Minimal Culture Expansion: A Historial Perspective

The evolution of In-Vitro Fertilization (IVF) illustrates the development of a minimal culture expansion process.  In the late 1970’s, the first IVF was performed.  In the 1990’s, in an effort to improve conception outcomes, fertility specialists elected to extend the cell culture time.  Specifically they extended cell culture to the blastocyst stage which is a more mature developmental phase. In doing so, the fertility specialists transitioned In-Vitro Feritlization from a simple tissue transplant to a cell culture technique.  These specialist maintain that their cell culture techniques are the practice of medicine and not the production of biologic drugs.  No parents who have undergone IVF,  think of their daughters or sons as biologic drugs, do they?

Adult, autologous stem cell therapy was found itself on a similar path.  In an effort to optimize clinical outcomes, some practices expand a patients’ own stem cells thereby increasing the total number of cells available.  Expansion takes 12-14 days and is conducted in a state of the art cell culture lab.  No growth hormone or exogenous products are used to increase the cell count.    If you are a patient who is concerned that this therapy may no longer be available please visit:  www.safestemcells.org

Patrick’s Test: Evaluation of Sacroillac Joint Dysfunction

The Patrick’s Test is a physcial examination test  to determine the presence of sacroiliac joint dysfunction in patients with lower back pain. It is important to evaluate all sources of lower back pain.  Common sources of lower back pain include lumbar facet dysfunction, lumbar ligamental instability, lumbar degenerative disc disease and sacroillac joint dyfunction.

The sacroillac joint is a synovial joint formed by the articular surfaces of the sacrum and ilium.  The stability of the joint is maintained by a series of ligaments which include the anterior and posterior sacroillac ligament.  The joint functions as a shock absober for the pelvis and lumbar spine.

Trauma is the most common cause of SI dyfunction.  Patient often times report falling directly onto their buttucks or being involved in a rear end motor vehicle injury.

Symptoms of SI joint dsyfunction include mild to moderate pain, unilateral in nature, aggrevated by prolonged sitting often times referred into the buttuck and posterior thigh.

The patrick’s TTest is performed by flexing the patients leg and putting the foot of the tested leg on the opposite knee.  Pressue is applied on the superior aspcect of the tested knee joint lowering the leg into further abduction.

Patrick's Test

The test is positive if there is pain at the hip or sacral joint, or if the leg can not lower to the point of being parallel to the opposite leg.

At the Centeno-Schultz Clinic, sacroillac joint dyfunction is treated with core stabilization, restoration of muscle imbalances and prolotherapy.

Expansion of Adult Stem Cells: Making A Drug?

Autologous, adult mesenchymal stem cells have proven to be an effective therapy for patients who have orthopedic injuries.  Specifically, autologous, adult mesenchymal stem cell therapy has regenerated cartilage in knees, hips and thumbs, repaired tendon injuries, reduced the size of protrusions in the lumbar spine and healed long bone non-union fractures.

Regenexx isolates a patients own mesenchymal stem cells in a state of the art cell culture laboratory.  Then, in an effort to provide maximal clinical results, it expands the stem cells by a factor of 1,000X.  The process takes 12-14 days and typically yields a mesenchymal stem cell count of 5-10 million cells.  The stem cells are expanded through the use of the patient’s own blood products.  No growth hormone or exogenous stimulates are utilized.  The patented process is unique in its ability to yield such a large number of autologous, mesenchymal stem cells.

In a previous blog, I discussed BMAC:  Bone Marrow Aspirate Concentrate.  The therapy involves taking a patients bone marrow, concentrating it via a centrifuge and re-injecting the concentrate into the area of damaged tissue.  The entire process is conducted in a single setting.  There is no isolation or culture expansion of the stem cells.   BMAC differs significantly from the Regenexx procedure in the type  and absolute number of stem cells injected.  BMAC  yields a high concentration of hemapoetic stem cells which will differentiate into blood products.  The important repair stem cell, mesenchymal stem cells, are in very low concentrations.

Your Own Tissue is Not Yours: It is a Drug

Regenexx utilizes a patients’ own stem cells to repair damaged ligaments, tendons, cartilage and bone.  Regenexx exclusively uses autologous adult mesenchymal  stem cells which are derived from the bone marrow of the patient being treated.  The clinical successes utilizing adult autologous stem cells have been published in peer reviewed journals.  Additional studies have been submitted and accepted and are awaiting publication.  Comprehensive outcome studies have been completed without any evidence of tumor growth.  There have been no complications.  Sounds to good to be true?

