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Ross Hauser, MD

Ross Hauser, MD: the use of Stem Cell Therapy in the treatment of joint and spine degeneration.

Stem cell therapy is exploding in the medical field, and for good reason. Stem cells have the potential to regenerate into any type of body tissue. The amazing thing about stem cells is that when you inject them into the body, they know what kinds of cells your body needs for example, meniscus cells or cartilage cells. It is a very exciting time for medicine, especially in the field of regenerative medicine. In our office we often refer to this as Cellular Prolotherapy.

In Stem Cell Therapy we use a persons own healing cells from bone marrow, fat, and blood (alone or in various combinations) and inject them straight to the area which has a cellular deficiency.

The goal is the same: to stimulate the repair of injured tissues. Stem cells aid in fibroblastic proliferation where cell growth, proteosynthesis, reparation, the remodeling of tissues, and chondrocyte proliferation occurs. Our bone marrow contains stem cells,also termed mesenchymal stem cells and progenitor cells, among other names. These immature cells have the ability to become tissues like cartilage, bone, and ligaments.

Consequently, researchers and clinicians are focusing on alternative methods for cartilage preservation and repair. Recently,cell-basedtherapyhas become a key focus of tissue engineering research to achieve functional replacement of articular cartilage.1

Not all injuries require stem cells to heal. For many patients the success rate with traditionalProlotherapyin this office is in the 90%+ range for all patients. However, for those cases of advanced arthritis, meniscus tears, labral tears, bone-on-bone, or aggressive injuries, our Prolotherapy practitioners may choose to use stem cell injections to enhance the healing, in combination with dextrose Prolotherapy to strengthen and stabilize the surrounding support structures formeniscus repair.

In our research published inThe Open Stem Cell Journal,Rationale for Using Direct Bone Marrow Aspirate as a Proliferant for Regenerative Injection Therapy(Prolotherapy). We not only showed the benefit of bone marrow derived stem cells as a Prolotherapy proliferant solution, but also that this exciting field of medicine needs doctors and scientisists working together to expand research and technique guidelines.

Typically the tissue that we are trying to stimulate to repair with Stem Cell Therapy or Cellular Prolotherapy is articular cartilage, but we can also proliferate soft tissues structures such as ligament and tendons. This is new technology so we are studying it as we use it to treat patients.

We chose to review this study to support our research and to inform people about the human studies usingbone marrow stem cellsfor articular cartilage lesions. Articular cartilage is a type of cartilage that covers joint surfaces and is most susceptible to injury compared to other types of cartilage.

Researchers at Cairo University School of Medicine and the University of Pittsburgh School of Medicine reported on the use of bone marrow mesenchymal stem cells and aplatelet-richfibrin scaffold to heal full-thickness cartilage defects in five patients. The researchers studied the treatment results from the bone marrow mesenchymal stem cells which were used in a platelet rich fibrin glue, placed on the tear and covered with a flap of the patients cartilage.

Platelets were used as a scaffold because platelets contain various growth factors that stimulate cartilage regeneration. The researchers expected that the biological effect of multiplegrowth factorson tissue regeneration is greater that of a single growth factor.

Results

The patients showed significant functional improvement. Two of the patients underwent arthroscopy after the transplantation and showed near normal articular cartilage. Three postoperative MRIs revealed complete healing and congruent cartilage tissue, whereas two patient MRIs showed incomplete congruity in the cartilage tissue.

Conclusion

Osteoarthritis is a cartilage degenerative processNo treatment is still available to improve or reverse the process. Stem cell therapy opened new horizons for treatment of many incurable diseasesIn this research four patients with knee osteoarthritis were selected for the study. They were aged 55, 57, 65 and 54 years, and had moderate to severe knee Osteoarthritis. After their signed written consent, 30 mL of bone marrow were taken and cultured for MSC growth. After having enough MSCs in culture (4-5 weeks) and taking in consideration all safety measures, cells were injected in one knee of each patient.

The walking time for the pain to appear improved for three patients and remained unchanged for one. On physical examination, the improvement was mainly for crepitus. It was minor for the improvement of the range of motion.

Results were encouraging, but not excellent. Improvement of the technique may improve the results.4

Platelet Rich Plasma contains a myriad of substances that stimulate healing:

Numerous studies have shown that PRP enhances the effects of Stem Cell Therapy5,6As the study above notes Results were encouraging, but not excellent. Improvement of the technique may improve the results. Platelet Rich Plasma therapy improves the technique and improves the results.

Our ultimate goal withallforms of Prolotherapy is to get the patients back to doing the things that they want to do without pain. It is our hope that the Stem Cell Therapy (Cellular Prolotherapy) treatments will form functionally, structurally, and mechanically equal to, if not better than, living tissue which has been designed to replace (or work alongside of) damaged tissue. It is hard to prove the above statement because we cannot sacrifice human beingsafterProlotherapy to see if the tissue looks and acts normally. Wecan, however, report that the majority of our patients who receive Stem Cell Therapy along with traditional Hackett-Hemwall Prolotherapy get back to activities and have dramatically decreased pain levels using this comprehensive approach.

Links to our other articles for your specific conditions

A page with more information on stem cell injection treatments combined with Prolotherapy and PRP Treatments for back pain.

In this article wediscusses research that showsthatstem cell injection therapywill aid in the repair ofarticular cartilageandmeniscus tears. The treatment relieves symptoms of stiffness,pain, disability, and inability to walk as commonly reported by our patients diagnosed with knee osteoarthritis.

Many patients have many questions about stem cell tretament for knee osteoarthritis, lets hear yours.

References for this article

1.Mazor M, Lespessailles E, Coursier R, et al.Mesenchymal stem-cell potential in cartilage repair: an update. J Cell Mol Med. 2014 Oct 29. doi: 10.1111/jcmm.12378. 2. Diekman BO, Guilak F.Stem cell-based therapies for osteoarthritis: challenges and opportunities. Curr Opin Rheumatol. 2013 Jan;25(1):119-26. doi: 10.1097/BOR.0b013e32835aa28d. 3. Hauser RA, Orlofsky A.Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series.Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. doi: 10.4137/CMAMD.S10951. eCollection 2013. 4. Davatchi F, Abdollahi BS, Mohyeddin M, Shahram F, Nikbin B. Mesenchymal stem cell therapy for knee osteo
arthritis. Preliminary report of four patients. Int J Rheum Dis. 2011 May;14(2):211-5. doi: 10.1111/j.1756-185X.2011.01599.x. Epub 2011 5. Mishra A, Tummala P, King A, Lee B, Kraus M, Tse V, Jacobs CR. Buffered platelet-rich plasma enhances mesenchymal stem cell proliferation and chondrogenic differentiation. 2009 Sep;15(3):431-5. 6. Kasten P, Vogel J, Beyen I, Weiss S, Niemeyer P, Leo A, Lginbuhl R. Effect of platelet-rich plasma on the in vitro proliferation and osteogenic differentiation of human mesenchymal stem cells on distinct calcium phosphate scaffolds: the specific surface area makes a difference. J Biomater Appl. 2008 Sep;23(2):169-88. Epub 2008 Jul 16.

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