Dec 19, 2016
I use bone marrow derived stem cells because they have been proven to be most effective at treating orthopedic conditions when compared to adipose derived stem cells. There have been 13 papers published showing bone marrow superiority to adipose tissue in regards to treating orthopedic conditions and to the best of my knowledge, none reporting adipose derived results for arthritis. In addition to Adult Mesenchymal Stem Cells, bone marrow has 1,000-10,000x more hematopoietic stem cells than adipose tissue; the former is necessary for muscle repair. Recently, we learned that bone marrow also has osteochondral reticular cells which are not found in adipose tissue and serve as orthopedic repair cells. While adipose tissue and bone marrow both have stem cells, the skeletomuscular specific cells only found in bone marrow make it the best at treating orthopedic conditions. I don’t have a stake in doing bone marrow derived stem cells, I practice evidence based medicine and do what’s been shown to provide the best results. If with continued research something superior to bone marrow derived stem cells becomes available, then I will gladly adopt that protocol.
http://www.regenexx.com/fat-vs-bone-marrow-stem-cell-video/
- As I have reported on this Blog many times, research has shown the amniotic fluid samples being marketed as having stem cells actually do not have any viable stem cells when received and viewed in the laboratory. I do use amniotic fluid concentrate from time to time for its concentrated hyaluronic acid effect.
http://www.regenexx.com/amniotic-stem-cells-great-deception/
- Since we manually process bone marrow when aspirated, I am able to customize PRP which we call SCP or super concentrated platelets. The ubiquitous beside centrifuge only has one setting for volume and concentration so those using this approach are treating every patient without concern for individual differences. With the addition of the Abbott Ruby Hemocytometer, I am able to customize the treatment of the individual patient. We can concentrate our SCP from 3-40X over baseline-with or without red or white blood cells. From my outcomes data base, I know what volume and concentration works best for treating the various body parts.
- We’ve developed HD BMC or high dose bone marrow concentrate which is far superior to that produced with bedside centrifuges used by most claiming expertise in Regenerative Medicine
- I perform BMAs in compliance with the peer-reviewed literature recommendations as well as in keeping with my internal best practices research to maximize MSC yield. As stated, I count cells and know the quality in addition to the quantity of the injectate. Most doctors don’t count cells and have no idea what dose they are giving their patients
Tags: adipose tissue, amniotic fluid, arthritis, BMA, bone marrow, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Interventional Orthopedics, Mesenchymal Stem Cell, MSC, PRP, Regenerative, SCP, stem cells
Dec 9, 2016
I started the day by reading the Steve Chapman article appearing in the Perspective Section of the Chicago Tribune, Thursday December 8. The title of my Blog this week is influenced by the header of his article and I admit I am paraphrasing some of that content. While his intent was not necessarily directed at the discipline of Regenerative Medicine, his statement” since the advent of the internet, truth doesn’t have a chance” really resonates with me. He goes on to state that in many of these internet claims, the idea of objective reality is obliterated. “The chief product is fiction masquerading as fact.”
Unfortunately, while Chapman was rendering his opinion in the political arena, what he opines is just as applicable in the world of Regenerative; but there are exceptions. As many readers of this Blog are aware, I have an existing web site www.sheinkopmd.com. I have tried to continually emphasize and repeat the Regenexx message; namely, that which we do is based on data, the integration of a clinical practice with a clinical research initiative. Yesterday, we forwarded our two-year outcomes data to Regenexx for statistical analysis. That data has been compiled in a clinical knee trial over the past four years wherein the Regenexx SD procedure was used in 50 patients with grades two and three osteoarthritis of the knee who met the inclusion criteria. Once statistically analyzed, I will submit that data for scientific publication, scientific presentation and it will be published on the Regenexx and my web sites.
To emphasize why it is so important for a patient experiencing arthritic related limitations be fully educated, let me share with you a relevant research letter recently published:
Survey: Many treatments prescribed despite little evidence of high value to patients.
Information from a research letter published in the Dec. 6 issue of the journal Annals of Surgery wherein researchers randomly surveyed 5,000 members of the American College of Physicians found that many prescribe costly treatments despite a lack of evidence supporting their use.
