Stemcelldoc's Weblog

February 21, 2014

Autologous, Allogenic and Artifical Stem Cells

Opening Flower Bud

At the Centeno Schultz Clinic we utilize a number of regenerative therapies which include bone marrow derived stem cells.

Regenexx utilizes a patient’s own bone marrow derived stem cells to treat common orthopedic conditions which include:

Knee osteoarthritis

Knee meniscus

Hip osteoarthritis

ACL injuries

Non-Union fractures of long bones.

Stem cells can be divided into two principal classes:  autologous vs allogenic.

Autologous cells are a patient’s own stem cells.  One individual is both  the donor and  the recipient

Allogenic cells are cells that are from someone else.

Artificial embryonic stem cells from natural cells are receiving increased attention.  There are two principal methods to create artificial stem cells:  IPSC(induced Pluripotent Stem Cells)  and STAP (Stimulus-Triggered Acquisition of Pluripotency) which are discussed in Dr. Cenento’s video.

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December 10, 2011

Orthopedic Stem Cells Sources: Autologous vs Donor

At the Centeno-Schultz Clinic we acknowledge the regenerative potential of stem cell therapy for common orthopedic conditions.  Stem cell treatment utilizing Regenexx C and Regenexx SD has been used successfully as an alternative to

shoulder surgery

knee surgery and joint replacement

Peer reviewed studies have demonstrated its safety.

Regenexx utilizes a patient’s own stem cells which are referred to as autologous.

Stem cells can also come from donors and are referred to as allogeneic.

Is there a difference?

Yes as discussed in Dr. Centeno’s recent chapter on Stem Cell Therapy.

Autologous stem cell cells do not have the same communicable disease transmission risk as donor cells since they are the patient’s own cells.

Donor stem cells have the following concerns.

Gene transmission:  Stem cells transplanted from the bone marrow of mice bred to have osteoporosis were able to induce osteoporosis in healthy mice.

Immunosuppressive potential is reduced in mismatched settings.

December 3, 2011

Orthopedic Stem Cells: How they work

At Centeno-Schultz Clinic we acknowledge the regenerative potential of stems cells in treating common orthopedic injuries.   Dr. Centeno authored a chapter on stem cell use in orthopedic injury.
Regenexx C & Regenexx SD are alternatives to knee surgeries.

How do stem cells work?

Three principal ways:  differentiation, paracrine affect and regulation of inflammation.

Mesenchymal stem cells are multipotent and can differentiate into cartilage, tendon, bone and ligament.

Paracrine means that mesenchymal stem cells release certain growth factors to assist in tissue repair.  Mesenchymal stem cells  can be viewed as construction managers as they recruit other cells to the local area and coordinate the repair of damaged tissue.  The growth factors include TGF-beta, VEGF and FGF.

Finally MSC’s have been demonstrated to regulate inflammation.  Inflammation is not all bad and is the first step in healing.

July 31, 2011

FDA “Power Play”: Stem Cell Struggle

Stem cells are being used with increasing frequency to treatment many medical conditions.

Unfortunately the FDA has taken the position that the stem cells in your body are prescription drugs subject to regulation and control.  The Centeno-Schultz Clinic believes otherwise as we believe stem cells are body parts to be used by doctors for healing.  Accordingly we have decided to challenge the FDA’s position.  This has turned out to be a landmark case against FDA which will determine the limits of its power for years to come and ultimately decide the pace at which stem cells come into common medical use by physicians.

A local Denver magazine (5280) examined the landmark  nature of our struggle.

“Power Play: A Front Range M.D. has developed a potentially revolutionary treatment for orthopedic injuries. So why is the FDA trying to stop him?”

June 29, 2011

Current Treatment of Chronic Pain is Lacking

Chronic pain is a significant problem which affects one in five patients according to the World Health Organization.

A recent article concludes that despite all the new treatments and improved understanding of the underlying pathology only 50% of the patients treated had a response to treatment and the reduction in pain was only about 30%.

Conclusions:

Narcotics were the most commonly prescribed medication yet were associated with only small improvements in pain and were often misused.  Studies indicated that nearly 50% of long-term users may be misusing their narcotics thereby putting them at risk for overdose and death.

Regarding fusions of the lumbar spine it was noted that “High complication rates and repeat procedures are realities of spinal surgery ”

The Centeno-Schultz Clinic acknowledges the many of the main stream treatment modalities  for chronic pain are ineffective.  The Centeno-Schultz Clinic distinguishes itself by:

Publications in peer-reviewed journals.

Identifies the source of a patient’s pain as opposed to making it with oral narcotics.

Avoids  the use of NSAID’s.

Limits it use of steroids to low dose given their signficant complications including apoptosis.

Utilizes guided injections of regenerative therapies which include prolotherapy, PRP, platelet lysate(Regenexx PL), bone marrow derived and adipose derived stem cell therapy.

December 7, 2010

Adipose Derived Stem Cell Therapy: Regenexx AD

Regenexx has recently added another tool to their regenerative medicine tool box: Adipose derived stem cells.  As discussed in a prior blog, bone marrow derived stem cells are ideal for orthopedic application such as osteochondral defects and areas of degeneration in the knee, hip, ankle and thumb.  Patients have the ability to use their own mesenchymal stem cells through the Regenexx procedure.  Regenexx therapy has been demonstrated to be safe.

