Ankylosing Spondylitis, Chronic Fatigue and Depression Improved After Stromal Vascular Fraction Treatment for Osteoarthritis

A Case Report

Bora Bright; Ralph Bright; Pelin Bright; Amita Limaye


J Med Case Reports. 2018;12(238) 

In This Article

Case Presentation

Our patient was a 27-year-old Australian woman with grade IV OA confirmed by X-ray images of her pelvis; ultrasound scans showed right knee joint effusion, enthesitis, and synovitis; a CT scan of her spine indicated annulus bulges at L3/4 and L4/5, and bilateral grade 2 sacroiliitis changes; a background of AS (human leukocyte antigen-B27 negative) confirmed by MRI imaging; chronic pain syndrome with pain amplification; and post-traumatic stress disorder. Her body mass index (BMI) was 39.4 kg/m2. She did not have any: infection with hepatitis B, hepatitis C, or human immunodeficiency virus (HIV); malignancy; previous history of allergic reaction to any component of our therapeutic measure; active cardiac, respiratory, neurologic or endocrine disease necessitating receipt of medication. She was not pregnant or in lactating condition. A written and informed consent was obtained from our patient. Arthritic symptoms were measured using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Hip Disability and Osteoarthritis Outcome Score (HOOS) by scoring for pain intensity, walking ability (distance), joint stiffness, physical function, sports and recreation, and quality of life. Changes to her AS symptoms were measured using the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. For liposuction and stem cell treatment, she was admitted to Macquarie Stem Cells. Under light sedation and using aseptic technique, 450 ml of fat was harvested from her abdomen. Cell isolation was performed in PC II safety cabinet. Cells were isolated using collagenase digestion using Liberase GMP grade (enzyme blend).

Our patient's preoperative HOOS score (baseline score) for both hips was 122 (range 0–168), WOMAC for her right knee was 70 (range 0–90), and the baseline ASQoL questionnaire was 18 (range 0–18). We obtained 2.058 billion nucleated cells with a viability of 89.10% using Muse® Cell Analyzer. A total of 738 million cells were injected on the day: 100 million cells injected into each hip and right knee intra-articular under ultrasound guidance, and 438 million cells were administered as an intravenous infusion. The remaining 1.320 billion cells were cryogenically frozen into four separate vials of 330 million cells following the protocols of Thirumala et al..[12] Follow-up intravenous infusions of 330 million cells were provided at 3 months, 12 months, and 36 months. Our patient's follow-up intervals were performed at 1 day, 3 months, 6 months, 12 months, 24 months, and 36 months respectively. Neither local nor systemic adverse events were observed during the follow-up and she was satisfied with the therapy after 3 months with an increasing trend over the period. At 3-month post-treatment, she exhibited increased mobility. Her HOOS and WOMAC scores decreased to 82 and 37, respectively from her baseline scores. She also noted that pain in her spine, hips, and right knee associated with OA and AS had decreased. Interestingly, in addition to her decreased pain and increased mobility, she was feeling more energetic. Within 6 months after the first SVF infusion, her HOOS and WOMAC questionnaire scores had decreased to 79 and 31, respectively. She showed dramatic improvements over 2 years after her first SVF infusion and presented with decreased dependency on a wheelchair or walking stick (HOOS and WOMAC scores not available). Her dependency on pain relief and anti-depressant medications was found to be decreased as is evident from Table 1. At the 36-month follow-up, she presented significant improvements overall. She remained free from NSAIDs and her pain levels were minimal. Follow-up HOOS and WOMAC scores had decreased to 32 and 20, respectively. Her pre-treatment to post-treatment ASQoL score had decreased to 3 signifying increased quality of life. She still presents some symptoms of depression; however, her anxiety appears to have resolved almost completely. Her progressive improvement is observed over 3 years with WOMAC, HOOS, and ASQoL (Figure 1a, b).

Figure 1.

Western Ontario and McMaster Universities Osteoarthritis Index and Hip Disability and Osteoarthritis Outcome Score progressive improvement chart. a Percentage improvement of Western Ontario and McMaster Universities Osteoarthritis Index (red) and Hip Disability and Osteoarthritis Outcome Score (blue) on Y-axis over 36 months (on X-axis). The graph highlights the measurements taken at 0 (baseline or pre-treatment score), 3 months, 6 months and at 36 months after first stromal vascular fraction infusion. b Patient improvement based on subjective questionnaires after stromal vascular fraction treatment. Improvement of patient in terms of Western Ontario and McMaster Universities Osteoarthritis Index and Hip Disability and Osteoarthritis Outcome Score that measure osteoarthritis and Ankylosing Spondylitis Quality of Life questionnaire that measures quality of life of a patient with ankylosing spondylitis over baseline. The percentage improvement over baseline (on Y-axis) and questionnaires used in the study (on X-axis). ASQoL Ankylosing Spondylitis Quality of Life, HOOS Hip Disability and Osteoarthritis Outcome Score, SVF stromal vascular fraction, WOMAC Western Ontario and McMaster Universities Osteoarthritis Index