Musculoskeletal Care of the Mature Patient

 FROM THE INTERNATIONAL CELLULAR MEDICINE WORKSHOP

Warning: stem cells are not FDA approved for use in orthopedic surgery unless the application is in conjunction with a surgical procedure. Strictly forbidden are staged expansion and any form of “pushing”. Be aware that experimentation is not necessarily research.

What are stem cells?

Stem cells help to create new cells in existing healthy tissues, and may help repair tissues in areas that are injured or damaged. They are the basis for the specific cell types that make up each organ in the body. 

Stem cells are distinguished from other cells by a few important characteristics: they have the ability to self-renew; they have the ability to divide for a long period of time; and, under certain conditions, they can be induced to differentiate into specialized cells with distinct functions (phenotypes) including, but not limited to, cardiac cells, liver cells, fat cells, bone cells, cartilage cells, nerve cells, and connective tissue cells. The ability of cells to differentiate into a variety of other cells is termed multipotency.

 The delivery of stem cells may have a therapeutic benefit by accelerating the repair of injured tissue or by slowing the degenerative process that occurs in OA. The goal is biologic repair rather than a prosthetic implant.

While it is true that stem cells are multipotent, in order to make them functional, there has to be harvesting, then separation from other cell lines, next comes specific organ or tissue activation followed by return to the patient. 

Stem cells in Platelet Rich Plasma

It is the nucleated cell portion where the stem cells live. While platelets have growth factors, mesenchymal stem cells from centrifuged platelets with immediate reinfusion are too few in number and underperform

Stem Cells from Adipose Tissue

Adult mesenchymal stem cells are exceedingly numerous here, so much so that they need not be expanded but they still need to be pushed (activated) in order to differentiate into stromal tissue and secrete growth factors while promoting angiogenesis. 

Stem cells from Bone marrow

The bone marrow needs to be recovered by needle aspiration, concentrated, expanded and pushed before reinfusion to a joint at some later time. It is a two step process and apparently adversely affected by many commonly used pharmaceuticals. 

 Stem cells from Aphoresis (hematopoietic stem cells)

Whole blood is collected from a vein and placed in a centrifuge. The mononuclear cells where the stem cells reside are filtered out. Everything else is returned to the patient. It takes four hours for the collection of whole blood and that whole blood is re-administered at about the same time. It is a process preceded by agents that mobilize bone marrow and infusion or freezing of the stem cell must take place in 48hours

 To be continued

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