Stem Cells Research 干细胞研究

This page provides research information on stem cells.
Enjoy!

Benefits of Stem Cell Research

Stem cell research originated in the 1980s within the field of biotechnology. Since then, progress has been made towards developing a number of potential treatments for what are still considered untreatable diseases. However, controversy regarding the means and methods of study have slowed further progress within the field. This article will address the medical benefits of stem cell research and the controversy surrounding its practice.

Identification

The study of stem cells examines the characteristics and functions of embryonic cell formations. These are the very first cells to form when conception takes place, and they're responsible for the design and construction of the body. From the moment they appear, they continue to divide into the various tissue, muscle, skin, blood and brain cells that make up the body. The stem cell's ability to differentiate itself into specialized tissue and organ masses make it a highly valuable component within the medical field. They are the only cells in the body capable of this level of diversification. Understanding how these cells grow and develop is the primary focus of stem cell research.

Features

Left to their own devices, embryonic cells will develop into different types of cells. Getting these cells to reproduce replicas of themselves was the first problem scientists sought to resolve. It wasn't until 1998, when James Thomson, a scientist at the University of Wisconsin, succeeded in isolating a set of embryos and growing them into stem cell lines. Once this was accomplished, it became possible to observe the process that enables the cell to differentiate.

Scientists knew that the DNA structures within embryonic cells were responsible for their diverse, reproductive abilities; however observations revealed that secretions from neighboring cells also played a part in the differentiation process. As of yet, research attempts have not been able to induce these cells to grow into specific types of cells.

Potential

Organ and tissue transplant materials are in constant demand within the medical field. Accident victims and cancer survivors depend on replacement organs and healthy cell formations to live. These are areas where stem cell applications can greatly reduce the time required to find a replacement organ, or breed healthy cells masses. Other areas in which stem cells would benefit include -

• Alzheimer's disease
• stroke
• heart disease
• diabetes
• rheumatoid arthritis
• Parkinson's disease
• spinal cord injuries

The use of stem cells to replace damaged or diseased cell formations could potentially revolutionize the way physicians diagnose and treat injury and illness. A complete understanding of how these cells work is needed to make full use of their benefits.

Types

As stem cell research progressed, the discovery of adult stem cell formations soon followed. These cells are found in specific organs, or tissue masses within the body. They act in much the same way as embryonic cells as far as reproducing, but they're only able to reproduce cells of their own type. Continued research into adult cells has centered on comparing the different reproductive processes carried out by these two types of cells.

Considerations

The process of removing stem cells from an embryo causes the embryo to die. This inevitable result is the cause of much controversy. The question of at what point is a fetus considered a living being is the central issue surrounding the research taking place. Pro-life advocates define the procedure as an act of murder, stating life begins at the moment of conception. This controversy has had a considerable impact on further developments within the field. As such, adult stem cell research efforts are looking into ways to simulate the differentiating process of embryonic cells.

Also at issue is the inherent potential to clone humans once a full understanding of the process is reached. This concern became particularly apparent when the first successful cloning of a lamb was done in 1997. Proponents of stem cell research continue to stress the treatment benefits that will accompany further progress made within the field. To date, current federal legislations prohibit further embryonic experimentation.

Resources

* The National Institutes of Health - Stem Cell Information
* Stem Cell Resources

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Adult Stem Cells and the Science of Aging
 
For those seeking to exercise greater control over their own aging process, science has made considerable advancements in it's research, and more importantly, in actual human results.

The most exciting results and advancements have come from the stem cell branch of study. Specifically, adult bone marrow stem cells.

Recent presidential debates have publicly opened the door to the amazing power discovered in adult stem cells. How do these discoveries effect human aging?

The two grades of aging.

Science tells us that there are two distinct measurements of aging, chronological and biological. There is nothing that can be done to halt, or even slow down chronological aging. Chronological aging is based and measured entirely on the passing of time.

If you were born forty years, ten months and twenty seven days ago, chronologically that is your age. However, chronological aging is not nearly as important as biological aging. Biological aging details how the body, or more specifically, the organs are functioning based on a measure of years.

For instance, a person may be thirty five years old yet have the lungs functioning at a performance of a twenty year old. The opposite may also be true. A person can be in their early thirties yet have their body and organs functioning at a much older age. Therefore, understanding the difference between chronological aging and biological aging is of key importance in the control and suppression of aging.

But what determines the rate in which biological aging occurs? The body's ability to renew itself.

Stem cells and the aging process.

Interestingly enough, adult stem cells seem to be effected by chronological aging. Science has proven that at a certain age, usually between twenty five and thirty five, the body's adult bone marrow stem cells dramatically reduce their circulation within the body. This in turn significantly reduces the body's renewal process, leading to organ degradation, a breakdown in function and the advancement of aging.

A key point to be aware of is that the adult stem cells are in fact still within the body. Every human being has millions upon millions of healthy, genetically intact adult stem cells within the bone marrow. However, there is a point in time when the body significantly reduces it's release of bone marrow stem cells.

As this release is slowed down, aging begins to speed up. The key question now is, is there anything we can do to stimulate the release of bone marrow stem cells?

Here are four specific steps you can take to put the brakes on the aging process.

1.Rigorous exercise; Numerous studies have shown conclusively that rigorous exercise has a positive effect on the body's aging process. Exciting new studies also indicate that exercise stimulates the body's release of bone marrow stem cells.

