STEM CELL THERAPY FOR OSTEOARTHRITIS

Lately I’ve had quite a few conversations about Stem Cell therapies with both friends and patients, so it seems like a good time for a blog post on the topic.

Let me make clear at the start that we will only be discussing adult stem cells. None of what I’m about to explain refers to embryonic stem cells. Adult stem cells are the cells your body uses to heal and repair damaged tissue. The therapies I’m discussing concentrate your own adult stem cells, to amplify their effectiveness. Even those who are anti-abortion can benefit from adult stem cells with a clear conscience.

The reason stem cells are so exciting for Preventive and Regenerative Medicine, is that they have two unusual abilities:

  • they produce growth factors which encourage the healing of damaged cells around them, and
  • they exhibit what’s known as “plasticity,” which means that they can transform (“differentiate”) into a variety of cell types.

This combination of characteristics empowers stem cells to heal tissue that we used to think was beyond salvaging. Therapies being explored with significant success so far include:

  • growing cartilage in joints that have bone-on-bone osteoarthritis
  • improving lung function in patients with emphysema,
  • growing blood vessels in ischemic limbs—so that diabetics can heal chronic wounds instead of having their foot or leg amputated
  • treating erectile dysfunction in men who have had prostate procedures
  • improving pancreatic function (and therefore blood sugar control) in diabetics

In addition, progress is being made in devastating neurologic disorders such as spinal cord injury and stroke patients, though those treatments have a ways to go yet.

Where do we get adult stem cells from?

For decades, we’ve been using stem cells from bone marrow to treat leukemia, and more recently, to get better outcomes in orthopedic procedures. However, bone marrow is not the only source of adult stem cells. In fact, they can be obtained from body fat, which has two major advantages:

  • Unlike a bone marrow biopsy, obtaining a small amount of fat (60 to 100cc) via a mini-liposuction is essentially painless;
  • 1mL of adipose tissue contains 300 to 500 times as many mesenchymal stem cells as you can get from 1mL of bone marrow.

In many cases, the number of cells that you can get makes a difference, as you will see below.

The process of getting cells from body fat is relatively straightforward:

Circ Res . 2007;100:1249-1260.
Circ Res . 2007;100:1249-1260.

 

The aspirated fat cells are washed to remove any blood, the remaining fat tissue is incubated with an enzyme called collagenase, and then centrifuged to separate the adipocytes (fat cells) from what’s known as the stromal vascular fraction (SVF), which contains the stem cells along with other cells that contribute growth factors.

IMAGE test tube separated

However, the trick is not just to get stem cells—you want to also make sure they are alive.  A number of factors can adversely affect the viability of the stem cells, such as:

  • Using ultrasound for the liposuction
  • Incubating for too long
  • Sending the cells out of the office to be incubated elsewhere, and re-implanting them at a later date

Any of the above will give you a lower number of viable cells. But if you do it right, and use the cells immediately, here’s what you get:

IMAGE 100M cells- all viable!

Up to 100 million stem cells, almost all of them viable!  (Remember that number: 100 million. It’s about to come into play.)

WHERE’S THE BEEF?

So let’s look at some results:

In 2014 a paper was published showing the results of using this process to regrow cartilage in knees:
Intra-Articular Injection of Mesenchymal Stem Cells for the Treatment of Osteoarthritis of the Knee: A Proof-of-Concept Clinical Trial

The authors took patients with severe cartilage defects (osteoarthritis) of their knees. They performed the procedure described above, and tested three different “doses” of stem cells: 10 million, 50 million and 100 million.

As it turned out, the two lower doses didn’t help all that much. But the results using 100 million cells (there’s that number again!) were remarkable. See for yourself:

IMAGE Arthroscopy bef & after
As you can see, in the “before” photos there are huge gaps in the coverage of cartilage. In the words of the authors,

Six months after injection of Adipose-derived mesenchymal stem cells, a thick, glossy white, and firm cartilage is regenerated and covers the majority of cartilage defects.

For those of you who prefer MRIs, here are the before-and-afters, at 3 and 6 months:
IMAGE MRI bef and after

As you can see, the results are quite impressive, and the patients had dramatically reduced pain as well. The authors concluded,

These results showed that injection of 100 million adipose-derived MSCs into the osteoarthritic knee improved function and pain of the knee joint without causing adverse events, and reduced cartilage defects by regeneration of hyaline-like articular cartilage.

And that, folks, is why we do what we do.

Here I am diligently inspecting the first stem cell pellet I ever processed.
Here I am inspecting a stem cell pellet during a conference.

If you’d like to learn more about stem cell therapies and how we use them at Evolved Science, give us a call!

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