In Search of the Holy Grail for Arthritis
Ira Pastor, ideaXme exponential health ambassador and founder of Bioquark, interviews Dr. Virginia Byers Kraus, Professor of Medicine, Pathology, and Orthopaedic Surgery, and a faculty member of the Duke Molecular Physiology Institute in the Duke University School of Medicine.
Ira Pastor Comments:
On the last several shows, we have spent time on different hierarchical levels of the biologic-architecture of the life and aging processes. We’ve spent some time talking about the genome, the microbiome and systems biology; all fascinating topics.
However, we can’t forget that while all of these integrated and varied biologic processes are important in the maintenance of our daily health and wellness, when things go wrong, the trickle down is unfortunately a wide range of chronic degenerative disorders responsible for human suffering and death, and an annual global healthcare expenditure of over $7 trillion.
One of the major set of pathologies still responsible for a part that $$$ figure in 2019, remains the basket of diseases that encompasses the term “arthritis,” of which there are dozens of different types currently classified.
Arthritis is a term often used to mean any disorder that affects joints (the most common forms being osteoarthritis (OA) and rheumatoid arthritis (RA)), where symptoms generally include joint pain, stiffness, redness, warmth, swelling, and decreased range of motion. In some types of arthritis (on the auto-immune side of things) other organs can be affected, and the onset of arthritis can be gradual or sudden.
In 2018, the U.S. Center for Disease Control (CDC) data estimated that around 55 million people in the U.S. suffer from one form of arthritis, and it is estimated that number will increase by around 80 million by 2040.
There is no known cure for either rheumatoid or osteoarthritis. Joint replacement surgery may be required in eroding forms of arthritis.
Treatment options vary depending on the type of arthritis and can include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, and various medications which can help reduce inflammation in the joint (and immune responses in case of auto-immune forms of arthritis) which can help decrease pain and potentially slow the rate of joint damage, hopefully to “zero”, which is the nature of the current class of “holy grail-ish” type drugs in the Rheumatoid Arthritis space known as Disease Modifying Anti-Rheumatic Drugs (DMARDs).
No drug fulfilling the criteria for a “Disease Modifying OsteoArthritis Drug” (or DMOAD) is approved by the regulatory agencies such as the FDA or EMEA.
But whether one is looking for a DMOAD, or looking beyond the current state of the art of the DMARDs to the next RA holy grail type intervention, many thought leaders would agree that it would be a form of intervention that stimulates Chondrogenesis, or the process by which new fresh cartilage is created in the joint, literally reversing the pathogenesis of such diseases, as opposed to just slowing or stopping them.
Once damaged in humans, cartilage has very limited repair capabilities. Because chondrocytes are bound in lacunae, they cannot migrate to damaged areas. Also, because hyaline cartilage does not have a blood supply, the deposition of new matrix is slow. Damaged hyaline cartilage is usually replaced by fibrocartilage scar tissue instead. But this is not the case in other species such as newts and zebrafish, where fresh cartilage is regrown and regenerates perfectly over a lifetime.
Dr. Virginia Byers Kraus
Today’s guest who is going to take us further into all of these themes is Dr. Virginia Byers Kraus.
With an MD and PhD from Duke University, Dr. Kraus is Professor of Medicine, Pathology, and Orthopaedic Surgery, and a faculty member of the Duke Molecular Physiology Institute in the Duke University School of Medicine. She is a practicing Rheumatologist with 20 years experience in Osteoarthritis research.
Dr. Kraus is past president of the Osteoarthritis Research Society International (OARSI), the premier organization focused on the prevention and treatment of osteoarthritis through the promotion and presentation of research, education, and the worldwide dissemination of new knowledge.
In 2019, she was elected to the Association of American Physicians and awarded the Lifetime Achievement Award from OARSI. She is co-principal investigator of the OARSI/Foundation for NIH Osteoarthritis Biomarkers Consortium Project, which advances the validation and qualification of biomarkers for OA diagnosis, prognosis, and clinical trials.
She also directs the Duke Biomarkers Shared Resource which is a facility that assists investigators with the design and implementation of molecular and protein assays to evaluate biochemical and inflammatory markers.
Dr. Kraus is also the Director of the Molecular Measures Core in the Center for the Study of Aging and Human Development.
On this show we will hear from Dr. Kraus:
How she developed an interest in science, medicine, and rheumatology. The importance of appropriate biomarker development, validation and qualification in the diagnosis, prognosis, and development of effective interventions in arthritis. Her recent paper entitled Analysis of “Old” Proteins Unmasks Dynamic Gradient of Cartilage Turnover in Human Limbs, in which she highlights the discovery of interesting protein/microRNA constituency differences of various joints of the body, leading to clues for different regenerative medicine interventional possibilities.
Finally, we’ll discuss her work in the Molecular Measures Core in the Center for the Study of Aging and Human Development where her group is focused on “understanding the means to optimize whole person reserve and resilience through analyses of molecular factors indicative of cellular and tissue level ability to withstand and recover from stressors.”
Credits: Ira Pastor interview video, text, and audio.
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If you liked this interview, be sure to check out our interview with Dr. Denise Faustman, Associate Professor of Medicine at Harvard University.
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