Keynotes

Michael H Heggeness MD PhD

Professor and Chair, Department of Orthopaedic Surgery,
University of Kansas School of Medicine-Wichita


Michael W. Perry

Studies on the mechanism of action of rhBMP2, and implications for the cause of rhBMP2 nerve related complications.

Recombinant human bone morphogenic protein has been in clinical use for over a decade. The molecule has provided surgeons with a very potent tool to enhance bone formation and foster spinal fusion. However, it is interesting that the actual mechanism of action of rhBMP2 in inducing bone formation has never really been clearly defined. This is particularly notable, as the molecule has been clearly associated with major complications including local swelling and inflammation, new onset radiculopathies and retrograde ejaculation. My laboratory has been studying the cellular and molecular events that follow intramuscular injections of rhBMP2 in laboratory mouse and rat models. The results show that when peripheral nerves are exposed to BMP2 they are profoundly affected. The nerves display a profound proliferation of small cells from within the nerve, with concomitant expression of inflammatory markers. Many of these cells also express stem cell markers including Sox2, cMyc, Klf4 and Oct4. When these cells are harvested and cultured in appropriate media, they can be observed to differentiate into osteoblasts. There seems little doubt that the cells which ultimately form bone after the clinical use of BMP2, are derived from cells which are stimulated to migrate from adjacent peripheral nerves, and that the observed nerve related complications are the result of this process.


Studies on the mechanism of action of rhBMP2, and implications for the cause of rhBMP2 nerve related complications.

Recombinant human bone morphogenic protein has been in clinical use for over a decade. The molecule has provided surgeons with a very potent tool to enhance bone formation and foster spinal fusion. However, it is interesting that the actual mechanism of action of rhBMP2 in inducing bone formation has never really been clearly defined. This is particularly notable, as the molecule has been clearly associated with major complications including local swelling and inflammation, new onset radiculopathies and retrograde ejaculation. My laboratory has been studying the cellular and molecular events that follow intramuscular injections of rhBMP2 in laboratory mouse and rat models. The results show that when peripheral nerves are exposed to BMP2 they are profoundly affected. The nerves display a profound proliferation of small cells from within the nerve, with concomitant expression of inflammatory markers. Many of these cells also express stem cell markers including Sox2, cMyc, Klf4 and Oct4. When these cells are harvested and cultured in appropriate media, they can be observed to differentiate into osteoblasts. There seems little doubt that the cells which ultimately form bone after the clinical use of BMP2, are derived from cells which are stimulated to migrate from adjacent peripheral nerves, and that the observed nerve related complications are the result of this process.

Michael W. Perry, M.D.

Laser Spine Institute LLC
Co-Founder, Chief Medical Director
(www.laserspineinstitute.com/)


Michael W. Perry

O negócio da medicina: um roteiro para a construção de uma bem sucedida prática médica centrada no paciente.

Os médicos fazem parte de uma classe de pessoas muito inteligentes, competitivas e motivadas que dedicam sua vida inteira ao aprendizado e ao aperfeiçoamento de suas habilidades médicas. Apesar de terem amplo conhecimento, e do fato de serem reconhecidos por suas habilidades, médicos geralmente possuem um conhecimento limitado sobre como operar um negócio. Como cofundador e diretor médico do maior instituto ambulatorial de coluna do mundo, o Dr. Michael Perry irá ressaltar alguns dos momentos mais decisivos para sua organização no desenvolvimento de um negócio de sucesso. Os participantes entenderão como o Laser Spine Institute tornou-se referência não só em cuidados com a coluna vertebral, mas também em cuidados voltados ao paciente, e a importância de fazer um alinhamento adequado com consultores e investidores. Dr. Perry também abordará outras questões como a relevância de introduzir assuntos de negócios a cirurgiões e médicos, a necessidade de ter transparência com empregados, e de prestar um serviço de cuidados ao paciente excepcional na construção de uma prática médica.


The Business of Medicine: A Roadmap to Building a Successful Patient-Centered Medical Practice/ASC

Physicians are a very intelligent, competitive and motivated group, whose whole life is dedicated to learning and perfecting their medical competence. Despite their vast medical knowledge, and the fact that they are well compensated for their skills, physicians often have limited knowledge of how to operate a business. As the Co-Founder and Chief Medical Director of the largest outpatient spine institute in the world, Dr. Michael Perry will highlight some of his organization's defining moments in growing a successful business. Attendees will hear how Laser Spine Institute has become the premier location not only for spine care, but for world-class patient centered care as well, including the importance of aligning with appropriate advisers and financial supporters. Dr. Perry will also focus on other considerations, such as the significance of including surgeons and physicians in business matters, the need for transparency with employees, and of delivering superior patient-centered care in building a medical practice.

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