2.Breathing exercises: Deep, systematic breathing exercises such as chi kung or yoga have shown very positive results in the areas of aging. Deep diaphragmatic breathing oxygenates the blood, which in turn helps to maintain cellular health.

3.Proper nutrition: obviously this is not a new concept, but certainly worth mentioning. Properly feeding the body with essential nutrients is elementary in slowing down the aging process by simply keeping organs biologically sound and healthy.

4.Stem cell enhancers: In recent years science has discovered specific nutrients that greatly help the body release it's own bone marrow stem cells into the blood stream. These enhancers facilitate the circulation and travel of adult stem cells throughout the body. This has shown to be a massive advancement in adult stem cell science.

Science has proven that we are not as vulnerable to aging as we once thought. There is a certain measure of control we can exercise if we decide to. The stimulation, release and circulation of your own adult bone marrow stem cells can literately be the passage to the fountain of youth.


CANCER UPDATE FROM JOHNS HOPKINS :

AFTER YEARS OF TELLING PEOPLE CHEMOTHERAPY IS THE ONLY WAY TO TRY ('TRY', BEING THE KEY WORD) TO ELIMINATE CANCER, JOHNS HOPKINS IS FINALLY STARTING TO TELL YOU THERE IS AN ALTERNATIVE WAY.

1. Every person has cancer cells in the body. These cancer cells do not show up in the standard tests until they have multiplied to a few billion.. When doctors tell cancer patients that there are no more cancer cells in their bodies after treatment, it just means the tests are unable to detect the cancer cells because they have not reached the detectable size. 

                                                                                                    
2. Cancer cells occur between 6 to more than 10 times in a person's lifetime..

3. When the person's immune system is strong the cancer cells will be destroyed and prevented from multiplying and forming tumors.

4. When a person has cancer it indicates the person has multiple nutritional deficiencies. These could be due to genetic, environmental, food and lifestyle factors.

5. To overcome the multiple nutritional deficiencies, changing dietand including supplements will strengthen the immune system.

6. Chemotherapy involves poisoning the rapidly-growing cancer cells and also destroys rapidly-growing healthy cells in the bone marrow, gastrointestinal tract etc, and can cause organ damage, like liver, kidneys, heart, lungs etc..

7. Radiation while destroying cancer cells also burns, scars and damages healthy cells, tissues and organs.

8. Initial treatment with chemotherapy and radiation will often reduce tumor size. However prolonged use of chemotherapy and radiation do not result in more tumor destruction.

9. When the body has too much toxic burden from chemotherapy and radiation the immune system is either compromised or destroyed, hence the person can succumb to various kinds of infections and complications.

10. Chemotherapy and radiation can cause cancer cells to mutate and become resistant and difficult to destroy. Surgery can also cause cancer cells to spread to other sites.

11. An effective way to battle cancer is to starve the cancer cells by not feeding it with the foods it needs to multiply..



*CANCER CELLS FEED ON:

a) Sugar is a cancer-feeder. By cutting off sugar it cuts off one important food supply to the cancer cells. Sugar  substitutes like NutraSweet, Equal, Spoonful, etc are made with Aspartame and it is harmful. A better natural substitute would be Manuka honey or molasses, but only in very small amounts. Table salt has a chemical added to make it white in color. Better alternative is Bragg's aminos or sea salt or Himalaya rock salt

 b) Milk causes the body to produce mucus, especially in the gastro-intestinal tract. Cancer feeds on mucus. By cutting off milk and substituting with unsweetened soy milk cancer cells are being starved.

c) Cancer cells thrive in an acid environment.. A meat-based diet  is acidic and it is best to eat fish, and a little chicken rather than beef or pork. Meat also contains livestock antibiotics, growth hormones and parasites, which are all harmful, especially to people with cancer.

d) A diet made of 80% fresh vegetables and juice, whole grains, seeds, nuts and a little fruits help put the body into an alkaline environment. About 20% can be from cooked food including beans.. Fresh vegetable juices provide live enzymes that are easily absorbed and reach down to cellular levels within 15 minutes to nourish and enhance growth of healthy cells.. To obtain live enzymes for building healthy cells try and drink fresh vegetable juice (most vegetables including bean sprouts) and eat some raw vegetables 2 or 3 times a day. Enzymes are destroyed at temperatures of 104 degrees F (40 degrees C).

e) Avoid coffee, tea, and chocolate, which have high caffeine. Green tea  is a better alternative and has cancer fighting properties.. Water-best to drink purified water, or filtered, to avoid known toxins and heavy metals in tap water. Distilled water is acidic, avoid it.

12. Meat protein is difficult to digest and requires a lot of digestive enzymes. Undigested meat remaining in the intestines becomes putrefied and leads to more toxic buildup.

13. Cancer cell walls have a tough protein covering. By refraining from or eating less meat it frees more enzymes to attack the protein walls of cancer cells and allows the body's killer cells to destroy the cancer cells..

14. Some supplements build up the immune system (IP6, Flor-ssence, Essiac, anti-oxidants, vitamins, minerals, EFAs etc.) to enable the bodies own killer cells to destroy cancer cells.. Other supplements like vitamin E are known to cause apoptosis, or programmed cell death, the body's normal method of disposing of damaged, unwanted, or unneeded cells.

15. Cancer is a disease of the mind, body, and spirit. A proactive and positive spirit will help the cancer warrior be a survivor. Anger, un-forgiveness and bitterness put the body into a stressful and acidic environment. Learn to have a loving and forgiving spirit. Learn to relax and enjoy life.

