Stem Cell Treatment for Ankylosing Spondylitis – AS

SpA (Spondyloarthritides) disorders are a family of autoimmune inflammatory conditions that share common manifestations like inflammation in the sacroiliac joints, spinal cord, or peripheral joints and often predispose to genetic factors such as the HLA-B27 gene. Members of the Spondyloarthritides disease family include reactive arthritis, axial spondyloarthritis (axSpA), psoriatic arthritis, and arthritic spondylitis, which is also associated with inflammatory bowel diseases such as ulcerative colitis & Crohn’s disease.

Ankylosing Spondylitis & Spinal Arthritis

What is ankylosing spondylitis?

Ankylosing spondylitis (AS) is a progressive inflammatory rheumatic disease primarily found in the axial skeleton and sacroiliac joints.[1] The primary clinical manifestation of AS is frequent back pain and progressive stiffness in the “Bamboo spine.” Other affected areas include Oligoarthritis (arthritis affecting two to four joints), usually in the shoulders and hips. Other patients report having degenerative disc disease or enthesopathy, a disorder of the connective tissues between bones and tendons (entheses), ligament enthesopathy, and anterior uveitis. Although extensive research has been done, our current understanding of the underlying pathogenesis of ankylosing spondylitis is still minimal. Common causes are usually attributed to hereditary reasons (e.g., HLA-b27), infections, and autoimmune attacks.

Ankylosing spondylitis is classified as a type of arthritis in the spine and causes severe inflammation of the spinal joints, which leads to severe, chronic pain and frequent discomfort. For patients with more advanced AS, the chronic inflammation leads to new bone formations, causing sections of the spinal cord to become fused (fixed, immobile position) and is commonly referred to as bamboo spine. Bamboo spine generally develops due to ossification in the outer fibers of annulus fibrosus disc intervertebral (intervertebral discs), leading to Osteonecrosis of the hip or the formation of syndesmophytes (bony growth originating inside a ligament) between the adjoining vertebrae.

Spondyloarthropathy is highly heritable and is often associated with progressive rigidity, rheumatoid arthritis, peripheral arthritis, gouty arthritis, and chronic inflammatory response in the spine and pelvis regions.

Who Gets Ankylosing Spondylitis?

For most patients, diagnosis of ankylosing spondylitis comes at an early age and usually always results in some physical dysfunction and reduction in overall quality of life. Over 90 percent of patients with ankylosing spondylitis are estimated to carry mutations in the HLA-B27 gene. Recent research also shows that men are 2-3X times more likely to get diagnosed than women. Other known causes of AS include Tumor necrosis factor-alpha (TNF α) and IL-1. ANCA (Anti-neutrophil cytoplasmic antibodies) are also associated with Ankylosing spondylitis but do not necessarily correlate with how severe the patient’s condition will get.

Symptoms & Complications of Axial Spondyloarthritis

As Ankylosing spondylitis develops, patients report chronic inflammation in the spine, and radiology scans often show new bone formation in all spinal cord segments. Eventually, the calcification of vertebral and paravertebral ligaments will aggravate nerve endings, resulting in chronic pain. The rate of new bone formation varies from patient to patient but is generally caused by increased differentiation of osteoblast cells. Patients diagnosed with spinal arthritis are at very high risk of developing spinal fractures, osteoporosis, lupus, spinal cord injuries, hypertension, heart diseases such as CHF, pulmonary complications leading to COPD or IPF (upper portion of the lung), and metabolic syndromes such as sarcopenia, type 1 diabetes, type 2 diabetes, neuropathy, femoral nerve pain and diabetic nephropathy. Patients with AS also have a higher prevalence of dementia and Alzheimers, primary Sjogren’s Syndrome, ALS, and MND compared with the general public. If left untreated, the condition degenerates over time, resulting in spinal mobility loss and limitations in lateral and anterior flexion movement. Other systemic failures common for patients with AS include weight loss, chronic fatigue, and fever. Pain is often worse when resting for most patients but can improve with light physical activity. ^[2]

Diagnosing Ankylosing Spondylitis Stage 4 Advanced

Ankylosing spondylitis and axial spondyloarthritis can be diagnosed today by checking for changes in the sacroiliac joints and spine using radiology scans such as an MRI. Genetic screenings are also done to check for the presence of the HLA-B27 marker. Patients who are HLA-B27 positive have a better-than-average risk of developing certain types of autoimmune disorders. For patients with acute inflammatory attacks, simple blood tests can measure the concentration of CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate). However, it should be noted that there are many patients with ankylosing spondylitis whose ESR & CRP rates do not increase, so having normal CRP and ESR results might not correspond with the actual amount of inflammation present.

