Can Your Own Stem Cells Regenerate Cartilage?

Lay media attention on stem cell (SC) therapy has generally focused on two areas:

1. The promise of embryonic SC
2. The proliferation of charlatans preying on the dreams and fears of helpless patients.

While embryonic SC, in theory, appear to potentially be the best option for tissue regeneration, the hype has exceeded the hope. Because of political and ethical concerns, research efforts using these cells has been disappointing.

At the same time, news articles and television commentaries have also dealt with controversial areas of SC therapy. An inordinate amount of time has been devoted to exposing the seamy side... individuals involved in obvious hucksterism, the possible abuse of SC therapy by practitioners, as well as the implication that all SC research conducted outside academic centers is suspect.

As a result, there has been neglect regarding of some fascinating and promising work, particularly in arthritis treatment.

One of the more intriguing studies was recently published by Korean investigators (Pak J. Regeneration of human bones in hip osteonecrosis and human cartilage in knee osteoarthritis with autologous adipose-derived stem cells: a case series. J Med Case Reports. 2011; 7: 296)

The Korean physicians treated four patients. Two (a 29 year old woman and a 47 year old man) had osteonecrosis of the hip. Two other patients (a 70 year old woman and a 79 year old man) had osteoarthritis of the knee. They were all given a mixture of autologous stem cells (the patient's own stem cells) derived from fat along with platelet rich plasma, hyaluronic acid, nanogram amounts of dexamethasone, and calcium chloride.

Pre and post treatment MRI scans were obtained in all subjects. In the case of patients with osteonecrosis, new bone formation was noted. In the patients with osteoarthritis, new cartilage formation was seen.

Along with the MRI findings, both subjective pain measures and functional outcomes improved.

I found these findings to be extremely interesting for a number of reasons.

First, the mixture used in the Korean report is similar to the one that we use at our center, with one exception. The exception is this: In addition to the SC, we also use bone marrow derived stem cells.

And, while our center has had excellent results with knee osteoarthritis (more than 90 per cent success), our experience with both hip osteoarthritis as well as hip osteonecrosis has been disappointing.

Why the difference between hip and knee? I suspect it's because the mechanical forces are different. The anatomy of the hip joint allows extreme rotation as opposed to the knee joint which is primarily a hinge joint with some rotation and some gliding. Activity level and body weight may also be contributing factors.

Nonetheless, this report from Korea underscores what we believe to be true... the use of autologous stem cells, also known as repair stem cells, will prove to be a fruitful area of progress in osteoarthritis research for years to come.