Stem Cell Therapy for the Treatment of Hip Osteonecrosis: A 30-Year Review of Progress

Hernigou, Philippe; Trousselier, Matthieu; Roubineau, François; Bouthors, Charlie; Chevallier, Nathalie; Rouard, Hélène; Flouzat-Lachaniette, Charles-Henri

doi:10.4055/cios.2016.8.1.1

Cited by 126 publications

(107 citation statements)

References 45 publications

(50 reference statements)

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“…76 All in all, the combination of CD and MSCs in ON of the FH seems to be favorable compared with CD alone, when patients are treated in an earlier ON/precollapse stage and receive a greater cell number. [77][78][79][80][81] Further details on studies on cellular therapies are given in Table 4.…”

Section: Cellular Therapiesmentioning

confidence: 99%

Osteonecrosis in children and adolescents with acute lymphoblastic leukemia: a therapeutic challenge

et al. 2017

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Osteonecrosis (ON) represents one of the most common and debilitating sequelae of antileukemic treatment in children and adolescents with acute lymphoblastic leukemia (ALL). Systematic screening strategies can focus on early detection and intervention to prevent ON from progressing to stages associated with pain and functional impairment.These strategies hold promise for reducing ON-associated morbidity without the risk of impairing leukemia control. Herein, we critically reviewed clinical data on pharmacological, nonpharmacological/nonsurgical, and surgical (including cellular) treatment options for ON, which are covered in the literature and/or are conceivable based on the supposed underlying ON pathophysiology. Prevention of ON progression is of paramount importance, and attempts seem to be more effective in early (precollapse) disease status than in late-stage (collapse) ON. Based on the results of ongoing prospective magnetic resonance imaging screening studies, which will hopefully identify those patients with a high risk of ON progression and debilitating sequelae, prospective interventional studies are urgently needed. Although there is still a lack of high-quality studies, based on currently available data, core decompression surgery combined with cellular therapies (eg, employing mesenchymal stem cells) appears most promising for preventing joint infraction in children at high risk of developing late-stage ON.

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Section: Cellular Therapiesmentioning

confidence: 99%

Osteonecrosis in children and adolescents with acute lymphoblastic leukemia: a therapeutic challenge

et al. 2017

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“…[35][36][37][38] The basis for intervention has been the interpretation of stem cell therapies as high-risk biologic treatments despite data to the contrary. 10,12,21,22,39 Although an increasing number of warning letters to multiple clinics have been sent by the FDA, there are still numerous facilities that are operational and offering a full range of treatments to include administration of culture expanded cells, SVF delivered by intraarticular, intravenous, epidural, intra-discal, as well intrathecal transplantations. The US-FDA divides biologic therapies into low-risk and high-risk therapies by determining if the product has undergone minimal manipulation and autologous use (Fig.…”

Section: Regulatory Implications Facing Cartilage Regenerative Medicinementioning

confidence: 99%

Concepts in regenerative medicine: Past, present, and future in articular cartilage treatment

Anz

Bapat²,

Murrell

2016

Journal of Clinical Orthopaedics and Trauma

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Regenerative medicine is emerging with great interest and hope from patients, industry, academia, and medical professionals. Cartilage regeneration, restoration, or repair is one of the prime targets that remains largely unsolved, and many believe that regenerative medicine can possibly deliver solutions that can be widely used to address the current gap(s) in treatment. In the United States, Europe, Australia, and India the regulation of regenerative based treatments has become a big debate. Although the rules and regulations remain unclear, clinicians that are interested should carry-on with the best available guidelines to ensure safety and compliance during delivery in clinical practice to avoid regulatory infraction. Many have made significant investment of time, resources, and facilities in recent years to provide new regenerative treatment options and advance medical care for patients. Instead of reinventing the wheel, it would be more efficient to adopt currently accepted standards and nomenclature borrowed from transplantation science, and cord blood storage industries. The purposes of this article are to provide some historical background to the field of regenerative medicine as it applies to cartilage, and how this field has developed. This will be followed by a separate discussion on regulatory oversight and input and how it has influenced access to care. Furthermore, we discuss current clinical techniques and progress, and ways to deliver these treatments to patients safely, effectively, and in a cost sensitive manner, concluding with an overview of some of the promising regenerative techniques specific to cartilage.

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“…Osteonecrosis of the femoral head was one of the first conditions of the hip where cellular therapies showed good clinical outcomes for review see (51). Many of these patients have been previously treated with steroids, a drug that results in adipocyte differentiation of bone marrow stem cells.…”

Section: Use Of Msc For Orthopaedic Problemsmentioning

confidence: 99%

“…Extensive osteocyte death and the observation that reduced MSC numbers are seen in the bone marrow of the iliac crest (26) form a logical basis for this treatment and possibly recommend the use of allogeneic MSC. Another likely benefit may result from angiogenic cytokines secreted by the mononuclear bone marrow cells (51). Interestingly, the bone marrow concentrate can be percutaneously injected with a small trocar into the necrotic head (52).…”

Section: Use Of Msc For Orthopaedic Problemsmentioning

confidence: 99%

Stem Cell Considerations for the Clinician

Hasty

Cho

2016

Physical Medicine and Rehabilitation Clinics of North America

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Summary While there is ample evidence that beneficial results can be obtained from the use of MSC, several questions regarding their use remain to be answered. A better definition is needed for the mechanism/s by which the MSC are eliciting the positive outcome of their use whether it lies in the paracrine factors that are made by the MSC that affect the innate or adaptive immunity or impact the metabolism of resident cells, or their contribution as precursor cells giving rise to more differentiated reparative cells. If paracrine effects are desirable, commercial sources of allogeneic MSC could provide an easily obtainable, well-characterized reagent for the clinician. In their function as reparative cells, the longevity and fate of allogeneic MSC needs to be further evaluated on longer-term basis. The use of autologous cells has both advantages and its own inherent disadvantages involving additional procedures for collection, preparation and characterization of the MSC. It is apparent that a critical number of MSC are necessary for an optimal outcome for implantation. It remains to be determined if tissues such as adipose tissue provide more MSC than bone marrow and if the capability for differentiation is equivalent. A better understanding is also needed for how individual patient factors such as age, sex, drug regimens and co-morbidities influence the MSC population. For many of these questions, preclinical models will be helpful, but the task of evaluating and implementing these findings for orthopaedic patients falls onto the shoulders of clinical researchers. Evaluation of these questions is a daunting, but such a challenge fits the concept of personalized medicine in today’s medicine.

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Stem Cell Therapy for the Treatment of Hip Osteonecrosis: A 30-Year Review of Progress

Cited by 126 publications

References 45 publications

Osteonecrosis in children and adolescents with acute lymphoblastic leukemia: a therapeutic challenge

Osteonecrosis in children and adolescents with acute lymphoblastic leukemia: a therapeutic challenge

Concepts in regenerative medicine: Past, present, and future in articular cartilage treatment

Stem Cell Considerations for the Clinician

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