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Stem Cell Therapy For Osteoarthritis: What is the Data?
Stem Cell Therapy For Osteoarthritis: What is the Data?
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Home Page > Health > Medicine > Stem Cell Therapy For Osteoarthritis: What is the Data?
Stem Cell Therapy For Osteoarthritis: What is the Data?
Posted: Mar 05, 2009 |Comments: 1
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Stem Cell Therapy For Osteoarthritis: What is the Data?
By: Nathan Wei
About the Author
Nathan Wei, MD FACP FACR is a nationally known board-certified rheumatologist. For more info: Arthritis Treatment and Tendonitis Treatment Tips
(ArticlesBase SC #803790)
Article Source: http://www.articlesbase.com/ – Stem Cell Therapy For Osteoarthritis: What is the Data?
In the last few years, a number of methods have been developed to repair cartilage damage. These include osteochondral transplantation, microfracture surgery and autologous chondrocyte (cartilage cell) implantation.
A feature common to all of these techniques is that they are limited to the repair of focal lesions. Patients with OA are excluded from treatment.
OA cartilage lesions are usually larger and unconfined and so do not provide an appropriate environment for chondrocytes to be retained long enough to build a framework (matrix).
So…successful repair of OA cartilage damage is dependent on the ability to form a matrix within the joint.
Effective cartilage engineering protocols have already been developed in which chondrocytes in young animal models have been shown to be effective in creating cartilage.
Generating cartilage using adult human cartilage cells is far more challenging. Older OA patients have cartilage that is less responsive to stem cell stimulation and their stem cells seem to respond less well to the usual growth factors.
There are three potential avenues for obtaining stem cells. The first are embryonic stem cells which have the attraction of being relatively pristine. However, political and ethical interests have made this source of stem cells unobtainable. Plus, there is the theoretical possibility that theses stem cells may grow unchecked leading to unregulated growth, ie cancer.
A second source are mesenchymal stem cells grown in a laboratory from normal volunteers. While carefully screened for diseases and genetic problems, these stem cells do carry the potential for possible rejection reactions.
Finally, the last source and the one that seems to have the most promise- at least for now- are autologous stem cells. These are stem cells harvested from the iliac crest of the patient.
Autologous stem cells provide an attractive option for osteoarthritis patients and their clinicians. However it must also be recognized that autologous therapies are expensive. Ideally, it would be good to treat the specimen obtained from the iliac crest to growth factors, cytokines, and chemokines, to stimulate an increase in the number of stem cells.
However, both governmental regulations as well as sterility concerns preclude this step.
In addition, the search for better matrix production to allow stem cells a “home” to grow in and multiply is still being studied.
There have been a few clinical trials that have demonstrated some promise. The first comes from Murdoch University in Australia.
Working with Australia’s adult stem cell company, Mesoblast Limited (ASX:MSB), the University’s pre-clinical trials of Mesoblast’s patented adult stem cells had shown the therapy to significantly protect cartilage against damage in knee osteoarthritis.
The project’s principal investigator, Professor Rick Read stated, “We are delighted with the significant cartilage protective effects of Mesoblast’s allogeneic (donor unrelated) cells in our large animal model of knee osteoarthritis, without any adverse events of the cells at all.”
Mesoblast’s cartilage trials evaluated the effectiveness and safety of the company’s allogeneic adult stem cells to treat osteoarthritis of the knee in 48 arthritic sheep joints.
The results showed that osteoarthritic sheep knee joints receiving Mesoblast’s stem cells had significantly greater thickness of joint cartilage, reduced cartilage breakdown, and greater biomechanical strength three months later than did control joints receiving hyaluronic acid.
In another study, Duke University Medical Center researchers have “reprogrammed” adult stem cells taken from a small deposit of fat behind the kneecap into functioning cartilage, bone, or fat cells that could potentially be grown into replacement tissues for osteoarthritis.
The research team has provided evidence that stem cells taken from different adult sources have the potential to be transformed into multiple specialized cell types.
In the current study, the researchers took the fat pads from patients whose knee joints were removed during total joint replacement surgery. The fat pad is a dense structure behind the patella, or kneecap that is unlike typical fat tissue found throughout the body.
They were able to isolate and grow adult stem cells from this tissue.
According to scientists at Cardiff University, stem cells identified in their studies can be turned into cartilage cells (chondrocytes) in huge quantities. This may mean that limitations in cartilage transplants, in which healthy cartilage cells are collected and transplanted into a damaged joint, could be overcome.
However, despite recent media reports that heralded the identification of these stem cells as a breakthrough in the treatment of osteoarthritis, this research is currently only being considered to treat people with limited cartilage damage only.
