Discussions driven by the media as well as physicians and other clinicians without extensive scientific or research training have contributed mightily – and often erroneously – to the understanding of stem cells in general and their use in joint pain treatment specifically. The following are five need-to-knows about stem cells and their treatment in joint pain, chronic tendonitis and arthritis.
- Stem cells (progenitor signaling cells) are a type of cell in the body that have the ability to duplicate themselves (clonality) and specialize into other types of cells that are necessary to maintain the health of tissue and the individual. Cells specialize based on environmental cues (chemical signaling) that come from cellular injury.When cartilage cells (chondrocytes) sustain cellular damage from a heart attack, the injured cell membranes become leaky. Proteins usually confined to the intracellular space escape into the extracellular space and become small molecule signals that sound the alert. Stem cells in the synovium (joint lining) around blood vessels (called pericytes) and in distant locations called niches are attracted to the area and naturally turn themselves into new heart cells to attempt to repair the damage. Vascular endothelial growth factor (VEGF) is transcribed (made) by cellular DNA reading machinery and attracts new blood vessels that are coated with stem cells (pericytes). Wherever the new blood vessels branch, stem cells are dragged in with them that can repair and regenerate normal tissue without scarring.
- The concept of the “stem cell” when described in the context of clinical applications like “stem cell injections” is really oversimplified. There are basically two types of mesenchymal stem cells: Type 1 (MSC1) is pro-inflammatory, and Type 2 (MSC2) is anti-inflammatory. They each play a major role in tissue catabolism (breakdown) and anabolism (build up). It’s more than just the cells that do the work, too. There are MANY other cells in the bone marrow that contribute to tissue repair and regeneration that are NOT found in adipose, or fat tissue stem cells. Cells communicate with one another and with the extracellular matrix through complex signaling cascades. Cell signaling prompts come from environmental cues.The mesenchymal stem cells (MSC) that are used in clinical medicine, unlike embryonic stem cells that can become ANY cell type, can only specialize into cartilage, tendon, bone, ligament, fat, some muscle types and other connective tissues.One of the biggest areas of study now is identifying more exactly the proteins involved in the signaling cascades so that in the future we can “manipulate” cells in vivo (while they are active in the body) to perform the tasks we want them to.
- Bench scientists and orthopedic surgeons practicing regenerative techniques have come to agree that when the patient’s own stem cells are injected into a damaged joint or tissue using a minimally invasive, virtually painless and bloodless, in-office procedure they work via three basic mechanisms. Cells are concentrated and captured using isopycnic centrifugation. The cells engraft upon injection and form connections with other cells and the extracellular matrix through adhesion molecules called cadherins and integrins. Once engrafted, the cells communicate with one another and elaborate growth factors specific for the tissue injury. Groups of cells then work together to effect a healing response.The cellular signals that are elaborated call in “stem” cells and other reparative cells. Cellular signals modulate the immune response and the inflammatory response, eliminating the release of pain causing molecules, or blocking their receptor sites so that the catabolic processes are able to be challenged by anabolic processes. Stem cells produce other stem cells that can specialize into cell types like cartilage (chondrocytes). The ability for these techniques to grow cartilage has been demonstrated clearly in the animal model and in vitro. However, these trophic effects are felt to play a smaller role than initially thought. Patients with more healthy cartilage tissue (cells and scaffold) in the setting of osteoarthritis typically have a better clinical response, although patients with severe disease, including bone-on-bone, have been documented to have five years or more relief from their joint pain.
- The use of stem cells in joint pain treatment is FDA cleared for safety. Our cell based therapy management strategies are effective and clinically-proven to provide lasting relief from joint pain. Recognizing bias, we believe that patients seeking “stem cell treatments” for orthopedic joint pain should only seek the advice of an expert in the field, who is typically someone with a chemistry or biochemistry background who is a fellowship trained orthopedic surgeon specializing in regenerative medicine. Regenerative Medicine Clinic of Wilmington is home to the region’s only orthopedic surgeon specializing in this treatment. We were the first in the country to introduce this technology to orthopedic surgical procedures in the shoulder and knee, and Dr. Yeargan wrote all of the original protocols that are in use all over the country today. This is where it all started.
- Unfortunately, not everyone is a candidate for stem cell treatment for joint pain. Exploring your non-operative joint pain treatment options is imperative, however, before considering joint replacement surgery, an often painful and sometimes uncertain treatment with long-term recovery. Even if you’re not a candidate for cell based therapies, we offer the entire range of biologic treatments that you won’t find under one roof anywhere else in the nation.