Stem cell therapies - offering hope or just hype?

Published on 01 July 2010
Source: Arthritis Today

Sally Roberts

In the second of a three-part series looking at developments in stem cell therapy to treat osteoarthritis, Jane Tadman looks at an exciting new project in Oswestry.

Cultured stem cells are not routinely used in the UK to treat the common joint condition of osteoarthritis. However, this could change following a new Arthritis Research UK programme grant, throwing a potential lifeline to millions of sufferers in the future.

A new clinical trial proposes to test the effectiveness of mesenchymal stem cells (cells derived from a patient’s own bone marrow) at repairing worn cartilage in osteoarthritis of the knee in comparison to chondrocytes (cartilage cells). A combination of both types of cells will also be trialled.

The aim is to repair damage to the joint, stopping osteoarthritis getting worse and delaying or even avoiding the need for knee replacement surgery.

Up to 70 people with established knee osteoarthritis will take part in the proposed trial, scheduled to start by the end of 2010, to be run at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, Shropshire, as part of a five-year £500,000 research programme.

The hospital has been at the forefront of using a surgical technique originally pioneered in Sweden called autologous chondrocyte implantation (ACI) on patients with cartilage problems usually caused by sports injuries, for many years. They have also been using stem cells from bone marrow to repair fractured bone for the past four years.

But now a team led by scientist Sally Roberts, Professor of Orthopaedic Research, and James Richardson, Professor of Orthopaedic Surgery, whose academic base is at Keele University, are confident that the procedure of cartilage regeneration produces sufficient amounts of robust new cartilage cells for the technique to be extended to patients with osteoarthritis.

Professor James RichardsonProfessor Richardson said the study offered a real chance to help osteoarthritis patients, for whom there is currently little effective treatment. “It’s great that Arthritis Research UK is funding this work in Oswestry to take things further. We are the first laboratory in the UK producing mesenchymal stem cells and chondrocytes, so we are unique in being able to test the effectiveness of both types of cell therapy,” he added.

Stem cell transplantation surgery involves two operations and a period of at least six months’ convalescence and rehabilitation. In the first operation, a patient’s own chondrocytes or bone marrow cells are removed via keyhole surgery, and grown in the laboratory for three weeks. They are then reimplanted back into the area of damaged or worn cartilage where over several months they form new cartilage. The Oswestry team will follow up the patients for a year, and will measure success by looking at the quality of the cartilage, and the patient’s ability to perform everyday activities.

Once ethical approval is obtained, patients taking part in the trial will be recruited from orthopaedic departments around the UK, on the advice of the local specialist.

Arthritis Research UK is funding the study over five years and over that period, as well as running the clinical trial, scientists will seek a better understanding of the biology of repair of ACI by studying biopsies of the repair tissue formed after surgery.

Despite her enthusiasm for the project, Professor Roberts warns that stem cell therapies, although promising, are not the answer to all health problems. “Stem cells are portrayed as ‘wonder cells’ that can do anything, but they can’t give you the joints of a 15-year old,” she says. “At the moment they are not the ‘magic bullet’ and they don’t solve the underlying problem of osteoarthritis, which still needs to be addressed. They have been hyped up. They certainly have huge potential – we just need to learn how to harness it properly.”

Professor Richardson adds: “The important thing is to run a randomised trial. If successful, we need to find out if it is cost-effective. If a few years can be saved, the benefit to the patient may be not to prevent the need for a joint replacement, but to prevent need for a revision of a joint replacement.”

Whatever the outcome of the trial, use of stem cell therapies to treat osteoarthritis is still experimental – and routine clinical use is probably still several years away.