Everything You Need to Know About Stem Cells
Where do we get them from?
Welcome to my clinical stem cell blog!
This info is going to pertain to what is currently happening in the United States clinically – so remember that as we go through.
We’re going to start off with a basic question – where do stem cells actually come from?
Well, when it comes to what we can actually harvest live in a clinically setting, those stem cells will come from your own bone marrow or adipose (fat) tissue. That’s it.
Some other things that you may see advertised include:
– Cord blood stem cells (these can be complicated, as it depends on the company who makes them. If they are using plain cord blood, we run into an issue with matching blood types. If they are using MSCs isolated from the cord blood, that is better, but know that there is some die-off of the cells that occurs due to the processing. The company we use provides viability testing results on each batch)
– Wharton’s jelly stem cells (same as above, the viability of these depends entirely on the manufacturer. The nice thing about Wharton’s jelly, however, is that it contains growth factors and hyaluronic acid, so it can be used in joints)
– Amniotic stem cells (there was actually a study done that showed no amniotic products contain any live cells post manufacturing, but these products can still be used for joints and soft tissue applications with great efficacy)
While all forms of regenerative medicine are offered in our clinic, I (Dr. Solt) have specialized in adipose derived stem cells since beginning of 2017. I make sure to take the time to really assess your case and together we come up with what form of regenerative therapy is best suited to get you the healing you are looking for. Additionally, if we did decide that an off-the-shelf product is better suited for you than harvesting your own fat or bone marrow, you can trust that I have vetted the companies used sufficiently, and have had only positive outcomes with those products.
What are Bone Marrow Stem Cells used for?
The method of isolating stem cells from bone marrow has been around the longest and therefore has the largest body of clinical evidence for use.
It’s not in jeopardy of being removed for use by the FDA, has a high safety profile, and multiple uses.
Let’s talk about harvesting it! A tool called a trocar is most commonly used to access the marrow within bones, usually from the hip (either the back or the front), under a local, or sometimes general, anesthesia.
Many people fear pain from this due to the way it gets portrayed in movies, but truthfully, the discomfort is usually rated a 2-3/10, with a sensation of pressure. The weirdest part is the vacuum sensation the patient feels as the marrow is being pulled up. It’s over really quickly though.
As for volume, there is research that supports only the first 5-10cc of marrow being the most potent, while other schools of thought will tell you that you can pull up to 40-60cc in one location. It really depends what you’re doing with it afterwards. So…
After extraction, the doctor can either use the pure bone marrow aspirate, or can run it in a centrifuge to create BMAC (bone marrow aspirate concentrate).
As for the harvesting site, your body will replace the taken marrow within just 8hrs, and recovery is a breeze.
Now, personally, I like using bone marrow in relatively young and healthy patients, mainly for musculoskeletal concerns (hips, knees, shoulders, etc.). However, I have even seen research supporting the use of it in alopecia areata, so definitely not going to pigeon hole it!
Traditionally, many people are familiar with bone marrow transplants for cancer patients, though in the regenerative medicine world, we are really only concerned with autologous use.
And finally, yes, bone marrow stem cell production DOES dramatically decline with age.
All Things Adipose Derived Cells!
I fell in love with adipose derived cell therapy many years ago and have been blessed to facilitate well over 500 of these procedures for patients from all walks of life and medical histories.
This procedure starts with a minor liposuction where 1-2 sticks of butter worth of fat are removed. Most people are happy to see it go and my patients joke that it’s the best 2 in 1 procedure ever – lipo AND stem cells!
After the extraction, we can do a couple things with the tissue:
1) Create a graft, which means processing the whole adipose tissue into microfat or nanofat, which can be used to treat joints and soft tissue, or as a filler for aesthetics, amongst other uses. This method maintains the stem cells within their niche, and research has shown this encourages a greater CFU formation vs using SVF in the same manner. Which brings us to SVF…
2) SVF stands for stromal vascular fraction, and it is the product we end up with after an enzyme breaks down the adipocytes and actually liberates the mesenchymal stem cells in addition to other regenerative cell populations. This is the process that allows adipose derived cells to be delivered intravenously. It is also the process the FD@ frowns upon, as they believe that once a doctor performs this process that they have created a drug (but it’s your own tissue?) which should then go through the pharmaceutical industry to be sold back to the patient at a price of $500k. Again, it’s your own cells. Can you believe the insanity?
These procedures can take anywhere from 1-3 hrs and are done as outpatient, usually under local anesthesia or sometimes light sedation. Some doctors opt for full general anesthesia if performing larger extractions, or other procedures at the same time.
How do Stem Cells actually do their job?
This part is specifically about how MSC’s (mesenchymal stem cells) work. We’d be here for days if we had to dive into all subtypes!
The important thing to know about MSCs is that the way they function in vitro (aka in a petri dish) is really quite different than how they function in vivo (aka in the body).
Scientists discovered early on that in vitro, MSCs can actually turn into other cells! Things like nerve, cartilage, muscle, fat, etc. It was thought this was how they performed in vivo as well.
Turns out, that’s not the case! In 2016, the grandfather of the MSC, Arnold Caplan (he literally holds the patent for the MSC, look it up on Google patents), published a paper urging the scientific community to rebrand MSC to “medicinal signaling cell” when talking about in vivo applications.
That’s because one of the ways administered MSCs work in the body is by signaling to the native stem cells and pericytes (these are a particular type of stem cell that sits wrapped around blood vessels ready to jump into circulation) to get up and start working!
Some other ways MSCs work include:
– Self replicating so there are more of them to go around
– Donating their mitochondria to native damaged cells so they can regenerate
– Influencing the TH1 and TH2 response to modulate the immune system
– Secreting exosomes into areas they can’t reach, like across the blood brain barrier
And the scientific community is still learning more!
Stem Cell Limitations, Candidacy, and other Points!
Straight up: stem cells are amazing, but they are not a miracle cure all!
Here are some other points you need to know:
¤ Stem cells perform poorly when given back to a person who is in a poor state of health and/or wildly inflamed. Addressing underlying issues is necessary before ever getting treatment, and anyone who tells you otherwise is just trying to take your money. You don’t need to be in “perfect” health, just in a state that is conducive to healing. Truthfully, a person can make massive strides in attaining this state within just a week, it just depends how committed their are to making changes in their diet and lifestyle.
¤ You don’t get to receive stem cells if you have active cancer, are taking things like cortisone or NSAIDs, are a smoker, won’t give up alcohol, or have uncontrolled diabetes. While many of these can be temporary situations, we must wait until the patient is no longer in them to consider treatment.
¤ Stem cells are not covered by insurance, and we likely don’t want them to be, as that can put restrictions on who gets to receive them.
¤ You can expect to pay anywhere from $5000 – $20,000 (and sometimes more) for a true stem cell treatment. This usually includes your surgery, processing the tissue to extract the stem cells, re-administration (price can go up depending on how many areas are being treated), and all follow up care. I personally do multiple follow ups in the first year (24hrs, 1 week, 1 month, 3 month, 6 month, 9 month, 12 month)
¤ Stem cells are the long game. Initial results are conservatively seen somewhere in 6-12 weeks, but there are exceptions to this. Generally, neurological issues take the longest to resolve as nerve cells are the slowest cell type to heal & regenerate.
Have questions? Ready to schedule a consultation? We can’t wait to hear from you! Give the office a call at 480-267-7856