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Adult stem cells for arthritis

 

Arthrosis or, more commonly, arthritis is a degenerative or traumatic disease of articular joints. All joint structures such as cartilage, bone, synovium, meniscus, ligaments and musculature can be affected. The degeneration leads to a change, confinement or elimination of its physiological functions. An arthritis develops from the disproportion of strain and resilience of the joint. Inherent inferiority of cartilage - is the cause of primary arthritis. Causes of secondary arthritis can be metabolic interferences, neurogenic and rheumatic diseases, (inappropriate) biomechanical stresses, trauma (sports injuries), inflammation or age-related wear-out.

The appropriate therapy for arthritis depends on the extend of the degenerative or traumatic cartilage damage and can be non-operative, like physiotherapy, orthotic (brace), medicamentous, local injection therapy, radiosynoviorthetic therapy or “operative” for instance arthroscopy or artificial joint replacement. Attempts to stimulate the regeneration of cartilage by means of various non-invasive methods induced the production of fibrous cartilage, however not the regeneration of a fully functional, intact and resistant hyaline cartilage that can withstand general or athletic stresses. Based on these findings, new therapeutic concepts to treat cartilage damage by means of transplantation of autologous cells have emerged. 

Aside of the autologous chondrocyte transplantation (ACT), adult mesenchymal stem cells or ACBM - autologous concentrated bone marrow cells - are put to use for tissue engineering of bone, cartilage and soft tissue. Adult stem cells show an excellent ability to proliferate and differentiate.

A clinical therapeutic use of adult stem cells in orthopedics is a new approach. Its success depends upon many factors (extend of disease, general condition of the patient, quality of the retrieved stem cells etc.). What actually extinguishes a stem cell in its therapeutic capacity, like its ability to differentiate into various tissue or its reparative skills, remains issue of scientific research. 

 

Case study: Knee arthritis after stem cell therapy

Images: MRI of knee arthritis with edema prior (left) and after (right) adult stem cell injection. 

Example of a medial knee arthritis grade 2-3 with bone edema. This patient suffered from permanent knee pain and relied on long-term pain medication for over 1,5 years. Patient used to be an active tennis player prior to his medical condition and was not able to play sports for 1,5 years.

After a gradual deduction of pain medication following adult stem cell therapy, this patient was off his daily pain medication after 5 weeks and reported to be pain free. First attempts to play tennis with a brace at 6 weeks after stem cell therapy; normal sports activity levels were reached at 3 months after stem cell therapy.

  

Cartilage does not equal cartilage

We can distinguish between two types of cartilage: fibrocartilage and hyaline (hydrous) cartilage that is essential for functional joints and vertebral discs. Solely the complex hyaline cartilage can withstand high exposures and sustain the attenuation function of joints and discs. Fibro cartilage is not suit to withstand these extreme impacts. 

The capacity of adult, autologous stem cells to build and regenerate hyaline cartilage can be exemplified in the following magnetic resonance images. The images display the degenerative, dried out nucleus of lumbar discs prior and after an abrasion surgery on the adjacent vertebral joint. The abrasion technique caused a bleeding of the bone and stimulated repair mechanisms of the adult stem cells embedded in the vertebral bone marrow. The treated discs were followed up by another MRI 3 months after the abrasion and clearly displayed hyaline cartilage structures (new nucleus – the so called neo-nucleus). 

(Source: M.John, T.Hoogland et al: Die perkutane, transforaminale, endoskopische Diskusabrasion: Eine neue interventionelle Therapie zur Regeneration schmerzhaft degenerativer lumbaler Bandscheiben, 2007).

 

 

 

Case 1: The pre operative images display the affected vertebral disc as remarkably darker with a predominantly fiberous, degenerative cartilage. Post operative images at 3 months display a hyaline disc nucleus. 

 

 

 

Case 2: The pre operative MRI (above) displays a dried out intervertebral disc L4-5 that consists predominantly fibrocartilage. 3 months post operative MRI (below) shows a disc with a new, hydrated hyaline cartilage nucleus.   

 

 

 

 

 

 

Therapy Spectrum 

 

ACS - Autologous Conditioned Serum

 

ACP - Autologous Conditioned Plasma

 

ACBM - Autologous Concentrated Bone Marrow

 

Hyaluronic Acid

 

Alternative Therapies 

 

Homeopathy 

 

DNA Analysis