This blog is the 5th blog and the last one of a series that dealt with telomeres, lifestyle and stem cells, topics that were on the agenda of the 22nd Annual Anti-Aging Conference in Las Vegas (Dec.10 to 14, 2014). Here are summaries of two talks from this conference that dealt with methods of repairing damage to your joints or bones without surgery. Treatments consist of stimulating local stem cells through a treatment called “prolotherapy” where needles are used to inject concentrated dextrose. I will explain below why this method is effective. A modification of this original prolotherapy is when the effect of it is amplified by growth factors from so-called platelet rich plasma (PRP), which is mixed with the dextrose injection. The ultimate healing jerk occurs when you mix in stem cells with the PRP into the injured tissues. Images before the procedures and images some time after the procedures were shown at both lectures with impressive results.
1. Dr. Fields’ talk was entitled “Repairing joints and spine without surgery: prolotherapy/PRP/stem cell therapy”.
This talk concentrated on the use of prolotherapy with concentrated dextrose and prolotherapy with platelet rich plasma (PRP) with or without the addition of stem cells in the treatment of various musculoskeletal injuries.
When prolotherapy is done by itself 12.5% Dextrose is used to inject into the area of injury. Dr. Fields said that the reason it works is that local stem cells in the injured area are getting activated where the Dextrose is injected and these activated stem cells will do the healing (details explained in an interview with Dr. Reeves). This result can be improved by injecting a small amount of PRP very focally to an area of ligament rupture. PRP is obtained by centrifuging blood from the patient’s vein. The red blood cells are discarded, but the platelet fraction and some of the plasma is use as the PRP preparation. To amplify the effect of the PRP stem cells from bone marrow and from fatty tissue are mixed into the injection. Dr Fields explained that bone marrow is aspirated from the pelvic bone and in the same patient a liposuction is also done to receive adipose tissue. Both tissue samples are put through a cell separator to obtain bone marrow derived stem cells and adipose derived mesenchymal stem cells. Both fractions are combined as they make a superior stem cell mix and are activated by adding platelet rich plasma. This mix was used for bone fractures that were slow to heal, for ruptured tendons, ligaments, Achilles tendons and rotator cuff tears. Dr. Fields showed before-slides and several weeks to months after-slides with MRI scans of the original injuries and the final healed tendons and ligaments. I have never seen such beautiful healing with no residual scar. Stem cells are the specialists of healing such defects because they change into whatever cell type is required and they fill in the defects. This explains the perfect function after the injury is healed following stem cell and PRP injection. It also explains why many athletes who had this done went on to winning more medals after the repair. You do not hear about success stories that often after conventional surgery, because the range of motion and strength suffer from scarring following conventional surgical repairs.
Case histories: several patients with knee injuries that were treated with prolotherapy were shown on video testimonials explaining that their procedures only involved needles in the injured area, that they experienced almost complete pain relief on the day of the procedure and that they could rehabilitate right away.
Slides were also shown of specific knee ligament injuries involving the medial collateral ligament (MCL), the posterior cruciate ligament (PCL) and the anterior cruciate ligament (ACL). These are very important support ligaments within the knee.
But this was not all: there were lower back injuries with ruptured discs. Conventional medicine would have offered a discectomy, but here these patients were treated with prolotherapy. They experienced a stabilization of the weak areas, spontaneous resorption of the prolapsed disc and stabilization and strengthening of the weak spine. MRI scans of the spinal injury before treatment and several months after the treatment were shown with a complete normalization of the spine. In my work as a Medical Advisor for Workers’ Compensation cases that I was doing for 16 years I have never seen a single case like that.
A similar spinal injury in the neck was shown as well with a testimonial from that person. Again there was minimal pain, immediate rehabilitation and a full range of motion several weeks after the injury had been treated with stem cells.
What is treated with prolotherapy?
Basically all of the major joints can be treated with prolotherapy: the shoulder, knee, back, the neck, ankle, elbow and hip. The types of injuries that are treated are sports injuries, fibromyalgia, sciatica, muscle tears, tendonitis, arthritis, bursitis and temporomandibular joint problems (TMJ).
Dr. Fields also stressed (and so did Dr. Purita, which we will learn below) that activated platelet rich plasma needs to be used to activate stem cells.
Two special cases were presented, namely patellar tendinitis and Achilles tendinitis, which both respond very well to prolotherapy and PRP plus stem cell therapy. This provides complete healing of these otherwise very difficult clinical entities.
