Before I underwent knee replacement surgery three years ago last July, I was hellbent on waiting for a stem cell therapy alternative to regrow my arthritic joint. Having endured more than a decade of discomfort and a course of cortisone injections to keep the surgeons at bay, the advances in stem cell research had not yet reached a point where it could be considered a non-surgical alternative therapy.
There were several clinical trials. The closest still accepting volunteers was in Chicago. The only one in Toronto had reached its complement of candidates. Eventually, I was referred to an orthopaedic surgeon who explained to me why knee replacement using stem cells to regrow cartilage was still seeking answers for its most challenging limitation.
Mesenchymal stem cells harvested from a patient could be turned into chondrocytes, the name given to cartilage cells. Cartilage cells, however, need a matrix upon which to grow. That natural matrix is made of collagen, a structural protein our bodies produce that forms connective tissue. At the time of my referral, no stem cell treatment had yet to come up with a way to produce collagen and put it where it was needed to support growing cartilage.
The treatment of Liesel, the elderly gorilla, used mesenchymal stem cells harvested from a younger donor female gorilla who had undergone minor surgery in 2022. StemCellX, a company formed by leading stem cell scientists, worked with researchers from the University of Sheffield in the United Kingdom on Liesel’s treatment.
StemCellX is focused on cutting-edge research and stem cell treatments for veterinary medicine. It provided the harvested mesenchymal stem cells that were kept frozen until the procedure. There was no mention of concern about Liesel rejecting the stem cell infusion. That’s because mesenchymal cell transplants exhibit low rejection rates and tend to be well tolerated in transplantation. There was high confidence that Liesel would benefit since StemCellX has successfully treated dogs and horses with moderate to advanced osteoarthritis.
Several clinical trials using mesenchymal stem cell therapies for treating osteoarthritis have recently reported success. One from Brazil documents the use of bioscaffolds made up of collagen or hyaluronic acid applied to knee joints in place of natural collagen with intra-articular injections of mesenchymal stem cells to induce cartilage regeneration in osteoarthritic knee joints. The following illustration appears in the journal article that describes this clinical trial.
In another two-year case study published in the journal, Regenerative Medicine, 329 patients with knee osteoarthritis received mesenchymal stem cell therapy with significant improvements to the knee joint. In this clinical trial, the goal was to reduce or delay the need for total joint replacement.
In a University of California, Irvine (UC Irvine) clinical trial, laboratory-made neurons grown from embryonic stem cells have been injected into the brains of 12 patients with Parkinson’s. The clinical trial is ongoing but initial results are encouraging showing that the added neurons have formed synapses to link to the patients’ brain cells and produce dopamine.
Dopamine is a neurotransmitter used to send signals to neurons in the brain. Naturally produced by our bodies, too much dopamine causes aggressive behaviours in people Too little leads to diseases like Parkinson’s, restless leg syndrome and depression. Dopamine is often called the pleasure molecule because when produced it can induce those types of feelings. Getting the dopamine balance right, therefore, has turned out to be a way to treat Parkinson’s.
In the UC Irvine study, PET scans have been used to observe how the brain’s uptake of the neurons is succeeding. After a year, these laboratory-produced neurons appear to be surviving while Parkinson’s symptoms are shown to be lessening. The university’s ongoing research into Parkinson’s is not only focused on delaying the onset of the disease but also rebuilding the brains of patients suffering from it. The ongoing trial which started in May 2021 will conclude in 2024. At that time and based on reported success, the plans are to increase the number of Parkinson’s patients receiving neurons created from embryonic stem cells.
In the United States, embryonic stem cell research is considered highly controversial. Those opposed to a woman’s right to choose associate this type of research with abortion with the harvesting and use of embryonic stem cells violating the right to life and equivalent to committing murder. UC Irvine’s embryonic stem cell research is possible because the State of California is funding this important field of study, recognizing that scientific progress in this field could inevitably improve the quality of life for millions including Parkinson’s Disease sufferers.
]]>That’s why traditional therapies have involved developing drugs to artificially replace the missing dopamine. But recently surgeons have developed deep-brain stimulation (DBS) as a treatment, implanting a wire deep inside the brain to provide stimuli to minimize tremors and other symptoms. Stem cell research has also yielded some potential promise, producing cells that can be implanted in the area of the Thalamus and Substantia Nigra to become new dopamine producers.
Insightec’s procedure involves none of the above. Instead, the company has designed a non-invasive technology that alleviates the primary symptoms of the disease. They call their treatment Exablate Neuro. It involves brain surgery without an incision to eliminate tremors. The technology combines high-intensity ultrasound-producing helmet and magnetic resonance imaging (MRI) for guidance. The ultrasound beams target the area of the brain called the Vim point, where the Substantia Nigra resides. The focus of the beam ablates the Vim point without damaging nearby neurons and brain tissue. The patient remains awake throughout the procedure to ensure no unintended side effects occur such as tickling. The patients are asked to perform tasks during the procedure as well to ensure that only the targeted area is affected by the heating of tissue up to 60 Celsius (140 Fahrenheit) degrees. The entire procedure takes between 2 and 3 hours with the patient discharged on the same day. In terms of post-procedure side effects, patients report tingling in the fingers and tongue. In other cases, loss of balance has been reported. But both of these side effects disappear within a month or two.
Exablate Neuro received U.S. FDA approval in 2017, and has been adopted by surgeons around the world with to-date, over 50 medical centres treating more than 2,000 Parkinson’s patients using the technology.
Insightec is using ablative ultrasound not just to treat Parkinson’s. The company has developed the Exablate Body system to target uterine fibroids, and for metastatic bone cancer for pain palliation, and the Exablate Prostate, to treat prostate cancer.
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