CUTTING EDGE HEALING
Therapies Without Surgery:
At the Regenerative Medicine Center of APM Spine and Sports Physicians’, in our continuous quest to provide our patients and community with access to the finest, most Cutting Edge Treatment, we are now offering some new options to facilitate “biologic healing.”
Biologic healing, or what is more commonly referred to as Regenerative Medicine, describes a process by which we assist the body to heal itself using as few pharmaceuticals as possible. We have been providing this service since 1992, when we introduced Prolotherapy to our patients. Then, just over ten years ago, we brought PRP (Platelet Rich Plasma) injection therapy to the area. For the last 10 years, we have gained a lot of experience using Prolotherapy and PRP to promote healing of injured and inflamed tissues that frequently cause pain and limit function.
Adult Stem Cells
ADULT STEM CELLS
Fat derived adult stem cells (ADSCS) are considered mesenchymal stem cells found in specific layers of fat called the stromal vascular fraction (SVF). These stem cells are
similar in some ways to bone marrow derived stem cell, but are easier to extract, and are more abundant.
What makes fat derived stem cells so interesting is that, in comparison to blood and bone, fat yields millions of stem cells per treatment. Furthermore ADSCS can be induced in vitro outside of the body to differentiate into many different tissues, including osteoblasts, bone, chondroblasts, cartilage, myoblasts, muscle and neurons nerves, as well as others.
Thus the possibilities are endless as a cure for disease and injury; needless to say, optimizing the use of these potent cells is the new frontier of medicine.
Current restrictions enforced in the USA by the FDA limit any modification of stem cells to certain research facilities. In time, as more standardized protocols are developed these restrictions should be loosened. It is still unclear how we will be able to best optimize stem cell function. Some studies suggest ADSCS are locked in to the fatty tissue and require enzymes to release the actual stem cell. In vivo (in the body) studies regarding optimal use of fat derived stem cells are in the early stages, but results look very promising.
Fatty tissue serves as a reliable, accessible and abundant source of adult stem cells with the ability to develop along multiple pathways. Unlike bone marrow derived stem cells, fat provides a biomaterial scaffold, as well as specific growth factors, that modulate inflammation which can be used to repair and regenerate tissue. ADSCS can also stimulate the recruitment of stem cells to the site of injury, and promote their differentiation along specific cell lines. It is also believed that ADSCS are immunoprivileged cells providing the injured tissues with antioxidant chemicals and free radical scavengers. They also suppress immune reactions, since fat adipose derived stem cells are stromal cells, which are multipotent progenitor cells. They are also believed to even help failing heart muscles. Current studies are underway worldwide using ADSCS in patients with heart damage after a heart attack to repair damaged myocardial tissue. One observation in these studies is that these cells contain VEGF, a growth factor that promotes the development of new blood vessels, which are crucial in carrying oxygenated blood to the injured tissue. Studies are also underway using fat derived stem cells in treatment for leukemia, spinal cord injury, stroke, liver damage and Alzheimer’s.
With all of the amazing possibilities in sight, various medical centers are looking for standardized and streamlined approaches to extract the fat, process it, and in some cases bank the fat for future use as people age
PRP (Platelet Rich Plasma Injections)
Platelet Rich Plasma Injections were originally used by dentists in the 1990s to help with implant dentistry. Later large animal veterinarians used PRP to keep performance
horses functioning at their best.
PRP is all natural, in that we obtain the solution by drawing a patient’s own blood then concentrating the platelets and special proteins called growth factors in a special centrifuge. We then take this solution, and under direct ultrasound or x-ray guidance inject it into the damaged or degenerated tissue. This promotes a natural healing cascade of seemingly invisible cellular changes that over time heals the body. The healing process time and the PRP injections, with or without the addition of prolotherapy, can take 36 months. To optimize healing, we encourage our patients to modify their exercises in an effort to address some of the compensatory changes that have occurred in their bodies in response to the laxity and pain.
The growth factors also include a number of signal proteins that regulate the inflammatory process and facilitate natural wound healing and tissue regeneration by proliferating myoblasts cells that form skeletal muscle. Pure PRP is distinguished from regular PRP by the absence of red blood cells and neutrophils, as well as by the sheer concentration of the platelets and growth factors contained in each sample. In this case the old adage more is better is likely to hold true, in so far as the number of platelets and growth factors are concerned. The irony is that prolotherapy and PRP both work by the same mechanism. They both stimulate inflammatory and proliferative responses, thereby acting as signals to the cells and catalysts for tissue regeneration. Therefore, it appears clear that the addition of actual stem cells be it fat derived or obtained by bone marrow aspiration may only be necessary in select patients who have more severe muscle and tendon tears cartilage loss and significant arthritis as well as those who fail to respond to PRP and prolotherapy injections
Of the host of regenerative therapies, Prolotherapy is considered by most to be the “original” regenerative solution and for many years.
Prolotherapy solution consists of a concentrated solution of sugar water and local anesthetics as well as other substances that, when injected, stimulates a very localized inflammatory response that signals the body to heal itself. This solution also promotes tightening of lax connective tissue often seen in chronic or recurrent sprains and degenerative conditions by improving joint stability. We can reduce abnormal loading forces around the joints and avoid activating alarm cells, called mechanoreceptors, which cause more pain and result in abnormal compensatory movement patterns. Over time, the domino effect of joint instability can result in irreparable changes to the bone structure of the joint, often leaving surgery as the only treatment option. Thus prolotherapy provides a unique service to the body and will be around for a long time to come.