Stopping arthritis before it starts

A novel off-the-shelf bio-implant containing embryonic stem cells has the potential to revolutionize the treatment of cartilage injuries

More than a million Americans undergo knee and hip replacements each year. It’s a last resort treatment for pain and mobility issues associated with osteoarthritis, a progressive disease caused by degeneration of the protective layer of cartilage that stops our bones grinding together when we sit, stand, write, or move around.

But what if doctors could intervene and repair damaged cartilage before surgery is needed?

For the first time, researchers at the Keck School of Medicine of USC have used a stem cell-based bio-implant to repair cartilage and delay joint degeneration in a large animal model. The work will now advance into humans with support from a $6 million grant from the California Institute of Regenerative Medicine (CIRM).

The research, recently published in npj Regenerative Medicine, was led by two researchers at the Keck School of Medicine of USC: Denis Evseenko, MD, PhD, associate professor of orthopaedic surgery, and stem cell biology and regenerative medicine, director of the skeletal regeneration program, and vice chair for research of orthopaedic surgery; and Frank Petrigliano, MD, associate professor of clinical orthopaedic surgery and chief of the USC Epstein Family Center for Sports Medicine.

Osteoarthritis occurs when the protective cartilage that coats the ends of the bones breaks down over time, resulting in bone-on-bone friction. The disorder, which is often painful, can affect any joint, but most commonly affects those in our knees, hips, hands and spine.

To prevent the development of arthritis and alleviate the need for invasive joint replacement surgeries, the USC researchers are intervening earlier in the disease.

“In some patients joint degeneration starts with posttraumatic focal lesions, which are lesions in the articular (joint) cartilage ranging from 1 to 8 cm2 in diameter,” Evseenko said. “Since these can be detected by imaging techniques such as MRI, this opens up the possibility of early intervention therapies that limit the progression of these lesions so we can avoid the need for total joint replacement.”

That joint preservation technology developed at USC is a therapeutic bio-implant, called Plurocart, composed of a scaffold membrane seeded with stem cell-derived chondrocytes—the cells responsible for producing and maintaining healthy articular cartilage tissue. Building on previous research to develop and characterize the implant, the current study involved implantation of the Plurocart membrane into a pig model of osteoarthritis. The study resulted in the long-term repair of articular cartilage defects.

“This is the first time an orthopaedic implant composed of a living cell type was able to fully integrate in the damaged articular cartilage tissue and survive in vivo for up to six months,” Evseenko said. “Previous studies have not been able to show survival of an implant for such a long time.”

Evseenko said molecular characterization studies showed the bio-implant mimicked natural articular cartilage, with more than 95 percent of implanted cells being identified as articular chondrocytes. The cartilage tissue generated was also biomechanically functional—both strong enough to withstand compression and elastic enough to accommodate movement without breaking.

With support from the $6 million translational grant from CIRM, the researchers are using this technology to manufacture the first 64 Plurocart implants to be tested in humans.

“Many of the current options for cartilage injury are expensive, involve complex logistical planning, and often result in incomplete regeneration,” said Petrigliano. “Plurocart represents a practical, inexpensive, one-stage therapy that may be more effective in restoring damaged cartilage and improve the outcome of such procedures.”

For the entire article, please click on the link below:

Stopping arthritis before it starts

Mesenchymal stem cells in osteoarthritis therapy: a review

 

 

Osteoarthritis (OA) is a chronic joint disease that generally occurs worldwide with pain and disability. The progression is slow, and it is mostly diagnosed midlife and often disturbs the knees, hips, feet, hands, and spine. Sex, age, obesity, occupation, and hereditary factors are risk factors that increase the opportunity for OA. Physical examinations involving X-rays and MRI, joint fluid analysis and blood tests are common tools for the diagnosis of OA. Interventions including exercise, manual therapy, lifestyle modification, and medication can help relieve pain and maintain mobility in the affected joints, yet none of the therapies enables the promotion of regeneration of degenerated tissues. Mesenchymal stem cells (MSCs) are a promising source for the treatment of OA due to their multipotency for differentiation into chondrocytes and their ability to modulate the immune system. Herein, we review the pathogenesis and treatment of OA and address the current status of MSCs as a novel potential therapeutic agent in OA treatment.

Osteoarthritis (OA) is a common chronic disease and accounts for major physical pain and disability in older adults. It is assumed to be the fourth leading cause of disability in the world in 2020 []. OA consistently influences the knees, hips, hands, feet, and spine []. The knee is the most frequently affected site and accounts for almost 85% of the burden of OA worldwide, followed by the hand and hip []. The particular syndromes of OA encompass chronic pain, stiffness, mobility restriction, and joint tenderness []. A number of risk factors such as female sex, age, obesity, genetic factors, and Oxidative stress increase the chances of developing OA []. It is growing more prevalent today because of the combined factors of aging, obesity and the increasing numbers of damaged joints, and an estimated 250 million people are affected by this syndrome [].

