Why the variability in Clinical Response to Stem Cell intervention for arthritis

Mesenchymal Stem Cells, or MSCs, are multipotent stromal cells that can differentiate into a variety of cell types or affect other cells by releasing the proteins categorized as Cytokines and Exosomes. Cytokines are small proteins that are important in cell signaling. The process is quite complex but this introduction allows me to help you better understand the Regenerative Medicine world.

The patient who called this morning indicated that she had not experienced any benefit form an orthobiologic intervention she had several weeks ago; yet on Friday, several patients reported satisfaction and our outcomes surveillance documented significant functional improvement as well. Why the variability in response? Perhaps it might or could be explained by the genetic makeup of the individual’s cartilage or the nature of the biologic intervention. In the current regenerative marketplace, I note advertisements for Amniotic Fluid, Cord Blood, Wharton’s Jelly, Exosomes, Adipose derived and bone marrow derived interventions.

The long-term durability of our cellular orthopedic treatment has been documented in patients for at least five years. The observation of this response is significant, as steroids and viscosupplementation have typically shown to be effective in relieving pain respectively for up to 6 weeks and 6 months. Our earlier research has documented a six-month average response to amniotic fluid and an average 18-month improvement to mechanically processed adipose tissue. Our current biologic interventions contain high concentrations of anti-inflammatory cytokines and anabolic growth factors in addition to Mesenchymal Stem Cells, all modifying the course of disease progression. The short-term pain relief observed is due to the anti-inflammatory effects of the biologics used in the interventions. The long-term pain relief is attributed to potential disease-modifying properties by improving joint homeostasis and cartilage quality. We believe our biologic interventions to be disease-modifying.

What is next? While most readers of this Blog are familiar with the regenerative alternatives, Exosomes are new and there is little if any clinical data available to allow me to opine about clinical usage including safety and efficacy at this time. They are cell-derived vesicles (a small membrane-bound sack that stores and transports substances though out the cell or outside the cell) present in bodily fluids as well as in extracellular matrix. Evidence is accumulating that they play a key role in signaling between cells and may function as a potent anti-inflammatory and disease modifier depending on the environment from which the Exosome is recovered. While the use of non-autologous stem cells is not FDA compliant, to the best of my knowledge, Exosomes produced by Mesenchymal Stem Cells are not restricted and are now being made available for clinical use in arthritis. Stay tuned as we continue to document successes, safety and efficacy in the world of Orthobiologics. To learn more, schedule a consultation by calling (847) 390-7666. 

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The U.S. FDA regulation of cell therapies finally is enforced

“Mitch, not sure if you heard, but the FDA via the DOJ has requested injunctions against the mothership clinics of Berman and Lander, as well as the US Stem Cell clinic run by Comella. We can hope that criminal indictments might follow, since they certainly are some of the most flagrant violators of the law in recent med I can think of. The SCIA group can’t be too far behind. It seems that advertising all kinds of cures for everything that ails the patient makes you a higher priority target.” (Personal communication)

I am dedicated to providing patients with the best possible care in regenerative medicine and am pleased to announce that I have adopted a technology platform developed by Greyledge Technologies (Vail, CO). Their technology to generate platelet-rich plasma (PRP) and bone marrow-derived cell concentrate (BMC) is derived from successfully operating a laboratory that is registered with the FDA (listed as a “component preparation and collection facility”, FEI 3008724474), which has cleared two audits with no issues. Based on their platform, I offer my patients customized therapy, since each preparation is analyzed for platelets, red blood cells and white blood cells (among 23 parameters), which I review prior to treatment. This knowledge permits me to make adjustments based on my more than 40 years of experience in orthopedic surgical and now cellular orthopedic practice. No other system or technology gives me this kind of capability to personalize your treatment.

