Increased Knee Cartilage Volume in Degenerative Joint Disease using Percutaneously Implanted, Autologous Mesenchymal Stem Cells

Abstract

Background: The ability to repair tissue via percutaneous means may allow interventional pain physicians to manage a wide variety of diseases including peripheral joint injuries and osteoarthritis. This review will highlight the developments in cellular medicine that may soon permit interventional pain management physicians to treat a much wider variety of clinical conditions and highlight an interventional case study using these technologies Objective: To determine if isolated and expanded human autologous mesenchymal stem cells could effectively regenerate cartilage and meniscal tissue when percutaneously injected into knees. Design: Case Study Setting: Private Interventional Pain Management practice. Methods: An IRB approved study with a consenting volunteer in which mesenchymal stem cells were isolated and cultured ex-vivo from bone marrow aspiration of the iliac crest. The mesenchymal stem cells were then percutaneously injected into the subject’s knee with MRI proven degenerative joint disease. Preand post-treatment subjective visual analog pain scores, physical therapy assessments, and MRIs measured clinical and radiographic changes. Results: At 24 weeks post-injection, the patient had statistically significant cartilage and meniscus growth on MRI, as well as increased range of motion and decreased modified VAS pain scores. Conclusion: The described process of autologous mesenchymal stem cell culture and percutaneous injection into a knee with symptomatic and radiographic degenerative joint disease resulted in significant cartilage growth, decreased pain and increased joint mobility in this patient. This has significant future implications for minimally invasive treatment of osteoarthritis and meniscal injury. Key words: autologous mesenchymal stem cells, osteoarthritis, knee, cartilage

Intravenous injection of adipose‐derived mesenchymal stromal cells benefits gait and inflammation in a spontaneous osteoarthritis model

“…32 In general, OA is considered to be a systemic disease and decreasing overall inflammation represents one mechanism by which MSCs can assist in supporting cartilage health. 33 Although movement of guinea pigs on the treadmill improved with treatment, we did not detect a histological change in the joint at the end of the study, which is consistent with other studies of similar duration. 34 Given the short timeframe following injection, we did not anticipate structural improvements.…”

“…Further, modulation of the PGE 2 pathway has been demonstrated to ameliorate inflammation in OA 32 . In general, OA is considered to be a systemic disease and decreasing overall inflammation represents one mechanism by which MSCs can assist in supporting cartilage health 33 …”

Progress of Stem Cell Research in Knee Osteoarthritis

“…Injecting human umbilical cord MSCs into the joint cavity to treat degenerative knee arthritis has been shown in clinical trials to significantly enhance patient quality of life and joint function [27]. A severe case of knee OA was described by Centeno et al After six months of injection of bone marrow, MSCs grown in phosphate buffer suspension, the ROM score rose and the VAS pain score fell [28]. At a 6-month follow-up, the European Union reported a phase I trial on a preliminary series of 18 patients and found that MSCs produced from fat decreased the pain and function component scale of WOMAC [29].…”

Diagnostic and Therapeutic Role of Extracellular Vesicles in Articular Cartilage Lesions and Degenerative Joint Diseases

“…In recent years, stem cell therapies, especially the transplantation of MSCs, have been widely used in the field of regenerative medicine. In spite of achieving some remarkable results in ACD and early OA treatment (Murphy et al, 2003;Centeno et al, 2008;Jo et al, 2017) many safety risks limit its wide application in clinical practice, such as immune rejection (Zhang et al, 2013) and tumorigenic potential of transplanted cells (Nori et al, 2015). With the deepening of research, an increased amount of evidence showed that the beneficial effects of stem cell transplantation might not be limited to its multi-differentiation potential but more related to the paracrine secretion of trophic factors, among which EVs are considered to be one of the most critical functional components (Meirelles et al, 2009;Jin et al, 2011;Wu et al, 2011).…”