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Stem Cell Treatment For Osteoarthritis Of The Knees And Hips...can It Work?

Jul 12, 2008
Osteoarthritis (OA) is the most common form of arthritis in adults and affects roughly 40 million Americans. It is a disease that affects articular cartilage, the gristle that caps the ends of long bones.

OA is a disease of weight-bearing joints such as the neck, low back, hips, and knees.

Because the ability to ambulate depends entirely on properly functioning legs, the impact of OA on the hips and knees cannot be discounted. In fact, it has been estimated that more than 100,000 Americans cannot walk independently from their bed to the bathroom.

The focus of treatment for this disease has been primarily on pain relief and lifestyle changes. Proper weight management, exercise, physical therapy, and non-steroidal anti-inflammatory drugs have been the mainstays of treatment. For patients with more severe problems, injections of corticosteroids ("cortisone") and viscosupplements have also been used.

Unfortunately, these measures, while temporizing, aid in symptom control only. There have been no treatments that have been shown conclusively to regenerate cartilage and to heal damaged cartilage.

Glucosamine and chondroitin preparations have demonstrated a modest effects in the maintenance of cartilage... but studies have demonstrated conflicting evidence in regards to the quantity of improvement.

Recently, though, there has been increased interest in the use of stem cells as a possible treatment modality for this disease.

The use of fetal stem cells is highly controversial... however, there is another good source that escapes the controversy- adult stem cells.

So what are stem cells? They are progenitor cells, meaning they are the earliest form of cell. Stem cells (SC) are manufactured in the bone marrow and are pluropotential. This means they can differentiate into any kind of tissue cell. Stem cells are responsible for growth and healing in the body.

The adult type is embryo-free and can create a specific body part, such as tissue, cartilage and bone.

So how are adult stem cells obtained? According to Dr. Nathan Wei, "Adult stem cells are harvested from the posterior iliac crest of the pelvis (the back of the pelvis. Using local anesthetic with ultrasound guidance, a small biopsy needle is introduced. A syringe is connected to the needle and is used to remove stem cells from the bone marrow." Dr. Wei goes on to say, "The stem cells are then prepared and concentrated using a technique involving a specially designed centrifuge."

"At the same time we also draw blood from the patient in order to isolate platelet rich plasma. This platelet rich plasma contains specific growth factors that promote the regeneration of collagen, a major constituent of cartilage," he adds.

He goes on to say, "We then will enter the knee with another small needle using local anesthetic and "tease" the cartilage and the tendons that are the source of the arthritis ... as well as the source of much of the pain- all under ultrasound guidance. When we're done we'll inject the stem cells and the platelet rich plasma. The end result is cartilage regeneration."

According to most experts, potential side-effects are minimal. "Most patients are surprised at how quickly they are active again. The advantage of stem cell therapy is that it's like getting a new set of tires. Unlike getting a knee replacement, you can go back to aerobics and running, Dr. Wei states."

Dr. Wei says, "The advantage is that the patient is their own donor and provides their own therapy. It's a lot like getting a blood transfusion for yourself."

Because the cells aren't foreign to the body, engineered or manipulated in any way, there's no chance for contamination or rejection when the isolated cells re-enter the body.

Dr. Wei did offer a caveat. "The procedure is best for patients in the 30-60 year age range. When patients are older, their chondrocytes- cartilage cells- don't respond as well to stimulation by the stem cells and platelet rich plasma."
About the Author
Nathan Wei, MD FACP FACR is a board-cerfied rheumatologist. For more info: Arthritis Treatment or Arthritis and Osteoporosis Center of Maryland
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