Dr. Nathan Wei states, “Our current understanding of stem cell biology is obviously not where it needs to be. However, early work at our center using autologous stem cells obtained from iliac crest bone marrow and then concentrated has shown very promising results in patients with osteoarthritis of the knee. It is important to comment on the fact that prior to introduction of the stem cells, irritation of the cartilage and adjacent capsule is important to initiate an inflammatory response which then leads to cell proliferation which is an essential part of healing and subsequent cartilage regeneration.”
Dr. Wei adds, “For sure, though, I feel that this approach which is relatively painless will prove to be more effective than other therapies we currently have for osteoarthritis.”
For more information about stem cells and osteoarthritis, call the Arthritis and Osteoporosis Center of Maryland at (301) 694-5800.
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About the Author:
Nathan Wei, MD FACP FACR is a nationally known board-certified rheumatologist. For more info: Arthritis Treatment and Tendonitis Treatment Tips
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1. PT 01/11/2009
I’ve been enduring osteoarthritis in both ankles going on 12 years & counting: only diet & exercise would reduce pain: Medicine described/prescribed did little. It’s a big fuss.
Mesoblast stem cell therapy at best is at its infancy, perhaps years, at least 10, to be reliably successful. There are just too many variables. I don’t see anything out there that warrants long-term remediation. I’m very suspicious of all the promises, while asking you to spend big bucks.
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Nathan Wei, MD FACP FACR is a nationally known board-certified rheumatologist. For more info: Arthritis Treatment and Tendonitis Treatment Tips
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Stem Cells For Osteoarthritis: I Look Ten Years Younger Since my Facelift… But my Knees Still Feel Their Age… What Can I Do?
One of the first articles to mention stem cell therapy for osteoarthritis was an article published in the December 2003 article Arthritis and Rheumatism (Murphy JM, et al. Arthritis Rheum. 2003; 48: 3464-3474.)
The research team took two groups of goats and created osteoarthritis in their knees by removing the medial meniscus and cutting out the anterior cruciate ligament. After six weeks, one group of goats received an injection of sodium hyaluronan (a lubricant commonly used to treat symptomatic osteoarthritis of the knee) while the other group received a single dose of 10 million stem cells, originally extracted from the goats’ bone marrow, and then suspended in sodium hyaluronan before injection into the knee.
In the knees which had been treated by stem cell injections, researchers observed a regeneration of joint tissue and a decrease in cartilage degeneration.
The authors commented on their findings… “there may be a therapeutic benefit associated with local delivery of stem cells following traumatic injury to the knee. The longer term effect of this may be a reduction or delay in the progression to osteoarthritis.”
The authors concluded that “this is a scaffold-free method for cell delivery and is therefore unencumbered by the complexities associated with placement of a solid cell construct.” This latter statement is important because so many techniques to date have involved the complicated use of different scaffolds (frameworks) to hold stem cells in place.
Stem cells are progenitor cells- the cells that all others are derived from. They have three interesting characteristics that make them prime candidates for tissue regenerative techniques. They are capable of dividing and renewing their numbers for an unusually long period of time; they are undifferentiated, meaning they have not yet committed to being a “heart” cell or a “lung” cell; and they can become any type of specialized cell. Another term to refer to this property is that stem cells are “pluripotential.”
While most research and ethical concerns have been centered on the use of embryonic stem cells, adult stem cells are more accessible with no ethical “baggage.” The cells that were used in the above study were adult stem cells obtained from the bone marrow.
At the Arthritis and Osteoporosis Center of Maryland, research efforts have been aimed at using adult stem cells obtained from the bone marrow to treat osteoarthritis of the knee or hip. Stem cells are obtained from the iliac crest of the patient’s hip and then concentrated using a special technique. The area of interest- usually the medial compartment of the knee is then prepared with a special instrument under ultrasound guidance. This technique ensures that local inflammation is created at the site of needed repair. This is a critical component of the procedure since the exact location of pathology will determine where the stem cells will be placed.
Along with stem cells, platelet rich plasma, also obtained from the patients is infused. The platelet rich plasma attaches to tyrosine kinase receptors on the cell surface of the stem cells and triggers gene expression within the nucleus of the stem cell. This “turns on” the stem cell to divide and differentiate into cartilage.
The entire procedure is done using local anesthetic with ultrasound guidance.
According to Dr. Nathan Wei, “Preliminary results are very promising. Longer term data is required and we are specifically addressing not only patient function but also measurements of cartilage thickness.” He adds, “the best approach as far as framework preparation for the stem cells and ensuring an adequate number of stem cells are of key importance. If you don’t have enough viable stem cells, the procedure won’t be effective. Also, the stem cells need to be primed properly… and have a scaffold (framework) to attach to. “
Nathan Wei, MD FACP FACR is a nationally known board-certified rheumatologist. For more info: Arthritis Treatment and Tendonitis Treatment Tips
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