What are the different types of stem cells?

Stem cells promote healing. They are alive, and act like mini “factories” that produce different healing proteins or factors.

They themselves do not turn into tissue, and their existence is temporary, but introducing “adult” stem cells to an injury site (like an arthritic joint) has an activating effect. Think of it like this; an earthquake on the island of Maui may last for 30 seconds, but an earthquake under the ocean off the coast of Maui will trigger a tsunami wave that will travel all the way to Alaska. When the right type and the right number of stem cells are placed inside of an encapsulated joint, they travel to the injury, engraft, and (for up to three weeks) secrete protein factors that stimulate healing and proliferation.

There is a lot of confusion regarding what stem cells actually are, where they come from, and how they should be used.

The FDA published a statement in November of 2017 outlining their position on different cellular therapies. First, they stated that no stem cells should be administered intravenously (through an IV). They also state that adipose, or “fat” derived stem cells, should not be used in joints.

Basically, there are only two types of viable “stem cells” that can be used to treat joint conditions: bone marrow stem cells and umbilical cord stem cells.

Many people believe that PRP (platelet rich plasma) and stem cells are interchangeable. They are not. This PRP substance is separated out when your blood is spun down in a small table top centrifuge. The layer is extracted with a syringe, and then injected. In the same statement from the FDA in 2017, PRP was excluded as a form of cellular therapy. Why? Because there are essentially no stem cells in PRP. PRP is rich in “factors”, which are the proteins that living stem cells make, but these healing factors or proteins are not living, so after 6-8 hours they break down and are gone.

Amnion, or amniotic tissue, amniotic fluid, or the amniotic membrane, are also not stem cells. This is perhaps one of the richest sources of “factors” (proteins) which are not living, but there are no stem cells here either. So the benefits of these factors only last for a few hours.

Adipose, or fat, is one of the most common sources of stem cells, because it is so easy to access. However, in November of 2017, the FDA statement was clear that adipose/fat-derived stem cells should not be used in joints. They state that using adipose derived cellular tissue product in joints is not a homologous application.

Then there are bone marrow cellular tissue product, or “stem cells”. These are classified as homologous for use in joints. Stem cells are extracted from bone marrow and then injected into the joint. These cells are safe to use with joints, but the problem is that adult bone marrow does not have enough stem cells to produce that activating effect, even in a liter of bone marrow.

A study conducted by the Mayo Clinic found there was no improvement in patients who received bone marrow concentrate (BMAC) vs the saline injected group. So, in this study, after they drilled a hole in the patient’s pelvis and then extracted approximately one liter of bone marrow, they used a centrifuge to spin down and separate the cell matrix. They then injected this concentrate into the respective joint.

The most interesting part of this study is that they took this concentrate to their lab at the mayo clinic and analyzed it. What did they find? There was only about 35,000 stem cells present in the concentrated aspirate. That is simply not enough to solve the problem.

Umbilical cord derived cellular matrix (UCM) tissue products are classified exactly the same as bone marrow derived cellular (BMAC) tissue products according to the FDA. They are both tissue based products (HCT/P) that conform with CFR part 1271 section 361 of the PHS act.

The point is that both the umbilical cord (UCM) and the bone marrow concentrate (BMAC) have protein factors, collagen, hyaluronic acid, and living cells. They are also both classified as homologous use in joints according to the FDA.

Advanced Regenerative Orthopedics is a multispecialty medical group with physicians, surgeons and university scientists. We are quite capable of performing bone marrow aspirates. We do not because you simply cannot get enough cells. It is yesterday’s technology. With the umbilical cord cellular matrix (UCM), we can reliably place exponentially more product into the joint.

Remember, we want an earthquake under the ocean to create a tsunami wave-like activation of the native tissue so there is true healing. The 35,000 MSC-like cells you get from BMAC is more like a big splash in the ocean with limited activity. The truth is, numbers matter, and the bigger the initial activation, the more effective the healing process.

This is the cellular matrix product that the physicians at Advanced Regenerative Orthopedics use to treat chondromalacia pain in the knee, shoulder, and hip for our patients who are candidates! If you are suffering from pain caused by a degenerative joint condition like arthritis, contact us today for a free consultation to determine if stem cells may be the solution!