Experts are researching ways to use stem cells to treat arthritis in the knee and other joints. At the Manchester Stem Cell Centre, we use Bone marrow derived stem cells to treat arthritis and here are five things you need to know
- Scientists define stem cells as cells that can do both of these things: Self renew: Stem cells can divide and duplicate themselves, both in the body and in a lab. A small amount of stem cells can be harvested from human bone marrow tissue and enhanced to be injected in the affected joints. Differentiate: Stem cells can develop into different types of cells. For example, it is possible for a stem cell to develop into a bone, muscle, cartilage. These properties can be used in cases
- Stem Cells are special: Stem cells are located throughout the body. What makes stem cells special is that they can divide and duplicate into different cell types. Stem cells are known to transform to accommodate a certain need when placed in a certain environment. For example, stem cells in the vicinity of damaged cartilage are thought to develop into cartilage tissue. There are two basic forms of stem cell – the embryonic stem cell and adult stem cell. Adult stem cells, which are also known as mesenchymal stem cells or MSCs are of great interest to researchers, scientists and surgeons alike. MSCs are free of the controversy that surrounds the embryonic stem cells and yet have the potential to form new tissues. This gives us the ability to repair and regenerate tissues such as cartilage and bone more effectively.
- Stem Cells for Osteoarthritis and Sports Injuries
Stem cells may be applied during surgery (such as surgery to repair a torn knee meniscus) or directly into the arthritis joint through injections. Medical imaging, such as ultrasound is used to deliver cells precisely to the site of cartilage damage when administering stem cell injections.
- The source of Stem Cells : Stem cells are harvested autologously – directly from the patients. Consequently, there is no risk of disease transmission, rejection or ethical controversy that can exist using cells from an unrelated donor. All humans have a supply of MSCs in various tissues and these can be harvested using specialised techniques.
The most common type of stem cells used for treating arthritis are mesenchymal stem cells. Mesenchymal stem cells are usually collected from the patient’s bone marrow.
The process of collecting cells is often called harvesting.
- Bone marrow stem cells are harvested from one of the patient’s bones, which is later processed and used as a stem cell injection.
Bone marrow is usually taken from the pelvic bone using a needle and syringe, a process called bone marrow aspiration. The patient is given a local anaesthetic and may also be given a sedative before the procedure.
- Stem Cells and its Applications: There are no professional medical guidelines for who can and cannot receive stem cell therapy for arthritis. For now, the decision about who gets stem cell therapy is up to patients and doctors. According to some evidence, people with severe arthritis can benefit from stem cell therapy. Most research indicates that younger patients who have relatively mild osteoarthritis or cartilage damage see the most benefit. Some doctors have certain criteria for recommending stem cell therapy. For example, they only recommend it to patients who are healthy and have relatively little cartilage damage.
- Stem cells in itself can be used in a variety of degenerated ailments to help in the repair and regeneration of damaged tissues and structures. In joint preservation, one role of stem cells is in the possible treatment of arthritis of the hip and knee joints. Improvised treatments are developed to meet the demands in joint preservation. This can potentially be accomplished by regeneration of cartilage (gristle). In simple terms, the gristle on the joint surface is the barrier to arthritis. Once this layer is damaged, the joint is likely to progress to arthritis, which presents as pain, stiffness and loss of function. Stem cell therapy may be used in an attempt to encourage regeneration of this gristle layer. The procedure is designed to help preserve the natural hip and knee joints and perhaps to delay or prevent the need for more major operations such as replacement of the hip or knee joint.
Another area of particular interest for stem cell therapy in the hip and knee is to help with the regeneration of dead bone. In a condition called avascular necrosis, or AVN, there is death of a segment of the bone near the joint. This can sometimes progress onwards to become severe arthritis. Early reports of the use of stem cells to regenerate bone in AVN are encouraging.
There are many other reasons why stem cells might be used. These techniques may be relevant to different patients and are employed as required.
- The Stem Cell Procedure: The procedure is in the form of arthroscopy (keyhole surgery) of the hip or knee. Patients often ask whether stem cell therapy involves surgery on two separate occasions. For the techniques that we use, only a single operation is normally required. This is normally carried out as day-case procedure for knee arthroscopy; most hip arthroscopy patients will have one night’s stay in hospital. Once the patient is under general anaesthesia, an aspirate of their blood and/or marrow is taken with a special needle. The aspirate is then processed in the operating theatre, and while the patient is still asleep, in order to harvest the stem cells. At the same time the keyhole operation (arthroscopy) is commenced to access the hip or knee joint. The surgeon uses specialist arthroscopy techniques to prepare the tissue bed so that it is ready to receive the stem cells. The harvested stem cells, alongside a suitable scaffold, are then injected through the same keyholes that are routinely used for the arthroscopy.
- Side effects and stem cells : Any surgical intervention carries a degree of risk however the surgical procedures used for stem cell therapy are the same as those for routine hip or knee arthroscopy operations. There is a theoretical risk of infection, but this is low and surgery is in any event covered by antibiotic treatment. As for the stem cells, these are derived from the patient’s own blood or marrow, so there is no risk of rejection or disease transmission.
- Stem Cells and Evidence: Stem cell therapy is a relatively new procedure. However, it has created so much interest worldwide that extensive research has been taking place in this field. Animal and human studies have been published that have suggested a safe and favourable response to stem cell therapy in hips, knees and even ankles. Our practice routinely collects data on almost all patients who undergo surgical treatment under our care; assessment questionnaires are periodically sent to those who have undergone surgery. This is an invaluable source of information that helps us to inform our patients, publish in the literature, and to train others who are interested in the techniques we undertake.
Through many trials and research around the world scientists have injected OA patients with Bone marrow derived cells in different occasions. Their results have been thoroughly compared by peers and patients, evaluating pain scores and walking ability post treatments. Some of the trials showed that in patients with knee OA treated with intra-articular injection of autologous bone marrow-derived stem cells (BM-SCs) observed that the patients demonstrated rapid and progressive improvement of algofunctional indices by 1 year and also showed a highly significant decrease of poor cartilage areas with improvement of cartilage quality.
Another study carried out in injections of BM-SCs in knee OA was shown to improve pain, functional status of the knee, and walking distance without any adverse events. An increase in cartilage thickness and a considerable decrease in the size of edematous subchondral bone were noticed. A trial in Germany showed a good defect filling and repair of tissue with BM-SCs in patients with knee OA and a significant clinical improvement. Another study reported that BMSCs in patients with medial femoral condyle lesions, could result into normal arthroscopic appearance.
- Hear it from our Experts:
Mesenchymal Bone Marrow stem cells are one of the best sources of stem cells that have the potential to regenerate the worn out joint cartilage. Using a 360° holistic approach in order to treat your joint disorders is the best you to achieve complete joint regeneration .
The Synthesis treatment curated by our Regenerative Experts is one of a kind 360° approach that is known to regenerate the joints by using Bone marrow derived stem cells, provide an optimal environment for the cells to grow and also restore the lost joint fluid.
To find out more speak to our Stem Cell experts and you could be playing your favourite sport or running the next marathon again!