Articular Cartilage in Osteoarthritis

The entire article appears at the Journal of Prolotherapy website

The Deterioration of Articular Cartilage in Osteoarthritis by Corticosteroid Injections
 
Ross A. Hauser, MD
 
abstract
The hallmark feature of osteoarthritis is the breakdown in the articular cartilage of joints such as the knee and hip. Both animal and human research has consistently shown that corticosteroid injections into normal and degenerated knees accelerate the arthritic process. A summary of the effects of the intraarticular corticosteroids on articular cartilage includes: a decrease of protein and matrix synthesis, matrix hyaline appearance becomes fibrotic, clumping of collagen, alteration in chondrocyte cell shape, chondrocyte cell proliferation inhibited, chondrocyte cytoxicity enhanced, loss of chondrocytes, surface deterioration including edema, pitting, shredding, ulceration and erosions, inhibition of articular cartilage metabolism, articular cartilage necrosis, thinning of articular cartilage, decrease in cartilage growth and repair, formation of articular cartilage cysts, and ultimately articular cartilage destruction.

Ross A. Hauser, M.D
Dr. Hauser the Medical Director of the comprehensive Prolotherapy clinic, Caring Medical & Rehabilitation Services in Oak Park, Illinois

Bone marrow injections for cartilage repair

Direct uncultured bone marrow cells regenerate articular cartilage in animal study

The question still remains, “Is Bone Marrow Prolotherapy the very best type of stem cell therapy?” Let’s put it another way, “Is direct bone marrow injection the best way to introduce stem cell therapy into a joint?” Let’s take a look at why these researchers give a resounding “yes” answer to that question.

Researchers from the Graduate School of Human Comprehensive Sciences, at the University of Tsukuba Japan have successfully regenerated articular hyaline cartilage by using uncultured bone-marrow-derived cells.1  The researchers wanted to determine if autologous (cells from the same animals) bone marrow cells could regenerate articular cartilage. To determine this they generated large full-thickness articular cartilage defects in the knees of 48 Japanese white rabbits. The animals were divided into four groups: the uncultured bone marrow cell group; the peripheral blood cell group; a fibrin group (gel used in the study);  or a control group, where nothing was done.  The knees of the rabbits were studied 3 months after the treatments were given. The articular cartilage underwent histological and histochemical investigation (under the microscope). So what did placing bone marrow cells do to the articular cartilage in this study?

According to the authors, “In the bone marrow cell group, regeneration of cartilage could be detected in almost all of the sections…the percentages of Safranin-O-stained areas (stains for cartilage granules) with respect to the regenerated soft tissue area were significantly higher in the bone marrow cell group than in the other groups.’1  They also noted “…our group has reported that autologous bone marrow-derived culture-expanded cartilage repair.  Comparing these latter results with those of the bone marrow cell group (direct bone marrow injection) there was no significant difference in any criteria….In conclusion, the transplantation of autologous uncultured bone marrow-derived mononuclear cells contributes to articular cartilage repair.  The easy and safe method used in this study is potentially viable for clinical application.”

The question still remains does bone marrow have to be cultured to get more stem cells to make it effective?  Our experience at Caring Medical is no, just like these researchers found. They found, as we surmise, that the stem cells in human bone marrow are smart enough to find the injured area and start proliferating, differentiating and proliferating the necessary cells to make the tissue that is degenerated or torn.  In other words, the body knows best.  Direct bone marrow injection for the regeneration of tissue such as articular cartilage and meniscus works in humans and there is no reason it won’t work in people.  We hope to be one of the centers to prove it!

1Chang F, Ishii T, Yania T. Repair of large full-thickness articular cartilage defects by transplantation of autologous uncultured bone-marrow-derived mononuclear cells.  Journal of Orthopaedic Research. 2008;26:18-26.

Ross A. Hauser, M.D.
Dr. Hauser the Medical Director of the comprehensive Prolotherapy, PRP, and Bone Marrow Prolotherapy clinic, Caring Medical & Rehabilitation Services in Oak Park, Illinois. Dr. Hauser is one of the leading experts in the treatment of chronic pain and sports injuries with Prolotherapy.