Direct stem cell injections to regenerate articular cartilage
Can direct mesenchymal stem cell injections regenerate articular cartilage?
Ross A Hauser, MD
The answer to this question is a definitive “YES” according to a peer reviewed journal article.
I enjoy reviewing articles, I kind of think it is akin to going antiquing! For those of us like me who enjoy going to antique shops, it isn’t so much that I am looking for anything in particular, it is just that hidden amongst all the “stuff” in the place is often a spectacular gemstone! If you came into my office, you will see that I have the most awesome mirror in the world! It is basically part of a saddle that you would use for horseback riding. The person cut out the middle, put in an oval mirror and buffed and shined the saddle and then sold it at an antique shop for $125. I have enjoyed that mirror now for 15 years! What does this have to do with stem cell therapy or Bone Marrow Prolotherapy? Plenty!
A recent peer-reviewed article from Tokyo Medical and Dental University on articular cartilage defects in rabbits showed that direct mesenchymal stem cell injections stimulated articular cartilage repair.1 The authors weren’t trying to prove that direct bone marrow injection stimulates articular cartilage defects to heal, because they used the direct mesenchymal stem cell injection as a control.
The study went as follows: full-thickness osteochondral defects (5mm x 5mm wide, 3mm deep) were created in the trochlear groove of the femurs in adult rabbits. The defect was filled with synovial mesenchymal cells suspension and then as controls, some of the cells were directly injected into the joint or nothing was done at all. In other words, what were the results of directly filling the defect compared to just injecting mesenchymal stem cells intra-articularly versus doing nothing at all? In total there were 36 rabbits in the study. The rabbits' knees were then examined macroscopically, histologically, as well as under the microscope for fluorescent dye (the mesenchymal stem cells were tagged with a dye to identify them.) The scoring was performed in a blinded manner by two observers.
The knees were examined at 12 weeks and 24 weeks. In the control group of animals where nothing was done, the articular cartilage defect remained, but in the intra-articular group as well as the group of animals where the mesenchymal stem cells were placed directly on the wound the defects were completely covered by new articular cartilage tissue. In the directly placed group, the regenerated cartilage matrix was well developed. In other words at 6 months, the intra-articular stem cell therapy group was regenerating articular cartilage, but it wasn’t at the level of the normal cartilage, whereas when the stem cells were placed directly on the wound, the process was taking place at a faster rate.
What does it mean? It means that if you inject stem cells into a joint that has an articular cartilage defect, the stem cells do adhere to the wound and start regenerating cartilage. You can place the stem cells on the wound or you can inject them into the joint. In other words, if you want an alternative to another knee surgery, which would be required if you want the cells placed on the articular cartilage defect, then you can just have the stem cells injected into the joint. This is what direct Bone Marrow Prolotherapy is all about. This is why I believe the best type of stem cell therapy or stem cell injection is Bone Marrow Prolotherapy.
To review Bone Marrow contains stem cells and growth factors that assist with wound healing. While the animal data is compelling, whether or not bone marrow stem cell therapy regenerates articular cartilage in humans is still debatable. Caring Medical is one of the clinics in the country using Bone Marrow Prolotherapy which is a type of stem cell therapy or stem cell injection for patients with articular cartilage and meniscus defects as an alternative to surgery.
Some of the conditions that we use Bone Marrow Prolotherapy for include the following:
In the discussion section of this study, the authors make note of the fact that the mesenchymal stem cells that did not adhere to the articular cartilage wound, adhered to synovial cells. Those who follow the work at Caring Medical know that I believe regeneration of cells other than just articular cartilage needs to occur in order for a joint to feel good. I believe synovial cells must hypertrophy and regenerate so they can make enough joint fluid so the joint doesn’t feel stiff. Remember joint fluid is what nourishes the articular cartilage and menisci. So I see the stem cells adhering to the synoviocytes as something that is beneficial. The other factor the authors note is, “These results indicate that synovial mesenchymal stem cells and bone marrow mesenchymal stem cells are useful cell sources for cartilage regeneration.” I couldn’t agree more!
Stem cells differentiating into other types of cells
Stem Cell Injection Therapy at Caring Medical: Typically we see patients every 8 weeks for stem cell injections using Bone Marrow Prolotherapy. Generally 4-5 visits are needed. We hope to discover and prove that Bone Marrow Prolotherapy is most effective means to regenerate articular cartilage and meniscus tissue in an outpatient setting.
For appointment information, click here.
To watch Dr. Hauser discuss bone marrow stem cell injection therapy, click here.
1Koga H, Shimaya M, Muneta T. Local adherent technique for transplanting mesenchymal stem cells as a potential treatment of cartilage defect. Arthritis Research Therapy. 2008;10:R84.
PMCID: PMC2575632.
Published online 2008 July 29. Doi: 10.1186/ar2460.
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