PRP Vs. Alternative Stem Cell Sourcing
Market Options are Increasing Over PRP Alone
In just the past year there has been an explosion of information and availability of new products becoming available around adult stem cells being harvested and used in patients. These cells can be used in a variety of ways to help heal injuries, and as we are learning, there seems to be no end to the possibilities. Before I go to deep into this discussion, let's take a moment to drill down to the subject I am specifically reporting on.
Fetal Stem Cells
When George W Bush was president, there was great controversy over stem cells and research in and around stem cells. These were "fetal" stem cells, cells where the fetus of a newborn infant would be harvested, resulting in the abortion of the fetus. This understandably raised a lot of ire among many people concerned that infanticide for the sake of creating stem cells was morally wrong. There are already existing "lines" of fetal stem cells that can be used for research, so what George W was talking about falls into that category. There are advances there - but not what I am discussing and not to the level I am discussing either.
Adult vs Fetal Stem Cells
After the fetal stem cell period, the next level is adult stem cells. Live birth is pretty much the dividing line. There are both hematopoetic and mesenchymal stem cells that this point, with hematopoetic being related to "blood" and mesenchymal being related to about everything else - bone, muscle, tendons, fat, etc. For the sake of our discussion, we don't want hematopoetic cells in our mix of products as this is where the greatest chances of transfer of disease or cancer may lie. We only want those cells, the MSC or mesenchymal stem cells if we can get those - and processed in such a manner that will not cause immunogenicity or rejection from the person receiving them.
PRP- Platelet Rich Plasma, Autograft
If you needed to have an injection into your foot to relieve pain for plantar fasciitis, it is likely you would have two options. One is a cortico-steroid, the other is PRP. PRP is derived from your own blood. The doctor draws a volume of blood from your vein then puts it into a special vial that is placed in a machine that basically separates the blood into constituent parts through spinning it. One of these levels, the plasma, tends to be where your own mesenchymal stem cells reside. By concentrating your own bodies MSCs into a small volume, then drawing those into a large needle and injecting this into an area of concern, the MSCs have a good chance at finding the inflammation you are experiencing - sore foot for example - and working quickly to heal it. Alternative to this would be shooting in some steroid which may give some temporary relief but also tends to dry out the tendon instead of replenishing it. There is no chance of rejection - it is your own blood. The volume of MSCs is relatively low, but is much higher in that injection than you would find normally in your blood in any one location. It works to some degree.
Cadaver Stem Cells
One of, if not the first, commercially viable stem cell products on the market was derived from cadaver bones (bones of the deceased). These cadavers are processed to determine a lot about their health when they were living so that the chance of passing on some kind of medical issue are minimized as much as possible. There are also chemical tests to be sure of this same thing. Once the cadaver passes these tests, bones are collected that contain high volumes of serum that have within them viable stem cells. These products are processed in a means that reduces the potential for rejection by the receiving patient in the future. The stem cells are separated from the rest of the material and concentrated in a substrate that can then be applied where the surgeon or doctor determines they can be used. These have proven to be somewhat active and are used particularly when regeneration of a bone may be intended such as in a revision case for spinal fusion where old screws are removed and filling the "hole" is important.
This can be combined with PRP in an injection and enhance the number of total MSCs available which can aide in healing. There are several companies today that use this technology, the oldest of this variety. Newer breakthrough products have come to the market from the originator companies. Although good, and proven, the newer products tend to be significantly more viable and active.
Young Adult Stem Cells
As stated earlier, at birth all cells become "adult" even though they may still be quite young and may actually still be undifferentiated. That is the key to finding the most active and "willing" cells to be able to get the most from them.
One company utilizes the foreskin "trimmings" from male circumcisions to gain a volume of young adult cells that can be treated in such a manner to provide a matrix that is grown on a supporting web resulting in a source of MSCs. No, you won't grow a foreskin wherever they are used, but this is exactly what is used to source the young stem cells. This is an approved allograft product (allograft means something that came from one human and is used in another) by the FDA.
Several other companies are using the lining of the placenta to derive a source for MSCs. All of the births are caesarian so the placenta can be properly handled to gain, aseptic as possible, the lining. The inner most lining of the placenta is called the "amnion" layer and includes a barrier like skin. It is fairly thin, only a few cells in depth, but also contains MSCs in significant volumes. Several companies are now offering amnion derived stem cell solutions. Activity from these products is quite high but may vary depending on a number of factors.
Safety is high as the donor is known months prior to the donation. Complete workups can be performed long before the mother gives birth. The end result is a product that has great versatility and at a reasonable cost in comparison to other options on the market today. There is no problem when processed properly of immunogenicity. The end products can come in a number of forms, some it is thought are much better than others.
Mimedix provides a product known as Epifix which is amnion derived and then freeze dried providing a product that has a 5 year shelf-life and doesn't require refrigeration or freezing. When reconstituted, it is applied directly to the wound in question. Another company, Bio-D has an amnion product and it too is captured in a similar manner but is frozen using a process known as cryogenic preservation. This is a step-wise process where the temperature is slowly lowered reducing the chance of causing problems for the viability of the cells being preserved. Once brought down to a stabilizing temperature below minus seventy, all biological activity theoretically halts and the product can be held here for a couple of years.
Fewer companies have gone deeper into the placenta to the second distinguishable layer, the chorion layer, to derive product containing MSCs. The chorion layer does not have the skin-like layer found in the amnion layer, but studies have shown it has about twice the numbers of viable and active MSCs. Along with a plethora of active growth factors and other supporting and naturally occurring healing stimulators, the chorion layer is very powerful in its ability to provide a substantial healing effect. This would most likely be used in a multitude of deeper wounds and injuries, from Charcot's Foot, knee and ankle surgery, hip replacements, spinal fusions, muscle repairs, tendon repairs, even re-growing gingiva, your gums in your mouth, when needed.
These products perform a number of great processes when applied. From creating a new periosteum which basically means bringing the bone back to life with revascularization of the bone surface to healing surfaces (internal and external) without scars or adhesions. This is important in a number of different types of surgeries.
PRP is a great first step. Usually not covered by insurance, it is less expensive than any of the other products mentioned. But PRP doesn't have #1, the level of active Mesenchymal Stem Cells available for the repair you want, and #2, the cells are your cells - 50, 60, 70 years old, compared to the extremely active and youthful cells available from any one of these other great products in the market.
Ask your doctor. I'm not a doctor nor do I suggest in any way that I am a medical specialist. I had a doctor tell me regarding these stem cell products that "I had a new hammer and everything looked like a nail," well he was right - except he was being fesitious. I'm not. This is a great time and the medical miracles I have seen with these products is amazing.
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