Stemcelldoc's Weblog

July 21, 2009

Origins of the Regenexx Procedure

pulling-hair-out

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……..

July 15, 2009

Colorado Stem Cell Therapy Makes News

Colorado based Regenerative Sciences was the focus of a recent New York City news segment.  Dr. Max Gomex discussed the Regenexx procedure where a patient uses their own stem cells to heal a variety of orthopedic conditions.  Examples outlined included non-surgical therapies for rotator cuffs tears, mensical tear, loss of cartilage in the knee and hip as well as degenerative lumbar discs.  Dr. Gomex also discussed the opportunity to bank stem cells for future use.

New treatment opportunites now exist in the Rocky Mountains…..lostlake colorado

April 22, 2009

Age Management Medicine Enters Stem Cell Therapy Discussion

Filed under: Uncategorized — Tags: , , — stemcelldoc @ 9:18 am

The adult stem cell debate about the FDA trying to classify the patient’s stem cells as drugs is heating up.  Interesting article this morning from a physician proferssional organization on Regenexx, the FDA, and Adult Stem Cell Clinical and Lab Guidelines.  I think the article says it all.

Age management is a new field that many doctors have embraced.  This AMMG professional group recognizes that physicians should work directly with patients on using their own stem cells as therapies and should produce professional guidelines to allow the safe use of these therapies.

FDA. FDAregulation.FDAregulationofstemcells.autologousstemcelltherapy.Regenexx
FDA.FDAregulatio

March 10, 2009

Trendelenburg Test

trendelenburg-test1

Positive Trendelenburg Test with Weakness of Left Gluteal Muscles

The Trendelenburg test is a simple maneuver to evaluate the strength of the gluteus medius and gluteus minimus muscle.  It is performed by having the patient stand unassisted on one leg while the other leg is raised off the ground.  The examiner places their fingers on the posterior ilaic spine.  If there is a significant drop of the hip on the side of the raised leg,  their is weakness in the gluteus medius and minimus muscle.gluteal-muscles

The gluteus medius and mimus muscle are responsible for rotating the hip inward and extending it outward(abduction). 

They are critical in stabilizing the trunk and  keeping it in an upright position when one’s foot is raised while walking.

If there is weakness in the glueus medius and minimus there is structural instability with disproportionate forces placed on the hip and knee.  These forces can ultimately result in excessive wear of the joint cartilage and pain. knee-cartilage-22Often times surgery is the recommended therapy.

At the Centeno-Schultz Clinic we emphasis structural integrity.  If a patient has a positive Trendelenburg, they will be scheduled for therapy to restore gluteal strength which  typically is in the form of intramuscular stimulation(IMS).  If there has been hip or cartilage damage, a novel technique using your own stem cells can used to assist in the regeneration the cartilage.

March 2, 2009

Biceps Tendon Repair

The biceps muscle is what gave Popeye his notoriety.

Flexing His Biceps

Flexing His Biceps

The biceps muscle consists of two separate heads:  the short head which originates from the coracoid process and the long head which originates  the cartilaginous socket referred to as the labrum.

Attachment of short head of the biceps muscle

Attachment of long head of the biceps muscle

The muscle inserts onto the radius, one of the bones in the forearm.  Tendons attach muscle to bone.

Two Heads of Bicep Muscle

Two Heads of Bicep Muscle

The biceps functions to stabilize the shoulder,  flex the elbow and rotate the forearm.  The long head of the biceps tendon is vulnerable to injury because it travels through the shoulder joint to its attachment point at the labrum.  Tears of biceps tendon can be either partial or complete.

Symptoms commonly associated with a torn biceps tendon include sudden sharp pain, an audible snap, weakness and tenderness along anterior shoulder.

Treatment options often include surgery where the biceps tendon is reinforced with sutures and anchored to the bone.

