Regenerative Medicine
PRP and mesenchymal stem cells (MSCs) are one of the most fascinating developments in the treatment of musculoskeletal conditions.
Dr. Sohagia has special interest in regenerative medicine. He has been using PRP and STEM CELLS for his patients since 2009. These therapies are used to naturally treat and heal the cause rather than masking the symptoms. Adult MSCs are undifferentiated cells with the potential to multiply in specialized cells. These cells can be harvested from patient’s own body and recruited into damaged or painful joints, muscles, tendons, ligaments, menisci, or discs on same day as minor outpatient procedure. Stem cells can be harvested from bone marrow or fat cells and often PRP is used in adjunct to optimize the outcome. Regenerative therapy uses your own cells to amplify the healing process.
PRP TREATMENT:
Platelet-rich plasma (PRP) injections are gaining popularity to treat variety of conditions, from sports injuries to cosmetic procedures including hair loss treatment. This treatment uses a patient's own blood cells to accelerate healing in a specific area. The results of PRP treatment are most noticeable after several weeks for joint injections and are not permanent; patients may require additional injections at the direction of their doctor. Because PRP treatment uses patient’s own cells, it is safe and can be administered alone or used in conjunction with other procedures.
WHAT IS PLATELET-RICH PLASMA?
PRP consists of two elements: plasma (liquid portion of blood), and platelets (type of blood cell that plays an important role in healing throughout the body). Platelets are well-known for their clotting abilities, but they also contain growth factors that can trigger cell reproduction and stimulate tissue regeneration or healing in the treated area. Platelet-rich plasma is simply blood with highly concentrated platelets.
To create platelet-rich plasma, clinicians take a blood sample from the patient and place it into a device called a centrifuge that rapidly spins the sample, separating out the other components of the blood and concentrating platelets within the plasma.
WHAT IS A PRP INJECTION?
After creating platelet-rich plasma from a patient’s blood sample, that solution is injected into the target joint, muscle or tendon. Doctor uses ultrasound or fluoroscope to guide the injection. The idea is to increase the concentration of specific bioproteins or hormones, called growth factors, in a specific area to accelerate the healing process. Pure PRP provides the highest concentrations of growth factors and can be combined with your own adult stem cells for best results.
The mechanism behind PRP injections is not completely understood. Studies show that the increased concentration of growth factors in platelet-rich plasma may stimulate or speed up the healing process, shortening healing time for injuries, decreasing pain, and even encouraging hair growth.
Human platelets are extremely rich in connective tissue growth factors. Injecting these growth factors into damaged ligaments, tendons, and joints, stimulates a natural repair process.
WHAT IS PRP TREATMENT USED FOR?
Joint, Muscle, Tendon and Ligament Injuries
PRP injections are utilized to treat a range of musculoskeletal injuries and conditions. For example, chronic tendon injuries such as tennis elbow, golfer’s elbow, runner’s knee or jumper’s knee can often take a long time to heal with physical therapy and medication. PRP treatment can help to stimulate the healing process, decrease pain and enable a return to activities sooner.
OSTEOARTHRITIS
Research studies show that PRP injections may help treat osteoarthritis pain and stiffness by modulating the joint environment and reducing inflammation.
PRP Therapy Risks and Side Effects
It is a low-risk procedure and does not usually cause major side effects. The procedure involves a blood draw, so you should make sure you are hydrated and have eaten beforehand to prevent feeling lightheaded. After the procedure, you may experience some soreness and bruising at the injection site.
Because PRP injections are made up of your own cells and plasma, the risk of an allergic reaction is much lower than with other injectable medications like corticosteroids. Less common risks of PRP injections include bleeding, tissue damage, infection, and nerve injuries.
STEM CELL THERAPY
Stem cell therapy is different from PRP therapy. Unlike platelets taken from your blood, stem cells are retrieved from your bone marrow or fat deposits.
Stem cells are the building blocks of the body. They are unspecialized cells that can replace a variety of different specialized cells in your body. They have the remarkable potential to self-renew and to differentiate into many different cell types in the body. When a stem cell divides, each new cell has the potential either to remain a stem cell or become muscle cells, nerve cells, cartilage cells, heart cells, red blood cells or brain cells. Unlike platelets, stem cells are not readily available – every person has those in their bone marrow or fat deposits. Therefore, extracting stem cells is more complicated than isolating platelets from a blood sample.
