Adipose Vs. Bone Marrow Stem CellsJuly 5, 2019
Stem cell therapy has a dramatic and positive effect on joint pain. For many years patients have come to us hoping to avoid joint replacement surgery with stem cell treatments. We have been fortunate to have helped many not only relieve their pain but to help the patient heal, repair, and rejuvenate their damaged joints and negate the need for surgery or further treatment.
There are many types of stem cells. There are bone marrow stem cells and there are stem cells from adipose (fat).
Research has shown that the concentration of stem cells from adipose is up to one thousand times more concentrated than that of bone marrow. The amount of stem cells that you get out of bone marrow is really not very plentiful. The cellular structures in regard to the stem cells in bone marrow are also not as favorable as that in adipose. In bone marrow stem cells you have cells that make blood cells and these cells are not as beneficial in rebuilding joint structures. The adipose in our opinion is much more favorable for the patient, not only for its cellular count but also adipose contains a lot of other structural elements cells that help recruit the immune system and cellular structures into a damaged area to help it heal.
Recent research on adipose-derived stem cells
A late 2017 study in the The American journal of sports medicine (1) demonstrated the effectiveness of adipose derived stem cells in the treatment of knee osteoarthritis patients.
What happened in the study?
- Eighteen patients with osteoarthritis of the knees, 15 women, and an average age of 61 years old.
- Patients were divided into low-, medium-, and high-dose groups receiving higher stem cell numbers.
- There were no treatment-related adverse events during the 2-year period.
- An intra-articular injection of adipose-derived MSCs improved knee function, as measured by various and well-accepted knee pain scoring systems and reduced knee pain, as measured with the visual analog scale (VAS), for up to 2 years regardless of the cell dosage.
- However, statistical significance was found mainly in the high-dose group.
- Clinical outcomes tended to deteriorate after 1 year in the low- and medium-dose groups, whereas those in the high-dose group plateaued until 2 years. The structural outcomes evaluated with MRI also showed similar trends.
Conclusion: Higher cell numbers resulted in better outcomes at two years. The need for follow up treatment may be necessary.
A study in the Journal of translational medicine (2) suggests that SVFs (Stromal vascular fraction of adipose tissue,combined with PRP (Platelet Rich Plasma therapy) and administered by injection, demonstrate healing potential in patients with degenerative osteoarthritis. Patients demonstrated significant improvements in their degenerative osteoarthritis leading to a better quality of life. These improvements included a clinically significant reduction in pain.
How much improvement?
- Pain functional status of the knee was improved 12 months post injection in all patients and this improvement was maintained at the 2 year time point of the study’s follow up.
- Some patients showed improvements as early as 3 and 6 months after the injection of (stem cells) and PRP.
- The stem cell/ PRP injections also significantly reduced the requirement of pain medication in 8 out of 10 patients. These medications are often associated with undesired side effects and although it may mask the pain, it does not help the underlying disease.
- In addition, clinical improvement corresponded well with improvement on MRI imaging.
- The researchers were able to demonstrate safety with no serious side effects reported during the 2 year follow-up.
What Does This Mean?
The importance of the study above shows that combining adipose derived stem cells and PRP, doctors were able to bring about long-lasting pain relief and joint repair.
At the Magaziner Center, Dr. Greenberg treats the area of injury or arthritis with both stem cells and PRP. If stem cells are the seeds in the lawn, PRP is the fertilizer that helps the lawn grow. PRP is a combination of growth factors and platelets naturally found in the body. They provide cell signals (direct) and nourishment to help the stem cells flourish and develop into new joints, ligaments, tendons, and other body parts.
A January 2019 study in the journal Acta Biomed (3) examined 6 patients affected by hip osteoarthritis were treated by intra-articular injection of autologous adipose-derived MSC between June 2017 and June 2018. No adverse effects were recorded. Preliminary results showed a positive outcome according to all the grading systems used in this study.
Most cases of stem cell and platelet rich plasma (PRP) treatments are successful, yielding positive results. We have had sidelined pro athletes resume their high intensity career and have witnessed elderly patients who were once wheelchair bound because of pain and instability walk again without assistance. Our patients have seen an end to their pain and a return to their normal level of functioning, even after failing surgery to a torn meniscus.
1 Jo CH, Chai JW, Jeong EC, Oh S, Shin JS, Shim H, Yoon KS. Intra-articular Injection of Mesenchymal Stem Cells for the Treatment of Osteoarthritis of the Knee: A 2-Year Follow-up Study. The American Journal of Sports Medicine. 2017 Oct:0363546517716641.
2 Bansal, H., Comella, K., Leon, J., Verma, P., Agrawal, D., Koka, P., & Ichim, T. (2017). Intra-articular injection in the knee of adipose derived stromal cells (stromal vascular fraction) and platelet rich plasma for osteoarthritis. Journal of Translational Medicine, 15, 141.
3 Dall’Oca C, Breda S, Elena N, Valentini R, Samaila EM, Magnan B. Mesenchymal Stem Cells injection in hip osteoarthritis: preliminary results. Acta Bio Medica Atenei Parmensis. 2019 Jan 10;90(1-S):75-80.