Stems Cells and Knee Regeneration

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.

image

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).

image

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.

Kasemkijwattana C, Hongeng S, Kesprayura S, Rungsinaporn V, Chaipinyo K, Chansiri K.

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. chann@swu.ac.th
Abstract
OBJECTIVE:

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.

RESULTS:

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.

CONCLUSION:

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. 

About Dr Bradstreet
Dr Bradstreet is a graduate of the University of South Florida College of Medicine and received his residency training at Wilford Hall USAF Medical Center. He is a Fellow of the American Academy of Family Physicians. He is an Adjunct Professor at the Southwest College of Naturopathic Medicine in Arizona. He is extensively published in the peer-reviewed literature on subjects of autism, oxidative stress, mitochondrial disorders, virology, hyperbaric oxygen, and toxicology (especially heavy metal chelation). He is trained in the the isolation and use of stem cells.

12 Responses to Stems Cells and Knee Regeneration

  1. Cindy says:

    What is the practical way you can help autistic children with stem cells?
    Do you personally do it? Where can we do it?

    Thanks

    • Practical and children with autism are rarely used in the same sentence. I am in the process of developing an MSC self donated program for autism. It is not practical but it is manageable and the cost should be far less than existing programs – which can cost in excess of $15,000. The main autism issue is not getting or providing stem cells but anesthesia for fat harvesting since that is the source of stem cells. With cooperation it is minimally uncomfortable but teaching that to a child with autism is unlikely. The are other issues related to stem cells and viral persistence which I will discuss during my lectures on Stem Cells at Autism One.

      • Cindy says:

        I’m sorry for my bad English – when I said ‘practical’ I actually meant to ask in which way exactly does it help…through healing inflammation, etc…?
        And, after developing that program, will we be able to do it in your clinic…the whole process of preparing, anesthesia, harvesting, cleaning and finally injecting it back in the child?
        Thanks and sorry for misunderstanding

  2. Nicole Wallace says:

    I’ve heard that stem cell treatment for a child who has tested positive for XMRV is problematic as retroviruses will replicate in stem cells. Nicole

  3. Allen Martin says:

    are you accepting volunteers with bad knees for reearch & testing?

    • Knees are very complex when it comes to regenerating cartilage. Most of the best work uses fibrous scaffolding (some form of structure to support cells). One anecdote from my own process with stem cells: my right knee is largely a mess – I was seeing significant improvement with pain and swelling – which made me very happy when I got a little frisky and jumped over a ledge and tripped landing with my right knee on concrete. After I blessed myself out and felt crushed that all that good repair was lost – I got on with life. Amazingly I experienced healing within a few days – in fact everything is healing fast. Bruises, cuts scrapes and the like all heal very quickly after my stem cells. I still don’t have the knee I had before a clip in football changed it forever, but it is making steady progress without intrarticular injection and scaffolding placement.

  4. JOYCE W. CRAIG says:

    IS THEIR A PROGRAM FOR KNEE/STEM CELL THERAPY IN ALABAMA? I LIVE IN HUNTSVILLE WHICK IS NEAR VANDERBILT AND UAB IN BIRMINGHAM. IS THERE A LIST OF PHYSICIANS PRACTICING THIS THERAPY ON-LINE?
    I WANT TO VOLUNTEER FOR A RESEARCH PROJECT IF ANY ARE AVAILABLE. WILL YOU PLEASE PROVIDE ANY INFO YOU THINK MIGHT HELP ME IN MY SEARCH FOR RELIEF OF KNEE PAIN?

    • The data on knee MSC (stem cell) grafting is still mixed. It seems in serious loss of articular cartilage that the stem cells need a scaffolding to attach to. This procedure is at its infancy. A few docs around the country are trying it with arthroscopically or ultrasound directed implantation. I think it is a safe procedure but the outcome is clearly unpredictable at this time. I did see significant improvement in my own knee (status post 11 repairs including a midpatellar graft transfer) from intravenous stem cells from EmCell. It was worth the trip for me. If you want to discuss this further we should talk via appointment.

    • Heather L says:

      I have witnessed stem cell use in regenerative medicine. I was in the hyperbaric chamber back in CA with this elderly lady. She said she had already had one knee replacement, but when the doctor said it was time for the other one, she said, “I’ll get back to you.” And she did… with a MRI just 3 months after the first one showing a brand new cartilidge plate. (Yes, I have personally seen the before and after MRIs. She is quite proud of them. I was absolutely amazed).

      She had stem cell injections in conjunction with hyperbaric “dives”. She said they took out her own fat from her belly, mixed it with her own plasma and injected it into her knee. She then underwent hyperbaric oxygen therapy to increase the release of even more stem cells and voila! she had a “knee replacement” without ever being opened up. She said this was so much better than a knee replacement because she didn’t have to deal with all the pain and recovery time. She said she still did physical therapy but it was a piece of cake compared to rehabing after surgery. This lady had spunk. She said, “UC Davis has been using this procedure for million-dollar race horses for years and if it’s good enough for a million-dollar race horse, well it’s good enough for me!”

      When I met her, she was back for more hyperbaric dives. She had been in a car accident and the seatbelt tore her shoulder up (broken clavical and ripped rotator cuff, tendons and ligaments, etc.). The doctor told her she needed surgery. She told the doctor, “I’ll get back to you.” Hahahaha! She was 2 weeks into the hyperbaric dives when I met her and post the stem cell injections and she said she had almost regained full range of motion and the pain was almost all gone.

      Dr. Christen Zuschke (Regenerative Medicine Institute, Mobile, AL) does the stem cell injections. Dr. Lloyd Manchikes (Integrated Pain Management of Alabama) recently opened two hyperbaric chambers, also in Mobile, AL.

  5. noosh says:

    I jsut received my Mri report for my left knee and it reads as follows
    Complex oblinguely-oriented radial pattern –Parrot beak– type tear inner posterior horn and posterior root medial meniscus…does stem cell work on Meniscus tear…and if it does ..I linve in Phoenix , AZ…can you please direct me…I am 57yrs old

    • In this case you may benefit from primary surgical repair of the meniscus – sometimes they can sew it back together and other times they have to remove the fragment. Stem cells cannot fix this type of structural injury – at least not where the science is today. Consult your orthopedists about your arthroscopic options.

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