Could stem cells be the cure for arthritis?

Osteoarthritis effects over 10 per cent of the adult population in the USA and the figures are pretty similar in this country.   Just under four per cent of the over seven billion people that need to remain upright and ambulant on this glorious planet of ours are compromised by knee osteoarthritis, which amounts to 280,000,000, a disturbing statistic given that many of those will be so incapacitated that they will need some form of unaffordable surgery.  I’m not sure of the statistics for solitary wrist osteoarthritis, which I know I have because I’ve had it X-rayed and ultra-sounded while not submitting to an MRI yet. I’m confident that I’m a proud albeit silent member of some elite group of singleton joint sufferers somewhere on the planet.

Without avoiding the nightshade group of vegetables as I like tomatoes and capsicum I’ve religiously committed to a vegetarian lifestyle and an alkaline diet.  I take every natural osteoarthritis treatment known to man including glucosamine, chondroitin, curcumin, fish oil, rose hip, Boswellia serrata, curcumin, and rose hip.  I’ve even considered getting hold of calcium pentosan polysulfate, an antiarthritic agent that allows my aged advanced cats to chase after each other and birds that they fantasise have forgotten how to fly.  An American colleague of mine used it on a well-known twice Oscar wining actor with spectacular results even though it’s not really indicated for any humans, regardless of acting prowess.  Since the rules are a little less cavalier in this country, wisely my vet declined to give it to me.

There’s also aspirin and non-steroidal anti-inflammatory drugs, together with Mobic another stronger anti-inflammatory, but all of these have side effects and being committed to natural treatments there’s no way I’d go near any of these.  There are even anti-depressants, which are deployed for a huge array of maladies absent depression, topical capsaicin, non-steroidal anti-inflammatory ointments and, if all of these fail, steroids that can be injected into the joints. Strengthening exercises, weight loss, physical and occupational therapy are also advocated.

Then there’s stem cell treatment. Due to the seductive promise of stem cell treatments I’ve had patients fly interstate to treat their arthritic knees and countless others have surrendered vast sums of money to clinics around the world hoping that their incurable disease can be remediated. When I asked a prominent orthopaedic surgeon if he endorsed stem cell therapy he indicated in rather restrained terms that it was ‘highway robbery’ and claimed that it just didn’t work.  Before accepting his position I thought it would be a good idea if I did my own research to separate the facts from the fake news.

Ageing throws out a few curve balls to the superhero potential of stem cells and one of them is the fact that ageing stem cells are just that, ageing. Even though they have the capacity to multiply and regenerate organs that are hurtling into decline, their lifespan is limited and unlike stem cells isolated from more youthful protagonists, they eventually peter out and die.

All their good works are quickly reversed, which is why a lot of research on arthritis indicates that pain may be ameliorated and function temporarily restored, but in the long term these stem cell benefits are not maintained and the degenerative osteoarthritic process sadly prevails.

Aside from their ephemeral existence, stem cells face a hostile environment. Cartilage destruction is fuelled by inflammation, a relentlessly raging inferno that consumes all in its path, including the brave fire fighters that are the gallant stem cells who ultimately are no match for the conflagration that is consuming all in its wake. Ageing also sees the rise of senescent cells, senile yet cunning warriors whose prime mission appears to be the neutralising of naïve stem cells preventing them establishing any form of primacy. Nature is not entirely malevolent when it unleashes these hostile actors as any cells with the potential to replicate indefinitely also have the capacity to mutate into cancer cells and once these have free reign, their lethal intent will be unrestrained.

This is the essence of the zero sum game that typifies ageing and which any strategy that attempts to combat ageing must negotiate. That which has the nous to look after us might also be sowing the seeds of our own demise. Senescent cells might accelerate ageing, but they also help terminate abnormal cells or any cells that are actively multiplying in case they harm us, even if they are beneficial stem cells.

This might explain the conclusions of two authoritative reviews which have examined the benefits of stem cells treatments. Although initial short-term gains have been promising with reduction of pain and improvement of function and flexibility in the long term these improvements have plateaued and subsequently diminished. The authors therefore concede that because of these ultimate disappointments they cannot yet endorse stem cell therapies as a viable proposition to treat osteoarthritis. This is in line with regulatory agencies in Europe, the USA and Japan which oversee the legitimacy of novel technologies used to manage medical conditions. To date none of these bodies have approved the use of stem cells for osteoarthritis.