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Stem Cell Therapy

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Article written by Lucas J. Bader MD

*Words in red are defined in Glossary section at bottom of page

What are Stem Cells?

Stem cells are a category of cells found throughout the body that have the potential to grow into many different types of cells. Stem cells can grow up to be brain cells, heart cells, lung cells; essentially any type of cell you can think of. With regards to joint disease, scientific inquiry has focused on a special subset of stem cells referred to as mesenchymal stem cells. Mesenchymal stem cells have the potential to morph into cartilage, bone, tendon, muscle, and ligament. Excellent sources of mesenchymal stem cells are fat and bone marrow. Localization of stem cells in fat and bone marrow has clinical implications since these areas can easily be accessed to harvest stem cells for use in treatment.

One of the principle findings in osteoarthritis is the inability of the joint to regenerate proper functioning cartilage cells and subchondral bone cells. Therefore, mesenchymal stem cells offer tremendous treatment potential, since in theory they can directly and/or indirectly trigger the genesis of new and optimally functioning cartilage and sub chondral bone.

Proposed Mechanism of Action:

Currently, researchers are exploring three potential mechanisms of action to explain stem cells’ ability to thwart and potentially reverse osteoarthritis.

Mechanism 1: Mesenchymal stem cells differentiate into new and correctly functioning cartilage and subchondral bone cells. These cells, in turn reduce symptoms and restore optimal joint function.  

Mechanism 2: Mesenchymal stem cells orchestrate a cascade of events through release of chemical mediators that instruct native cartilage cells, sub chondral bone cells, and synovial cells to repair themselves and the surrounding extracellular matrix. This leads to diminished symptoms and improved joint function.

Mechanism 3: Mesenchymal stem cells hinder the chronic inflammatory process that fuels the chronic pain and pervasive architectural destruction associated with osteoarthritis. As a result, symptoms dramatically subside.

All mechanisms seem plausible and most likely all three modes contribute to joint healing.

Selected Evidence:

Swiss scientists induced arthritis in goat knees. Goats injected with stem cells showed increased new tissue growth and reduced joint degeneration compared to the non-treatment group. (MurphyJM,FinkDJ,HunzikerEB,BarryFP.Stemcelltherapyinacaprine model of osteoarthritis. Arthritis Rheum. 2003;48(12):3464–3474.)

Czech researchers injected fat-derived mesenchymal stem cells into more than 1800 joints of patients with osteoarthritis. At one year from treatment, nine out of 10 participants reported a 50% or greater improvement compared to their base line. (Michalek et al. Autologous adipose tissue-derived stromal vascular fraction cells application in patients with osteoarthritis. Cell Transplant. 2015 Jan 20. doi: 10.3727/096368915X686760.)

Current Controversies:

Scientific consensus has yet to coalesce around certain aspects of stem cell treatment.  Current controversies include: a) What is the ideal source of stem cells? b) What is the optimal volume and frequency of stem cell treatment? C) What, if any, adjuvant treatments should be incorporated during the primary stem cell procedure?

Dr. Bader works closely with patients to formulate their optimal, patient-specific stem cell strategy and to give them their best chance at success.  

Click here to learn more about stem cell therapy and to schedule an appointment with Dr. Bader.

Glossary:

Cartilage: Complex biomechanical structure at the end of bones within the joint. Primarily composed of the extracellular matrix and chondrocytes. Cartilage acts to efficiently distribute force throughout the joint. The consequence of which is optimal joint motion and whole body movement. Cartilage deterioration the central hallmark of osteoarthritis.

Cartilage extracellular matrix: The environment external to chondrocytes. Main constituents include water, collagen, and proteoglycans. The matrix provides tensile and compressive strength and is responsible for cartilage’s mechanical properties. 

Chondrocyte: Chief cartilage cell. Chondrocytes synthesize the majority of the extracellular matrix components. Dysfunction and deatth of chondrocyte cells are critical steps in the genesis and propagation of osteoarthritis.

 Subchondral bone: Area of bone just beneath cartilage. Subchondral bone contains numerous blood vessels and nerve endings that serve as a conduit and communication outlet to the rest of the body. Subchondral bone influences cartilage’s shock absorption attributes and contributes to cartilage nutrition. In the later stages of osteoarthritis, sub chondral bone becomes thickened and rigid, compromising the joints ability to properly cushion joint forces.

Synovium: Produces synovial fluid. Synovium mediates the nutrient and toxin exchange between the external blood stream and the internal cartilage. Significant inflammation of the synovium is a cardinal finding of arthritis.

Are you interested in Stem Cell Therapy? Book an appointment with 
LJB Orthopedics at their locations in LA, Palmdale, & Sherman Oaks, CA.

Reference:

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  2. YelinE,MurphyL,CisternasMG,ForemanAJ,PastaDJ,HelmickCG. Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons with 
1997. Arthritis Rheum. 2007;56(5):1397–1407. 

  3. Kolf CM, Cho E, Tuan RS. Mesenchymal stromal cells. Biology of adult mesenchymal stem cells: regulation of niche, self-renewal and differentiation. Arthritis Res Ther. 2007;9(1):204. 

  4. Glenn JD, Whartenby KA. Mesenchymal stem cells: emerging mechanisms of immunomodulation and therapy. World J Stem Cells. 2014;6(5):526–539. 

  5. Stockmann P, Park J, von Wilmowsky C, et al. Guided bone regenera- tion in pig calvarial bone defects using autologous mesenchymal stem/ progenitor cells – a comparison of different tissue sources. J Crani- omaxillofac Surg. 2012;40(4):310–320.
  6. 38. Wen Y, Jiang B, Cui J, et al. Superior osteogenic capacity of different mesenchymal stem cells for bone tissue engineering. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(5):e324–e332.
  7. 39. Zuk PA, Zhu M, Ashjian P, et al. Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell. 2002;13(12):4279–4295.
  8. Barry F, Murphy M. Mesenchymal stem cells in joint disease and repair. Nat Rev Rheumatol. 2013;9(10):584–594. 

  9. MurphyJM,FinkDJ,HunzikerEB,BarryFP.Stemcelltherapyinacaprine model of osteoarthritis. Arthritis Rheum. 2003;48(12):3464–3474. 41. Horie M, Choi H, Lee RH, et al. Intra-articular injection of human
  10. mesenchymal stem cells (MSCs) promote rat meniscal regeneration by being activated to express Indian hedgehog that enhances expres- sion of type II collagen. Osteoarthritis Cartilage. 2012;20(10): 1197–1207.
  11. Wyles CC, Houdek MT, Crespo-Diaz RJ, et al. Adipose-derived mesenchymal stem cells are phenotypically superior for regeneration in the setting of osteonecrosis of the femoral head. Clin Orthop Relat Res. 2015.
  12. Michalek et al. Autologous adipose tissue-derived stromal vascular fraction cells application in patients with osteoarthritis. Cell Transplant. 2015 Jan 20. doi: 10.3727/096368915X686760

 Lucas J. Bader MD

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