The underlying thread behind all stem cell research is the hope that stem cells (SC) may someday be able to manufacture normal mature tissue to replace worn out parts.
Efforts to get embryonic SC research are stalled for a variety of reasons. And allogeneic (donor) stem cell studies are finding difficulty getting untracked.
The bright light is the application of autologous stem cells (ASCs) – a patient's own SCs.
These cells have opened up a whole new field of treatment-regenerative medicine. And more data is being accumulated regarding the utility of this form of treatment particularly in disorders related to soft tissue (ligaments, tendons) an cartilage.
The source for autologous stem cells can be either bone marrow or fat. Once removed, the patients' cells are concentrated. While some centers process these cells outside the body using various growth factors, the FDA is not particularly fond of cell manipulation outside the body.
At our center, we see no need to process these cells. There are plenty of autologous growth factors that can be used that do not require special processing outside the body.
Also, the performance of a SC procedure does not consist of merely injecting stem cells into a diseased joint. It's critical that the area of joint damage be located. This location is accomplished using a combination of imaging procedures such as plain x-rays, magnetic resonance imaging, and diagnostic ultrasound.
The reason, it's important to locate the injured area is that the initial part of an ASC procedure involves the induction of acute injury. This acute injury, performed with special instruments, is what initiates inflammation in the area of concern and is the first step in the healing cascade.
SCs and autologus growth factors are immediately introduced into the area of injury and the healing process begins.
If the Holy Grail of regenerative medicine can be achieved, which is the generation of normal functioning cartilage, it is quite possible that joint replacement therapy might be postpone indefinitely.
There are a number of questions that still need to be answered. First and foremost: Are ASCs going to be the answer? Do they really require incubation with factors outside the body? What is the character of the connective tissue and cartilage made? Is it sufficiently strong to withstand the rigors that will be placed on it? What degree of biomechanical abnormality can be overcome and what is the degree at which a joint replacement is more advisable?