The results of treatment of arthritis with Stem Cells are variable and there are many reasons why results are so different. When comparing results look at what was being treated and how. With stem cell treatments the cells and additives will travel all over your body and may improve multiple areas that may not have been the primary reason for treatment. Many symptoms will change. For example patients being treated for OA of the knees may see improvement in migraine headaches. The knees are reported as the primary outcome. The migraine headache improvement is a bonus. If you want to know “How to treat Osteoarthritis” this is the best option for many people.
Disease or Symptom
While many diseases have shown improvements the greatest and most consistent improvement in results for treatment with stem cells have been seen with the treatment of Osteoarthritis. Many patients have reported a permanent 100% improvement with return to full working duties, social and sporting life.
Testing to Improve Treatment Results
But not everyone gets these results. 3% of patients do not respond at all. Zip, zilch, nothing. We do not know why yet but the first step is to identify these total non-responders and compare them to the 100% responders (Super Responders). We have been able to identify some differences and will use this to test patients before treating them. It is important to be able to predict non-responders so that we do not subject them to an unnecessary procedure with the associated discomfort, cost and disappointment. This test is in the validation stage and hopefully it will eventually allow us the predict how much improvement each patient can expect which will help with their cost/benefit analysis.
When treating Osteoarthritis with Stem Cells people all around the world are getting different results. We were the first to start treating people so we had no one to compare our results with. Over time we evaluated every step making improvements as we went. Our early results were very similar to those that have since been published by Michalek and his group.
Patient variability
As our processes and procedures improved our results also improved.
- We have made improvements to our aftercare so that patients get better results with rest, exercise and physiotherapy.
- We got better at identifying pre-existing conditions such as tendonitis that need extra attention during and after treatment. Tendonitis pain can be mistaken for osteoarthritis joint pain and needs separate treatment.
- We realized that some patients are never going to respond no matter what we do. For some reason their bodies do not respond to themselves. We are investigating this phenomenon.
- Patients with Gout need to be well controlled before treatment because a flare of Gout may kill most of the freshly implanted cells
Cell Type
There has been a lot of discussion about which cell type or mixture to use and where to get them from. Embryonic stem cells have been collected by separating an embryo into individual cells. The USA has banned the harvesting of new embryonic stem cells. Fortunately they multiply very strongly and laboratories have a plentiful supply.
Adult Stem Cells
As the name suggests these come from adults. If they are yours they are Autologous. If they come from someone else they are Heterologous. The most commonly used donors are Bone Marrow and Fat (Adipose). You can grow more bone marrow so it is expendable. Most people are happy to part with some fat.
Bone Marrow vs Adipose
Bone Marrow is constantly being replaced and new blood cells are made every day. The stem cells in bone marrow age at the same rate that you do. As they get older they can still replace all your blood cells but it takes longer.
Adipose tissue is at the centre of your immune system. It is on the front line of defence against infection. Adipose tissue is the largest endocrine organ in your body. Adipose stem cells do not have to work constantly and for some reason are spared the aging that bone marrow goes through. So the good news is that your Adipose stem cells are relatively young and virile.
Cell Separation: Enzymes or physical
Our bodies are full of enzymes. We need them as part of the process of breaking down old or damaged tissue so that it can be repaired or replaced. Enzymes are named by adding -ase to the end of the target material. Protein is broken down by proteinase. Collagen is broken down by collagenase. Adipose tissue is held together with collagen so we can use collagenase to separate the cells.
Collagenase is manufactured by a large American pharmaceutical company called Roche. It is used in humans to treat Dupuytrens Contractures.
Because collagenase is a manufactured drug there are potential risks in its production. These risks can be avoided by using physical methods to separate the cells and not using any chemicals at all. Ultrasound is very effective for cell separation and is chemical free. The original probes were placed inside the adipose tissue. This has the potential for contamination or infection. Using a probe outside the container avoids this potential risk.
Number of cells Needed for Results.
When treating Osteoarthritis we often need to treat multiple joints. We have also found that giving some cells intravenously improves our results.For this reason we need a lot of cells. Bone Marrow does not yield these large numbers so we have continued to use Adipose tissue.
Counting cells
We have used several devices to count the cells. Hemocytometers are a manual method which is time consuming and operator dependent. We have trialed several photographic devices but not found them useful. Coulter Counters are fast, reliable and accurate. Flow cytometers have been the industry standard and the method most understood by other scientists. We have trialed and been satisfied with two models which give us good results.