While improvements in fitness and preventive healthcare are increasing longevity and quality of life, they cannot entirely prevent wear and tear on the body. Keeping fit requires physical effort, which places heavy demands on bones, muscles and tendons. Active people inevitably face strains and other injuries that affect their ability to remain active and fit. These can accumulate over a lifetime, leading to chronic pain and limited mobility, the enemies of fitness and health. Surgery is often the one recourse available to repair injuries and debilitating conditions, especially in joints and muscles. Invasive procedures carry risks, however, particularly in complicated surgeries such as rotator cuff repairs, where some studies have shown persistently high failure rates[1].
An emerging, increasingly popular treatment for joint wear and tear relies on injecting stem cells into affected joints to promote faster healing and tissue regeneration. Stem cells have the unique capacity to develop into different types of cells, including brain, lung, muscle and tendon. Treatments use different types of stem cells, such as adult and umbilical cord, which are extracted, reprogrammed and then injected back into patients, usually at the affected joint[2]. These regenerative therapies hope to turn-back the biological clock by increasing the number of available stem cells at the damaged site, making them as plentiful as they were during childhood. The objective is to help adult bodies heal their wounds more quickly and effectively, as they could earlier in life.
Stem cells are like blank slates that can become almost any kind of cell. Once reprogrammed they can help heal or regenerate damaged tissues and organs.
Research studies and less formal anecdotal evidence suggest that stem cell therapies do reduce inflammation and pain, accelerate healing, and promote tissue regeneration, particularly in knee[3] and shoulder joints[4]. The surprising results of some studies have even left research teams searching for explanations. For example, in “the world’s first prospective, blinded and placebo-controlled clinical study to test the benefit of using bone marrow stem cells, a regenerative medicine therapy, to reduce arthritic pain and disability in knees,” Mayo Clinic researchers discovered that patients with arthritic conditions in both knees showed similar benefits in both joints, even though only one knee was treated – the other received a placebo:
“Given that the stem cell-treated knee was no better than the control-treated knee — both were significantly better than before the study began — the researchers say the stem cells’ effectiveness remains somewhat uninterpretable. They are only able to conclude the procedure is safe to undergo as an option for knee pain, but they cannot yet recommend it for routine arthritis care.”
One explanation offered by the Mayo team is that stem cells tend to migrate to where there is damage and therefore some of the cells injected into the damaged knee may have migrated to the other. The study’s lead author, Shane Shapiro, MD, hypothesized that “the stem cells we tested can home to areas of injury where they are needed, which makes sense, given that stem cells injected intravenously in cancer treatments end up in the patients’ bone marrow where they need to go… This is just a theory that can explain our results, so it needs further testing.”[5]
Stem cells are just one in a set of therapies in Regenerative Medicine, which are grouped into three general categories: Rejuvenation, Replacement and Regeneration. Their objectives include helping our bodies return to ‘younger’ states of health and fitness. “Regenerative medicine is a game-changing area of medicine with the potential to fully heal damaged tissues and organs, offering solutions and hope for people who have conditions that today are beyond repair.”[6] One of those conditions is age related deterioration of our bodies, particularly joints.
Implications
Regenerative medicine is benefitting from cutting edge technologies that include stem cell therapies. It will also benefit from wearable monitors that help doctors and patients identify illnesses and injuries before they become severe. Early intervention combined with innovative treatments will reduce the onset of disabling chronic conditions and help people remain active throughout their lives. This is critically important because physical activity is crucial to preventing costly illnesses that increase mortality and undermine quality of life.
Viewed from a public policy perspective, studies of preventable illnesses related to physical inactivity and poor fitness are conservatively estimated to cost between $2.5 and $4 trillion dollars over ten years[7]. For example, type-2 diabetes costs the US economy over $200 billion per year, and the odds of an inactive, overweight person contracting the disease are 31% higher than for their fitter counterparts[8]. The economic impacts are both personal and systemic. A recent global study found that diabetics in the US have the highest lifetime health care costs, $283,000 per person. It also noted that American women with type 2 diabetes suffered the highest annual income loss worldwide, $21,392 per year, and faced 50% lower chances of finding employment[9].
These numbers suggest that effective, accessible and generally affordable healthcare will remain beyond reach absent improvements in population fitness and significant reductions in chronic illnesses and conditions. The good news is that emerging technologies, including advanced wearable sensors and regenerative therapies are introducing practical solutions for addressing these otherwise intractable problems. The bad news is that unhealthy lifestyles remain prevalent and have been resistive to change, as exemplified by high levels of obesity in the United States[10], and it’s unclear whether greater health and fitness awareness will radically change underlying behaviors.
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Image reference
Image courtesy of Wikipedia, Human_embryonic_stem_cells.png: (Images: Nissim Benvenisty), derivative work: Vojtech.dostal (talk) via the Creative CommonsAttribution 2.5 Generic license.
References
[1] Maria Valencia Mora, Miguel A Ruiz Iban, Jorge Dias Heredia, Raul Barco Laakso, Ricardo Cuellar, Mariano Garcia Arranz, Stem cell therapy in the management of shoulder rotator cuff disorders, May 26, 2015, World Journal of Stem Cells, pgs. 691-699, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4444610/
[2] About regenerative medicine, Center for regenerative medicine, Mayo Clinic, Accessed July 27, 2017, http://www.mayo.edu/research/centers-programs/center-regenerative-medicine/patient-care/about-regenerative-medicine
[3] Kathleen Doheny, Stem cells for knees: Promising treatment or hoax?, WebMD, accessed April 14, 2017, http://www.webmd.com/osteoarthritis/news/20170407/stem-cells-for-knees-promising-treatment-or-hoax#1
[4] Maria Valencia Mora, Miguel A Ruiz Iban, Jorge Dias Heredia, Raul Barco Laakso, Ricardo Cuellar, Mariano Garcia Arranz, Stem cell therapy in the management of shoulder rotator cuff disorders.
[5] Kevin Punsky, Mayo Clinic finds surprising results on first-ever test of stem cell therapy to treat arthritis, December 6, 2016, Mayo Clinic News Network, http://newsnetwork.mayoclinic.org/discussion/mayo-clinic-finds-surprising-results-on-first-ever-test-of-stem-cell-therapy-to-treat-arthritis/
[6] About regenerative medicine, Center for regenerative medicine, Mayo Clinic.
[7] Frank W. Booth, Christian K. Roberts, Matthew J. Lave, Lack of exercise is a major cause of chronic diseases, retrieved May 24, 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241367/
[8] Can you prevent type-2 diabetes?, WebMD, accessed July 28, 2017, http://www.webmd.com/diabetes/type-2-diabetes-guide/preventing-type-2-diabetes
[9] Honor Whiteman, What is the global economic burden of type-2 diabetes?, Medical News Today, March 17, 2015, http://www.medicalnewstoday.com/articles/290948.php
[10] Adult obesity facts, Centers for Disease Control and Prevention, accessed July 30, 2017, https://www.cdc.gov/obesity/data/adult.html