Stem Cell


    1. Once considered only in the elderly, now osteoarthritis is seen in younger patients.

      Once considered only in the elderly, now osteoarthritis is seen in younger patients.

      Human aging is associated with bone and joint degenerative changes that include loss of bone density and ligament flexibility.

    2. Chronic musculoskeletal pain accounts for most medical complaints in the United States.
    3. In 2005, one in two adults greater than 18 years of age reported experiencing musculoskeletal pain lasting 3 months or longer.
    4. Nearly 15 million Americans reported dysfunction in activities of daily living (ADL’s) as a result of a musculoskeletal ailment.
    5. Osteoarthritis is the most common type of osteoarthritis characterized by degeneration of the articular cartilage and ultimately joint destruction. – It is estimated that 27 million Americans 25 years of age and older have clinical osteoarthritis of some joints; There is a higher percentage of affliction in the older population.
    6. Once considered only in the elderly, now osteoarthritis is seen in younger patients.
    7. Osteoarthritis is a progressively debilitating and irreversible disease that affects mostly cartilage and associated changes in the bone and synovium.
    8. All joints can be affected in Osteoarthritis with the hand, knee, hip and spine being the major sites.
    9. Generally, cartilage defects in Osteoarthritis are usually large, unconfined and affect more than one location.
    10. Acute cartilage injury often occurs in normal young patients and probably requires localized treatment in contrast to patients with Osteoarthritis (the elderly) where the entire joint surface will require treatment.
    11. Osteoarthritis is the most common type of osteoarthritis characterized by degeneration of the articular cartilage and ultimately joint destruction.

      Osteoarthritis is the most common type of osteoarthritis characterized by degeneration of the articular cartilage and ultimately joint destruction.

      The disease has a striking impact on quality of life and economic costs.

    12. Cartilage damage leads to decreased function and loss of mobility and autonomy for the patient.
    13. Osteoarthritis has clear links to other conditions such as neuropathic pain, depression, and sleep disorders.
    14. Osteoarthritis is a complex condition with broad pathology and is often characterized as a biomechanical disease associated with abnormal joint loading from obesity, joint instability, or trauma, and inflammation of the joints, and genetics.
    15. There is a poor understanding of the Osteoarthritis disease mechanisms:
      1. Lack of biomarkers of early disease.
      2. Slow progression.
      3. Signaling pathways, biomechanical events and cellular functions remain obscure.
    16. Osteoarthritis is the loss of hemostasis in joints especially in articular cartilage and the underlying bone (insufficient repair response).
    17. Osteoarthritis is a major disability in the elderly.
    18. Current treatment strategies for Osteoarthritis are inadequate.
    19. Manifestations of Osteoarthritis include:
      1. Joint pain.
      2. Impairment to movement.
      3. Local tissue inflammation surrounding the joint.
    20. Much of the Osteoarthritis research has focused on the loss of articular cartilage by:
      1. Mechanical stresses.
      2. Aging or dead cells that produce cartilage.
    1. The synovium plays a crucial role in the development of Osteoarthritis of the joint.
    2. Synovial inflammation occurs in the majority of patients and is a predictive factor in the disease progression.
    3. Infiltration of T cells and macrophages are increased in the synovium in early Osteoarthritis. This indicates that synovial inflammation is a feature in early disease and might be an indicator of future tissue destruction.
    4. The synovium seems to have two faces to its role in Osteoarthritis:
      1. Inflammatory.
      2. It may be the focus of effective repair responses involving local populations of MESENCHYMAL STEM CELLS (called MSC’s). . . Where the MSC’s become activated and are capable of differentiating into cartilage, bone and other tissue which might provide repair cells to help to maintain healthy joints.
    1. Osteoarthritis is associated with a progressive and often severe inflammation. Because MSC’s have been shown to possess anti-inflammatory function, they are a suitable cell type for this purpose.


        Several characteristics of MSC’s make them attractive in this respect.

        1. MSC’s migrate to and engraft onto multiple musculoskeletal tissues, especially sites of injury.
        2. MSC’s at site of injury undergo site specific differentiation.
        3. MSC’s at the site can exert significant effects on the local environment and on resident endogenous tissue progenitor cells through direct or indirect interactions and soluble factors.
        4. MSC’s have shown potent anti-inflammatory and immunosuppressive activities.
        5. All the above make MSC’s a promising candidate for cell therapy for diseases that often involve the immune system (OA and RA).
    2. Degenerative changes seen in arthritic disease are associated with deletion of the MSC’s reservoirs or alterations in their activity.
    3. Defective activity of the MSC’s might contribute to the development of Osteoarthritis.
    4. MSC’s isolated from patients with endstage Osteoarthritis are functionally deficient in their proliferative and differentiation abilities whereby they had reduced ability to produce cartilage, fat and bone.
    1. Non-pharmacological and pharmacologic treatments are used for early and moderately early cases of Osteoarthritis, but protection of the articular cartilage has not been shown.
    2. It is a striking fact that no appropriate pharmacological intervention, biological therapy or procedure prevents the progressive destruction of the osteoarthritic joint.
    3. All current treatment regimens produce symptomatic rather than regenerative results, for example:
      1. Non-steroidals for pain.
      2. Viscosupplementation with injection of sodium hyaluron.
      3. Nutraceuticals like chondroitin sulfate, omega 3- fatty acids, etc.
    4. None of these treatments have a useful impact on the progressive loss of joint tissues that leads to the total joint replacement.
    5. Total joint replacement can be successful resulting in enhanced mobility and reduction in pain.
    6. Total joint replacement risks includes thrombosis, infection and very high cost in hospitalization and rehabilitation.
    7. There are increased risks of Osteoarthritis after meniscus or ACL injury.
    8. MSC procedures (STEM CELL injection) have had therapeutic effects in osteoarthritis possibly through their trophic effect and anti-inflammatory and immunosuppressive activities which can significantly affect the local environment in carrying out the regenerative function.
    1. First generation is Hyaluronic Acid.
      1. Successful in the treatment of painful Osteoarthritis of the knee.
      2. Benefits covered by insurance.
      3. Limits include:
        1. Temporary effect.
        2. Best used in early osteoarthritis.
    2. PRP (Second generation biologic)
      1. Has demonstrated superior results compared to Hyaluronic Acid.
      1. More powerful than PRP.
      2. Function like mini drug stores to repair injury sites.
      3. Come from multiple sources like bone marrow and adipose.
      4. The ADULT STEM CELL is an undifferentiated cell that is held in reserve until replacement or repair is needed.
      5. It can turn into many cells.
      6. It can orchestrate a repair response in joints, muscles and tendons.