Articular cartilage growth with bone marrow stem cell injections
Articular cartilage regeneration with bone marrow Prolotherapy
Can animal data be transferred to humans?
Human stem cells differentiate into different cells as needed by the body.
Researchers at Kuala Lumpur Sports Medicine Centre in Kuala Lumpur, Malaysia successfully stimulated hyaline articular cartilage in a goat’s knee by simply injecting bone marrow mixed with a little hyaluronic acid (joint fluid component).1 In this study, the researchers created a 4-mm full thickness articular cartilage defect in the goat’s stifle joint (equivalent to the human knee with a defect of 200-mm2 defect) followed by subchondral drilling. Some of the goats were controls (no treatment), whereas the rest were divided into two groups, one group treated with just injection of hyaluronic acid and the other with hyaluronic acid plus 2cc of bone marrow aspirate weekly for three weeks. The bone marrow contained from 159 to 438 x 106 nucleated cells. After 24 weeks, the animals were then sacrificed and examined. Group A (controls) repaired with scar tissue, Group B (hyaluronic acid) healed with scar tissue plus a little proteoglycan and type II collagen, while Group C (Bone Marrow plus Hyaluronic Acid) showed almost complete covering of the defect with evidence of hyaline cartilage regeneration. According to the authors, “In group C the defect coverage was almost complete, and the color of the repair tissue was indistinct from surrounding cartilage. The surfaces were smooth and appeared level with adjacent normal cartilage.”1
The reason that researchers try these different approaches to stimulate articular cartilage repair is because the other surgical procedures such as autologous chondrocyte implantation or microfracture or drilling do not produce good consistent hyaline cartilage. In this paper, they note in reference to subchondral bone drillin,g “The defect is eventually replaced by a hybrid of fibrocartilage and hyaline-like cartilage rather than original cartilage. The replacement-tissue is inferior biomechanically because it is composed mainly of type I collagen, which is better at resisting tensile forces rather than compressive forces as found in a typical joint. Furthermore, whereas fibrocartilage does reduce friction when compared with bare bone, it does so to a lesser degree than hyaline cartilage.”1 Let us be reminded in this goat study, bone marrow aspirate injection stimulated new tissue formation that actually became hyaline articular cartilage!
This study is significant in that all that was used to stimulate cartilage repair from an injection standpoint was bone marrow aspirate. Unfortunately in humans, it is not as easy to study articular cartilage repair because you cannot just sacrifice humans to see if cartilage grows or not! Let’s look at this example, a human study where mesenchymal stem cells from autologous bone marrow were injected.2 In one case, the patient was doing much better clinically but when the cartilage material was examined under x-ray it was not hyaline (normal) cartilage but fibrocartilage. This means that the fibrocartilage that formed has enough properties like regular cartilage to give some pain relief, but in actuality is not hyaline or normal cartilage. MRI of the other patient in this study showed that the cartilage defect had been completely covered by the bone marrow mesenchymal cell transplantation, but because it wasn’t biopsied, you don’t know if it was covered with scar tissue (fibrous tissue), fibrocartilage, or hyaline cartilage.
Conclusion: The conclusion of this paper was that autologous bone marrow mesenchymal cell transplantation may be an effective approach to promote the repair of articular cartilage defects.
Caring Medical commentary: This reminds us again that a lot of basic scientific research has been done in regard to osteoarthritis and articular cartilage repair. We are reminded again that bone marrow does contain mesenchymal stem cells but also contains paracrine factors and support cells that affect differentiation of stem cells into cartilage and have a myriad of other functions that also helps tissue repair!
So what is the next step? Bone Marrow Prolotherapy! If you or someone you know has a large articular cartilage defect or desires an evaluation for Prolotherapy or Bone Marrow injections, contact us here.
Remember Prolotherapy stimulates the body to repair injured musculoskeletal tissues, such as ligaments, tendons, cartilage, meniscus, labrum and joints, by the induced proliferation of cells. Some of the proliferants used in Hackett-Hemwall Prolotherapy include dextrose, sodium morrhuate, testosterone, growth hormone, platelet-rich plasma and bone marrow. Typically patients are treated every four to six weeks for an average of four to six visits.
References:
1. Saw KY, Hussin P, Loke SC. Articular cartilage regeneration with autologous marrow aspirate with hyaluronic acid: an experimental study in a goat model. Arthroscopy: The Journal of Arthroscopy and Related Surgery. 2009; 25:1391-1400.
2. Wakitani S, Nawata M, Tensho K. Repair of articular cartilage defects in the patella-femoral joint with autologous bone marrow mesenchymal cell transplantation: three case reports involving nine defects in five knees. Journal of Tissue Engineering and Regenerative Medicine. 2007; 1:74-79.
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