What is a stem cell?

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Stem Cell is a term use to describe a type of cell that is capable of proliferating (multiplying numerous times) and differentiating (becoming) into different type of tissue cells.  There are different types of stem cells, which can be classified depending tissue of origin or the type of cells they can become. Embryonic Stem Cells are the most powerful type of cells, which are the building block of the human fetus. They are called Totipotent cells, because they can differentiate into any kind of organ. The use of these cells are extremely controlled by the FDA and is only use in clinical research. They have  the potential to develop into tumors (teratomas). The source of embryonic stem cells is from unborn or unwanted embryos and is extremely controversial.

Another source of stem cells, which are very powerful, comes from the amniotic tissue or umbilical cord. These cells are obtained from the amniotic tissue, placenta or umbilical cord during normal delivery or Cesarean Section. The amniotic cells are highly anti-inflammatory and can multiply to a significantly higher degree than normal adult stem cells. There is no controversy or ethical issues and are readily available to regenerative medicine interventions.

Adult stem cells are present in every tissue in the human body and are responsible for tissue regeneration among other functions. They reside in an immature or dormant stage in every tissue. With the appropriate stimulus (such as trauma, cell death, high intensity work out), they can become a mature cell (differentiate).

There are two main sources of adult stem cells in clinical use in the United States: Bone Marrow and Adipose Tissue. They contain a significant population of different type of stem cells. Hematopoietic Stem Cells are mainly found in bone marrow and usually differentiate into red cells, platelets and other blood cells. Mesenchymal Stem Cells are mainly grafted from adipose tissue and can differentiate into bone, muscle, cartilage and adipose tissue.  In Regenerative Medicine, most adult stem cells can be readily obtained and processed in the clinic for “same day, point of care” interventions.

What is Stem Cell Rich Therapy?

In the United States and most International Research and Academic Institutions, the term “ Stem Cell Therapy “ is limited to the use of stem cells, which have been expanded (grown) in the laboratory. The number of cells can be in the billions and they are thoroughly tested and analyzed. In order word, 100% of the cells injected are stem cells. Unfortunately in most clinic regenerative medicine practices in the United States, the FDA does not allow the use of stem cells properly without a special research license called an IND. The current term use in these clinics is “Stem Cell Therapy”. This is incorrect and sometimes misleading, since the public equates it’s use with real stem cell therapy. Whether the cells are obtained from Bone Marrow or Adipose Tissue, the concentration of stem cells is no more than 5% of the total cell population. In other words, it is 95% stem cell free. At the Regenerative Spine and Joint Institute we have created a more appropriate term for the Bio-Cellular Interventions with stem cells. It is called, Stem Cell Rich Therapy because it has a significantly higher concentration of stem cells (from bone marrow, adipose tissue or amniotic tissue). It denotes that what we are injecting has a higher concentration of stem cells than what is present in these tissues without proper processing. It is an accurate term and not intended to mislead the consumer. We have having been using the term PRP (platelet rich plasma) in the same manner for over 20 years.

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How do Stem Cells heal?

Adult stem cells assist the healing process in multiple ways.  Most tissues contain areas where stem cells live in an immature state (dormant) called the niche. With the appropriate signaling (usually associated with tissue damage associated) the cells can proliferate (duplicate themselves) or differentiate (become an adult cells such as a muscle or nerve cell). These stem cells reside in the bone marrow (large reservoir for dormant cells) are also available for tissue healing through a process called homing. Homing is analogous to smoke signals send by damage tissue from a distance. Bone marrow cells react to these chemicals (cytokines) and break loose from the bone marrow, enter the circulation and reach the damage tissue via pores in the arteries. However, the main mechanism of action in which the stem cell rich therapy, as used in regenerative medicine, is through the secretion of powerful growth factors. The wonderful substances can revive moribund cells, prevent formation of scar tissue, decrease inflammation, help fight infection and attract other type of stem cells.

What are Bio-Cellular Regenerative Therapies?

Bio-Cellular Regenerative Therapy Is a broad term that describes the use of different substances, cells and tissue grafts, in order to induce biologic enhancement of tissue repair and regeneration.  It is an integral part of Tissue Engineering techniques utilized in an attempt to stop, restore or reverse painful degenerative changes in tissues such as joints, tendon, ligaments, nerves and intervertebral disc. These interventions are minimally invasive, cost effective, mostly performed though a needle like approach and can potentially prevent major surgical interventions and disability.

Based on the specific techniques utilized, they are categorized as Biologic Stimulants (contain substances that stimulate cells to perform a specific function and Bio-Cellular Grafts (contain different type of cells, including stem cells and other tissues such as collagen, fat, bone grafts). Stem Cell Rich Therapies in the main component of Bio-Cellular Grafts.

For more information See Bio-Cellular Regenerative Therapies

Bio-Cellular Regenerative Therapy Is a broad term that describes the use of different substances, cells and tissue grafts, in order to induce biologic enhancement of tissue repair and regeneration. It is an integral part of Tissue Engineering techniques utilized in an attempt to stop, restore or reverse painful degenerative changes in tissues such as joints, tendon, ligaments, nerves and intervertebral disc. These interventions are minimally invasive, cost effective, mostly performed though a needle like approach and can potentially prevent major surgical interventions and disability.

