Adult Stem/Stromal Cells with Platelet Rich Plasma for Use in Regenerative Medicine
Regenerative medicine is an evolving new field of medicine, which enhances a patient’s own healing mechanisms to induce therapeutic results. Over the past 30 years, injection therapies have increased and improved. Originally known as prolotherapy, use of injections of concentrated dextrose into damaged tissues led to stimulation of inflammatory capabilities and often improved the sites. Next, use of platelet concentrates (PRP) were injected into wound and injury sites to take advantage of the important healing factors contained in platelets.
Now, there are advances that directly stimulate the wound healing processes, PLUS, provide needed cells that have the ability to change into the types of cells to actually repair an injury site. These are known as adult stromal cells, and are found in bone marrow and fat deposits. These cells and platelet concentrates are carefully placed via guided ultrasound directly into tissues like ligaments, tendons, muscle, joints, nerve injury, etc. to amplify the healing capabilities and lead to repair and return to comfort and function. Note, that these are taken from an individual and returned to that same individual (known as autologous tissue), and have nothing to do with use of embryonic stem cells or use of another person’s tissues.
Basic understanding of Adult Progenitor (Stem) Cells:
The adult progenitor cells are found in fat, bone marrow, and, to a lesser extent in muscle, skin, and every organ of the body. Our body uses them for self-repair and maintenance of our tissues. Without them, we would not be able to heal a wound, repair a fractured bone, maintain working organs, or a myriad of other basic functions. These undifferentiated cells are concentrated around our extensive blood vessel networks, and can be called upon in times of injury and damage, such that needed fibrous, muscular, neurological, fat, bone and cartilage to change into the types cells needed to heal the site. The signals that decide what cell type is needed come from damaged tissues, and can be amplified by addition of platelet concentrates which contain the major growth factors and signal proteins. This activates, recruits and stimulates cell change (differentiation) to control the healing processes. For many years, platelets were recognized as important in helping clot bleeding areas, but are now known to be much more important, serving to control the entire series of inflammation and healing changes we know as “wound healing”.
Mechanisms Of Action For Adult Stem Cells & Platelet Concentrates:
When there is an injury, one of the first responses is the attraction of platelets, the blood component that is responsible for clotting. The platelets “plug” the hole, if there is bleeding. After the bleeding is stopped, they begin to release important compounds held inside them in structures called “alpha granules” . These granules provide powerful growth factors and signal proteins (cytokines) which target area undifferentiated cells to begin to activate and change, or recruit other cells critical to healing the particular site. Following obtaining a small volume blood sample, centrifugation concentrates the platelet fraction (4-6 times circulating amounts) that can be added to harvested tissues containing adult progenitor cells, and become a very potent stimulus for your healing of damaged or injured sites. Adult undifferentiated cells can most easily be gathered by use of a small syringe and a blunt tip tube from areas of fat deposit. Similar cells can be obtained from bone marrow, but the lower number of such cells, costs, and difficulty in getting bone marrow samples makes this option somewhat less attractive.
This combination is then placed under high-definition ultrasound guidance directly into the areas of identified damage. Once placed, the components enter into the actual “microenvironment” of injury and become active to help the site begin to heal itself without requiring open surgical intervention. This combination is also often recommended in areas of previous surgery which has incompletely healed, and to precede the plan for necessary open surgery to prepare the site for maximal response following surgery.
These therapies are still considered within the early clinical stages of development. For this reason, insurance carriers are hesitant to provide coverage, preferring to make it patient responsibility to reimburse for the treatments. Thousands of such treatments have proven the safety and effectiveness of this form of regenerative therapy, using a patient’s own tissues to help in the healing processes.
Patients have been treated for a wide variety of musculoskeletal problems, ranging from tendon, ligament, joints (shoulders, elbows, hips, knees, ankles, neck-back, etc), muscle, and scar limitations of range of motion. In addition, it is well proven as effective for filling contour irregularities or augmentation of lost structural fat, nerve pain problems, and in skin trauma and chronic wound healing situations.
How is this done on me?
First, an accurate evaluation and diagnosis is completed by detailed history, physical examination, internal evaluations (X-ray, MRI, CAT scan, Ultrasonography, etc.), and review of records of surgical care (if done). Based on a combination of these findings, a treatment plan is developed for each individual case and situation.
Next is to gather the combination of platelets and adult progenitor cell source within your fat. Platelet concentrates are made from a small volume blood draw, placed in a centrifuge device to isolate and concentrate (up to 6 times circulating amounts). Simultaneously, under local anesthesia, a small volume of fatty tissue is removed with a microcannula and small syringe to remove the needed fat tissue and associated progenitor cells found attached to the fat cells and adjacent small capillary network. Once completed, the two components are combined and precisely injected into the desired location of damage or injury using handheld, high-definition, ultrasound-guidance.
In the early post-treatment period, it is recommended to avoid use of anti-inflammatory medications (such as Motrin (ibuprofen), Mobic, Aleve (Anaprox), Rolafan, etc.). Use of these drugs may slow or limit your ability to fully heal the problem area.
You will be asked to move the involved areas in order to maintain range of motion and weight-load of the problem area(s). No casting or splinting is typically requested, as wound healing under controlled work load is considered important to accomplish a full recovery. In some cases, use of moist, cold compresses to the treated site is recommended, which may help reduce swelling and limit some post-treatment discomfort. We suggest that patients carefully “listen” to their body, and avoid excessive or potentially harmful activities in the early post-treatment period.
In some cases, it is recommended that a supplemental treatment may be of value in the 2-4 month timeframe to further enhance the final wound healing processes. This is often true in the more extensive or complex cases. Secondary treatments may involve only the use of platelet concentrates, or your treating physician may recommend PRP and progenitor cells within your fat. Secondary treatments are often less bothersome in the post-treatment period than the first time.
Treatments are usually performed under local anesthesia, with good tolerance remembering the site treated are often already somewhat painful and inflamed prior to treatment. Oral pain medication is oftenprescribed to help for the first 2-3 days of discomfort.