Adam W. Anz, MD, is an orthopedic surgeon and sports medicine specialist at Gulf Breeze, Fla.-based Andrews Institute for Orthopaedics & Sports Medicine. He is the director of the Andrews Institute Regenerative Medicine Center and oversees the ATC Fellowship Program at the Andrews Research & Education Foundation, where he serves as a board member.
Dr. Anz shared the following five insights on stem cell use for cartilage regeneration.
Note: This story has been edited lightly for style and format.
1. Historical progress: Emerging techniques using stem cells for cartilage regeneration are based upon decades of developmental progress, beginning with benchtop research in the 1970s, preclinical animal studies in the 1990s and [several current] strides in the last decade through well-designed clinical trials. A clear pyramid of developmental evidence has been built and guides emerging clinical application.
2. Foundational work: While the earliest work on stem cells is attributed to Alexander Maximow at the University of Chicago in the 1920s, foundational work applying stem cells to cartilage repair started on the bench top of Arnold Caplan in the late 1970s. Through continued benchtop and animal work all over the world, the mechanisms and logistics are becoming clear.
3. Early research: The first preclinical animal study involved a rabbit model and implanted bone marrow cultured stem cells on a collagen gel, which differentiated into chondrocytes by the second week after implantation. Repair tissue organized into cartilage tissue with development of a subchondral bone plate by the 24th week. Similar studies have followed with adipose, synovium and periosteum derived cells.
4. Developing technology: One stem cell technology that has been developing through U.S. FDA trials involves mobilized peripheral blood stem cells. This technology follows the footsteps of the hematology oncology profession’s development of the harvest of stem cells for bone marrow transplant. While bone marrow transplant originally involved bone marrow aspiration harvest, the profession developed harvest via pharmaceutical mobilization followed by venous harvest with apheresis to improve efficiency of harvest.
5. Research underway: Developmental work applying PBSC to cartilage repair is emerging from a group in Malaysia. Dr. Khay Yong Saw and colleagues first reported a case series involving arthroscopic marrow stimulation followed by multiple postoperative PBSC injections in five patients, with safety data and histology suggesting good cartilage repair tissue. Case series was followed by a randomized controlled trial illustrating further safety and efficacy. A multicenter, randomized controlled trial is underway at Andrews Institute for Orthopaedics & Sports Medicine, with an Investigational New Drug Application reviewed and approved by the FDA.