Regenerative/Biologics

Regenerative Medicine

What is Regenerative Medicine?

Regenerative medicine is a scientific and medical discipline which focuses on reining the power of stem cells and the regenerative capacity of the body in order to restore the functioning of damaged cells, tissues and organs. The goal of regenerative medicine is to find the path to cure previously untreated injuries and diseases.

Stem Cells

Stem cells are present in all of us acting like a repair system for the body. However, with increased age sometimes we don’t get optimum stem cells to the injured area. Regenerative medicine functions to amplify the natural repair system of the patient’s body.

To obtain the stem cells, your doctor administers a local anesthetic to the back of the hip (Posterior superior iliac spine) and takes a small bone marrow sample through a needle. The sampling procedure is called bone marrow aspirate, which is different from bone marrow biopsy and is less painful. Blood is also taken from a vein of the patient’s arm. These sample cells are processed and then re-injected into the area where repair of the damaged tissue is required. Imaging guidance such as real-time fluoroscopy or musculoskeletal ultrasound is used along with MRI to plan the location of the injection.

Mesenchymal Stem Cells

Mesenchymal stem cells (MSCs) are multipotent cells derived from non-marrow tissues, such as umbilical cord blood, adipose tissue, adult muscle or dental pulp of deciduous baby teeth. The isolated MSCs are also injected on the same day, along with natural growth factors obtained from the blood platelets of the patient. The main objective is to deliver a much greater number of stem cells to the injured area to restore its function.

Pluripotent Stem Cells

Researchers are employing different approaches for creating new pluripotent stem cell lines, such as in vitro fertilization embryos, nuclear transfer, and induced pluripotent stem (iPS). Different government and private organizations are committed to developing new stem cell-based therapies for chronic, debilitating diseases.

Pluripotent stem cells hold the greatest potential to treat a wide range of diseases but to create new stem cell therapies takes a long time. Before testing pluripotent stem cells in human disease, researchers must grow the right cell type, i.e.. differentiation of stem cells, and then their safety is first tested in animals before moving to human trials.

Regenerative medicine has a great potential to cure injured and impaired tissues. Scientists all over the world are researching ways to rein stem cells and use them for diagnosing and treating various disease conditions. 

Risks and Complications of Regenerative Medicine

Some risks factors are associated with regenerative medicine and include immune reactions from injected stem cells and also cells may become contaminated with bacteria, viruses or other pathogens that may cause disease. The procedure to either remove or inject the cells also has the risk of introducing an infection to the damaged tissue into which they are injected. In some cases, certain complications such as formation of tumors can be seen as a result of unproven stem cell treatment.

Why Regenerative Medicine

Regenerative medicine-based therapy is increasingly being recommended in the management of various orthopedic conditions due to its diverse benefits listed below.

  • It uses natural components of your body tissues, thus reducing the risk of adverse reactions or infection.
  • In addition to regenerating tissues, it also provides pain relief.
  • Certain degenerative conditions and injuries which were previously only treated by surgery may now show significant improvement with regenerative medicine, delaying or altogether avoiding the need for surgery. This is particularly beneficial for the aged and those with health conditions in whom surgery is not recommended.
  • In combination with surgery, it enhances healing and recovery.
  • Regenerative medicine procedures take no more than 2 hours and you can return to your activities in a day or two, making it ideal for sports professionals and those who do not wish to be disabled by a surgical procedure and a long recovery period.
  • The effects of treatment are usually long lasting and may be repeated if necessary.

Regenerative Orthopedics

Regenerative orthopedic is a subspecialty of regenerative medicine that focuses on regeneration of lost tissue, acceleration of healing, and pain relief to treat orthopedic conditions such as osteoarthritis, tendonitis, low back pain, joint injuries, ligament injuries, sprains and strains etc. Regenerative orthopedics uses:

  • Stem cells: Undifferentiated cells that can transform into any type of tissue. These are usually obtained from the bone marrow or fat.
  • Platelets: Platelets obtained from blood that help activate stem cells
  • Growth factors: Proteins obtained from blood that are essential for tissue repair and regeneration
  • Some of the conditions that can be treated with regenerative orthopedics include many common conditions such as osteoarthritis (degenerative arthritis), low back pain, strains and sprains, nerve injuries, and tendon and ligament tears.