Based on the specific techniques utilized, they are categorized as Biologic Stimulants (contain substances that stimulate cells to perform a specific function and Bio-Cellular Grafts (contain different type of cells, including stem cells and other tissues such as collagen, fat, bone grafts).

Biologic Stimulants Therapies (BST)

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Is a type of therapy in which mostly substances are injected into the specific tissues (joints, discs, nerves, ligaments, tendons), in order to enhance the natural healing capabilities of damage or degenerative tissue. Even though, these biologic stimulants do not contain stem cells, they can be extremely effective in the treatment of early tissue damage or degeneration. We usually use several stimulants to achieve better outcomes and more frequently in combination with other bio-cellular therapies.
  • Prolotherapy (Creates cellular proliferation, nutritional benefits)
  • Ozone (Increases tissue oxygenation, improves healing)
  • Traumeel (Homeopathic anti-inflammatory)
  • Viscous Supplementation (Increases joint lubrication, sustain release of growth factors)
  • Peptide Therapy (anti-inflammatory, increases protein synthesis)
  • Hormone Therapy (accelerate protein synthesis, improves healing)

Bio-Cellular Graft Therapies

Is a type of Bio-Cellular Regenerative Therapy used in the treatment of moderate to advanced degenerative conditions or injuries. It utilizes your own blood derived growth factors PRP (which are chemicals that instruct cells to perform specific tasks) and stem cells derived from your bone marrow, peripheral blood or adipose tissues. These are frequently combined with your of tissue scaffolds (fibrin, adipose tissue) or synthetic (collagen, hyaluronic acid) in order to obtain the most effective results.

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PRP stands for Platelet Rich Plasma. This is a type of therapy in which the patient’s own blood is withdrawn from a vein and concentrated by a special device. Ultimately creating a concentrate of platelets in plasma. This concentrate contains up to 500% greater concentration of bioactive proteins along with multiple growth factors. They are essential in inducing and accelerating tissue repair and regeneration. The PRP is injected into specific tissues by using the most advanced tissue guidance with sonography (ultrasound) and fluoroscopy. Most of the benefit is seen in the connective tissues, bone, hyaline cartilages and development of new blood vessels necessary for tissue healing.
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BMAC stands for Bone Marrow Aspirate Concentrate and it is obtained by aspiration of bone marrow blood, usually from your iliac crest and takes about 3 minutes. It is usually performed under local anesthesia and intravenous sedation. BMAC contains multiple types of stem cells and other important cells that produce red cells, platelets, antibodies and others. More importantly, it contains a type of stem cell called mesenchymal stem cells (MSC). These cells are responsible for secreting growth factors that can significantly enhance the tissues ability to heal and regenerate. These are the cells with the greatest capability to repair bone, cartilage and muscle. The total number of mesenchymal stem cells present in BMAC is usually .1% of the total cell population.
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ADSC stands for Adipose Derived Stromal Cells. It contains a mixture of different types of stem cells and non-stem cells, which are obtained from your own adipose tissues, through a process called lipo-aspirate. The process usually takes 20 minutes and is performed under local anesthesia, frequently assisted with intravenous sedation. With a small liposuction cannula, a small amount of adipose tissue is removed, around 50cc. The lipo-aspirate is then taken to the laboratory (in houe) and the cellular components are extracted. The cell extract is rich in multiple type of cells, including stem cells. It contains a type of stem cell called mesenchymal stem cells (MSC). These cells are responsible for secreting growth factors that can significantly enhance the tissues ability to heal and regenerate. The number of mesenchymal stem cells (MSC) can be up to 500-800% more than in BMAC and they have greater anti-inflammatory and regenerative capabilities. The total population of MSC present in ADSC is roughly 5-8% of the cell population.
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AATG stands for Allogeneic Amniotic Tissue Graft and refers to amniotic tissues and fluids obtained from donors (carefully screened with no communicable diseases) during a cesarean section. It contains collagen, growth factors and a very small percentage of live amniotic stem cells. These cells are mesenchymal in origin and are more powerful than traditional adult mesenchymal cells. We utilized amniotic grafts in patients that cannot donate their own cells or are unwilling to undergo the graft extraction procedure. The procedure consists of injecting the cryo-preserved amniotic tissue (once is thawed), under sonograhic or fluoroscopic guidance, into the affected or injured tissue. AATG has been used in the world and the US with no reported complications of communicable diseases. It does not add extra time or an additional procedure to the regenerative treatment. We occasionally combine the AATG with BMAC or ADSC for a more robust repair.
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SCAFFOLDS are biologic grafts or materials, used in tissue engineering techniques, combined with growth factors and stem cells. It helps provide a 3D environment for the cells to be protected, proliferate and arranged them selves according to the tissue in which they are transplanted. More importantly, they act as a slow release systems for growth factors or biologic stimulants. It is an essential component in tissue engineering techniques. Scaffolds come from fibrin (obtained from your own blood), lipo-aspirate (from your own adipose tissues), collagen and Hyaluronic Acid (naturally manufactured tissue filers).

“These interventions are not designed as stand alone therapies and in order to achieve maximum tissue repair and regeneration may have to be repeated. It is important to continue to exercise proper ergonomics, bio-mechanics, avoidance of triggering factors, continue physical, chiropractic and massage therapy (as needed), and abide by a sound Regenerative Lifestyle. “