13/07/2021
Stem cells treatment in Ukraine: regenerative medicine against osteoarthritis
From a biological perspective, degenerative cartilage diseases (e.g. articular cartilage defects) such as osteoarthritis are clinically challenging entities because chondrocytes have hardly limited native regeneration potential. Stem cell treatment as a last approach of regenerative medicine can resolve this problem, at least particularly.
Does it really work?
The years of clinical practice have shown a huge potential for stem cells to promote chondrogenesis. Mesenchymal stem cells may serve as a chondrocyte source where endogenous regeneration may be limited. Over the last several years, clinical studies have explained the use of mesenchymal stem cells in isolation as injectable and as surgical adjuvants for cartilage regeneration and treatment of knee degenerative conditions.
An unprecedented efficacy of mesenchymal stem cells in treating degenerative conditions of the knee has emerged in the last several years. Now we have a lot of evidence proving stem cell treatment: stem cell therapy may help restore cartilage focally or diffusely where the nascent regenerative potential in the intra-articular surroundings is limited. Novel research directions should include work on elucidating optimal cell concentration and dosing, as well as standardization in methodology and reporting in prospective trials.
How does it work?
In addition to their chondrogenic potential, mesenchymal stem cells are an ideal alternative cell source for cartilage repair for several reasons. Firstly, mesenchymal stem cells are easily cultured and have the ability to self-renew while undergoing differentiation into mesenchymal lineages. Secondly, mesenchymal stem cells also have significant paracrine activity wherein growth factors and cytokines nourish cartilage via angiogenesis and direct chondrocyte proliferation in a feedback loop. Finally, mesenchymal stem cells can act as immunomodulatory mediators. Clinical evidence proved that stem cells therapy is:
- A non-operative therapeutic option;
- An adjuvant therapy.
With the potential for chondrogenesis from a rich and readily available cell source, mesenchymal stem cell therapy is a potential area wherein novel non-operative and operative approaches for the treatment of knee cartilage defects and osteoarthritis.
Which kind of stem cells physicians can use to restore your cartilage? In the context of cartilage regeneration for the treatment of osteochondral defects and osteoarthritis, stem cell therapy usually describes the use of mesenchymal stem cells. Mesenchymal stem cells are a broad category of adult multipotent stromal cells that have the potential to self-renew and directionally differentiate into multiple lineages of cells including osteoblasts (bone), adipocytes (fat), myocytes (muscle), and chondrocytes (cartilage). Many clinics prefer to use allogeneic mesenchymal stem cells derived and expanded from the human umbilical cord and bone marrow.
Ukrainian scientists can offer (instead of invasive surgery or useless pharmacotherapy) various types of stem cell treatment depends on:
- Stage of cartilage disease;
- Diagnostic findings;
- Client’s health status, and his preferences.
Nowadays, mesenchymal stem cells relevant for knee cartilage regeneration are numerous and varied in quality. Ukrainian experts can use mesenchymal stem cells derived from bone marrow, adipose, and umbilical tissue to treat osteoarthritis, or other cartilage defects. All these types of stem cells have the capacity for self-renewal and differentiation into the chondrocyte lineage.
What about adverse events?
The majority of adverse events included local transient pain and swelling at the injection site.
What kind of treatment should I choose? In Ukraine, medical experts use various stem cell-based approaches, both in isolation and as adjuvants to existing surgical therapies, for the treatment of osteochondral lesions and osteoarthritis as a spectrum of degenerative diseases of the knee.
For example, they can inject mesenchymal stem cells to the synovium for modulating gene expression patterns to reduce matrix metalloproteinase expression with less cartilage degeneration. Injection of cultured mesenchymal stem cells induced partial regeneration of hyaline cartilage, which occurred more quickly in the group pretreated with low-dose steroids. Some physicians also use multiple rounds of stem cell therapy and reach the necessary effect on reducing chondrocytes loss.
Intra-articular mesenchymal stem cell injections have been combined with various growth factors, cytokines, and drug delivery materials in an attempt to improve clinical efficacy as well. In addition to the evidence for injectable mesenchymal stem cell therapy, there is broad clinical experience describing the use of mesenchymal stem cell therapy as an intraoperative adjuvant for cartilage regeneration in procedures such as arthroscopic drilling. In any case, a stem cell treatment program has to be created in individual mode after a detailed check-up and examination.
Due to local legal nuances, Ukrainian experts may help realize clinical potential stem cell therapy that should include standardized study methodology and reporting, further study on dosing, and comparison with other therapies to demonstrate clinical efficacy and safety.
