Stunning Stanford study finds way to regrow joint cartilage. Could it mean an end to osteoarthritis?

STANFORD, Calif. - New groundbreaking research by Stanford researchers has shown to do something that was previously believed not possible: reverse age-related cartilage loss in joints. The findings could drastically change the way arthritis is treated and potentially put an end to the highly common procedure of joint replacement. 

It’s a seminal discovery that astonished even researchers. 

"We were surprised," said Dr. Helen Blau, director of Baxter Laboratory for Stem Cell Biology at Stanford University School of Medicine. "We were amazed to see that extent of regeneration of the cartilage."

The researcher said she had been testing her investigational drug on how it affected weakened muscles due to age, but then talked with a colleague about turning the focus on how the treatment would affect joint cartilage. 

The tests were conducted on various forms of degenerated cartilage and the findings were consistent. 

What they're saying:

"We tested it in three different models – in ACL [anterior cruciate ligament ] injury models of OA [osteoarthritis], and with aging, and then also in human explants. So we know that it also works on human, at least on human knee tissues that were removed in the course of surgery for knee replacement," Blau said. "So, we were quite surprised."

Researchers honed in a lipid compound known as prostaglandin E2, which acts as a hormone-like mediator and a key component in regulating inflammation, which decreases in aging cartilage. 

"We discovered that it's due to the fact that there's an increase in a prostateglandin-degrading enzyme triggered by aging and injury. And we named this a gerozyme," the researcher said.

That gerozyme, also known as 15-PGDH, increases with age and drives the degeneration of tissue.

Fountain of youth? 

Blau and her colleagues discovered a small-molecule inhibitor that can be taken orally or locally injected to acutely block PGDH.

"That causes a modulation of the PGDH. It physiologically shifts it back to pre-injury or to youthful levels. And this has that very beneficial effect on reprogramming the cartilage to make the products that are needed to lubricate the joints," the researcher explained. So it makes the collagens and the glycosaminoglycans that are needed by the joint and that are lost with osteoarthritis." 

Asked if this treatment could be viewed as an elixir of youth or aging reversal, Blau responded by saying, "What we’re really doing is more likely we're reprogramming cells to function in a way that they used to work and resetting that dial and function of the cells. "So I guess yes, it's a kind of fountain of youth."

1 in 5 Americans affected 

The findings could be a game-changer for 20% of Americans, who suffer from age or injury-related osteoarthritis.

"Osteoarthritis is a common debilitating disease that is difficult to treat effectively," researchers wrote in their published study which appeared in the peer-reviewed journal Science. 

An estimated $65 billion dollars in direct medical costs are associated with osteoarthritis treatment in the U.S. every year.

Currently, treatment options are limited, with a big focus on pain management and mitigating inflammation. 

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Joint replacement obsolete?

For many, the answer is eventual joint replacement. Figures show more than 1 million knee and hip replacements are performed every year in the U.S.

But ultimately, the new discovery could make those procedures obsolete.

"That's our dream," Blau said. "Our dream is that this could replace hip and knee replacement." 

‘Not ready for prime time'

But the researcher also cautioned that getting to the stage where the therapy is readily available to the public is still years away.

"This is not ready for prime time," she said. "There are still many phases of research and testing that need to be done. We need to go step by step and make absolutely sure that it's safe and working well in people and go through all the trials that are necessary," the scientist stressed.

Perhaps demonstrative of the widespread demand for a remedy for osteoarthritis, the interest has been overwhelming, the Stanford expert said. 

"We are being inundated with emails from people, understandably, who are so keen to have this treatment. But it is going to take time. It is not available now," she emphasized. 

The drug has shown to be effective and safe in Phase 1 clinical trials targeting muscle weakness, and researchers expressed cautious optimism of a similar path with the testing on cartilage.  

"It's been through some trials already, which should help with the path forward," Blau said, adding, "But I don't know how complicated it will be. So I really don't know until we get further along the trail."

When pressed to provide a rough estimate of how many years she believed it would take before this potentially trailblazing treatment would be available to those suffering from osteoarthritis, she responded: "If all goes well, maybe two to four."

Big picture view:

The discovery has led to a revolutionary, new approach to treating damaged cartilage. 

"Cartilage is one of the least regenerative tissues," researchers wrote in the published study. 

This idea of regrowing existing cartilage was once believed to be impossible, largely in part due to the fact that cartilage has no regeneration ability because of its lack of stem cells, which are essential for the regeneration of a tissue. 

"But what we found is a different mechanism, where the existing cells change their gene expression. So we don't have new cells, we don't have any cell death, we have a change in the gene expression pattern of the cells that are already there," Blau said. "We're simply empowering the cells that are already present in the joint, to function better."