These general criteria for diagnosing spondyloarthritis include:

• Frequent inflammatory back pain
• Family history of inflammation in the tendon-bone attachments, heel, shoulder, or hip joints
• Positive test for HLA-B27 Gene – DNA Testing at Regen Center
• Elevated levels of inflammation measured by CRP/hs-CRP or ESR Blood tests
• Family history of spondyloarthritis or other rheumatic/autoimmune conditions
• Previous diagnosis for chronic lymphocytic thyroiditis
• A fair response to nonsteroidal anti-inflammatory drugs (NSAIDs)
• Psoriasis
• History of spinal inflammation
• Inflammatory bowel disease
• Frequent inflammation of the eye (uveitis)
• Inflammation of the sacroiliac joint was confirmed with an MRI scan

Treatment options for Ankylosing Spondylitis in 2025

Traditional antirheumatic drugs can help to improve back pain,  disturbed sleep, peripheral arthritis acute phase responses, and temporarily improve quality of life; however, the major contributing factor of axial spondyloarthritis is new bone formation, which is generally not affected. Due to this new alternative, AS treatment focuses on managing osteogenic differentiation to prevent new bone formation and induce sustained disease remission.^[3]

Traditional Treatments of Spondyloarthritis:

There is currently no cure for hereditary Ankylosing spondylitis. The success of modern biological treatments and traditional pharmaceutical medications can help contain the disease and reduce pain; however, early intervention is vital. It can be challenging to reach a confirmed diagnosis early, requiring a lengthy diagnostic stage. Annual physical exams and tests can be used to detect the root of the symptoms.

Commonly used non-surgical treatments for Ankylosing spondylitis include Physical therapy & Exercise. Regular physical therapies can help restore some functionality in the joints. Occupational therapy is a great way to strengthen the tissues and muscles needed for a flexible, healthy body. Non-impact exercises can provide patients with fast relief of pain and stiffness. This natural therapy can help reduce the risk of future disabilities.

Prescription Medications – DMARDs – NSAIDs

NSAIDs (nonsteroidal anti-inflammatory drugs) are the most common first treatment used for controlling symptoms. The family of such medications includes naproxen, aspirin, and ibuprofen. Other disease-modifying antirheumatic drugs (DMARDs) might be added to the patient treatment course for patients who do not respond to NSAIDs. DMARDs such as sulfasalazine include local injections of steroids to reduce stiffness, inflammation, and other discomforts. Prolonged use of medications causes severe reactions, liver cirrhosis, kidney failure, gastrointestinal bleeding, peptic ulcers, hepatorenal damage, and cardiovascular events such as MI.

TNFα antagonists

Tumor necrosis factor-alpha is a physical blocker that is often referred to as an “antagonist.” These TNFα antagonists include biological therapies such as infliximab, etanercept, adalimumab, and golimumab. Biologic medications such as interleukin 17 inhibitors & TNF blockers can trick the immune system to stop or slow down the inflammation process; however, the course of inhibiting the production of proinflammatory cytokines such as IL-17, IL-22, IFN-γ, and TNFα can result in severe side effects and for some patients reactivate tuberculosis or make patients more prone to getting new infections.

Surgical Treatment of Bamboo Spine

Thanks to advancements in medicine, surgery is very seldom used today. However, surgery might be required for some late-stage cases if pain or extreme swelling occurs rapidly. Surgeries would mainly look to replace damaged joints with new artificial joints. Such surgeries are prevalent in knee replacements and total hip replacement surgeries. Correction surgeries are also needed for patients with severe flexion deformities (downward curvature in the spine), particularly in cervical spine (neck) areas.

Risks of Surgery

Joint replacement surgeries are inherently risky and temporary, as artificial joints need replacements over time. In addition, the preparation for surgery requiring general anesthesia makes the procedure even more complex to the risk of surgery. Any abrupt changes to the upper airway area can lead to problems intubating the airway. In some cases, direct spinal or epidural anesthesia may be impossible due to extensive calcification of the damaged ligaments. Stiffness of the thoracic ribs can decrease pulmonary function or result in aortic insufficiency.

Stem Cell Treatment for Ankylosing Spondylitis

In the last two decades, considerable progress has been made in the regenerative treatment of spondyloarthritis.

The Regeneration Center Enhanced mesenchymal (UC-MSC+) protocol includes a proprietary combination of adult mesenchymal stem cells, osteoblast-specific growth factors, adipocytes, and chondroblasts with ≥95% cell surface proteins consisting of CD90, CD73, and CD105 markers. Learn more about stem cell therapy. We offer a viable treatment option for patients who are unresponsive to traditional treatments. UC-MSC+ cells offer significant regenerative and immunomodulatory properties that can help reduce inflammatory responses and help repair surrounding tissues via the secretion of soluble factors provided with the growth factors during treatment.^[5]

For the treatment of immune-mediated inflammatory disease, the Regeneration Center has developed a unique combination therapy using hematopoietic stem cells and UC-MSC+ cells that are particularly effective in stabilizing an otherwise abnormal rate of osteogenic differentiation. Learn about how we treat ibm muscle disease with stem cells.

