Biocellular Regenerative Medicine
Information about "Biocellular Regenerative Medicine":
Regenerative medicine is an evolving new field of medicine, which enhances a patient’s own healing mechanisms to induce therapeutic results. Over the past 30 years, injection therapies have increased and improved. Originally known as prolotherapy, use of injections of concentrated dextrose into damaged tissues led to stimulation of inflammatory capabilities and often improved the sites. Next, use of platelet concentrates (PRP) were injected into wound and injury sites to take advantage of the important healing factors contained in platelets.
Now, there are advances that directly stimulate the wound healing processes, PLUS, provide needed cells that have the ability to change into the types of cells to actually repair an injury site. These are known as adult stem cells, and are found in bone marrow and fat deposits. These cells and platelet concentrates are carefully placed via guided ultrasound directly into tissues like ligaments, tendons, muscle, joints, nerve injury, etc. to amplify the healing capabilities and lead to repair and return to comfort and function. Note, that these are taken from an individual and returned to that individual (known as autologous tissue), and have nothing to do with use of embryonic stem cells or use of another person’s tissues.
Basic understanding Of Adult Stem & Stromal) Cells:
The adult "progenitor" (Stem and Stromal) cells are found in fat, bone marrow, and, to a lessor extent in muscle, skin, and every organ of the body. Our body uses them for self repair and maintenance of our tissues. Without them, we would not be able to heal a wound, repair a fractured bone, maintain working organs, or a myriad of other basic functions. These undifferentiated cells are concentrated around our extensive blood vessel networks, and can be called upon in times of injury and damage, such that needed fibrous, muscular, neurological, fat, bone and cartilage to change into the types cells needed to heal the site. The signals that decide what cell type is needed come from damaged tissues, and can be amplified by addition of platelet concentrates which contain the major growth factors and signal proteins. This activates, recruits and stimulates cell change (differentiation) to control the healing processes. For many years, platelets were recognized as important in helping clot bleeding areas, but are now known to be much more important, serving to control the entire series of inflammation and healing changes we know as “wound healing”.
We now have the ability to separate and concentrate the cells from this area, and intravenous placement is rapidly gaining experience and offering help, many times in cases which have no cure, or inadequate medication (drug) improvements. The safety and potency of using a person's OWN is considered excellent and delivery does not expose patients to allergic reactions to the cells. These are the SAME cells that we use daily in maintaining our body's health, and repair in cases of injury or degeneration with age.
The cells are important, but they are not the only reason that the changes and improvements often reported and seen, as there is a VERY important factor in the actual secretions made from these cells which are effective at cross the blood brain barrier and influencing many different kinds of cells. This effect is known as "paracrine" effects which are now believed to be the most important of all factors in cellular and biocellular therapies. The impact is widespread if given in a vein, and felt to be locally, a very powerful influence on your own healing and repair. Through very small particles associated with these cells, tiny structures known as exosomes and microvesicles are felt to be the way in which these cells influence many cells and tissues requiring the information to initiate the regenerative processes and cause the repair processes to increase. This, in turn, directly impacts your own body to respond and react to the needed regenerative effects. Much research is being done at this point in time, and more detailed information is streaming to us at a very rapid rate.
Mechanisms Of Action For Adult Stem/Stromal Cells & Platelet Concentrates:
When there is an injury, one of the first responses is the attraction of platelets, the blood component that is responsible for clotting. The platelets “plug” the hole, if there is bleeding. After the bleeding is stopped, they begin to release important compounds held inside them in structures called “alpha granules”. These granules provide powerful growth factors and signal proteins (cytokines) which target undifferentiated cells to begin to activate and change, or recruit other cells critical to healing the particular site. Following obtaining a small volume blood sample, centrifugation concentrates the platelet fraction (4-6 times circulating amounts) that can be added to harvested tissues containing adult progenitor cells, and become a very potent stimulus for your healing of damaged or injured sites. Adult undifferentiated cells can most easily be gathered by use of a small syringe and a blunt tip tube from areas of fat deposit. Similar cells can be obtained from bone marrow, but the lower number of such cells, costs, and difficulty in getting bone marrow samples makes this option somewhat less attractive.
This combination is then placed under high-definition ultrasound guidance directly into the areas of identified damage. Once placed, the components enter into the actual “microenvironment” of injury and become active to help the site begin to heal itself without requiring open surgical intervention. This combination is also often recommended in areas of previous surgery which has incompletely healed, and to precede the plan for necessary open surgery to prepare the site for maximal response following surgery.
These therapies are still considered within the early clinical stages of development. For this reason, insurance carriers are hesitant to provide coverage, preferring to make it the patient responsibility to reimburse for the treatments. Thousands of such treatments have proven the safety and effectiveness of this form of regenerative therapy, using a patient’s own tissues to help in the healing processes.
