REGENERATIVE MEDICINE IS STEM CELL THERAPY
One of the most frequent questions we receive in our office is can cartilage be regrown? “I AM BONE ON BONE.”
Medical research and clinical observation has clearly shown that cartilage has poor ability to spontaneously repair itself. Traditional treatments such as microfracture (a surgical option that creates small holes in the bone to allow blood flow to the damaged cartilage area in an attempt to stimulate new cartilage growth), bone drilling and autologous osteochondral graft (cartilage from one area patched into the “hole”) were not fully satisfactory to fulfill the patient needs. This is why medical research centers on regenerative medicine (bone marrow aspirate concentrate injections or stem cell therapy) as treatments that should be further researched and possibly be considered the future of treatment for degenerative joint disease.
While stem cell therapy has been explored as possible treatments for neurological type disorders, in our practice, we focus on stem cell therapy as a treatment for musculoskeletal disorders, only. We treat degenerative joint disease, degenerative disc disease of the spine, and tendon and ligament injury.
We offer stem cells drawn from patient’s own bone marrow. Stem cells are “de-differentiated pluripotent” cells, which means that they continue to divide to create more stem cells; these eventually “morph” into the tissue needing repair — for our purposes, collagen, bone, and cartilage.
We are proud to have authored numerous research papers and forthcoming research papers on the use of stem cells in regenerative healing. These include the following peer-reviewed studies.
- Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections –
- Stem cell therapy for knee osteoarthritis – Short-Term Outcomes in Treatment of Knee Osteoarthritis With 4 Bone Marrow Concentrate Injections
The excitement in the medical community is focused on how stem cells work, rebuilding the damaged part of the body from within by turning a diseased joint environment into a healing joint environment. Doctors and researchers are hopeful that they have found a possible answer for osteoarthritis in the promise of Stem Cell Therapy.
Numerous studies support the healing effects of stem cell treatments. It should be pointed out as well that some studies suggest limited or little or no positive impact of treatment.
Stem Cell Therapy Research Studies and Reviews
Stem Cell Therapy is the injection of a damaged area of the body with stem cells that have been drawn from the patient’s own bone marrow or other sources. Stem cells are “de-differentiated pluripotent” cells, which mean that they continue to divide to create more stem cells; these cells eventually “morph” into the tissue needing repair—for our purposes, collagen, bone, and cartilage.
The excitement in the medical community is focused on how stem cells work, rebuilding the damaged part of the body from within by turning a diseased joint environment into a healing joint environment. Doctors and researchers are hopeful that they have finally found a possible answer for osteoarthritis in the promise of Stem Cell Therapy.
Numerous studies support the healing effects of stem cells. In one study (1), doctors tracked patients for five years after they had received stem cell injections for knee osteoarthritis. At the end of the five-year follow-up period, the knees of patients who had been treated with stem cells were still better than they had been before treatment. At five years, we would have to call that a “curative effect.”
Research has shown that bone marrow stem cells increase the cell proliferation of chondrocytes and inhibit inflammatory activity in osteoarthritis—in other words, according to the researchers, stem cell injections cause the regrowth of cartilage and halt damaging chronic inflammation.(2)
Stem Cell Therapy can be useful not only for the regrowth and repair of cartilage damage, but also for the repair of bone damaged by osteoarthritis. In animal studies, doctors found that stem cells injected into the site of a bone fracture promoted rapid and accelerated bone healing.(3)
The research into Stem Cell Therapy has helped revolutionize the way standardized medicine addresses problems of bone degeneration and necrosis (bone death). Cartilage can be regrown, bone can be regrown, and chronic inflammation (swelling) can be shut off.
How Stem Cell Therapy Works
In my practice, I use stem cells daily to reduce or eliminate patients’ pain involving the musculoskeletal system, including but not limited to joints, tendons, ligaments, and muscles from head to toe. The great news is that most patients see improvement with this treatment protocol.