As a result of the technology I have adopted, my office has been able to create a scientific outcomes data base using the same parameters in cellular orthopedics as when I was the director at one of the five largest joint replacement programs in the country. At that time, I pioneered the integration of patient are with research and education. The latter allowed me to rise to the position of full professor; having publish over 75 scientific articles in the field of hip and knee joint replacement. I am happy to update you with the fact that I am at it again. On June 10, my paper concerning the preliminary outcomes of combined intraarticular and intraosseous stem cell intervention for knee arthritis will be presented in Las Vegas at of The Orthopedic and Biologic Institute (TOBI) annual meeting. The manuscript concerning Autologous Bone Marrow Concentrate and Platelet Product for Symptomatic Knee Arthritis: A Randomized Controlled Trial, Minimum 2 Year Follow-Up was submitted to a major orthopedic journal and is one of three papers I have been invited to deliver from the scientific podium of The Medrebels, October 26 to 28 meeting in Austin, Texas.

If you want to avail yourself of the best opportunity to postpone, perhaps avoid a joint replacement for arthritis while enjoying pain relief and restoration of an active life style, chose science over advertised anecdote. Call (847) 390-7666 to schedule an appointment. You may access my website and watch the webinar at www.Ilcellulartherapy.com.

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A Word on the Future of Cellular Orthopedics

A Word on the Future of Cellular Orthopedics

Actually, that future started last week when we used a more aggressive PRP adjunct at the time of two Bone Marrow Concentrate/ Stem Cell interventions; one for an arthritic hip and the other, in an arthritic knee. More accurate and descriptive would be a Bone Marrow Concentrate/Adult Mesenchymal Stem Cell/ Hematopoietic Stem Cell/ Growth Factor Concentrate/Platelet Rich Plasma/Interleukin-1 Receptor Antagonist cellular orthopedic intervention to an arthritic joint but even I get confused, so I will stick to cellular orthopedics and Bone Marrow Concentrate.

It would seem from current Regenerative Medicine Science, that while concentrated and activated Platelet Rich Plasma alone has not been provided a predictable and reliable independent approach to arthritis, when aggressively used in conjunction with stem cell interventions, PRP significantly enhances the results in the short term. It will require another several years to determine if what we are seeing in the short term will continue to improve our outcomes in the long run. I am not waiting as concentrating and activating the platelets will cause no harm; and if there is the promise of long term benefits when used as an adjunct both at the time of the Bone Marrow collection, concentration and intervention as well as again in two to five days, there is no reason not to proceed.

What about the future? While we have been great advocates of counting cells at the time of the stem cell intervention, new tools are being introduced to allow us to better customize that which we inject after concentrating and processing of the bone marrow. We now will be able to get a more accurate count of that which is present in the concentrated and processed injectate prior to the intervention and add bone marrow or platelets if indicated.

Are Mesenchymal Stem cells really Stem Cells? Professor Arnold Caplan of Case Western Reserve is widely considered the father of mesenchymal stem cells. He now takes the view that MSCs aren’t stem cells and that he should have never given them that name. He also believes that the primary function of these cells is paracrine, so he calls them “medicinal signaling cells”. To save you the trouble, paracrine is defined as “a form of cell-cell communication in which a cell produces a signal to induce changes in nearby cells.” I am not negating the importance of mesenchymal stem cells, rather I want the reader to better understand the role of each component involved with regenerative medicine. It was Professor Caplan’s prodding that in part is responsible for my having entered the discipline of interventional orthopedics. Long ago, we became friends as team mates of the Roosevelt High School championship football team in Chicago; and our professional paths, while parallel, he in basic orthopedic research while I chose orthopedic surgery finally crossed again five years ago.

To learn more about the basic science behind Cellular Orthopedics or to find out about how you might postpone or avoid a Total Joint replacement for an arthritic joint, schedule a consultation (312) 475 1893

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Special Announcement - Now Enrolling for FDA Approved Stem Cell Study
Dr. Mitchell Sheinkop has completed training and is credentialed for the first of its kind FDA approved stem cell clinical trial for knee arthritis. Our clinic is now enrolling patients in this trial. Contact us at 312-767-5761 for details. Click here to learn more.