Regenerative Healing for Osteoarthritis

Joints, cartilage, ligaments, tendons and synovial fluid (for joint lubrication) undergo a continuous but slow turnover and remodeling process. This is affected by many physiological factors such as diet, supplements, activity, stress, gut health, allergies, immune status, infections, aging, hormones, toxic load and/or various medications. The continuous repair of joints and tissue depends on these nutrients: glucosamine, sulfur (MSM), hyaluronic acid, copper and vitamin C for collagen synthesis (found in tendons, cartilage, ligaments). Minerals are also very important because they stick to the collagen and provide structural support.

Four of the most common destructive processes that can impair the health of the connective tissue and shift the body towards degeneration and away from repair are:

• Inflammation: Short term inflammatory responses are good they bring immune cells and collagen building precursors to an area to promote healing and regeneration. Chronic low-grade inflammation that could be caused by excessive joint wear and tear, and/or low body stores of anti-inflammatory fatty acids (GLA, EPA) and/or excess of the inflammatory fatty acids (arachidonic acid). Many natural compounds such as turmeric, Boswellia, NAC, resveratrol, MSM, green-lipped mussel, phytocannabinoids, and Pycnogenol have been shown to support healthy inflammatory responses and promote repair.

• Oxidative stress resulting from free radicals generated from various causes including excessive inflammation, infections, poor diet, oxidized fats, and toxic metals: Oxidative stress can be significantly reduced by dietary antioxidants such as resveratrol, turmeric, NAC, and vitamin C as well as by an adequate supply of essential minerals selenium, copper, manganese, magnesium, and zinc.

• Autoimmune conditions could be caused by toxic metal/chemical load, intestinal infections, dietary allergies, microbial overload, prolonged stress, and other chronic illness. Various nutrients such as niacinamide, NAC, astragalus, DHEA peptides, and vitamin D to name a few help support and modulate the immune system. Therapies to heal the digestive tract, stabilize mast cells, and treat ongoing infections are an important part to optimize immune function.

• Catabolic factors: Excessive cortisol production (stress hormones) or steroid treatments such as cortisone can have a devastating effect on the ability to form collagen, which is a major component of cartilage, tendons, and ligaments. Promoting healing with stress reduction and balancing the nervous system are a critical part of promoting healing and wellness. 

Lifestyle and Diet Recommendations:

  • Movement – Exercise should be emphasized because it improves blood and lymph circulation, which enables the nutrients to reach the target tissue more effectively. Moderate exercise has been shown to reduce oxidative stress and inflammation as well as having immune boosting effects. It also reduces the risk of cardiovascular disease, diabetes, improves metabolism and weight control. 20-30 minutes of moderate exercise such as fast walking 3-5 days a week has been shown to be as effective as strenuous activity.
  • Hydration – Water is a major component of synovial fluid, which lubricates the joints to reduce friction between cartilage and connective tissue. It is also a major component of cartilage and combines with hyaluronic acid to cushion joints and absorb impact. Try and drink 60-80 ounces of purified water daily. It is preferred to drink a majority of that water before 3 pm to limit nighttime urination.
  • Low inflammatory diet – Focus on plant-based, whole foods. Limit highly processed foods, meat, dairy, sugar, and gluten.
  • Fasting – Simply put, fasting cleanses the body of unhealthy or unnecessary cellular debris at the same time stimulating growth hormone promoting our bodies regenerative abilities. Daily intermittent fasting has many health benefits including the prevention of insulin resistance, reversing minor insulin resistance, decreasing inflammation, and helping with weight loss. The most prevalent shifts in the reversal of degenerative and metabolic disease along with stimulating the production of stem cells come from long periods of fasting lasting 48–120 hours.
  • Detoxification – Toxic overload increases system inflammation, reactive oxygen species, immune dysregulation and breakdown of membrane function and communication. Symptoms manifest as inflammation, fatigue, weight gain, digestive issues, skin problems, insomnia, cognitive decline, depression, anxiety, sinus congestion, headaches or migraines, joint pain, and muscle aches or weakness. First and foremost, it is important to minimize exposure to environmental toxins. Once our exposure to environmental toxins has been minimized, it is important to enhance the body’s natural reduction of toxic load by increasing the biotransformation, excretion, and elimination of toxins.

