The Positive Effects of Stem Cell Therapy on Osteoarthritis

Sep 18, 2019

Knee osteoarthritis is a chronic disease that affects more and more individuals each year. The cartilage substance within the knee wears away, leading to symptoms such as tenderness, stiffness and pain.

It’s been said that 67 million people will be suffering from knee osteoarthritis by the year 2030. Currently, there is no treatment that can reverse the condition, and drugs and physiotherapy only provide temporary relief.

In severe cases, surgical procedures are required and even then they don’t have a guaranteed chance of success.

Recently the field of regenerative medicine, more particularly stem cell therapy, has shown promise in treating knee osteoarthritis through various studies and experiments. 

Homeopathic and medicinal advancements are always welcome, but researchers have found that stem cell studies may pave the way for new and effective treatments that could combat osteoarthritis of the knee.

Stem Cell Treatment

Self-regenerating cartilage that includes elastin fibers, cartilage matrix and chondrocytes is a slow process. During the time, newly formed cartilage substances won’t be able to carry intensive burdens.

The MSCs, or mesenchymal stem cells, inside the joint have a remarkable ability to turn into chondrocytes. But even then, the newly-formed material won’t be strong or stable enough to support even minimal pressure and stress on the joints.

Further adding to the complication is the fact that mesenchymal stem cells are not plentiful in the joint and the process of differentiating into usable material is quite slow.

Stem Cell Management

The primary use of stem cells is to facilitate or encourage the internal healing process within the knee joint cartilage, thereby relieving the patient of osteoarthritic symptoms.

It’s recommended that stem cell therapy should be combined with other treatments to bring about improved quality of life and raise the patient’s functional status.

Researchers have been using multipotent adult MSCs that are available in several tissues and can differentiate into chondrogenic material. Studies have shown that these mesenchymal stem cells may be cultured in labs without affecting their potential to differentiate into usable material.

What’s more, these stem cells have proven themselves more than capable of differentiating both inside and outside vitro. Examples of MSC collection include the adipose tissue, skeletal muscle, trabecular bone, deciduous teeth, the periosteum, and bone marrow.

Once acquired, these MSCs can turn into important material such as muscle, cartilage, fat, and bone, among others. Mesenchymal stem cells have become very promising when it comes to treating osteoarthritis and arthritis in general.

Adult MSCs in the multipotent variety are currently under scrutiny. There are a few criteria that must be taken into consideration when growing stem cells in laboratories.

Important characterized factors that can prove to be useful in treating osteoarthritis include Wingless proteins, hedgehog proteins, insulin growth factor, fibroblast growth factors, bone morphogenic protein, and transforming growth factor.

All of the materials stimulate anabolic activity and signal downstream processes which lead to cell growth, survival and proliferation, as well as reduced apoptotic signaling.

Transforming growth factor and FGF2 lead to positive differentiation. Plus, the methods used didn’t show ossification, fibrinogenesis or hypertrophy. More than that, the delivery system could potentially target the target cells without slowing down chondrogenic differentiation or compromising the tissue’s integrity.

Clinical Trials

There has been a succession of clinical trials regarding MSCs and their potency in treating osteoarthritis.

Therapeutic suggestions involving stem cells hold a significant advantage compared to traditional surgery in that there’s no need for cartilage biopsy and therefore, no extra cellular damage or external stress are applied.

The idea that a single injection could treat advanced knee osteoarthritis is appealing to both patients and clinics as well.

Patient Stem Cells

To circumvent the graft versus host disease, platelet-rich plasma and mesenchymal stem cells are collected directly from the patient. The cells are sent to specialized laboratories for processing before being re-introduced into the patient’s knee joint.

The patient’s harvested cells are studied and evaluated for helping with cartilage build-up, type 2 collagen and glycosaminoglycan deposition, and chondrogenic activity before being re-injected.

The mesenchymal stem cells are also scrutinized in vitro to see how well they could differentiate under specific conditions. Type 2 collagen and glycosaminoglycan are both essential components that help with MSC differentiation into chondrocytes.

It’s worthy to note that stress on the knees should be as minimal as possible, as the newly formed cartilage will be extremely fragile and vulnerable in extreme duress.

Stem cell injections hold both advantages and disadvantages over traditional osteoarthritis treatment. Stem cell therapy is quick and uneventful compared to current solutions. Moreover, a large percentage of patients gain ambulatory status within 24 hours. Though there aren’t any issues with a patient’s own stem cells, there is the cost of stem cell injections. 

A typical stem cell injection costs approximately $4,000 per knee. This cost isn’t typically covered by health insurance, and therefore it won’t be accessible to everyone. 

A series of tests must be conducted before a patient is deemed a good candidate for stem cell therapy. BMI, or Body Mass Index, should not go over 35 as obesity presents a huge risk due to the fact that it can place constant pressure on the affected knee.

Also, stem cell injections for knee osteoarthritis may only be used if the degeneration of the cartilage isn’t complete. The chances of success improve when the joint fluid and cartilage are readily available, but in certain cases, e.g., bone to bone contact, even stem cell therapy isn’t likely to work.

Most importantly, the patient who had just undergone stem cell therapy should stop strenuous physical activity after the injection in order to prevent stress in the affected joints. A single stem cell injection may not be enough to facilitate a complete or satisfactory recovery, which means patients may be required to go back, and this equals more time and money.