16. Cancer cells cannot thrive in an oxygenated environment. Exercising daily, and deep breathing help to get more oxygen down to the cellular level. Oxygen therapy is another means employed to destroy cancer cells.

      1. No plastic containers in micro.

      2. No water bottles in freezer.

      3. No plastic wrap in microwave.

Johns Hopkins has recently sent this out in its newsletters.. This information is being circulated at Walter Reed Army Medical Center as well. Dioxin chemicals cause cancer, especially breast cancer. Dioxins are highly poisonous to the cells of our bodies. Don't freeze your plastic bottles with water in them as this releases dioxins from the plastic. Recently, Dr. Edward Fujimoto, Wellness Program Manager at Cast le Hospital, was on a TV program to explain this health hazard. He talked about dioxins and how bad they are for us. He said that we should not be heating our food in the microwave using plastic containers. This especially applies to foods that contain fat. He said that the combination of fat, high heat, and plastics releases dioxin into the food and ultimately into the cells of the body. Instead, he recommends using glass, such as Corning Ware, Pyrex or ceramic containers for heating food You get the same results, only without the dioxin. So such things as TV dinners, instant ramen and soups, etc., should be removed from the container and heated in something else. Pa per isn't bad but you don't know what is in the paper. It's just safer to use tempered glass, Corning Ware, etc. He reminded us that a while ago some of the fast food restaurants moved away from the foam containers to paper. The dioxin problem is one of the reasons.

Also, he pointed out that plastic wrap, such as Saran, is just as dangerous when placed over foods to be cooked in the microwave. As the food is nuked, the high heat causes poisonous toxins to actually melt out of the plastic wrap and drip into the food. Cover food with a paper towel instead.
 
What is Stem Cell Therapy for Baldness

Baldness is a condition which most men suffer. Even if it is such a common occurrence, many men still experience depression and anxiety from receding hair line and thinning crown. If hair loss is a problem for men, how do you think will women feel if they experience their scalp showing wider than before?

Science is continuously seeking treatment for problems that common people suffer, and a recent study on stem cell therapy is now creeping in the baldness treatment arena.

What is stem cell therapy and how will it treat baldness?

Baldness is believed to be irreversible especially when hair follicles start to die. If indeed there is a stem cell therapy where hair follicles will be cultured and multiplied, this may be the treatment men have been waiting for so many years.

What is stem cell therapy?

Stem cell therapy or hair cloning is a process by which a hair follicle will be taken from the head and cultured to multiply. It will then be transplanted to the balding areas of the head. Laser will then be used for the new transplanted hairs to induce growth and likewise signal the neighboring hair follicles to regenerate.

This has been tested in animals, but human testing is still awaiting results.

Stem cell therapy has been proven to work wonders in many conditions such as spinal cord injury, cancers, heart and brain damage. Its effectiveness in treating baldness is still a hope among scientists.

If this becomes effective, there will be minimal issues on balding and hair thinning. Stem cell therapy for baldness may be the Holy Grail for hair loss problems. This may lead to a more self-confident population because they can wear their hair proud.

On the other hand, please take note that hair loss or baldness may come from many causes such as illness, stress and genetic characteristics.

If there is a medical problem underlying the hair loss problem, treating the illness or the medical issue may cause the reversal of hair loss. Baldness may then be avoided.

You may not need to undergo a quite costly procedure such as stem cell therapy for your baldness. Merely taking note of your health condition may be sufficient. Your doctor will be helpful in assessing your problem and if you will need a procedure such as laser or stem cell therapy.

Again, please note that men and women have different hair loss issues. For men, it starts quite early as they reach their late twenties. For women, problem comes a little bit later but the effect in their social functioning may be greater.

It is therefore necessary that you check your lifestyle, your health and your stress level if you are starting to see significant amount of hair in your brush. It may be a symptom of a deeper medical problem than mere copied hair pattern from your ancestors.

Live your life to the fullest with full hair head by ensuring that you have a healthy body. This is because healthy body converts to healthy hair. And healthy hair may never need stem cell therapy at all.

Stem Cell Treatment for Osteoarthritis

While many new and amazing therapies for rheumatoid arthritis have been developed in recent years, very little progress has been made in the treatment of osteoarthritis.

Osteoarthritis (OA) is the most common form of arthritis and affects approximately 30 million Americans. OA is a disease of articular cartilage, the gristle that caps the ends of long bones. Cartilage has both gliding as well as shock absorbing properties.

It is this flexibility of function that enables a joint to work properly.

Normal cartilage is composed of cells called chondrocytes that sit inside a matrix consisting of collagen and glycosaminoglycans... much like grapes inside Jello.

Osteoarthritis develops when the chondrocyte begins to malfunction and starts to produce destructive enzymes. At the same time water content inside the matrix changes making it more susceptible to stress. Small cracks, called "fissures" develop. Also, local inflammation involving the lining of the joint- called the synovium- begins. The end result is a gradual and premature wearing away of cartilage.

This process is most apparent in weight-bearing areas such as the neck, low back, hips, and knees.

Current approaches to the treatment of OA involve the use of analgesics (pain-relieving medicines), non-steroidal anti-inflammatory drugs (NSAIDS), physical therapy, proper weight management, exercises, injections of steroids, injections of viscosupplements (lubricants), and surgery.

While many of the above treatments help relieve pain, they do nothing to prevent cartilage loss... and more importantly, they do nothing to restore cartilage.

