Stem Cells For Joints?
As a potential curative for other degenerative diseases and disorders, stem cells have been increasingly used in the treatment of injuries and ailments related to ‘wear & tear’. For example, osteoarthritis, known as degenerative arthritis, is part of a group of mechanical abnormalities in the joints, especially one’s cartilage. It is distinguished by the erosion of articular cartilage, pain, stiffness, and crepitus. Traditional and current surgical procedures for joints are limited in providing pain relief and functionality to those afflicted by forms of arthritis. However, where it was once believed that the disappearance of cartilage due to arthritis was conclusive, recent discoveries in regenerative medicine have shown otherwise. Stem cell therapy has demonstrated profound healing activity in individuals with different forms of arthritis.
The specific stem cells applied to treat osteoarthritis used to come from human umbilical cord tissue – donated following women who had normal, healthy births. Usually, the ESC’s are derived from the inner cell mass of the blastocyte and differentiated into the chondrocytes necessary for cartilage regeneration. However, embryonic stem cells are considered as a better source of chondrocytes, ethical concerns and safety-related complications have researchers looking for alternatives. Therefore, recently, pluripotent and multipotent mesenchymal stem cells have been employed for osteoarthritis therapy due to the significant healing factor they provide.
The Reprogramming of Stem Cells
Induced pluripotent stem cells become reprogrammed similar to ESCs via transcription factors Oct 4, c-Myc, Klf4, Nanog, Esrrb, Linx28, and Sox2. The utilization of induced pluripotent stem cells allows regeneration but also introduces agents that promote chondrogenesis or inhibit cartilage degeneration. Whilst these studies showcase great potential, it is evident that there is a lack of efficiency due to the difficulty in reprogramming cells. Overall, because the healing potential of stem cells can facilitate the regeneration of damaged cartilage, researchers have focused on engineering the cells to differentiate into supporting osteoblasts, chondroblasts, and adipocytes for the surrounding region. If focusing on a specific area for injection, like the knee, doctors often start by taking stem cells from the patient’s bone marrow, fat tissue, or blood.
What Published Studies Show
Published studies, despite producing mixed results, have attested to cartilage regeneration and lessened pain in patients. For example, Keith Bjork, MD, an orthopedist in Amarillo, TX, suggests that his results, out of approximately 500 patients, are the strongest evidence for why stem cell therapy is beneficial. Marc Darrow, MD, physical medicine specialist in LA, notes that x-rays infer an increase in cartilage while the patients describe a decrease in pain immediately after the injection. However, researchers are not entirely certain as to how it lessens pain in patients. In arthritis, inflammation is often a common cause for pain but researchers are still unaware as to how the stem cells reduce inflammation in the affected joint – whether it’s directly or through surrounding cells.
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The majority of researchers can agree on the potential of stem cell treatments but the promise of recovery can be outweighed by the potential damage to patients. Consequently, the FDA has been debating whether to tighten regulations on stem cell clinics. In the New England Journal of Medicine, FDA officials warned the lack of evidence for unapproved stem cell treatments as being “worrisome.” There are some clinics claiming the ‘holy-grail’ to be found in regenerative medicine and offering treatments that aren’t supported by clinical research. In 2016, the FDA hosted a public workshop to promote the awareness of unofficial stem cell clinics and their potential dangers. Of course, people understand that all medical treatments have benefits and risks but the problem is staying aware, specifically about unproven stem cell therapies because they are especially unsafe. For instance, one patient went blind due to an operation of stem cell injection in the eye to treat macular degeneration. Another patient received a spinal cord injection and grew a tumor, due to the cells becoming cancerous. The FDA notes: “even if the stem cells are your own cells, there are still safety risks…”
More Research Equals Less Worry
Gradually, the concern will lessen regarding the appropriate treatment of stem cells. Additional steps are being made to publicize the dangers of unsanctioned centers; even doctors who offer the treatment for arthritic knees agree that further study is necessary. The most common side effects are joint stiffness and pain at the injection site. However, the effects are tremendously positive. Recent studies in Iran detail eighteen patients who were treated using a bone marrow concentrate injection in multiple joints, including their knee, ankle, and hip. The results show that all of them received therapeutic benefits – indicated by lower pain scores and higher function scores. The slightest adverse effect in the patients was a rash or erythema – otherwise, there was no formation of tumors or negative physiological changes.
Researchers at the University of Paris did a similar kind of study, on a large scale approach, and grated autologous bone marrow to with 342 patients who had avascular osteonecrosis at the first or second stage. Afterward, they followed up with their patients, 8 to 18 years after their initial bone marrow stem cell treatment, and concluded that patients who had the greater number of progenitor cells transplanted into their hips had far better outcomes and did not require any surgery.
Knowledge and Recovery
Consumers who decide to try stem cell treatment for achy joints should consult their doctor and research on the specifics of stem cell treatment. Questions regarding the necessary area of injection, the source of stem cells – and if it’s your own, the site of retrieval – and whether or not the donor cells or tissues were tested for maximum efficiency. The fee’s may also var and it isn’t guaranteed that your insurance company will provide coverage unless it’s a fully established procedure. The FDA also suggests that patients to ask about the clinic about the risks and benefits and if the treatment is under an FDA-approved clinical trial. As a forewarning, the treatment, at its current stage, is not a permanent solution – the relief of pain could continue for as long as 6 months or 2 years.
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