The structural variations in OA include articular cartilage, subchondral bone, ligaments, synovium, and periarticular muscles. The articular cartilage defect is the most obvious syndrome of OA, which is caused by degeneration of the extracellular matrix [,]. People diagnosed with OA suffer physical weakness, mental pressure and impaired quality of daily life []. Currently, both nonpharmacological methods and pharmacological methods are applied to treat OA. Nonpharmacological methods, including self-management, regular exercise, and weight control, are highly recommended and are regarded as first-line treatments for OA [,]. Pharmacological methods recommended in the guidelines are paracetamol and NSAIDs, which are often used when nonpharmacological methods are not able to relieve pain and reduce disability. Patients with hip and knee OA who do not respond to topical analgesics are recommended to take intra-articular corticosteroids []. Duloxetine is a serotonin and norepinephrine reuptake inhibitor, which is recommended in some guidelines to reduce the severe pain of OA []. New treatments, such as nerve growth factor (NGF) antibodies, have been evaluated and have shown positive results in reducing pain in patients with hip and knee OA []. Surgical options such as joint replacement surgery, knee osteotomy, and knee joint distraction are either recommended for patients with late-stage OA or young and energetic patients with moderate radiographic severity in OA []. However, the above treatments are designed to reduce pain and improve the mobility of joints instead of promoting the regeneration of damaged articular cartilage. The regenerative treatments are intended to repair and replace the injured cells and tissues with new ones. As a regenerative cell therapy of OA, mesenchymal stem cells (MSCs) have the potential of self-renewal and differentiation into cartilage and the capability of immune modulation. A number of preclinical and clinical studies have confirmed the potential for MSCs as a novel therapeutic strategy for the treatment of OA. In this review, we provide an extensive review of the pathogenesis and treatment of OA and emphasize the therapeutic features of bone marrow MSCs (BM-MSCs), adipose tissue-derived MSCs (AD-MSCs), and umbilical cord-derived MSCs (UC-MSCs) in OA treatment (Figure 1).

To read more, please click on the link below:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868850/

 

Mesenchymal stem cells in osteoarthritis therapy: a review

Osteoarthritis (OA) is a chronic joint disease that generally occurs worldwide with pain and disability. The progression is slow, and it is mostly diagnosed midlife and often disturbs the knees, hips, feet, hands, and spine. Sex, age, obesity, occupation, and hereditary factors are risk factors that increase the opportunity for OA. Physical examinations involving X-rays and MRI, joint fluid analysis and blood tests are common tools for the diagnosis of OA. Interventions including exercise, manual therapy, lifestyle modification, and medication can help relieve pain and maintain mobility in the affected joints, yet none of the therapies enables the promotion of regeneration of degenerated tissues. Mesenchymal stem cells (MSCs) are a promising source for the treatment of OA due to their multipotency for differentiation into chondrocytes and their ability to modulate the immune system. Herein, we review the pathogenesis and treatment of OA and address the current status of MSCs as a novel potential therapeutic agent in OA treatment.

To read the entire published study, please click on the link below:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868850/

 

 

Bone Marrow Aspirate Concentrate for the Treatment of Knee Osteoarthritis: A Systematic Review

 

A systematic review was performed by searching the PubMed, Embase, and Cochrane Library databases up to July 2020 to identify human studies that assessed the clinical outcomes of isolated BMAC injection for the treatment of knee OA. The electronic search strategy used was “bone marrow aspirate concentrate knee osteoarthritis.”

Eight studies met the inclusion criteria, including a total of 299 knees with a mean follow-up of 12.9 months (range, 6-30 months). Of all patient-reported outcomes assessed across studies, 34 of 36 (94.4%) demonstrated significant improvement from baseline to latest follow-up (P < .05). Five studies evaluating numerical pain scores (visual analog scale and Numeric Rating Scale) reported significant improvements in pain level at final follow-up (P < .01). However, 3 comparative studies evaluating BMAC in relation to other therapeutic injections failed to demonstrate the clinical superiority of BMAC.

The BMAC injection is effective in improving pain and patient-reported outcomes in patients with knee OA at short- to midterm follow-up. Nevertheless, BMAC has not demonstrated clinical superiority in relation to other biologic therapies commonly used in the treatment of OA, including platelet-rich plasma and microfragmented adipose tissue, or in relation to placebo. The high cost of the BMAC injection in comparison with other biologic and nonoperative treatment modalities may limit its utility despite demonstrable clinical benefit.

 

How does Stem Cell & PRP therapies work?

Minimally invasive, cell-based therapy introduces cells from one part of the body to the impacted area, for accelerated restoration. Stem cells work by releasing proteins called growth factors to help heal, repair and restore damaged areas. An innovative, surgery-free treatment that helps your body restore itself by isolating stem cells from one location of the body to the area of disease, injury or inflammation. This process uses a minimally invasive surgical technique, conducted right in our clinic.

When you think Regenerative Medicine, names like Kobe Bryant , Chris Johnson, Alex Rodriguez, and Chauncey Billups should all come to mind. These four athletes (among many others) have used cell therapy to make unlikely recoveries from severe sports-related injuries. But how? To begin, cells are the basic structural and functional units of all living organisms. Cell therapy entails the injection of cellular material into a patient’s body. In Regenerative Medicine, the objective is to improve the biological function of damaged or degraded tissues and organs.

To this end, the injection of cellular material, either from the patient (autologous) or from a donor (allogeneic), may be employed to address a range of conditions. Cell therapies primarily fall into two categories: Platelet-Rich Plasma and Stem Cell. PLATELET-RICH PLASMA (PRP)

Platelet-Rich Plasma (PRP) or Platelet Lysate Injection Treatments is a growth factor based treatment, where blood is drawn from a patient and then placed in a centrifuge where it is spun out to separate the platelets from the remainder of the blood. To complete the process the doctor takes the platelets and recombines them with a lower volume of blood plasma to create a fluid with a higher-than-normal concentration of platelets, thus growth factors (special proteins that trigger growth and healing in the body) and then injected into damaged tissue for to help expedite the process of rebuilding collagen and tissue.

To see if you are a candidate for this type of revolutionary therapy, please contact Miami Stem Cell (305) 598-7777 to schedule a free evaluation.

 

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