An image was shown from the late C. Everett Koop, MD, the former Surgeon General of the Untied States who had this to say about prolotherapy: ““I have been a patient who has benefited from prolotherapy. Having been so remarkably relieved of my chronic disabling pain, I began to use it on some of my patients.” This may yet be the strongest argument to at least consider prolotherapy in otherwise hopeless cases.
2. Dr. Joseph Purita gave a lecture on the “Effects of PRP And Stem Cell Injections”. As explained above PRP stands for platelet rich plasma, which is a “soup” of various growth factors and exosomes =cell-to-cell mediators). He discussed the importance of the proper harvesting of PRP. He explained that apart from white blood cells (WBC) and platelets an important component of PRP are very small embryonic like stem cells (VSELs). They can be seen with the microscope. The missing link has been the observation that white blood cells produce inflammatory substances, which have been detrimental when stem cell injections with PRP were done in the past (poor survival rate of stem cells). Now it has been detected that photo-activation of the PRP before injection leads to anti-inflammatory behavior of the WBC in PRP. Dr. Purita calls this “light activated PRP”, which leads to the best results with stem cell/PRP injections. Soft laser stimulation with red, green and blue soft lasers have been shown to improve tissue healing significantly when stem cells and light activated PRP are used. As already described in Dr. Field’s talk the main sources for good stem cells are the fat tissue (from the “love handles”) and the bone marrow (obtained from pelvic bone). Dr. Purita also explained that nitric oxide and electrical stimulation also help to improve stem cell survival and reduce inflammation. All of these methods are revolutionizing orthopedics where injured tissues can be mended with the help of injecting stem cells, light activated PRP and using laser treatments. Dr. Purita showed very detailed technical aspects of these procedures with various applications. For instance, he showed a slide regarding treatment for osteoarthritis of the knee. All this is contained in the plasma that is used to inject PRP into a joint with degenerative arthritis. When you mix this with bone and adipose tissue derived stem cells and inject it into the knees of a person with degenerative arthritis, you get the ideal remedy to calm down the degenerative process with instant pain relief and the stem cells are transforming into cartilage cells (chondrocytes) building up hyaline cartilage. The end result is a new knee surface where the old and the new repaired knee surfaces are knitted into one seamless unit.
PRP by itself can be used successfully for repairing bursitis of shoulders and rotator cuff tears, muscle tears and sprains, meniscus tears of the knee, mild to moderate osteoarthritis of various joints and spine disorders, particularly facet joint problems.
Dr. Purita gave a thorough overview of stem cells. He pointed out that stem cells fulfill two criteria:
- They are undifferentiated and they are capable of self-renewal by replication
- They can undergo differentiation into specific cell lineages.
From a practical point of view as already mentioned in Dr. Field’s talk there are two sources for stem cells that are important: stem cells derived from adipose tissue (also called MCS or mesenchymal stem cells) and bone marrow derived stem cells, obtained usually from the pelvic bone. When they are mixed and stimulated with PRP they are the miracle mix that will help heal all these injuries.
What does the FDA say to stem cell therapy? “The FDA states it is ok to use these cells as long as they are put back into the same patient and they are minimally manipulated.”
Dr. Purita listed a host of other factors beside platelet rich plasma that supports stem cells, increases their survival on transplantation and stimulates them to differentiate and heal the defect at the recipient site as quickly as possible. Photoactivation of platelet rich plasma with low level lasers (soft lasers) will release exosomes, which are tiny particles, released by platelets and white blood cells. They contain proteins and genetic material required for wound healing and stimulation of stem cells.
Towards the end of the talk Dr. Purita showed an MRI scan of a knee with avascular necrosis (dead bone) before and after treatment with stem cells, PRP and low level laser therapy. There was a complete resolution of the avascular necrosis without any surgery. A second case was shown where the initial MRI scan showed a complete tear of the medium collateral ligament (MCL tear) of the knee and the follow-up scan showed the same ligament intact. This was achieved without surgery, just by treating the patient with an injection of stem cells; PRP and using low-level laser therapy to activate PRP.
Prolotherapy and stem cell therapy are the hottest new treatment modalities for ruptured tendons, ligamentous injuries, and disc herniations in the neck and in the lower back. You will not get this from your primary care physician or from your regular orthopedic surgeon at the present time, because they profit from the conventional procedures. But you owe it to your health to try these alternatives first as they are much less invasive and they involve your own cells that will heal the defects with a very high probability. You still have the option to seek the advice of an orthopedic surgeon, should these alternative procedures fail (which is unlikely). Unfortunately most insurance carriers will not pay for this service at this time.
Disclaimer: Dr. Schilling has no conflict of interest with regard to Regenexx or any of the other companies of which images were shown; they simply displayed the best images with regard to the many illustrations in this blog.