Jun 23, 2014
The ability of stem cells to divide and become more specialized cells—such as bone, blood, or muscle—makes them attractive agents in many areas of medicine. Additionally, the ability to harvest stem cells from an individual and reimplant them in the same patient thus potentially reducing or eliminating the risk of infection makes stem cell therapy appealing to both patients and physicians.
What is a stem cell?
Although there are many different definitions of a stem cell, all share two common characteristics: In the body, the offspring of a single cell are able to reconstitute a functional tissue, also called potency, and these cells are able to proliferate or renew themselves.”
The development of stem cells starts with Totipotent cells developing from the fertilized egg and having the ability to divide and become all the different cells in an organism as well as the placental cells. Embryonic cells are pluripotent, meaning they can differentiate into various cell types. Multipotent fetal stem cells can develop into more than one cell type but are more limited than pluripotent cells.
One of the proven stem cell therapies is the use of bone marrow stromal cells for tissue replacement in building bone within focal cavities. The use of stem cells in a systemic way to strengthen bone or replace cartilage, is what we do at Regenexx and what we study
Regenerative medicine
Every second, 15 million blood cells ‘drop dead’ in your body (apoptosis)—and stem cell replacement keeps you alive. The source of those blood cells is bone marrow stem cells; without them, you die.”
Additionally, the pericytes located on blood vessels detach and become MSCs in the presence of inflammation or injury. “These MSCs, medicinal signaling cells, not only become the first line of defense against an auto-immune reaction by stopping an overaggressive immune response, they also make molecules that stop cells from dying from apoptosis.”
. A phase II study has found that using MSCs to treat degenerative disk disease results in lower mean pain scores, reduced opioid use, and fewer surgical and nonsurgical interventions for persistent pain at 12 months.
Stem cells and bone.
Cells may be taken from the bone marrow space and concentrated without any manipulation other than simple centrification. Because research found a positive correlation between the number and concentration of colony-forming units and the volume of mineralized callus at 4 months, we now apply the technique to treating nonunion (failure of bone to heal).
With regard to the use of stem cells in treating osteonecrosis of the femoral head, a prospective case series of patients with stage 1 or stage 2 osteonecrosis followed for one year demonstrated 75 percent significant symptomatic improvement; they did not require any further surgical intervention, and exhibited no further collapse.
Cartilage repair and regeneration
Concerning the use of stem cells to treat OA and delay total joint replacement. We have preliminary data to support our treatment approaches. While all interventions short of joint replacement to date are symptom modifying, stem cells introduce the potential to alter the natural history of the disease and regenerate the joint.
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, PRP, regenerative medicine, stem cells
Feb 18, 2014
Musculoskeletal Care of the Mature Athlete
A 67-year-old man came to my office to learn more about Bone Marrow derived Stem Cells for his arthritic knees. While he had been discouraged by his sports medicine physician from seeking the Regenerative Cellular alternative, he was not ready to undergo a bilateral total knee replacement after having investigated the potential complications associated with the surgery. I started with a review of his medication profile and determined that BMAC/Stem Cells might not produce the quantity and quality potential I would want to see to justify the procedure. My concern had to do with the adverse effects of certain medicinals on stem cell numbers. I offered an alternative, Concentrated Stem cell Plasma.
The development of Regenerative Cellular interventions for the management of arthritis started several years ago with Platelet Rich Plasma. Platelets not only play a role in initiating the clotting cascade, they contain an abundance of anti-inflammatories and healing agents termed growth factors. At the outset, clinicians performed a venous puncture and filled a test tube with blood. The latter was now spun in a centrifuge and the plasma with platelets suspended was injected in the arthritic knee. Within a year, it became apparent that two or three staged PRP interventions would result in better outcomes. About a year ago, the group of physicians at Regenexx began concentrating the Platelet Rich Plasma 10X and the results of treatment have been very encouraging in that patients did better and for longer than with standard PRP. More recently, we have developed a better way to activate with a faster and longer acting release of growth factors.
