As seen in the January 24, 2020 issue of Archives of Orthopedic Trauma Surgery, researchers in Seoul, South Korea have published their findings on the efficacy of using stem cells for the treatment of osteoarthritis of the knee. Entitled, “Human umbilical cord blood-derived mesenchymal stem cell implantation for osteoarthritis of the knee,” Song et al. demonstrated a regeneration of cartilage with “satisfactory clinical outcomes in patients older than 60.” Research into the validity of biological models of care has increased dramatically in recent years. This study further points to the effectiveness of such treatments available for real time use.
Stem cells—a compelling biological treatment option
Stem cell therapy offers an innovative and versatile treatment modality across many areas of medicine. Sought after for their multipotent ability to transform into a wide variety of mature and healthy cells, stem cells have long been studied for use in clinical applications. However, to make stem cell therapy accessible, a number of factors must be overcome.
First, the sourcing of cells must be considered. Typically in osteoarthritis research, mesenchymal stem cells are used; they are classified as either embryonic, adipose-tissue, bone marrow, or umbilical cord blood-derived. For the purposes of this study, the latter source of umbilical cord blood-derived mesenchymal stem cells (UCB-MSCs) was used.
UCB-MSCs offer a few distinct advantages. First, they are much easier to obtain than cells from bone marrow; cord blood is generally regarded as medical waste and no invasive procedures are needed to access it. Once obtained, their limited exposure to environmental degradation makes them a heartier cell line to expand in the laboratory setting. Mesenchymal stem cells are frequently chosen for the study of connective tissue disorders because they reliably “home” to the site of injury. In addition, their ability to assimilate into the body without provoking an immune response is favorable over other stem cells (such as those sourced from donor marrow, for example).
Though this treament option can take several months to take effect, the invasiveness of the procedure is quite low, while the long-term gain (the possibility to be pain-free with an increased range-of-motion) is quite high
The prevalence and impact of osteoarthritic disease
Osteoarthritis (OA) is the inflammatory process that accompanies the wearing down of cartilage between bones. The joints in the hips, hands, spine, and knees are most often affected. Symptoms can range from stiffness to constant pain and loss of mobility.
The most common type of arthritis and one of the top reasons why patients seek orthopedic care, OA primarily affects the elderly. And since the world’s population is constantly aging, its incidence is expected to rise accordingly. This creates a financial burden on insurance companies and patients alike, taxed with costly surgical, pharmacological, and recovery treatment costs. When considering treatment options, patients must weight the risks and benefits of medication and side effects, surgery and weeks to months of mobility impairment (not to mention the inherent risks of surgery), and/or weekly appoints with a physical therapist.
Study methodology and further implications
Patients included in this study had a mean age of 64.9 years and exhibited a “kissing lesion” of the medial compartment of the knee. (Such a lesion refers to an area of roughness on the bone resulting from friction.) UCB-MSCs were implanted at the site of knee injury in 25 patients; they were then followed for the next two years to assess for cartilage regeneration.
At both the one and two-year mark, Song et al. saw a significant improvement for all patients within this trial. Patients of all weights improved by similar amounts; the highest improvement scores were seen in patients between the ages of 60-65 years with the highest degree of osteoarthritis.
Treatment with stem cell injections, therefore, present an enticing option. Though this treatment option can take several months to take effect, the invasiveness of the procedure is quite low, while the long-term gain (the possibility to be pain-free with an increased range-of-motion) is quite high.