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December 25, 2017

Alpha 2 Macroglobulin: New Treatment for Arthritis

alpha 2 macroglobulin
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Dying young is about the only way you can avoid getting arthritis. And, that’s a rough way to avoid it and even then you may not avoid completely because arthritis does strike the young. Arthritis hits one in five Americans. And, two-thirds of those sufferers are under age 65. So you don’t have live excessively long to get it. A new treatment is now available for arthritis and it involves the use of alpha 2 macroglobulin (A2M).

Alpha 2 macroglobulin is a protein. It is a biologically based treatment that gets more to the root cause of arthritis which makes it promising. I learned about it from a medical school classmate of mine who has started to use alpha 2 macroglobulin in his practice (six patients thus far and he reports it has worked very well). I then got some firsthand training in its use at a recent regenerative medicine course and workshop I attended.

Arthritis is the leading cause of disability in the United States and the second most chronic disease. We discussed currently available treatments  for knee arthritis in Treatments for Aging KneesBut, all those treatments have shortcomings.

It would be nice to have a safe and effective treatment for this malady. The nice thing about A2M is your body naturally makes it which makes its use safe compared to other available treatments for arthritis. We just don’t make enough alpha 2 macroglobulin as we age. But there are ways around that……

What is Alpha 2 Macroglobulin?

Alpha 2 macroglobulin is a large protein molecule. Ninety-nine percent of it is made in the liver. There are four main biochemical processes that lead to joint (articular) cartilage breakdown – the hallmark of arthritis. The following chemicals/molecules lead to the degradation of articular cartilage

  • Cytokines
  • Metalloproteases (MMPs)
  • A disintegrin metalloproteinase with thrombospondin motifs (ADAMTs)
  • Cartilage breakdown products

Collectively these substances are known as proteases. Alpha 2 macroglobulin captures and inhibits the activity of these four groups of proteases. It essentially traps them and removes them from the joint. This better enables the body’s natural repair and regenerative pathways including stem cells to repair the articular cartilage damage.

In short, alpha 2 macroglobulin is a master inhibitor of cartilage degrading enzymes. See this study. And, this study.

Our joints are in a constant state of trying to achieve balance between breakdown and repair. In arthritic sufferers breakdown exceeds repair and alpha 2 macroglobulin shifts that inequality back to repair by shutting down the destructive breakdown part of the cycle.

How is Alpha 2 Macroglobulin Used?

Alpha 2 macroglobulin is isolated from blood, concentrated, then injected into a joint. It is not much more complicated than that. Typically 100 cc of a patient’s blood is obtained. The blood then goes through a centrifugation and filtration process to isolate alpha 2 macroglobulin which is then concentrated. The filtration system also allows for the isolation of platelet rich plasma (PRP).

Some experts in the field of regenerative medicine question the need to concentrate alpha 2 macroglobulin stating that blood plasma has enough alpha 2 macroglobulin to shut down the degrading cartilage enzymes without the need to concentrate it.

PRP has been used in the treatment of musculoskeletal problems and is most effective in the treatment of soft tissue injuries but also has been used to treat arthritis. PRP contains growth factors necessary for tissue repair. Together alpha 2 macroglobulin and PRP provide a 1-2 punch in the treatment of arthritis. Alpha 2 macroglobulin shuts down the destructive processes that leads to joint degeneration and PRP provides the growth factors for repair.

Alpha 2 macroglobulin has been used successfully alone without PRP. It is likely to be most successful as a stand alone treatment in the healthier and younger patient who has a more intact and robust regenerative capabilities than someone older who may need a boost from PRP or even stem cells. Alpha 2 macro globulin is also used as an adjunct to stem cell injections for joint problems.

How Much Does it Cost?

The cost ranges from $2,500 to $3,000. The kit used to isolate and concentrate alpha 2 macroglobulin runs upwards of $1,500 and that cost is passed on to the patient. That cost needs to be put into perspective with other forms of treatment of arthritis. The cost of stem cell treatments run $5,000 to $7,000. The cost of a joint replacement (which carries significant risks) is typically $25,000 and up. The long term use of NSAIDs (non steroidal anti-inflammatories can cost several hundred to thousands of dollars annually while increasing the risk of gastrointestinal bleeding and heart attacks.

Alpha 2 macroglobulin is an experimental treatment at this point. There are no studies to know how long alpha 2 macroglobulin injections are effective, but likely they would need to be performed on a periodic basis. How long that is is unclear. But, it appears safer than conventional treatments for arthritis. The main side effect or complication relate to the risk of a infection from a joint injection (which can occur with cortisone injections too).

For more information watch the video below.

https://www.youtube.com/watch?v=-flOOYlGsr0

 

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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