Sep 25, 2020
What are Exosomes?
Exosomes are microscopic bubbles packed full of proteins and genetic material such as DNA and RNA. When released from cells they allow those cells to communicate with each other. The molecules and genetic material direct cell behavior such as cell growth or differentiation.
In the past decade, interest in exosomes has exploded for several reasons. First, they allow communication between cells and aid in tissue repair and regeneration. Second, they have been proposed to be useful vehicles for drugs and could be used as therapeutic agents. Third, they can be useful biomarkers of disease which aids in diagnoses and prognosis.
What is the difference between Exosomes and Stem Cells?
Stem cells are living things that have the ability to renew themselves and to turn into different kinds of cells. They contain thousands of molecules known to decrease inflammation, regenerate tissue and fight infection. Exosomes are substances secreted by all cells, including stem cells.
During the repair process, different kinds of cells or molecules are needed at the different stages of healing. The stem cells act like the conductor in an orchestra, directing cells where to go and what to do. They organize the complex symphony of cellular activity that leads to tissue healing. Different types of exosomes are produced by the stem cells and released at different times depending upon the needs of the body.
Can we use manufactured products that contain exosomes to treat orthopedic conditions?
There are currently no FDA approved exosome products. These products require FDA approval before they can be marketed for use in patients. Their safety and efficacy have not yet been proven. Although they have the potential to repair injuries and regenerate tissues, there is still much to be learned about their behavior in the body. Patients should avoid exosomes until research studies prove they are safe and effective.
Sources:
https://bmcbiol.biomedcentral.com/articles/10.1186/s12915-016-0268-z
https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomes
https://www.sciencedirect.com/science/article/abs/pii/S1931524418300070
Sep 18, 2020
The field of Regenerative Medicine is based on the principle that the human body can heal itself. Scientific discoveries in cellular biology, genetics and tissue engineering have been translated into treatments for previously untreatable conditions. The American Association of Blood Banks (AABB), an international association representing individuals and institutions involved in cellular treatments, describes regenerative medicine as “the process of replacing or regenerating human cells, tissues or organs to restore or establish normal function.”.
In the United States, Regenerative Medicine is a rapidly emerging field. Yet the foundations of this practice date back to ancient civilizations where human anatomy was studied and documented. Their findings were essential to the work of 18th and 19th century scientists who made huge breakthroughs in cellular biology. Cellular research completed in the 1700s and 1800s has lent a great deal to our understanding of how cells divide and proliferate. This knowledge continues to guide the advancements in the 21st century.[i]
Using cells to heal:
Since the first bone marrow cell transplant for the treatment of leukemia in 1968[ii], scientists and researchers have explored new ways to use Regenerative Medicine for the treatment of other medical conditions such as arthritis, disc degeneration and tendon injuries.
These regenerative treatments involve the use of a patient’s own cells to heal their injuries. Orthopedic medicine physicians treat injuries of the joint, ligament, tendon and bone. Platelet rich plasma (PRP) is the most commonly used orthopedic regenerative medicine treatment. PRP is produced by concentrating the platelets in a sample of a patient’s own blood. Platelets contain hundreds of growth factors that decrease inflammation and stimulate healing.
Another regenerative therapy is by using Cells that are derived from a patient’s own bone marrow and fat tissue. These Adult stem cells called Mesenchymal stem cells (MSCs) are found in these tissues and have the ability to develop into bone, tendon or cartilage cells and are important to support growth and development. In the body, they have been shown to stimulate cell growth, prevent cell death and inhibit pain or inflammation.
Prolotherapy is a form of regenerative therapy that does not involve the use of your own cells, but instead uses sugar water (dextrose) to stimulate a healing response in ligaments, tendons and joints.
These treatments do much more than simply relieve pain caused by conditions such as tendon injuries, disc degeneration or arthritis. They target the root cause of the pain and stimulate healing. This gives new hope for patients wishing to avoid medications or surgery for the treatment of their painful sports injuries and chronic degenerative conditions.
Orthopedic Conditions treated with Regenerative Medicine:
Regenerative therapies have been studied in a variety of orthopedic conditions including:
- Knee pain – arthritis and patellar tendon tears
- Hip pain – arthritis and gluteal or hamstring tendon injuries
- Shoulder pain – arthritis and rotator cuff tendon tears
- Low back pain – disc degeneration, facet joint and sacroiliac joint arthritis
- Neck pain – pinched nerves and facet joint arthritis
- Elbow pain – tennis elbow and golfer’s elbow
- Ankle and Foot pain – plantar fasciosis and arthritis
- Wrist and hand pain – carpal tunnel syndrome, tendon injuries and arthritis
Is it Safe?
