March 27, 2016 Zoe Heard

Stem Cell Therapy and Osteoarthritis

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A recent media release has created significant interest in stem cell therapy as a treatment for osteoarthritis. Is the hype and promise created able to be substantiated?

In real estate parlance, I would use the old chestnut – “Caveat Emptor” – Buyer Beware.

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Osteoarthritis is a condition characterized by generalized wear/loss of joint surface layer (articular cartilage) on 2 opposing joint surfaces. This can create pain, swelling, stiffness and functional deficit. Unfortunately once this joint surface layer is damaged or worn it has virtually no ability to heal itself. Osteoarthritis or articular cartilage wear develops because of multiple reasons – age, activity, obesity, injury to the joint surface or important supporting structures such as ligaments or menisci, joint malalignment, activation/release of bad biomolecules and probably other reasons that have yet to be identified. Osteoarthritis is a complex disorder with many facets.

The basic science behind stem cell treatments is interesting. In a nutshell, stem cells are the “parents” of different lines of tissue cells. Mesenchymal stem cells are capable of differentiating (transforming) into muscle, tendon, bone or joint surface cells (chondrocytes) given the right circumstances and environment. These chondrocytes are important in looking after the joint surface layer but have a very limited regenerative (repair) capacity. Basic laboratory studies have shown stem cells are capable of producing joint surface like tissue in some circumstances. It is thought in some circles that injecting stem cells into an arthritic joint may enable some repair or restoration of a joint surface layer. The theory sounds good – but does it work in practice?

Well we don’t know. To date unfortunately there are no randomised published scientific studies in peer review journals that indicate that stem cell injections reconstitute articular cartilage and allow for reversal of an arthritic process. I’m always a bit wary of treatments that are hailed as “miracles” in the media, before there are any credible published results. Using patient testimonials or observational registries as a support for stem cell therapy does NOT constitute proof of treatment success. This is not the way that reputable centres and individuals seek to promote themselves, their treatments and their businesses.

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Interestingly here in Australia and in the US, the relevant health regulatory authorities have approved stem cell therapy only for the treatment of some leukaemias and blood disorders. For all other conditions it is considered experimental treatment but there is no regulation over patients receiving treatment that involves the use of their own stem cells. The Therapeutic Goods Administration has hinted that there will be a crackdown on centres promoting and undertaking stem cell treatments for non approved conditions.

I recognize that there are patients with osteoarthritis for whom conventional treatment techniques don’t result in a lot of improvement and for whom surgical procedures are not ideal. Unfortunately these people are vulnerable and are easily lured into trying unproven and often expensive treatment modalities with the promise of a cure. I’m not against stem cell or any other reasonable treatments for osteoarthritis and we certainly don’t want to stifle innovation and progress and credible research.

Stem cell therapy needs to be undertaken in a controlled and responsible manner by practitioners who are genuinely looking to help sufferers and to try and find answers to osteoarthritis through responsible and rigorous research that is subject to scrutiny by the scientific community. We do not need the current unregulated “free for all” approach to stem cell therapy that currently exists, undertaken by medical businesses with questionable motives. If you are considering these treatments, do your homework and go in with open eyes. Do not be blinded by media hype for a treatment that offers much but to date has produced little.

For more information on stem cell therapies, the Stem Cells Australia website at http://www.stemcellsaustralia.edu.au/ is an excellent educational resource put together by most of the major universities and research organisations in Australia.

There are some excellent handouts regarding stem cell therapies that are downloadable for patients at:

https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/rm001a_stem_cell_treatments_faq_131220.pdf

http://www.stemcellsaustralia.edu.au/AboutUs/Document-Library/Patient-Information.aspx

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