At the Centeno-Schultz Clinc we have successfully injected the biceps tendon where it is attached into the shoulder joint.  A novel alternative to biceps tendon surgery is the injection of stem cells into the area of damage.   The stem cells have the potential or repairing and regenerating the torn tendon.   Regenexx is a simple needle-in, needle-out procedure which allows the patient to avoid the risks of surgery, anesthesia and the extensive time and expense associated with post surgery physical therapy.

bicepstendentear.bicepstendintear.stemmcelltherapy.bicepstondentears.Regennex

February 19, 2009

Mesenchymal Stem Cells

There are various types of adult stem cells. The type of adult stem cells which are associated with tissue repair are called mesenchymal stem cell (MSC). These specific stem cells are capable of repairing damaged tendons, ligaments, intervertebral disc and fractured bones. There are two major sources of mesenchymal stem cells:  bone marrow derived and adipose (fat) derived.  Bone marrow stem cells are obtained via a needle which is inserted into iliac crest.  Adipose stem cells are typically collected during a liposuction.

Why is this important?  Bone marrow derived mesnechymal stem cells has been demonstrated to be superior in their ability to repair cartilage, tendon and ligament when compared to adipose derived cells.  Bunnell demonstrated  that  adipose stem cells are biologically similar, although not identical, to mesenchymal stem cells derived from the bone marrow. Vidal demonstrated that equine bone marrow derived mesenchymal stem cells have far greater regenerative properties for damaged cartilage than adipose derived cells.  Kisiday also demonstrated  that bone marrow derived mesenchymal stem cells have superior ability to repair and change into cartilage.

If you have an orthopedic condition and elect to use stem cell therapy, bone marrow derived stem cells offer the best success.  Regenexx exclusively utilizes autologous bone marrow derived mesenchymal stem cells  for damaged  ligaments, tendon, and cartilage.

February 15, 2009

Stem Cell Accountability

Human nature being what it is, there has been an unfortunate increase in the number stem cell therapies which are available and proclaim success  for a large number of disorders.  This has occurred domestically as well as internationally with hybrids  which recruit the patients here in the Unites States only to ship off the cells overseas.

In response, the International Society Stem Cell Researchers (ISSCR) has created a comprehensive set of guidelines for  stem cell therapy.  Patients and their physicians must be aware of these guidelines.  I will summarize two of the guidelines and comment how Regenexx has addressed the standard.

1)  Stem cells from other people (allogenic) are more risky and require closer monitoring.  Research would suggest that stem cells from a donor  may carry a  genetic disease transmission risk.  What does this mean?  Stem cells from one patient when used in another patient may transmit serious diseases.  In the animal model for example when a young mouse is injected with stem cells from a mouse with known osteoporosis, the younger mouse develops osteoporosis.   Regenexx acknowledges this significant risk and therefore only uses a patients own stem cells.  These  cells are referred to as autologous.

2)The use of animal components to grow stem cells must by replaced human components.  Stem cells are commonly cultured in Fetal Calf Serum (FCS).  There are multiple concerns with this practice including transmission  of infectious processes such as mad cow disease.  Fetal Calf Serum is not appropriate for human use.  Regenexx uses  a patient’s own blood to grown and expand their stem cells.  Regenexx has not and never will use fetal calf serum.

February 14, 2009

Adult Stem Cells

What are adult stem cells? They are cells within our body that can renew themselves and turn into other cells (differentiate).   Conceptually they can be thought of as the repairmen of the body. They live inside us in various tissues, poised to leap into action to repair damage as it occurs.  The problem is that as we age or get larger injuries,  our bodies are unable to recruit sufficient number of stem cells to fully  repair the area of damage.

There are many different types of adult stem cells but the most common are called hematopoetic stem cells.  What does this mean.  These are adult stem cells that will change (differentiate) into blood (hematopoetic)  products such as red blood cells or platelet.  Hematopoetic stem cells are easy to obtain from a peripheral blood or from bone marrow.  They are very plentiful in both blood and bone marrow. Unfortunately many ” stem cell therapies” are employing these hematopoetic stem cells due to the abundance and ease to access.  Such is the case with bone marrow aspirate concentrates which are bedside units that concentrate cells obtained from one’s bone marrow. 

Bone Marrow Aspirate Concentrate Unit

Bone Marrow Aspirate Concentrate Unit

 Unfortunately for patients, despite the advertised claims, these cells can only differentiate into blood products.

