Stems Cells and Knee Regeneration
May 13, 2011 12 Comments
I’ve been studying stem cells for several years watching as this science starts its maturation process. There is no doubt in my mind that stem cell therapies will dominate the medical landscape in the next few decades. My colleagues and friends in Thailand have been working to enhance the restoration of lost cartilage from joints using self-donated stem cells (MSCs). This is especially important to knees and hips where cartilage loss is a common source of pain, disability and surgery. While we have made tremendous gains with surgical artificial joint replacement and resurfacing – it remains a painful and expensive process.
Below is a photo of an actual knee without significant cartilage loss. The shiny and smooth surface is cartilage and that is what gets worn out or damaged from injuries common to athletes.
This picture below is the “old school” approach: fairly radical joint replacement surgery which I hope will be replaced by stem cell implantation. (I am keeping this image small so I don’t make too many of you sick).
Below is the progress report and publication from the Thai team investigating the use of stem cells in knee arthritis. I think you will see (by contrast to this image of surgery) why I am so excited about stem cells.
Autologous bone marrow mesenchymal stem cells implantation for cartilage defects: two cases report.
J Med Assoc Thai. 2011 Mar;94(3):395-400.
Department of Orthopedics, Faculty of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakhrinwirot University, Nakhon Nayok, Thailand. firstname.lastname@example.org
The authors reported the results of autologous bone marrow mesenchymal stem cells (BM-MSCs) implantation in two patients with large traumatic cartilage defects of the knee.
MATERIAL AND METHOD:
Two patients with grade 3-4 according to the International Cartilage Repair Society Classification System were performed autologous bone marrow mesenchymal stem cells (BM-MSCs) implantation on December 2007 and January 2008. The bone marrow aspiration was performed in the outpatient visit under local anesthesia and sent to the laboratory for BM-MSCs isolation and expansion. The BM-MSCs were re-implanted into the defects with the three-dimensional collagen scaffold. The patients were clinical evaluated preoperatively and postoperatively with Knee and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Score (IKDC Score) and arthroscopic examination. The duration of follow-up was 30-31 months.
There was no postoperative complication. The clinical evaluation with Knee and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee Score (IKDC Score) showed significant improvement. The arthroscopic assessment showed the good defect fill, stiffness and incorporation to the adjacent cartilage.
The autologous bone marrow mesenchymal stem cells implantation showed the potential for the treatment of large cartilage defects. The one-stage procedure is the advantage over the conventional autologous chondrocytes implantation. The long-term follow-up with long last hyaline-like cartilage is required.
This was a different approach to what we do here in the US and it is intriguing to say the least. They used Adult MSCs (previously discussed on this blog) and did not pre-convert them to cartilage cells. I think that was a wise choice. In essence they let the MSCs decide based on their environmental signals to become a certain type of cell. It is impressive work and over the years of my travels to Thailand I have come to respect their medical community’s skills and creativity.
This is an important area of stem cell research and I like it for application to many areas. In the US we activate the stem cells with platelet factors (then use both together for implantation) and this also seems to work better than using pre-manufactured cartilage cells.