Bone Marrow Aspirate Concentrated/Stem Cells remain the best possible alternative in our Cellular Orthopedic Regimen at this time. Concentrated Stem Cell Plasma (PRP 10X) is a reasonable alternative although with a shorter outcome potential and probably to a lesser extent. No bridges are burned. I have suggested the 10X PRP option to patients heavily dependent on pharmaceuticals for co-morbidities or when I anticipate a possible compromise in the quantity or quality of stem cells because of age or other factors. Primum Non Nocere, First No Harm. There is nothing lost and a lot gained by a staged approach to the Regenerative Medical management of arthritis.
Addendum: I now have several patients who were managed as above when their pharmaceutical profile excluded them from a stem cell procedure; that went on to loose weight and get fit, and minimize their medication dependency. By so doing they became reasonable candidates for stem cells; and, now are enjoying the longer term and more comprehensive benefits of Bone Marrow Concentrate Stem Cell intervention.
Tags: C-SCP, Concentrated Stem Cell Plasma, Growth Factors, joint replacement, Orthopedic Care, Orthopedics, Platelet Rich Plasma, PRP, Ultrasound Guided Injection
Oct 17, 2013
ESPN news http://m.espn.go.com/nba/story?storyId=9765198, Los Angeles Lakers Kobe Bryant traveled to Germany to receive PRP Platelet Rich Plasma injection therapy. Kobe made major news by receiving this treatment for his ailing knee in 2011 that provided dramatic improvement. According to the report, Kobe has had this treatment on his knee and ankle, and returned for further treatment to promote healing and potentially extend his playing career. While many professional athletes like Kobe have received biologic based injections as PRP, these therapies are now available locally to everyday people with daily pain from arthritis including the spine, shoulder, hip, knee, wrist/hand & foot ankle. It worked on him in 2011, but a newer therapy for advanced tendon or cartilage disease is BMC Bone marrow concentrate, that utilizes the body’s own regenerative cells that are re-injected into painful joints or tendons on the same day. More data is needed to best determine which patient and which conditions are best candidates for these promising therapies; and I am working on it. Each and every patient for whom I perform a cellular orthopedic (stem cell) intervention becomes part of our database following HIPPA and FDA rules and guidelines.
On Monday and Tuesday, I travelled to Broomfield, Colorado to finalize the plans for the clinical trial IRB application concerning a next generation of stem cell therapies. I hope to start enrolling patients who meet the inclusion criteria by the end of this month; once we receive IRB approval. Your original story may begin now with less pain and more function without surgery as a major advance in the orthopedic care of the aging athlete. You don’t have to be a professional athlete nor do you have to travel outside the country to avail yourself of the most recent advances in Cellular Orthopedics. Your own bone marrow provides the necessary mesenchymal stem cell resource, that when concentrated, allows for a minimally invasive intervention to relieve pain, improve motion, enhance your recreational profile and potentially reverse or at least influence the progression of arthritis. We will announce the start up date on the Regenexx Web site and in this Blog. Until that time, we offer the most advanced menu of Regenerative Medical Care following FDA guidelines.
Tags: athletes, Bone Marrow Concentrate, Knee, Platelet Rich Plasma, PRP, stem cells
May 16, 2012
Assume you have read my blog or learned from the web about our ethos – don’t just recover, conquer. You have scheduled an appointment, undergone the assessment, completed X-rays and the MRI and I have determined that you are a candidate for a regenerative medical procedure for your arthritis. The next step is informed consent.
While there is no data that allows me to promise that I can cause your cartilage to re-grow, there is ample evidence-Regenexx has over 5,000 cases-that allows me to say it is more likely than not that your bone marrow aspirated and concentrated adult mesenchymal stem cells may reduce or eliminate your pain and improve your function. One hope of stem cell treatment is influencing cartilage repair; unlikely though after, age 50. On the other hand, I have a new approach being instituted, arthroscopic debridement with stem cell repair. As an orthopedic surgeon, this will be one of my contributions to the new world. As far though as altering the bio-immune response of the synovium in the arthritic joint, there is little question and that is why I am willing to say that within a reasonable degree of medical certainty, I can minimize or eliminate your pain. Now you ask at what risk? As of now, there are two downsides as no procedure is risk free. Associated with any invasive procedure including minimally invasive needling is the risk of infection. While we only use a needle, it is an invasive procedure. Regenexx to the best of my knowledge has not experienced any deep infections in association with their outcomes surveillance. Second, there are a certain percentage of patients who do not respond as hoped. The revision intervention for superficial infection is an antibiotic; for failure it is a repeat attempt at Regenerative Medicine or a joint replacement. To date in the closely monitored outcomes of the 5,000 Regenexx patients, no tumor growth has been reported. Please keep in mind that your adult cells are reintroduced in to a closed environment, a capsulated joint. I repeat the Regenexx experience and data because theirs is the only outcomes evidence available. All other approaches and all other companies have depended on anecdote in the absence of gathering scientific evidence.
