Treatment of Osteoarthritis

with autologous stem cells from your

own bone marrow.

Information for patientsHealth People

Cells health 4 Osteoarthritis

What is Osteoarthritis?

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Osteoarthritis is a degenerative joint disease that mostly affects the cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over each other. It also helps absorb shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away. This causes the bones under the cartilage to rub together. The rubbing causes pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage. People with osteoarthritis mainly have joint pain and reduced motion. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs, and is the most common type of arthritis. Rheu-matoid arthritis, the second most common form of arthritis, is a generalized disease, which involves other parts of the body besides the joints.

Who Gets Osteoarthritis?

Osteoarthritis occurs most often in older people. Younger people sometimes get osteoarthritis primarilyfrom joint injuries.

What Causes Osteoarthritis?

The basic cause of osteoarthritis is unknown. Factorsthat might contribute to its manifestation include overweight, getting older, joint injury, genuine joint malformation, genetic defects in joint cartilage or excessive stress to the joints by certain jobs and by playing specific kinds of sports.

How Is Osteoarthritis Diagnosed?

Osteoarthritis can occur in any joint, most often in the hips, knees, hands, and spine. The most frequent anddisturbing symptom is pain, in the advancing state restriction of mobility, stiffness in a joint after getting out of bed or sitting for a long time; swelling or tenderness in one or more joints; a crunching feeling or the sound of bone rubbing on bone.

To diagnose osteoarthritis, and to rule out other prob-lems, several methods are applied, Medical history, physical exam, blood tests, X-rays, MRI and other exams, like arthroscopy, including the removal and analysis of fluid in the joints.

How Is Osteoarthritis Treated?

The main goals of arthritis treatment are to improve joint function and to maintain healthy movement without pain. To achieve this, first of all doctors often combine treatments to fit a patient's needs for a healthy lifestyle, like body weight control, exercise, particularly swimming, with instruction and support by physiotherapy, partly temporary rest and joint care, medication, non-drug pain relief techniques like acupuncture and other complementary methods, local infiltration, and sometimes surgery. Beside conven-tional treatments, stem cell therapy can be used to treat arthritis. The stem cells can form new cartilage and grow new blood vessels.

About stem cells

The discovery of the stem cell has lead to a revolution in modern medicine. Stem cells are in fact the "smart cells" of our bodies. These cells migrate to injured areas within the body and transform themselves into new tissue cells that replace the damaged ones. The body repairs itself by continuously producing new cells and tissues in this manner.

Cells health 4 Osteoarthritis

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Stem cells have the capacity to multiply and to renewthemselves almost indefinitely. This contrasts with nerve cells, muscle cells and blood cells, which cannot multiply themselves and have limited life spans. Stem cells can also develop into specialized cells.Stem cells from the bone marrow can develop into cardiac muscle, as well as liver, brain, nerve, fat, skin tissue and cartilage.

The Osteoarthritis Treatment

The entire procedure consists of the following phases:eligibility, stem cell collection and processing, stem cell treatment, and follow-up.

Examples of bone marrow-derived stem cell develop-ment are illustrated below.

ObjectivesThe stem cells can repair damaged cartilage, form new cartilage and grow into new blood vessels, thus improving function and reducing pain.

Type of treatment

The arthritis procedure employs autologous adult stem cells. These cells are collected from your own bone marrow. A few days prior to treatment, the stem cells will be isolated from bone marrow taken from your hip (iliac crest).

Eligibility phase

If you meet the following conditions, you are eligible for treatment:

- Osteoarthritis diagnosis based on your medical history, laboratory findings, X-rays and MRI.

- The Cells4health medical team approves you for treatment.

- Your bone marrow contains a sufficient quantity of viable stem cells. This is assessed during the processing phase.

Liver

Brain

Blood cell

Cardiac muscle

Adult Stem Cell

Skeletal muscle

Bone marrow

Epithelial cell

Neuron

Stem Cell

Specialized Cell(e.g., neuron)

Stem Celle.g., hematopoietic stem cell

Cells health 4 Osteoarthritis

Preparation Application of local anesthetic

Disinfection of the collection site Needle insertion into the hip bone Sample collection

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Stem Cell Collection and Processing

Prior to scheduling bone marrow collection, you will beasked to fill out the patient consent form. This form grants explicit written permission for bone marrow collection. You must discontinue using any blood diluting medications at least 10 days before your collection date.

You should consult your physician before discontinuing the use of blood diluting drugs, to avoid any risk, and, in case, to institute an alternate medication. When we meet you on the collection day, after an individual consultation with your treating physician, we'll have everything prepared to begin the collection and make your stay comfortable for you.

The treating physician will collect approximately 150 -200 ml of bone marrow from your hip bone. Stem cellcollection is performed as an out-patient procedure underlocal anesthesia in sterile conditions.It is compara-ble in pain to a dentist visit. During the collection, you will barely feel the needle insertion into the iliac bone on your back. Afterwards, the collection site might look like a "blue spot" and sometimes may be a bit painful for 3 - 4 days. Normally, there are no other side-effects. Theoreti-cally, there is a small risk of infection. We minimize this risk by working in a sterile environment.

(iliac crest)

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Bone Marrow

Collection

Procedure

These pictures show the Bone Marrow Collection Procedure

Osteoarthritis

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Within 48 hours, the stem cell samples are processedand quality tested by a highly specialized laboratory intotally sterile, clean room conditions. Since they are in sterile tubes and never come into contact with the air, these samples cannot be contaminated.

Bone marrow processing and quality testing consists of:

- Stem cell isolation - stem cells are separated from the red blood cells and blood plasma- Stem cell counting- Stem cell vitality measurement

Stem Cell Implantation

Your high-quality stem cell sample can be implanted via intrathecal injection.

Intrathecal Injection

Your high-quality stem cell sample will be directly injected into the affected joints. Additionally, depend-ing on the volume of stem cell concentrate, we receive, -which will be known after the processing phase-, we administer some part intravenously.

Possible Adverse Events from the treatment

- Some pain at the injection site. On demand, and according to the personal doctor/patient's agree- ment, we perform the procedure after i.v. injection of a sedative.

- Potential infection risk, which is minimized by performing the procedure under sterile conditions.

Treatment advantages:

- Simple- Out patient

Follow-up

Once you have returned home, a member of our medi-cal team will regularly monitor your progress via telephone and email. For your convenience, telephone 'hotline' is always at your disposal.

Cells health 4 Osteoarthritis

General

No additional charges will be incurred unless you arerequired to extend your stay at the medical center as a result of complications. Costs do not include additional stem cell treatments. If another treatment is necessary, we will discuss potential options with you.You will receive an invoice one week prior to treatment. This invoice must be paid in-full before treatment can begin.

Note:

If your bone marrow sample is negative or thestem cells cannot be administered due to unforeseenmedical circumstances, you will only be required to pay charges incurred to that point. In the case of a negative bone marrow sample, it might be possible to schedule another bone marrow collection.

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Osteoarthritis