AbstractBackground: TPX-100, a promotor of osteoblast and chondroblast differentiation, is a potential osteoarthritis (OA) therapy. This retrospective study compared MRI 3D femoral bone shape changes (B-scores) after intra-articular TPX-100 or placebo and analyzed the relationship between cartilage thickness and bone shape change over 12 months.Methods: 104 participants with bilateral knee moderate to severe (ICRS 2-4) knee cartilage defects were randomized for evaluation of efficacy and safety of 200mg of TPX-100. Each subject’s contralateral placebo-treated knee served as a paired internal control. After MRI quality control, 78/93 subjects (84%; 156 knees) were analyzed for quantitative femoral B-score and cartilage thickness. All analyses were centrally performed, blind to treatment assignment and clinical data.Results: TPX-100-treated knees (n=78) demonstrated a statistically significant decrease in pathologic bone shape change compared with placebo-treated knees at 6 and 12 months: 0.0298 (95% C.I. -0.037, 0.097) vs 0.1246 (95% C.I. 0.067, 0.182) (P=0.02); and 0.0856 (95% C.I. 0.013, 0.158) vs. 0.1969 (95% C.I. 0.123, 0.271) (P = 0.01), respectively. The correlation between bone shape change and medial and total tibiofemoral cartilage thickness changes at 12 months was statistically significant in TPX-100-treated knees (P<0.01). Conclusions: This is the first report of a potential therapy demonstrating a significant effect on bone shape measured by B-score in knee OA. These data, in combination with previously reported statistically significant and clinically meaningful improvements in WOMAC function versus placebo, support TPX-100 as a candidate for disease modification in knee OA.Trial Registration: NIH clinicaltrials.gov,NCT01925261. Registered 15 August 2013, https://clinicaltrials.gov/ct2/show/NCT01925261?term=NCT01925261