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Skin cell jab to cure tennis elbow by regenerating damaged tendon
Last updated at 09:35am on 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, a series of 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's Hospital in London, 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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2008年4月8日《每日邮报》报道，注射皮肤细胞可以帮助英国数百万网球肘患者摆脱疼痛困扰。这种领先的技术也可用来治疗全身其他部位的肌腱和韧带损伤——如跟腱撕裂。
英国研究人员从网球肘患者本人的皮肤中分离出皮肤细胞，然后将皮肤细胞注射到患者疼痛的关节部位。这些细胞能刺激受损肌腱再生，从而有利于病情缓解。研究人员已经在12名患者中安全的检测了这种治疗方法。11名患者在数周内治愈且未出现任何副作用，仅有1名患者对此治疗没有反应。
网球肘在医学上成为肱骨外上髁炎，是一种退行性疾病，因连接前臂和上臂的肌腱劳损而引起。通常认为，网球肘与肘部反复过度活动有关，但偶尔一次提重物也可引发。在英国大约有200百万本病患者，年龄主要在40-55岁之间。患者开始感觉肘部晨僵，肘关节外侧剧烈疼痛，疼痛沿胳膊向上和向下放射，使腕部力量减弱以致有些患者甚至连坛盖都拿不起来。治疗方法包括休息、抗炎、物理治疗和注射类固醇——尽管近年来发现注射类固醇并不比休息更有效。
几年以前发现，在患者的病变部位注射自己的血液可以刺激新生组织生长，封闭损伤。但这种方法存在产生瘢痕组织的问题，新生肌腱的弹性比健康肌腱的弹性差很多，从而限制了关节运动的幅度。
新的治疗方法从患者臀部取下一片4mm的皮肤，分离出特异的”干“细胞。虽然成人干细胞的多向分化性不如胚胎干细胞，但仍能诱导发育成类似于其起源部位的组织。例如，皮肤干细胞可以分化成肌肉肌腱或者韧带，但不能分化为肝细胞或者肾细胞。成人干细胞较胚胎干细胞的巨大优势在于，患者使用自己的干细胞不会被身体所排斥。大约4～6周，皮肤来源的少数干细胞可以培养分裂成100百万以上个细胞。在超声引导下可以把这些细胞注入肌腱损伤部位。
四年前兽医治好了一匹摔倒在跑道上而导致肌腱严重损伤的冠军马，网球肘的新治疗方法就是从中改良而来的。皇家兽医学院马整形外科教授Roger Smith说：“马和人之间有许多相似之处，他们以同样的方式衰老、运动，遭受类似的劳损。”
去年，David Connell领导的皇家国立整形外科医院的一个研究小组在对这项技术进行了初步检测。其中一名患者叫Michael Arciero，54岁，是萨里切斯顿的一名医院搬运工。一年前被诊断为左网球肘。他回忆说：“无论什么时候我试着提起东西，疼痛都会一直放射到我的手。医生用血液注射来治疗我的病情，数周后病情有所改善。但当我的右胳膊突然发病时，变得更加虚弱，可能因为我右利者，平时更多使用右臂。这次接受治疗后，医生叮嘱我两周内避免提重物，但是两天内疼痛就消失了。一周以后我又回到体育馆开始锻炼了。
这种疗法的一期临床实验目前正在进行中。50名受试者中有半数接受干细胞注射，另一半则接受自体血液注射。伦敦St Bartholomew医院整形外科顾问 Simon Owen-Johnstone先生评价这项研究说：“这似乎是解决网球肘的根本办法，我希望有更多帮助网球肘患者的新疗法。” |
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发表于 2008-4-18 07:47:44