Regenerative therapies for the treatment of osteoarthritis
When is this procedure indicated?
Thanks to the excellent clinical and scientific results obtained in last decade, GSD Centers for Regenerative Medicine represent a national and international reference point in the application of regenerative medicine in the orthopedic, trauma and sport medicine fields. With its wide range of competencies and frequent injury, the skeletal system provides a rich testing ground for the field of regenerative medicine. Likewise, intra-articular ligaments, articular cartilage and menisci have almost no ability to heal after injury. Extra-articular ligaments and tendons, on the other hand, mount a repair response, but produce a regenerate that is inferior to uninjured tissue.
How is it performed?
- Mesenchymal Stem Cells
Mesenchymal Stem Cells (MSCs) have the ability to contribute to tissue healing through the production of a wide range of growth factors and molecules, adapting to the specific conditions of the patient’s pathology. MSCs are able to “feel” the environment in which they are used and react accordingly by releasing the molecules necessary to counteract the pathological microenvironment. In inflammatory situations, including chronic ones, they promote the restoration of the normal physiology of the treated tissue.
The tissues normally used to obtain MSCs are bone marrow, through suction from the iliac crest (pelvic bones) and adipose tissue, through a small liposuction (normally from the abdomen ADSC). An important finding is that since it is always an autologous use, no significant adverse effects have ever been found in any of the described techniques. Furthermore, they do not prevent the possibility of performing any type of subsequent treatment.
MSCs are multipotent stem cells with a strong capacity for self-renewal as well as a differentiation capacity to form chondrocytes, adipocytes and osteocytes. Bone marrow and adipose tissue (ADSC) have been the most source for harvesting MSCs. Particularly, BMAC represents one of the safest and most feasible source of MSCs and its intra-articular administration has shown pain reduction, functional improvement and most likely a tissue regeneration. BMAC is obtained through density gradient centrifugation of BMA. It has been shown to deliver high levels of hematopoietic stem cells (HSCs), MSCs, platelets, chemokines and cytokines including PDGF and transforming growth factor beta (TGF-β).
It must be noticed that growth factors can be both contained in alpha granule of platelets as well as actively secreted by MSCs. To this reason, BMAC holds anti-inflammatory, angiogenic, trophic and immunomodulatory properties which most likely induce cartilage repair4. In addition, MSCs have been shown to be able to suppress all immune cells playing a crucial role both in OA pathogenesis and progression, due to their immunoregulatory abilities
- Bone Marrow Aspirate Concentrate (BMAC)
Our Bone Marrow contains, although in low concentration, mesenchymal stem cells which are today considered a powerful tool to promote the restoration of tissue homeostasis (physiological condition) and help with tissue regeneration. Clinicians are able to extract bone marrow directly from the patient's iliac crest or tibia, concentrate a therapeutic dose of mesenchymal cells and other growth factors to treat a variety of musculoskeletal conditions.
What to Expect: Under a proper anesthesiologic protocol , a certified surgeon will bone marrow from the patient’s iliac crest or tibia. Extracted Bone Marrow is washed, processed in the operating room and then injected into the site of injury. Total procedure time is 1 hour, followed by recovery period from the anesthetic treatment.
- Adipose-tissue concentrate (ADSC)
Long thought to be a simple cushioning tissue, adipose (fat) is now regarded as one of the tissues that provides the greatest regenerative potential. The mesenchymal cells contained in the fat make it an excellent tool to promote the restoration of tissue homeostasis (physiological condition) by controlling inflammation, and promoting regeneration. Our doctors isolate adipose tissue through a mini-liposuction procedure (not to be confused with liposuction for aesthetic purposes), and use devices that mechanically break or separate the adipose tissue into an injectable formulation.
What to Expect: Under a proper anesthesiologic protocol, a certified surgeon performs a mini-liposuction on the patient. Extracted fat is washed, broken down or separated, and then injected into the site of injury. Total procedure time is 1 hour, followed by the normal recovery times of the anesthetic treatment.
The use of Mesenchymal Stem Cells (MSC): Knee – hip- ankle arthritis
We use Terumo BCT SmartPrep® System. The SmartPrep system provides valuable flexibility and is cleared to process all three major autologous biologics—concentrated bone marrow aspirate (BMA), platelet-rich plasma (PRP) and concentrated adipose tissue—using a single platform:
- Offers one-button processing
- Is designed to deliver a rich mixture of cells in high concentrations
- Is the only system cleared to process the three major autologous biologics on one platform: concentrated BMA, PRP and concentrated adipose tissue
- Produces concentrated, high-quality, injection-ready biologics with a simple operation