Growth Factor Therapy vs Mesenchymal Stem Cells: Is GF Therapy Better?

How Growth Factors And Stem Cells Help OA

Osteoarthritis (OA) is a common disorder of the joints that arises from the dysfunction of several different tissues. These tissues include bone, cartilage, synovium, tendons, ligaments, and muscles. OA is the consequence of progressive wear-and-tear types of joint stress. This repetitive, low-grade injury pattern creates an imbalance in tissue breakdown and repair rates, favoring progressive joint destruction. OA may initially manifest as only pain but develop into debilitating joint dysfunction. The initial tissue damage causes inflammation, a complex biological process involving immune cells and small signaling molecules called cytokines. Tissue repair acts through a different class of regenerative cells called mesenchymal stem cells (MSCs). Small molecules and proteins secrete growth factors, and counteract the harmful effects of uncontrolled inflammation. Medications that physicians typically use to treat OA, such as non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, target the inflammation pathway. Newer therapies manipulate growth factors and MSCs to tilt this biological scale in favor of joint regeneration.

GF therapy helps build joint cartilage

Doctors can tap into the regenerative capacity of joint tissue by stimulating growth factors that create cartilage and synovium. In a recent randomized placebo-controlled trial of sprifermin, a recombinant analog of fibroblast growth factor 18 (FGF-18), patients received novel growth factor therapy injections into knee joints with OA. Dosing intervals ranged from every 6 months to 1 year. The researchers found that, compared with sham injections, sprifermin joint injections demonstrated increases in the size of the femorotibial cartilage. This finding may represent a reversal of OA damage, as cartilage degeneration and joint height shortening represent two hallmarks of OA. The clinical significance of these changes is unclear. Patients are often affected by the symptoms of OA, like pain or stiffness, despite having no physical evidence of joint damage.

A multifaceted approach to joint repair

Since the early 2000s, stem cell therapy has found applications in managing a wide variety of disease states. In a review and meta-analysis, patients demonstrated improvements in pain, knee joint function, and quality of life after receiving MSC joint injections. MSCs were found to reduce the burden of disease in OA through many different actions. MSCs regulate the immune system by secreting several different cytokines and growth factors. In this way, MSCs create a balanced repair environment. MSCs also migrate to the injury site and transform into several cell types to enhance the function of endogenous tissues and augment tissue repair.

Direct comparisons

In determining the better therapy, growth factor therapy versus MSCs, a direct head-to-head comparison would need to be made. Currently, the evidence to favor one therapy over the other is lacking, as randomized clinical trials directly comparing the two have not yet been performed. While there is still much work to be done in determining the superior therapy, emphasis should be placed on the fact that some different options currently exist for patients with OA. With an ever-increasing fund of knowledge regarding the biology of joint diseases, surely more are on the way. A thorough evaluation by a specialist will be able to provide information on what therapy is best for each patient.