In this article I will present research to support the use of stem cell treatments for knee osteoarthritis. I will discuss newly published research by the Darrow Stem Cell Institute on the use of bone marrow derived stem cells and discuss the use of amniotic and placenta tissue treatments, umbilical cord blood treatments and adipose or fat derived stem cells. We will explore the newest research and clinical applications. I also invite you to ask your questions using the form below about your knee pain.
The first research we will look at was conducted at the Darrow Stem Cell Institute in Los Angeles, California on patients with knee osteoarthritis.
Short-Term Outcomes in Treatment of Knee Osteoarthritis With 4 Bone Marrow Concentrate Injections
Brent Shaw, Marc Darrow, MD JD : Darrow Stem Cell Institute, Los Angeles, CA, USA
Armen Derian : Mayo Clinic, Phoenix, AZ, USA
Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders June 18, 2018
Preliminary research suggests that bone marrow concentrate (BMC), which contains mesenchymal stem cells and platelets, is a promising treatment for knee osteoarthritis. The aim of this study was to build on this preliminary research by reporting the short-term progress of 15 patients (20 knees) with knee osteoarthritis through 4 BMC (bone marrow derived stem cell treatments.)
The timetable of the four treatments:
- First treatment
- Second treatment approximately 14 days after first treatment.
- Third treatment, approximately 21 days after second treatment, 35 days after first treatment
- Fourth treatment, approximately 34 days after the third treatment. Approximately 69 days on average after first treatment
- The last follow-up was conducted a mean 86 days after the first treatment.
What we measured: Overall improvement percentage was compared after each treatment for the following:
- pain at rest
- pain during activity
- functionality scale scores
What we found:
- Patients experienced statistically significant improvements in active pain and functionality score after the first treatment.
- Additionally, patients experienced a mean decrease in resting pain after the first treatment, yet outcomes were not statistically significant until after the second treatment.
- On average, patients experienced:
- an 84.31% decrease in resting pain,
- a 61.95% decrease in active pain,
- and a 55.68% increase in functionality score at the final follow-up.
- Patients also reported a mean 67% total overall improvement at study conclusion. Outcomes at the final follow-up after the fourth treatment were statistically significant compared to outcomes at baseline, after first treatment, after second treatment, and after third treatment.
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Supportive research on bone marrow derived stem cells
A new study in the journal Cytotherapy. 2018 Oct 11, examined the injection of mesenchymal stromal cells (bone marrow derived stem cells) as a treatment for knee osteoarthritis.
The study subjects were randomized into two groups:
- A single injection of stem cells, or
- A placebo injection of saline solution
Patients were followed up for 6 months after the injection.
Scores were recorded for :
- Pain level and function improvements to include: walking distance, painless walking distance, standing time and knee flexion compared with the placebo group at 3 and 6 months
The conclusion of this research was the bone marrow derived stem cell injection demonstrated safety and effectiveness.
- Bone marrow derived stem cell injection provided significant and clinically relevant pain relief over 6 months versus placebo. (1)
Researchers at Georgia Regents University are looking at stem cells for osteoarthritis treatment. The reason? “Current pharmacological treatment strategies are ineffective to prevent the osteoarthritic progression; however, cellular therapies have the potential to regenerate the lost cartilage, combat cartilage degeneration, provide pain relief, and improve patient mobility.” Among the cellular therapies are bone marrow-derived stem cells which have been shown to have a higher chondrogenic capability (the ability to make cartilage) than fat derived stem cells, and they have been studied more extensively than the fat derived stem cells.(2)
- Chinese university researchers writing in the journal Molecular medicine reports found that bone marrow stem cells increase the cell proliferation of chondrocytes (cartilage builders) and inhibit inflammatory activity in osteoarthritis. In common language, stem cell injections regrow cartilage and halt damaging chronic inflammation.(3)
- In one of the most cited research studies on the subject, with over 178 listed publications referencing their study, doctors in Iran found that six months after stem cell treatments, patients displayed an increase in cartilage thickness, extension of the repair tissue over the subchondral bone and a considerable decrease in the size of edematous subchondral patches (damage).(4)
As the above research shows, cartilage can be regrown, bone can be regrown, and chronic inflammation (swelling) shut off. The long-term outlook for the patients with bone marrow derived stem cells has to be thought of as a treatment with a curative effect.
Adipose (Fat derived) stem cells for knee osteoarthritis
There are numerous studies on the benefit of adipose derived stem cells for knee osteoarthritis. It is for some an effective treatment. Most of the emails we get from people asking us about the difference between adipose derived stem cells and bone marrow derived stem cells are looking for that definitive edge in which treatment they should choose.
In our office we do not use adipose stem cells. A primary reason is the liposuction procedure needed to harvest the stem cells. We are also not convinced that adipose stem cells work better than bone marrow derived stem cells. So three important factors in our decision are extra expense, discomfort of the lipo cell harvest, no clear or definitive benefit of the adipose procedure.