Regenerative treatments use a patient’s own cells and can be performed safely, without the risk of disease transmission or immune reaction. Advanced equipment is used to concentrate the cells and cellular molecules in the blood, bone marrow or fat tissues. In the hands of a skilled physician, the use of ultrasound and digital x-ray image guidance permits the precise placement of the cells in the injury site, making the procedure safe, comfortable and effective. Dozens of published scientific articles have documented the safety of cell therapy with some tracking patients’ outcomes for more than 10 years.
However, there is a big difference between a board certified Regenerative Medicine specialist and “stem cell” clinics who merely sell umbilical cord blood, amniotic tissue or exosomes. The use of these donor birth tissue products are not permitted by the FDA because they have not been tested for safety or efficacy. They are typically sold by healthcare providers who do not have any Regenerative Medicine training and dozens of patients have been hospitalized with infections after the use of these contaminated products.
We recommend that you seek a board certified, fellowship trained physician who specializes in your medical condition and has extensive experience treating patients, conducting research and training other physicians. Ask your physician about his or her Regenerative Medicine training experience and their use of evidence-based therapies. These physicians conduct cell therapy research and track their patients’ outcomes in published regenerative medicine registries.
The work they are doing today will help shape the future of Regenerative Medicine, just as their predecessors did hundreds of years ago.
Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated thousands of patients with cell based therapies for more than three decades. They are published authors and cell therapy researchers. Their facility in Carlsbad contains the most advanced Regenerative Medicine technology in San Diego and offers same day treatments with the highest level of safety and efficacy.
[i] https://www.unmc.edu/regenerativemed/about/whatis/history.html
[ii] https://www.sciencedirect.com/science/article/pii/S2213879X1500053X
Aug 28, 2020
The liquid portion of blood called plasma has been used for several years to help patients facing life-threatening conditions such as immune deficiency disorders and organ transplantation. Because it has helped treat so many chronic and rare diseases, it has been referred to as “the gift of life.”[i]
More recently, physicians have discovered that a patient’s own plasma and its’ cells can help expedite the recovery from orthopedic injuries. Platelet rich plasma treatments, known as PRP, use the healing power of platelets to harness growth factors and other proteins that are essential for healing.
How Platelet Rich Plasma Treatment Works
Blood is comprised of red blood cells, white blood cells,platelets and plasma. The plasma contains hormones, electrolytes and nutrients that are needed to nourish cells during the healing process.
During platelet rich plasma treatment, the patient’s own blood is drawn and placed in a centrifuge machine where the platelets are separated and concentrated. This results in a PRP solution that contains up to 10 times more platelets than that typically found in blood.[ii] With its super-charged healing capabilities, platelet rich plasma can be used to treat a number of orthopedic conditions, including:
· Joint arthritis (knee, shoulder, hip, thumb or spine)
· Injured tendons like rotator cuff tendon, Tennis elbow and Achilles tendon
· Ligament sprains in the wrist, ankle or sacroiliac joints
· Carpal tunnel syndrome
· Degenerated discs, mild spinal stenosis and sciatica
Not All PRP Treatments Are the Same
When it comes to platelet rich plasma treatment, one size does not fit all. Several factors can influence the success rate of treatment:
· The patient must receive an accurate diagnosis.
· Image guidance with ultrasound or fluoroscopy (x-ray) for targeted delivery to the injured tissues is necessary.
· The PRP formulation must be customized to the specific injury being treated.
· The initial injury severity must be considered.
When administered appropriately and in the right formulation for the specific injury, most patients begin to experience results within four to eight weeks after platelet rich plasma treatment. About 10% of patients will feel relief within days.
PRP treatments are performed on an out-patient basis in the physician’s office. There is no need for hospitalization or lengthy rehabilitation. The entire procedure takes less than an hour and patients may typically resume normal activity within days.
Dr. Christopher Rogers of San Diego Orthobiologics Medical Group performed one of the first PRP treatments in San Diego in 2009. He and Dr. Mary Ambach are experts in the field of regenerative therapy for orthopedic injuries. They have successfully treated thousands of patients with PRP and other orthobiologics.
Sources:
[i] Donating Plasma: What is Plasma
[ii] OrthoInfo: Platelet Rich Plasma
Jun 19, 2020
The human body is programmed to heal. Whether it is recovering from a small scrape or from major surgery the body’s initial response to any kind of injury or trauma is to kick into healing mode.
But sometimes it can use a little help. And that is what cell-based therapies offer.
How Cell-Based Therapy Works
Cell-based therapy assists the body to heal injured tissues. This is especially useful for the treatment of injured tendons, ligaments and joints. Cell-based therapy delivers targeted healing factors that are taken from the patient’s own cells to boost the body’s ability to speed healing and recovery.
There are several treatments options available, and each one offers unique benefits that enable your physician to choose the best option for you.
