Futuristic Alternatives to Limb Lengthening Surgery
I want to talk about some of the alternatives to limb lengthening surgery and then I’m going to speculate about some future possibilities.
Part I:
So, currently, the only alternatives to limb lengthening surgery are for younger individuals whose epiphyseal plates haven’t fused after puberty. Because if your growth plates do close up shop...well then you’re done growing...for life. Typically this’ll happen sometime after age 17 for guys and age 15 for girls but can vary from person to person.
Now, let’s say that a growing boy whose growth plates haven’t fused yet and their family doctor notices they have a growth hormone deficiency and that they may not grow to be normal size or near their predicted max, then they can refer them to an endocrinologist to administer growth hormone therapy to assist in bolstering a stronger growth response.
GH therapy is often prescribed for teens with growth hormone deficiency, idiopathic short stature, dwarfism, Russell Silver, Turner, or Prader-Willi-syndromes.
Now if you’ve already ruled out poor nutrition and underactive thyroid for kids who have normal GH levels or who don’t respond to the GH therapy that isn't growing taller, it may actually be due to an IGF-1 (insulin-like-growth-factor-1) deficiency. Then something like Increlex can be used to help.
And then you have Vosoritide from the company Biomarin, which is an innovative biomedical drug that helps those with achondroplasia achieve better growth. Basically it binds to a receptor that essentially inhibits the FGFR3 pathway, which, if left alone to cause havoc, can affect how the chondrocytes convert to new bone.
This is similar to what CK Biotech is doing by making drugs that interfere with CXXC5, a negative feedback regulator of the Wnt/Beta-Catenin signaling pathway which can allow for normal bone growth in kids who still are growing.
So as you can see, when it comes to those who are still growing, there are quite a few options to assist with maximizing height. However, what about adults or those who’re at growth plate senescence? What options do they have other than the current limb lengthening surgery…
Well, unfortunately...none...as of yet. But I wanted to speculate on what could be in the future.
So the current limb lengthening technology involves breaking the legs, implanting some sort of lengthening device, lengthening the bones, and having to get a device removal all while mitigating pain through consistent rehab.
If there could be an alternative to any one of these steps, that would be progress. For example, there has been research started to try to induce stem cells to have bone cells transdifferentiate back into chondrocytes. If this works, it basically means you could “reactivate your growth plates”.
Also, the focus on LIPUS technology (which is low-intensity pulsed ultrasound) and how it could stimulate bone growth as some studies have been noted in jaw bones of rats but hey.
Finally, what about expediting the healing process with stem cells to help bone healing. Well this actually has been occurring for example I know some LL surgeons use BMAC injections to help patients with healing bones especially the tibia since it heals slower than the femur.
Well, perhaps we’re just daydreaming and hoping for the day where we could take a pill that will magically lengthen our bones at a slow enough rate we can control on our smartphones that won’t cause soft tissue problems and would be more affordable than typical limb lengthening…
BUT, unfortunately we’re not there yet so we’ll have to do our best with the current technology which is still amazing considering where it was just a decade ago.
Part II:
"The following is a Guest Post from a growth disorder support group initiative: BGRI.. I am always interested in learning about future advancements in scientific methods and they have run into such topics such as bone tissue engineering". - Victor Egonu
Hello to the Cyborg4Life-community!
It is great, that Victor has started a communication about innovative height increase therapy approaches and he has invited our "Biomedical Growth Research Initiative" ( http://www.growthresearch.org ) to write a guest article. So we feel honored to contribute a little bit to this topic, as this is also very important for us.
Of course tissue engineering has some very interesting input for possible future height increase therapy options, especially the field of bone tissue engineering and growth plate tissue engineering. There are already hundreds of tissue engineering studies, like e.g. here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC129392/
https://pubmed.ncbi.nlm.nih.gov/25114207/
https://clinicaltrials.gov/ct2/show/NCT03103295
https://clinicaltrials.gov/ct2/show/NCT00980278
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007661/
As Victor already pointed out in his blog and video: one of the options for innovative limb lengthening approaches may also be Low Intensity Pulsed Ultrasound (LIPUS), maybe in combination with a stretching device. There are already some published studies concerning LIPUS and mandibular growth, that could also pave the way for limb lengthening approaches, e.g. here:
https://pubmed.ncbi.nlm.nih.gov/23785932/
https://www.jstage.jst.go.jp/article/josnusd/58/3/58_16-0010/_article
Also biomedical limb regeneration research may open up new roads for limb lengthening. Basically said it may be possible, that the same or similar pathways, that could lead to limb regeneration could also be used to influence the length of a limb. There is already a lot of groundwork done in this area: https://humanlimbregeneration.com/
All these approaches (and some others, like e.g. gene therapy) could have implications for new safe, effective and patient-friendly height increase therapy options.
But we urgently need interested researchers and students, that want to apply for grants to start specific projects for the indication "height increase / limb lengthening".
