Injury

Regenerative Therapies: Stem cells and PRP

Regenerative Therapies: Stem cells and PRP

Regenerative therapy: Stem cells and PRP

In recent years there has been a notable advance in regenerative medicine. The objective is to stimulate or regenerate damaged cells, tissues or organs, in order to restore their proper functioning. Regenerative medicine includes the use of stem cells, and the therapeutic application of various methods that stimulate tissue repair such as PRP (platelet-rich plasma).

Platelet-rich plasma therapy (PRP)

Platelet-rich plasma (PRP), as the name implies, is a substance with a high concentration of platelets (minimum 1,000,000) contained in a reduced plasma volume. This type of concentrate represents a natural source of autologous growth factors, this being one of its main virtues.

Although the platelet count of PRP has not been standardized, the therapeutically effective concentration of PRP is considered to be more than 1 million / μL. Platelet-rich plasma can be obtained and prepared from the peripheral venous blood of the patient. The obtaining and activation of platelets ex vivo is a simple, fast and economic technique that allows obtaining a biomaterial rich in growth factors.

Platelets are anucleated cells that circulate through blood vessels and have an essential role in the processes of hemostasis and thrombosis. These cells also actively participate in other physiological processes including wound healing and tissue regeneration through the release of growth factors, and molecules that induce chemotaxis and differentiation of endothelial and mesenchymal stem cells.

The joint action of these molecules sequentially modulates the revascularization of damaged tissue through the proliferation of new blood vessels. In addition, it favors the restitution of damaged connective tissue through the migration, proliferation and activation of fibroblasts, and the proliferation and differentiation of mesenchymal stem cells that give rise to the different cell-specific types of each tissue.

In addition to its regenerative action, platelets also release a large amount of substances that are involved in the defense against microorganisms. These induce the recruitment and activation of cells of the immune system in the inflammatory focus in regeneration. Platelets also release substances with bactericidal effects, contributing to directly kill pathogens.  PRP therapy is particularly effective as a natural anti-inflammatory.

Stem cell therapy

Stem cell therapy has had a great popularity boom in recent years due to its great benefits and few adverse effects. Stem cells are able to divide indefinitely and differentiate into various types of specialized cells. These properties allow them to be used in the regeneration of destroyed or injured tissues.

There are many different types of stem cells. These include embryonic stem cells that exist only in the early stages of embryonic development and adult or somatic stem cells that are found in different tissues of the human body.

Adult stem cells are found mainly in the bone marrow. However, stem cells have also been isolated in the skin, adipose tissue, periodontal ligaments, synovial membranes, trabecular bone, and nervous system.

Previously it was thought that tissue-specific stem cells could not be differentiated into cells from a different tissue. However, several experiments conducted in recent years have shown that stem cells from the bone marrow can form cells from completely different tissues. These findings are of great importance since they have led to the use of hematopoietic stem cells (the most abundant and accessible) in the regeneration of neurological, epithelial, vascular, muscular, osteoarticular, and glandular tissue.

Application of stem cell therapy in osteoarticular diseases

One of the most common and widespread indications in regenerative medicine is the use of mesenchymal stem cells in the treatment of different pathologies related to the musculoskeletal system. Orthopedics has been a pioneer in the use of cell therapy for more than a decade, initially used in the treatment of tendon injuries. However, its application in the treatment of osteoarticular pathologies started a few years ago.

Osteoarthritis is a degenerative disease that involves the overproduction of proinflammatory cytokines (TNF, interleukin-1β), proteases (MMP-13) and other catabolic mediators (nitric oxide), which trigger the progressive deterioration of articular cartilage, synovial membrane inflammation, and remodeling of the subchondral bone.

Several scientific studies have proven the effectiveness of mesenchymal stem cell therapy in the treatment of osteoarthritis of the knee. Intra-articular injection of mesenchymal stem cells decreases inflammation of the synovial membrane and leads to the regeneration of the joint cartilage, which causes a reduction of joint pain and stiffness, increasing joint functionality.

Biological therapy through the use of stem cells is an excellent alternative in the treatment of low back pain caused by degenerative diseases of the spine such as osteoarthritis or herniated disc. In the near future, this therapeutic method could become a solution for complex cases that do not respond to conventional treatment. Injection with mesenchymal stem cells allows regenerating the articular cartilage and decreases inflammation in the injured intervertebral disc, which reduces pain and increases mobility. The improvement of the symptoms is usually perceived after 3 weeks, reaching its maximum peak at 8-12 weeks.

Injection with stem cells can be very beneficial in patients with severe shoulder arthritis in which there is a complete destruction of the articular cartilage, large bone spurs and significant reduction of movement. Previously the only treatment available for these patients was the total replacement of the joint with titanium prosthesis, however, in many cases, the results were not entirely satisfactory. At present, the application of injections with stem cells allows to considerably reduce the symptoms of severe shoulder arthritis, constituting an alternative to shoulder replacement surgery.

It should be noted that stem cell treatments function primarily as a powerful anti-inflammatory. Stem cell therapy may not be appropriate in injuries where there is a damaged or torn tendon or ligament. At this time, stem cells cannot repair torn tendons or ligaments. However, stem cell therapy is still in its infancy and the future of this new modality of treatment is filled with promise.

Most insurance plans do not currently cover stem cell therapy.

Sources

  1. Wang-Saegusa, R. Cugat, O. Ares, R. Seijas, X. Cuscó, M. Garcia-Balletbó. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch Orthop Trauma Surg, 131 (2011), pp. 311-317.
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  3. Bajada S, Mazakova I, Richardson JB, Ashammakhi N. Updates on stem cells and their applications in regenerative medicine. J Tissue Eng Regen Med. 2008; 2: 169-83.
  4. K. Gupta, A.K. Das, A. Chullikana, A.S. Majumdar. Mesenchymal stem cells for cartilage repair in osteoarthritis. Stem Cell Res Ther., 3 (2012), pp. 25.
  5. Jorgensen, D. Noel. Mesenchymal stem cells in osteoarticular diseases. Regen Med, 6 (2011), pp. 44-51.