Regenerative medicine combines principles of biology and engineering to develop therapies for diseases characterized by cell depletion, lost tissue, or damaged organs. The broad aim of regenerative medicine is to engineer, regenerate, or replace tissue using natural growth and repair mechanisms, such as stem cells. Regenerative medicine is a way to fix the root causes of disease by harnessing the body’s natural capacity to repair itself – in other words, to regenerate lost cells and tissue and restore normal functioning. Ultimately, the goal of regenerative medicine is to improve the daily wellbeing of patients with debilitating chronic diseases by developing a new generation of therapies that go beyond treating symptoms.
The focus of clinical interest at Ohio Restorative Medicine is the repair of musculoskeletal joint damage through Regenerative Medicine methodologies. Our office utilizes Mesenchymal Stem Cells in the form of Bone Marrow Aspirate Concentrate (BMAC) and Platelet-Rich Plasma (PRP). BMAC and PRP are biotherapeutic regenerative therapies that create an environment in which your body’s own tissues can repair themselves, providing natural pain relief and increased mobility and function in damaged joints.
MESENCHYMAL STEM CELLS
Your body started out as ONE cell that became TRILLIONS of cells through the process of differentiation, a type of directed change and development that led to three distinct tissue types: endoderm (examples: linings of the digestive and respiratory tracts), mesoderm (examples: muscle and connective tissues, including bone and cartilage), and ectoderm (examples: brain and skin). Embryological and fetal development are fascinating processes that occur in a stepwise fashion, during which cells become more and more specific to a particular role in the building of your body. An example of this role-building is the formation of mesenchyme, the parent tissue to all of your connective tissues, including bone and cartilage.
Remnants of embryological and fetal mesenchyme are still present in your body. Called mesenchymal stem cells, they, like their predecessors, have the ability to develop into other cells or tissues including bone, cartilage, and muscle, among others. Mesenchymal stem cells were first identified in the late 1960s and research directed towards their possible therapeutic uses has blossomed ever since. A March 2020 search for “mesenchymal stem cells” on clinicaltrials.gov (US National Library of Medicine and National Institutes of Health), yielded 1,058 studies submitted to the website, which contains information about medical studies in human volunteers.
Adult mesenchymal stem cells can be found in a variety of locations in your body, but most clinically used mesenchymal stem cells are harvested from bone marrow or adipose (fat) tissues. Mesenchymal stem cells reintroduced into damaged tissues, such as those found in osteoarthritis of the knee, interestingly do not actually engraft into the damaged tissue and become new cartilage cells. They do however create a trophic (nutritive) environment that may help your tissues repair themselves. Mesenchymal stem cells rescue and/or repair injured cells and tissues through diverse mechanisms including the transfer of organelles (mitochondria), electrolytes, and genetic materials, and release of bioactive trophic chemicals. Bioactive trophic chemicals released from mesenchymal stem cells include chemokines, cytokines, exosomes, growth factors, and glycosaminoglycans. These chemicals have an immunomodulatory effect that suppresses inflammatory immune system responses and scar formation, and modifies new blood vessel formation, programmed cell death, and cell growth. Thus, mesenchymal stem cells have the potential to repair damaged connective tissues like the cartilage that is being worn away in osteoarthritis.
PLATELET RICH PLASMA
Platelets are small fragments of cells called megakaryocytes, which are found in hemopoietic red bone marrow. Platelets are activated in response to tissue injury leading to their release of hundreds of growth factors and other healing elements and chemicals, such as cytokines and chemokines. Platelets are commonly spoke of in relation to their function in blood clotting, though they actually have more diverse roles in tissue healing, beyond just clotting. They play a role in angiogenesis (new blood vessel formation), inflammation and subsequent activation of immune system cells, vasoconstriction (constriction of blood vessels), and tissue regeneration through the enhancement of fibroblast function (increased collagen and other extracellular matrix components production).
Platelet-rich plasma (PRP) is a concentrate of platelets and plasma made in-office from a patient’s own blood. Drawn blood is processed through a special centrifuge (the Arthrex Angel system) that utilizes 3-sensor technology to prepare customized PRP formulations. The Angel system has the capability to deliver platelet concentrations up to 18x baseline with adjustable white blood cell concentrations. The Angel system utilizes the principle of flow cytometry, or light absorption by cells, to achieve precise separation with reproducible results.
PRP has been widely used as a safe and novel treatment in dentistry, orthopedics, ophthalmology, neurosurgery, and cosmetic surgery for three decades. PRP is well tolerated, it very rarely leads to complications, it is easy to prepare and administer, and it is less aggressive than other therapeutic options that might be indicated for some patients, such as steroid injection or even surgery. In fact, with respect to musculoskeletal inflammatory conditions, PRP has been shown to have better long-term outcomes than steroid injection.
PRP has been demonstrated to benefit patients with symptomatic tendinopathies, knee lesions, surgical meniscus repairs, plantar fasciitis, hip osteoarthritis, and lateral elbow epicondylitis, among others, making it a great option for use in musculoskeletal system conditions.