Adult Stem Cells For Tissue Regeneration

Runners, jumpers, and other athletes such as skiers, cyclists, and soccer players put heavy stress on their knees. Runner’s knee is a term used to refer to a number of medical conditions that cause pain around the front of the knee (patellofemoral pain). These conditions include anterior knee pain syndrome, patellofemoral malalignment, and chondromalacia patella.

A dull, aching pain under or around the front of the kneecap (patella) where it connects with the lower end of the thighbone (femur). Pain occurs when walking up or down stairs, kneeling, squatting, and sitting with a bent knee for a long period of time.

The knee is a complex structure and is very sensitive. A number of factors can contribute to runner’s knee, including:

• Malalignment of the kneecap
• Complete or partial dislocation
• Injury
• Excessive training or overuse
• Tightness, imbalance, or weakness of thigh muscles
• Flat feet

Patellofemoral pain may be the result of irritation of the soft tissues around the front of the knee. Strained tendons are fairly common in athletes. Other contributing factors to patellofemoral pain include overuse, muscle imbalance and inadequate stretching. Pain that begins in another part of the body, such as the back or hip, may cause pain in the knee (referred pain).

In some people with runner’s knee, the kneecap is out of alignment. If so, vigorous activities can cause excessive stress and wear on the cartilage of the kneecap. This can lead to softening and breakdown of the cartilage on the patella (chondromalacia patella) and cause pain in the underlying bone and irritation of the joint lining.

Treatment:

The joint preservation model advocates an in-depth analysis of a person’s back, hips, and legs - in addition to just focusing on the knee joint.  If one area is out of allignment, this will have downstream effects on the knee and, if not treated, will result in constant knee pain.  

These biomechanical issues are addressed with things like IMS (intramuscular stimulation) and targeted physical therapy.  If there knee cartilage damage, a person’s own stem cells can be transplanted into the joint in order to regenerate the lost cartilage.

This conservative approach, as an alternative to knee surgery, helps to avoid more traditional knee surgery pain and pain after  knee surgery.

     In orthopedic speak, “repair” means surgery.  Regrettably, knee surgery options are limited to microfracture, partial or total knee replacement.  A big concern of many is knee surgery pain and pain after knee surgery.  A good friend described total knee replacement as “sawing off the end of your bones and hammering in titanium tent pegs.” 
    

He then went on to say how he feared that total knee replacement surgery would forever limit his activities like mogul skiing and trail running.  Unfortunately, this is in large part true.  While knee replacements can get the poorly mobile back on their feet - once the pain after knee surgery subsides, aggressive activities are limited.

   There is an alternative to knee replacement surgery: with a relatively pain free, short recovery period, that allows return to aggressive, high impact activities like running, skiing, or in this particular case - kick boxing. It is transplantation of your own stem cells.  In a new, though prooven stem cell transplant procedure, cartilage can be re-grown in knees simply by placing them in the joint with a needle.  Thus the painful “bone on bone” arthritis, partial ligament and meniscus tears, can be healed effectively with your body’s own natural tissue, allowing quick return to your usual activities.

The process begins by isolating a person’s own (Autologous) Mesenchymal stem cells (MSCs) from a sample of bone marrow drawn from their hip.   The MSCs then divide in a natural growth medium that comes from the same person’s blood platelets.  The result is to take the relatively small number of MSCs found in a sample bone marrow, say 2 million, and expand them to a population of 20 – 50+ million.  With these numbers, substantial tissue growth is made possible.  The MSCs are then injected with a small needle, under live x-ray, into areas of bone, cartilage, and ligament/ tendon damage.

     Cartilage can be regrown in generalized arthritis and/or solitary cartilage defects in knees, shoulders, ankles, hips, and fingers.  It can also grow to repair partial meniscus tears. Ligaments and tendon injuries, such as sprains or partial tears of the ACL, PCL and MCL of the knee, the rotator cuff and supporting ligaments of the shoulder, ankle and hand/wrist, as well as plantar fasciitis, golfer’s and tennis elbow, can also be repaired.  Bone can be re-grown in chronic non-healing stress fractures or fractures of larger bones that have not healed in spite of casting or even surgery.  Chrinic conditions such as avascular necrosis have also been successfully treated.  Finally, some painful disc bulges in lumbar spine (low back) can be corrected to relieve back and leg pain.

 People undergoing these treatments are back on their feet the same day.  Those undergoing hip, knee, and ankle injections can begin walking longer distances after the first week.  Their activity levels are gradually increased over the following month, with the expectation that they will be back to their pre injury activity level after three months.

Stem cells are primal cells found in all multi-cellular organisms. They retain the ability to renew themselves through mitotic cell division and can differentiate into a diverse range of specialized cell types.  In adult organisms, stem cells and progenitor cells act as a repair system for the body, replenishing specialized cells.

Stem cells are, in essence, the building blocks of the body.  In adults, they are produced in the bone marrow, fat, and joint fluid.  When released into the bloodstream, they migrate to areas that need repair.  Research has shown that they hone in on areas of injury, and are more effective if placed at or near the damaged site. [  ]  Once there, they become whatever kind of tissue needs help regenerating itself.  Mesenchymal stem cells (MSCs) are the class of stem cells that most commonly repair cartilage, bones, and muscle.  As we age, we produce fewer and fewer MSCs, which explains, in large part, why we have more trouble healing ourselves now than when we were children.

For many years, researchers and clinicians have known that  stem cells can repair and regenerate damaged tissues.  Most of these experiments have been done in animal models. Research has shown that stem cells can improve function of heart muscle after a heart attack , increse insulin secretion from the pancreas in diabetes , and heal brain tissue after a stroke .   Only recently have there been published studies of bone and cartilage regeneration in humans using autologous adult mesenchymal stem cells.[ 1,2 ].

2. Embryonic stem cell injections or cord blood injections: These are stem cells from someone else injected IV. Most of this is happening in third world countries. A few issues. One question is how these stem cells were isolated, as there has been at least one significant allergic reaction (which should never happen with a true stem cell) reported on a California company offering embryonic stem cells in Mexico. Assuming they are stem cells, the second issue is disease transmission. First, there are the common diseases such as HIV, Hepatitis, and other viral infections we can detect. Second, there is the issue of stem cells being able to transmit genetic disease such as an increased risk for osteoporosis (see earlier post). Finally, there isn’t much data that shows that if you have a bum knee, a bad kidney, and liver spots on your skin, that these cells will be able to home to one of these areas to allow repair. In fact, most studies show that even in severe injury models (where a severe life threatening injury is created like a heart attack or a lung injury) direct infusion of cells to the damaged area results in more repair than placing the cells in the blood stream.

3. Adult stem cell injections IV: I have seen clinics beginning to use various marrow concentrate systems to inject marrow nucleated cells into the veins (IV). Again, the issues with IV infusion as discussed above apply here as well. The other big issue that that MSC’s make up about 1 in 50,000 to 1 in 500,000 of these marrow nucleated cells. This means a very very dilute stem cell population is actucally being injected. As an example, 50 cc of bone marrow might contain trillions of cells, but only less than 0.0002% (in some older patients) are actually stem cells capable of tissue repair.

4. Bone Marrow concentration via bedside centrifuge: There are companies advertising systems (as above) that take whole bone marrow and magically produce millions upon millions of stem cells. Actually, the stem cells they refer to are CD34+ heme progenitors (stem cells that make more blood products) and not MSC’s which can repair tissue. So the same issues as above apply