Stem Cells for Knee Pain

Case Report #2 - M.W.

This patient is a 48 year old female who presented complaining of pain in both knees due to arthritic changes.  An orthopedic surgeon had suggested to her that she would need bilateral total knee replacement surgery.  She did not want to undergo such drastic surgeries at this stage in her life and was eager to avoid it by trying an alternate therapy.

She had been active and athletic for most of her life, until a few years ago when her knees started giving her pain.  As the pain worsened, she gradually had to give up her normal exercise routine and over the past couple of years had gained weight as well. She is otherwise in good health with no other medical issues.  Unfortunately, she had been rather dependent upon non-steroidal anti-inflammatory drugs (NSAID's) to control her pain, typically taking ibuprofen daily.

Her radiology studies showed bilateral medial compartment osteoarthritis, or degenerative changes in both knee joints, especially the inner portion on each leg.  This is also consistent with where she experienced her pain. She actually had good range of motion when I saw her, and her pain was only evident when walking up or down steps.  She had no evidence of ligament or tendon involvement.

I have all patients fill out a comprehensive pain questionnaire that involves three different types of assessments for pain.  These include the Short Form McGill Pain Questionnaire(SF-MPQ), the Visual Analog Scale (VAS), and the Present Pain Inventory Score (PPI).  Her answers to these questions on the day of surgery were scored as 20, 67, and 3.5 respectively (for a total score of 91).

We developed a personalized pre-op plan involving supplements that appear to help viability of stem cells, along with her ceasing to take pain medications for the week prior to surgery.

She underwent manual liposuction and stem cell harvesting/isolation.  We also drew blood and obtained platelet-rich plasma (PRP).  I injected both knees with a mixture of stem cells and PRP, and she left our office with a plan to start physical therapy and also seek metabolic nutrition counseling through her medical plan.  She went to the physical therapist 2 days after the procedure.

I saw her back in the office on post-op day #8.  She stated that she felt less pain and that the exercises from the therapist seem to be helping strengthen her legs as well.  Her pain scores were as follows: SF-MPQ = 14, VAS = 28, and PPI = 1.5, for a total of 44.  This is roughly a 50% drop in her pain over one week.  She had also avoided using NSAID's since the procedure.  More impressive was the fact that in the past she had to help pull herself up her stairs at home by using the hand rail, due to knee pain.  Over the past 3 days, she had been walking up the stairs without requiring assistance.

She will continue with physical therapy and her selected supplements, and is awaiting the nutritional service consult as well.  This case just serves to illuminate the multiple factors that are involved in successful stem cell therapy.  First and foremost, it takes a motivated patient who is willing to actually put in the time and effort necessary to make success happen.  And it takes adjustments in diet and exercise to help augment the results.

Stem Cells to Improve Failing Vision

In yet another amazing story in regenerative medicine, a woman in Japan received a retinal stem cell graft as therapy for age-related macular degeneration (AMD), as first reported in September, 2014.  She is the first of six patients who are to have this treatment, being performed at the RIKEN Center for Developmental Biology in Kobe, Japan.

AMD is a major cause of visual loss and blindness in adults over the age of 50.  The most common type is known as "dry" AMD (or central geographic atrophy), wherein vision loss occurs due to the loss of the photoreceptors known as rods and cones.  There is no recognized medical or surgical treatment for this condition, although certain vitamin and supplement regimens may help.  About 90% of cases are "dry" AMD.  (The other type is known as "wet" AMD where vision loss occurs due to the abnormal growth of  blood vessels.  There are multiple medications that can help with this condition, although some require direct injections into the eye on a routine basis.  The goal is to reduce the growth of these blood vessels and eliminate them.)

The woman mentioned earlier had skin cells harvested and then reprogrammed into specialized retinal pigment epithelial cells.  This is a type of induced pluipotent stem cell (iPS), wherein a patient's own cells are induced into a stem cell line that is wanted for a particular type of tissue therapy. These cells were then grafted into her eye as a patch with the hope of allowing these cells to maintain her own rods and cones.

Shinya Yamanaka and colleagues at Kyoto University first discovered iPS cells in 2006; Yamanaka was awarded the Nobel Prize for this work in 2012.

Mike Cheetham of the Institute of Ophthalmology at University College London (another site researching human embryonic stem cells and AMD) had this to say in regards to the Japanese trial - "If it goes well, it could be the start of a new era in personalized medicine."