Surgeon helping pioneer efforts to regrow knee cartilage

When Dr. Jack Farr II saw his grandfather's knees become bowed out, then saw his father get a knee replacement, he knew
he was next.

So he spent his career trying to develop new techniques to replace–and now even regrow–the cartilage around knees.

His labors are part of an international effort to develop alternatives to joint replacements. Any breakthrough could be good
news for everyone from injured young athletes to weekend-warrior boomers hoping to defend their over-60 racquetball championship.

It also could become a boon to the $25 billion orthopedic implant industry, which is centered in Warsaw, opening a new line
of business that could yield another $2 billion in revenue.

"I was just looking at my genetics and trying to see what other options there were other than metal and plastic for
me in the future," said Farr, 54, a surgeon at OrthoIndy hospital on West 86th Street at Interstate 465.

The Indianapolis native, who studied at Rose-Hulman Institute of Technology and the Indiana University School of Medicine,
has focused his practice on sports medicine and knee restoration for patients under 50.

When Farr began his practice in 1986, he immediately searched out alternatives to total joint replacement. He traveled up
to Toronto, Canada, to learn from Dr. Allan Gross, who had pioneered techniques in cartilage transplants.

Ten years later, Farr heard about Massachusetts-based Genzyme Corp., which was testing a product that used cell therapy to
regrow cartilage. Cell therapy implants cartilage cells and extracellular materials from a donor into the patient with the
damaged knee. The implant is designed to grow new cartilage as it connects to the patient's existing cartilage.

Farr was one of the first doctors trained to implant Genzyme's product, known as Carticell. It is the only cartilage
regeneration product on the market that uses cell therapy. But many more are poised to join it.

New Jersey-based ReGen Biologics Inc. is in position to win regulatory approval by summer for its cartilage regeneration
product. Belgium-based TiGenix showed off strong results in February from a late-stage clinical trial of its cartilage regeneration
device. And most major orthopedics companies, including Zimmer Holdings Corp. and DePuy Inc., are working to develop their
own cartilage regeneration products.

"This is all kind of happening now. It's very exciting," said Robin Young, editor in chief of Orthopedics
This Week
, a trade publication.

Young is high on cell therapy approaches to cartilage regeneration because it could extend treatment to patients not yet
ready for a total joint replacement.

"It will expand the market by bringing more people into the market," Young said.

Farr is currently trying out a new cartilage regeneration product co-developed by Warsaw-based Zimmer and ISTO Technologies
Inc., based in St. Louis, Mo. The product, which will be called DeNovo ET, takes cells from young donors and implants them
in a knee that has suffered a traumatic injury.

If successful, DeNovo would improve upon Carticell because it requires a smaller incision and shorter surgery time and it
can be molded to more precisely fill the defect in a patient's cartilage.

Farr did the first surgery in the trial in November and another one in February. He expects about 12 patients will receive
the test product before Zimmer and ISTO submit the results to the U.S. Food and Drug Administration.

This trial will simply determine if the DeNovo product is safe and effective in the short term. Within the next year, Zimmer
hopes to be talking with the FDA again about doing another trial to gauge the product's long-term effectiveness. It's
unclear when the product would be on the market.

"It's a natural extension of the business that we're in while still being in the core business of orthopedics,"
said Zimmer's chief scientific officer, Cheryl Blanchard. "It would allow us to treat [patients] earlier in the continuum
of care."

But Zimmer is just one company that has called on Farr for help. Genzyme used him in a massive follow-up study of its Carticell
product. And Maryland-based Osiris Therapeutics Inc. tapped him to test its technology that uses adult stem cells to regrow
cartilage. Farr is also doing clinical trial work for DePuy, a division of Johnson & Johnson.

In a forecast released in March, Young, the magazine editor, predicted 50,000 orthopedic patients will receive cell therapy
treatment annually by 2016, with the number doubling every year after that. He estimated that as many as 1.2 million patients
annually could be eligible for cartilage regeneration procedures.

Cell therapy procedures could generate $2 billion in revenue by at least 2020, Young predicted.

The "holy grail" would be to repair cartilage and never need any joint replacements, said Zimmer's Blanchard.
But in good news for orthopedic implant makers, current cartilage regeneration methods promise only to delay the need for
knee surgeries.

Farr agreed. He said new technologies for cartilage regeneration won't do away with joint replacements in his lifetime.

"I'm past the point it can help me," said Farr, a father of three. "But maybe it can help my kids."

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