Easing Early Arthritis with Stem Cells

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Stem cell therapy is used to treat many different medical conditions, from heart repair to neurological disorders. One exciting new area under study in a clinical trial at University Hospitals is treating cartilage injuries or early arthritis with stem cells. UH orthopedic specialist James Voos, MD, describes the clinical trial – and how some stem cell treatments outside a hospital setting may not offer a comparable level of quality.

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Podcast Transcript

Macie Jepson

We're breaking down a complex topic today on Healthy@UH. We're talking about stem cell therapy because, frankly, I find it confusing. Hearing a lot about it. Heart repair, neuro disorders such as Parkinson's, stroke recovery. But we're hearing also a lot of pain free life, a promise for a pain free life without surgery for people. So, what is it exactly and how do we know that we're getting the real deal? Is there enough science behind this to actually guarantee results? Hi, everybody. I'm Macie Jepson.

Pete Kenworthy

And I'm Pete Kenworthy. And this is Healthy@UH. University Hospitals Sports Medicine Institute is one of the few US institutions to obtain FDA approval to multiply and grow stem cells for arthritis treatment. Joining us today is Institute Medical Director and Chairman of the Department of Orthopedic Surgery at UH, Dr. James Voos. Dr. Voos, thanks for being with us.

Dr. James Voos

Thank you.

Pete Kenworthy

So, let's start here. What are stem cells?

Dr. James Voos

Stem cells are present throughout our body, and they are the building blocks that help us regenerate our tissue. Stem cells can help us regrow brain tissue or form our bones, form our muscles, and in this particular scenario in arthritis, help us to grow new cartilage. So, we all have our stem cells active within us here now. These new treatments help us to unleash the power of those stem cells in a more controlled fashion to treat diseases versus just doing our normal day to day building.

Macie Jepson

And so UH is actually FDA approved to be studying this, and actually we grow stem cells here. How does that work?

Dr. James Voos

That's correct. The FDA requires approval for anybody to more than minimally manipulate a stem cell. If we recall back in the late 80s, early 90s, Dolly the sheep in the UK that was cloned to form a new sheep out of a stem cell. Many years ago, the FDA prep provided those protections so that we didn't clone ourselves here across the country.

Pete Kenworthy

So, as Macie mentioned at the outset, we've heard about advances in treatment of heart disease, stroke, spinal cord injuries, these kinds of things with, stem cell. But University Hospitals is actually recruiting patients for studying the treatment of early arthritis. Is that right?

Dr. James Voos

That's correct. We have an active clinical trial going on. It's listed on clinicaltrials.gov. That's the FDA website that lists all of the federal studies for patients 18 to 60 years old with either acute cartilage injuries or early arthritis. So, it really allows us to reach out to those patients that may not need a joint replacement yet, are starting to be slowed down by that early arthritis, to give them the opportunity to either push a joint replacement down the line or to get back to their activities a little bit quicker than otherwise.

Macie Jepson

It's crazy to think that this could be done without FDA approval somewhere out in the universe. But I mean, how do we know always that we're getting the real thing?

Dr. James Voos

You may get off an airplane down in Florida or in other states and see billboards everywhere for stem cell therapy, and you may not necessarily be getting a stem cell treatment. Typically, in these type of treatments, someone may have their bone marrow or blood drawn from the bone in their hip and spun down, and those cells given back to the patient, and that's considered a stem cell injection. And while there may be some cells in there, there's not very many. It's a lot of growth factors in just a few cells. This study that we're talking about here currently is taking just those couple cells, identifying the best ones and multiplying them into the hundreds of thousands so that, therefore, those cells can be much more active, much more potent. I've used the analogy that our current stem cell treatments that may be on the market are the analogy of taking a couple of drops of lemon juice and dropping it in a gallon of water and calling it lemonade. While technically it's lemonade, it may not taste very good and may not be the concentration that you wanted. So, these current stem cell treatments really allow us to make the most of those stem cells and really to optimize their ability to work on the body.

