For Eleni Crockett, living with severe arthritis was sheer agony – until a ‘wonder jab’ changed her life. The joint condition had destroyed her knees, causing swelling and horrendous pain that was so bad she could barely walk.
At just 63, her only option on the NHS was major surgery: a total knee replacement.
But this might last only ten years, she was warned – if it worked at all.
Instead, Eleni opted for a radical and experimental new therapy. She paid £7,500 for injections of stem cells taken from her own body fat at the private Regenerative Clinic in London’s Harley Street.
The treatment, called Lipogems, could banish her pain and immobility, she was told.
It simply involved taking a small amount of fat from her stomach, back or thighs, and injecting it straight into her damaged knees.
For 63-year-old Eleni Crockett (above), living with severe knee arthritis was sheer agony – until a ‘wonder jab’ changed her life. She paid £7,500 for injections of stem cells taken from her own body fat at the private Regenerative Clinic in London’s Harley Street. The treatment, called Lipogems, could banish her pain and immobility, she was told
Princess Michael of Kent, the wife of the Queen’s cousin Prince Michael, recently appeared in a slick promotional video for a clinic in the Bahamas that offers similar joint therapy. (Above, the princess in the Bahamas)
Stem cells inside the fat would then help healthy new cartilage to grow, restoring her joints to good health – or so the theory goes.
And, for Eleni at least, the investment paid off.
‘It’s tremendous,’ says the PA from North London, who works at a European bank in the City.
‘The swelling has disappeared and I’m no longer on painkillers.’
And she’s in good company. Princess Michael of Kent, the wife of the Queen’s cousin Prince Michael, recently appeared in a slick promotional video for a clinic in the Bahamas that offers similar joint therapy.
‘Look at that,’ the Princess declares proudly in the five-minute film, holding her right arm high above her head after stem-cell injections for a painful shoulder. ‘It’s amazing – I think stem cells are the future, there’s no doubt in my mind.’
The Princess paid for her treatment and received no money for endorsing the procedure.
But for all the anecdotal evidence supporting the treatment, it remains hugely controversial. Most specialists say there is little robust evidence to show it works and it has not been approved by the UK medicines regulator, the National Institute for Health and Care Excellence.
So what’s the truth about using your own fat to fix creaky knees – and are some clinics preying on patients’ desperation to sell a largely unproven therapy?
Growing demand… despite the costs
The truth is that for the millions in the UK who seek treatment every year for osteoarthritis, there is often little hope.
Standard approaches include advising patients to lose weight and get more exercise.
Many are reliant on painkillers, while injections of inflammation-reducing steroid drugs can help, but neither option works long- term and they come with troublesome side-effects.
Ultimately, in severe cases, the only solution available on the NHS is a total knee replacement. But one in five fails, with infections, swelling and worse mobility, caused by a poorly fitting prosthesis, all common.
Having to have a second implant can happen, too. A few decades ago, it was rare for someone under 65 to have a total knee replacement. However, people in their 40s are increasingly becoming patients – and, as they often demand far more of their new joint, the complication rates for these younger patients are higher than average.
So it is not really surprising that there is increasing interest in ‘regenerative medicine’: therapies that encourage the body to heal itself – in the case of knee arthritis, by growing new cartilage and potentially delaying surgery.
And despite little real evidence that it works, private clinics are already offering patients early access to such therapies – at huge cost.
The Regenerative Clinic was co-founded by internationally renowned orthopaedic specialist Professor Adrian Wilson.
Simon Checkley, the clinic’s chief executive, admits: ‘There are lots of people saying, “What the hell are you doing? You’re sticking fat into people’s knees and charging them thousands of pounds – is that really ethical?”
‘But we’ve had patients with such bad arthritis that they can’t walk, completely transformed by treatment. You can’t argue with that.’
Some patient testimonies back this up. Eleni says: ‘It’s changed my life. I had severe osteoarthritis but I was so desperate to avoid surgery. I’m glad I did. Even if I do go on to need surgery, I’ll potentially have delayed it for ten years.’
Yet, understandably, most doctors remain highly sceptical.
A few decades ago, it was rare for someone under 65 to have a total knee replacement. Now, people in their 40s are increasingly becoming patients – and, as they often demand far more of their new joint, the complication rates for these younger patients are higher than average. So it is not really surprising there is increasing interest in ‘regenerative medicine’: therapies that encourage the body to heal itself. (File image)
There may be dozens of trials from around the world, but they are inconsistent in their methods, and use too few patients to be considered reliable.
