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Stem Cells & Osteoarthritis

Clinician's Brief (Capsule)

Orthopedics

|January 2017

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Mesenchymal stem cell therapy may halt or reverse the inflammatory cascade that causes osteoarthritis. Potential mechanisms of action include immunomodulation, reversal of the proinflammatory cascade, proangiogenic and antiapoptotic effects, and decrease of scar tissue production. Intravenously injected mesenchymal stem cells (MSCs) can accumulate in areas of inflammation (eg, joints), where they can then exert local effects.

MSCs can be obtained from adipose tissue or bone marrow. Adipose tissue is prepared and centrifuged to produce a centrifuged pellet known as the stromal vascular fraction (SVF). SVF contains MSCs, endothelial precursor cells, monocytes, macrophages, regulatory T cells, pericytes, mast cells, preadipocytes, fibroblasts, and smooth muscle cells.

Platelet-rich plasma (PRP) is another source of autologous treatment for osteoarthritis. PRP contains vascular endothelial growth factor, platelet-derived growth factor, fibroblast growth factor 2, and transforming growth factor-ß, which may enhance regenerative processes and promote healing of intra-articular surfaces. PRP can be coadministered with MSCs or SVF.

This study evaluated the effects of SVF and PRP coadministration on outcome measures in dogs with hip osteoarthritis as compared with baseline. Client-owned dogs (n = 22) with hip osteoarthritis were administered intra-articular injections of either SVF–PRP or saline placebo. Data collected included body weight, visual analog scale score, goniometry measurements, BCS, lameness score, and client-performed canine brief pain inventory survey.

Results suggested that SVF–PRP injection is safe; no negative consequences were noted during the 24-week study period. Improvements in pain inventory scores and peak vertical force occurred at some time points, with significant improvement noted in dogs with baseline peak vertical force <38% of body weight.

Commentary

Using MSCs and PRP to combat osteoarthritis is becoming a trend. The ultimate dilemma is how to choose a practical, affordable system that offers consistent, sterile, and beneficial results. A recent article showed that not all PRP-concentrating systems are alike,1 which suggests there is still variability that prohibits the purchase of a gold standard PRP-delivery system, stem cells notwithstanding.

The data presented in this paper suggested that the combination of SVF and PRP may be beneficial, and some of the data showed improvement in lameness scores. However, the authors conceded it is difficult to score lameness and subsequent improvement in function via standard methods. Administration of MSCs and PRP, also known as regenerative medicine, presents an exciting new horizon for veterinary analgesia because of the limited drug therapies that can be used to treat chronic painful conditions. However, there is still much to learn regarding the production, administration, and effectiveness of this modality.—Heather Troyer, DVM, DABVP, CVA, CVPP

References and Author Information

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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