My goal as a regenerative medicine physician is to know what research backs up the various treatments that I offer to patients. And actually it is more than just a goal, it is my duty to know. If I cannot find some evidence that a therapy is beneficial, then I shouldn't be doing it. As a doctor, I am responsible for being informed and only offering safe and efficacious solutions for my patients.
This blog is my effort to compile the data that I find into an easy-to-understand synopsis for patients looking to educate themselves. The intent is to summarize the research and give an educated opinion about it. And many of these blogs stem directly from questions that patients have asked me.
Along that line, I receive many inquiries into cellular therapies, including platelet-rich plasma (PRP) and stem cells. These 2 techniques involve using a patient's own cells to elicit a healing response within their own body. They are very safe as there are no foreign substances used, no pharmaceuticals, no implants. But there is some question as to which is better, or in what circumstances to use one therapy over the other.
Obtaining PRP is relatively simple, involving only a blood draw from the patient. The blood is then put through a series of spins in a centrifuge in order to obtain a highly concentrated sample of platelets and growth factors within the plasma. This liquid product can then be injected into a joint, tendon, ligament, muscle, or the like, in order to help facilitate healing and pain relief. There is rarely any downtime, and only minimal side effects associated with it.
Obtaining stem cells is a bit more involved, requiring a minor procedure to obtain either fat cells through manual liposuction or occasionally bone marrow via a bone marrow harvest. These both require incisions and some post-operative care due to the fact that these are both more invasive than just obtaining blood. Also, the process involved in isolating the stem cells is more complex and time-consuming. This directly relates to more expense for the patient.
Given these factors, using PRP tends to be the first recommendation for many patients. Obviously this depends on each patient and the specific medical issue being addressed. That being said, the benefits associated with PRP along with the low risk and ease of obtaining and preparing the sample make this an ideal first therapeutic option. Also, the monetary cost to the patient is much less when compared to a stem cell procedure. There are some situations however, where PRP may not be appropriate. Again, the decision must be made after careful consideration between you and your physician. Learn the pros and cons of each and ask questions. The final choice will ultimately depend on your specific circumstances.
Friday, December 15, 2017
Friday, May 12, 2017
More Research with Stem Cells and Multiple Sclerosis
A recent study (JAMA Neurol. 2017; 74(4):459-469) by Paolo Muraro, et al. looks at long-term results of stem cell therapy on multiple sclerosis (MS). This study followed 281 MS patients with predominantly progressive forms of the disease that were not responding to standard therapies. These patients received autologous hematopoietic stem cell transplants between 1995 and 2006 (meaning that the stem cells were taken from their own peripheral blood).
The observational data was collected from 25 different medical facilities in 13 countries, with 77% of the patients exhibiting progressive forms of MS and median follow-up was 6.6 years. Multiple factors were looked at in this study, including age, number of prior disease-modifying treatments, disease sub-type/severity, baseline Expanded Disability Status Scale (EDSS) score, and the overall intensity of conditioning regimen and graft manipulation. The primary outcomes were both MS progression-free survival and overall survival.
Out of the 281 patients, 8 died within the first 100 days of transplant and these were considered a transplant-related mortality of 2.8%. It is not known if these deaths were truly attributable to the stem cell therapy, but were considered for mortality based on the structure of the study.
The 5-year probability of progression-free survival was 48% and overall 5-year survival was 93%. It is remarkable that almost half of the patients remained free from neurological progression at 5 years. Better outcomes were associated with younger age (not surprising, as this has been repeatedly shown), relapsing form (vs. progressive MS), fewer previous immunotherapies, and lower baseline EDSS scores.
These findings support further studies of stem cell therapies for treatment of MS in order to delineate the exact modalities and procedures that will provide consistent and beneficial results. Once again, stem cells seem to be a key link in the future of medicine and treatment of difficult disease processes.
The observational data was collected from 25 different medical facilities in 13 countries, with 77% of the patients exhibiting progressive forms of MS and median follow-up was 6.6 years. Multiple factors were looked at in this study, including age, number of prior disease-modifying treatments, disease sub-type/severity, baseline Expanded Disability Status Scale (EDSS) score, and the overall intensity of conditioning regimen and graft manipulation. The primary outcomes were both MS progression-free survival and overall survival.