Orthopedic techniques such as chondrocyte transplantation and cartilage plug surgery are helpful for discrete, relatively small areas of cartilage loss but are generally reserved for younger people who have had traumatic injuries to cartilage. But what about the older person who suffers from osteoarthritis?

In recent years there has been much interest in the role of regenerative techniques to
rebuild cartilage.

The topic of much study are stem cells. Stem cells are pluripotential cells, meaning they are cells that can become any kind of tissue, given the right stimulus. Stem cells can be obtained from embryonic tissue, which is a source of much controversy. Or they can be obtained from adults. The adult body has a small number of stem cells in many tissues. They are activated by injury or illness. Adult stem cells, as a rule, do not have the ability to differentiate as well as embryonic stem cells.

However, in recent years, techniques have been developed to harvest mesenchymal stem cells- stem cells found in the bone marrow. These mesenchymal stem cells cells, when properly prepared and concentrated, have the ability to differentiate into cartilage and bone.

Stem cells are harvested from the patient's iliac crest bone marrow using local anesthetic and a special type of biopsy needle. The stem cells are then specially concentrated.

After the stem cells are prepared, the physician, using ultrasound guidance and local anesthetic, finds the area of arthritis involvement and irritates the area using a special large needle. This irritation is important because it initiates an inflammatory reaction which is the prelude to healing and regeneration. The areas that are irritated include the capsule, tendon insertions, pericapsular soft tissue, as well as cartilage.

Blood is drawn from the patient and spun in a special centrifuge in order to obtain platelet rich plasma. Platelets are blood cells that contain multiple growth and healing factors.

Once the irritation has been completed, stem cells as well as the platelet rich plasma are injected into the prepared area.

The growth factors within the platelet rich plasma act on receptors found on the surface of stem cells and cause the stem cells to differentiate and multiply.

The end result is cartilage regeneration as well as lessening of pain. While the data is preliminary, the early results appear to be very promising.

   
DISCOVER STEM CELL NUTRITION'S AMAZING POWER

Adult Stem Cell Nutrition is cheaper and just as effective as stem cell therapy. Adult Stem Cell Nutrition is the NEW revolution in health which many sufferers who are victims of all kinds of health problems and conditions are discovering its amazing abilities. It's also the new anti-aging powerhouse in natural health products.  

One man after taking stem cell nutrition, started to notice that his white snow hair was changing to its former darker color!

Stem cell nutrition is helping sufferers either recover completely or improve in the following conditions or diseases:

Alleviates Anxiety, Weight Loss, Cures Diabetes, Depression, Removes Age Spots, Repairs Burn Injuries, Arthritis, Increases Energy, Multiple Sclerosis, Lowers Blood Pressure, Normalizes Cholesterol, Circulation Problems, Autism, Parkinson's Disease, Mental Clarity, Pain, Sleep, Stroke, Improves Vision, Inflammation, Accident Recovery Time, Allergies, Ankle Ulcer, Asthma, Athletic Recovery Time, Atrial Fibrillation, Autoimmune Disorder, Chronic Cough, Irritable Bowel Syndrome, Liver Spots, Lung Disease, Migraine Headaches, Neuropathy, Prostate Problems, Restless Leg Syndrome, Restrictive Neck Motion, Sinus Problems, Improves Skin Disorders, Tinnitus, Heart Disease, Leukemia, Alzheimer's, Cancer, Multiple Sclerosis  & more!!!


Adult Stem Cells to Fix Fractures  

A new study presented in San Fransisco in the United States of America by Froilan Granero-Molto has revealed that adult stem cells can help improve healing of broken bones and could eventually serve as a new treatment for the ten to twenty percent of fractures that are unsuccessful in healing.

The lack of fracture fix often leads to several surgeries, long periods of immobilization, pain, bone deformities, and sometimes worse with death. The exact reason why a patient's fracture does not often heal remains unknown in most cases but it seems that adult stem cells could help a lot there.

Researchers actually believe that a key reason for bone union failure may be a deficiency in adult stem cells, which normally become reparative cells in response to damage done. Stem cells in human bone marrow can become a lot of things like bone, cartilage, muscle, and more.

These adult stem cells, which can be obtained from a patient's bone marrow in a minimally insidious process, have been reported to improve fracture healing in a few patients, Spagnoli said. However, animal studies are needed before clinical trials can begin on human beings.

Therefore, Spagnoli and her coworkers performed a study in mice with leg fractures. They simply took adult stem cells from the bone marrow of mice and engineered the cells to express a potent bone regenerator, insulin-like growth factor one. Then they transplanted the treated cells into mice with a fracture of the tibia bone in the leg. Using computed tomography scanning, they showed that the treated mice had better fracture healing than did the untreated one. They established that the stem cells had migrated to the fracture site in the mice and increased the bone and cartilage that bridged the bone gap to make it heal better.

This study provided critical data needed to implement a novel curative approach in patients with fracture healing problems.

If scientists can duplicate the results of this animal study in humans, it may lead to a way to help a lot of people around the world who suffer from fractures that do not heal properly.

The use of adult stem cells would have several advantages over embryonic stem cells. First of all they simply do not have the ethical controversy that surrounds embryonic stem cells taken by cord blood banks from umbilical cord blood, and they may avoid the immune rejection response, since the patient's own cells can be used to treat them directly.