- Doctors at Colorado State University wrote in the Journal of orthopaedic research of how patients saw a greater improvement with bone marrow-derived mesenchymal stem cells when compared to adipose-derived (fat) stromal vascular fraction and placebo treatment.(5)
- Doctors in Taiwan noted that: Mesenchymal stem cells (MSCs) isolated from either bone marrow or adipose tissue show considerable promise for use in cartilage repair. . . MSCs can directly differentiate into chondrocytes (cartilage building cells). . . hey also have immunosuppressive and anti-inflammatory paracrine effects. (They change the joint environment from breakdown to healing by telling the other cells to start repairing.) (6)
Amniotic and Placenta tissue, Umbilical cord blood extracts for knee osteoarthritis
There is growing research in the US National Library of Medicine National Institutes of Health research base, known as “Pubmed”,” on the effectiveness of donated and processed “afterbirth” products such as amniotic fluid, placenta tissue, umbilical cord extracts, and Wharton’s Jelly. We will be updating that information here.
In new research from George Washington University and Keck School of Medicine at the University of Southern California, doctors wrote “application of placental cells or tissue allografts appears to be safe and has potential to improve outcomes for orthopaedic sports medicine indications.”(7)
At our Institute, we have been offering regenerate medicine treatments for knee osteoarthritis for more than 20 years. At this time we are only offering the bone marrow derived stem cells treatment. We have found this treatment to be effective and reliable in helping our patients. At the time of this writing I personally perform 50 – 70 bone marrow derived stem cell treatments a month.
Our conclusions about bone marrow derived stem cells for knee osteoarthritis
Returning to our own published research cited above, I would like to recap the learning points:
- We found that in the short-term, receiving multiple injections may be more effective than receiving a single BMC stem cell injection.
- Outcomes at the final follow-up after the fourth treatment were statistically significant compared with outcomes at baseline, after first treatment, after second treatment, and after third treatment.
- Functionality score increased after first treatment, illustrating that patients experienced an immediate benefit in performing everyday activities with less difficulty.
- By the second injection, patients began to report improvement with pain at rest. Patients then experienced additional decreases in resting pain with each treatment thereafter.
- The increase in mean functionality score with successive BMC treatments shows that increasing the number of BMC treatments improves patient performance in daily activities.
The present findings may provide new clinical insights into treating OA with BMC. If BMC treatments become more affordable or covered by insurance companies, there could be an increase in the number of patients receiving multiple BMC treatments for OA. If patients who reported improvement to a single injection received multiple, they may experience increased symptomatic relief such as the patients in our study. An additional finding illustrated that patients experienced a greater pain relief when injected with a high-nucleated cell count compared to a lower dose.21 Our study demonstrates that gradual increase in BMC injections in a short time period may be more effective than a single injection.
When patients were asked whether they experienced adverse side effects at each follow-up, the most common complaints were pain at the extraction site and inflammation at the injection site. Grinding, popping, and snapping sensations in the knee joint were common with specific movements, as was joint stiffness, especially 1 to 2 days following treatment. However, the stiffness generally resolved by the next follow-up visit.
Ask Dr. Darrow about your knee pain
STEM CELL INSTITUTE
A leading provider of bone marrow derived stem cell therapy, Platelet Rich Plasma and Prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025
1. Emadedin M, Labibzadeh N, Liastani MG, Karimi A, Jaroughi N, Bolurieh T, Hosseini SE, Baharvand H, Aghdami N. Intra-articular implantation of autologous bone marrow-derived mesenchymal stromal cells to treat knee osteoarthritis: a randomized, triple-blind, placebo-controlled phase 1/2 clinical trial. Cytotherapy. 2018 Oct 11. pii: S1465-3249(18)30605-4.
doi: 10.1016/j.jcyt.2018.08.005. PubMed PMID: 30318332.
2. Burke J, Hunter M, Kolhe R, Isales C, Hamrick M, Fulzele S. Therapeutic potential of mesenchymal stem cell based therapy for osteoarthritis. Clinical and Translational Medicine. 2016;5:27. doi:10.1186/s40169-016-0112-7.
3. Zhang Q, Chen Y, Wang Q, Fang C, Sun Y, Yuan T, Wang Y, Bao R, Zhao N. Effect of bone marrow-derived stem cells on chondrocytes from patients with osteoarthritis. Mol Med Rep. 2016 Feb;13(2):1795-800. doi: 10.3892/mmr.2015.4720. Epub 2015 Dec 28.
4. Emadedin M, Aghdami N, Taghiyar L, Fazeli R, Moghadasali R, Jahangir S, Farjad R, Baghaban Eslaminejad M. Intra-articular injection of autologous mesenchymal stem cells in six patients with knee osteoarthritis. Arch Iran Med. 2012 Jul;15(7):422-8.
5. Frisbie, DD, Kisiday, JD, Kawcak, CE, Werpy, NM, McIlwraith, C. Evaluation of adipose-derived stromal vascular fraction or bone marrow-derived mesenchymal stem cells for treatment of osteoarthritis. J Orthop Res. 2009;27:1675–1680.
6 Chang YH, Liu HW, Wu KC, Ding DC. Mesenchymal stem cells and their clinical applications in osteoarthritis. Cell Transplant. 2015 Dec 18.
7 McIntyre JA, Jones IA, Danilkovich A, Vangsness Jr CT. The placenta: applications in orthopaedic sports medicine. The American journal of sports medicine. 2018 Jan;46(1):234-47.