To the best of my knowledge, the cost of Regenerative Medicine is assumed by the patient. No insurance carrier and certainly not Medicare at this time will pay for stem cell management of arthritis. If the aspiration of your bone marrow and the concentration thereof is done under IRB oversight, we are in complete accordance with FDA governance. Someday, the indemnification community may choose to cover Regenerative Medicine, especially when our studies demonstrate the cost savings when compared to a total joint replacement. The global charge for a joint implant runs between $45,000 and $60,000; a revision, about $70,00 to $120,000. Should an infection ensue, the costs may go up by another $150,000 additional. Then there is rehabilitation; Regenerative Medicine is a matter of weeks, not months as in a joint replacement
What about outcomes; am I really able to compare those of stem cell management with a total joint replacement? Watch Kobi Bryant in the NBA playoffs or Alex Rodriguez, as third baseman for the New York Yankees. If you want to learn more, call and schedule an appointment. In my new website, where I hope to become your resource for Regenerative Medicine, there will be a section of new patient stories and the results of treatment. Stay tuned.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street . Chicago . Illinois . 60610
847.390.7666 or 312.475.1893
Tags: bone marrow, Bone Marrow Concentrate, Platelet Rich Plasma, PRP, Regenerative, Regenerative Pain Center, stem cells, treatment
Apr 25, 2012
Musculoskeletal Care of the Mature Patient
The number one reason in the United States for a trip to a physician has to do with pain arising in the musculoskeletal system, especially in the Boomers and maturing athletes. Might regenerative medicine and stem cells provide an extended warranty for your frame? That was my basic question when I attended the American Academy of Orthopedic Surgeons continued medical education course last weekend “Advances in Care of the Aging Athlete”. What was generally reinforced is that the number one way to stay healthy and young is through fitness and sports; stay active on an aging frame. In other words put old on hold. Certainly proper nutrition is a key component as is Resveratrol and maybe testosterone supplementation for Manopause. Woman beware, hormone replacement therapy is generally not good for your health.
In the end though, the real problem is cartilage deterioration with age be it from genetics, congenital, developmental insult or trauma. The recent media attention to stem cells has introduced a clinical possibility of changing the natural history of progression of degenerative arthritis and perhaps even reversing the programmed death of cells. Peyton Manning went to Europe for stem cells in the neck, Governor Perry chose Asia for his back and Terrell Owens returned to football after stem cell intervention in Korea. You all probably are aware of the Fred Couples, Kobe Bryant and Alex Rodriguez having returned to top performance with the assistance of regenerative medicine. By harvesting Mesenchymal Stem cells form you bone marrow and concentrating them, the injectate is the best of all potential immune modulators with the greatest possible ant-inflammatory effect. There are a large number of animal studies confirming the efficacy of stem cell management of cartilage; such clinical treatment is now the standard of care in the veterinarian world, particularly with the injured or arthritic hoarse. As well, there is an emerging body of science to support adult mesenchymal derived stem cell management of the aging human joint appearing in peer reviewed medical journals. The International Journal of Rheumatic Diseases to illustrate, recently published an article concerning four patients with moderate to severe osteoarthritis of the knee who experienced marked improvement with mesenchymal stem cell therapy. The problem is that for the most part, human clinical trials are taking place outside the United States. Enter Regenexx and its IRB clinical trial. That’s why I joined the Regenexx Network. To learn more, schedule an appointment.
Tags: arthritis, bone marrow, Clinical Trial. Mitchell B. Sheinkop, Osteoarthritis, PRP, Regenerative Pain Center, stem cells, treatment
