November 17th, 2013

Stem Cell Guide in Plain English

When most of us hear the term “Stem Cells” we think of controversial research and futuristic medicine. In the media and on the internet there are increasing stem cell options and claims that are sometimes difficult to understand and evaluate. Here is my translation of the current research and clinical practice and what it means for you, the patient:

There are 2 main types of stem cells: adult and embryonic.

Embryonic stem cells are the most commonly studied and publicized. There are several issues with using them for patients, though: political/ethical controversy and practical issues with controlling and using them in the clinic.  They do not currently have an established role in the treatment of human disease.

Adult stem cells, though, have been steadily gaining support among scientists, physicians, and patients.  The main type of adult stem cells harvested for orthopedic issues, mesenchymal stem cells, have been shown in the lab to grow into many tissues including cartilage, bone, nerve, and muscle, and there are numerous studies showing them to be useful in a variety of diseases, including arthritis, heart failure, peripheral vascular disease, COPD, and stroke, among others.

Adult stem cells can be obtained in the office from you (autologous), or can be obtained from a donor, expanded in a lab, and sold to you in a vial (allogeneic).

While available in many tissues in your body, autologous stem cells are usually obtained from your fat (a mini-liposuction) or from your bone (a bone marrow aspiration) in the office setting. Bone marrow-derived stem cells have been used longer and fat as a source of the useful mesenchymal stem cells is a more recent application in humans (although has been used in veterinary medicine for longer). This accounts for the larger numbers of research studies that describe bone marrow-derived stem cells in arthritis as compared to fat. Recent studies, however, confirm that the mesenchymal stem cells derived from fat are very similar to those derived from bone marrow, and both behave similarly in the laboratory, growing into cartilage, bone, muscle, nerve, etc when encouraged to do so. Additionally, there is a limit to how much bone marrow we can get from a patient at any given time, there is a decline in bone marrow-derived stem cells with age, and mesenchymal stem cells comprise only a small percentage of a bone marrow aspiration. As a result, we typically get only a few stem cells in a bone marrow aspirate (25,000 according to one study) and these stem cells need to be expanded in culture to get enough of them to do some good in arthritis. The FDA has made expanding the cells in culture illegal in the US and this expansion is only done overseas at high cost. Fat aspiration (mini-liposuction) typically produces 50-100 times more stem cells than a bone marrow aspirate, is a safer and less painful procedure, and produces numerous stem cells that can be re-injected within 1-3 hours after collection. There are over a hundred current IRB-approved studies underway currently using fat-derived stem cells in patients, both here and abroad. We are participants in some of these.

Mesenchymal stem cells can also be obtained in a vial from a pharmaceutical company (allogeneic). These stem cells are from tissue (such as placenta) from a donor, which have been expanded and purified by the pharmaceutical company and sold to you. There is evidence that these cells can be used by someone else without causing an immune response/rejection or increasing risk of complications. The use of these cells also avoids another procedure (liposuction or bone marrow aspiration). On the negative side, these cells are expensive (approximately 250,000-500,000 per vial, a fraction of those obtained through liposuction, for several thousand dollars) and they’re not yours. Thus they may, or may not, survive well in your body. There are some studies that suggest someone else’s cells may not produce the same improvement as your own (in heart disease, for example).

To make matters more complicated, fat-derived mesenchymal stem cell quality is affected by the harvesting and preparation methods. Some methods produce more cells initially, but the cells are not as healthy and do not grow and divide as well if tested in a laboratory. Other methods cause increased inflammatory reactions in the patient. Still other methods don’t filter the cells sufficiently and leave clumps, which may cause embolism if injected into the vasculature, increasing risk.

Given the complexity of the field, any patient seeking stem cell therapy needs to be an informed consumer. Hopefully the above brief summary helps you formulate some questions to ask your provider if you’re considering stem cell therapy.

At Boundless, we offer multiple stem cell options, personalized for each patient, and couched in a comprehensive regenerative approach. We have partnered with one of the world’s leading stem cell researchers to offer fat-derived mesenchymal stem cells in a stromal vascular fraction (other supportive cells) optimized and standardized to deliver the highest numbers of active, healthy mesenchymal cells, filtered to minimize adverse effects in the event of a vascular injection. We additionally offer allogeneic (pharmaceutical) and bone marrow-derived stem cells for those patients who would benefit from these alternate sources. We are collaborating in several IRB-approved research studies including the use of fat-derived stem cells in arthritis.