Possible funding sources are of course organizations like e.g. the National Institutes of Health in the USA: https://grants.nih.gov/funding/index.htm
More specifically there are also some grant programs with a specific interest in growth disorders, like the Biomarin grant program: https://biomarin.envisionpharma.com/ienv_biomarin/visiontracker/portal/login.xhtml?windowId=95c
Another small grant program is run by the Human Growth Foundation: https://www.hgfound.org/research-grants
In the UK the Child Growth Foundation has a good grant program (which is unfortunately currently suspended because of the corona crisis ... but will probably resume next year or in 2022): https://childgrowthfoundation.org/research-awards/
So basically there are some research approaches, that may lead to innovative height increase therapy options ... and there are some good funding sources. So now the most important point is: we need (biomedical) researchers and students, who want to work in this area! So this is our call for you! The "Biomedical Growth Research Initiative" (BGRI) and probably the biggest part of the community of people with growth disorders worldwide would appreciate the support of researchers and students with innovative ideas and projects very much!
If you are a (biomedical) student or a researcher and if you want more information about this opportunity, please contact me ( [email protected] ) I will be happy to answer all your question!
-Harald Oberlaender
Part III:
"The following is a Guest Post from a growth disorder support group initiative: BGRI.. I am always interested in learning about future advancements in scientific methods and they have run into such topics such as bone tissue engineering". - Victor Egonu
A call for business angels and other investors or donators
Here is another call from the "Biomedical Growth Research Initiative" (BGRI), this time concerning business angels and other investors or donators.
As we already discussed in this blog post: there are several fields of biomedical research, that may lead to safe and effective height increase therapy options.
We as a support group have already received two very innovative research proposals from university research groups in Canada and the USA. These research groups would prefer a cooperation with private investors or donators.
So we are looking for donators or investors with a (personal) interest in growth research. We need at least 250.000 dollars to start at least one of these proposed research projects.
Of course every interested donator or investor would receive the official research proposals written by the researchers and he/she could visit the laboratories of the university research groups before making any decisions. And of course every funding would go directly to the universities, not to the BGRI.
Early donators or investors would receive a part of the future profits, that would be the result of a commercialized superior height increase therapy.
But what kind of market potential does such an improved height increase therapy have?
In order to answer this question the BGRI has developed a market analysis, which you can download at the end of this blog post.
Below you will find the most important points from our market analysis:
Current market:
Currently there are mainly two therapy options to increase height: growth hormone treatment for children and limb lengthening surgery for adults. Additionally in 2005 the FDA approved Increlex for the small sub-group of short statured children because of severe primary IGF-1 deficiency.
The global Human Growth Hormone (hGH) market was worth approximately $3,7 billion in 2016 (https://www.grandviewresearch.com/industry- analysis/human-growth-hormone-drugs-market ) and is projected to grow at a CAGR of 7,5% until 2025. Obviously the small market segment of a few medically defined short stature syndromes is already extremely lucrative.
Concerning the current market of limb lengthening surgery there are no exact numbers: Nevterheless it can be said, that there is a significant demand worldwide with treatment centres around the world (http://www.shortsupport.org/Health/Leg- Lengthening/hospitals.html ).
Future market potential:
There is no doubt, that a safe and effective minimally invasive or even non invasive height increase / limb lengthening therapy for children and adults would instantly take a significant share of the existing multi-billion-dollar-height increase / limb lengthening market. More importantly it would most probably create a completely new market, as it would offer the first minimally invasive or non invasive therapy option for the vast majority of short statured people, for which there is currently no therapy option available (e.g. because they don´t have the indication to receive growth hormones, they aren´t satisfied with the results and/or they don´t want to do the drastic limb lengthening surgery currently available).
Especially a completely new market for “cosmetic” height increase could be developed. As height is such an important attractivity factor and as even medium-sized men would like to increase their height, there is a huge market demand / market gap concerning a safe and effective “cosmetic” height increase therapy. For some medical indications (e.g. achondroplasia, amputations, trauma …) the new therapy option would probably be covered by medical insurance. A coverage by medical insurance would definitely improve the already significant market potential.
The final market potential depends on several factors, that can´t be predicted exactly right now, e.g. the exact costs of the new therapy option(s), the demand for “cosmetic” reasons, the coverage by medical insurance and other factors. Nevertheless the severely limited therapy options, that are currently available for a few medically defined short stature syndromes, have already created an annual height increase market of nearly 4 billion dollars.
So it can be predicted, that a patient-friendly and effective universal height increase / limb lengthening therapy with a much broader indication spectrum, has a short-term market potential of at least 1 billion dollars annually.
One important aspect is, that such a universal height increase therapy could probably also be used in combination with other drug therapy options in order to deliver improved growth results for medically defined growth disorders (like e.g. achondroplasia).
If you want more details, please feel free to download the complete market analysis. In our opinion it is very clear, that this is a very interesting market with very few competition yet. So we think, that it is surely also a very attractive investment case.
We would be very happy to start communications with interested donator or investors.
The two research projects, for which there are already concrete research proposals, could be started within a few weeks after funding is in place. And there are surely many other research groups, that could be motivated to start similar research projects, if there was a sufficient funding source.
So please feel very welcome to contact me ( [email protected] ) or Victor ( [email protected] ) for more details.
-Harald Oberlaender