Mesenchymal stem cells may be used in other ways, such as turning them into progenitor cells that can start cartilage implantation to repair osteochondral and chondral lesions, or to produce bioactive factors to encourage regenerative action within the affected joint.

Donor Stem Cells

Allogeneic stem cells are also good material for therapeutic applications. These cells are collected from mothers after they have a normal and healthy birth, and those who have been screened for infectious diseases and other markers. The mesenchymal stem cells are checked to ensure they pass standards set by the International Blood Bank.

Umbilical cords are an excellent source of potent stem cells, and also have the benefit of circumventing invasive procedures such as bone marrow aspiration and liposuction. Studies have found that stem cells that come from umbilical cord tissue have greater positive characteristics compared to stem cells collected from fat, for example.

According to the Rush Medical Center University, MSCs harvested from a healthy mother’s umbilical cord are mixed with a natural polymer called hyaluronan, which aids in tissue and cell regeneration and healing, then injected into the patient’s affected knee joint.

In a 2-year clinical study with 18 participants, scientists enrolled patients who were aged 18 and above with BMIs, or Body Mass Index, of less than 35. At the start, six patients with lesions that ranged from 2 to 5 centimeters were enrolled. An additional six individuals were added, which had lesions greater than 5 centimeters.

All patients underwent a thorough screening process, then were closely monitored for 12 months to determine the stem cell injection’s efficacy and safety. A follow-up evaluation was made 24 months after the therapy.

Both stem cell treatments proved to be identical, whether the source came from a donor or collected from the patients. The difference in mesenchymal stem cells came from where it was collected, and ascertained the fact that older cells harvested from bone marrow and fat had less potency compared to cells harvested from umbilical cords.

Stem cells rose to prominence when it was discovered they could potentially open up a whole avenue of regenerative medicine. Biomedical research has included the use and the study of stem cells and how they could improve one’s health and treat diseases.

The most popular lines of inquiry involve a non-pharmacological knee treatment, and drug discovery. A number of cases that had knee osteoarthritis and stem cells are ongoing, but all of them are still in the stages of infancy and early development.

Current clinical investigation status about knee osteoarthritis and autologous stem cell treatment are still under observation. The most pressing concerns researchers are trying to solve include the mesenchymal stem cells’ route and mode of delivery, the kind of MSCs, intervention timing, and dosage among others.

A gold standard will be ultimately useful for all studies concerned regarding osteoarthritis of the knee and stem cell therapy. One branch has explored a unique approach of adding grafts in both scaffold-assisted and scaffold-less aspects to help with regenerating osteoarthritis of the knee.

Mesenchymal stem cell grafts are looking to be possible alternatives to knee surgery and total knee replacements in the future. Until then, we can only hope that better and cheaper procedures could be made in regards to knee osteoarthritis and stem cell therapies.

hUC-MSCs, or human derived umbilical cord mesenchymal stem cells, are facing the same issues as other kinds of MSCs in clinical trials that involve treatment of knee osteoarthritis, most notably the handling of stem cells.

Also, more clinical data is required for researchers to gain a better understanding of knee OA and how stem cells collected from human umbilical cords may be properly utilized.

In vivo and in vitro chondrogenesis research put the spotlight on stem cell therapy and how it can be used to repair damaged or lost tissue. At the same time, the field is facing somewhat similar issues in regards to tumorigenesis and stem cell characterization in vivo.

Stem cells collected and maintained in vivo are only screened for genomic profiles of the karyotype and ploidy aspects since cultured cells were known to gain or lose whole or fragmented chromosomes and undergo genomic rearrangements. Discovery of individual capacity to repair DNA and maintain genomic integrity in light of diagnostic practice and research, has blown the subject wide open.

Some researchers believed that pluripotent stem cells maintained in vitro must have markers for maintaining genomic integrity and genotoxic damage repair added to the characterization process. 

It was largely believed that some types of stem cells, including haematopoietic cells and mesenchymal stem cells collected from bone marrow and iPSCs lost the TP53 gene while in vitro culture, marked by loss of heterozygosity at the TP53 locus. Scientists have also reported that cells that have lost their heterozygosity were more likely to produce teratoma tumors that developed when the cells were injected in mice. 

There’s still a lot of work needed in stem cell biology, more particularly the understanding of basic protocol which can pass on to the advanced platforms and ultimately lead to a gold standard in regards to mesenchymal stem cells and clinical trials. Differentiation protocols, stem cell culturing and other factors remain areas for improvement within the field.

Conclusion

Researchers express cautious optimism with stem cell therapies and its promise in treating various kinds of osteoarthritis, including knee OA. It’s been forecasted that currently, there’s not enough clinical data to turn stem cells into viable forms of treatment for knee osteoarthritis.

Safety and efficacy is largely a concern. Several factors, such as donor compatibility of the stem cells, complications that may arise during and after surgery and the costs of entry are still being checked and double-checked.

As of today, the quality of data that proves the stem cell therapy’s efficacy isn’t enough to justify human treatment. Pharmacological solutions for knee osteoarthritis still have the upper hand in this regard. Newer alternatives, e.g., nutraceuticals are quickly emerging into prominence as a form of treatment for knee OA.

The race to coming up with a viable and effective treatment for osteoarthritis of the knee is close, and currently the participants are improved stem cell procedures, novel pharmaceutical methods and nutraceuticals. Which one is set to come out on top in terms of treating knee osteoarthritis and osteoarthritis in general?

To your health,

The Healing Miracle Team

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