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.

Is Knee Arthroscopy Effective ?

Knee arthroscopy is a common orthopedic procedure.  It is estimated that 1 million arthroscopic knee surgeries are performed annually in this country.

Knee arthroscopy involves making a small incision into the knee-joint through which a small camera and surgical tools are inserted.

Various parts of the knee are visualized which include the meniscus, the cartilage and supporting ligaments.  When damage is noted the area can be debrided:  rough surfaces are made smooth.

This is a significant advancement from the open surgeries performed in the 1980’s.

Is knee arthroscopy effective?

A recent article in the New England Journal of Medicine demonstrated that knee arthroscopy for osteoarthritis  provided no additional benefit to optimized physical and medical therapy.

A non surgical alternative to treat common orthopedic conditions is the use of your own mesenchymal  stem cells. The  Regenexx procedure allows patients to use their own mesenchymal stem cells to treat many knee, hip and shoulder conditions.

Regenerative Sciences Heads to South America

Regenerative Sciences, a Colorado based autologous mesenchymal stem cell therapy clinic focused on orthopedic applications, signed a licensing agreement with industry leader Stematix to bring the Regenexx procedure to various parts of South america.  From the press release:

David C. Bonner, Ph.D., Chairman and CEO of Stematix, said, “We at Stematix are excited to be working with Regenexx, the leaders in applied regenerative medicine for orthopedic. We anticipate that this cutting edge, proven treatment will provide needed care for many patients in clinics established in Latin America. We are working toward a first clinic in Argentina during 2010. The expertise and experience of Dr. Centeno and Dr. Schulz will be invaluable in establishing our clinic in Argentina, and we look forward to incorporating advances in the treatment methodology that the Regenexx clinic in Denver will lead. “

Stem Cell Therapy for Lumbar Disc Protrusions

Lumbar disc protrusions can cause lower back and leg pain which can vary from mild to severe.

Today in clinic, I had the opportunity to followup with a patient who underwent autologous stem cell therapy using the Regenexx procedure.  He has kindly allowed me to share his experience. Patient is a 37-year-old male with longstanding lower back and leg pain.  The back pain was sharp in character, constant in duration, progressive in nature and aggravated by coughing, sneezing and flexion.  He would experience episodic pain which would incapacitate him.  Physical examination was significant for lower back pain aggravated by flexion, extension and straight leg raise.

Micro-discectomy and other surgical treatments were dismissed by the patient and his family.

 4 weeks after having his own stem cells injected into the L5/S1 disc along with platelet derived growth factors, the patient had significant reduction in his back and leg pain.  MRI prior to and after stem cell therapy was significant for a reduction in the L5/S1 protrusion which is illustrated below.

 

 

 

 

 

 

 

 

 

 

 

Cryostorage: Freezing Your Stem Cells

Storage of adult autologous stem cells is appropriate when there is an interruption in therapy or the total number of cells available exceeds the number appropriate for a given application.

Freezing the cells in cryostorage is the standard.

International Cellular Medicine Society has established laboratory guidelines that address this specific and critical issue.  When freezing adult autologous stem cells it is important to prevent formation of large crystals in the cells which cause disruption of cell structure and possible cell death.  To avoid possible damage to cells, two precautions are taken:  the use of cyroprotective agents such as DMSO or glycerol and controlled rate of freezing.

Regenerative Sciences, which pioneered the Regenexx procedure has adopted the ICMS laboratory and clinical guidelines.  The quality of adult autologus mesenchymal stem cell therapy has now been elevated.

Training Camp for Stem Cells

When teams from sea level play our Broncos they come early so as to acclimate.  Denver is the mile high city.

Travlers headed to Machu Picchu stop at Cusco to acclimate.

So to with stem cells.  Degenerative joints, knees and lumbar discs are tough environments.  They have poor blood flow, low oxygen content and limited nutrients. 

Stem cells need to be prepared for such a task:  pre-conditioning is essential for maximal results.

Rosova et. al. demonstrated that when mesenchymal stem cells are pre-conditioned in low oxygen environments their tissue regenerative potential is improved.

