A recent case report from Mayo Clinic highlights the potential of allogeneic, culture-expanded bone marrow-derived mesenchymal stem cells (BM-MSCs) in treating painful lumbar facet joint arthropathy (LFJA). The phase 1 clinical trial investigates the safety and preliminary efficacy of intra-articular BM-MSC injections for this common cause of lower back pain, which affects 15% to 40% of adults with LBP.
Addressing LFJA with Stem Cell Therapy
LFJA involves degenerative changes in the lumbar facet joints, leading to pain and reduced spinal flexibility. Current treatments primarily focus on symptomatic relief, such as analgesics, physical therapy, and corticosteroid injections, without addressing the underlying degenerative process. The Mayo Clinic's research explores regenerative medicine as a potential solution.
"MSCs have attracted significant interest for the treatment of symptomatic synovial joint degeneration due to their anti-inflammatory and immunomodulating effects and low immunogenicity," explains Wenchun Qu, M.D., Ph.D., a physiatrist and pain specialist at Mayo Clinic. The trial aims to assess if BM-MSCs can provide meaningful therapeutic benefits for pain management, functional activities, and potentially modify the disease.
Case Report Details
The case report, published in PAIN Reports, details the treatment of a 61-year-old female with chronic low back pain due to LFJA. The patient had experienced pain for over three years, rated as 8 out of 10 on the Visual Analogue Scale (VAS), and had not found long-term relief from previous treatments, including corticosteroid injections and radiofrequency ablation. MRI scans indicated severe LFJA at L4-L5 with right-sided facet synovitis.
The patient received a single injection of 10 million BM-MSCs into each of two affected joints. The researchers monitored the patient for two years, assessing pain levels, spine function, work functional status, and conducting blood sample analysis and MRI scans.
Promising Initial Results
The patient tolerated the BM-MSC injection well, with no significant adverse events reported during the study period. Significant improvements were observed in pain symptoms, spine function, and work functional status at multiple follow-up visits. Notably, MRI evaluation at the one-year follow-up showed a decrease in the grade of facet synovitis. The patient also reported improvements in mental and social health.
Implications and Future Directions
"Our case report suggests that administering intra-articular allogeneic BM-MSCs has a favorable feasibility and safety profile. And this treatment may have the potential to offer meaningful therapeutic benefits for pain management, functional activities and imaging changes," says Dr. Qu. He also noted, "While this case shows safety and pain relief for cell therapy, we are looking forward to having data from the entire phase 1 study to inform us with more certainty."
While these initial findings are promising, the researchers emphasize the need for larger, randomized controlled trials to confirm the efficacy and safety of BM-MSC therapy for LFJA. This study provides a foundation for future research and contributes to the growing body of evidence supporting regenerative medicine approaches for musculoskeletal conditions.
