Elsevier

Medical Hypotheses

Volume 71, Issue 6, December 2008, Pages 900-908
Medical Hypotheses

Regeneration of meniscus cartilage in a knee treated with percutaneously implanted autologous mesenchymal stem cells

https://doi.org/10.1016/j.mehy.2008.06.042Get rights and content

Summary

Mesenchymal stem cells are pluripotent cells found in multiple human tissues including bone marrow, synovial tissues, and adipose tissues. They have been shown to differentiate into bone, cartilage, muscle, and adipose tissue and represent a possible promising new therapy in regenerative medicine. Because of their multi-potent capabilities, mesenchymal stem cell (MSC) lineages have been used successfully in animal models to regenerate articular cartilage and in human models to regenerate bone.

The regeneration of articular cartilage via percutaneous introduction of mesenchymal stem cells (MSC’s) is a topic of significant scientific and therapeutic interest. Current treatment for cartilage damage in osteoarthritis focuses on surgical interventions such as arthroscopic debridement, microfracture, and cartilage grafting/transplant. These procedures have proven to be less effective than hoped, are invasive, and often entail a prolonged recovery time.

We hypothesize that autologous mesenchymal stem cells can be harvested from the iliac crest, expanded using the patient’s own growth factors from platelet lysate, then successfully implanted to increase cartilage volume in an adult human knee.

We present a review highlighting the developments in cellular and regenerative medicine in the arena mesenchymal stem cell therapy, as well as a case of successful harvest, expansion, and transplant of autologous mesenchymal stem cells into an adult human knee that resulted in an increase in meniscal cartilage volume.

Section snippets

Autologous platelet approaches

The platelet augmentation approach is based on the concept that platelets contain key growth factors such as platelet derived growth factors (PDGF’s), transforming growth factors (TGF’s), fibroblast growth factors (FGF’s), and various forms of interleukins (IL) [6]. In response to tissue injury, a complex cascade of cellular and noncellular signals triggers platelet receptors, resulting in expulsion of these growth factors within the site of injury. This process is known as degranulation and

Stem cells and regenerative medicine

Embryonic stem cells have been in the popular media for many years and have shown promise scientifically while creating significant controversy. As a result, many researchers have focused on adult stem cells, or stem cells isolated from adult humans that can be transplanted into damaged tissue. Adult stem cells consist of three main types: CD34+ heme progenitors destined to become blood components, endodermal stem cells used to replace endodermal linings such as endometrium, and mesenchymal

Growth factors in regenerative medicine

Recombinant human growth factors have just begun to be used in modern clinical practice. These are proteins in the cytokine family that have the ability to promote growth of certain tissues. The first of these to be available in spinal surgery practices is the bone morphogenic protein (BMP) family. Both BMP-2 and BMP-7 are currently being used to promote fusion [53], [54]. Animal trials with these growth factors may show some promise in repair of peripheral joints [55]. In addition, FGF-2 has

Results

The pre and post-procedure MRI analysis demonstrated an increase in meniscus volume that was more than the standard deviation of the serial three ROI measurements. At three month follow-up, modified VAS scores decreased from 3.33 to 0.13.

Conclusion

This case report shows MRI evidence of increased meniscus volume. While there has been evidence from animal models of cartilage regeneration using MSC’s, this is the first case report of an increase in meniscus size in a human subject (of which we are aware). While the patient reported clinical response could have been due to the dexamethasone injection provided post transplant procedure, the levels injected (10 ng/ml) were approximately one million times lower than those used clinically

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