Stem cells associated with regeneration of damaged tendon, ligament, bone or disc are termed mesenchymal stem cell (MSC). 

Mesenchymal Stem Cell

Mesenchymal Stem Cell

 MSC’s can not be harvested from blood nor can they be obtained in clinically significant numbers from bedside bone marrow aspirate concentrates.  Herein lies the critical difference between current therapy and RegenexxRegenexx isolates MSC’s and then expands them so that you as a patient have the critical number of MSC’s to repair damaged tissue.  Regnexx uses your own stem cells and expands them for a variety of orthopedic aplications.

February 11, 2009

Criticial Differences in Bone Marrow Derived Stem Cell Therapies

The bone marrow is rich in stem cells.  These cells are typcially obtained by a technique referred to as a  bone marrow aspirate where a needle is placed into  the iliac crest and cells are withdrawn through a syringe.  iliac_crest_model

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Bone Marrow Aspirate Concentrate Unit

Withdrawing cells in this fashion is called aspiration.  Bone marrow aspiration is a common practice for obtaining stem cells.  A popular technique is to take the bone marrow aspirate ( the cells obained from the bone marrow aspiration)  and spin it down in a centrifuge thereby creating a concentrate of bone marrow nucleated cells.  This technique is called BMAC:  Bone Marrow Aspirate Concentration.   The concentrated bone marrow aspirate contains stem cells and has been termed and advertised as ‘stem cell concentrate.”   There are several units commercially-available.

 There are many different types of stem cells in bone marrow. Stem cells that are crticial for regeneration of cartilage, tendon and ligament are very specific and are called mesenchymal stem cells.msc-srtem-cell2

A crtical question which has recently been studied is what is the concentration of  mesenchymal stem cells from commerically available  units.  Equally important, is the question of whether or not the concentration of stem cells from BMAC can made a difference clinically.XXXX demonstrated that bedside bone marrow concentrate machines utilizing a 60cc bone marrow aspirate can produce between 70,000-90,000 mesenchymal stem cells.  What does this mean?  Animal research and data collected at Regenexx suggests that millions of  mesenchyml stem cells are required to repair cartilage, tendon and muscle injuries.  Furthermore unlike the BMAC units, Regenexx expands the number of mesenchymal stems stem to approximately 100-1,000 times the number obtained from BMAC.  So in considering stem cell therapy it is essential to understand both the type and absolute number of stem cells injected since both will play a critical role in the success of a procedure.

bonemarruwaspirate.stemmcell.Harvest BMAC.

January 28, 2009

MRI Images Showing Torn Rotator Cuff

The rotator cuff comprises 4 principal muscles that stablize and support the shoulder joint:  the  supraspinatus, infraspinatus, teres minor and subscapularis.  Tendons are fibrous tissue that connect muscle to bone.  Tears in the rotator cuff can be within the muscle itself or at the site where the tendon attaches to the bone.  There are different types of rotator cuff tears:  parital  tears where only a portion of the muscle or tendon is torn or full thickness tears wheree the tear extends throughout the entire muscle or tendon.  If the injury involves a complete tear through the muscle ot tendon then it is called  a rupture.

The  normal MRI on the left demonstrates the supraspinatus muscle as it attaches on the humerus.  On the right, the same mucle is torn (dark signal).mri-of-torn-rotater-cuff1 The MRI below also shows a tear in the rotator cuff as noted in the dark signal in the muscle( white arrow).

 

shoulder_mri_cuff-i

New treatment options for rotator cuff tears include regeneration of the damaged muscle or tendon using stem cell therapy.  Regenexx enables patients the ability to use their own stem cells to heal tears in the rotator cuff.  Regenexx is a simple needle-in, needle-out procedure that enables the patient to avoid surgery, anesthesia and the extensive physical therapy commonly associated with surgical repair.

Please review the MRI below in which a patient had a tear in their rotator cuff.  They underwent stem cell therapy at Regenexx with healing of the tear, 100% resolution of pain and return to normal function.

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