February 6, 2017
Stem Cells, Platelet Rich Plasma, And Healing
By Michael D. Shaw
A “stem cell” is an undifferentiated cell that can divide via mitosis to produce either more undifferentiated cells, or differentiate into specialized cells. As such, these cells have the ability to produce new cells, mature into a variety of different cell types, and mobilize in response to an injury. As Connecticut-based pain management specialist David Kloth, MD puts it:
“Stem cells are the repairmen of the body, the workhorse cells which do the actual rebuilding. These cells usually travel to the injured areas via the bloodstream, and create healing. If the injured area has a poor blood supply, this is called an area of hypoxia or low oxygen content. Areas of hypoxia can include joints, meniscus tissue, rotator cuff, spinal discs, and other tendonous/ligamentous structures. These are areas that typically do not heal on their own; they need assistance getting these repairmen to the jobsite.”
One method of providing such assistance involves the use of Platelet Rich Plasma (PRP). The fluid portion of blood is called “plasma,” which holds in suspension red cells, white cells, and platelets. While platelets are best known for effecting the clotting mechanism, they also contain hundreds of proteins called growth factors–essential to the healing process. The idea is to get this PRP directly into the injured area.
In practice, a PRP therapy session will usually take less than an hour. To start, around 30 milliliters of blood is drawn from your forearm, and put into a special sterile tube that prevents clotting. The platelet-rich fraction is obtained via centrifugation. The PRP serum is further treated with anti-clotting factors and other FDA-approved additives, to enhance the healing properties.
As described on a website run by Angie Sadeghi, MD…
Upon injection, platelets act as the framework on which damaged tissues in the body regenerate. Platelets contain storage organelles–dense and alpha granules. When introduced and activated at the treatment site, the granules kick-start the healing process in three stages:
2. Quick creation of new cells needed to repair the injury
3. Recreating the damaged tissues
PRP therapy has been used by elite athletes for a number of years, and is most effective in treating chronic tendon injuries (tennis elbow). It has also been applied to other sports-related injuries such as pulled hamstrings and knee sprains.
Less publicized uses include surgical wound healing; cosmetic skin enhancement; speeding healing of fractures; and pain relief in certain lower back and spine issues.
Stem cell therapy is being promoted as a potential medical miracle, applicable to such conditions as Alzheimer’s dementia, Parkinson’s disease, heart disease, degenerative joint disease, paralysis, and even aging. Indeed, a group led by Charles Murry of the University of Washington demonstrated that human embryonic stem cells could fix damaged hearts of non-human primates–albeit not without complications. The work was published in 2014 in Nature.
According to a 2006 paper entitled “Nutraceuticals Synergistically Promote Proliferation of Human Stem Cells”: “[C]ertain natural compounds can promote proliferation of hematopoietic stem cells in vitro, and more specifically that a combination of blueberry extract, green tea extract, carnosine, and vitamin D3 demonstrate synergistic activity in these assays.”
Dr. Sadeghi is skeptical. “There are no clinical trials to prove the benefit of these ingredients in a complicated environment outside of the laboratory, inside the human body, to prove efficacy. So, unless you have deep pockets, I would wait.”
Finally, it is noted that for more severe problems such as osteoarthritis, healing can only be achieved by delivering larger numbers of stem cells to the affected area. This is accomplished by injecting stem cells from adipose tissue and/or bone marrow directly into the location. Typically, four to six weeks later, PRP injection is made at the same site, followed by another such injection four to six weeks after the first one.
As Dr. Kloth puts it, “These platelet injections allow the stem cells to continue growing and multiplying into cartilage tissue and also continue to recruit other cells to effectuate the repair.”
For the record, the stem cells used in these procedures are always adult–not embryonic–stem cells.