Out of the 281 patients, 8 died within the first 100 days of transplant and these were considered a transplant-related mortality of 2.8%. It is not known if these deaths were truly attributable to the stem cell therapy, but were considered for mortality based on the structure of the study.
The 5-year probability of progression-free survival was 48% and overall 5-year survival was 93%. It is remarkable that almost half of the patients remained free from neurological progression at 5 years. Better outcomes were associated with younger age (not surprising, as this has been repeatedly shown), relapsing form (vs. progressive MS), fewer previous immunotherapies, and lower baseline EDSS scores.
These findings support further studies of stem cell therapies for treatment of MS in order to delineate the exact modalities and procedures that will provide consistent and beneficial results. Once again, stem cells seem to be a key link in the future of medicine and treatment of difficult disease processes.
Friday, January 20, 2017
Stem Cells Repair Teeth
Researchers at the King's College London published an interesting study in Scientific Reports wherein a novel stem cell treatment was used to self-heal tooth cavities.
The study involved the use of a molecule called Tideglusib, a kinase inhibitor that actually activates stem cells and pushes them into repair mode. This same inhibitor has also been successfully used in the treatment of Alzheimer's disease through clinical trials.
Traditionally, large cavities have been filled with a variety of substances, including porcelain, composite resin, cement, gold, and amalgams that may have mercury or silver. These types of fillings remain in the tooth indefinitely, and can break over time. This obviously then requires another filling to replace the damaged one. The reason to have fillings is that teeth cannot naturally repair large cavities on their own.
Ordinarily, our teeth heal damage by promoting the release of dentine within our bodies. Dentine is the hard, dense bony tissue of our teeth that occurs below the enamel. This natural coating helps to protect the soft pulp of our teeth. In the case of large cavities, the amount of dentine that is naturally produced is insufficient to completely heal the deficit. In addition, it appears that fillings themselves subsequently prevent normal mineral levels from being restored in the affected tooth.
The researchers in this study proposed a new treatment option that involves biodegradable collagen sponges along with Tideglusib to promote stem cell activity. The sponges help to deliver glycogen molecules into the cavity and then deteriorate over time, allowing dentine and the natural mineralization to fill in the cavity. Through this treatment modality, stem cells are signaled and attracted to the damaged area, helping to activate the natural repair mechanism.
This novel approach would diminish the need for traditional fillings and the possibility of needing those replaced in the future. Once again, our very own cells are used to heal and treat our own bodies!
The study involved the use of a molecule called Tideglusib, a kinase inhibitor that actually activates stem cells and pushes them into repair mode. This same inhibitor has also been successfully used in the treatment of Alzheimer's disease through clinical trials.
Traditionally, large cavities have been filled with a variety of substances, including porcelain, composite resin, cement, gold, and amalgams that may have mercury or silver. These types of fillings remain in the tooth indefinitely, and can break over time. This obviously then requires another filling to replace the damaged one. The reason to have fillings is that teeth cannot naturally repair large cavities on their own.
Ordinarily, our teeth heal damage by promoting the release of dentine within our bodies. Dentine is the hard, dense bony tissue of our teeth that occurs below the enamel. This natural coating helps to protect the soft pulp of our teeth. In the case of large cavities, the amount of dentine that is naturally produced is insufficient to completely heal the deficit. In addition, it appears that fillings themselves subsequently prevent normal mineral levels from being restored in the affected tooth.
The researchers in this study proposed a new treatment option that involves biodegradable collagen sponges along with Tideglusib to promote stem cell activity. The sponges help to deliver glycogen molecules into the cavity and then deteriorate over time, allowing dentine and the natural mineralization to fill in the cavity. Through this treatment modality, stem cells are signaled and attracted to the damaged area, helping to activate the natural repair mechanism.
This novel approach would diminish the need for traditional fillings and the possibility of needing those replaced in the future. Once again, our very own cells are used to heal and treat our own bodies!
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