One of the most promising areas for arthritis treatment is the use of autologous adult mesenchymal stem cells. These are progenitor cells (cells that can differentiate into other cells) that are present within the patient.
Most descriptions of the use of mesenchymal stem cells have come from evaluations of patients with osteoarthritis. While most of these reports have been largely anecdotal, one recent presentation from our center revealed our experience with 22 patients with osteoarthritis of the knee (American College of Rheumatology meeting, November, 2010, Atlanta, Georgia).
The findings were quite encouraging. Among other joints we have evaluated include the shoulder as well as the hip. Further investigation is planned for joints such as the base of the thumb, ankle, and the base of the big toe.
What is extremely exciting is a recent report from RNL BIO, a biopharmaceutical company specializing in the use of donor adult stem cell therapeutics.
They described a patient report utilizing stem cell therapy on an orthopedic spine surgeon who suffered from autoimmune arthritis.
According to the press release, "Dr. Stanley Jones, the surgeon and patient, reports that he had a sudden onset of acute pain in his wrist in September 2009; shortly thereafter the patient experienced pain in his knees as well. Dr. Jones saw a rheumatologist who diagnosed him with autoimmune arthritis. He was placed on cortisone, a steroid hormone, to suppress immune response and alleviate pain. Unfortunately Dr. Jones suffered complications from the cortisone... His condition deteriorated and his ability to perform routine activities of daily living or his profession was impacted.
... After a workup, he received stem cell infusions in Kyoto, Japan in May 2010. Post infusion, he began to notice improvement and by the end of 5 months, he had a complete recovery and was able to resume sports as well as operating."
While the exact diagnosis regarding this patient's arthritis is unknown, the clinical presentation suggests the diagnosis of rheumatoid arthritis.
The major difference between the use of autologous mesenchymal progenitorcells in treating osteoarthritis and treating other forms of arthritis is fairly significant.
In treating osteoarthritis, we use a combination of growth factors and a tissue scaffold in order to hold the stem cells in place so that they can grow new cartilage.
The situation described above with using donor autologous mesenchymal stem cells makes use of their ability as immunomodulators.
These cells have been used in autoimmune disease such as lupus.
According to the NIH, "the objective of hematopoietic stem cell therapy for lupus is to destroy the mature, long-lived, and auto-reactive immune cells and to generate a new, properly functioning immune system"....
"The patient's own stem cells have been used in a procedure known as autologous hematopoietic stem cell transplantation. First, patients receive injections of a growth factor, which coaxes large numbers of hematopoietic progenitor cells to be released from the bone marrow into the blood stream. These cells are harvested from the blood, purified away from mature immune cells, and stored. After sufficient quantities of these cells are obtained, the patient undergoes a regimen of cytotoxic (cell-killing) drug and/or radiation therapy, which eliminates the mature immune cells. Then, the hematopoietic stem cells are returned to the patient via a blood transfusion into the circulation where they migrate to the bone marrow and begin to differentiate to become mature immune cells. The body's immune system is then restored."
( http://stemcells.nih.gov )
Essentially, this is the theory behind using autologous mesenchymal stem cells for treating other autoimmune types of arthritis such as rheumatoid disease.
Those differences aside, what is similar is that mesenchymal progenitor cells are being asked to create new tissue and correct abnormalities brought about by disease processes.
The bottom line is this: autologous mesenchymal stem cells are the future in dealing with arthritis.
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