Patients have been treated for a wide variety of musculoskeletal problems, ranging from tendon, ligament, joints (shoulders, elbows, hips, knees, ankles, neck-back, etc), muscle, and scar limitations of range of motion. In addition, it is well proven as effective for filling contour irregularities or augmentation of lost structural fat, nerve pain problems, and in skin trauma and chronic wound healing situations.
How is this done on me?
First, an accurate evaluation and diagnosis is completed by detailed history, physical examination, internal evaluations (X-ray, MRI, CAT scan, Ultrasonography, etc.), and review of records of surgical care (if done). Based on a combination of these findings, a treatment plan is developed for each individual case and situation.
Next is to gather the combination of platelets and adult progenitor cell source within your fat. Platelet concentrates are made from a small volume blood draw, placed in FDA approved centrifuge device to isolate and concentrate (up to 6 times circulating amounts). Simultaneously, under local anesthesia, a small volume of fatty tissue is removed with a microcannula and small syringe to remove the needed fat tissue and associated progenitor cells found attached to the fat cells and adjacent small capillary network. Once completed, the two components are combined and precisely injected into the desired location of damage or injury using handheld, high-definition, ultrasound-guidance.
In the early post-treatment period, it is recommended to avoid use of anti-inflammatory medications (such as Mobic, Meloxicam, Aleve (Anaprox), Rolafan, etc.). Use of these drugs may slow or limit your ability to fully heal the problem area. Use of Advil is permissible, and recommended to take two (200 mg over the counter) motrin/advil 3-4 times per day.
You will be asked to move the involved areas in order to maintain range of motion and weight-load of the problem area(s). No casting or splinting is typically required, as wound healing under controlled work load is considered important to accomplish a full recovery. In some cases, use of moist, cold compresses to the treated site is recommended, which may help reduce swelling and limit some post-treatment discomfort. We suggest that patients carefully “listen” to their body, and avoid excessive or potentially harmful activities in the early post-treatment period.
In some cases, it is recommended that a supplemental treatment may be of value in the 2-4 month timeframe to further enhance the final wound healing processes. This is often true in the more extensive or complex cases. Secondary treatments may involve only the use of platelet concentrates, or your treating physician may recommend PRP and progenitor cells within your fat. Secondary treatments are often less bothersome in the post-treatment period than the first time.
Treatments are usually performed under local anesthesia, with good tolerance remembering the sites treated are often already somewhat painful and inflamed prior to treatment. Oral pain medication is often prescribed to help for the first 2-3 days of discomfort.
Most patients have some pain with this procedure, but this is minimized with local anesthesia and mild sedation, if needed. Because this treatment is directed to areas that may be painful, there is often discomfort for the first 2-3 days. For many patients, this is minimal. It is normal to have intermittent tenderness off and on for the first few weeks and after heavy use of the problem area.
Known Risks or Complications: Very Uncommon Incidence
Incidence of complications are considered relatively rare, but as in any medical or surgical procedure they are possible. Although wound healing may be enhanced, it remains out of either the physician or patient control. It is considered very important to carefully follow the verbal and written instructions to optimize your care and safety.
1- Allergic Reaction: Reaction to local anesthesia or medications is always possible. Because the stem-stromal cells and PRP used in this process are autologous (from the patient him or herself), there is no fear of rejection or allergy.
2- Infection: The stem cells and PRP that we inject are some of the same cells that are activated to fight infection, so this risk is also low. However, anytime that material is injected into the body, there is a risk of infection, which could be serious and in the extreme, life-threatening.
3- Excessive Bleeding or Clot Formation: Unlikely, either in the area treated or at the fat donor site, cold compression is typically adequate to control.
4- Irregularity At Fat Donor Site: Very unlikely due to small volumes (usually only 5-8 teaspoons) needed and has not been reported with our patients using the very small tubes to harvest the cells needed
5- Fat or Blood Embolism: Extremely unlikely events, patients are ask to take a “child’s” aspirin (81 mg) for up to 10 days as a mild preventative to clot formation. At this dose, aspirin will not materially impact the inflammatory processes. to our knowledge, this has not been reported in the medical literature at this time.
6- Incomplete Improvement Of Problem: Although many patients are significantly helped, complete wound healing is not within the control of the patient or the physician, therefore, no guarantees can be given
7- Worsening Of Condition: This has been extremely unusual, and is thought to be a subjective patient response, or, advancement of disease or injury processes
8- Temporary or Permanent Injury To Nerves: Any injection may injure nerve structures in the path of the needle used to inject. This is typically transient, with gradual improvement over time and healing
9- May Not Eliminate The Need For Open Surgery: Even if invasive surgery is required after regenerative therapy, often patient’s outcomes are believed to be improved based on more effective healing response
10- There is almost always at least some temporary discomfort or occasionally significant pain following treatment, and appropriate medication will be prescribed.
11- If sedation is used for the procedure, the risk of sedation (very rare) and reactions to these medications is possible.