UC-MSC+ cells are engineered to provide low immunogenicity and immunomodulatory properties. UC-MSCs+ therapy for Ankylosing spondylitis does not require immunosuppressive medications. UC-MSC+ cells do not express HLA-DR, which makes them the ideal therapeutic medium for transplantation in patients with immune-mediated disorders. UC-MSC+ can eradicate dysfunctional cells and restart the immune system by replacing damaged cells with cells differentiated into standard B and T cells required for immune system homeostasis.^[4]

The Regeneration Center Protocol for AS

Total Number of MSC+ Cell Infusions: Total Endogenous Cell Count and range of growth factors will vary based on patient needs.

Types of Stem Cells and Delivery Methods: For patients with moderate AS, multiple sessions of clinical grade expanded UC-MSC+ Mesenchymal Cells along with our proprietary mix of growth factors that can include Bone Morphogenetic Proteins (BMPs), Insulin-like Growth Factor-1 (IGF-1), Transforming Growth Factor-beta (TGF-β), Platelet-Derived Growth Factors (PDGF), Connective Tissue Growth Factors (CTGF), Epidermal Growth Factors (EGF), Vascular Endothelial Growth Factors (VEGF), Fibroblast Growth Factors (FGF) and Nerve Growth Factors (NGF). The regenerative therapy protocol we recommend will depend on the patient’s medical needs. The isolated cells and growth factors are delivered via intravenous drips, direct local injections, intradiscal injections, intrathecal injections, fluoroscopy-guided stem cell delivery (in a hospital setting only), or a combination of different delivery methods to achieve the best results.

Rehabilitation Post Treatment: Physical Rehabilitation in Bangkok is optional but highly recommended. Complete physical rehab services post-therapy can be provided upon request for 2-3 hours per day and up to 5 days per week.

Total Treatment Time Required is estimated to be around two weeks (depending on the type and severity of the condition). Medical and travel visas for extended accommodations at a hotel or apartment for the patient and family can also be provided upon request.

Spondyloarthritis Treatment Guidelines & Requirements

The Regen Center UC-MSC+ Stem Cell treatment for spinal arthritis and Ankylosing spondylitis will require 10-14 days total. Due to the varying severity, our medical team must evaluate the patients using current medical records. Evaluations can be done in person or online (submitting documents online). After completion of the medical review, our recommendations with a detailed treatment plan will be provided, including specifics such as the exact total number of nights required and total medical costs for treatment of ankylosing spondylitis with UC-MSC+ stem cells. Please prepare all current medical records and contact us today to begin the evaluation process.

Published Clinical Citations

[1] ^Chiowchanwisawakit, P., Thaweeratthakul, P., Wattanamongkolsil, L., Srinonprasert, V., Koolvisoot, A., Muangchan, C., Nilganuwong, S., Arromdee, E., & Katchamart, W. (2019). Relationship Between Health-Related Quality of Life and Patient Acceptable Symptom State With Disease Activity and Functional Status in Patients With Ankylosing Spondylitis in Thailand. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 25(1), 16–23. https://doi.org/10.1097/RHU.0000000000000750

[2] ^ Luft F. C. (2017). Mesenchymal stem cells provide novel insights into ankylosing spondylitis. Journal of molecular medicine, 95(2), 119–121. https://doi.org/10.1007/s00109-016-1496-y

[3] ^Chiowchanwisawakit, P., Pithukpakorn, M., Luangtrakool, K., & Permpikul, P. (2021). HLA-B*27:04 associated with enthesitis and younger age of onset, and HLA-B allele profile in patients with ankylosing spondylitis in Thailand: A cross-sectional study. International journal of rheumatic diseases, 24(3), 411–417. https://pubmed.ncbi.nlm.nih.gov/33448675/

[4] ^Abdolmohammadi, K., Pakdel, F. D., Aghaei, H., Assadiasl, S., Fatahi, Y., Rouzbahani, N. H., Rezaiemanesh, A., Soleimani, M., Tayebi, L., & Nicknam, M. H. (2019). Ankylosing spondylitis and mesenchymal stromal/stem cell therapy: a new therapeutic approach. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 109, 1196–1205. https://doi.org/10.1016/j.biopha.2018.10.137

[5] ^ Zheng, G., Xie, Z., Wang, P., Li, J., Li, M., Cen, S., Tang, S., Liu, W., Ye, G., Li, Y., Wang, S., Wu, X., Su, H., Wu, Y., & Shen, H. (2019). Enhanced osteogenic differentiation of mesenchymal stem cells in ankylosing spondylitis: a study based on a three-dimensional biomimetic environment. Cell death & disease, 10(5), 350. https://doi.org/10.1038/s41419-019-1586-1