What if We Could Reverse Osteoarthritis?

If you don’t know anything about osteoarthritis here is a quick refresher course from The Mayo Clinic in Rochester, Minnesota. The Mayo is world-renowned as a treatment centre for numerous afflictions that beset humankind. So in going to its website for a definition of osteoarthritis, it makes a lot of sense. What does it say? Here is the exact quote:

“Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of the bones wears down over time. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips and spine. Osteoarthritis symptoms can usually be managed, although the damage to joints can’t be reversed.”

The Mayo says the only thing that those who have osteoarthritis can do is stay active, maintain a healthy weight, and try treatments to slow the progression of the disease while helping to improve pain and joint function.

Bone and Joint Canada (BJC), a not-for-profit organization that racks osteoarthritis notes that 4.6 million out of 40 million, that is more than 10% of the population, suffer from osteoarthritis. And that number is expected to grow in thirty years to 10 million.

In the United States, the Centers for Disease Control have calculated that osteoarthritis affects 32.5 million, and as in Canada, that number is expected to grow as the population of the country ages.

No country on the planet, in fact, is spared because osteoarthritis seems to come with aging. But is the Mayo Clinic right? Is osteoarthritis uncurable?

University of Adelaide researchers in Australia where one in five over the age of 45 suffer from the condition, beg to disagree with the Mayo. These researchers are working to restore Grem1 stem cells which disappear as we age coincident with cartilage thinning and degeneration.

A paper published in Nature Communications on October 31, 2023, describes the efforts of the research being done at the University’s Medical School. It describes osteoarthritis as the dysfunction of mature cartilage cells combined with an imbalance of Grem1 stem progenitor cells. Dr. Jia Ng from the Adelaide Medical School, is the lead author of the paper. In a news release from the University, he states:

“The findings of our study reimagine osteoarthritis not as a ‘wear and tear’ condition but as an active, and pharmaceutically reversible loss of critical articular cartilage stem cells.” With the discovery of the role of Grem-1 stem cells related to cartilage thinning, “are now able to explore pharmaceutical options to directly target the stem cell population that is responsible for the development of articular cartilage and progression of osteoarthritis.”

Research with stem cell injections so far has not effectively repaired osteoarthritis. A five-year clinical trial using Fibroblast Growth Factor 18 (FGF18), encoded by the FGF18 gene in humans and first discovered in 1998, has shown promise. A current Phase 3 trial using Sprifermin, a recombinant human FGF19 analog, has been encouraging.

Until recently regenerating cartilage medically has been next to impossible. Surgical efforts have been tried. These include:

• Drilling holes in bones to stimulate natural healing and cartilage regrowth.
• Inducing small injuries in bones within a joint to stimulate self-healing.
• Membrane-induced Autologous Chondrocyte Implantation or MACI which harvests chondrocytes from a patient, grows the cells in the lab, and then surgically implants them into damaged areas.
• Bone and cartilage grafting takes a larger segment of material from the patient to implant it where it is needed.
• Mosaicplasty involves harvesting healthy cartilage from non-weight-bearing areas in a joint and transplanting it into the damaged area.

A pharmaceutical solution would be a welcome change and could prove the Mayo Clinic’s pronouncement about osteoarthritis being irreversible false.