Stem Cell Therapy for Arthritis

A: Osteoarthritis is a chronic condition and therefore typically requires long term medications. The commonly used treatment options are:

1. Mechanical – braces, wrapping, etc.
2. Physical – exercise, physical therapy, and occupational therapy
3. Medications which include:
   1. Non-steroidal anti-inflammatory drugs (NSAID)
   2. Steroid anti-inflammatories
   3. Non-narcotic pain medications – primarily Tylenol/acetaminophen
   4. Narcotics such as hydrocodone and others
4. Injections into affected joints. This includes steroids and numerous other newer medications
5. Durable medical equipment such as wheelchairs, canes, walkers, etc.
6. Joint repair surgery
7. Joint replacement surgery

These therapies are often considered as a hierarchy with each level building on the one below as illustrated in this diagram.

An osteoarthritis patient may be prescribed one, several or all of these at one time or another during the course of their illness. Some patients suffer without using any treatments. The effectiveness of treatment varies greatly both between patients and over the course of the illness. Many patients with osteoarthritis do very well for many years with exercise with or without NSAID. Others do very well with periodic injections or repair or replacement surgery.

For more information on the treatment of osteoarthritis visit: https://www.mayoclinic.org/diseases-conditions/osteoarthritis/diagnosis-treatment/drc-20351930

If you are a person doing well using these options, this might not be the right time to consider adult stem cell treatment.

A: If you are doing well with your current medical therapy, you may not be an ideal candidate for adult stem cell therapy. Persons should consider adult stem cell therapy for osteoarthritis include:

1. Persons who have not responded to current medical treatment
2. Persons who are no longer responding to current medical treatment
3. Persons who cannot tolerate the recommended treatment
4. Persons wishing to avoid the recommended treatment, such as surgery
5. Persons for whom nothing has been effective.

Adult stem cell therapy DOES NOT assure a response in these patients. However, it does offer an alternative that they may wish to consider. We will discuss the results below.

A: All stem cells, adult stem cells or from other sources, share two important characteristics:

1. The ability to multiply. This means in theory they can make an infinite number of copies.
2. The ability to become any type of cell. For example, stem cells from fat can become skin, muscle, or bone stem cells. The transformed cell can then make an infinite number of copies.

Stem cells that are obtained from mature adult tissues are referred to as adult stem cells. The potential exists for adult stem cells to become any type of cell. This ability to become any type of cell and then make as many cells as needed make adult stem cells an area of extreme interest. Some adult stem cells also have widespread availability. We simply have to harvest them from adult tissues. (Understanding Adipose-Derived Stem Cells) The two tissues most commonly used tissues to obtain or harvest adult stem cells are bone marrow and fat.

Fat adult stem cells are also known as adipose-derived adult stem cells. Adult stem cells from fat are easier to obtain and exist in larger numbers than bone marrow adult stem cells. These qualities have resulted in an increasing interest in fat (adipose) derived adult stem cells.

A: Currently there are no treatment groups large enough to answer this question conclusively. The Food and Drug Administration (FDA) has NOT approved the use of adult stem cells/SVF for any disorder including osteoarthritis. With those things said, we do have enough experience to talk about early trends in therapy. Adequate numbers of the knee, hip, and shoulder osteoarthritis patients have been done to give us the following patient satisfaction numbers:

1. Knee – 83% patient satisfaction
2. Hips – 80% patient satisfaction
3. Shoulders – 79% patient satisfaction

A satisfied patient can be considered a patient that is happy they had the procedure. The satisfied would make the decision to do it again after having undergone the procedure.

In another group of 34 patients who had been recommended to have a knee replacement, a similar 85% patient satisfaction was seen. Out of this group, only one had gone on to have a knee replacement at 18 months.

A: Harvesting adult stem cells from fat is very safe. The procedure has little discomfort and a fairly easy recovery. First, an area such as the stomach or leg is picked to remove the fat. We then take you to the procedure room and sterilize the area. A local anesthetic is then injected into the area. Fat is suctioned using a special syringe and cannula. Typically we suction about 50 ml (about 1 1.2 oz.) of fat.

Swelling and bruising are common following the procedure at the harvest site. Swelling and bruising typically resolve within 2-3 weeks after the procedure. Most patients receive a prescription for pain medications for use as needed. We give a dose of antibiotics before the procedure but no antibiotics are needed afterward.

Next, we take the harvested cells and use a centrifuge and incubator to do some simple processing. The processing isolates the adult stem cells from the other fat cells. The final product is called Stromal Vascular Fraction (SVF). SVF obtained from fat can contain up to about 25 million adult stem cells from 50 ml of fat. SVF also contains a large number of growth factors. Growth factors are chemical “text messages” our cells use to communicate with each other. After we have obtained the SVF, the next step is to deploy the SVF for your peripheral neuropathy.

A: The term for actually using adult stem cells/SVF is deployment. The typical deployment for osteoarthritis is into the affected joints. Separate protocols exist for injections into:

1. Knees
2. Hips
3. Shoulders
4. Ankles
5. Elbows
6. Hands
7. Neck and spine

For many of these joints, injection involves using an X-ray, ultrasound, MRI, or other imaging tools. These help ensure the adult stem cells/SVF is deployed directly into the joint. For most joints like shoulders, hips, and knees, office ultrasound can be used. CT and MRI are usually necessary for deep joints like the back or neck. Frequently, a portion of the adult stem cells/SVF is also given intravenously (IV). This allows the benefit to other less involved joints and soft tissues. IV deployment is also believed to have an anti-inflammatory effect.

A: This is the most common question asked by our adult stem cell/SVF patients. Our current level of understanding of using adult stem cells/SVF can probably answer this question better for osteoarthritis than any other area. In osteoarthritis and other disorders with a strong inflammatory component, the response tends to be quite quick. Improvement in one or two days is common. We believe this is due to the strong anti-inflammatory effect of the growth factors associated with adult stem cells/SVF. This anti-inflammatory effect lasts for 2-3 months. From there, we most commonly see continued gradual improvement as the adult stem cells help provide healing to the joint.

It is too early to say conclusively that adult stem cell treatment promotes the growth of new cartilage. However, some early evidence is pointing in that direction. Osteoarthritis may or may not require repeat deployment. Typically it is best to wait 3-6 months before considering repeat deployment. Most of the time repeat deployment is done because some improvement has been seen and more is sought. Occasionally, repeat deployment is done because the patient has lost some benefit previously gained. The question of how many and how often is an area of intense interest and close study at this time.