The use of bone marrow-derived stem cells was first tested in the 1960s. Even then, doctors knew that stem cells had unique regenerative powers due to their ability to morph into bone and cartilage and migrate to the site of damage once introduced into the body. Using stem cells from a patient’s own bone marrow was particularly interesting, because these types of autologous stem cells are readily available without ethical (embryonic) problems in their use. In musculoskeletal medicine, stem cells provide an answer to the conundrum of cartilage and other soft tissue rejuvenation.
Some research suggests that the introduction of stem cells into the joint also reawakens and revitalizes the stem cells already present in the synovial fluid of the knee, as well as in the cartilage and bone.
This “supercharges” the healing process of all structures in and around the joint (cartilage, menisci, ligaments, and tendons). Stem Cell Therapy is considered a solution with limited side effects.
Where Do We Get the Stem Cells for Therapy?
For each treatment, stem cells are taken from the patient’s iliac crest at the back of the pelvis. These cells are valuable because they are undifferentiated cells, meaning that they do not have a tissue type but can grow to become other, more specialized types of cells. If a joint, cartilage, tendon, ligament, or muscle needs regeneration, stem cells can supply the building material.
How Is the Procedure Done?
The Stem Cell Therapy injection procedure is a very simple, in-office procedure with no general anesthesia, as it involves almost no pain. Moreover, it takes only about 30 minutes from start to finish. During bone marrow Stem Cell Therapy, a practitioner will inject lidocaine at the top of the buttocks, at or near the posterior superior iliac spine, to numb the area. A tiny incision (which heals quickly after the procedure) is made to allow insertion of a needle to aspirate bone marrow.
No stitches are necessary. The solution obtained is spun in a centrifuge. The stem cells are then harvested and injected into the target area or joint under ultrasound guidance when required.
Although bone marrow aspiration is typically painful during other procedures such as bone marrow transplantation, it is nearly pain free in this case. A relatively small amount is collected.
Joints: Repairing, Not Replacing
Joint osteoarthritis can involve a myriad of pathologies, among them loss of cartilage, trauma, overuse, postsurgical trauma and tissue removal, bone hypertrophy, metabolic diseases such as gout or pseudogout, and autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, and infectious destruction. When I see a patient with a previous recommendation for joint replacement surgery, it is usually because traditional medicine considers that the joint is damaged enough that repairing or providing treatment options other than replacement surgery are not practical or warranted.
However, research has clearly shown that Stem Cell Therapy can repair and rebuild bones and the cartilage that covers them. This was documented in a study (4) on diabetic patients in which doctors reported that adding stem cells from human bone marrow to a fractured diabetic bone augmented the repair process and increased the strength of the newly formed bone.
Bones of diabetics are known to be more fragile than those of nondiabetic people and can take longer to heal after a fracture. Diabetics are more likely than non-diabetics to sustain fractures as a result of falling, as they often suffer from impaired vision and reduced sensitivity in their feet.
Bones healed with the addition of Stem Cell Therapy were significantly stronger and able to withstand more stress than the bones of patients in a control group.
Stem Cells Change the Healing Environment
In new research, doctors have found that stem cells work by changing the environment of the joint they are working on—basically, they “turn on the lights” and call in construction crews of helper cells.
Researchers looked at the remodeling and healing done by osteoblasts—specialized mesenchyme-derived (stem) cells accountable for bone synthesis. They found that these cells rebuild bones through various mechanisms, including “cell homing” or “cell signaling.” (5)
What this means is that the stem cells “communicate” with the surrounding tissue to help them navigate to the site of the wound, then differentiate themselves into bone-building material. Other research suggests positive results even in cases of avascular necrosis (death of bone tissue due to a lack of blood supply), where stem cells were able to sequester blood cells to the site.(6)
This research confirms other studies (7) which speculate that not only could Stem Cell Therapy repair bone damage in cases of hip osteonecrosis (bone death), but it could also halt the disease acceleration by correcting the decrease in the local mesenchymal stem cell populations, reinforcing the natural healing environment.
