Mesenchymal stem cells’ ability to make cartilage slows as we age:
A recent research study was done to evaluate the multi lineage character of mesenchymal stem cells from bone marrow in patients undergoing joint replacement surgery. The potential of the cells to undergo differentiation along chondrogenic (form cartilage), osteogenic (bone) and adipogenic (fat) pathways was investigated. The bone marrow was taken from the iliac crest, femur, or tibia bones of patients undergoing total knee or hip joint replacements and then analyzed. These stem cells were compared to stem cells from normal donors (patients without end-stage osteoarthritis.) The results showed that the number of stem cells from patients with advanced osteoarthritis was the same, but had a significantly reduced proliferative capacity. The stem cells from people with advanced osteoarthritis showed a reduced ability to form cartilage (reduced chondrogenic potential).
There was no decline observed in chondrogenic potential with age in cells obtained from individuals with no evidence of osteoarthritis. In the author’s own words, “We found that the ability of mesenchymal stem cells from patient bone marrow to undergo chondrogenic differentiation was significantly reduced compared with that in controls. This change was disease-associated and not age-associated and suggests that this may indeed be a contributory factor in osteoarthritis.”
The authors surmised that the loss of cartilage that is characteristic of advanced osteoarthritis may result from changes in the differentiation profile of the progenitor cells that contribute to the homeostatic maintenance of these tissues. How does all this relate to stem cell injection therapy?
The theoretical basis for any type of Prolotherapy is the notion that the body is not going to heal itself so it needs some help. Prolotherapy by definition is an injection treatment that stimulates the body to repair injured musculoskeletal tissues. So what could be better than injecting mesenchymal stem cells and their involved growth factors into the area needing stimulation to heal? For patients with advanced osteoarthritis who have lost the ability to heal articular cartilage, then surely increasing the number of stem cells in the joints makes sense, right?
It may be that these injected cells are not as good as cells from say someone who is 18 years old versus a person aged 72 (with advanced osteoarthritis). I don’t know about you, but I’ll stick with my own cells because it is much safer with no chance of rejection!
You should also realize that Bone Marrow Prolotherapy is not just done once, but typically four to six visits, every six to eight weeks. Consequently, with Bone Marrow Prolotherapy, the body’s injured structures are stimulated to heal multiple times, over many months. In the majority of the cases they do heal, as is evidenced by patients who have less pain, more range of motion of the joint, and increased walking and exercise abilities. For the patients that want objective x-ray evidence of healing before and after Bone Marrow Prolotherapy x-rays of the joint are taken.
Going back to this study, of interest is the fact that there was no difference between sites of bone marrow harvest with respect to total nucleated cell count or yield of mesenchymal stem cells. Meaning from this study one could harvest bone marrow from the iliac crest or tibia and the amount of cells/cc would be about the same.
1Murphy JM, Dixon K, Beck S. Reduced chondrogenic and adipogenic activity of mesenchymal stem cells from patients with advanced osteoarthritis. Arthritis & Rheumatism. 2002;46:704-713.