Regenerative Injection Therapies

  • Peptide Therapy – Peptides are short chains of amino acids, which are molecules that make up proteins.  These molecules have the ability of binding selective cell membrane receptors leading to intracellular signaling and communication. These messenger molecules have crucial roles in human physiology affecting the function of hormones, neurotransmitters, and growth factors. A number of peptides are able to trigger a signaling cascade which triggers the proliferation of collagen, elastin, and fibroblast.
    • AOD -9064 + HA – is being used to help regenerate hyaline cartilage and is showing strong efficacy in the treatment of osteoarthritis. Theses peptides signal the body to enhance the differentiation of mesenchymal stem cells into bone, cartilage, and muscle.
    • Pentosan polysulfate is a peptide being used in the treatment of osteoarthritis. It has been shown to signal the production of synovial fluid, stimulate the synthesis of cartilage and prevent further breakdown of cartilage.
    • GHK-Cu – This peptide has a variety of roles in the human body including promoting activation of wound healing cascades, attracting immune cells to the area of injury, decreases oxidative stress and has inflammation-modulating effects. GHK-Cu role in signaling tissue remodeling helps remove damaged/scarred tissue and generates new, healthy tissue.
    • BPC-157 – Body Protective Compound accelerates healing and repair. it has a protective effect on organs and has been used in the treatment of traumatic brain injury (TBI), arthritis, joint injury/pain, stomach ulcers, intestinal permeability/leaky gut, irritable bowel syndrome, and inflammatory bowel disease.
  • Platelet Rich Plasma – Platelet-rich plasma therapy involves using your own blood plasma and platelets as an enriched source of growth factors and cytokines. This concentrated source of platelets, growth factors and cytokines stimulates healing of bone and soft tissue.  Our bodies are constantly trying to find equilibrium between breakdown and regeneration of tissues.  When we have an injury to a tissue or repeated stress on a joint resulting in osteoarthritis, tendinopathies, or rotator cuff injuries the stronger emphasis is put on breakdown over repair and equilibrium is lost.   The goal of using regenerative medicine such as platelet-rich plasma injection therapy is to shift the equilibrium back towards regeneration by stimulating an inflammatory response and supplying growth and repair factors to the area helping the body repair and heal itself.  This is a therapy that can be utilized for minor tearing of ligaments and tendons, osteoarthritis, plantar fasciitis, ligament instability, and injuries related to overuse.
  • Stem Cell Therapy – Mesenchymal adult stem cells used in regenerative medicine are autologous meaning from your own body. Mesenchymal stem cells that are found in bone marrow, synovial fluid, and adipose tissue most often. These cells can derive cartilage, bone, muscle, tendon, and ligaments. Allogenic stem cells are derived most often from placental cord blood. These cells can give rise to identical cells and can also produce differentiated cell lines and derive cartilage, bone, muscle, tendon, and ligaments. Both can reduce inflammation, secrete cytokines and growth factors to induce cellular proliferation or growth and angiogenesis the growth of new blood vessels. Which one is superior regarding regenerative medicine is still up for debate and opinions vary widely among practitioners. Stem cells injected into a source of injury or degeneration become activated, secrete various cytokines, and stimulate a healing response.  Stem cell therapy should be considered for osteoarthritis, intervertebral disc disorder, ligament/tendon damage, and cartilage injury.
See article discussing further health benefits of turmeric.

Reference:

  1. Cerovecki, Tomislav, et al. “Pentadecapeptide BPC 157 (PL 14736) improves ligament healing in the rat.” Journal of orthopedic research 28.9 (2010): 1155-1161.
  2. Sakata R, Reddi AH. Platelet-Rich Plasma Modulates Actions on Articular Cartilage Lubrication and Regeneration. Tissue Eng Part B Rev. 2016 Apr 25
  3. Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy. 2015 Sep 29. pii: S0749-8063(15)00659-3. doi: 10.1016/j.arthro.2015.08.005
  4. Dong Rak Kwon and Gi Young Park. Effect of Intra-articular Injection of AOD9604 with or without Hyaluronic Acid in Rabbit Osteoarthritis Model. Ann Clin Lab Sci. 2015 Summer;45(4):426-32.
  5. Kumagai, K., Shirabe, S., Miyata, N., Murata, M., Yamauchi, A., Kataoka, Y., & Niwa, M. (2010). Sodium pentosan polysulfate resulted in cartilage improvement in knee osteoarthritis – An open clinical trial-. BMC Clinical Pharmacology,10(1). doi:10.1186/1472-6904-10-7
  6. Pickart, L., & Margolina, A. (2018). Regenerative and Protective Actions of the GHK-Cu Peptide in the Light of the New Gene Data. International Journal of Molecular Sciences,19(7), 1987. doi:10.3390/ijms19071987
  7. Kong, L., Zheng, L., Qin, L., & Ho, K. K. (2017). Role of mesenchymal stem cells in osteoarthritis treatment. Journal of Orthopaedic Translation,9, 89-

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