In preclinical studies, the use of stem cells uniformly demonstrates improvements in osteogenesis (bone formation) and angiogenesis (blood vessel formation).(8) The stem cells modulate the healing environment in a positive manner. This manipulation of the healing environment extends beyond the bone itself to include the regeneration of cartilage. Rebuilding cartilage in severe osteoarthritis is considered one of the great challenges in orthopedic medicine. Stem cells provide a solution to this challenge because they are plentiful, can direct themselves to morph into collagen fibers (cartilage), and are able to modulate the immune response of the microenvironment of the stem cells already present in the diseased tissue.(9)
In other words, the new stem cells have the ability to change the environment and revitalize the stem cells already present in the diseased joint.
Beyond Osteoarthritis—Treatment of Tendinopathies
Are bone marrow stem cells the new player in nonsurgical tendon repair? In the latest research, doctors writing in the medical journal Hand Surgery suggest that bone-marrow derived stem cells accelerate tendon healing in animal studies.(10) Doctors know that chronic tendon injuries present unique management challenges because of the long-held belief that they result from ongoing inflammation. This thinking has caused physicians to rely on treatments demonstrated to be ineffective in the long term—e.g., anti-inflammatory medications and cortisone shots.
This is why there is mounting excitement about Stem Cell Therapy.
Published in the Journal of Muscles Ligaments Tendons, researchers from Italy wrote: “Tendon injuries represent, even today, a challenge, as repair may be exceedingly slow and incomplete. Regenerative medicine and stem cell technology have shown to be of great promise.” (11)
Most recently, a study from the Feinstein Institute for Medical Research indicated the potential effectiveness of bone marrow (stem cells) for Achilles tendon healing, particularly during the early phases.(12)
Am I Too Old for Stem Cell Therapy?
A recent study from the journal American Health and Drug Benefits suggests that to save on national health care costs, patients over the age of 70 should just have a knee replacement and not even explore steroid or hyaluronic acid (viscosupplementation injections).(13)
In recent research, doctors have noted that health care interventions for knee osteoarthritis are poorly perceived, and that patients expect the “inevitable” joint replacement. The expected failure of conservative treatment to manage pain and symptoms is common partly because clinicians frequently trivialize osteoarthritis.(14)
This is almost paradoxical. The patients are too old for other treatments, yet some doctors suggest that they should simply proceed to the most invasive and dangerous treatment that requires the most healing and recovery time. What is too old for a knee replacement? And, what is too old for extended recovery and rehabilitation? Evidently,
there is no limit.
In another recent study in the medical journal Transplantation, researchers reported results of Stem Cell Therapy in patients who showed rapid and progressive improvement (in function), with enhanced knee cartilage quality. “[Stem Cell Therapy] . . . may be a valid alternative treatment for chronic knee osteoarthritis. The intervention is simple, does not require hospitalization or surgery, provides pain relief, and significantly improves cartilage quality.”(15)
National University of Ireland rese archers suggest that stem cells should be considered as reservoirs of repair cells that fix damaged joint tissue, strengthen the healthy joint tissue while also repairing the problems associated with chronic inflammation (swelling and stiffness).(16) Duke University research agrees and adds that stem cells are viable even in elderly patients who may yet still display significant chondrogenic (cartilage regrowth) potential.(17)
In the hands of an experienced practitioner who is familiar with joint injections and the healing properties of Stem Cell Therapy, this treatment can be ideal for repairing and regenerating joint cartilage.
The research and clinic observations surrounding stem cell therapy would be too large to fit on one page. I invite you to explore these articles:
References on this page
1 Davatchi F, Sadeghi Abdollahi B, Mohyeddin M, Nikbin B. Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients. Int. J. Rheum Dis. 2015 May 20. doi: 10.1111/1756-185X.12670.
2 Zhang Q, Chen Y, Wang Q, Fang C, Sun Y, Yuan T, Wang Y, Bao R, Zhao N. Effect of bone marrow-derived stem cells on chondrocytes from patients with osteoarthritis. Mol Med Rep. 2016 Feb;13(2):1795-800. doi: 10.3892/mmr.2015.4720.
