Stem cell therapy is a less invasive treatment than joint replacement

A stem cell therapy for osteoarthritis is to be tested on patients in the UK for the first time.

A year-long trial, funded by Arthritis Research UK, will mix stem cells with cartilage cells in the lab and inject them back into damaged knee joints.

The new treatment could be an alternative to joint replacement surgery, experts hope.

Scientists from Keele University will study up to 70 people from the end of this year.

The trial will be run at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, Shropshire as part of a five-year research programme.

Three treatments are being tested in a randomised trial of patients with osteoarthritis of the knee.

Cell therapy

Using keyhole surgery, a patient's cartilage cells – also known as chondrocytes – and bone marrow stem cells will be removed and grown in a laboratory for three weeks.

They will then be re-implanted separately in some patients, and mixed together in other patients, into the area of damaged or worn cartilage.

Scientists will then test the effectiveness of all three types of cell therapy, based on the quality of the new cartilage formed over a period of 12 months.

Chondrocytes – cartilage cells – have been grown in a lab and re-injected into patients' damaged knees for the last 15 years.

But scientists now want to find out if combining cartilage cells and stem cells in the same process could work better, and specifically if one type of cell stimulates the other.

Less invasive

Osteoarthritis affects an estimated 8m people in the UK.

The condition is caused by wear and tear to the surface of joints, leading to stiffness and pain.

At present there is little effective treatment for osteoarthritis patients, apart from pain-relieving drugs and joint replacement.

The trial will focus on knee joints, but the results could have implications for other joints, say the scientists.

The advantage of stem cell treatment is that it's much less invasive than major joint replacement surgery.

Sally Roberts, professor of orthopaedic research at Keele University and lead scientist on the trial, says it's also a more "biological approach".

"We are using the body's own cells to repair damaged joints. The hope is that it will be permanent and long-term repair," she said.

But, even if successful, the treatment won't be used on everyone with osteoarthritis.

"Surgeons don't want to put implants into young patients in their 30s, so we are targeting these people for the use of this cell therapy if we can produce robust new cartilage cells.

"Stem cells certainly have huge potential – we just need to learn how to harness it properly," she added.

Jane Tadman, spokesperson for Arthritis Research UK, said: "This is just the start of developing this technique, and it could be a few years before such treatment will be in routine use."

Richard Rudd's mother, father and two daughters all agreed it was time to let him go.

On October 23 2009, Richard was riding a motorcycle when he hit a car at speed.

He was found six metres away from his bike.

Diagnosed as paraplegic at the scene, after spending a month undergoing various tests and scans it was confirmed that the paralysis of both arms and legs was to be permanent.

Richard's father – also called Richard – said at the time: "To keep somebody alive whilst they're suffering and they're not going to get better, it's playing God, if you like, because it's going against nature.

"If nature had been left to take its course, Richard would have been gone a few weeks back."

The family was clear that Richard would not want his treatment to be continued. They remembered when discussing a friend who had become paraplegic following a car accident, he said: "If ever this happens to me, I don't wanna go on. I don't wanna be like him."

Initially it was believed that Richard had fallen into a coma from which he was unlikely ever to emerge.

His ventilator was the only thing keeping him alive.

Richard was unable to respond to his family – or even to doctors treating him – but then a startling discovery was made.

Defining death

The attending consultant, Professor David Menon, discovered that Richard was able to move his eyes in response to simple commands and questions.

This meant that, in theory at least, Richard could make the decision to live or die himself.

Professor Menon is a world-leading expert in the treatment of brain injuries and 13 years ago he established the Neuro Critical Care Unit (NCCU) in Addenbrooke's Hospital in Cambridge.

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Between survival and death there is a slightly grey area

Professor David Menon
Addenbrooke’s Hospital

It is now the largest unit of its kind in Europe with provision for 21 patients at any one time.

In this unit, the rules governing death are directly challenged.

"It's really important to think about death not as an event but as a process," said Professor Menon.

"That process can be strung out quite considerably and slowed down. It can also be interrupted."

In the UK today the legal definition of death is brain death, not whether the heart is beating as many believe.

And Professor Menon thinks that it is not just survival that is important but the quality of that survival.

"Between survival and death there is a slightly grey area," he said.

"The successes of modern medicine are often rightly publicised, but we rarely discuss what happens when medicine fails.

"For example, death is commonly viewed as an event which involves cessation of the heartbeat.

"In actual fact, it is irreversible damage to the brain that decides whether a person survives or not, and the heart needs to have stopped for several minutes before such damage results.

"Indeed, it is common, as with head injury, for the brain to be irreversibly damaged, while the function of the heart and lungs is maintained by intensive care."

Around 40% of patients admitted to the unit make a meaningful recovery.

Two months after Richard's accident, a speech therapist was asking him the same 20 simple questions – about his interests and family – each day.

Before the accident, Richard (r) was a keen motor cyclist and F1 fan

He answered by moving his eyes left or right to signal yes or no responses.

If Richard consistently answered correctly it would demonstrate that he had the capacity to finally be asked the question about what he wants: to continue treatment or stop it – effectively ending his life.

Richard had been in the NCCU for six months before Dr Menon asked him the question he had wanted to ask him ever since he saw his eyes move for the first time.

"He remembered he had had an accident," said Professor Menon.

"He was aware that he was being treated on an artificial ventilator and being fed through a tube going into his stomach and this was likely to be going on for some time. I didn't specify how long.

"Finally I then asked him if we were happy for us to go on treating him and he said 'yes'. I asked him again and on three occasions he made it clear, just with yes/no answers, that this was a consistent response."

Making progress

Richard is now able to make facial expressions and his long-term memory is intact.

He has been moved to a different unit nearer his home in Worcester and, after seeing slow but steady improvements, Richard Rudd Snr has changed his view.

"We all sit round and talk in the pub or at work and say 'if this happened to me, turn the machine off'," he said.

"It's all hypothetical and you don't know until it happens to yourself. As a family and friends, if that person can't decide for themselves, sometimes you feel that you can decide for them.

"Because, in theory, you think you can never live in that situation, you sometimes put that judgement onto somebody else.

"At the end of the day, you probably have no right to do that.

"But now Richard's in the situation where that's actually happened. It's real life – it's not pretend. He is in that situation.

"The will to live takes over."

Between Life and Death is on BBC One at 2235 BST on Tuesday 13 July, on BBC HD at 0000 BST on Wednesday 14 July and afterwards on iPlayer.