In surveying the internet this morning to see how badly fiction is masquerading as fact, I didn’t have to surf too far. The number of camp follower, non-specialist stem cell related web sites are of great concern. I hope the FDA shares my opinion. You can find treatment for arthritis, cancer, aesthetics, hair loss, sexual enhancement, and neurologic diseases all with one stop shopping. The web sites offer adipose derived stem cells and amniotic fluid containing stem cells. Missing from the offerings are outcomes data, scientific support and FDA compliance. Regenexx does it and so do I; namely, practice cellular orthopedics on a scientific basis under IRB oversite (a function of the FDA) with all intervention recommendations supported by scientific evidence.
To learn more, schedule an appointment 312 475 1893. You may view my webinar at ilcellulartherapy.com
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Platelet Rich Plasma, Regenerative, regenerative medicine
Nov 21, 2016
The current marketing of amniotic fluid as a regenerative approach to arthritis based on delivery of
viable stem cells falls is no different than the bending of the truth behavior we recently experienced
in the run up to the presidential election. Did the campaigns of the candidates reinforce some
notion that facts don’t necessarily matter? It seems that every office session, a patient shares with
me their having accepted a free lunch in exchange for the promise that for $7,000 to $9,000,
Amniotic Fluid containing living stem cells may be injected into an arthritic joint to regenerate that
joint.
During my entire 40-year plus orthopedic surgical and now regenerative medicine career, I never
accepted a free lunch from the army of pharmaceutical and orthopedic sales personnel who show
up daily as these gifts are contrary to corporate compliance requirements; and obligate me to listen
to sales pitches, Medical decisions must be based on evidence based medicine. At this time, there is
no scientific evidence of living stem cells in amniotic fluid once that fluid has been harvested,
sterilized, fast frozen for storage and fast thawed when used.
Before going any further, I will make it clear that, when indicated, I use amniotic fluid in my practice; but I also will make it clear, not as a source of stem cells or regeneration. Amniotic Fluid contains 15
times more hyaluronic acid than any available drug; hyaluronic acid is marketed under many trade
names starting with SynVisc. When I believe a patient with an arthritic joint might benefit from
hyaluronic acid, the best methodology is amniotic fluid. As well, the latter may contain viable
growth factors that play a role in controlling the limitations imposed by arthritis. At issue is the
question as to whether it is worth $7,000 to $9,000 for “generic” hyaluronic acid; when in fact, in a
proprietary form is covered by health insurance and Medicare?
There is another alternative if you are interested in Amniotic Fluid as a source of Hyaluronic Acid
and Growth Factors for which there is no charge to you if you meet the clinical trial inclusion
criteria. I am the principal investigator in a national amniotic fluid clinical trial underwritten by a
large pharmaceutical company that started working with amniotic fluid in 2006. Their focus now is
the use of amniotic fluid in the arthritic knee and determining dose and the duration of efficacy.
Facts do matter and the company is willing to underwrite the costs for gathering medical evidence.
To learn if you meet inclusion criteria, make an appointment at 312 475 1893
Tags: amniotic fluid, arthritis, bone marrow, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Growth Factors, hyaluronic acid, Knee, Orthopedic Surgeon, stem cells
Nov 16, 2016
This week, I am repeating stem cell/growth factor interventions in two patients; one with arthritis of the
hip, and the other with osteoarthritis of both knees. Four years ago, at the initiation of my interventional
orthopedic practice, I spoke of adult mesenchymal stem cells alone but now we know that Bone Marrow
Concentrate has in addition to the adult mesenchymal stem cells, hematopoietic stem cells, growth
factors and platelets all playing a role in managing the symptoms and the altered functional impairment
attributable to osteoarthritis. The outgrowth is in new speak; namely, Bone Marrow Concentrate and not
just mesenchymal stem cells. When the two patients I alluded to were initially cared for, we had not yet
gained the understanding of the importance of platelets in the regenerative process. Platelets contain
the growth factors and those growth factors are responsible, in addition to Mesenchymal and
Hematopoietic Stem Cells, for regulating cartilage well-being. By having become aware of the
contribution following concentrated platelet rich plasma in conjunction with the bone marrow
concentrate intervention, I believe we are already seeing improved outcomes.