Rheumatoid Arthritis Stem Cell Treatment, Research, Therapy, Information 
       
Stem Cell Therapy for Rheumatoid Arthritis

Stem cell transplantation now offers a potentially useful treatment for rheumatoid arthritis.

At the Leiden University Medical Center in The Netherlands, researchers conducted a study in which a new type of treatment for patients with severe, refractory RA was formulated based upon high-dose chemotherapy (HDC) similar to that described above, and which was then followed by autologous hematopoietic stem cell transplantation (HSCT). The treatment was found to be safe, effective, and the patients improved. (From Arthritis & Rheumatism, Vol. 52, Issue 8, pp. 2272 - 2276: "Long-term follow-up of health status in patients with severe rheumatoid arthritis after high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation.")

A similar study was conducted by researchers in which hematopoietic stem cell transplantation (HSCT) was so successful that it was identified as "a possible cure for rheumatoid arthritis." (From Arthritis & Rheumatism, Dec. 12, 2005; Vol. 40, Issue 6, pp. 1005 - 1011: "Autologous hematopoietic stem cell transplantation. A possible cure for rheumatoid arthritis?") The research was funded by the Reid Charitable Trusts, and the Australian National Health and Medical Research Council.

In 2004, researchers in Australia conducted a study in which stem cells derived from bone marrow were administered to patients with RA; 2 of the patients experienced remission 11 and 13 years after the treatment, and the third patient with RA had a relapse 2 years after treatment, which then remitted, treatment-free, for 11 years. (From Arthritis & Rheumatism, May 28, 2004; Volume 41, Issue 3, pp. 453 - 459: "Long-term outcome of autoimmune disease following allogeneic bone marrow transplantation (BMT).")

In 2002, researchers in Australia again conducted a study in which stem cells were administered to patients with the most severe cases of RA. The researchers found that the treatment constituted a safe and effective therapy for a "treatment-resistant disease". The study was funded by the National Health and Medical Research Council of Australia, and by Amgen of Australia. (From Arthritis & Rheumatism, Sept. 27, 2002; Vol. 46, Issue 9, pp. 2301 - 2309: "A pilot randomized trial comparing CD34-selected versus unmanipulated hemopoietic stem cell transplantation (HSCT) for severe, refractory rheumatoid arthritis.")

In the United States, a recent segment on the daily television program, "Good Morning America", featured a young girl with juvenile rheumatoid arthritis who had been successfully treated with stem cells, and who is now free of the disease.

Researchers at Northwestern University Medical School, in collaboration with the Robert H. Lurie Comprehensive Cancer Center of Chicago, Illinois, and with researchers at the University of Wisconsin at Madison, conducted an early study in 2001 in which stem cell therapy was administered to a group of 4 patients afflicted with RA. (From Arthritis & Rheumatism, April 26, 2001; Vol. 42, Issue 11, pp. 2281 - 2285: "Autologous hematopoietic stem cell transplantation in refractory rheumatoid arthritis: Sustained response in two of four patients.") Even in this early study, the autologous HSCT treatment was found to be safe and effective in all of the patients to whom it was administered, with a strong positive response in half of the patients.

As stated on the website of the National Institute of Allergy and Infectious Diseases (NIAID), a division of the National Institutes of Health (NIH),
"Autoimmune diseases, including rheumatoid arthritis, type-I diabetes, and multiple sclerosis, afflict an estimated 5 percent of the U.S. population. The human and financial burden of these diseases is immense." (From the National Institute of Allergy and Infectious Diseases website).

As corroborated by the American College of Rheumatology,

"Rheumatoid arthritis (RA) is an autoimmune disorder of unknown etiology characterized by symmetric, erosive synovitis and, in some cases, extra-articular involvement. Most patients experience a chronic fluctuating course of disease that, despite therapy, may result in progressive joint destruction, deformity, disability, and even premature death. RA results in more than 9 million physician visits and more than 250,000 hospitalizations per year. Disability from RA causes major economic loss and can have a profound impact on families." (From the American College of Rheumatology, in a statement issued by the ACR Subcommittee on RA Guidelines).

Musculoskeletal diseases such as rheumatoid arthritis are recognized internationally not only as problems that impact individual lives, but also as problems that impact national economies. With an aging global population in which the number of people over the age of 50 is expected to double by the year 2020, the discovery of cures for diseases such as rheumatoid arthritis will become an economic, if not a medical, imperative. In an effort to address such growing international concerns, the United Nations, the World Health Organization and 37 countries have proclaimed 2000 to 2010 as the "Bone and Joint Decade". Additionally, individual countries have also proclaimed their own decades in which extra research would be dedicated to bone and joint health, and in the United States, 2002 to 2011 was declared to be the "National Bone and Joint Decade." As president George W. Bush stated in his proclamation,

"...In the U.S., musculoskeletal disorders are a leading cause of physical disability. Such conditions also affect hundreds of millions of people around the world. The National Bone and Joint Decade, 2002-2011, envisions a series of international initiatives among physicians, health professionals, patients, and communities, working together to raise awareness about musculoskeletal disorders and promoting research and development into therapies, preventative measures, and cures for these disorders. Advances in the prevention, diagnosis, treatment, and research of musculoskeletal conditions will greatly enhance the quality of life of our aging population."

(From the White House website).

In the treatment of all forms of arthritis, especially rheumatoid arthritis, stem cells offer a potentially useful therapy.