In the US, Google has banned all advertising for products that contain stem cells or another regenerative therapy which uses blood cells, known as platelet-rich plasma, or PRP, because regulators describe the treatments as ‘new and exploratory’. And in the UK, experts have rubbished claims that Lipogems can treat arthritis.
Some doctors have claimed it provides no benefits, much like another controversial knee procedure called arthroscopy.
Professor Chinmay Gupte, consultant orthopaedic surgeon and senior lecturer in knee surgery at Imperial College London, warns: ‘These are extremely expensive treatments, and largely unproven. The problem is when you’re desperate, you’ll try anything.’
The patients who say it didn’t work
The one-hour Lipogems procedure involves extracting a cupful of fat from the stomach, back or thighs.
Fat has high levels of mesenchymal stem cells (MSCs), which have the capacity to regenerate and repair damaged tissue and are being investigated for their potential in a range of conditions, from multiple sclerosis to heart disease.
But Lipogems therapy does not use pure stem cells – doing so would require a licence from health watchdogs the Medicines and Healthcare Regulatory Authority and the Human Tissue Authority.
Instead, the fat cells are ‘minimally manipulated’ in a 15-minute process to remove excess oil and fat in a machine that shakes it through a cylinder filled with ball bearings.
These are extremely expensive treatments, and largely unproven. The problem is when you’re desperate, you’ll try anything.
Prof Chinmay Gupte, consultant orthopaedic surgeon and senior lecturer in knee surgery at Imperial College London
What remains is ‘micro-fragmented fat’, a cluster of cells which contains thousands of different types of cell. One to five per cent of these are said to be stem cells. Up to 8ml is then injected back into the patient’s knee and they leave the same day.
Prof Wilson says many feel an immediate benefit because some of the cells produce an early anti-inflammatory effect.
The treatment is also remarkably multi-purpose, with patients at the Regenerative Clinic patients often having ankles, knees or elbows treated at the same time.
Injections into the face, to smooth out wrinkles, can be given. The clinic has also recently begun offering the injections ‘to rejuvenate the vagina’, and help restore tissues after childbirth and the menopause.
They say unpublished data shows 82 per cent of 92 of their patients treated with Lipogems ‘experienced a dramatic reduction in their pain’ and improved knee function after one year.
But two-year data exists for only 15 patients. According to the clinic, 12 have done well, while ‘a few’ have gone on to have pain or additional surgery.
Despite little real evidence that it works, private clinics are already offering patients early access to such ‘regenerative’ therapies – at huge cost. The Regenerative Clinic was co-founded by internationally renowned orthopaedic specialist Professor Adrian Wilson. (Pictured, Harley Street)
But it insists: ‘If it lasts for a year, which studies do show, it’s unlikely to be a placebo. We know the placebo effect doesn’t last for much longer than about six weeks.
‘Our data shows most have a dramatic improvement in pain well beyond that point.’
But Professor Sally Roberts, head of the Spinal Studies and Cartilage Repair Research Group at Robert Jones & Agnes Hunt Orthopaedic Hospital in Oswestry, Shropshire, warns: ‘With MSCs from fat, you don’t know what you’re getting, or what effect you’re getting.’
And an online search reveals that some patients have been left feeling angry and ripped off. One wrote: ‘I was charged £8,000 for the procedure and got nothing but extra pain, which they can’t deal with.’
Another complained: ‘Since the surgery sadly my pain has increased.’ One male patient needed a total knee replacement just 15 months after his treatment in February 2018. He said: ‘I did not experience any noticeable improvement after the operation.’
Fears that cells may turn to bone
Exactly how the ‘stem cells from fat’ treatment works is unclear. One theory is the cells home in on damaged tissue and, in this case, turn into cartilage cells, which rebuild the joint.
It’s not without risk: some experts fear that if the cells keep multiplying they could eventually turn into bone and have a damaging effect.
The more credible explanation is the bundle of fat cells work together to release proteins that trigger regeneration inside the knee joint – like a ‘mobile pharmacy, churning out the good stuff’, says Prof Wilson.
The next step, he says, is to identify precisely what’s in the fat that triggers this healing process.
Then it might be possible to use whatever it is in higher concentrations. The clinic is now backing a study in Pakistan – where running a clinical trial is significantly cheaper – to prove the treatment actually works.
A thousand patients will receive several different treatments, including Lipogems and PRP. All will have an MRI scan at 12 months to see whether cartilage has regrown.
Prof Wilson adds: ‘No matter what we say, this will take five to ten years to become mainstream in the UK because of the resistance of my colleagues.
‘Our outcomes are good. It will just take a while for the rest of the medical profession to catch up.’
Until the evidence emerges, however, for patients it remains an expensive lottery.