Stem Cells, PRP, and Arthritis
Dennis M. Lox M.D.
Stem cells are not the magical cells of mystery or science fiction. Stem Cells are found in every human being from the moment we are conceived to the our last days. The interesting thing is Mother Nature did not mean from any being to be immortal. Therefore, self renewing cells such as stem cells are not present throughout the body in sufficient quantities to repair our joints. This results in the wear and tear phenomenon of degenerative osteoarthritis. Arthritis or more properly termed degenerative osteoarthritis is a condition in which joint repair cannot keep pace with joint breakdown, leading to a net loss of joint cartilage. This is obviously clear when viewing an x-Ray of a knee or hip and your physician informs you that you are bone on bone. This really means the space separating the the two bones are narrowed. In knee arthritis the femur and tibia are separated by the cartilaginous two knee menisci. Degeneration or prior surgery to the meniscus results in less tissue and less space reflected by knee joint narrowing. Actual most knee surgery accelerates the effect of knee osteoarthritis, which is contrary to most patients long term goal of health and vitality. Knee surgery after age 50, is especially prone to accelerate knee arthritis, propelling a trend towards total knee replacement surgery.
Traditional medical modalities such as prescription anti-inflammatories and cortisone injections have not been shown to deter the progression of degenerative knee osteoarthritis. Actually studies have shown that knee arthritis progresses on serial x-Rays over 3-5 year periods. This means that viewing side by side comparative knee x-rays will show less joint space over time. Now every human is a unique individual and some will progress at different rates. Humans have a multitude of variables affecting their outcome.
This is where the field of Regenerative Medicine has emerged with options to deter, halt or regress this process. Platelet Rich Plasma (PRP) and Stem Cell Therapy are two strategies to assist in the degenerative aspect of arthritis be it the hips, knees, ankle, spine, shoulder, wrist or hands.
Platelet Rich Plasma (PRP) has gained notoriety over the last decade as elite high profile athletes have gained media attention after turning towards this regenerative therapy. PRP is rather simple. A sample of the patients blood is drawn and prepared as it is spun and concentrated to deliver a high concentration of blood platelets. Originally, we thought of platelets as merely a cell which clots the blood. Now we know so much mor elf the secrets of these tiny blood platelets. They contain numerous cytokines and growth factors which can be used to aid in tissue repair and healing. PRP has been used on various elite athletes in nearly every sport, from Tiger Woods, Kobe Bryant, Alex Rodriquez, to the late Pope John Paul.
PRP has its place, however an expert skilled Sports and Regenerative Medicine specialist such as Dr. Dennis Lox, needs to access the time and place for each treatment based on their injury and individual needs. No two patients are alike and cookie cutter templates or franchise approaches to patients does not allow for personalized medicine. Non-specialists cannot be expected to discern the intricacies of patients needs from weekend warriors, professional athletes or 90 year patients.
Stem cells may have a more specific role in the management of degenerative arthritis.
Knee and hip arthritis account for nearly a million joint replacements in the U.S. every year. This is a multibillion dollar assembly line of replaced parts. The knee and hip bear the burden of stress from athletic injuries to the effects of being overweight.
Stem cells are complicated smart cells present in every one of us. These are known as adult stem cells, as composed to embryonic cells which are entirely different stem cells and not found in adults.
Stem cells are found in certain areas of our bodies in abundance. In order of highest frequency, these adult stem cells are found in Adipose (Fat) tissue, bone marrow, and the peripheral blood. As we age these stem cels numbers decline, which as we know leads to many of the tell tale signs in the mirror of aging. Mother Nature did not intend to make our joints last forever, therefore there are few if any stem cells in joints. This is reflected in poor healing and the resultant overall net degeneration of joint cartilage as opposed to net repair. A normal joint results in a net balance of repair and breakdown.
Stem cells function to aid knee or degenerative arthritic joints by sending molecular signals which act as traffic lights stopping signals from breaking down the joints and orchestrating go signals that direct repair. Stem cells can do two more unique functions. They may continue to divide to creat more stem cells or they commit to become another cell type (differentiation), such as a new cartilage cell. Once committed to differentiate into a new cell. The stem cell cannot revert back to a stem cell in the human body. Laboratory research has uncovered the ability to do so, known as induced pluripotent stem cells (IPS cells). These IPS cells much li,e embryonic stem cells can become almost any tissue type including neoplasticism cells (cancer). This properties of embryonic and IPS cells lead them be less controllable than adult stem cells.
Knowing when and how to use PRP and stem cells is best left for the expert, when dealing with joint arthritis. Humans, unlike laboratory animals come in all shape and sizes. Dr. Dennis Lox is an expert in Sports and Regenerative Medicine. He has treated patients in all shapes and sizes. From teenage to professional athletes. From early post-traumatic arthritis in 20 year olds to 96 year olds trying to remain functional.