Stem Cells and Regenerative Medicine
Stem Cell Therapy
Treatment for most orthopedic conditions starts with a noninvasive, conservative treatment plan. This can include simple methods such as rest, medication, applying ice or physical therapy. Only when these methods fail to relieve symptoms will your doctor suggest surgery. With surgery, there are potential risks and complications such as bleeding, clot formation and damage to adjacent tissues. Stem cell therapy is an advanced nonsurgical treatment that has the potential to heal tissue without the need for surgery.
Stem cells are undifferentiated cells that have the unique ability to differentiate into certain types of tissues and self-renew. Stem cells can be of two types, embryonic stem cells or adult stem cells. Embryonic stem cells can differentiate into any cell of the body and adult stem cells have the ability to differentiate into specific types of cells. The field of orthopedics utilizes adult stem cells found in bone marrow, amniotic fluid, or fat, called mesenchymal stem cells, for treatment of many musculoskeletal diseases that have limited therapeutic options.
The benefits of stem cell treatment over other surgical options include:
- No rejection because the stem cells are taken from your own body
- Promotes natural healing of the damaged tissues.
- Effective alternative therapy to surgery.
- Treats severe injuries and degeneration that cannot be repaired, such as degenerative disc disease.
- Is not associated with the potential risks and complications of surgery.
Stem cell therapy has found its use in many fields of medicine, with particular advantages in orthopedic injuries. Stem cells are found in various areas of the body and are often harvested from bone marrow, fat, or amniotic fluid.
The use of stem cells for treatment of disease is often referred to as regenerative medicine. Stem cells are most often used for their ability to become specialized cells that help regenerate and repair diseased or damaged tissues. Mesenchymal stem cells have the ability to differentiate into bone and cartilage cells and can be used to treat a wide variety of orthopedic conditions. Some examples include:
- Tendon tears
- Ligament tears
- Cartilage damage
Stem cell therapy involves the extraction of stem cells, typically from the bone marrow, fat, or amniotic fluid, and processing of the cells. Once the stem cells are harvested and processed, they can be implanted to the site of damage. This procedure can be done by either using your own stem cells (autologous stem cells) or using stem cells that have been extracted and processed from amniotic fluid (allogenic stem cells).
Amniotic fluid includes a mixture of stem cells and growth factors and may also include the amniotic membrane. These cells have the ability to develop into various tissue types including cartilage, tendons, nerves, muscle, and bone. These cells also have the ability to promote healing through the multiplication of reparative cells.
When amniotic fluid is obtained for regenerative medicine purposes, it is sent to a lab where it is then processed and cryopreserved. Cryopreservation is the process of cooling the fluid to a low enough temperature such that the healing properties of the cells are maintained. This fluid is then sent to your healthcare provider’s office where it may be used for injection.
The injection of amniotic fluid is performed as an outpatient procedure, within the clinic office setting. The area of injection is cleansed, and the fluid is injected into the area damaged or diseased tissue. The injection is routinely given under the guidance of ultrasound to ensure that the needle is inserted accurately. You may be recommended one or multiple injections to provide the greatest amount of healing.
Autologous Stem Cells
Autologous stem cells are stem cells extracted from your own tissue/body. For this procedure, you will be required to go to the hospital for a very brief, outpatient procedure. Local (twilight) anesthesia will be administered in the operating room. The stem cells are then harvested from bone marrow found in the pelvic bone (iliac crest). A narrow needle is inserted into the iliac crest and a sample of bone marrow is extracted. The bone marrow is then centrifuged, and stem cells are separated and obtained.
Once the stem cells have been separated from the other components of the bone marrow, the cells are injected into the diseased or injured region of the body. You will then be awakened from the procedure, and typically discharged home in 1-3 hours.
Potential Effects of Stem Cells:
- Differentiate into tissue specific cells (i.e. cartilage cells or bone cells)
- Encourage tissue regeneration
- Decrease inflammation
- Produce growth factors to enhance the process of healing
Following the treatment, you may experience irritation and mild pain for 24-48 hours. Typically, a day of rest (avoidance of exercise) and cold application to the injection site is all that is needed to reduce mild pain
Risks and Complications
Stem cell injection is usually a safe and non-invasive treatment procedure. However, as with most treatment procedures, stem cell injection is rarely associated with certain complications. The risks and complications that could be associated with these injections include:
- Increased pain at the injection site
- Tissue damage
- Injury to neighboring nerves
Undergoing the procedure under the hands of a skilled medical provider can greatly minimize these risks.
Regenerative Medicine Basics
Regenerative medicine is a scientific and medical discipline which focuses on reining the power of stem cells and the regenerative capacity of the body in order to restore the functioning of damaged cells, tissues and organs. The goal of regenerative medicine is to find the path to cure previously untreated injuries and diseases.
Stem cells are present in all of us acting like a repair system for the body. However, with increased age sometimes we don’t get optimum stem cells to the injured area. Regenerative medicine functions to amplify the natural repair system of the patient’s body.
To obtain the stem cells, your doctor administers a local anesthetic to the back of the hip (Posterior superior iliac spine) and takes a small bone marrow sample through a needle. The sampling procedure is called bone marrow aspirate, which is different from bone marrow biopsy and is less painful. Blood is also taken from a vein of the patient’s arm. These sample cells are processed and then re-injected into the area where repair of the damaged tissue is required. Imaging guidance such as real time fluoroscopy or musculoskeletal ultrasound is used along with MRI to plan the location of the injection.
Mesenchymal stem cells (MSCs) are multipotent cells derived from non-marrow tissues, such as umbilical cord blood, adipose tissue, adult muscle or dental pulp of deciduous baby teeth. The isolated MSCs are also injected on the same day, along with natural growth factors obtained from the blood platelets of the patient. The main objective is to deliver a much greater number of stem cells to the injured area to restore its function.
Researchers are employing different approaches for creating new pluripotent stem cell lines, such as in vitro fertilization embryos, nuclear transfer, and induced pluripotent stem (iPS). Different government and private organizations are committed to developing new stem cell-based therapies for chronic, debilitating diseases.
Pluripotent stem cells hold the greatest potential to treat a wide range of diseases but to create new stem cell therapies takes a long time. Before testing pluripotent stem cells in human disease, researchers must grow the right cell type, ie. differentiation of stem cells, and then their safety is first tested in animals before moving to human trials.
Regenerative medicine has a great potential to cure injured and impaired tissues. Scientists all over the world are researching ways to rein stem cells and use them for diagnosing and treating various disease conditions.
Some risks factors are associated with regenerative medicine and include immune reactions from injected stem cells and also cells may become contaminated with bacteria, viruses or other pathogens that may cause disease. The procedure to either remove or inject the cells also has the risk of introducing an infection to the damaged tissue into which they are injected.
In some cases, certain complications such as formation of tumors can be seen as a result of unproven stem cell treatment.
Publications on Regenerative Medicine
- The effect of platelet-rich plasma in patients with early hip osteoarthritis: a pilot study
- Platelet-Rich Plasma Versus Surgery for the Management of Recalcitrant Greater Trochanteric Pain Syndrome: A Systematic Review
- Intraosseous infiltrations of Platelet-Rich Plasma for severe hip osteoarthritis: A pilot study
- Combining Platelet-Rich Plasma Instillation With Core Decompression Improves Functional Outcome and Delays Progression in Early-Stage Avascular Necrosis of Femoral Head: a 4.5- to 6-Year Prospective Randomized Comparative Study
- Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials