Ross
Hauser, MD
Injection of mesenchymal
stem cells (Stem Cell Therapy) has been shown effective in patients as a stand
alone treatment and now as a remarkable treatment that can rebuild
the meniscus tissue of the knee. In many articles we
discuss Stem Cell Therapy, Platelet Rich Plasma Therapy,
and Dextrose Prolotherapy as part of a Comprehensive program that takes an
aggressive approach to healing the problems of osteoarthritis and cartilage
deterioratioon.
A challenge in comprehensive
Prolotherapy is how can we get these stem cells to repopulate an area the
quickest? How can we get stem cells to proliferate and differentiate the
way we want them? Recently researchers at Stanford University Medical
Center asked these questions. Specifically they tested, whether platelet
rich plasma (PRP) may be useful for cartilage regeneration by seeing
mesenchymal stem cells grew more quickly when grown in a medium
with PRP.1
https://www.youtube.com/watch?v=rVDTrKTFj6c
Stem cell and PRP therapy for knee repair
Recent research discussed the
beneficial effects of stem cell injections. Doctors in Iran followed six women
whose MRIs suggested advanced knee osteoarthritis. The knee osteoarthritis was
so severe that knee replacement surgery was recommended. The women, average age
54, received a stem cell treatment with the stem cells derived from their bone
marrow. The results?
“During a one-year follow-up
period, we found no local or systemic adverse events. All patients were partly
satisfied with the results of the study. Knee Pain, functional status of the
knee, and walking distance tended to be improved up to six months
post-injection, after which pain appeared to be slightly increased and
patients’ walking abilities slightly decreased. Comparison of magnetic
resonance images (MRI) at baseline and six months post-stem cell injection
displayed an increase in cartilage thickness, extension of the repair tissue
over the subchondral bone and a considerable decrease in the size of edematous
subchondral patches in three out of six patients.”2
https://www.youtube.com/watch?v=XIQ0mxRL9Sw
It is easy to speculate that had
the treatments been more aggressive, a more positive result would have been
achieved. Platelet Rich Plasma Therapy as a stand alone treatment has already
shown very positive results in numerous studies.
Combining stems cells with Platelet Rich Plasma Therapy as a
means to accelerate tissue regeneration in advanced degeneration has been the
subject of numerous animal and human studies. The initial findings have been
very positive. 3,4,5
How does PRP enhance
stem cell treatments?
Platelet Rich Plasma (PRP) has
the ability to both increase stem cells and guide them in healing. In initial
findings, PRP assisted stem cells in “figuring out” what they needed to be – whether
a cartilage cell, or a bone cell, or a collagen cell for ligaments and tendons.
Here is what the science says: “Platelet-rich plasma has recently emerged as a
potential biologic tool to treat acute and chronic tendon disorders. The
regenerative potential of PRP is based on the release of growth factors that
occurs with platelet rupture. Its autologous nature [the recipient and donor
are one and the same person] gives it a significant advantage in tissue
engineering applications.”6 So the platelets are already attuned to provide a
healing environment or “scaffold” to build on. In the research cited, results
confirmed that PRP enhances MSC stem cell proliferation and suggested that PRP
causes chondrogenic differentiation of MSC in vitro – the platelets told the
stem cells what to do.
Growth Factors in
Cartilage Regeneration
Growth factors or PROLIFERANTS
(Prolotherapy is so called because of its able to proliferate growth factors)
act when tissue is injured. In the cause of chronic pain caused by joint degeneration,
PRP and Prolotherapy release substances that activate the healing response.
(See cartilage repair) The platelets themselves
secrete a variety of cytokines (messenger cells that regulate various
inflammatory responses), including adhesive proteins and growth factors such as
platelet-derived growth factor, transforming growth factor beta, vascular
endothelial growth factor, basic fibroblast growth factor, Insulin-like growth
factor-1 (IGF-1), and epidermal growth factor.
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