Stem Cell Treatment for Osteoarthritis Pain Relief in India

Osteoarthritis (OA) is a degenerative disease that causes inflammation and pain in the joints. It affects the joints of the knees, joints of the hip, joints of the spine and hands. The symptoms of Osteoarthritis are pain, swelling, limitation of mobility and stiffness. Of all the OA, knee osteoarthritis constitutes about 85% of them.

By 2019, OA affected 528 million individuals globally. 60% of women contribute to all the osteoarthritis cases, and 73% of the patients affected are over the age of 55 years. Knee osteoarthritis is the most common form of OA, with a prevalence of 365 million.

This blog aims to highlight the significance of regenerative medicine, especially stem cell therapy, in the treatment of Osteoarthritis.

STAGES OF OSTEOARTHRITIS
Stage 0	Normal	There are no signs of pain and impairment
Stage 1	Minor	Minimal cartilage changes but no pain or uneasiness
Stage 2	Mild	Mild pain and discomfort due to cartilage damage
Stage 3	Moderate	Increased pain, stiffness and discomfort during activity due to significant cartilage damage
Stage 4	Severe	Severe cartilage loss leading to extreme pain, stiffness and discomfort

Limitations of conventional treatment strategies in Osteoarthritis

1. Symptom management: The existing traditional treatment strategies are rather palliative than curative.
2. Physical exercises: Since the condition of OA is associated with pain and physical restrictions, engaging in physical exercises poses a significant challenge.
3. Braces and supportive devices: Braces and supportive devices aim to provide support, align the affected joint and correct the deformity. However, such an option only provides support and doesn’t cure the condition.
4. Pharmacological therapy: Pharmacological agents such as NSAIDs, analgesics and COX-2 inhibitors are prescribed to provide relief from symptoms. The long-term use of such medications also carries the risk of side effects and toxicity.
5. Surgical option: Surgical procedures such as arthroscopy, arthroscopic lavage and joint total replacement cause undue pain and suffering and are also associated with the risk of adverse events.
6. Lifestyle modifications: Implementing changes in existing lifestyles, like dietary modifications and improving obesity, is often challenging since it requires consistent efforts and perseverance.
7. Root cause of the disease: All the above-mentioned treatment strategies only manage the condition and treat symptoms but don’t address the underlying cause of the disease.

Relationship between Gut microbiome and Osteoarthritis

The gut microbiome is the collection of microbes that live in the intestine and play an important role in protecting the gut from harmful bacteria and endotoxins. The intestinal membrane acts as a barrier between the gut and the body, allowing only water and nutrients to enter. However, damage to the intestinal barrier makes the membrane more permeable, and any changes in the composition of the microbiome cause gut dysbiosis, ultimately leading to the escape of endotoxins into the bloodstream.

Due to the endotoxins, the immune system gets activated, produces inflammatory cytokines and activates macrophages, which triggers inflammation in joints. It exacerbates the existing Osteoarthritis due to enhanced inflammation. Therefore, lifestyle modifications like dietary changes and reducing weight are of significant importance in managing OA.

Stem cell therapy for Osteoarthritis

Regenerative therapies should be taken into consideration in light of the current challenges faced by the existing treatment strategies. There are several mechanisms of stem cell injections for joint pain relief.

Regeneration of cartilage

In OA, stem cells migrate to the site of injury and differentiate and proliferate into specialized types of cells, such as chondrocytes, osteoblasts and adipocytes. After differentiation, they upregulate the chondrogenic hormones and trigger the repair of cartilage. Stem cells also stimulate the release of SRY-box transcription factor 9 (SOX-9), aggrecan and type II collagen (Col2), which results in cartilage regeneration.

Immunomodulatory effects

Stem cells exert immunomodulation by suppressing the dendritic cell maturation and NK cell proliferation. It also inhibits cell apoptosis by down-regulating T and B cells. It also promotes the shift of inflammatory M1 phenotype macrophage to anti-inflammatory M2 phenotype.

Anti-inflammatory effects

Stem cells exert anti-inflammatory effects by decreasing the inflammatory cytokine levels such as TNF-α, IFN-γ, IL-1, and IL-6. The release of anti-inflammatory cytokines such as IL-10 and other soluble factors such as Prostaglandin E2 (PGE-2), Indoleamine 2, 3-dioxygenase (IDO) and TNFα-stimulated gene/protein 6 (TSG-6) leads to an anti-inflammatory effect.

