Before considering any stem cell therapy we strongly recommend you consider the other treatment options as suited to your condition. The safety of stem cell therapy is still to be fully determined. If you are considering entering into a trial or undergoing stem cell therapy privately you should discuss the treatment thoroughly with your doctor.
1. What is involved in stem cell therapy? 2. Where do the stem cells come from? 3. What benefit may stem cells have? 4. Are stem cells safe? 5. Where is the technology at? 6. Is there further research in progress? 7. Where can I get more information on cell therapy?
1. What is involved in stem cell therapy?
Adipose tissue (fat) is taken from the body (usually the abdomen) using a mini-liposuction technique. Harvested tissue is then processed to extract the stem cell component. These isolated stem cells then undergo ‘expansion’ to increase the number of cells and ultimately improve efficacy. Patients will then receive multiple injections of these cells into the arthritic joint of concern. Depending on the condition of the joint, intervention from an orthopaedic surgeon may be required to optimise the results.
All patients who undergo this type of treatment will continue to have review consultations with their treating doctor post-stem cell injections.
2. Where do the stem cells come from?
The stem cells used in this process are from your own body, they are known as autologous adult stem cells. The cells are harvested and then injected back into the area being treated on the same day. As adult stem cells are derived from the patients’ own body, they lack the ethical concerns associated with embryonic stem cells. Currently, adult stem cells are most commonly derived from either bone marrow or adipose tissue (fat), with fat providing either a similar (De Ugarte et al, 2003) or a higher yield of stem cells (Kern et al, 2006). Furthermore, the mini-liposuction technique required to harvest the adipose derived cells is less invasive and less painful than the bone marrow biopsy required to harvest bone marrow.
3. What benefit may stem cells have?
Recent investigation has demonstrated that adipose derived stem cells can differentiate into cartilage and bone supporting their potential use in the treatment in osteoarthritis (Diekman et al, 2010; Kern et al 2006). Indeed, the use of adipose derived stem cells has shown cartilage regrowth in rabbits (Dragoo et al, 2007, Cui et al, 2009) and has been shown to significantly improve function in dogs (Black et al, 2007, Black et al, 2008). Bone marrow derived stem cells have been shown to stimulate cartilage regeneration in dogs (Mokbel et, al 2010), and similarly in Pigs (Zhou et al, 2006). There have so far been 11 studies in humans looking at the use of stem cells to treat cartilage defects or osteoarthritis. These studies are all small case series and provide only limited evidence for the procedure’s efficacy.
4. Are stem cells safe?
Stem cell therapy is in a development phase. The total safety of the therapy is yet to be elucidated. Preliminary use in humans has been shown to be safe with the local injection of bone marrow derived stem cells in 339 patients (Centeno et al, 2011). bone marrow derived stem cells injected to treat knee osteoarthritis and followed up for 11 years was also shown to be safe in all 41 patients in the trial (Wakitani et, al, 2010). The use of adipose derived stem cells in humans has demonstrated its safety and efficacy in phase I and II clinical trials of up to two years (Garcia-Olmo et al, 2005; Garcia-Olmo et al, 2008; Garcia-Olmo et al, 2009). Intravenous administration of adipose derived stem cells has also been shown to be safe in mice and humans (ra et al 2011).
However, the effect on cancer has been varied. For example, a recent study reported that adipose-derived stem cells can promote the spread and invasion of breast cancer (Muehlberg et al, 2009). It should be noted that this research was performed using murine (mouse) breast cancer cells in a petrie dish, and that other studies have shown that adipose derived stem cells may inhibit breast cancer metastases and invasion in mice (Sun et al, 2009). Importantly, as stated above, phase I and II safety trials in humans injected with adipose-derived stem cells demonstrated no adverse effects, including tumor growth, in a two year follow up clinical trial.
5. Where is the technology at?
To date, we have treated a number of patients at Lakeside Sports Medicine Centre with stem cell therapy and continue to follow their results for over 12 months. Our first patient was treated in 2010 with adipose derived stem cells. This patient had a large hole in the cartilage of his left knee known as a ‘chondral defect’. He had a single injection of stem cells and his condition has been followed up with several MRI scans at 7 weeks, 5 months and 12 months post-procedure. He was featured on ‘6:30 with George Negus’ as part of Stem Cell Awareness Day. The report can be seen via this link: http://www.youtube.com/watch?v=8N2QT4AKpXM.
The pictures of how his knee progressed are below.
As you can see in the final picture there is complete coverage of the defect that has lasted out to 12 months. The patient has been pain free from 2 weeks after the procedure. He has returned to boxing and has lost 10Kg, which has undoubtedly played an important role in his pain control.
The issues with these results:
We have also treated 3 patients (4 knees) with osteoarthritis of their knees. Each of these patients received a single injection of adipose derived stem cells and have been followed for a period of over 12 months. All patients had an improvement in pain and function but none demonstrated cartilage regeneration on MRI. A graph of their outcomes based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is given below.
We interpret the results obtained from a combination of the cartilage defect cases and osteoarthritis patients in a number of ways:
We have designed a case series of 60 patients with all grades of cartilage defects and osteoarthritis. All patients will receive 4 injection and be followed for 12 months pain scales, outcome measures and MRI.
The total number of places are limited, however, we are able to offer treatment to patients. They will be treated as if in a trial and followed in the same way with pain scales, outcome measures and MRI. The results we gather will be published as a prospective case series.
There is currently NO rebate from Medicare, Workcover, TAC or Private Health Insurance for this service. We intend that the evidence we generate from our research will go towards supporting a rebate in the future.
7. Where can I get more information on cell therapy?