Skin cell jab to cure tennis elbow by regenerating damaged tendon
By ANGELA BROOKS
8th April 2008
An injection of skin cells could help millions of Britons who suffer
from painful tennis elbow.
The 15-minute procedure uses cells taken from a tiny piece of their
own skin. They are then injected into the joint to regenerate the
damaged tendon that causes the painful condition.
British researchers have already safety-tested the radical therapy in
a pilot study of 12 patients.
Eleven were cured within weeks with no side effects and only one
patient failed to respond.
The pioneering technique could also help treat tendon and ligament
damage throughout the body - such as a torn Achilles tendon.
Tennis elbow, which is known in medical terms as lateral
epicondylitis, is a degenerative condition thought to affect two
million people in Britain - mainly between the ages of 40 and 55.
It is caused by fraying of the tendon that joins the forearm muscle
to the upper arm.
Repeated overuse of the arm is most often to blame, but it can also
be triggered by an isolated incident - lifting something too heavy
can be enough to trigger an attack.
Patients initially suffer feelings of stiffness in the elbow first
thing in the morning, as well as severe pain on the bony outer side
of the joint.
This pain can radiate up and down the arm, weakening the wrist so
severely that some find even taking the lid off a jar impossible.
Doctors recommend rest, anti-inflammatories
physiotherapy sessions and steroid injections - although steroids
have recently been shown to be no more effective than rest.
It was found a few years ago that injecting patients with their own
blood at the site encouraged the growth of new tissue, sealing the
tears.
The problem is that this generates scar tissue, which is far less
elastic than healthy tendon and so limits the range of movement.
In the new treatment, a 4mm piece of skin is taken from the hip and
used to isolate special "stem" cells.
Stem cells are capable of morphing into any form of tissue.
Although adult stem cells tend to be less flexible than embryo stem
cells, they can be coaxed into developing tissue similar to their
site of origin.
For instance, skin stem cells can be grown into muscle tendon or
ligaments but not into liver or kidney cells.
The huge advantage they have over embryonic stem cells is that using
the patients' own stem cells means they won't be rejected by the
body.
The few stem cells taken from the skin are cultured until they have
grown over one million cells. This takes between four and six weeks.
The cells are then injected under ultrasound guidance into the tendon
defects.
This technique has been adapted from a treatment developed by
veterinary surgeons four years ago to get champion racehorses back on
track following serious tendon damage.
The work on horse injury was pioneered by Roger Smith, professor of
equine orthopaedics at the Royal Veterinary College.
"There are many similarities between horses and humans," says
Professor Smith. "They age and exercise in the same way and suffer
from similar strain injuries."
A team working at the Royal National Orthopaedic Hospital in
Stanmore, Middlesex, led by Dr David Connell, tested the technique in
a pilot study last year.
One of the patients was Michael Arciero, 54, a hospital porter from
Chessington in Surrey.
He had been diagnosed with tennis elbow in his left arm a year
previously.
"Whenever I tried lifting anything, pain shot all the way down to my
hand," he recalls.
"I was treated with blood injections, which worked although my arm
took weeks to improve.
"But when the condition flared up in my right arm, it was much more
debilitating, probably because I'm right-handed and rely on that side
more.
"After the procedure, I was told to avoid lifting anything heavy for
a fortnight, but within two days the pain had gone. A week later, I
was back at the gym."
The first clinical trial of the treatment is under way, with half of
the 50 testers being given injections of the stem cells and the
others receiving injections of their own blood.
Commenting on the research, Mr Simon Owen-Johnstone, a consultant
orthopaedic surgeon at St Bartholomew'
said: "This appears to be a radical solution for tennis elbow, and I
would welcome any new treatment that helps these patients."
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StemCells subscribers may also be interested in these sites:
Children's Neurobiological Solutions
http://www.CNSfoundation.org/
Cord Blood Registry
http://www.CordBlood.com/at.cgi?a=150123
The CNS Healing Group
http://groups.yahoo.com/group/CNS_Healing
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