MSC-derived exosomes

MSC-derived exosomes stimulate TGF-β1, which inhibits the process of angiogenesis and activity of osteoclast and suppresses the calcification of chondrocytes. These processes mitigate the process of chondrocyte damage and alleviate pain.

Perks of stem cell therapy in Osteoarthritis

1. Reduction in inflammatory process
2. Reduced morning stiffness
3. Enhanced functional capacity
4. Redevelopment of cartilaginous tissue
5. Decreased dependency on medications, especially anti-inflammatory drugs
6. Improvement of quality of life.

What do the clinical trials suggest about the safety and efficacy of stem cell therapy in Osteoarthritis?

1. “A systematic review and meta-analysis of randomized controlled trials determining the efficacy and safety of mesenchymal stem cells for Osteoarthritis” reveal that mesenchymal stem cells reduce pain and increase functional outcomes in patients suffering from OA.
2. A “prospective, randomized, double-blind, phase IIb clinical trial of intra-articular injection of autologous adipose-derived mesenchymal progenitor cells for the treatment of osteoarthritis” reported significant improvement in pain, functions of joint, cartilage regeneration and quality of life after follow-up for 12 months.
3. Another systematic review titled “Improved outcomes after mesenchymal stem cells injections for knee osteoarthritis: results at 12-months follow-up” reported improvement in the visual analog scale, WOMAC score and KOOS score. The review also reported improvement in pain, functional capacity and overall improvement of quality.

Visual analog scale

The visual analog scale is a simple pain rating scale that ranges from no pain to the worst possible unbearable pain. It is used to determine the intensity of pain in patients suffering from Osteoarthritis. It is a self-markable scale where patients mark the intensity of pain they feel.

Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC score): 

WOMAC index is an outcome-based tool used in OA to measure the subscale of pain, stiffness and physical function. Each subscale has its scoring system; for example, pain has a scoring range of 0 to 20, physical function has a scoring range of 0 to 68, and stiffness has a scoring range of 0 to 8. All the scores from the three subscales are added to determine the severity of OA.

Knee Injury and Osteoarthritis Outcome Score (KOOS score)

KOOS is an assessment tool designed in the form of a questionnaire that is used to assess outcomes such as symptoms, pain, sports and recreation function, activities of daily living, and knee-related quality of life.

Osteoarthritis Treatment Success Stories

Conclusion

Regenerative medicine in Osteoarthritis has shown remarkable ability in treating the condition effectively and has shown how stem cells help Osteoarthritis. The regenerative capacity of stem cell therapy for arthritis pain relief outclasses the other therapies since they do not provide effective outcomes.

Therefore, stem cells offer great benefits such as cartilage regeneration, reduction of pain and inflammation and enhanced mobility in the treatment of Osteoarthritis.

FAQs

Q: Define Osteoarthritis?

Osteoarthritis is a degenerative disease that causes inflammation and pain in the joints. It affects the joints of the knees, joints of the hip, joints of the spine and hands. The symptoms of OA are pain, swelling, limitation of mobility and stiffness.

Q: What are the stages of Osteoarthritis?

The four stages of Osteoarthritis are stage 0 – there are no signs of pain and impairment, stage 1 – no pain or uneasiness, stage 2 – mild pain and discomfort, stage 3 – increased pain, stiffness and discomfort during activity and stage 4 – extreme pain, stiffness and discomfort.

Q: What are the perks of stem cell therapy in Osteoarthritis?

The perks of stem cell therapy in Osteoarthritis are reduction in inflammatory process, reduced morning stiffness, enhanced functional capacity, redevelopment of cartilaginous tissue, decreased dependency on medications, and improvement of quality of life.

Q: How do stem cells exert anti-inflammatory effects?

Stem cells exert anti-inflammatory effects by decreasing the inflammatory cytokine levels such as TNF-α, IFN-γ, IL-1, and IL-6 and enhancing the anti-inflammatory cytokines such as IL-10, Prostaglandin E2 (PGE-2), Indoleamine 2,3-dioxygenase (IDO) and TNFα (TSG-6).