3. Huang S, Xu L, Zhang Y, Sun Y, Li G. Systemic and local administration of allogeneic bone marrow derived mesenchymal stem cells promotes fracture healing in rats. Cell Transplant. 2015; 24(12):2643-55. doi: 10.3727/096368915X687219.
4. Watson L et al. Local administration of non-diabetic MSCs to diabetic femoral fractures enhances callus remodelling and deposition of reparative bone. End Abstr. 2015; 37.
5. Titorencu I, Pruna V, Jinga VV, Simionescu M. Osteoblast ontogeny and implications for bone pathology: an overview. Cell Tissue Res. 2014 Jan;355(1):23-33. doi: 10.1007/s00441-013-1750-3. Epub 2013 Nov 29.
6. Calori GM, Mazza E, Colombo M, Mazzola S, Mineo GV, Giannoudis PV. Treatment of AVN using the induction chamber technique and a biological-based approach: Indications and clinical results. Injury. 2013 Sep 19. pii: S0020-1383(13)00423-3. doi: 10.1016/j.injury.2013.09.014. [Epub ahead of print.]
7. Hernigou P, Flouzat-Lachaniette CH, Delambre J, Poignard A, Allain J, Chevallier N, Rouard H. Osteonecrosis repair with bone marrow cell therapies: state of the clinical art. Bone. 2015 Jan;70:102-9. doi: 10.1016/j.bone.2014.04.034. Epub 2014 Jul 10.
8. Lau RL, Perruccio AV, Evans HM, Mahomed SR, Mahomed NN, Gandhi R. Stem cell therapy for the treatment of early stage avascular necrosis of the femoral head: a systematic review. BMC Musculoskelet Disord. 2014 May 16;15:156. doi: 10.1186/1471-2474-15-156. PubMed Abstract.
9. Qi Y, Feng G, Yan W. Mesenchymal stem cell-based treatment for cartilage defects in osteoarthritis. Mol Biol Rep. 2012 May;39(5):5683-9. Epub 2011 Dec 20.
10. He M, Gan AW, Lim AY, Goh JC, Hui JH, Chong AK. Bone marrow derived mesenchymal stem cell augmentation of rabbit flexor tendon healing. Hand Surg. 2015 Oct;20(3):421-9. doi: 10.1142/S0218810415500343.
11. Tetta C, Consiglio AL, Bruno S, Tetta E, Gatti E, Dobreva M, Cremonesi F, Camussi G. Muscles: the role of microvesicles derived from mesenchymal stem cells in tissue regeneration; a dream for tendon repair? Ligaments Tendons J. 2012 Oct 16;2(3):212-21. Print 2012 Jul.
12. Shapiro E, Grande D, Drakos M. Biologics in Achilles tendon healing and repair: a review. Curr Rev Musculoskelet Med. 2015 Feb 6. PubMed.
13. Pasquale MK, Louder AM, Cheung RY, Reiners AT, Mardekian J, Sanchez RJ, Goli V. Healthcare utilization and costs of knee or hip replacements versus pain-relief injections. Am Health Drug Benefits 2015 Oct;8(7):384-94.
14. Smith TO, Purdy R, Lister S, Salter C, Fleetcroft R, Conaghan PG. Attitudes of people with osteoarthritis towards their conservative management: a systematic review and meta-ethnography. Rheumatol Int. 2013 Dec 5. [Epub ahead of print.]
15. Orozco L, Munar A, Soler R, Alberca M, Soler F, Huguet M, Sentís J, Sánchez A, García-Sancho J. Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study. Transplantation. 2013 May 15. [Epub ahead of print.]
16. Barry F, Murphy M. Mesenchymal stem cells in joint disease and repair. Nat Rev Rheumatol. 2013 Oct;9(10):584-94. doi: 10.1038/nrrheum.2013.109. Epub 2013 Jul 23.
17. Diekman BO, Guilak F. Stem cell-based therapies for osteoarthritis: challenges and opportunities. Curr Opin Rheumatol. 2013;25(1):119-126.
Do you have questions? Ask Dr. Darrow
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