Regenerative medicine encompasses a wide menu of options and combination of options best suited to your problem. Below are some examples of the various options and combinations available at the Regenerative Medicine Specialists. Our doctors can help you chose the right treatment option for you and your circumstances. In office, same day.
Stem cells exist throughout our bodies and are normally in a dormant, resting state but with the potential to activate and differentiate. When necessary, they are capable of differentiating into almost any type of body cell required, depending on local conditions and signaling molecules (cytokines and growth factors) present. They also produce and release a myriad of signaling proteins themselves which attract and activate other stem cells, increase blood flow, and promote regeneration and proper healing. When a lizard loses its tail, these are the types of cells responsible for growing it back. Stem cells can be found in the circulating blood and local tissues but are especially concentrated in the bone marrow and fat. In particular, mesenchymal stem cells (MSCs), which are prone to becoming cells that produce connective tissues like bone, cartilage, tendon, and ligament are found in the highest concentrations in the fat. Hematopoietic stem cells, on the other hand, are more prevalent in the bone marrow. Both types are important for tissue healing and play different roles which we will not belabor here. The central point is that stem cells can heal chronic injuries and degeneration that are causing pain and disability. Our doctors can help you decide which treatment option is best for you and your circumstances.
Lipoaspirate concentrate is obtained under local anesthesia in our office setting. It is not painful but requires more skill and time than simple venipuncture for PRP and therefore is more expensive.
Bone marrow aspirate concentrate (BMAC) is also obtained under local anesthesia in our office setting. Sometimes a special x-ray machine called a fluoroscope is used to help guide the extraction device, but is often times not required. BMAC extraction is not painful, but is more time consuming and requires more skill than PRP and lipoaspirate and therefore is more expensive as well.
Stromal Vascular Fraction (SVF) is obtained from the patient in almost the same way as lipoaspirate but requires more complex and time-consuming processing which renders it more expensive to produce. However, it has the highest concentration of stem cells and factors and can also be given intravenously and thus used for a wider array of applications.
Platelet Rich Plasma (PRP)
Easy, Affordable, Effective
PRP or Platelet Rich Plasma, as the name implies, is an injectable concentrate of your body’s own platelets derived from whole blood. PRP also contains some stem cells, WBC, RBC, bacteriocidal. Platelets are circulating fragments of bloodcells that play a crucial role in blood clotting and wound formation and healing. Once activated, they are capable of releasing a myriad of signaling molecules (cytokines) including growth factors (GFs) that attract healing cells, including stem cells, to the areas where they are injected. These stem cells in turn release signals of their own and all this creates an enviroment that promotes improved blood flow, healing, and healthy tissue regeneration which minimizes scarring (fibrosis) and dysfunctional tissue architecture which can propogate pain and limitation of normal movement.
PRP is the easiest orthobiologic regenerative medicine concentrate to obtain as it involves only a simple venipuncture and blood draw (usually about 30-60cc). It is the most inexpensive option but is very effective and it may be all you ever need to get back to your best life. It is typically better for soft tissue (tendon, ligament, muscle) conditions, but can be used for some joint conditions as well.
PRP is used alone or in combination with various stem cell treatments as activators. They are also used as “booster shots” weeks or months after other treatments to enhance their healing effectiveness over time.
Cytokines: Cytokines are a broad and loose category of small proteins that are important in cell signaling. They are released by cells and affect the behavior of other cells. Cytokines include chemokines, interferons, interleukins, lymphokines, tumour necrosis factor but generally not hormones or growth factors (despite some terminologic overlap). Cytokines are produced by broad range of cells, including immune cells like macrophages, B lymphocytes, T lymphocytes and mast cells, as well as endothelial cells, fibroblasts, and various stromal cells; a given cytokine may be produced by more than one type of cell.
They act through receptors and they regulate the maturation, growth, and responsiveness of particular cell populations. Some cytokines enhance or inhibit the action of other cytokines in complex ways.
Cytokines are important in:
- health and disease (specifically in host responses to infection)
- immune responses
A growth factor is a naturally occurring substance capable of stimulating cellular growth, proliferation, healing, and cellular differentiation. Usually it is a protein or a steroid hormone. Growth factors are important for regulating a variety of cellular processes.
Growth factors typically act as signaling molecules between cells. Examples are cytokines and hormones that bind to specific receptors on the surface of their target cells.
They often promote cell differentiation and maturation, which varies between growth factors. For example, bone morphogenetic proteins stimulate bone cell differentiation, while fibroblast growth factors and vascular endothelial growth factors stimulate blood vessel differentiation (angiogenesis).
Growth factor is sometimes used interchangeably among scientists with the term cytokine. Historically, cytokines were associated with hematopoietic (blood forming) cells and immune system cells (e.g., lymphocytes and tissue cells from spleen, thymus, and lymph nodes). For the circulatory system and bone marrow in which cells can occur in a liquid suspension and not bound up in solid tissue, it makes sense for them to communicate by soluble, circulating protein molecules. However, as different lines of research converged, it became clear that some of the same signaling proteins the hematopoietic and immune systems used were also being used by all sorts of other cells and tissues, during development and in the mature organism.
While growth factor implies a positive effect on cell division, cytokine is a neutral term with respect to whether a molecule affects proliferation. While some cytokines can be growth factors, such as G-CSF and GM-CSF, others have an inhibitory effect on cell growth or proliferation. Some cytokines, such as Fas ligand, are used as “death” signals; they cause target cells to undergo programmed cell death or apoptosis.
Cytokines and growth factors can be found in platelets and stem cells and play a very important role in the regenerative medicine process. They can also be found in commercially available products for injection and can be used as stand alone treatments or in combination with PRP and stem cell treatments.