Regenerative therapy with Stem Cell has become a more frequent treatment for orthopedic conditions in the US, including knee, hip and shoulder osteoarthritic pain.
For those patients with joint pain, the current steps of treatment in U.S. include first, activity modification, physical therapy, and medication management. The next step in the ladder includes steroid or hyaluronic acid intrarticular injection. If this fails, then a total knee or hip replacement is offered to the patient, as the last resort, to control the pain.
Every year around more than a million patients have a total joint replacement in the US (just in the knee and hip), but there are still many patients that do not want a replacement or cannot have it for medical conditions or other matters, leaving them in a limbo for pain control.
Adult Mesenchymal Stem Cells Manage The Body’s Innate Regenerative Capability
Marrow derived adult Mesenchymal Stem Cells (MSCs) can be isolated and culture expanded. Although these cells are capable of differentiating into lineages that result in the fabrication of bone, cartilage, muscle, marrow stroma, tendon/ligament, fat and other connective tissues, MSCs have recently been shown to be intrinsically therapeutic. Such culture expanded adult MSCs are immuno-modulatory especially in muting T-cells and, thus, both autologous and allogeneic MSCs have been used to mute or cure graft-versus-host-disease, Crohn’s disease, AMI, MS, diabetes, rheumatoid arthritis, lupus and are now being tested in over 600 clinical trials for a huge spectrum of diseases (clinicaltrials.gov). Furthermore, these MSCs set-up a regenerative micro-environment which is anti-apoptotic, anti-scarring, mitotic for tissue intrinsic progenitors and angiogenic. These immuno and trophic activities result from the secretion of powerful bioactive molecules that, in combination, support localized regenerative event.
The MSCs reside in every tissue of the body and function as perivascular cells (pericytes) until a focal injury occurs. At sites of injury or inflammation, the pericyte is released and functions as a MSC that provides molecular assistance in activities leading to tissue regeneration. Such assistance involves many tasks involving the immuno-protection and trophic activities provided by the MSCs. Although it is proposed that all MSCs are pericytes and have common capacities, it is expected that MSCs from different tissues location or anatomical sites of injury will not be equivalent. Thus, adipose-derived and marrow-derived MSCs naturally reside as pericytes and have different functional capacities. The fact that uncultured, freshly isolated autologous “stromal vascular fraction (SVF)” from fat has been shown to be therapeutically effective strongly argues that the MSCs in the SVF are a potent multi-drug and site-specific delivery vehicle. The important central logic is that MSCs from a number of different tissue sources are all therapeutic for a number of different clinical conditions because they initiate and manage the host’s response capacity. Such management not only results in the arrest of disease processes, but in the regeneration of tissues previously thought to be not capable of such regeneration.
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