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An adult stem cell is an undifferentiated cell, one of the body’s most important natural repair mechanisms. They repair organs, muscles, heart, lungs, skin, and nerves by replacing old, dead, or diseased cells throughout the body. They are characterized by the cell's ability to renew itself through cell division and differentiate into specialized cells. Stem Cell therapies were initially developed in the 70's and 80's in the form of a Bone Marrow Transplant.
Embryonic Stem Cells
Induced Pluripotent Stem Cell
Adult Stem Cell
A Stem Cell can be used to generate healthy and functioning specialized cells which can then replace diseased or dysfunctional cells. Some of the Potential diseases currently being treated or studied with Stem Cells are:
Recent studies have focused on the use of adult stem cells for disorders such as osteoarthritis. Mesenchymal stem cells (MSCs) are non-hematopoietic, multipotent progenitor cells, which can be isolated from various human adult tissues. The potential to form cells of chondrogenic (Cartilage) lineage has indicated the potential of these cells in cases of osteoarthritis. In recent years, MSCs have been shown to possess broad range of regenerative capabilities, modulating disease progression improving cartilage lesions closely associated with osteoarthritis.
There is much debate in the Regenerative Medicine World regarding Adipose Vs Bone Marrow Derived Stem Cells. Bone Marrow Stem cells have been around and known about since the 60's, therefore there has historically been more research and treatment with Bone Marrow Stem Cells, large amounts of Mesenchymal Stem Cells were discovered in Adipose (Fat) Tissue much later.
Supporting Studies for Adipose over Bone Marrow Stem Cells:
Adipose tissue-derived multipotent stromal cells have a higher immunomodulatory capacity than their bone marrow-derived counterparts (June 2013)
The only honest answer to this fundamental question is we don't know for sure. The initial excitement and interest in stem cells for orthopedic conditions came out of the understanding of their ability to differentiate into various cell types as seen in the figure above showing an overview of the Mesengenic process where "Pericytes" become MSC's (mesenchymal stem cells) which then can become muscle,tendon,ligament, bone, fat, marrow or cartilage cells. This has been observed in the laboratory with cell culture. The interesting point is that the FDA does not allow stem cells to be cultured and then injected into a patient, the only option is to process the stem cells in a minimally manipulated way such as centrifugation, or possibly mechanical or enzymatic separation and then must be injected into the patient the same day. Most likely this does not allow the Pericytes time to differentiate into anything, so the next big question is what are these Pericytes and what do they do to help tissues heal. Pericytes it turns out live on blood vessels, where they have several functions, of our interest is in how these cells respond to tissue injury and what role they play in tissue healing and regeneration. The following image summarizes some of the current thinking of how these cells respond, and according to Dr. Caplan these pericytes behave more like Medicinal Signaling cells (MSC) rather than the traditional Mesenchymal Stem Cell (MSC).
Dr. Caplan suggest we think of these cells as injury drug stores, and it seems their first response is to protect the damaged tissue from an overzealous immune response, and to secrete a number of different bio-molecules and growth factors that work together to promote regeneration of tissue, creating what he calls a "Regenerative Microenvironment". Most likely this microenvironment is also important in working along side the growth factors released from the alpha granules in Platelets that is obtained from Platelet Rich Plasma (PRP), which is why we always include PRP with our stem cell/Pericyte procedures. The following article from 2015 provides further evidence of this growth factor release and cell to cell communication.
What happens after this initial regenerative microenvironment is created is not completely understood. It could be that some of these Pericytes go on to become other cell types, such as muscle,cartilage,tendon, bone, or just simply continue to send signals to the cells already present in the tissue of interest to continue to respond, regenerate and remodel. I suspect it is some combination of both. It will be fascinating to see how the science improves our understanding of how our bodies heal and repair, and how we can use the bodies own intrinsic healing strategies to improve patient outcomes.
Our current opinion is that Adipose Derived Stem Cells when isolated down to the Stromal Vascular Fraction gives the largest number of Cells for regenerative potential. Some providers are simply doing a whole fat graft and calling this a stem cell procedure, this is not what we do. We take additional steps to isolate the progenitor stem cell from the whole fat, to yield only the stromal vascular fraction. We then combine this with a leukocyte-poor and red blood cell poor Platelet-Rich Plasma.
This is all done by a simple in-office Lipo-aspiration procedure under local anesthetic and blood draw to obtain the PRP. Then the PRP/Stem Cell SVF sample is immediately injected into the pathologic area that same day. We are careful to stay within the FDA Guidelines of minimal manipulation and do not do any kind of stem cell culture and expansion, as this is currently not allowed in the United States by the FDA.
Please call our office 501-673-3116 or enter your information on our contact page to schedule an appointment so we can evaluate you and see if you would be a candidate for this procedure.