I receive a continuous flow of questions from patients pertaining to Regenerative Medicine; fundamentally, the majority have to do with FDA approval, safety, and efficacy? In general, my response may be summarized under two bullets:
1) An understanding of the term “off label”
2) The difference between the biologic and the kit used for preparation
It is important to differentiate between a drug and the use of cells or tissues, the latter having been taken from your body. I will focus on Human Cells, Tissues, and Cellular-Based Tissue Products (HCT/P’s). Within the standard of the Practice of Medicine, as long as your cells and tissues are processed by FDA-approved techniques including preparation and the preparation kits, your cells and tissues may be used to relieve the pain and limited function caused by osteoarthritis. At times, grafts from donor sources may be used as long as they do not contain living cells.
The dilemma in the decision as to which biologic might be indicated is dependent on whether the problem is Osteoarthritis without inflammation; Osteoarthritis with inflammation; or a combination of Osteoarthritis with structural defects be those defects occurring in the articular cartilage, in the supporting bone (subchondral) or the menisci. In general, Platelet Rich Plasma (PRP) works through Growth Factors, proteins that are anti-inflammatory. Bone Marrow Aspirate Concentrate contains Mesenchymal Stem Cells that regulate via nano proteins called exosomes, additionally performing an anti-inflammatory function but with regenerative attributes as well.
Let’s switch to something more mundane, the first time you visit a physician for a painful joint, more likely than not, the recommendation will be a “cortisone” injection. In general, one or two steroid injections will do no harm; it is the preservative that harms cartilage cells. Triamcinolone is a corticosteroid that prevents the release of substances that cause inflammation and will benefit without harm. Should you receive a recommendation for a PRP injection into a joint, Leukocyte Poor is best for a joint while Leukocyte Rich is better for soft tissue.
Finally, what is the best treatment for the osteoarthritic joint? OA is multifactorial so the treatment of the process, not only the symptoms, is based on the understanding of causation:
1) Bone driven (subchondral lesions)
2) Metabolic (gout is the most common form)
3) Trauma (mechanical disruption of the bone supporting the cartilage or of the cartilage)
4) Cartilage (structural defects, meniscal tears)
5) Inflammatory (Rheumatoid Arthritis, Psoriatic Arthritis)
Now that I raised more questions than I answered, visit my website at www.sheinkopmd.com and schedule an office consultation by calling (312) 475-1893.