Musculoskeletal Care of the Mature Patient

 From the AMA Morning Rounds, Aug. 6, 2010, “Two new studies explore how to regenerate the body using its own cells.” Then I read on to learn that the process works when investigated in mice and amphibians. “Researchers identify genes able to turn fibroblasts into heart muscle.” Again, the work being reported was that of success with mice.  The published reports offer hope of novel approaches to the age-old dream of regenerating the body from its own cells. Animals like newts and zebra fish according to the New York Times, Aug. 6, 2010, can regenerate limbs, fins and even part of the heart. Might humans one day be coaxed to regenerate and rejuvenate?

Most research in the field of regenerative medicine focuses on the hope that stem cells can be trained to behave as normal adult cells do. Now go to your computer and Google stem cell clinics and you will be amazed at the international offerings and opportunities to spend your money on rejuvenation. Well, what goes around comes around and the notion of regeneration and rejuvenation is not new as you will learn from Pope Brock’s Charlatan, Crown Publishers, 2008. In 1917, Dr John R. Brinkley agreed to restore the virility of a 46-year-old Kansas farmer by transplanting two extra testicles from a goat. The American patient and consumer have a penchant for mumbo-jumbo and there is an opportunity for salesmanship in health care that is only limited by the imagination of the salesman.

What is the real story of stem cell therapy for osteoarthritis? In the last few years, a number of methods have been developed to repair cartilage damage. These include osteochondral transplantation, micro fracture surgery and cartilage cell implantation. The feature common to all these techniques is that they are limited to repair of focal lesions; patients with OA are excluded from treatment. Osteoarthritic cartilage destruction is large and unconfined and does not provide an appropriate environment for chondrocytes to build a framework. Successful repair of OA cartilage damage is dependent on the ability to form a matrix within the joint. So despite recent media reports that heralded stem cells as a breakthrough in the treatment of osteoarthritis, the use of stem cell therapy is as an adjunct to some other procedure in patients with limited cartilage damage alone.

More on stem cells next time

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