What’s Involved with Regenerative Procedures?

What is PRP?

Blood contains multiple components. It is not purely a liquid; it contains cellular components. Blood is made up of plasma, white blood cells, red blood cells, and platelets. Platelets are generally recognized as useful in blood clotting, but they also contain a number of growth factors. These proteins are useful in healing of injuries.

To create platelet rich plasma, your own blood is drawn into a syringe. That syringe contains an anti-coagulant to keep the blood from clotting. The blood is then spun in a centrifuge so as to separate out the components. Red blood cells will spin down to the bottom. The top layer is the plasma, and a middle layer is called the “buffy coat.” The plasma and buffy coat can then be spun again to further concentrate platelets, thereby creating the PRP. The collection of red blood cells is discarded.

What are stem cells?

An individual begins as a single cell organism, made up of the combination of an egg and a sperm. That one cell will divide over and over again. Eventually, those cells will become different things: bone, nerve, blood, skin, and so forth. Cells that can grow into anything are called stem cells, but even these cells have different potencies. That means they have different abilities to become anything, almost anything, and a bunch of things. See the difference? Totipotent cells have the most differentiation potential: they can become anything. They occur extremely early in the development of the organism. Pluripotent cells are slightly more limited, in that they can differentiate into one of three germ layers: the endoderm, ectoderm, and mesoderm. These are the embryonic stem cells. Multipotent cells differentiate into a variety of cells within a certain category. For example, a multipotent blood cell could become a red blood cell or a white blood cell, but it could not become a neuron or a bone. Injected stem cells are of the multipotent type.

There are two ways to get the stem cells. First, we take them from the patient. People typically have a good concentration of easily accessible stem cells in our bone marrow. The best access point is the iliac crest of the pelvis. Unfortunately, as we age, we have fewer and fewer of our own stem cells circulating. This partially explains why we don’t heal as well as we get older. It also means that using our own stem cells (if we don’t have that many anyway) may not be a great idea. It might be better to use donated (allogenic) tissue, which is the second way to get the stem cells.

High concentrations of stem cells are found in placental tissues and amniotic fluid. These stem cells are taken from tissues acquired from living, healthy donors after full term pregnancy and at a scheduled Cesarean section. Another source is the baby’s umbilical cord blood. This is collected at delivery, as well. These tissues are minimally processed and preserved to maintain the natural properties of the tissues. These tissues have been shown clinically and scientifically to support soft tissue repair, reduce inflammation, and minimize scar tissue formation. These tissues include a number of structural proteins, growth factors, and cytokines, which promote cellular proliferation, new collagen formation, and reduce inflammation.

How do stem cells work?

Previously, people believed that stem cells would become the substance into which they were injected. That is, if stem cells were injected into the knee, they became joint fluid and cartilage. If they were injected into the discs, they became nucleus pulposus (the juicy center). We have since learned that this isn’t the primary method of action; this only occurs to a limited degree. The stem cells and PRP coordinate and stimulate the innate healing ability within the body. As we age, this innate ability declines. Consider that we don’t need to inject children with these therapies because the children have enough healing ability on their own! We also don’t find profound success in treating 90 year olds because there isn’t much innate healing ability there.

Why would I choose one over another?

We know that stem cells show more promise than PRP. They are the “seeds”, whereas PRP is the “fertilizer.” For a likely better outcome, stem cells are the recommended option. When comparing stem cells, there are no head-to-head studies. Essentially, it comes down to your preference. Here are some things to consider about each option:

  • Bone marrow: Since it comes from you, there is no infection risk. It is the use of your own body’s cells and growth factors. There is also no need to separately draw blood to make PRP. However, older patients don’t have as many stem cells in their bone marrow, so this option may be suboptimal. Also, it requires that the physician aspirate it from your hip (which isn’t usually as bad as people think!).
  • Amniotic tissue: This is taken from a healthy, screened, donated placenta. Due to legal issues, the tissue bank cannot report the number of stem cells, but it is said to be high. Also, there are quite a bit of growth factors included in the product. However, it must be ordered, so this will increase the cost of the therapy. Also, a higher cost will be incurred if you choose to mix this with your own PRP (arguably improving the clinical outcome), versus the option of mixing it with saline, for your injection.
  • Umbilical cord blood: This is also taken from a healthy, screened donor. This product contains very high concentrations of stem cells. However, it also must be ordered, which will increase the cost of the injection. And, you must again decide whether to mix it with your own PRP, at a higher cost, or simply in saline.
  • Adipose (fat) tissue: This is taken from the abdomen in a liposuction procedure. This option is not mentioned elsewhere because we do not offer it. Presently, the FDA has taken the position that the product is not “minimally processed”, so it should not be used in this way. Still, many clinics offer it. We choose to defer for now.

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