Stem Cell Therapy Accountability

Stem cell therapy has become exceedingly popular in the political, clinical, regulatory and patient advocate forums.  Many clinics both here in the United States and aboard have sprung up as a result of this international interst.  Unfortunately there is a significant amount of ambiguity in terms of understanding the basic concepts of stem cell therapy

 There are many different types of stem cells.  For simplicity,  they can be divided into embryonic and adult.  Adult stem cells can be further categorized as being allogenic, meaning that they came from another individual or autologous meaning  that they came for the same patient.   Autologous adult stem cells can be further divided based upon phenotype but the majority of the published research has been with mesenchymal stem cells.  This cell line is associated high levels of ‘repair function’.

Unfortunately patients are often unable to obtain answers to  questions whcih are critical to the success of there therapy:  what type of stem cells am I receiving, how many cells,  were the cells expanded and if so under what conditions?

In an effort to ensure patient safety a new association was been formed:  The American Stem Cell Therapy Association (ASCTA).  The ASCTA is a physician run organization with the mandate to produce a laboratory and clinical guidelines for minimal culture expansion of autologous, adult stem cells (A-ASC’s).  The group is comprised of various medical and surgical specialities whose goal is to to bring safe stem cell therapy to patients.  Please visit:  www.stemcelldoctors.org

 

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Synvisc Shoulder Injection Pain

Synvisc, also called hyaluric acid, is injectable medication used in the treatment of osteoarthritis.

Hyaluric acid is an important component of articulat cartilage.  It binds water and is responsible for the resilience of cartilage. Osteoarthritis, unfortunately erodes the articular cartilage of a joint giving rise to pain and reduction in range of motion.

Synvisc when injected into a joint is commonly referred to as viscosupplementation.  It is thought that Synvisc supplements the viscosity of the joint fluid thereby lubricating the joint whereby in theory reducing the level of pain.

It can be injected in the knee, hip and shoulder joint.

The manner in which it is injected is critical.  Most clinician inject the joint without  x-ray guidance which can result in the deposition of the Symvisc outside of the intended joint.  This can and often times does create a significant amount of pain and affords the patient no therapeutic response since the medication was not delivered into the intended joint.  Jackson demonstrated that experienced orthopedics physicians are only successfully in entering the knee joint space 71% of the time when using an anterolateral approach WITHOUT x-ray.  At the Centeno-Schultz Clinic x-ray is always utilized with viscosupplementation to ensure accurate placement of the medication and to avoid the pain associated with injection of hyaluric  acid outside of the joint space.

If Snyvisc therapy fails to provide significant pain relief, patients now have the option of utilizing their own meseenchymal stem cells to regenerate cartilage in the knee, hip and shoulder.  It is a novel, needle-in, needle-out procedure with allows patients to avoid the risk of disease transmission as well as the trauma and rehabilitation associated with surgery.

Please review knee MRI below of patient who underwent the use of her own mesenchymal stem cells to regenerate cartilage.    Pre-treatment images are on the top and demonstrate a cartilage depth ranging between 0.2- 0.3cm.  Five months post therapy, the cartiage has increased on average by 1mm. 

Regeneration of knee cartilage through stem cell therapy

Clinically the patient has had a significant reduction in her pain and an increase in her range of motion.  We just received an e-mail from her along with a picture of her daily activity:)

Back to Loving Life

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Ultrasound And Stem Cell Differentiation

Mesenchymal stem cells have the potential to change into bone, cartilage, ligament or fat.  In a previous blog, I discussed the importance of exercise in providing clues to the mesenchymal stem cells to change into cartilage.

Are there other factors which provide clues to mesenchymal stem cells?

Schumann et. al., demonstrated that low intensity pulsed ultrasound (LIPUS)  made a significant difference in prompting mesenchymal stem cells to morph into cartilage.  At Regenexx, where patients are afforded the opportunity to utilize their own mesenchymal stem cells,  now utilizes LIPUS   in all patients with cartilage damage.  It is critical that the correct stem cells are placed in the correct location and provided every opportunity to prosper as well as to change into the desired tissue.  That is our commitment at Regenexx.

