Can Stem Cells Regenerate Cartilage?
Mesenchymal stem cells (MSCs) can naturally transform into many tissues including bone, cartilage, and fibrous tissue. There are hundreds of studies of animal models where these cells have been shown to help repair cartilage. In fact, as of this morning there are 1,789 such studies listed in the U.S. National Library of Medicine. So from a conceptual standpoint, we have good prima facie evidence that this can work.
When looking at different stem cell sources, the two most commonly used today are bone marrow and fat. Of the two, there’s much better evidence that Adipose (fat) derived MSC's are capable of cartilage repair and regeneration then bone marrow. So if you had to choose a stem cell source for the purpose of regenerating cartilage, Adipose (fat) would be your best choice. This is why we use adipose derived stem cells for all of our stem cell procedures.
The Myth of Cartilage Loss as a Primary Source of Pain
Cartilage is the shock absorber that lines the end of your bones. One of the hallmarks of arthritis that’s easy to see on x-rays and MRIs is the loss of cartilage. Given the orthopedic community’s obsession with cartilage loss, you would think we had solid evidence showing that loss of cartilage in a knee is directly associated with increased pain and disability. In reality, there is little evidence that’s actually true.
The largest government funded research studies to date do not relate more cartilage loss to pain. In other words, there are lots of people walking around out there with “bone on bone” knees who don’t have much pain and seem to get along just fine. There are also people with normal cartilage on their MRIs who are in tremendous pain.
Knee pain is a very complex thing that goes beyond the structure seen on an MRI. For example, the orthopedic surgical community has drilled into the heads of patients now for a generation that a torn meniscus on the MRI of a middle-aged person is a big deal. However, based on multiple research studies this seems to be more of a marketing message created to sell unnecessary surgeries than anything that’s based in scientific reality. In essence, a meniscus tear seen on an MRI of a middle aged person who has knee pain is about as important and clinically meaningful as the wrinkles on their forehead.
So if cartilage loss and meniscus tears usually don’t have much to do with why a knee hurts, what does cause this issue? Frankly, we’re just beginning to unravel this medical mystery. Luckily, we do know a few things:
- There is a toxic “witches brew” of chemicals that live inside the joint that cause swelling and continue to break down the structure.
- There are nerves inside and around the joint that along with the nerves in the spinal cord become “sensitized” to pain signals. These same irritated nerves can cause bad chemicals to be dumped into the joint.
- The bone in the joint can accumulate many tiny microscopic fractures and this leads to bone swelling, which can also lead to pain.
What’s really interesting is that of the MRI findings listed above (cartilage loss, meniscus tears and bone swelling), only bone swelling, or what’s called a bone marrow lesion (BML) is linked to knee pain!
In addition, some cases of knee pain that we have seen have not come from the knee at all but from a mechanical problem from the lower spine. In this case, the knee pain is better resolved with the referral to a local chiropractor.
So what to do if your knee pain is caused by a BML (bone marrow lesion)? It only makes sense to inject into the knee the best known source of stem cells that can repair ALL of the injured tissues bone, cartilage, fibrous tissues, synovium, and the fluid. The best known stem cells are derived from the SVF.
SVF - Stromal Vascular Fraction: When the fat is removed from the abdomen, it is then quickly escorted to our lab where the fat is minimally manipulated to efficiently and carefully extract all of the stem cells. At the end of all processing, we are left with a type of "soup": This is the SVF and is a rich supply of not only stem cells but all the necessary co-factors, growth factors, cytokines, and other factors not even fully understood yet, that make up the magic "soup" that regenerates the joint.