Stem Cell Therapy (Cellular Prolotherapy)
One of the most exciting additions in the regenerative medicine field of Prolotherapy has been Stem Cell Therapy. We often times refer to this, in our office, as Cellular Prolotherapy. It means that we use a person’s own healing cells from bone marrow, fat, and blood (alone or in various combinations) and inject them straight to the area which has a cellular deficiency. The goal is the same: to stimulate the repair of injured tissues. Stem cells aid in fibroblastic proliferation where cell growth, proteosynthesis, reparation, the remodeling of tissues, and chondrocyte proliferation occurs. Our bone marrow contains stem cells, also termed mesenchymal stem cells and progenitor cells, among other names. These immature cells have the ability to become tissues like cartilage, bone, and ligaments.
Typically the tissue that we are trying to stimulate to repair with Cellular Prolotherapy is articular cartilage, but we can also proliferate soft tissues structures such as ligament and tendons. This is new technology so we are studying it as we use it to treat patients. The medical literature supports its use in animals, thus, we extrapolate this to its use in humans. In addition, we have been continuing to add to the scientific literature with Bone Marrow Therapy papers based on our results and research.
There is always conflicting research into the efficacy of any treatment protocol and stem cell injection therapy is no different. Many times a patient will point to his or her own clinical dissatisfaction or research and say, stem cell therapy does not work as well as advertised. Let’s look at some of that research:
“Osteoarthritis (OA) is a cartilage degenerative process, involving the immune system, producing local inflammatory reactions, with production of pro-inflammatory cytokines [messenger cells made of proteins that regulate inflammation] and metalloproteinases [enzymes that work as messengers]. No treatment is still available to improve or reverse the process. Stem cell therapy opened new horizons for treatment of many incurable diseases. Mesenchymal stem cells (MSCs) due to their multi-lineage potential [ability to change into cartilage, bone cells, etc.], immunosuppressive activities, limited immunogenicity and relative ease of growth in culture, have attracted attentions for clinical use. [In other words ease of use].
In this research four patients with knee osteoarthritis were selected for the study. They were aged 55, 57, 65 and 54 years, and had moderate to severe knee OA. After their signed written consent, 30 mL of bone marrow were taken and cultured for MSC growth. After having enough MSCs in culture (4-5 weeks) and taking in consideration all safety measures, cells were injected in one knee of each patient.
The walking time for the pain to appear improved for three patients and remained unchanged for one. The number of stairs they could climb and the pain on visual analog scale improved for all of them. On physical examination, the improvement was mainly for crepitus. It was minor for the improvement of the range of motion.
Results were encouraging, but not excellent. Improvement of the technique may improve the results.”1
We agree that stem cell therapy has benefits but may not provide a full cure. This is why we recommend the use of Platelet Rich Plasma Therapy in conjunction with stem cell therapy. The study above involved direct stem cell injection. Stem cell therapy is more effective if the stem cells are given better direction. This is where the growth factors in blood platelets can be very effective. Platelets aid the stem cells in their various jobs including differentiation and then aid in the differentiated cells making the extracellular matrix to repair the injured tissue.
Platelet Rich Plasma contains a myriad of substances that stimulate healing:
- Platelet-Derived Growth Factor (PDGF) Attracts immune system cells to the area and stimulates them to proliferate. Has been shown to enhance ligament and tendon healing.
- Transforming Growth Factor-8 (TGF-8) Secreted by and affects all major cell types involved in healing. Similar affects as PDGF.
- Vascular Endothelial Growth Factor (VEGF) Helps new blood vessel formation, thereby increasing vascularity in injured areas.
- Fibroblast Growth Factor (FGF) promotes the growth of the cells involved in collagen and cartilage formation.
Numerous studies have shown that PRP enhances the effects of Stem Cell Therapy2, 3 As the study above notes – “Results were encouraging, but not excellent. Improvement of the technique may improve the results.” Platelet Rich Plasma therapy improves the technique and improves the results.
The goal of Stem Cell Therapy – Cellular Prolotherapy
Our ultimate goal with all forms of Prolotherapy is to get the patients back to doing the things that they want to do without pain. It is our hope that the Stem Cell Therapy (Cellular Prolotherapy) treatments will form functionally, structurally, and mechanically equal to, if not better than, living tissue which has been designed to replace (or work alongside of) damaged tissue. It is hard to prove the above statement because we cannot sacrifice human beings after Prolotherapy to see if the tissue looks and acts normally. We can, however, report that the majority of our patients who receive Stem Cell Therapy along with traditional Hackett-Hemwall Prolotherapy get back to activities and have dramatically decreased pain levels using this comprehensive approach.
1. Davatchi F, Abdollahi BS, Mohyeddin M, Shahram F, Nikbin B. Mesenchymal stem cell therapy for knee osteoarthritis. Preliminary report of four patients. Int J Rheum Dis. 2011 May;14(2):211-5. doi: 10.1111/j.1756-185X.2011.01599.x. Epub 2011
2. Mishra A, Tummala P, King A, Lee B, Kraus M, Tse V, Jacobs CR. Buffered platelet-rich plasma enhances mesenchymal stem cell proliferation and chondrogenic differentiation. 2009 Sep;15(3):431-5.
3. Kasten P, Vogel J, Beyen I, Weiss S, Niemeyer P, Leo A, Lüginbuhl R. Effect of platelet-rich plasma on the in vitro proliferation and osteogenic differentiation of human mesenchymal stem cells on distinct calcium phosphate scaffolds: the specific surface area makes a difference. J Biomater Appl. 2008 Sep;23(2):169-88. Epub 2008 Jul 16.