Vulcan Shoulder Support

Vulcan Shoulder supports are commonly used for dislocated shoulder, frozen shoulder, broken collar bone, and  rotator cuff injuries.  In concept the neoprene support provides therapeutic heat, support and shoulder pain relief. The compression and warmth can also provide pain relief following shoulder surgery.

How does it work?

The support fastens securely around the shoulder with the Velcro straps to provide support and re-assurance following injury.  If the injury is mild and you are of good health and not taking any know toxins to your own stem cells, it is possible for some of these injuries to improve.  Unfortunately as we age, the vitality of our stem cells and their ability to mount a successful response to injury declines.  The result is continued pain due to incomplete healing.  Immobilizing the joint also goes against the finding supported by Sen who demonstrated mechanical stress led mesenchynmal stem cells to change into cartilage and bone as opposed to fat.

 

At the Centeno-Schultz Clinic we are committed to identifying and correcting the underlying program.  Prolotherapy often used  successfully to treat rotator cuff injuries, AC joint and shoulder dislocations if damaged has occurred to the supporting ligaments.

A non-surgical alternative for  partially torn rotator cuff tendons, dislocation of shoulders and acromio-clavicular injuries is the use of your own stem cells. At Regenexx a patient’s own bone-marrow-derived stem cells are isolated, expanded and then injected exactly into the area of damage under intermittent x-ray guidance. 

Intermittent X-ray to ensure accurate placement of MSC

 Utilizing your own stem cells (autologous) prevents the transmission of disease.

Please review testimonial of a patient who had bilateral rotator cuff tears who previously underwent surgery on one side and elected stem cell therapy for the other side.

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Exercise Directs Path of Mesenchymal Stem Cells

Mesenchymal stem cells(MSC) can morph into ligament, cartilage, bone or fat.   How and why they differentiate is critical.    Sen et. al., recently demonstrated that mechanical stress (the laboratory equivalent of exercise) lead mesenchymal stem cells to differentiate into bone instead of fat, even if they are given chemical signals to become fat.  What does this mean?  MSC can become fat cells simply by lack of exercise.  There are other factors which give MSC’s clues to turn into fat vs cartilage, bone or ligament.

If you are a patient with worn knee cartilage and are restricted as a result of pain, one surgical option would be micro-fracture. 

This is a surgical procedure where multiple small punctures are made into the femur(thigh) bone in an effort to stimulate cartilage regeneration.  A fragile thin clot is formed at the site which mandates a period on 6-8 weeks of non-weight bearing.  No running, golfing, cycling.  No fun! 

Multiple Puncture Sites From Micro-Fracture

Regenexx offers patients the opportunity to use their own MSC’s to generate cartilage via a needle-in, needle-out procedure.  No surgery is required.  Most importantly, the physical restriction are minimal.  In contrast to micro-fracture technique, the Regenexx patient is encouraged to exercise.  The mechanical loading associated with exercise gives the stem cells signals to change into cartilage.

Please review knee MRI of a patient who underwent stem cell therapy at Regenexx with radiographic evidence of increased cartilage as well as complete resolution of her severe  knee pain.

How to Heal Torn Shoulder Ligaments

Ligaments connect bone to bone.  The shoulder is composed of two principal joints:  the acromio-clavicular (AC) joint and the glenohumeral joint.

The acromio-clavicular joint (AC) is compromised of three ligaments:  cocrocoacromial, corococlavicular and acromioclavicular ligaments.

Acromioclavicular Joint and Ligaments

Four ligaments make up the joint capsule that connects the humerus(upper arm bone) to the glenoid:   the superior, middle, inferior and posterior glenohumeral ligaments. 

Glenohumeral Joint and Ligaments

The function of these later ligaments is to keep the ball of the humerus in the shoulder socket.  If there is a tear of one or more of the ligaments, the shoulder can slip in and out of its socket and hence becomes unstable.  The anterior glenohumeral ligament is injured in most cases of shoulder dislocations.

Surgery is often recommended in patients with persistent pain and instability.

Utilizing your own stem cells is now an option in the treatment of torn shoulder ligaments.  Regenexx uses a patietnt’s own expanded mesenchymal stem cells to treat ligament tears.

Please review MRI image and case report below which illustrates the successes patients are having utilitzing their own stem cells at Regenexx.