What is regenerative medicine?
According to the National Institute of Health (NIH), regenerative medicine is defined as “the process of creating living, functional tissues to repair or replace tissue or organ function lost due to age, disease, damage, or congenital defects”. Regenerative medicine has many potential applications, including the treatment of tendon, joint, and spine pain. There are two potential sources of obtaining regenerative medicine cells, autologous and allogenic. Autologous means the cells are collected from your own body, concentrated and then injected into the location of your pain. This includes stem cells and platelet rich plasma (PRP). Allogenic means the tissue is collected from another source such as the umbilical cord of full term healthy babies whose parents have donated the tissue. The tissue is then prepared, frozen, and sent to the clinic where it is diluted with saline and injected.
What are the potential applications of regenerative medicine?
Tendinopathy refers to the disease of a tendon. The function of a tendon is to connect a muscle to a bone which allows for movement in life. Tendinopathy can be caused by an acute injury, but more commonly occurs with chronic overuse. It is manifested by localized pain with thickening of the tendon. Some of the more common locations of tendinopathy are the heel (Achilles tendinopathy), outside part of the elbow (Tennis Elbow), shoulder (rotator cuff), and the bottom of the foot (Plantar Fasciitis). While the plantar fascia is technically not a tendon, the mechanism of disease is like that of tendinopathy.
There are many potential causes of joint pain, but degenerative osteoarthritis (DJD or OA) is one of the most common causes. As the normal architecture of the joint starts to break down this creates inflammation and pain. The pain is usually brought on by physical activity and relieved with rest. There is often tenderness of the effected joint with limited range of motion and swelling. When the arthritis is advanced there may be feelings of instability as well. X-rays are the most widely used imaging modality to detect DJD and shows joint space narrowing, osteophyte formation, subchondral sclerosis, and cyst formation.
Like joint pain, there are many potential sources of neck and low back pain. Regenerative medicine therapies are not appropriate for all types of spine pain but may be considered in patients with either facet, sacroiliac, or disc related complaints. Sometimes it can be difficult to identify the primary pain generator. Under these circumstances your health care provider may order diagnostic injections prior to proceeding with regenerative medicine therapies.
What are the different types of regenerative medicine therapies?
Wharton’ Jelly, also known as substantia gelatinea funiculi umbilicalis, is the component of the umbilical cord that protects the umbilical veins and artery in utero. After the birth of the baby this tissue is donated by the parents and is processed in a way that allows one to take advantage of its robust regenerative properties. Wharton’s Jelly contains several components that are thought to help regenerate tissue. These include mesenchymal stem cells (MSCs), growth factors, and hyaluronic acid. Mesenchymal stem cells are multipotent cells and are present in the umbilical cord, as well as the fat and bone marrow of adults. MSCs can self-renew by dividing and can differentiate into multiple cell types including cartilage, bone, muscle, and connective tissue. Growth factors are the signaling molecules between cells. They help stimulate cell growth and differentiation of MSCs. Hyaluronic acid is thought to provide a microenvironment that controls stem cell behavior and differentiation.
Autologous Mesenchymal Stem Cells
A noted above, the term “autologous” means cells that are collected from your own body. There are two main sources of autologous MSCs, the bone marrow and fat. Bone marrow is collected through aspiration using a large bore needle. Collection usually takes place in the low back/hip. The bone marrow is then placed in a centrifuge to concentrate the stem cells. Fat tissue is collected through a process called lipoaspiration. Once the fatty tissue is collected, the stem cells are concentrated in a similar fashion. It is important to note that these cells are not processed in any way. They are simply separated from other cells present in these tissues and injected into the painful and degenerated tissue. One of the challenges of autologous MSCs is the lack of standardization among individuals. A patient’s age and co-morbidities can have a dramatic effect on the number of viable MSCs for injection.
Platelet Rich Plasma (PRP)
Platelet Rich Plasma (PRP) is simply defined as a portion of the patient’s own blood having a platelet concentration higher than baseline. The patient’s blood is collected by phlebotomy. The blood is then placed in a centrifuge and the PRP is separated from other components of the blood. Platelets have high levels of growth factors which are thought to promote healing of injured or degenerative tendons, joints, and discs.