Professor Richard Field, Professor Deiary Kader, Professor David Sochart, Mr Vipin Asopa, and Miss Irrum Afzal.
Background: Recent advances in regenerative medicine, particularly stem-cell therapy, hold promise for relieving symptoms of osteoarthritis by either replacing damaged cells and tissue or reducing inflammation. Whilst there is a growing body of research exploring such therapies, clinical use is currently not justified because existing research lacks the scientific rigor expected by EU Directive (EC 1394/2007). Despite this, a variety of stem-cell therapies based on obtaining cells from various sites and re-injecting them back into osteoarthritic joints, are being marketed with insufficient evidence of benefit.
Stem-cells are found in bone-marrow, peripheral blood and adipose (fat) tissue. Adipose tissue is a preferred sourced because it is thought to be a rich source of cells and easy to access using liposuction. Before considering the efficacy of stem-cell therapy, the exact nature of the intervention needs to be precisely defined. Several questions must be answered to define a consistent, high-quality, stem-cell based therapeutic product. These include, which site is the best source for obtaining adipose derived stem-cells (e.g. abdomen or buttock)? Can these cells be obtained using local anaesthetic? Being able to use local anaesthetic without harming stem-cells may allow development of out-patient therapy. Are cells best separated from adipose tissue using mechanical means or the enzyme collagenase? Using collagenase may increase the number of stem-cells obtained but has the disadvantage of risking damage to the patient if residue remains when cells are re-injected back into the host patient.
The aim of this project is to determine which combination of these variables will provide the best quantity and quality of stem-cells.
Methods: Adipose tissue will be obtained from 40 patients undergoing elective hip replacement surgery at SWLEOC. Patient will have provided informed consent and already be under general or regional anaesthetic at the time that abdomen and buttock adipose tissue is obtained with and without the use of local anaesthetic. The tissue will be transported to a laboratory at St. George’s, University of London, where stem-cells will be separated from the adipose tissue using enzyme or mechanical methods. The number and quality of stem-cells obtained under the different conditions will be measured and compared.
Summary: To investigate the effect of harvesting cells from the abdomen and hip, with and without local anaesthetic, using mechanical or collagenase methods. This will allow us to identify the best method to isolate cells before proceeding to a clinical study.