Health feature: Regenerative therapies, part 1: What are stem cells?
July 19, 2016
Editor's note: This is the first article in a series about regenerative therapies. The intention of this series is to inform medical consumers about current and future choices when looking at potentially undergoing a stem cell treatment and to provide a coherent explanation of what we know and are trying to understand about this new wave of medicine.
Stem cells have collected attention in the realm of public perception and in the medical community over the years because of their capability to transform the way we treat a variety of diseases, injuries and chronic pain. However, much is still unknown about the full potential for the regenerative properties of stem cells.
While research is ongoing to determine the potential applications for stem cells, and to better understand how the cells actually work, the consensus from both researchers and clinicians is that stem cells will change the face of medicine in years to come and will eventually be how we are able to treat, and even cure, a range of ailments.
The umbrella of regenerative medicine is a growing one, as more studies are constantly adding to the growing body of research about the benefits that stem cells might offer to a medley of conditions. Stem cells are found in multicellular organisms and are unspecialized cells that can spread throughout the body and change into highly specialized cells, often taking the place of dead or damaged cells.
The ability of stem cells to renew themselves into whatever tissue they are introduced to makes them highly malleable in terms of applying them with regenerative intentions within the body. While stem cells are mostly being used in an orthopedic context right now, their potential to treat cardiac problems, degenerative diseases and chronic illness is on the horizon.
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Dr. Thos Evans, of The Steadman Clinic, explained that stem cells are found throughout the human body, and that the advancement of stem cell research is one that is important for the future of medicine.
"Stem cells exist in multiple parts of our body such as bone marrow, fat, muscle, organs, components of bone and even blood vessels," he said. "What we're seeing using these types of cells in different treatments and research is really just the tip of the iceberg as far as what they're capable of."
Currently, the more common sources of stem cells used in a clinical setting are platelet rich plasma (PRP), bone marrow aspirate concentrate (BMAC) and fat aspirate, although these are often used in collaboration with one another on a case-by-case basis to increase effectiveness based on the location and type of injury.
The stem cells are typically harvested from the adult who will be receiving the treatment, as the use of an individual's own cells have a much lower risk of rejection or infection. Once a sample of the individual's bone marrow, blood or fat is taken to use in a stem cell treatment, it's consolidated in a centrifuge to provide a highly concentrated formula that can then be injected into the area of degeneration, chronic pain or injury.
Each location where cells can be harvested in the body has different concentrations of the actual stem cells, and no current treatment is a pure stem cell treatment. The consolidated breakdown of BMAC, for instance, comes out consisting of only 1 percent stem cells, although researchers and clinicians have seen promising results even with a lower dosage of the regenerative agents.
Dr. Robert LaPrade, of The Steadman Clinic, has spent years researching the growing field of regenerative medicine and biologics and said even the small amount of stem cells found in a BMAC injection is often proving to be effective in relation to healing.
"The 1 percent of stem cells (consolidated from BMAC) may help the homing of other stem cells in your system to come to that area and it also may make some of your normal cells release tissues that are beneficial," he said.
Researchers are finding that different types of stem-cell injections work differently throughout the body and may have a diverse localized reaction, depending on where the treatment is injected. Much of the research is still in the initial phases of designating the most efficient and effective collaborations of stem cells for different types of treatments, as a dose of BMAC might show regenerative properties for, say, tennis elbow but might actually cause irritation when applied to a knee injury.
"We're learning daily what patients respond best to, a BMAC or PRP injection, because certain types of patients respond differently to different treatments," Evans said. "For instance, we're finding that PRP is more helpful in treating muscle tears and tendon injuries or tendinitis by itself, but depending on the clinical situation, we might use BMAC along with it."
The Food & Drug Administration is largely responsible for providing the guidelines with which researchers can conduct studies involving stem cells, and clinicians can apply them to patients. It's important to note that although the use of fetal tissues regarding stem cell research has garnered a lot of attention over the past year, the application of such stem cells in a clinical setting isn't allowed, and much of the research regarding fetal tissues has shown a high rate of variability because of the immense concentration of the more primitive cells.
Dr. Scott Brandt, of ThriveMD in Edwards, explained that the data being gathered from research on that type of stem cell source has shown to be somewhat inconsistent and has led regulators to only allow applications of stem cell treatments to come from adult cells.
"The reason that we don't use embryonic cells and the embryonic world got shut down is that I liken embryonic cells to a Ferrari with no brakes," he said. "It's an unbelievable cell that starts at the beginning of time, but it can become anything at any time."
While the United States has put a hold on using embryonic cells for stem-cell research and clinical applications, some patients have been seeking the treatment in other countries, many of which have far laxer guidelines for the technology's use in clinical studies. And while the promise of stem cells has been increasing traffic to health care providers by those looking for the treatment, or sending them overseas in search of a miracle injection, doctors are quick to point out that stem cells have shown great potential, but they are not yet the magic bullet.
"It's important to take the time to educate yourself and go into the process of exploring stem-cell treatments with a realistic understanding of expectations and what the options are," Evans said. "Patients should be their own advocates and realize that these regenerative treatments are used in isolation, but also in conjunction with surgery."