Rheumatoid Arthritis Overview

Although general symptoms of arthritis have been documented for thousands of years, rheumatoid arthritis was first described as a distinct syndrome by the early 19th century physicians Heberden and Haygarth, after whom the associated features known as "Heberden's nodes" and "Haygarth's nodes" are named. The disease then received its current name in 1859, which is derived from a combination of Greek words: "rheumatos", meaning "flowing", the suffix "-oid", meaning "in the shape of", "arthro" meaning "joint", and the suffix "-itis" which indicates inflammation.

Rheumatoid arthritis (RA) differs from other forms of arthritis in a number of significant ways. Most notably, it is categorized not simply as an inflammatory disease, but as an autoimmune disease. Although symptoms typically include the usual pain, swelling, stiffness and loss of function in the joints that characterize most forms of arthritis, in RA these symptoms are considered to be the result of the body's immunological attack upon itself. RA is ranked among the more than 100 types of rheumatic diseases, along with Crohn's Disease, Celiac Disease, rheumatic fever, and other related classifications. Rheumatic diseases in general share similarities in how the joints, tendons, ligaments, bones and muscles are affected, and RA is considered to be one of the more severe types of rheumatic disorders.

Another way in which RA differs from most forms of arthritis is that it is a systemic disease, unlike osteoarthritis and the other more commonly occurring forms of arthritis. In other words, not only are the joints of the body affected in RA, but "extra-articular tissues" throughout the body may also be affected, such as the skin, blood vessels, and organs such as the heart, the lungs, the kidneys or the eyes. Weight loss, fever and a general sense of malaise are also not uncommon in patients suffering from RA.

Rheumatoid arthritis is also known to be a symmetric disease, affecting the same joints equally on both sides of the body. Although initial symptoms usually appear to be asymmetrical, they develop a characteristic symmetry as the disease progresses. The most commonly affected joints are those of the fingers and wrists followed by those of the arms and legs. The surrounding muscles, tendons, ligaments and connective tissue associated with each joint are also commonly affected by this disease. The buildup of fluid within the joint capsule can cause pressure on the cartilage and may result in a "squishy" sensation when pressure is applied during motion. Unlike the characteristic pain of osteoarthritis, which progressively worsens toward the end of each day, the pain that is associated with RA is usually most pronounced in the morning.

Considered to be a chronic affliction, RA is typically observed by initial symptoms consisting simply of inflammation of the lining, or synovium, of the joints. Pain, stiffness, swelling and loss of function of the joints can also be accompanied by mild fever, tiredness, and small lumps under the skin. In its most advanced stages, however, bone deformity and irreversible joint damage may result.

RA is often difficult to diagnose. According to the American College of Rheumatology,

"RA affects 1% of the adult population. This low prevalence means that the average physician often develops little experience with its diagnosis or management." (From the American College of Rheumatology).

Approximately 2.1 million Americans currently suffer from rheumatoid arthritis, 35% of whom go untreated, due either to the difficulty involved in making a correct diagnosis, or to an unwillingness to seek treatment, both of which are common in the early stages of the disease. Three-quarters of all people who suffer from rheumatoid arthritis are women, indicating an important hormonal component to the disorder. The disease is 4 times more common in smokers than in nonsmokers, suggesting a strong environmental factor. Rheumatoid arthritis that develops after the age of 60 is often milder than when it develops earlier in life. It has been found that approximately half of all people with RA will experience a remission within 2 years of the initial onset of symptoms. However, the symptoms often return. (From the AllAboutArthritis.com).

The time of onset most typically strikes between the ages of 25 and 50, but in rare circumstances the disease has also been known to occur in children and senior citizens. Indeed, juvenile rheumatoid arthritis (JRA) is the most common form of arthritis in children. According to the website of the Arthritis Foundation,

"JRA may be a mild condition that causes few problems over time, but it can be much more persistent and cause joint and tissue damage in other children. JRA can produce serious complications in more severe cases. Arthritis is best described by the four major changes in the joints that may develop. The most common features of JRA are: joint inflammation, joint contracture (stiff, bent joint), joint damage and/or alteration or change in growth. Other symptoms include joint stiffness following rest or decreased activity level (also referred to as morning stiffness or gelling), and weakness in muscles and other soft tissues around the involved joints. ... The signs and symptoms of JRA vary from child to child, and even from day to day in the same child. ... There is no single test to diagnose JRA." (From the Arthritis Foundation website).

In cases in which JRA is suspected, an official diagnosis should be made by a pediatric rheumatologist.

Rheumatoid arthritis in adults is characterized by three distinct stages. In the first stage, swelling of the synovial lining is observed. The second stage is marked by a thickening of the synovium due to the rapid division and growth of cells. In the third stage, the inflamed cells release enzymes which may digest the bone and cartilage. These symptoms cause the joints to lose their shape and alignment, resulting in further pain, loss of movement, and structural damage which has heretofore been considered permanent. Clearly, identification and treatment of RA in the early stages is of critical importance in the successful treatment and management of the disease.

Symptoms may occasionally include the formation of subcutaneous rheumatoid nodules (lumps of inflamed cells), which are found in 20 - 30 % of RA cases. Such nodules may appear anywhere on the body, but are most commonly found over bony prominences and extensor surfaces such as the elbow, ankle and fingers. (From http://arthritis.about.com/od/nodules/g/nodule.htm).