Stem cells are obtained through a quick liposuction procedure or through bone marrow aspiration. The content is then processed down in a centrifuge where the stems cells are separated. Then, they create a concentrated solution with the stem cells. This solution is injected into the site of injury or pain to trigger a healing response.
What is stem cell therapy?
Stem cell therapy refers to the extraction of stem cells from the body followed by the reinsertion of them into a point of injury or pain. The cells used are called “master cells”. They are cells that are unassigned, and they can actually develop into different types of cells. They can even replace damaged cells throughout your body. Like PRP, stem cell therapy is a relatively simple procedure and, compared to surgery, it is much less invasive for the patient.
Stem cell grows inside your bone marrow. It serves as part of your body’s repair system. There are two main types of stem cells: embryonic and adult stem cells.
What is the difference between PRP vs. Stem Cell Therapy?
Both PRP and stem cell therapy are treatments that help with the regeneration of damaged tissue in the body. PRP is different from stem cell therapy, however, and is best used for treatments dealing with acute pain and less severe injuries. Although PRP and stem cell therapy are different treatments, they can be used in combination to provide more effective results. For example, PRP treatment can be used as a follow up to stem cell therapy.
PRP and stem cell therapy are different types of treatments that can help with a range of problems in the body. Tendonitis, rotator cuff tears, spinal conditions, arthritis in joints, overuse injuries, and inflammation due to a herniated disc are several of the ailments that PRP and stem cell therapy can treat effectively.
A major benefit to both PRP treatment and stem cell therapy is that they often replace the need for surgery to handle pain issues and injuries. Rather than undergoing invasive surgery for knee, back, or shoulder problems, many patients are able to benefit from PRP and stem cell therapy. The recovery time for surgery can be many weeks, however, with PRP and stem cell therapy, patients can recover within days.
INDICATIONS FOR ADULT STEM CELLS THERAPY?
Stem cell regenerative therapy can be used in multiple conditions. They are most commonly used for the treatment of Musculoskeletal conditions that have failed to other conservative treatments, including:
Regenerative therapy is an outpatient procedure. This is generally painless and completely safe procedure in most cases. This therapy can be used to amplify the healing process in a joint, muscle, tendon, ligament or disc.
ADULT STEM CELLS FROM ADIPOSE TISSUE (ADIPREP):
Fat cells are removed with a small incision liposuction as an outpatient procedure. Fat cell are usually isolated from the abdominal, buttock, or thigh area, and processed within 15-20 minutes. This highly concentrated stem cell solution can be mixed with platelet-rich plasma (PRP) and then injected back into painful area.
ADULT STEM CELLS FROM BONE MARROW (BMAC):
Posterior Iliac crest or breastbone or tibia are great source of MSCs and processed with the bone marrow concentrating system. These stem cells have more chondrocytic (cartilage & bone-forming) properties that are useful for musculoskeletal conditions.
PLACENTAL/AMNIOTIC FLUID ALLOGRAFT:
Placental/Amniotic tissue can rarely evoke an immune response. The cells inherent in the placental tissues are found to be broadly multipotent, capable of differentiating into other cells. They have shown to have anti-inflammatory, anti-microbial, and anti-adhesive properties with a wide range of growth factors. Human placenta tissue-derived allografts (other human donors) are an alternative to other regenerative products.
THE PROCEDURE
Injections to the affected areas such as the tendon or joint are performed under all aseptic and antiseptic precautions with ultrasound or fluoroscopic guidance to ensure proper placement. The entire process takes less than one hour.
PRECAUTIONS
For the first week after the injections, it is critical to avoid anti-inflammatory medications, including Aspirin, Advil, Motrin, ibuprofen, Naproxen, Aleve, Celebrex Mobic. These will interfere with the healing response.
WHAT TO EXPECT AFTER THE PROCEDURE?
Considerable pain relief with functional improvement is noted within 2-3 months. There have been reports of cartilage thickening in stem cell therapy noted. Many patients have successfully delayed surgery as well. The success rate varies depending on the part of the body being treated but has been noted to be as high as 80-85%. Currently, cell-assisted regenerative therapies, including stem cell injections, are still considered experimental. Most insurance plans, including Medicare, do NOT pay for cell-assisted regenerative therapies. Please contact your physician or health care personnel for more information.
