Regenerative Medicine Explained?
Regenerative medicine is a system of treatment with a focus on non-surgical treatment of damaged tissue in tendons, ligaments, degenerative joints and other chronic musculoskeletal conditions using Orthobiologics. If we consider one certain type of orthobiologic such as Stem Cells, they are naturally occurring cells in the body that have the potential to turn into other types of cells and body tissues. They also serve an important signaling functioning, recruiting other stem cells to the target area and triggering nearby cells to begin the repair process. In fact, most scientists think that this messenger activity is the main way that stem cells work.
Contrary to what most people think, including most physicians, stem cells do NOT work their magic by differentiating into new tissue. Instead, they largely act as high-powered messengers that signal other cells--including other dormant stem cells--in and around the damaged tissue to turn on and begin the healing process.
“Orthobiologics”, refers to the use of biological substances to help musculoskeletal injuries heal quicker. They may be used to improve the healing injured muscles, tendons and ligaments and are derived from substances that are naturally found in body, where generally the donor and recipient are the same. When they are used in concentrations many times the normal, they can potentially help speed up the healing processes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931137/
Regenerative medicine utilises the potential of cells, growth factors, and other biologic components to support and enhance the body’s natural repair process. These treatments may reverse the effects of traumatic injury, chronic pain, or wear and tear due to age or overuse. Treatments may be very successful in reducing pain and inflammation, repairing injuries, restoring joint function, rejuvenating soft tissues, and improving overall quality of life.
Common musculoskeletal conditions treated include: inflammation, osteoarthritis, joint pain, tennis elbow, plantar fasciitis, tendinitis and tendinosis, tendon and ligament tears, muscle strains, bursitis, hip pain, back and neck pain.
Traditionally, the treatment for osteoarthritis and musculoskeletal injury has been to suppress inflammation with medications, such as anti-inflammatories and cortisone injections. However, aspects of the inflammatory cascade actually aid in healing and regeneration of tissue. The basis of a regenerative medicine protocol is to intensify these aspects to promote a controlled inflammatory response to generate a therapeutic process, so that healing and tissue regeneration/reorganisation can occur.
It is not uncommon for our practice to be visited by patients who have seen a number of healthcare providers seeking treatment for their osteoarthritis, chronic pain or sports injuries. The concept of a Regenerative Medicine consultation is to formulate a treatment protocol specific for the individual patient using very specific Orthobiologics.
The type of Orthobiologic to be used for a patients condition is part of the treatment protocol that should always given careful consideration. The types of treatment approach that may be considered include:
- PRP - An orthobiologic, that holds a lot of promise as a treatment modality. Although stem cell procedures also appear interesting in theory, technical difficulties in preparation and use makes them rather user-unfriendly. If one analyzes the pros and cons of the available orthobiologics, it becomes clear that the lack of adequately powered studies is an important issue preventing their recommendation for routine use. However, even with the limited published scientific data, PRP appears to be the most attractive option available, with minimal side effects; the relative ease of preparation, cost effectiveness and the ability to complete the procedure as a day care procedure goes in favour of PRP. Platelet-rich plasma (PRP) constitutes an alternative therapy to promote tissue regeneration mediated by the release of several growth factors and cytokines stored in the alpha granules of platelets. These molecules modulate angiogenesis, remodel the extracellular matrix and affect the recruitment, proliferation, and differentiation of local stem cells. In contrast with other regenerative therapies, generating PRP is an economical method and does not require complex equipment or training. In addition, due to its primarily autologous origin and relatively non-invasive collection technique, the risks of infection or immune rejection associated with PRP are minimised.
- Alpha-2-macroglobulin is a large protein molecule. Ninety-nine percent of it is made in the liver. There are four main biochemical processes that lead to joint (articular) cartilage breakdown – the hallmark of arthritis. The following chemicals/molecules lead to the degradation of articular cartilage
- Cytokines
- Metalloproteases (MMPs)
- A disintegrin metalloproteinase with thrombospondin motifs (ADAMTs)
- Cartilage breakdown products
Collectively these substances are known as proteases. Alpha 2 macroglobulin captures and inhibits the activity of these four groups of proteases. It essentially traps them and removes them from the joint. This better enables the body’s natural repair and regenerative pathways including stem cells to repair the articular cartilage damage.
In short, alpha 2 macro globulin is a master inhibitor of cartilage degrading enzymes.
- BioRenew Placental Tissue Matrix (PTM) Therapy. ActiveMatrix allografts are carefully harvested from placental connective tissue and preserved in fluid form. Filled with a high concentration of collagens, providing an effective biomechanical scaffold with various growth factors which have been shown to support correct tissue formation and modulate inflammation.In recent years, an increasing number of companies have been introducing commercially available regenerative medicine products derived from human perinatal tissue, including human amnion, placenta, and umbilical cord blood.
To make these products, at the time of birth, healthy women with normal pregnancies voluntarily donate their placenta or cord blood (it’s illegal for them to sell it). The after-birth tissue is then brought to a lab where cells are extracted and growth factors are isolated. The final product is then sterilized to reduce the risk of infection.
Although some manufacturers, and even some “stem cell clinics,” claim to be performing “stem cell” treatments, independent testing has shown that NONE of these products contain ANY live viable stem cells. They DO contain growth factors that can be helpful in certain circumstances. But these are NOT “stem cell” treatments, and anyone claiming otherwise is either ignorant of the science or is intentionally being misleading.
At the Ashmore Osteopathic Group, we use some of these products judiciously in certain treatments. But, they’re almost always combined with either PRP or your own stem cells.
- Bone Marrow Aspirate and Bone Marrow Aspirate Concentration (BMAC) Stem Cell Procedures. It’s important to note that currently there is no such thing as a pure stem cell treatment. Whether derived from bone marrow or fat, the solution that gets injected contains many types of cells, not just stem cells. It also contains healing proteins and growth factors. It’s a total package of stem cells, other cells, and the associated proteins and growth factors that are involved in the healing response.