As well, subchondroplasty has been added to our menu of services and the latter is proving very
beneficial in the knee. To refresh your knowledge base, subchondroplasty is a procedure popularized in France where in bone marrow concentrate is injected into the bone marrow adjacent to a joint at the
same time that the stem cell, growth factors and platelet containing concentrate is intervention of the
joint itself is being completed. The value of intervening into the bone supporting the joint is the fact that
there is communication between the joint itself and the supportive subchondral environment. I have
addressed Adult Mesenchymal Stem Cells many times in previous Blogs as the orchestrater of the
healing process. Now we know that Hemopoietic Stem Cells from the marrow contribute as well. Growth
Factors such as Interlukin-1 Receptor Antagonist Protein (IRAP) are present in bone marrow and
circulating blood; It was IRAP alone that extended the professional basketball career of Kobe Bryant by
seven years for an arthritic knee. With an improved means of extracting and activating the growth
factors contained in platelets, the two patients I introduced in the opening sentences of this blog should
enjoy a very satisfactory return to function and recreation.
Interventional Orthopedics is a dynamic process and I continue to learn from the integration of clinical
research and my clinical practice. On Thursday, I will host two very interested scientists dedicated to
customizing biologic preparations and together we will explore how to further leverage scientific
advancements in creating autologous biologic preparations thereby optimizing the practice of
Regenerative Medicine.
Call 312 475 1893 to schedule your consultation
Tags: arthritis, bone marrow, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Growth Factors, Hematopoietic Stem Cells, Interlukin-1 Receptor Antagonist Protein, IRAP, joint replacement, Osteoarthritis, Platelet Rich Plasma, PRP, Regenerative Pain Center
Nov 10, 2016
I am receiving increased requests for my Outcomes Data following a Bone Marrow Concentrate intervention for osteoarthritis of the hip. There is a paucity of said outcomes data in the scientific literature in part because of the relatively recent introduction of Regenerative Medicine for Osteoarthritis. I believe equally important is the fact that I was one of the first orthopedic surgeons to embrace the practice and remain one of the few in the subspecialty who practices evidence based medicine through the integration of clinical research with a clinical practice. Perhaps the recent presidential campaign, where honesty took a beating across the US, is responsible for the heightened patient awareness of the charlatans victimizing the public when it comes to Regenerative Medicine.
There is no question that there is value in facts and that is why my cellular orthopedic initiative is evidence based. Earlier this week, owing to these patient inquiries about my particular data base results when it comes to stem cells and growth factor for the hip, I reviewed my data base. There are now just over 150 patients with osteoarthritis of the hip who have undergone a Bone Marrow Concentrate intervention of the hip. The introduction of those bone marrow derived Mesenchymal Stem Cells and Growth factors has the potential to relieve pain, improve function, increase motion, regenerate the cartilage, alter the natural history of the arthritic joint, and delay, perhaps help avoid a hip replacement.
In order to qualify for submission to an orthopedic journal or scientific meeting, orthopedic data must be statistically significant with greater than a two-year follow-up. Our numbers will reach those criteria by January 1, so I thought I would present the preliminary data in this Blog format.
Of the 150 arthritic hips with grade 2 and 3 osteoarthritis at the time of the intervention over the past four years, 92% of patents on average, reported a clinically important improvement in hip-related pain after 1 year while 1% reported worsening. To the best of my knowledge, one patient in the group progressed to grade 4 osteoarthritis and elected to undergo a Total Hip Replacement. As far as Hip-Related function after a minimum of 1 year, 90% of patients reported a clinically significant improvement while 1% reported worsening. Of importance is the fact that of the 9% who initially showed no detectable change in hip-related function, all 9 were significantly improved by a booster intervention.
During my four and one half year, Interventional Orthopedic practice, I have learned that when a patient doesn’t reach a sought-after goal while under observation, a repeat intervention be it Platelet Rich Plasma or a Bone Marrow Concentrate, is a very important part of achieving success. Herein is the basis for my integration of a clinical research initiative with timely follow-up as contrasted with a procedure, a bill and a goodbye. If you want to learn more about evidence based Cellular Orthopedics be it for an arthritic hip or knee, call and schedule a consultation.
312 475 1893
Tags: arthritis, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Hip Arthritis, Hip pain, Hip Replacement, hip surgery, Interventional Orthopedics, Orthopedic Care, Osteoarthritis
