The degeneration of joints has a global impact, especially in reducing quality of life. This is the result of chronic pain that limits functional independence and mobility. Deterioration of joints occurs when the cartilage wears down and bone tissues become exposed. Along with structural deformity, there is considerable discomfort. Unfortunately, existing medical solutions are unable to manage the deteriorating structures. The medical field is in critical need of solutions that can help this condition. Stem Cell therapy is one of the therapeutic solutions that can help. Stem Cell therapy can be used to counter structural tissue loss instead of masking the symptoms of the condition. The addition to the practice of regenerative therapy will be a significant milestone in the management of Osteoarthritis.
1. Osteoarthritis Disease Mechanism
To fully understand the disease, it is important to analyze the microenvironment caused in the joints. Osteoarthritis is more than just mechanical degeneration; it is a biochemical disease that is progressive. The process begins with mechanical stress that leads to a pathological process within the synovial fluid. Changes in the synovial membrane and the synovial fluid led to chondrocyte activity, which results in overproduction of matrix-degrading enzymes. Breakdown of the cartilage matrix begins with the degradation of collagen fibers by matrix metalloproteinase, and the degradation of aggrecan by aggrecanase. Tissue damage leads to the release of interleukin-1β, TNF-α and other inflammatory mediators, which leads to chronic inflammation. Once the synovial membrane becomes inflamed, hypoxia is observed. The regression of the synovial membrane further leads to the degeneration of the cartilage layer, which also puts excessive mechanical loads on the subchondral bone. Chronic stress on the joint makes the bones spurs harden and grow on the margins of the joints. This hardening is the body’s attempt to stabilize a decaying structure. Eventually the entire joint succumbs to and is consumed by the catabolic environment.
2. Conventional Osteoarthritis Treatment Approaches
Conventional clinical approaches focus more on the alleviation of symptoms than on the regeneration of tissues. This means a large proportion of patients are prescribed non-steroidal, anti-inflammatory drugs (NSAIDs). While these drugs are efficient in the short term, their long-term use is associated with gastrointestinal bleeding and raised cardiovascular disease risk. For the longer term, intra- articular injections of corticosteroids provide anti-inflammatories to joint spaces. However, paradoxically, the long-term effects of these injections are the increased rate of degenerative diseases in cartilage. Joint lubrication is attempted to be re-established by the supplementation of hyaluronic acid (Visco supplementation). Regrettably the benefit of hyaluronic acid is short lived, and its administration needs to be repeated. The last resort for Osteoarthritis is joint replacement surgery. This surgery is successful in the removal of such diseased tissues, however, it brings all the risks of surgery to the patient, such as infections and clotting, aside from a lengthy rehabilitation process. Additionally, Joints are prosthetics, and in the case of failure of the prosthetics, surgery must be repeated. The challenges of joint replacement emphasize the large and growing need for treatments for Osteoarthritis.
3. Rationale for Regenerative Intervention
Regenerative therapies are able to heal tissues by homeostasis using the body’s intrinsic biological mechanisms. When the tissues are affected the body’s response to injury is captured by the advanced therapy. Once a Stem Cell is in the cavity of the joint, the cell is able to be active and sense the localized tissue inflammation. The primary therapeutic benefit arises from paracrine signaling. These therapeutic cells secrete a rich profile of bioactive molecules collectively termed the secretome. These extracellular vesicles deliver anti-inflammatory proteins that neutralize destructive cytokines. Additionally, this approach helps to modulate the polarization of macrophages and advanced the immune system from a catabolic state to one that is focused on healing and repair. With the assistance of the modulated immune system and the paracrine factors within the cellular repair system, a differentiated tissue of cartilage may be formed. The biological agents that help to shift the environment of the joint from a catabolic to an anabolic state rapidly help to alleviate the persistent inflammation that helps repair and remodel the joint. Structural repairs may be achieved from the biological agents alone, superseding the traditional Osteoarthritis methods of joint intervention that are currently available.
Figure 1: The Comparative of Conventional approaches and Rationale for Regenerative Intervention
4. Development Trends in Thailand
Thailand is recognized to be the most advanced nation in the Southeast Asian region in the implementation of advanced medical techniques, coupled with modern facilities. The cultivation of healthy cell uses high culture methods in Thai laboratories as a result of the countries aging population serviced by a growing healthcare system. Unlike the other countries in the region, Thailand combines stringent but flexible regulating policies that promote medical advancements, resulting rapid translation of clinical research to patient care. Coupled with the advancements in healthcare, the country retains a strong position in medical tourism and an influx of patients provides Thai clinics with a broad foundation for Stem Cell therapies and services. Thailand’s burgeoning research capabilities coupled with governmental support, has become a premier destination for Osteoarthritis services and regenerative medicine in the region.
The regenerative medicine provides the tools to transform orthopedic services, and shift practice paradigms. The global impact of chronic degenerative joint disease underscores the critical need for innovative treatments. Current treatments focus on symptom relief. But, cell-based therapies, such as Stem Cell therapy, offer a promising treatment option. Through complex signaling and unique immunomodulating properties, Stem Cell create a more tolerogenic environment in joints. This biological shift stops the degradation of cartilage and further allows for the restoration and repair of joint tissues. Thailand has taken the lead in developing groundbreaking joint therapeutics. They combine intensive scientific work with the clinical practice to provide innovative therapies to patients. Regenerative techniques and therapies will be the new foundation for orthopedic healthcare.