Stem Cell Therapy Helps Osteoarthritis Patient Regain Mobility

A knee injury that ended his amateur football career in 2003 is believed to have triggered the early onset of secondary osteoarthritis (OA) for Khairul Ikram Kamarul Bahrin, who began experiencing debilitating symptoms at a very early age of just 35 years old.

Although he was still able to walk and perform his daily routines, he had to stop participating in sports to avoid worsening his knee condition.

“I tore my ACL (anterior cruciate ligament) while playing football. I underwent surgery, but not long after, it tore again — and this time, the damage was worse, involving the cartilage and bone as well. Since then, my knee has never fully recovered,” said the oil and gas engineer when interviewed by Bernama recently.

Khairul Ikram Kamarul Bahrin's knee condition, which was often swollen and painful, became more serious, and finally in 2020 an MRI showed that his knee cartilage was severely worn, which is a symptom of early stage OA.

His knee condition, often swollen and painful, worsened over time, and in 2020 an MRI (Magnetic Resonance Imaging) scan revealed severe cartilage wear — an early symptom of OA.

“I was only 35 then, but the doctor said my knees were like those of a 50-year-old. I was really down. Sometimes I had to pray while sitting on a chair. The sports I loved had turned into a nightmare,” he shared.

After nearly two decades of suffering, a consultation with orthopaedic consultant Prof Datuk Dr Badrul Akmal Hisham Md Yusoff from  Hospital Canselor Tuanku Muhriz  (HCTM), Universiti Kebangsaan Malaysia (UKM) in early 2022, changed Khairul Ikram’s life. He is now 40 years old.

A COMMON PROBLEM, LIMITED TREATMENT

 Knee osteoarthritis is a degenerative joint disease commonly seen in the elderly and better known as primary osteoarthritis, but if it is caused by some intrinsic knee injury such as cartilage damage or meniscal tear or even as a result of an unstable knee, it is referred as secondary osteoarthritis, where it is commonly and increasingly affecting physically active younger individuals aged 35 and above. According to the World Health Organisation (WHO), more than 250 million people worldwide have OA, with the knee being one of the most commonly affected joints.

 In Malaysia, local studies show that up to nearly 20 per cent or 1 in 5 individuals aged 50 and above suffer from knee OA. According to the Global Burden of Disease Study 2019, it is estimated that 33 million individuals aged 30–44 years experience knee osteoarthritis problems.

Knee osteoarthritis is a degenerative joint disease that often occurs in the elderly, but is now becoming increasingly prevalent among younger people. Photo credit ree3d.com.

Contributing factors include obesity, sports injuries, genetic history, and overuse of joints. Common treatments include painkillers, physiotherapy, corticosteroid or hyaluronic acid injections, and in chronic cases, joint replacement surgery.

However, for younger patients who are still active and not ready for knee replacement surgery, effective treatment options are limited. This is because there are many factors that may hinder individuals under the age of 50 if they undergo knee replacement surgery—among them, the inability to sit cross-legged, sit on the floor, and for Muslims, the need to perform prayers while seated on a chair.

Most concerning is the likelihood of requiring a second surgery after 15 years to replace the artificial joint due to wear and tear from intensive use.

All of this makes knee replacement surgery a less attractive option for most knee OA sufferers.

This has led to the emergence of regenerative treatments such as stem cell therapy, pioneered by Dr Badrul Akmal Hisham.

In 2016, the UKM medical faculty researcher and professor began exploring the use of mesenchymal stem cells derived from umbilical cords for orthopaedic conditions, particularly knee OA.

“Stem cells have great potential to stimulate the regeneration of damaged cartilage, thereby helping to restore joint function without the need for invasive joint replacement surgery,” he said in an interview with Bernama.

A PROUD ACHIEVEMENT

His research positioned UKM as the first institution in Malaysia to successfully conduct a clinical trial of regenerative treatment using mesenchymal stem cells on six patients, starting from 2016 to 2018, with very promising results.

“All patients involved in the clinical trial showed significant improvement, allowing them to return to normal lives. They no longer needed to rely on painkillers and were able to avoid joint replacement surgery,” said Dr Badrul Akmal Hisham.

He explained that the procedure involved surgery on the affected knee followed by a stem cell injection in the same area two weeks later.

“The recovery time usually depends on the severity of the injury. If it’s very serious, then more time is needed to heal,” he said.

