Following up 8 years after two ‘first-in-man’ knee osteoarthritis treatments
We wanted to examine the utility of a combination of chondrocyte – a healthy cartilage cell - and bone marrow stromal/stem cell (MSC) transplantation in two late-stage knee osteoarthritis (OA) patients, with long-term follow-up. These patients suffered with severe knee pain over a five-year period, and X-rays showed there to be complete loss of cartilage in their knee joints. Both patients were offered knee replacement surgeries but, as keen sportsmen, they wished to avoid artificial knee joints. Professor James Richardson was an extraordinary orthopaedic surgeon based at the RJAH Orthopaedic Hospital in Oswestry (UK), who had been using cartilage cell therapy with the patients’ own (autologous) chondrocytes for over 20 years. In this study he performed two first-in-man combined autologous MSC and chondrocyte implantation procedures in an effort to regenerate these patients’ joint tissues. At one year post-surgery, both patients reported improvements in terms of knee pain and function, and clinical imaging revealed that subchondral bone marrow lesions, that had been present at the time of surgery, had decreased in volume. These clinical improvements were sustained up to the last follow-up (at 8 years).
These cases have supported the rationale for development of the Phase II clinical trial entitled ‘Autologous Stem cells, Chondrocytes Or the Two (ASCOT)’ that is currently underway at the RJAH Orthopaedic Hospital. This clinical trial has been designed to compare the safety and efficacy of MSCs and chondrocytes on their own or in combination for the treatment of knee cartilage injuries.
In October 2017, Professor James Richardson delivered a momentous announcement at the 11th annual Oswestry Cartilage Symposium. After more than 20 years of trials and research, the National Institute for Health and Care Excellence (NICE) finally approved chondrocyte cell therapy for the treatment of articular cartilage defects. This historic decision is anticipated to have a profound impact on the cartilage repair field in the UK and globally. Unfortunately, Professor Richardson passed away suddenly on the 18th of February, 2018, whilst on holiday with his family.
Combined Autologous Chondrocyte and Bone Marrow Mesenchymal Stromal Cell Implantation in the Knee: An 8-year Follow Up of Two First-In-Man Cases
Jingsong Wang, Karina T Wright, Jade Perry, Bernhard Tins, Timothy Hopkins, Charlotte Hulme, Helen S McCarthy, Ashley Brown, James B Richardson
From Cell Transplantation
Featured image credit: Professor James Richardson, image used with permission of the author
James Bruce Richardson was Professor of Orthopaedic and Trauma Surgery at the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.