- Platelet Rich Plasma therapy concentrates platelet cells from the blood and delivers them to the injured tissues. These cells are rich in growth factors that are needed to initiate the body’s healing and repair processes. Using a patient’s own blood, the platelets are separated and concentrated. They are then placed into the injured area to boost healing.
- Prolotherapy delivers a targeted solution of concentrated dextrose and local anesthetic to injured ligaments, tendons or joints. The body responds to the dextrose solution as an irritant which, triggers healing responses that had stalled prematurely.
- Stem Cells are found throughout the body and are activated when an injury occurs. Tissue harvested from the patient’s own bone marrow or adipose (fat) contain mesenchymal stem cells (MSCs). They activate healing by producing molecules that direct other cells in the area to form new blood vessels, awaken resident progenitors and stimulate new tissue growth. Cells can be obtained from several sources, however, only bone marrow and adipose (fat) tissue are FDA-compliant for orthopedic indications. Umbilical cord blood products are not approved by the FDA and not supported by clinical research for orthopedic use.
What to Expect While Recovering from Therapy
Unlike major surgery, cell-based therapies do not require hospitalization. They are performed in our office procedure suite with local anesthetic. Recovery usually takes less than 4 days from these minimally invasive procedures.
There may be some swelling and discomfort in the injected area, but these symptoms typically lessen within a few days. Patients begin physical therapy to regain strength and range of motion within the first few weeks. Depending on the extent of the original injury, as well as the specific treatment used, some patients are able to resume their normal activity levels just days after their procedures.
Staying well hydrated and following a nutrient-rich diet are key to overall wellness and are especially important before and after these treatments since the body’s requires high-quality fuel to power their healing efforts.
San Diego Orthobiologics Medical Group is a leader in regenerative medicine therapies and offers a great variety of treatment options depending upon each patient’s unique needs. With decades of experience in the field of minimally invasive interventional treatments, Drs. Christopher J. Rogers and Mary A. Ambach are experts in the field of regenerative medicine. They serve as faculty members and lecturers at national and international medical conferences and serve on the board of directors for several national regenerative medicine organizations.
Jun 12, 2020
Fat is an important tissue in the body. Fat provides energy, helps the body stay warm and plays a key role in the absorption of important nutrients such as vitamin A, vitamin D and vitamin E. It also helps the body heal because it contains cells that repair and replace damaged or injured tissue. These adipose derived stem cells, also known as pericytes, form new blood vessels, awaken native stem cells and stimulate the growth of new tissues.
How is Adipose Stem Cell Therapy Different from Bone Marrow Stem Cell Therapy?
Both adipose and bone marrow stem cell therapy have the power to heal. They each offer unique benefits that can address the specific healing needs of an individual patient, based on the extent of their injury or tissue damage.
The benefits of adipose stem cell therapy include:
- High Volume of Healing Cells: Studies have shown that adipose tissue may contain as many as 500 times the number of regenerative cells than an equivalent volume of bone marrow aspirate.
- Age-Resilient: Fat cells maintain certain reparative properties regardless of a person’s age. Bone marrow derived cells may lose their healing capacity with age.
- Flexibility: Research has demonstrated that fat cells and bone marrow derived cells can be used to repair and heal tissue in multiple sites of the body, including cartilage and tendons in the knees, hips, elbows and shoulders.
The LIPOGEMS® Advantage
San Diego Orthobiologics Medical Group was one of the first medical centers in the country to offer LIPOGEMS®, an adipose-based regenerative therapy for orthopedic conditions.
LIPOGEMS® preserves the healing properties of the cells without jeopardizing their structure and function. This means the cells work together naturally, as they do normally in the body, to assist in the healing of injured tissues.
Like all cell based treatments offered at San Diego Orthobiologics Medical Group, LIPOGEMS® is an autologous procedure, which means the patient’s own fat cells are used. Our practice does not endorse the use of donor cell products because they have not been tested for safety or efficacy.
These minimally invasive procedures are performed in our office procedure suites with excellent safety and comfort. The patient’s own fat cells are harvested, processed into small clusters and administered to the patient on the same day.
Positive Pain Relief Using Adipose Stem Cell Therapy
More than 20 clinical studies using LIPOGEMS® are underway worldwide and the initial reports indicate that more than 90% of patients experienced significant relief with the treatment. They are able to resume normal physical activity without pain which is critical to maintaining wellness and enjoying a higher quality of life.
With decades of experience in regenerative medicine, Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group are recognized experts in the field of Regenerative Medicine. They were the first clinicians in San Diego to use LIPOGEMS® and continue to advance the field by participating in FDA approved clinical trials. They serve as faculty members and lecturers at national and international medical conferences. They also serve on the board of directors for several national regenerative medicine organizations.
Resources:
https://understandlipogemsphysicians.com
https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/dietary-fats
