. The role of PRP, stem cell and other biologic cell-based treatments in sports medicine may sig- nal a new era where athletic musculo- skeletal and other orthopedic injuries are treated with growth factors, stem cells, bioactive proteins and tissue-spe- cific cell lines. However, there remains a significant amount of work that needs to be done proving efficacy and safety data before these therapies become the standard of care. Medhat Mikhael, MD, pain management specialist, medical director, Center for Spine Health at Or- ange Coast Memorial Medical Center, Foun- tain Valley, Calif.: Biologics will play a vital rule in the future of medicine. Researchers are working on produc- tion of about 900-plus medicines and vaccines to treat several diseases from autoimmune diseases and rheumato- logic diseases to cancer. Examples of some of the biological products are the monoclonal antibodies, therapeu- tic vaccines, blood products, gene therapies and cell therapy. It is basical- ly the future of medicine. The hope is that the changes in healthcare do not affect these researchers or the cover- age of these products to the patients in a negative way. Steve Yoon, MD, Di- rector, orthobiologics & regenerative medi- cine, Kerlan-Jobe Or- thopedic Clinic, Los Angeles: The use of bi- ologics within all fields of medicine is growing at a rapid pace due to its potential for healing in ad- dition to its possible anti-inflammatory and anti-scarring effects. Understand- ing the cellular and molecular path- ways and how it pertains to clinical outcomes will be key in understand- ing how to use this material. The use of biologics will increase both in the clinical and operative setting as it may prevent patients from undergoing sur- gery, and when surgery is warranted, it could possibly improve surgical out- comes. It's here to stay and the knowl- edge base and momentum is growing each year. n