This achievement marks a major milestone in regenerative medicine in Malaysia. The use of umbilical cord-derived stem cells offers a potential alternative to joint replacement for knee OA patients. This clinical trial was presented in the International Cartilage Repair Society Focus Meeting in Milan in 2018 and also published in Cytotherapy Journal by Elsevier, in May 2019.

EARLY SUCCESS AND FUTURE POTENTIAL

HCTM, as an academic hospital under UKM, plays a vital role in advancing stem cell treatment innovations to support the potential of health tourism, said Dr Badrul Akmal Hisham.

He added that this aligns with HCTM’s mission to provide safe, evidence-based, and innovative treatments that meet international standards, while also aiming to establish a regional reference centre for regenerative medicine.

Chief Executive Officer of KL Orthosports Sdn Bhd (KL Orthosports), Associate Professor Datuk Dr Badrul Akmal Hisham (fourth, left) and Director of Celler Therapeutics Sdn Bhd, Sasha Nordin (third, left)) pictured during the Memorandum of Understanding (MoA) Exchange Ceremony between KL Orthosports Sdn Bhd and Celler Therapeutics Sdn Bhd as well as the launch of the Malaysian Stem Cell Awareness Network at the HCTM Complex.

“Through strategic collaborations with research institutions and the private sector, HCTM is committed to strengthening R&D capacity. Our vision is to be a leader in innovation-based healthcare services, especially in stem cell treatment, and to become a key destination for health tourism at both regional and global levels,” he explained.

According to him, UKM’s commitment is further reinforced through partnerships with KL Orthosports Sdn Bhd and Celler Therapeutics SdnBhd, particularly in regenerative medicine.

In addition, the launch of the Malaysian Stem Cell Awareness Network reflects efforts to raise public awareness and knowledge of stem cell therapy.

The success of this clinical trial paved the way for broader access to stem cell treatment in Malaysia. However, to ensure its effectiveness and safety on a wider scale, factors such as treatment cost, regulatory approvals, and medical infrastructure must be addressed.

“With this success, we hope to provide access to more patients in need while continuing to monitor the research to ensure long-term outcomes,” he said.

He also shared his vision to collaborate with eight public universities, including medical universities and Konsortium Hospital Universiti Awam Malaysia (KHUAM) to conduct multi-centre trials focusing on approximately 500 patients.

“Based on this collaboration, we believe that within less than five years, Malaysians — especially — will benefit from this stem cell treatment through this consortium of university hospitals or KHUAM,” he said.

At the same time, he emphasised that while the treatment shows encouraging results for patients with mild to moderate OA, it is not a cure-all solution.

“While the treatment offers positive outcomes for many young patients, as in Khairul Ikram’s case, we need to be careful in selecting suitable cases. Treatment success depends on the level of joint damage and the patient’s commitment to physiotherapy and a healthy lifestyle post-treatment,” he explained.

INNOVATION MUST CONTINUE

According to Dr Badrul Akmal Hisham, HCTM is currently conducting more clinical studies to evaluate the long-term efficacy of the treatment across different levels of joint damage.

“This treatment has great potential, and we hope it can help more patients in the future to avoid more extensive and riskier surgeries,” he added.

To him, stem cell therapy is one of the innovative branches of regenerative medicine that shows tremendous promise — not only in treating various chronic and degenerative diseases, but also as a catalyst for the growth of Malaysia’s health tourism sector.

“Therefore, our main hope is that this treatment can establish Malaysia as a leading hub for stem cell therapy in Southeast Asia, attracting medical tourists from neighbouring and international countries seeking proven and evidence-based treatment at a very competitive costs,” he added.

Advancements in stem cell technology are expected to further enhance Malaysia’s reputation as a world-class healthcare provider, boosting investor and tourist confidence. Additionally, growth in this sector will directly contribute to the economy through increased medical tourism and indirectly via job creation and the strengthening of local research capacity.

NEVER GIVE UP

For Khairul Ikram, the treatment’s success not only allowed him to return to sports, but also restored his long-lost spirit and self-confidence.

“Football is not just a hobby, it’s part of my life. When I couldn’t play, I was devastated. But after this treatment, I feel like I’ve been given a second chance, and I’ve never stopped being grateful,” he said.

To those still suffering or yet to seek treatment, he offered this advice: “Many people think knee pain is normal as you age. But if you’re still young and active, and your knee starts hurting, know that it’s an early warning sign. The sooner you seek treatment, the better your chances of full recovery.”