Regenerative orthopedics is used to avoid or delay surgery, accelerate healing after surgery or injury, or when surgery or other therapies have failed. Recovery after treatment is quick and you may return to normal activities in 72 hours and to sports in 2 weeks.

Biologic Therapy

What is Biologic Therapy?

Biologic therapy includes innovative treatments that enhance the body’s natural capacity to heal. It is a type of regenerative medicine that uses various technologies to harvest the natural healing resources of the body such as stem cells, platelets and growth factors and targets their activity towards areas that need healing. These regenerative substances are present in various tissues and are usually obtained from the bone marrow, blood and fat.

Indications of Biologic Therapy

Biologic therapy is used to treat various medical and orthopedic ailments. It enhances the body’s ability to heal injuries including broken bones, and injured muscle, tendon, and ligaments. It can slow down degeneration, reduce pain, improve movement and delay the need for surgery.

Biologic therapy is an emerging field with a tremendous potential for growth and new applications.

Hyaluronates

What are Hyaluronates?

In order for joints to move smoothly they must contain an adequate amount of synovial fluid, which acts as a lubricant and shock absorber. Osteoarthritis causes synovial fluid to lose its properties by depletion of a component called hyaluronan. This leads to loss of cartilage and painful rubbing of the bones in the joints. A gel-like form of hyaluronan called hyaluronates or hyaluronic acid may be prepared and injected into the joints to increase their lubricating and shock-absorbing properties. Hyaluronate injections can relieve pain, improve mobility and delay the need for surgery.

Indications of Hyaluronate Injections?

Hyaluronate injections are usually performed after other non-surgical treatments for osteoarthritis such as medications, physical therapy and steroid injections have failed.

Hyaluronates Procedure

The procedure, also called viscosupplementation, first involves removal of any excess joint fluid with a syringe. Hyaluronates are then injected into the joint. Immediately following the injection, you may experience pain, swelling and warmth, which can be eased by ice applications. Avoid weight-bearing or strenuous activity involving the joint for the next 48 hours. The pain and swelling from osteoarthritis is gradually relieved with effects lasting for several months. A single dose or a total of 3 separate doses over several weeks may be required for optimum benefits.

Risks and Complications of Hyaluronates Procedure

Complications are rare but occasionally an allergic reaction may develop, intensifying symptoms.

PRP

Our blood consists of a liquid component known as plasma. It also consists of three main solid components which include the red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots.

Read more

Stem Cell Therapy

Stem cell therapy is a form of regenerative medicine that utilizes the body’s natural healing mechanism to treat various conditions.

Stem cells are being used in regenerative medicine to renew and repair diseased or damaged tissues and have shown promising results in treatments of various orthopedic, cardiovascular, neuromuscular and autoimmune conditions.

Stem cells are present in all of us acting like a repair system for the body. However, with increased age sometimes the optimum amount of stem cells is not delivered to the injured area. The goal of Stem Cell therapy is to amplify the natural repair system of the patient’s body. 

Types of Stem Cells

There are two major types of stem cells embryonic stem cells and adult stem cells. Embryonic stem cells (ESCs) are stem cells derived from human embryos. They are pluripotent, which means they have the ability to develop into almost any of the various cell types of the body.

As the embryo develops and forms a baby, stem cells are distributed throughout the body where they reside in specific pockets of each tissue, such as the bone marrow and blood.  As we age, these cells function to renew old and worn out tissue cells.  These are called adult stem cells or somatic stem cells. Like embryonic stem cells, adult stem cells can also replicate into more than one cell type, but their replication is restricted to a limited number of cell types.

Use of Stem Cells in Orthopedics

The unique self-regeneration and differentiating ability of stem cells has many applications in the field of orthopedics. The potential benefits include the possible healing of:

  • Bone defects
  • Nonunion fractures
  • Avascular necrosis
  • Cartilage injuries
  • Tendon & Ligament injuries
  • Meniscal damage
  • Spinal cord injuries
  • Intravertebral disc degeneration
  • Muscular dystrophies

Adult stem cells can be harvested from many areas in the body. These include adipose tissue (fat), bone marrow, peripheral blood, and umbilical cord blood.  The mesenchymal stem cell is the most commonly harvested. These have the ability to turn into cells that form the musculoskeletal system such as tendons, ligaments, and articular cartilage. To obtain stem cells from the bone marrow, a needle is inserted into the iliac crest of the pelvic bone to extract the stem cells.

