R E G E N E R AT I V E M E D I C I N E
Stem Cell Therapy: What Your Patients Need to Know By Christopher J. Rogers, MD, and Mary A. Ambach, MD
KAREN IS AN ACTIVE 58-year-old avid traveler who presented to our clinic with bilateral knee arthritis. She had difficulty walking and sleeping due to pain, stiffness, and swelling. Radiographs revealed moderate joint space narrowing. Physical therapy, steroid injections, and repeated hyaluronic acid gel injections offered temporary relief, but her condition continued to worsen. Her primary physician had advised her to consider knee replacement, but she was concerned about the potential for complications with surgery and wanted to pursue other options. An online search revealed many clinics that promote stem cell therapy. She attended a seminar given by healthcare providers that use umbilical cord blood stem cells, but was disappointed by their lack of scientific evidence. She eventually consulted our clinic to learn more about cell-based therapies. Karen is not alone. There are more than 30 million Americans who suffer with arthritis. Currently, no cure exists and standard medical care often does not sufficiently meet their needs. More than 600,000 patients per year undergo total knee replacement surgery after having failed conservative care. Although most patients are satisfied with the results of surgery, complications and adverse events can occur such as infection, deep venous thrombosis and persistent chronic pain. Many patients are not good candidates for surgery because they are too young or are medically unfit. Orthobiologics are cells and substances produced by cells that are used for the treatment of osteoarthritis, tendon tears, degenerated discs, and other orthopedic
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conditions. They promote the body’s intrinsic capability to heal and offer a viable option for patients who have failed conservative care or are not appropriate surgical candidates. Commonly used orthobiologics include platelet rich plasma (PRP), bone marrow aspirate concentrate, and minimally manipulated adipose tissue derived from a patient’s own (autologous) tissues. Decreased inflammation and tissue healing have been demonstrated in multiple clinical trials. These autologous cell-based therapies contain mesenchymal, adipose, or hematopoietic stem cells, which play a key role in the clinical benefits. However, they also contain many other cells, cytokines, proteins, and growth factors that may contribute to clinical improvement. What Is Regenerative Medicine? Regenerative medicine is a new medical specialty that uses advancements in cell biology, immunology, genetics, and tissue engineering to understand how the body heals itself. What Is Platelet Rich Plasma (PRP)? Platelet rich plasma is formed when a patient’s own highly concentrated blood derived platelets are suspended in plasma. Platelet rich plasma contains a high concentration of growth factors, cytokines, and other substances that promote tissue healing and immunomodulation. It is useful for the treatment of tendon, ligament, cartilage, disc, and joint injuries. Is Platelet Rich Plasma Therapy Safe and Effective? There are several randomized controlled
trials that demonstrate the safety and efficacy of PRP for the treatment of knee osteoarthritis, tennis elbow, patellar tendinopathy, rotator cuff tendinopathy, plantar fasciosis, and other orthopedic conditions. A list of scientific studies can be found at www.sdomg.com/prp and www.sdomg.com/endoret-research. What Are Adult Stem Cells? Stem cells have the capacity to differentiate into other cell lineages or self renew. Adult stem cells are found among differentiated cells in tissues and can generate different cell types for the specific tissue in which they live. A unique population of adult stem cells, mesenchymal stem cells (MSCs), were discovered to have an active role in connective tissue repair and have the capacity to differentiate into bone, cartilage, tendon, or adipose cells. They have colony forming capacity and have a characteristic set of cell surface markers. Significant progress toward safe and effective clinical applications of MSC mediated therapy has been made and continues to evolve rapidly. The best studied sources of MSCs include adipose tissue, which contain a heterogenous mixture of reparative cells. Is Autologous Stem Cell Therapy Safe and Effective? Several randomized controlled trials exist for bone marrow-derived cell therapies for knee osteoarthritis and hip osteonecrosis