Regenerative medicine is very complex newly evolving field of healthcare that is focused on two basic concepts:
Stopping or slowing the destructive process associated with aging and reversing and or restoring the negative effects brought on by the aging process and various destructive diseases.
Regenerative medicine deals with the "process of replacing, engineering or regenerating human or animal cells, tissues or organs to restore or establish normal function".
This field holds the promise of engineering damaged tissues and organs by stimulating the body's own repair mechanisms to functionally heal previously irreparable tissues or organs.
Aging is in fact not a natural and inevitable process but rather should be viewed as a disease of the body that is based on many factors including an individual’s genetics, occupational and life stressors, environmental exposures, health and lifestyle choices as well as injuries and diseases that accumulate over time. By treating aging as a disease we can than correctly develop therapies and treatment options to slow down and potentially reverse the damage associated with the aging process and avoid the need for invasive surgical options to relieve pain and restore function.
Over the years many different approaches have been utilized to slow or reverse the aging process however the last decade has seen an explosion of new and evolving treatment options being employed with varying degrees of success to make the process of modulating the aging process a reality. There are many ways in which physicians and non-physicians are approaching the concept of regenerative medicine.
The mainstay of treatment begins with the most basic concepts of health and wellness that include; proper nutrition/supplements, exercise and weight control, proper sleep and stress management, and a complete medical evaluation focused on treating and controlling existing disease states and employing preventative medicine options to avoid potential future medical issues. For individuals who are experiencing pain and loss of function it is important to add an aggressive diagnostic work up to correctly diagnose the underlying cause of the condition so the appropriate plan of management can be instituted.
Unless absolutely indicated, surgical options should be considered as a last resort and not a first line of treatment. Conservative management including all forms of alternative medicine should be considered which may include chiropractic care, physical therapy, acupuncture and massage. Once more conservative approaches have either failed or provided an incomplete return of function or relief of pain, more aggressive treatment options should be considered.
Interventional pain management is typically considered the next best option for diagnostic and therapeutic treatment options. The information obtained from preforming diagnostic injections is especially important before utilizing regenerative treatment options which are typically not covered by insurance and need to be deployed on a verified pain generator in order to be effective.
Although the use of MSC Stem cells have been considered the gold standard in regenerative medicine for many years, due to the availability of other therapies that are arguably much more effective as well as a less invasive option, this is becoming less and less the case. MSC stem cells which are typically obtained from a person’s bone marrow or fat cells have many pros and cons. The bone marrow is full of very important regenerative cells including stem cells as well as anti-inflammatory mediators which can provide significant relief of pain and healing when used in the appropriate setting. One of the problems encountered is as a person ages the populations of available stem cells begins to decrease and depending on the harvesting location and the technique used the amount of obtainable stem cells can varying significantly from person to person resulting in inconsistent outcomes.
There are many new and exciting regenerative treatments now available that are considered far superior to harvesting and utilizing MSC Stem cells. These treatments are being used alone as well as in combination with each other depending on the targeted therapy being considered. Treatments utilizing Platelet Rich Plasma (PRP), Alpha 2 Macroglobulin (A2M), MSC Stem Cell derived Exosomes and Amniotic Fluid based therapies are now available and being employed with many reported successful outcomes and are quickly becoming the gold standard in regenerative treatments options.
Platelet Rich Plasma (PRP)
Platelet Rich Plasma (PRP) as the name implies involves the concentration of platelets which make up a percentage of a person’s normal circulating blood supply. Platelets are very important in the body’s natural healing process. By concentrating the platelets and injecting them into an area of pain, inflammation and injury we are able to significantly enhance the healing process, improve function and reduce pain. In many cases we can restore the patient to their pre injured state, eliminating the need for further treatment including medications and therapy. This is considered a very natural and safe way to provided treatment for pain and injury.
PRP is used for a wide variety of conditions alone or in combination with other biologics such as A2M, Exosomes and Amniotic Fluid. PRP has been successfully used to treat Tennis and Golfers Elbow pain, Shoulder, hip and knee pain, Sacroiliac joint and greater trochanter pain, Facet pain, Interspinous ligaments, fracture sites and ligament tears. PRP has also been used with great success in treating lumbar discs and in many cases preventing the need for surgical intervention and fusion.
Alpha-2-Macroglobulin (A2M) is a large plasma protein found in the blood mainly produced by the liver. One of the benefits of A2M is its ability to inactivate proteinases. Proteinases are found in many parts of the body usually in response to disease or injury. These molecules breakdown tissue and bone and are a major contributing factor to formation of destructive arthritis. By concentrating the A2M from a person’s blood and injecting it into the target area, alone or with other biologics, we can potentially shut down the destructive process and promote healing and regeneration of the damaged tissues.
Exosomes are very tiny vessels produced by virtually every cell type as a way of cell to cell communication. They contain proteins (growth factors), mRNA (blueprint for protein production) and micro RNA (on-off switch for specific protein production)
Exosome are produced in a laboratory setting and are obtained from a single donor of placental tissue which was intensely screened for any possibly of infectious material. A further filtration process allowing for the concentration of the MSC exosomes is employed to filter out any potential viruses or bacteria. This process results in a very pure and sterile product with the risk of infection approaching near zero. Exosomes are typically used in combination with other biologics such as PRP to target a specific area of injury.
MSC exosomes carry the developmental message of peri-natal mesenchymal stem cells, meaning that they are involved in development of tissues like skin, hair, bones, muscle and cartilage. Exosomes are probably the most exciting recent development in regenerative medicine and are being used to repair and restore a number of underlying injuries and painful conditions. Currently they are being used for hair growth, cosmetic purposes, repairing spinal cord / nerve injuries, repairing lung damage, treating severe burns and repairing or resolving musculoskeletal conditions.
Amniotic fluid contains many very important components such as cytokines, growth factors, fibrinogen, collagen, hyaluronic acid and messenger RNA which promotes healing and modulate the inflammatory process. Amniotic fluid contains over 300 proteins and growth factors that are important in stimulating the healing process. Amniotic fluid, in essence, creates an ideal environment that fosters remodeling and repair of damaged tissue and the recruitment of a person’s own stem cells used in the repair process. The amniotic fluid is derived from multiple screened donors although considered very safe with the reported risk of disease transmission listed as 1 in 250,000 patients which is actually equal to the risk of being hit in your home by a crashing airplane.