膝関節症

変形性膝関節症に対する幹細胞関節内投与

knee_stem

幹細胞は関節内の炎症の抑制し、軟骨の修復にも働くため、関節内構造が再生され、痛みの大幅な軽減が期待できます。靭帯や筋肉の修復にも幹細胞は効果的なため、海外では一流アスリートなどもが治療を受けています

日本国内では東京医科歯科大学整形外科で「変形性膝関節症に対する滑膜幹細胞の投与」が行われており、損傷軟骨の再生が進んでいます。

変形性膝関節症とは

image_bone01

原因として、膝軟骨が摩耗して欠損した軟骨に原因がある場合と、膝の軟骨と軟骨との間にある三日月形のクッションの役割をしている半月板が損傷する場合の2つあります。原因として一番多いのは加齢に伴うもので、過激な運動など外部要因により引き起こすこともある。変形性膝関節症の場合は軟骨が損傷しており、同時に半月板も傷んでいることが多い。

kneestem cartige

すり減った軟骨を幹細胞で再生

膝の痛みのある方の治療は多くがヒアルロン酸注入と筋トレだと思います。これは痛んだ部分の根本的な解決をしておらず、爆弾を抱えたままの状態です。ご自身の幹細胞を培養し(治療の流れは下記参照)それをヒアルロン酸注入と同じように膝関節内に注入します。海外では1億セル程度の注入例が多いですが、当院では軟骨損傷具合に合わせて10億セルまで注入可能です。

治療実績の論文

Transplantation. 2013 Jun 27;95(12):1535-41. doi: 10.1097/TP.0b013e318291a2da.
Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study.
Orozco L1, Munar A, Soler R, Alberca M, Soler F, Huguet M, Sentís J, Sánchez A, García-Sancho J.
BACKGROUND:
Osteoarthritis is the most prevalent joint disease and a frequent cause of joint pain, functional loss, and disability. Osteoarthritis often becomes chronic, and conventional treatments have demonstrated only modest clinical benefits without lesion reversal. Cell-based therapies have shown encouraging results in both animal studies and a few human case reports. We designed a pilot study to assess the feasibility and safety of osteoarthritis treatment with mesenchymal stromal cells (MSCs) in humans and to obtain early efficacy information for this treatment.
METHODS:
Twelve patients with chronic knee pain unresponsive to conservative treatments and radiologic evidence of osteoarthritis were treated with autologous expanded bone marrow MSCs by intra-articular injection (40×10^6 cells). Clinical outcomes were followed for 1 year and included evaluations of pain, disability, and quality of life. Articular cartilage quality was assessed by quantitative magnetic resonance imaging T2 mapping.
RESULTS:
Feasibility and safety were confirmed, and strong indications of clinical efficacy were identified. Patients exhibited rapid and progressive improvement of algofunctional indices that approached 65% to 78% by 1 year. This outcome compares favorably with the results of conventional treatments. Additionally, quantification of cartilage quality by T2 relaxation measurements demonstrated a highly significant decrease of poor cartilage areas (on average, 27%), with improvement of cartilage quality in 11 of the 12 patients.
CONCLUSIONS:
MSC therapy may be a valid alternative treatment for chronic knee osteoarthritis. The intervention is simple, does not require hospitalization or surgery, provides pain relief, and significantly improves cartilage quality.


Arthroscopy. 2013 Apr;29(4):748-55. doi: 10.1016/j.arthro.2012.11.017. 2013 Jan 29.
Mesenchymal stem cell injections improve symptoms of knee osteoarthritis.
Koh YG1, Jo SB, Kwon OR, Suh DS, Lee SW, Park SH, Choi YJ.
PURPOSE:
The purpose of this study was to evaluate the clinical and imaging results of patients who received intra-articular injections of autologous mesenchymal stem cells for the treatment of knee osteoarthritis.
METHODS:
The study group comprised 18 patients (6 men and 12 women), among whom the mean age was 54.6 years (range, 41 to 69 years). In each patient the adipose synovium was harvested from the inner side of the infrapatellar fat pad by skin incision extension at the arthroscopic lateral portal site after the patient underwent arthroscopic debridement. After stem cells were isolated, a mean of 1.18 × 10(6) stem cells (range, 0.3 × 10(6) to 2.7 × 10(6) stem cells) were prepared with approximately 3.0 mL of platelet-rich plasma (with a mean of 1.28 × 10(6) platelets per microliter) and injected into the selected knees of patients. Clinical outcome was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index, the Lysholm score, and the visual analog scale (VAS) for grading knee pain. We also compared magnetic resonance imaging (MRI) data collected both preoperatively and at the final follow-up.
RESULTS:
Western Ontario and McMaster Universities Osteoarthritis Index scores decreased significantly (P < .001) from 49.9 points preoperatively to 30.3 points at the final follow-up (mean follow-up, 24.3 months; range, 24 to 26 months). Lysholm scores also improved significantly (P < .001) by the last follow-up visit, increasing from a mean preoperative value of 40.1 points to 73.4 points by the end of the study. Likewise, changes in VAS scores throughout the follow-up period were also significant (P = .005); the mean VAS score decreased from 4.8 preoperatively to 2.0 at the last follow-up visit. Radiography showed that, at the final follow-up point, the whole-organ MRI score had significantly improved from 60.0 points to 48.3 points (P < .001). Particularly notable was the change in cartilage whole-organ MRI score, which improved from 28.3 points to 21.7 points (P < .001). Further analysis showed that improvements in clinical and MRI results were positively related to the number of stem cells injected.
CONCLUSIONS:
The results of our study are encouraging and show that intra-articular injection of infrapatellar fat pad-derived mesenchymal stem cells is effective for reducing pain and improving knee function in patients being treated for knee osteoarthritis.

索引論文リンク

膝専門の整形外科医が担当


01
整形外科専門医 磐田振一郎

1971年生まれ 膝専門医の整形外科専門医
1996年 慶應義塾大学医学部 卒業
〜2001年 慶應義塾関連病院勤務(足利赤十字病院、小田原市立病院、伊勢慶應病院、川崎市立川崎病院、日野市立病院)
2004年 Stanford大学留学
2006年 国立病院機構村山医療センター
2009年 NPO 腰痛・膝痛チーム医療研究所設立
2016年 表参道ヘレネクリニック膝関節再生医療

診療費のご案内

施術 細胞数(セル数) 詳細 診療費
膝関節内 自己培養幹細胞投与
1億セル 細胞採取、細胞5年保管、関節内投与 移植コーディネータに相談

* 移植コーディネータ各社が、細胞治療費+コーディネート料+渡航費+ビザ発給等を加味して設定しています。総額として98万円〜1000万円で設定されています。

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