Could an injection replace surgery for arthritis patients?

arthritis
Scientists at USC discover a molecule that promotes cartilage regeneration and decreases inflammation.

When osteoarthritis worsens, joint replacement surgery is often the only option for patients. Although these procedures are well established, some peopleespecially younger patientsend up with limited mobility, or they eventually progress to the point where they need additional surgeries. A team led by University of Southern California scientist Denis Evseenko, M.D., Ph.D., hopes to delay or reduce the need for these operations with an injection.

Evseenko’s team has been studying a new small molecule for arthritis called “Regulator of Cartilage Growth and Differentiation,” or RCGD 423, which they describe in a new paper in the Annals of Rheumatic Diseases. The drug works on the body’s glycoprotein 130 receptor, which receives two types of signals that either promote cartilage development or trigger chronic inflammation. RCGD 423 enhances the reception of the cartilage growth signals while blocking the inflammatory ones that lead to degeneration.

The researchers found that during in vitro studies, the drug helped joint cartilage cells proliferate. When they injected RCGD 423 into mice, they observed improved healing of cartilage damage, the researchers report.

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“The goal is to make an injectable therapy for an early to moderate level of arthritis,” said Evseenko, associate professor of orthopedic surgery at USC, in a statement. “It's not going to cure arthritis, but it will delay the progression of arthritis to the damaging stages when patients need joint replacements, which account for a million surgeries a year in the U.S.”

Because there is no cure for osteoarthritis, the only options for patients are cartilage replacements and treatments that help manage symptoms. Several companies are working on next-generation treatments, including Hyalex Orthopaedics, which is developing a synthetic biomaterial that mimics cartilage. Centrexion Therapeutics is working on novel pain-relieving therapies, and Servier recently licensed a therapy from Galapagos that targets a cartilage-degrading enzyme called ADAMTS-5.

Evseenko himself is also looking at other alternatives to joint-replacement surgery, including using pluripotent stem cells to regenerate cartilage.

As Evseenko sees it, the potential of RCGD 423 doesn’t only lie in arthritis—it could lead to a whole new class of anti-inflammatory drugs. In a previous study published in Nature Cell Biology, RCGD 423 was shown to activate hair growth. His team has developed several similar drugs and is partnering with other scientists to explore their applications in rheumatoid arthritis, lupus, neurological and heart diseases.