Regenexx  employs this technique to ensure the best clinical results in patients who are undergoing autologous mesenchymal stem cell therapy for orthopedic conditions.

Origins of the Regenexx Procedure

Continued frustration and disappointment over the persistent failure of many surgical procedure to improve the pain and level of function of our patients led to the quest for an alternative.

Sakai was our first inspiration.  He recognized that disc degeneration was a relentlessly progressive phenomenon with no currently available effective treatment.  Working with rabbits, Sakai transplanted  mesenchymal stem cells into degenerative disc  to determine if stem cells were capable of repairing degenerated discs.  While mesenchymal stem cells are available from many sources, Sakai obtained cells from bone marrow.  The Regenexx procedure also uses bone marrow derived stem cells.

At 24 weeks, utilizing MRI and another methods, Sakai demonstrated that transplantation of mesenchymal stem cellss effectively led to regeneration of degenerative discs.

And the quest began……..

Stem Cell Therapy for Pulmonary Hypertension

Pulmonary hypertension is serious life threatening condition characterized by an increase in blood pressure in the pulmonary artery or vein.  It is can result in shortness of breath, dizziness and fainting.  In severe cases,  patients have severely decreased exercise tolerance and heart failure.

Treatment options to date have included a large number of medication’s including calcium channel blockers, prostaglandins, endothelin receptor anatagonists and phosphodiesterase inhibitors.  Median survival rate in patients untreated is 2-3 years from time of diagnosis.  Unfortunately for those patients who have failed conventional therapy, there has been no  treatment options until recently.

Dr. Grekos reported significant clinical success utilizing adult stem cell therapy in treating pulmonary hypertension.  Dr. Grekos notes:  This is the first time medical science has successfully reversed the disease process in pulmonary hypertension, a previously untreatable condition with a very grim prognosis,”

Unfortunately such therapy may not be available if the FDA continues to exert its jurisdiction.  The FDA contends that a patient’s own stem cells are a biologic drug over which they have jurisdiction.  A physician based organization has been formed which established both clinical and laboratory guidelines for the safe use of adult stem cell therapy: stemcelldocs.org

fdaregulationofstemcells.FDA.Regenexx.ASCTA.Stemcelltherapy

Adult vs Embryonic Stem Cell Therapy

Due to a number of factors including the political climate from 200-2008, adult stem cell research has made great strides in comparison to  embryonic stem cell research.    For example, the total number of research articles listed in the National Library of Medicine for adult stem cell types  exceeds 3,000 whereas Embryonic are only approximately 1,000.

 If we compare the National Library of Medicine searches for the following items:

• Cartilage Repair: 230 articles on embryonic vs. 1,113 for just one adult stem cell line(mesenchymal stem cells)
• Myocardial Infarction:  186 for embryonic stem cells vs.  341 for adult mesenchymal stem cells, 69 for Endothelial Progenitor Cells
• Wound Healing: 114 for embryonic stem cells vs.  330 for mesenchymal stem cells, 565 for adult epithelial stem cells

To delve further, the first 20 references for myocardial infarction for adult stem cells are almost all devoted to actual animal models of treatment and advanced concepts such as dosing.   Almost none of the 20 references in the same search for embryonic stem cells reveal any animal testing; the focus being review articles about what might be theoretically possible. 

 The conclusion, adult stem cells are much farther along in their development with regard to real world treatments.

Adult Stem Cell Therapy for Chest Pain

One million patients in the United States suffer from angina:  chest pain due to blockage of the arteries in the heart.   Thirty-three percent of these patients are not afforded any benefit from traditional therapy such bypass surgery, oral medications or insertion of stents in the blocked vessels. 

Adult, autologous stem cell therapy has recently been demonstrated to be of benefit to these patients.  At Northwest University, 167 patients with severe angina underwent a prospective, randomized study in which autologous, adult stem cells were injected into the heart muscle.  Six months after the procedure, those patients who had received autologous stem cell therapy had significantly improved exercise tolerance.  These are the same patients who were not candidates for conventional therapy.

 If you are a patient and disagree with their proposed restriction of your healthcare, please visit: www.safestemcells.org.