Currently, stem cell therapy is used to treat various degenerative conditions of the shoulder, knees, hips, and spine. Stem cells are also being used in the treatment of various soft tissue (muscle, ligaments and tendons) as well as bone-related injuries.

Who is a Good Candidate for a Stem Cell Procedure?

You may be a good candidate for stem cell therapy if you have been suffering from joint pain and want to improve your quality of life while avoiding complications related to invasive surgical procedures.

Procedure

The procedure begins with your doctor extracting stem cells from your own bone marrow. Bone marrow is usually aspirated from your hip region. Your doctor will first clean and numb your hip area. A needle is then introduced into an area of your pelvic bone known as the iliac crest. Bone marrow is then aspirated using a special syringe and the sample obtained is sent to the laboratory. In the laboratory, the aspirate is spun in a machine for 10 to 15 minutes and a concentrated stem cell sample is separated.

Your doctor then cleans and numbs your affected area to be treated and then, under the guidance of special x-rays, injects the stem cells into the diseased region.  The whole procedure usually takes less than one hour, and you may return home on the same day of the procedure.

Conditions Treated by Stem Cell Therapy

Stem Cells for Knee Pain

What are the Common Knee Injuries/Diseases?

Any injury or disease of the knee will adversely affect the joint's range of motion. The most common knee injuries/diseases include

  • Knee Arthritis
  • Ligament Tear
  • Meniscal Tear
  • Patellar Tendinitis
  • Patellofemoral Instability
  • Cartilage Injury

How do Stem Cells Help in the Treatment of Knee Pain?

Stem cells are present in all of us acting like a repair system for the body. However, with increased age sometimes the optimum amounts of stem cells are not delivered to the injured area. The goal of stem cell therapy is to amplify the natural repair system of the patient’s body.

How do you Prepare for the Stem Cell Procedure?

It is important that you stop taking any non-steroidal anti-inflammatory drugs (NSAIDs) at least two weeks before your procedure.

Preparing for a stem cell procedure is relatively easy and your doctor will give you specific instructions depending on your condition.

How are Stem Cells Derived from Bone Marrow or Umbilical Cord Blood used for Treatment of Knee Pain?

Procedure Using Stem Cells Derived from Bone Marrow

The procedure begins with your doctor extracting stem cells from your own bone marrow. Bone marrow is usually aspirated from your hip region. Your doctor will first clean and numb your hip area. A needle is then introduced into an area of your pelvic bone known as the iliac crest. Bone marrow is then aspirated using a special syringe and the sample obtained is sent to the laboratory. In the laboratory, the aspirate is spun in a machine for 10 to 15 minutes and a concentrated stem cell sample is separated.

Your doctor then cleans and numbs your affected area to be treated and then, under the guidance of special x-rays, injects the stem cells into the diseased region.  The whole procedure usually takes less than one hour, and you may return home on the same day of the procedure.

Procedure Using Stem Cells Derived from Umbilical Cord Blood:

The same procedure can also be performed using pre-packaged, ready-to-use umbilical cord blood. Donors undergo a rigorous screening process to meet the highest industry standards. State-of-the-art scientific technology is used to create a cellular suspension of mesenchyme cells. These cells can differentiate in different cell types such as bone, cartilage, and muscle. The product is frozen to maintain cellular integrity. No synthetic or chemical preservatives are used. UCB has been scientifically proven to have concentrations of mesenchymal cells and other cell populations necessary to stimulate the regenerative process.

What Postoperative Precautions must be taken?

Post-Operative Care

  • You will most likely be able to return to work the next day following your procedure.
  • You will need to take it easy and avoid any load bearing activities for at least two weeks following your procedure.
  • You will need to refrain from taking non-steroidal, anti-inflammatory medications (NSAIDS) for a while as this can affect the healing process of your body.

What are the Risks and Complications of Stem Cell Therapy?

Stem cell therapy is generally considered a safe procedure with minimal complications, however, as with any medical procedure, complications can occur.  

Some risks factors related to stem cell therapy include infection as the stem cells may become contaminated with bacteria, viruses or other pathogens that may cause disease during the preparation process.

The procedure to either remove or inject the cells also has the risk of introducing an infection to the damaged tissue into which they are injected. Rarely, an immune reaction may occur from injected stem cells.