Jason Dragoo, MD, Professor and Vice Chair Department of Orthopedic Surgery at the University of Colorado talks about the curative potential of stem-cell technology in treating knee cartilage damage and osteoarthritis.
How long have you been working in orthopedics?
Dr. Dragoo: Sixteen years in orthopedic surgery.
Of those 16 years, what percentage do you think you have spent working on knees?
Dr. Dragoo: Ninety percent.
Are knee injuries getting worse and are they happening to younger people?
Dr. Dragoo: There are more knee injuries as people become more adventurous over time especially here in Colorado. There are more injuries because athletes are climbing for years and later in life. We have had plenty of 80, 85-year-olds in the clinic that say I just want to go back and climb. Whatever you can do I just want to go back and climb the 14,000-foot peak again. So that is wonderful.
Talk specifically about what you are doing with stem cells. Where do you get these stem cells?
Dr. Dragoo: Mother Nature put this piece of fat in our knee. It is called the Fat Pad. It is right under the patella tendon right by the kneecap. We looked at the Fat Pad and it contains an extremely high number of stem cells. Back in 2006 I was with a group of scientists at UCLA and the University of Pittsburgh and we jointly discovered that there were stem cells within fat tissue. It set off a worldwide revolution of getting stem cells from fat. Being from orthopedic surgery we thought maybe stem cells reside in the knee and there is fat in the knee called the fat pad. So, we devised a way to harvest a portion of the fat pad and the cells within it during normal arthroscopic surgery. Then we process the cells in the operating room and give them back to the patient during the same surgical procedure. So, it has really revolutionized our ability to use cellular medicine along with arthroscopic surgery.
Who is a good candidate for this?
Dr. Dragoo: There are two groups that can really benefit from this technology. One is arthritis patients who have pain. We are studying number one how it helps these patients. Does it decrease their pain? And the initial studies say that it does. Does it decrease their inflammation? The initial studies say yes it does. The question is does it regrow the cartilage at the end of our bones or help decrease the effects of arthritis? That remains to be determined with our most recent study.
So, is this for someone who is in the beginning of arthritis or will it prevent or delay a knee replacement?
Dr. Dragoo: The best candidate is probably someone with moderate middle stage arthritis where the joint is more normal. There is a high possibility that this could add some cartilage to their joint and could increase their activity level. We have also seen patients with severe cases of arthritis that have had marked decrease in pain after cell therapy and arthroscopy treatment. So, both groups could possibly benefit from it.
If it is not regrowing cartilage how is it stopping the pain?
Dr. Dragoo: Studies have shown that stem cells give out factors that reside on opioid receptors. Those are one of the pain-relieving receptors that we have in our body and that is the reason that stem cell therapy is thought to decrease pain.
Is this something that you must do once every six months or is it once every three years?
Dr. Dragoo: We started the study approximately two years ago and we still have patients that have had good pain relief. We do not really know how long this will last, but we think the minimum effects are somewhere around six months.
Do you see this as a cure for arthritis or pain relief for arthritis?
Dr. Dragoo: I think this is a good treatment that helps decrease pain and increase activity levels in patients with moderate arthritis. There is a possible cure for patients with a pothole in their cartilage, chip, or a defect in it. We are doing a second study sealing the chips or sealing the surface of the defect with the same fat derived cells and that is completely resurfacing the joint. So that may be more curative.
What is the difference between PRP and this? what does it do for a knee?
Dr. Dragoo: PRP has a lot of factors that are anti-inflammatory and could be pain relieving. Cell therapy uses the cells and that is a renewable source of factors. So, if the cells continuously produce substances that can decrease pain or inflammation, then the theory is this treatment would last longer than PRP because as soon as the growth factors are gone the therapy no longer works.
So, what is the next step? Is this something that we are going see around the world?
Dr. Dragoo: We’re extremely excited about our initial results but I think the key to cellular medicine is to get the data. What we have seen is throughout the world this has been sensationalized and there has been a lot of unwarranted claims about stem cell medicine. So, we want to do it the right way and here at University of Colorado we are committed to telling the truth and to find out the true details about how it helps people and their joints.
Where are you at in the study? Can people join the study and fly in to do it?
Dr. Dragoo: Somebody flew in from California yesterday so many people fly in for the study. We also have additional centers performing the study including Cedars Sinai as well as Ohio State University.
Do the cells have to come from the fat pad or is it because you are already in there?
Dr. Dragoo: It is beneficial with orthopedic or arthroscopic surgery to harvest them directly from the knee because that is where the problem is. However, the cells could be harvested from the abdomen or thigh. Sometimes, it is problematic because we have world-class athletes that want this treatment but there are no fat reserves in their abdomen or thigh. Therefore, there is always a ready source of these cells within the knee.
How easy and quick is it to get those stem cells?
Dr. Dragoo: The whole procedure of harvesting the cells, preparing them, and giving them back to the patient takes approximately 20 minutes. So, it adds little time to the arthroscopic surgery and procedures that the patient is already undergoing.
What other procedure would you be performing when you are doing this?
Dr. Dragoo: The modern theory of cellular medicine is to optimize the joint first. So, we do arthroscopic surgery to remove the errors, debris, and inflammation to optimize the joint from a physical perspective and then we add the cells for what we hope is maintenance and improvement of the joint overtime.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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