Dextrose Prolotherapy stimulates stem cell growth

Prolotherapy Knee articular cartilage repair without surgery

Ross Hauser, MD

One of the goals of stem cell therapy treatment is to repair and regrow articular cartilage (I cover this subject at length in my article Stem Cells and Prolotherapy for Knee Osteoarthritis and Cartilage Regeneration.)

Of obvious interest to doctors and researchers is how to make stem cells more viable and effective once in the diseased joint environment. The answer maybe glucose and dextrose, dextrose is the main ingredient in traditional Prolotherapy.

One source of injectable stem cells is adipose (fat) tissue. Adipose-derived stem cells are an excellent source of multipotent stem cells (cells that can transform themselves into other cells, i.e., cartilage) and are capable of differentiating into a variety of other cells that are useful for musculoskeletal conditions.

Researchers at Duke University subjected human-adipose-derived stem cells to concentrations of glucose. Of interest in this study was not only did the higher concentrations of glucose cause the stem cells to proliferate but their differentiation into osteogenic (bone) stem cell lines was only observed when the glucose concentrations were physiologically normal to high levels.  If this research is applied to humans in vivo (in the body) versus in vitro (in a cell culture) then for a stem cell to differentiate into a cartilage, for instance, a normal or high glucose level is needed.

This study was backed by new research published in 2016 from Chinese scientists experimenting with stem cell viability in a glucose environment.2

Dextrose Prolotherapy Creates Stem Cell Beneficial Glucose Levels

Hypertonic dextrose stimulates bone marrow-derived mesenchymal stem cells to proliferate.

One important published paper on stem cell research from Purdue University confirmed the notion that dextrose, especially hypertonic dextrose is a significant factor in the ability of mesenchymal stem cells from bone marrow to proliferate.3

The mesenchymal stem cell consumption of glucose increased proportionally with the glucose concentration in the medium. The higher the glucose concentration in the medium, the greater the glucose consumption by the bone marrow stem cells. The primary results note that the higher glucose and serum concentrations appear to produce higher cell populations over time.

Glucose is the primary substance stem cells use for energy.

Sometimes we forget the cells of the body obtain their energy via aerobic metabolism.  The primary substrates or substances that are needed for aerobic metabolism are oxygen and glucose. The body breathes to get oxygen and we eat to breakdown the food into sugar. Even if a person just eats protein, ultimately the body finds a way to breakdown the protein into individual amino acids and eventually into glucose. Without glucose the cells and the body cannot live.

When a physician injects hypertonic dextrose into a joint, immediately the dextrose concentration is cut in half because of the joint fluid inside the joint. Thus, when Caring Medical injects 15% dextrose into a knee joint for instance, it immediately becomes 7.5%, assuming the person has a normal amount of fluid in the joint.

This percentage is within the parameters of what has been studied in vitro, as the above published research papers note. Realize, however, that there is a difference between in vitro (in a cell culture) and in vivo (inside the body).  In a cell culture the solutions are maintained at the elevated dextrose concentrations. This does not happen in the human body.  The human body is magnitudes more complex than a simple culture. In the human body when Prolotherapy solution is injected into a joint it induces a change in these structures to stimulate their healing and then the body quickly equilibrates. A good example of this is what occurs during athletic performance.

When a person receives Prolotherapy once per month with hypertonic dextrose, published Prolotherapy research from our office confirms that patients with degenerative arthritis of the knees (for instance) regain their ability to exercise and walk because the crepitation (crunching) and pain in their knees is significantly less after Prolotherapy treatments. The patients also notice that their range of motion is improved. We therefore assume that the degenerative process is reversing inside the body.

Stem cell Prolotherapy combined with dextrose Prolotherapy.

Some of our patients receive stem cell Prolotherapy in conjunction with traditional dextrose Prolotherapy. We obtain the stem cells from the patients’ own bone marrow or fat, process them, and then inject them into the injured joint(s) in cases of more severe degeneration or injury/tears.

We find that in most cases, the injury is accompanied by an overriding joint instability, so not only do we inject inside the joint (with the stem cells) but around the joint as well, using dextrose Prolotherapy to repair these loosened ligaments and tendons. When stem cell Prolotherapy is given, not only are thousands of stem cells injected into the joint, but also the growth factors that help support them. The growth factors are derived either from the bone marrow itself or from platelet rich plasma (Note: PRP or bone marrow may be utilized to obtain the growth factors). These solutions contain plenty of dextrose (glucose) naturally, so no additional dextrose is given.  In other words, when utilizing stem cell Prolotherapy, the dextrose Prolotherapy is given to the structures outside the joint, such as the ligaments or tendons. The dextrose is not injected into the joint when stem cells are utilized because we want the maximum amount of stem cells and growth factors injected into the joint (i.e. not to utilize some of the space for dextrose, because it is naturally contained in the bone marrow or PRP solution). This combination approach works exceedingly well to return our patients to full function.

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Mischen BT, Follmar KE. Metabolic and Functional Characterization of Human Adipose-Derived Stem Cells in Tissue Engineering. Plastic & Reconstructive Surgery. 2008;122:725-738. [Pubmed]

Jiang Y, Cai Y, Zhang W, et al. Human Cartilage-Derived Progenitor Cells From Committed Chondrocytes for Efficient Cartilage Repair and Regeneration. Stem Cells Translational Medicine. 2016;5(6):733-744. [Pubmed]

3 Deorosan B, Nauman EA. The Role of Glucose, Serum, and Three-Dimensional Cell Culture on the Metabolism of Bone Marrow-Derived Mesenchymal Stem Cells. Stem Cell International. 2011;  Article ID 429187, 12 pages. Doi:10.4061/2011/429187

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