As a systemic disease, RA can generate numerous complications. Many RA patients suffer from anemia, either chronically or as a consequence of gastrointestinal bleeding, which may be exacerbated by the use of NSAIDs (non-steroidal anti-inflammatory drugs), which are typically prescribed for RA. Additional secondary symptoms may also develop, such as Splenomegaly, Felty's Syndrome (leukopaenia), and Sjogren's Syndrome (lymphatic infiltration of the salivary and lacrimal glands), among other disorders. The lungs may be affected, and pleuritis or fibrosis may occur, or Caplan's nodules may develop as pulmonary effusions. Renal problems such as amyloidosis have been described in conjunction with RA, along with cardiac complications such as pericarditis, endocarditis, left ventricular failure, and cardiac valvulitis. Ocular problems such as episcleritis, scleromalacia, and keratoconjunctivitis sicca (dry eyes) have also been associated with RA. Neurological complications such as mononeuritis multiplex and atlanto-axial subluxation, though rare, have also developed as a result of RA.

As RA progresses, the inflammation and simultaneous soft-tissue swelling of many joints (polyarthritis) may lead to erosion, bony decalcification and irreversible destruction of the joint surface, which can result in permanent deformity. In the hands, the fingers follow a recognizable pattern of deviating towards the little finger (which is known as ulnar deviation), and other classic deformities have also been identified, such as "Boutonniere deformity", "swan neck finger deformity", and a "Z-thumb deformity". A "photo gallery" of arthritic deformities of the hand in patients with RA may be viewed at

http://arthritis.about.com/od/handandfingers/ig/Arthritis-Hand-Gallery/.

Vasculitis is another possible complication of RA, and one of the more serious complications that occur outside of the joints. As part of the autoimmune and systemic inflammatory reaction that characterizes RA, vasculitis is a severe inflammatory reaction to a blood vessel, such as an artery, a capillary, or a small or large vein. Such localized, acute inflammation results in damage to the tissue or organ which is served by the blood supply that is suddenly interrupted by the damaged vessel. Initial therapy for the onset of vasculitis in RA usually consists of systemic corticosteroids, which act as powerful anti-inflammatory agents, and which can work to salvage the blood supply to the associated tissue or organ by blocking the damage to the blood vessel. In cases in which the vasculitis proves to be controllable, methotrexate is often substituted for the low dose corticosteroids; if the vasculitis is not easily controllable, therapeutic options may include the use of immunosuppressive medications such as cyclophosphamide, Imuran&153;, or chlorambucil.

While most RA patients are able to cope with their symptoms, the overall life expectancy for anyone with RA is 5 to 10 years less than that of the general population. In the field of cellular aging, researchers are particularly interested in the physiological mechanisms at work in RA. The aging process is accelerated whenever damage at the molecular level occurs to such an extent that gross anatomical function is impaired, and this is precisely one of the distinguishing features of RA. In a study conducted at the Mayo Clinic, researchers calculated that RA patients age at approximately 1.25 times the rate of the general population; in other words, for each 10 years that elapse, people with RA have aged 12.5 years. "We've known for decades that the mortality rate among people with rheumatoid arthritis is higher, and that these patients are at increased risk for heart and lung disease," explains Sherine Gabriel, M.D., an epidemiologist who led the Mayo Clinic study. "With this study, we've now applied a mathematical model that shows consistency between our observed mortality rates and our understanding of the concept of accelerated aging." The research was supported by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a division of the National Institutes of Health (NIH).

It has long been known that RA patients have twice the incidence of heart failure as does the rest of the population, and researchers may have now identified the cause. In March of 2005, Mayo Clinic epidemiologists found that the systemic inflammation characterizing RA may be to blame for the increased risk of cardiovascular death in patients with RA. Not only do people with RA have a higher risk of coronary heart disease than those in the general population, but they also have a more silent, insidious form of heart disease which often goes unrecognized and undiagnosed until resulting in heart attack or sudden cardiac death . (From the Feb. 9, 2005 issue of Arthritis & Rheumatism).

Although the exact causes of rheumatoid arthritis remain unknown, and the many abounding theories remain unproven, it is widely agreed that a complex combination of interacting factors must be involved in triggering the onset of rheumatoid arthritis. Among the prevailing theories which seem to merit the most consideration, there is some evidence to indicate that a virus or bacterium may be involved, although it may also be necessary for the individual to possess a genetic predisposition to the disease. Seventy percent of all people with rheumatoid arthritis test positive for an inherited chemical marker on their cells, indicating that a strong genetic component is necessary for the expression of the disease. The HLA-DR4 marker has been shown to be an especially accurate measure of the severity of RA in people of northern European ancestry. In June of 2006, researchers in Norway and the Netherlands collaborated in studying a gene known as the "protein tyrosine phosphatase N22 (PTPN22) gene", which they have now identified as being associated not only with susceptibility to the RA disease itself, but also to factors which determine the progression of the disease. Approximately 85 percent of people with RA also test positive for an antibody known as "rheumatoid factor", and testing for the presence of this antibody constitutes a routine part of the diagnostic process whenever a physician suspects RA in a patient. Clearly, along with multiple other risk factors, family history is an important consideration in the differential diagnosis.

In some cases, severe psychological and emotional stress have been found to play a role in the onset of RA, as the disease occasionally occurs after a person has experienced a major "life-changing" event, such as a divorce, the loss of a job or the death of a loved one. In 1949, the noted endocrinologist Hans Selye proposed that stress hormones released by the adrenal glands may cause adverse reactions in joint tissue and also in major organs, whenever these stress hormones are released either in excessive quantities or in abnormal ratios. Some experimental evidence supporting this hypothesis has been demonstrated by the fact that rheumatoid arthritis may be artificially induced in animals by injections of the hormone deoxycorticosterone. Certain nutritional deficiencies have also been proposed as triggering the onset of rheumatoid arthritis, and the unusually high incidence of RA in certain countries such as Jamaica and northern Thailand is believed to be attributable to low levels of boron.