Read More About Regenerative Medicine
Regenerative medicine is a multidisciplinary science that has evolved with recent advances in tissue engineering. It combines biomaterials, growth factors and stem cells to accelerate the natural healing process.
A stem cell is characterized by its ability to self-renew and to differentiate along multiple pathways in a regulatable and reproducible manner. A stem cell has the remarkable potential to develop into many different cell types in the body. When a stem cell divides, each new cell has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a cartilage cell, a nerve cell, a red blood cell, a heart cell or a brain cell.
Stem cell therapy is a form of cell therapy that introduces new adult stem cells into damaged organs or tissue with the objective to treat a disease, injury or ailment and to heal the organ or tissue. Stem cells can be successfully harvested from peripheral blood, adipose tissue, bone marrow and umbilical cord blood. A stem cell can be harvested by a minimally invasive procedure and can be safely and effectively transplanted to an autologous host. With the increased incidence of obesity in the United States and abroad, subcutaneous adipose tissue is abundant, readily accessible and nearly pain free.
Human pathologies support the concept that adipose tissue contains multipotent progenitor cells. Children with a rare disease known as progressive osseous heteroplasia (POH) present to clinicians as a result of ectopic bone formation within their subcutaneous adipose layer of their skin. Histological analysis of these lesions demonstrates the presence of osteoblasts and chondrocytes in addition to adipocytes. Adipose tissue–derived stem cells are tripotent, with the capability of adipogenic, chondrogenic, and osteogenic differentiation potential. Various soft tissue tumors such as lipomas and liposarcomas lend further weight to the existence of adipose-derived stem cells. A stem cell within adipose tissue is responsible for replacing mature adipocytes through the life.
Bone Marrow Stromal cells are Mesenchymal stem cells (MSCs), have the capacity to differentiate into a variety of connective tissue cells including bone, cartilage, tendon, muscle, and adipose tissue. These cells may be isolated from bone marrow with ease, while retaining their capacity to differentiate when exposed to appropriate signals. The isolation of these cells from adult tissues raises opportunities for the development of novel cellular therapies without the ethical considerations associated with embryonic stem cells.
Multipotent cells have been isolated from various mesenchymal tissues in adults, including skeletal muscle, fat, and synovial membrane as well as hematopoietic, neural, and hepatic tissues. In certain degenerative diseases such as osteoarthritis (OA), stem cells are depleted and have reduced proliferative capacity and reduced ability to differentiate. The systemic or local delivery of stem cells to these individuals may therefore enhance repair or inhibit the progressive loss of joint tissue. OA is characterized by degeneration of the articular cartilage, with loss of matrix, fibrillation, formation of fissures, and ultimately complete loss of the cartilage surface. Other articular tissues are also affected, including the subchondral bone, ligaments, joint capsule, synovial membrane, and periarticular muscles. Although OA affects a large proportion of the population, there are few, if any, effective therapies available today that alter the pathobiologic course of the disease.
Stem cell therapy is believed to have the power to alleviate the suffering caused by several diseases. Stem cells are the building blocks of the body. The stem cells that are formed in early development of an embryo can become one of over 200 types of stem cells. These cells then become specific to a certain part of the body and become capable of self-renewing. Stem cell therapy is the latest innovation in the field of science and medicine today. Stem cell therapy is a kind of intervention that recruits new adult stem cells into the body, particularly to damaged tissues; has been used to treat various diseases and injuries. Although stem cell therapy is new and expensive, its benefits to people’s health and well-being are unquestionable. The ability of stem-cells to self-renew gives significant potential for generation of tissues that can replace diseased or damaged tissues in the body with a lower risk of rejection as well as harmful side effects. The procedure works well with diseases such as heart failure, diabetes, COPD, multiple sclerosis, Alzheimer’s, and more. Stem cell therapy can be significantly effective in treating degenerative joint and disk disease, chronic bursitis, tendinosis, and chronic pain from prior fractures, sprain or strain. Stem cell procedures are being used for treating bone fractures and non-unions, regenerating articular cartilage in arthritic joints, healing ligaments or tendons, and replacing degenerative vertebral disks.
It is expected, however, that as more knowledge of tissue engineering is obtained, stem cell procedures will become more common.