Pete Kenworthy

Those stem cell therapy places you're talking about when you get off the plane in Florida, they exist here in Northeast Ohio, too. I've seen a couple of them. My next question was going to be, are there risks? And I guess that's the risk is going to a reputable place to get this done. Do your research, I guess?

Dr. James Voos

Yeah. Do your research. You always want to know what's going into your body. And that's the first and foremost is wanting to know how are the cells prepared? What is it that's actually going into your body? And then ultimately what are the expectations? Is this going to help your pain? Does this decrease inflammation? Is there a promise of regeneration or regrowth? And that's where we really need to be cautious as scientists and as healthcare providers. Stem cells at this point in the musculoskeletal or orthopedic arena, have not been proven to regrow or regenerate tissue. So, we really want to be mindful of those terms. And what this clinical trial is doing is by multiplying those cells, does it give those cells the opportunity to perform that way, to hope to regenerate tissue? We know that it can improve your symptoms, but now can it take that next step and help you to regrow that joint? And that's really the aim of this study to see what happens. So, when we look at those places out there, it's really what are they promising and what's going into your body?

Macie Jepson

All right. So, we've talked about the best case scenario; that's regrowing cells and regenerating. We have to talk about the worst case scenario though, too. Are there risks? Can things go awry?

Dr. James Voos

Yeah. With any of these types of procedure, there's always potential risks. To draw the blood out of the hip joint can be a little bit sore. And then anytime you do an injection into the knee, whether it's a steroid injection or a joint lubricant injection or stem cells, there's always that rare risk of infection. Sometimes you can have an inflammatory reaction. The real risk is that if there are additional things added to those stem cells. Are there additional chemicals or reagents or tinkering with those cells? You really want to know what's going on there and efforts to reduce any type of adverse reaction to your body.

Pete Kenworthy

Well, Doctor, I think we should be clear here that stem cell treatment isn't for everyone, right? How do you determine what the best course of action is for where you are in your stage of arthritis or otherwise?

Dr. James Voos

Yeah, that's our biggest challenge currently. And we spend the majority of time in the office talking about what alternative treatments are, what other treatments there are leading up to stem cell. Often our patients come into the office holding onto a large grasp of hope that the stem cells are going to cure everything, and there may be some opportunity for that to happen. But I think it's most important to see a specialist, a sports medicine or orthopedic specialist that knows how to treat early arthritis, whether it's with physical therapy or sometimes it's as simple as changing your shoes or how you're working out, do different injections, whether it's a steroid injection or the lubricant or what we call viscosupplementation injections. There's other more simple growth factor injections like PRP or platelet rich plasma. And then ultimately there are multiple surgical options, and that's really where going to a sports medicine or orthopedic specialists like we have here at our UH Department of Orthopedic Surgery to really help you work through what those treatments are. Cause while stem cells are a great option, there are a lot of other treatments available to you that may be a much simpler and much easier to execute.

Macie Jepson

Well, as the lead physician for the Cleveland Browns, the Cleveland Monsters, the Cleveland Ballet, we couldn't let you go though without talking about the implications for athletes. Where do you see this going? Where is it now?

Dr. James Voos

Athletes being able to get back safely on the field or to extend the length of their careers can have dramatic impact. You can imagine if you're a professional athlete or a college athlete and you have some early arthritis or a traumatic cartilage injury, and receiving one of these treatments, if it allows you to continue to perform at a high level, that's being able to be drafted into the NBA or Major League Baseball, or if you're a veteran player, extending the length of your career several years, that can have very big implications both financially and on your family and on your performance goals. So, that's really where we positioned ourselves to be, the thought leaders, the academic leaders, and moving the use of stem cells forward.

Pete Kenworthy

Doctor, as always, we appreciate your time. Thanks so much for being with us.

Dr. James Voos

Thank you very much.

Pete Kenworthy

Remember, you can find and subscribe to this podcast on iTunes, Google Play, Stitcher, or wherever you get your podcasts. Search University Hospitals or Healthy@UH, depending on where you subscribe.

Macie Jepson

For more health news, advice from our medical experts and Healthy@UH podcasts, go to UHhospitals.org/blog.