Adipose derived stem cells offer structural support to areas of instability.  A case in point is when a patient’s meniscus is reduced in size either through degenerative processes or through a surgical procedure (menisectomy).  The reduction in meniscus size results in laxity of the collateral ligament and a change in the knee alignment. This is depicted in the illustration below.

 The loose collateral ligament and the reduced meniscus size often result in the meniscus being displaced outwardly(being spit out) In this non-anatomical position the meniscus cannot perform its function as a shock absorber thereby exposing the cartilage to excessive forces and potential degeneration.

Prolotherapy is used to treat loose ligaments.  Bone marrow derived cells are placed in areas of cartilage defects or excessive wear. When the meniscus is small and extruded outwardly, adipose derived stem cells are used in a structural capacity.  They are injected through ultrasound or x-ray guidance in such a fashion as to push the meniscus inwardly returning it closer to its true anatomical position.

The Centeno-Schultz Clinic offer patients a number of regenerative therapies including prolotherapy, platelet concentrates, bone marrow and adipose derived stem cells injected under ultrasound or x-ray guidance.

October 7, 2010

PRP Therapy: Critical Differences

Platelet rich plasma (PRP) therapy has gained increasing attention as a non surgical option for musculoskeletal injuries. Platelets are rich in growth factors which mobilize repair cells, promote cell division and accelerate healing.  At the Centeno-Schultz Clinic  PRP has been successful in treatment of elbow, hip, knee and heel  pain( lateral and medial epicondylitis, piriformis syndrome, patellar tendinopathy and Achilles tendinopathy.

 Maximal clinical results  are obtained when  an accurate diagnosis is established, injection of PRP is performed under ultrasound guidance and a labatory prepated PRP is utilized.

 Identifying the source of pain is essential.  Delivery of the platelet concentrate must be directly into the area of damage.  Ultrasound gives direct visualization of the damaged tissue and the where the injected platelets are going.  At the Centeno-Schultz Clinic we have a state of the art laboratory which enables us to prepare a customized platelet concentrate which has a higher number of platelets and less cellular debris than bedside centrifuge units commonly employed by most clinics.

May 22, 2010

Platelet Rich Plasma (PRP) Therapies and Growth Hormone

Platelet rich plasma therapy (PRP) involves the injection of a concentration of platelets  into an area of tissue injury.  Platelets are rich in naturally occurring growth factors which can speed up the healing process.   Blood  obtained from the patient is  spun down (centrifuged) creating a highly concentrated pellet of platelets.

Processing of the blood is done, in most cases, by a bed-side machine or, in the case of Regenexx, by a cell biologist in a state-of-the-art lab.

Injection of the platelet concentrate is performed under ultra-sound or x-ray guidance to ensure accurate placement.

PRP has been used successfully by professional athletes, as well as weekend warriors.

Unfortunately, the recent attention of a Canadian health provider utilizing PRP therapy has led to some confusion over this therapy.

At this Canadian practice, ultra-sound guided PRP therapy was combined with IV infusion of growth hormone and actovegin.  The latter two medications are total -body performance enhancers, whereas PRP is intended to have an effect only on the local tissue into which it is injected (meniscus, ligament, muscle.)

This is not the standard practice.  PRP therapy is not routinely combined with the use of performance-enhancing medications (growth hormone or actovegin).

If in doubt, ask your doctor questions.  How was the PRP made, what is the concentration, route of administration and whether or not other medications (enhancers) are being used.

At the Centeno-Schultz Clinic, PRP therapy is just one of  the many regenerative therapies directed at getting individuals back to pursuing their dream.

February 1, 2010

Is there a Cancer Risk with Stem Cell Therapy?

Mesenchymal stem cells can differentiate into many types of tissue including muscle, bone, cartilage and tendon.

Because mesnechymal stem cells are multipotent, there has been concern that implanted stem cells could form cancer cells.

Studies have demonstrated chromosomal abnormalities in mesenchymal stem cells that have been cultured for extended periods of time.  Other studies have demonstrated that mesnenchymal stem cells expanded  for less than 60 days poses no detectable risk of cell changes or cancer formation.

The critical question is whether mesenchymal stem cells are safe ?

Centeno et. a.l. have shown that they are safe.

Centeno, in a prospective study examined 227 patients and found no evidence of cancer formation at re-implantation site.  This finding is consistent with others who failed to find any evidence of cancer formation in mesenchymal stem cells culture expanded for limited periods.

Landmark study.  Stem cell therapy has a green light!

SAFE TO PROCEED

 

The Regenexx procedure utilizes minimally expanded autologous meenschymal stem cells to treat common orthopedic conditions.  This affords patients a non-surgical option with no extensive rehabilitation or the risks associated with anesthesia and surgery.

December 4, 2009

Safety of Implanted Mesenchymal Stem Cells

Fantastic publication today.

A four year study which examined 227 patient demonstrated no evidence of tumor growth in patients who had mesenchymal stem cells injected for orthopedic applications. Prior to injection, the mesenchymal stem cells has been expanded for a limited time. This differentiates them from those cells used in BMAC (bone marrow aspirate concentrates).  The findings are consistent with other reports which found  no evidence of tumor growth.  What is unique about the current study is the time frame ( 4 years) and number of patients.  Congrats to Dr. Centeno and other team members 🙂

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