A single test for diagnosing RA does not exist, and X-rays alone cannot detect the damage caused in the early stages of RA. Patients who have already suffered significant joint deterioration will often yield normal X-rays, as their "erosions" will be detectable only by ultrasound or MRI. Such damage has often progressed much farther than initially suspected, and by the time it is detectable by X-ray it will usually have become so extensive that it is irreversible. X-rays are useful in monitoring the progression of the disease in its advanced stages, but more sensitive imaging technologies should be employed when RA is first suspected.

Whatever the exact causes may be, there is no conventional medical cure for rheumatoid arthritis. Treatment therefore has focused on relieving pain, reducing inflammation, stopping or slowing damage to the joints, and improving the general well-being of the patient. In some cases, surgery may be prescribed for such procedures as joint replacement, reconstruction or fusion of the joint, or for the removal of diseased tissue from within the joint itself (known as a synovectomy).

The pharmacological treatment of RA may be divided into 3 general categories: disease-modifying anti-rheumatic drugs (DMARDs), anti-inflammatory agents, and analgesics. DMARDs are prescribed to prevent the bone and joint damage caused by RA, which is usually permanent once it has occurred. The anti-inflammatories and analgesics are known for improving pain and stiffness, but they do not prevent joint damage nor do they slow the progression of the disease.

DMARDs may be further subdivided into xenobiotic agents, which do not naturally occur in the body, and biological agents, which are less foreign to the body.

"Xenobiotics" include azathioprine, ciclosporin (cyclosporine A), D-penicillamine, gold salts, hydroxychloroquine, leflunomide, methotrexate (MTX), minocycline, and sulfaselazine (SSZ). Side effects are an important consideration, however, and may include liver and bone marrow toxicity, renal toxicity, allergic skin reactions and infections. Corticosteroids such as Prednisone may also be prescribed, which, while effective at reducing pain and stiffness, do not prevent bone damage and are still also known for their side effects. Biological agents include adalimumab (Humira), interleukin-1 blockers such as anakinra, an anti-B cell antibody such as rituximab (Rituxan), blockers of T cell activation such as abatacept (Orencia), and tumor tecrosis factor blockers such as etanercept (Enbrel) and infliximab (Remicade). Anti-inflammatory agents include glucocorticoids and nonsteroidal anti-inflammatory drugs (NSAIDs, most of which also act as analgesics). Analgesics include acetaminophen, opiates, and (topical) lidocaine.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are also commonly used to reduce short-term pain and swelling. Side effects, however, remain a serious consideration.

Whether or not surgery is recommended, conventional medical treatment for RA generally employs the use of NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin and ibuprofen. In fact, half of all NSAID prescriptions in the U.S. are for various forms of arthritis. NSAIDs in general constitute a large class of medications that are used to treat both pain and inflammation, and are therefore frequently used in the treatment of all types of arthritis. A number of NSAIDs are available over the counter, such as ibuprofen (Advil, Motrin), naproxen sodium (Aleve) and ketoprofen (Orudis, and Oruvail). Additionally, there are more than a dozen others, including a subclass of NSAIDs known as COX-2 inhibitors, that are available only by prescription.

All NSAIDs work according to the same principle, which is by blocking prostaglandins, which contribute to inflammation and pain. However, since each NSAID is a different chemical, each NSAID therefore has a slightly different effect on the body; each NSAID also comes with its own particular list of warnings and contraindications. Most NSAIDs only cause gastrointestinal irritation, which can include ulcers, bleeding and perforation of the stomach or intestine; some NSAIDs can also damage kidney function, however, and may cause other long-term problems. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. One should also be cautious of interactions between medications, as many other drugs cannot be taken with NSAIDs, because the NSAIDs will alter the ways in which the body uses or eliminates these other drugs.

According to the website of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a division of the National Institutes of Health (NIH),

"The U.S Food and Drug Administration has warned that long-term use of NSAIDs, or use by people who have heart disease, may increase the chance of a heart attack or stroke. So it's important to work with your doctor to choose the one that's safest and most effective for you. Side effects can also include stomach upset and stomach ulcers, heartburn, diarrhea, and fluid retention. For unknown reasons, some people seem to respond better to one NSAID than another." (From NIAMS - National Institute of Arthritis and Musculoskeletal and Skin Diseases website).

Cytokines are known to play a role in RA, and ongoing studies are investigating various ways of blocking the particular cytokines that are involved in the chronic pain that is associated with RA. A "distinct profile of T cells, macrophage and stromal cells related to cytokines in synovial fluid" has been found to characterize RA, and researchers are working to understand these factors in greater detail. (From Arthritis Research & Therapy, April 22, 2005).

The conventional medical view holds that most types of arthritis, including RA, are incurable. As stated on the website of the American Academy of Orthopedic Surgeons,

"At present, most types of arthritis cannot be cured."

(From the American Academy of Orthopaedic Surgeons website).

As corroborated by the Arthritis Foundation,

"Right now, there is no cure for RA."

(From a brochure published in 2000, entitled "Practical Help from the Arthritis Foundation," available at www.arthritis.org).