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New Straits Time 2019: Treating The Knee With Stem Cells

Spine and Orthopaedic Centre
The Spine and Orthopaedic Centre of Excellence has a line-up of specialists to treat a wide range of injuries related to the spine and arthroplasty.
Article by Sarah Rahim
KUALA LUMPUR: Diminishing life quality and excruciating pain will be a thing of the past with the advancement of treatment for knee osteoarthritis and joint cartilage injuries at UKM Specialist Centre (UKMSC), the exclusive private wing of UKM Medical Centre.

UKMSC Consultant Orthopaedic Surgeon (Arthroscopy and Sports Injury) Datuk Dr Badrul Akmal Hisham Md Yusoff said there is a new hope for orthopaedic patients following a groundbreaking success of the latest translational clinical research conducted at UKM Medical Centre using unrelated and unmatched donor mesenchymal stem cells sourced from the umbilical cord.

“This (stem cell) is an area of extensive research. But in Malaysia, the clinical application is not as widespread because of the limitation of evidence-based clinical trials, especially at hospitals with limited facilities and expertise,” he said.

Established in 2003, UKMSC has grown to be the “specialist centre where the gurus are”, referring to the professors who were also trainers, as well as having evidence-based principle as one of the main principles of its clinical services.

Now, UKMSC not only provides the latest and most advanced surgical treatment, they also perform much more complex operations, such as scoliosis and bariatric surgeries.

UKMSC is a registered private healthcare facility, bound by the Private Healthcare Facilities and Services Act 1998.

Dr Badrul said the strict regulations and standards for private medical centres and hospital were also on a par with the healthcare services rulings in Australia.

Patients seeking treatment here have the peace of mind of being cared for with the highest professionalism.

“The quality of clinical service is on a par with any private hospital on top of a strong culture of teamwork and research bounded by ethics. We have the latest imaging and diagnostic facilities, and laboratories technologies, multidiscipline and subspecialised doctors, as well as scientists are all in one place.”

In the UKM Medical Centre complex, there are the UKM Medical Molecular Biology Institute, Tissue Engineering Centre as well as the Cell Therapy Centre created to pool the research talents.

“This is why we can conduct pilot studies and perform clinical trials beyond offering a leading-edge surgical treatment for complex cases. Soon, these facilities will further integrate with the UKM Health Technopolis project, which will be launched to be hallmark of health research excellence of UKM.”

He said it was up to a university hospital to spearhead this area to treat patients.
Datuk Dr Badrul Akmal Hisham
UKMSC Consultant Orthopaedic Surgeon (Arthroscopy and Sports Injury) Datuk Dr Badrul Akmal Hisham Md Yusoff explaining how a procedure is done on the knee. - NSTP/ HALIMATON SAADIAH SULAIMAN
Dr Badrul said typically, stem cell treatment involved the use of bone marrow for leukaemia, adding that the Cell Therapy Centre is dedicated for this group of patients.

In 2016, Dr Badrul led a team of orthopaedic surgeons and stem cell scientists in a pilot clinical trial for Malaysia and UKM, where they succeeded in treating a group of patients using unmatched donor umbilical cord-derived mesenchymal stem cells for knee articular cartilage defects.

The results were presented at the International Cartilage Regeneration and Joint Preservation Society Focus Meeting, “I’m Not Ready for Metal” at Humanitas University in Milan, Italy, recently.

“This has been the cornerstone of our stem cell therapy for patients because having an unlimited source from an unrelated and unmatched donors will pave the way for treatment to be readily made available for any patient.”

He said one of the common knee injuries was related to cartilage damage and degenerative process.

“Once it is injured, it cannot regenerate into its original state in a normal condition due to the nature of the articular cartilage, which does not have a blood or nerve supply.

“Every time we come across a young patient who sustained a knee injury from sports, within five years, if they do not receive treatment, the cartilage will progressively damage and lead to secondary knee osteoarthritis, a degenerative form of debilitating joint disease,” he said, adding that if an athlete suffered this, it would be the end of his career.

He said the younger the stem cells, the better they are for treatment.

“We found that the best stem cells are those sourced from the tissue called Wharton’s jelly, which is in the umbilical cord structure.”

He said the treatment was suitable for those with early stage osteoarthritis and those who have medical conditions that prevented them from undergoing surgery, such as patients with heart problems.

“There are also patients who are not in favour of joint replacement surgery and would seek herbal and traditional remedies, including alternative medicine. The sad case is that most of them will become depressed when their condition do not improve and worse, deteriorate. These are the patients whom we feel will benefit from this minimally invasive treatment.”

Despite the potential of the therapy, Dr Badrul said the public needed to do a bit of reading to understand the treatment’s limitations.

He cited the example of advanced stages of knee osteoarthritis patients, whose conditions had worsened to the point of malalignment and instability of the knee joint.

“These conditions have progressed to the point of patients having a poor life quality, which disturbs their sleep, as well as forcing them to walk with aid.

“Seeking early treatment is beneficial for patient as the constant ingestion of painkillers and supplements may trigger other medical problems, such as gastrointestinal and kidney damage.”

Dr Badrul said despite the inconvenience suffered from shoulder and knee injuries, few patients sought proper treatment early.

He said only three to four out of 10 patients sought treatment by an orthopaedic surgeon, while others visited traditional healers, or opt for alternative medicine or a massage.

He said Malaysia had the advantage to be the hub for stem cell therapy for orthopaedics in Southeast Asia as the Health Ministry has issued the official guideline for stem cell research and therapy in 2009.

The move also established a solid monitoring and standard framework to ensure the use of stem cell for treatment is well regulated via the National Committee for Ethics and Stem Cell Research and Therapy, chaired by Prof Datuk Dr A. Rahman A. Jamal, who is UKM pro-vice-chancellor (Medical).

“UKMSC has a huge potential and is well known internationally and a trusted brand. As a leading research university, we are driven by evidence-based medicine, excellent service and always strive to give what is best for our patients,” he said.

The cost for stem cells treatment in UKMSC will be competitive and has more added value as clinical services provided by UKMSC has to also undergo UKM’s internal medical and surgical ethical board review and monitoring.

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