Yes and no. They certainly can be injected intravenously and some providers are claiming that stem cells “know where to go.” There really isn’t any evidence for this and it is likely against FDA regulation to do so at this time.
MSC’s do stay localized to the injection site across multiple studies. This is likely linked to the fact that they generally do not circulate in the bloodstream like other adult stem cell types and are primarily found resident in the tissues they serve. We believe it is crucial to inject directly into the damaged tissue to impact healing of that tissue.
Unlike embryonic stem cells, adult stem cells do not generally keep growing, even in culture. For example, most patients whose stem cells we grow to bigger numbers in the lab will lose their ability for continued cell growth after just a few weeks. In addition, the same body signals that would tell these cells to stop growing in healing a normal fracture or ligament tear are still present in your body.
Mesenchymal stem cells will stop proliferating when they physically contact each other (otherwise known in cell culture lingo as “confluence”). Culturing these cells, it becomes obvious that once they reach that point, they refuse to continue to grow (proliferate). This is because they are repair cells and when an area in need of repair is fully covered, they get the signal to stop growing. In patients where we have ongoing MRI surveillance of the re-implant sites, there has been no evidence of overgrowth where the regeneration has surpassed “expected optimal growth”.
Because an x-ray will only show the condition of the bone, not the soft tissue, the doctor usually needs an MRI to accurately evaluate the condition of the whole area. It is also common for the Regenexx Tampa Bay physician to do a diagnostic ultrasound of your area of concern (if it is a region outside of the spine). If a patient is unable to have an MRI, a CT arthrogram may be acceptable.
The doctor will need the most recent MRI available. The MRI should be without contrast and less than one year old. If you’ve had surgery or a scope done since having the MRI, we would need an MRI that was taken after the operation/procedure.
Are these embryonic stem cells?
No, they are simply your own adult stem cells. We only use autologous (your own) cells.
Are umbilical cord, amniotic, and placental stem cells better than adult stem cells?
Birth tissue stem cells isolated from an umbilical cord, amniotic membrane, or placenta may eventually prove to be effective treatments for many conditions. However, the research is very early at this time. Stem cells from other sources are more risky than your own stem cells. Furthermore, in the U.S., it is a violation of FDA regulation to use umbilical cord stem cells for orthopedic use. The birth tissue products sold in the U.S. do not contain living stem cells despite the sales pitch you may have heard.
What about stem cells derived from adipose (fat) tissue?
Fat tissue contains many mesenchymal stem cells, but these are distant cousins to the type obtained from bone marrow and aren’t as useful for orthopedic applications. Furthermore, true fat derived stem cell procedures for orthopedic use are currently in violation of FDA regulation since the process of obtaining the stem cells requires a step that “more than minimally manipulates” the tissue, thereby (according to the FDA) requiring FDA approval as a drug – which hasn’t happened yet. Either physicians who use fat in this manner are either using an unapproved “drug” or they are simply taking the fat and not breaking it down to get the stem cells and then calling it a “stem cell’ procedure.
What are the different types of Mesenchymal Stem Cells (MSC's)?
For orthopedic applications, two main types of MSCs have been used, bone marrow derived and adipose (fat) derived. Bone marrow MSCs are taken via a needle through a bone marrow aspirate. The bone marrow aspiration procedure sounds like a big deal, but we are consistently told by patients that the procedure is very comfortable. The second type of MSC is derived from fat tissue (adipose). This can be obtained via liposuction. For orthopedic applications, fat derived MSCs consistently and dramatically under perform bone marrow derived cells. In studies of cartilage repair, bone repair, and soft-tissue repair, bone marrow derived MSCs are much more adept at these tasks. This makes sense, as they perform this function naturally (homologous) every day. For example, if you break a bone, it’s these bone marrow MSCs that help mend that bone. In addition, for surgical microfracture to repair small amounts of knee cartilage damage, it’s bone marrow MSC’s that are released to do that job.
Doesn't fat (adipose tissue) have more stem cells than bone marrow?
Yes and No. First, many adipose stem cell clinics dramatically over-estimate the number of stem cells in their processed fat. This is a good hard core science review of the kits often used by physicians which over estimate these numbers. Basically, what physicians believe to be cells are actually small globs of fat tissue. Second, the proprietary Regenexx stem cell isolation method dramatically increases the number of stem cells isolated from bone marrow (based on our lab studies).
Still, on a weight to weight basis, fat can contain more mesenchymal stem cells than bone marrow, but the problem is that they just don’t work as well for orthopedic applications. In addition, in the Regenexx-AD knee stem cell procedure we offer the best of both worlds, bone marrow and fat.
Regenexx started with clinical trials from 2005 – 2007 (the first orthopedic stem cell procedures performed in the U.S.) Since that time, Regenexx has performed more of these procedures than any other clinic or medical group. The same-day procedure protocol that is currently performed in the United States was developed in 2010 and has been continually improved since that time.
If your hematocrit is below 30 or your hemoglobin is below 10, we may not be able to perform the procedure. If your hematocrit is between 30-36 or hemoglobin below 12, we may try to limit the IV blood or marrow draw amounts and will have you follow-up with your primary doctor.