Received Date: Feb 01, 2016; Accepted Date: Feb 15, 2016; Published Date: Feb 20, 2016
Citation: Pak J, Lee JH, lee SH. A Promising New Treatment for Osteoarthritis. Transl Biomed. 2016, 7:1. DOI: 10.21767/2172-0479.100046
At present, there is no definite cure for the underlying causes of osteoarthritis (OA). However, adipose tissuederived stem cells (ASCs) in the form of stromal vascular fraction can offer an alternative at this time. ASCs are one type of mesenchymal stem cells that have been utilized and have demonstrated an ability to regenerate cartilage in human patients with OA. Here, we highlight the possibility of ASCs regenerating cartilage in human OA patients.
Osteoarthritis; Adipose tissue-derived stem cells; Cell therapy; Cartilage regeneration
Osteoarthritis (OA) is the most common and debilitating disorder in the elderly, affecting an estimated 10% of men and 18% of women over 60 years of age . The pain and loss of function can be debilitating; in developed countries the resultant socioeconomic burden is large, costing between 1.0% and 2.5% of gross domestic product . Traditionally, OA treatment consists of pain management with joint replacement for end-stage disease [3-5]. This approach does not address the morbidity associated with early disease or the limitations of arthroplasty surgery, which include the possibility of adverse outcomes and the finite lifespan of prostheses .
In 2011, Dr. Pak of our group reported the first study that showed the possibility of autologous adipose tissue-derived stem cells (ASCs) [in the form of stromal vascular fraction (SVF)] regenerating cartilage in human OA patients .
|Study type||Number of subjects||Intervention treatment||Follow-up (months)||Outcome and comments|
|Retrospective cohort study ||81||Adipose SVF (ASCs) + PRP via percutaneous injections||26.6||ASCs + PRP are safe and potentially effective in treating patients with OA of knee and hip|
|Randomised double-blind dose escalation study (a proof-of-concept clinical trial) ||18||Culture-expanded ASCs via arthroscopic injections||6||1.0x108 ASCs into the osteoarthritic knee improved function and pain of the knee joint. Radiological, arthroscopic, and histological measures demonstrated regeneration of hyaline-like articular cartilage.|
|Comparative study ||54||Adipose SVF (ASCs) vs adipose SVF (ASCs) + fibrin glue as a scaffold||28.6||Clinical and arthroscopic outcomes of ASCs implantation were encouraging for OA knees in both groups, although there were no significant differences in outcome scores between two groups.|
|Multi-center case control study ||1114||Adipose SVF (ASCs) via percutaneous injection||17.2||ASC is a novel and promising treatment approach for patients with degenerative OA of knee and hip. ASCs implantation is safe and effective.|
Table 1: Important clinical studies on autologous ASC treatments for osteoarthritis form 2013 to 2015
Currently, there is no cure for painful OA in stages 2 and 3. For these patients, the intra-articular injection of ASCs can be an alternative treatment. As described in the Table 1, the joint injection of autologous ASCs was safe and efficacious. Also, obtaining approximately 100 g of adipose tissue and percutaneous joint injections of ASCs with or without PRP are considered to be a minimally invasive procedure and can be readily accepted by patients . These procedures carry a relatively low rate of morbidity and side effects [7-10].
Autologous adipose SVF can be as efficacious as autologous culture-expanded ASCs. Matter of fact, non-culture and nonexpanded adipose stem cells in the form of SVF can be considered to be more efficacious than culture-expanded ASCs; adipose SVF contains other cells and tissues that can contribute to excrete for more growth factors and can also work as scaffolding materials.
Furthermore, preliminary results of phase I or II clinical studies (ClinicalTrials.gov identifier NCT01585857 in France, NCT02219113 in Russia, NCT01300598 in Korea, NCT01739504 in USA, etc.) using autologous ASCs are promising since ASCbased therapy was shown to be safe and well-tolerated .
Taken together, ASC-based cell therapy can be a promising new treatment for OA. However, the possibility of using other stem cell-based approaches (bone marrow-derived stem cells, embryonic stem cells, induced pluripotent stem cells, etc.) has to be evaluated in the context of controlled long-term studies that would be compared with the outcome of ASC-based cell therapy.
Funded in part by a research grant from the National Research Laboratory Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (number 2011-0027928). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.