Rheumatoid Arthritis is a progressive destructive joint condition characterized by dysfunction of the synovium, cartilage, and bone, resulting in physical disability, loss of employment, and decline in the quality of life. Chronic inflammation and immune dysregulation are the hallmarks of the condition. Current treatment options focus mainly on the management of inflammation and pain. There is a need for treatment options that restore physical functions and repair damaged structures. Since the major immune dysregulation of Rheumatoid Arthritis occurs in the joints, there is a potential to use a certain Stem Cell type, like UC-MSCs, that acts as an immune modulator to repair physiological damage. This innovative approach may offer a paradigm shift for affected patients.
Understanding the Mechanism of the Disease
Impaired immune tolerance is the initial stage of Rheumatoid Arthritis, a condition where future Stem Cell interventions could act. Few populations of auto-reactive T cells are activated in the synovial tissue and subsequently activate both macrophages and synovial fibroblasts. Synovial macrophages and fibroblasts produce abundant pro-inflammatory cytokines. One of the actions of synovial macrophages is to produce a chronic invasive and destructive tissue, called a pannus. The pannus proliferates invasive synovial tissue and secretes matrix metalloproteinase that cleave and degrade articular cartilage, making UC-MSCs a vital research target. The chronic inflammatory environment promotes the maturation of osteoclasts. These cells that absorb bone attack the subchondral bone in Rheumatoid Arthritis. The perpetual combination of cytokine release and cell destruction obliterates the integrity of the joint. To stop this process, immune system modulation has to be very accurate, highlighting the precise therapeutic potential of a Stem Cell therapy utilizing UC-MSCs.
An Examination of the Limitations of Current Treatments
Modern strategies to treat Rheumatoid Arthritis (RA) mainly include the application of disease-modifying antirheumatic drugs (DMARDs) rather than advanced Stem Cell options like UC-MSCs. Methotrexate is one of the most common treatments. In addition to Methotrexate, inflammation reducing biological therapies may be prescribed. When there is a need for pain control due to inflammation, a glucocorticoid is prescribed. Even though these treatments are standard, the limitations are very obvious. As other treatments are also prescribed, the patient’s immune system is at risk and systemic infections of a greater risk are possible. Osteoporosis and other metabolic diseases may be a result of the long use of glucocorticoids. In addition to these ailments, a significant number of patients achieve no improvement and even a regression of symptoms, which is more harmful than the treatment. The most obvious problem of all these treatments is that none of the existing treatments can promote the growth of new cartilage. All existing treatments can do is prevent further degeneration, which really shows the need for new cartilage growth.
The Justification for Newer Biological Treatments
With the advent of newer biological treatments for Rheumatoid Arthritis, the use of an umbilical cord Stem Cell, specifically UC-MSCs, may eliminate some of the problems that conventional treatments have. The safety and the preservation of the umbilical cord Stem Cell is one of the main reasons for the use of UC-MSCs over other treatments. Therapies based on these cells have the potential to release a patented secretome in the joints. The secretome has the potential to contain strong anti-inflammatory cytokines. These have been shown to be effective to inhibit T lymphocyte proliferation. At the same time, this Stem Cell action prompts the formation of T regulatory cells that also help to restore balance to the immune system in Rheumatoid Arthritis. Additionally, exosomes produced by these UC-MSCs modulate the destructive activities of matrix metalloproteinases, which helps to shield the cartilage from the destruction caused by the lingering enzymes. These components help to mitigate the inflammation and encourage the endogenous chondrocytes to produce type II collagen.
Figure 1: Exploring the future of Rheumatoid Arthritis treatment
Regional Trends and Future Implementations
There is a rapid growth in the adoption of regenerative medicine and Stem Cell practices within clinical practice across the countries of Southeast Asia for conditions like Rheumatoid Arthritis. Of these countries, Thailand has the great potential to emerge as the primary location for these advanced UC-MSCs therapies. This is due to the existing advanced Medical Tourism coupled with Clinical Research and Services Facilities. Thailand’s leading research and Medical Science Academia have begun streamlining Laboratory protocol systems for Mass Expansion of Biologics. Thailand has introduced its safety and ethical guidelines for the modern applications for Cell-Based Therapies. Thailand’s government has focused its Biotechnological Research development for an advanced Healthcare System. Thus, within a short time therapeutical applications of UC-MSCs for this indication will cease to be investigational. Meanwhile, researchers are continuously adjusting and enhancing the specific delivery systems to achieve the greatest extent of therapeutic effect. Thailand is providing affordable regenerative medicine.
Overall Summary of the Therapeutic Evolution
The burden of Rheumatoid Arthritis merits the need for new therapeutic modalities, particularly Stem Cell interventions utilizing UC-MSCs. The combined mechanisms of destructive inflammation and cytokine mediated tissue damage demand a complex biological solution. It has become self-evident that post-inflammatory joint damage is permanent and progressive. The integration of a unique biological unit, like a Stem Cell, is paramount to the progression of modern medicine for Rheumatoid Arthritis. The medical field can now effectively combat the challenges posed by the deterioration of tissues and the disturbance of autoimmunity with the specialization of paracrine signaling of UC-MSCs. The extensive medical facilities and services available in Thailand make it the ideal country for the development of new advanced regenerative therapies. The progressive refinement of complicated lab protocols will make these therapies a biological reality to millions of patients with previously untreatable medical conditions. The complete biological restoration of joints is now possible.