Advice to improve your movement, fitness, and overall health from the world #1 in orthopedics.
If you’re one of the millions of Americans with osteoarthritis or chronic pain, you may have wondered about stem cell treatments or other types of regenerative medicine and whether they could offer some relief. Regenerative medicine is a form of treatment that uses the body's own cells to promote healing.
One promise of regenerative medicine is cell-based treatments that can regrow cartilage, tendons and other tissues. This could provide relief for conditions like osteoarthritis, chronic tendonitis and degenerative disc disease in the spine. While this might be true, the science needed to dependably prove how the treatments work and how they could be used is still developing.
“Regenerative medicine has tremendous potential, but the marketing is ahead of the science in a lot of areas,” says Scott A. Rodeo, MD, who directs the HSS Center for Regenerative Medicine and is Vice Chair of Orthopedic Research. The center was created to develop a greater understanding of the science behind regenerative medicine, to improve its effectiveness and to develop better therapies for people with arthritis and other chronic conditions.
“Our goal is to use only the most promising of these therapies in a safe way, and to learn the results so that we can answer key questions about how best to provide these treatments going forward,” Dr. Rodeo says.
Here are five things to know about regenerative medicine treatments for arthritis.
“The term ‘regenerative medicine’ is misleading,” says Peter J. Moley, MD, a physiatrist at HSS who specializes in treating orthopedic conditions without surgery. “‘Regeneration’ implies that we are regrowing lost tissue, and that’s often not the case.” For someone with osteoarthritis, for example, they won’t be able to regrow tissue that has been lost in their joints over the years.
However, that doesn’t mean that people can’t benefit from some of these treatments, even when tissues are not actually being regrown. “If I have a patient with a torn tendon and I give them an injection, it may stop hurting — even if the treatment doesn’t actually regrow the tendon,” Dr. Moley adds. “Often, the environment of the tissues around the tendon is changed by the cells that we’re putting in, and that helps reduce the pain and inflammation.”
Platelet-rich plasma (PRP) is one therapy that can be effective. It may even help some people avoid surgery. With this procedure, blood is taken from a person’s arm and processed. Certain cell types are removed; platelets, which contain growth factors that can stimulate tissue regrowth, are concentrated. The altered blood, or plasma, is then injected into the part of the body with the injury or pain.
This treatment has shown promise for certain conditions, especially knee pain in people with osteoarthritis. But it doesn’t work for everyone, and there is a lot that doctors still don’t know about how it works best in individual patients.
“There is variability between the cells that are in my plasma and the cells that are in your plasma,” Dr. Rodeo explains. “It can even change for the same person from day to day. Until we learn how to identify which factors we’re putting into each patient and link them with individual outcomes, it’s going to be hard to ensure this treatment provides the most benefit.”
When someone comes to HSS for a regenerative medicine treatment, researchers keep samples from their blood to study in the lab. They can look at which cells are in the blood and what proteins those cells are making. After a person’s treatment, their doctor can collect data on how they’re feeling and use imaging like MRIs to figure out what’s happening in the body.
This data will help researchers make better conclusions about why these treatments work — and what’s happening when they don’t — so that they can be improved. Similar research is being done with other regenerative medicine and stem cell treatments.
Scientists are also working with animal models and with different kinds of cells in test tubes.
Like many other areas of medicine, experts say that personalized approaches will be key to developing better treatments. “The mantra for precision medicine is ‘the right treatment for the right patient at the right time,’” Dr. Rodeo says. “If we can identify the best PRP or cell therapy formula for each individual treatment, we will have a much more precise way of offering this to patients.”
“We plan to develop specific criteria for each joint and each condition, to enable us to determine which treatment is most likely to be successful, and when surgery is going to be the best option,” Dr. Moley adds.
In people who are having surgery, researchers are exploring the use of treatments made from the person’s own cells as a way to boost recovery and healing. Dr. Rodeo, who is also an orthopedic surgeon, currently has two clinical trials studying regenerative medicine treatment in people having surgery to repair rotator cuff injuries in the shoulder.
One trial uses stem cells that have been taken from the patient’s own fat tissue. The other one uses stem cells isolated from umbilical cord blood that’s been donated by the parents of newborn babies. (These are called human umbilical vein endothelial cells.) The aim of both of these treatments is to provide growth factors and other components found in stem cells that may be able to reduce inflammation and speed healing.
“We decided to focus on rotator cuff surgery because it’s an area where we can make real improvements,” Dr. Rodeo says. “We recognize that these treatments may help.” These trials are currently ongoing and it’s too soon to know whether they will be successful, but research in the lab has suggested they may help.
“There’s a lot of excitement in this field,” Dr. Moley concludes. “If we put time and effort into the research, I believe this will lead to many effective new treatments for patients.”