Naturopathic Medical Doctors(NMD’s) understand the root causes of Fibromyalgia, arthritis, and autoimmune disease such as Rheumatoid Arthritis, and can guide you to complete recovery so that you can live everyday without focusing on pain management. We are the alternative specialists when it comes to immediate and chronic pain. We offer immediate solutions for sudden onset of pain syndromes and we can determine the underlying causes of chronic pain. We seek to have all of our patients lead an active, productive, and pain free lifestyle.
When the body produces pain in a specific location of the body, growth and immune factors are called to the location to stimulate healing and regeneration. These growth factors stimulate local tissue to repair acute and chronic injuries. Local connective tissue damage is the most significant factor contributing to chronic pain including pain in the feet, knees, hips, low back, neck, shoulders, elbows, and even the hands. Because of physical stress, aging, and injuries, our supportive connective tissue can become weakened and inflamed. Stem cells, derived and isolated from your own fat tissue, can turn on growth factors that induce healing, Stem cells are also able to differentiate into any cell type we may need, helping to restore connective tissue to its near original tensile strength and form. As we introduce stem cells into specific locations of injury or degeneration, they begin to regenerate the broken, worn out, and torn tissue that is the source of pain.
Understanding the Root Cause of Pain
To understand how stem cell and regenerative therapies work, we have to go back to the root cause of most pain. And before we can understand the root cause of pain, we need to know a little about the anatomy of the body. The frame or structure of the body is built on and around the skeletal system. The skeleton is made up of many bones that approximate one another but do not touch. One bone adheres to the next by a ligament, and this juncture is called a joint. The body is made for movement and activity. Layered over the bones and crossing the joints are hundreds of muscles that act as a pulley system. The muscles attach to the bones by tendons. Ligaments and tendons, are the same tissue, with slightly different functions, the ligaments providing support to the scaffolding. Overlying the muscles of course is connective tissue, fat, and the skin. Some joints contain fluid within a capsule. The fluid filled capsules, as we see in the knees, hips, and shoulders, provide cushion for weight bearing joints. These fluid filled joints allow for extreme force to be applied without having the bones contacting or rubbing on one another.
Ligaments and tendons(aka connective tissue) are often described as the glue that holds all things together. Though this glue is living and has a blood supply, two obvious risks exist. One is, connective tissue is very dense, which is why it is also very strong. Due to its density the blood supply is weakest in connective tissue compared to fat, bone, and skin. This equates to slow healing as connective tissue is damaged. It appears, for reasons we do not completely understand, that once a ligament or tendon is damaged, its recovery is limited to less than 100 percent of its original tensile strength.
Secondly, connective tissue as the glue, is under constant stress whether we are active or not. The constant stress, or constant wear and tear, requires time to heal and repair. If the repair process is unable to recover from an activity or an injury, the tissue becomes weak and frayed. A rubber band can illustrate this concept well. Brand new, it has elastic capabilities that restore it to its original shape when it is stretched or pulled. But stretch and pull it 1,000 times and see if it is any weaker than when we started. As ligaments and tendons stretch out they become unstable. As this begins to happen, the muscles receiving proprioception from the local damaged tissue, tighten in order to stabilize the local joint, so no further damage can occur. The muscles tighten in very specific patterns or points of contraction known as trigger points. Thus the second layer presents, sooner or later, with referred pain patterns from distal trigger points in associated muscles.
Lastly, we fail to recognize the normal process of aging, in which, everything begins to dry out. Ligaments and tendons and particularly capsule joints often just need some “loving” rejuvenation to rebuild the normal fluid structures present in our youth. A great abundance of knee pain, for example, is simply caused by a slow dehydration of the fluid within the capsule. The good news is, this pain is 100% curable.
Stem Cell Therapy
Stem cell and regenerative therapies are localized injections at the site of ligament, tendon, or capsule joints in order to restore the tissue to its original tensile length and strength, or restore the fluid within capsulated joints, and renew, restore damaged and old tissue such as cartilage. As connective tissue and fluids are restored to their youthful states, pain reduces at the local site. Trigger points, which developed to stabilize the nearby joint, are allowed to release through stretching, trigger point injections, massage, and acupuncture. Pain reduces and function increases.
With the recent addition and improvements in stem cell extraction, regenerative medicine has become a powerful tool to reduce pain and improve joint function. Patients have received injections for tennis elbow, plantar fasciitis, achilles tendonitis, rotator cuff tears, meniscal tears, osteoarthritis, knee pain, hip pain, and chronic low back and neck pain. Injections are given with a local anesthetic, using the smallest gauge needle possible, to minimize pain at the injection site. On occasion, an “achy” soreness is felt at the site of injury, just a few hours following the injection. This “soreness” is a positive sign that the healing response has been set in motion. This effect can last for several days and gradually decreases as healing and tissue repair occurs. Often, acupuncture is recommended, in the local region of the injections, which improves healing response and begins to reduce pain in local tissues.
This treatment is not a “quick fix” and is designed to promote long-term healing of the injured tissue. The regeneration of connective tissue can continue for months and may require a few repeated injections over time. Research and clinical data show that regenerative injections are extremely safe, with minimal risk for any adverse reaction or complication. Because stem cells are derived from your own tissue, there is no concern for rejection or disease transmission. There is a small risk of infection from any injection into the body, but this is rare. Current stem cell research and specific details of how we may treat individual orthopedic conditions are described in the following articles. Every patient’s needs and desires may be different and your doctor can help you decide what will be most beneficial for you.
DEGENERATIVE DISC DISEASE
(Although research supports this treatment, it is not currently available through our office)
Stem cell research supporting disc disease
Mesenchymal stem cells reduce intervertebral disc fibrosis and facilitate repair.
Stem Cells. 2014 Aug;32(8):2164-77
Authors: Leung VY, Aladin DM, Lv F, Tam V, Sun Y, Lau RY, Hung SC, Ngan AH, Tang B, Lim CT, Wu EX, Luk KD, Lu WW, Masuda K, Chan D, Cheung KM
Intervertebral disc degeneration is associated with back pain and radiculopathy which, being a leading cause of disability, seriously affects the quality of life and presents a hefty burden to society. There is no effective intervention for the disease and the etiology remains unclear. Here, we show that disc degeneration exhibits features of fibrosis in humans and confirmed this in a puncture-induced disc degeneration (PDD) model in rabbit. Implantation of bone marrow-derived mesenchymal stem cells (MSCs) to PDD discs can inhibit fibrosis in the nucleus pulposus with effective preservation of mechanical properties and overall spinal function. We showed that the presence of MSCs can suppress abnormal deposition of collagen I in the nucleus pulposus, modulating profibrotic mediators MMP12 and HSP47, thus reducing collagen aggregation and maintaining proper fibrillar properties and function. As collagen fibrils can regulate progenitor cell activities, our finding provides new insight to the limited self-repair capability of the intervertebral disc and importantly the mechanism by which MSCs may potentiate tissue regeneration through regulating collagen fibrillogenesis in the context of fibrotic diseases.
FOOT, ANKLE, HEEL, and PLANTAR FASCIAL PAIN
The major weight bearing joints of the body, in descending order are, the sacroiliac joint, hip joint, knee, and ankle. The ankle carries the brunt or weight of the whole body. With a history of any ankle strains or sprains, regular activity involving running, or lack of adequate arch support, ankle pain, plantar fasciitis, or foot pain can develop. Stem Cells can be injected in and around the supporting ligaments of the ankle to strengthen, tighten, and support the ankle reducing pain and improving activity. Most patients see benefit with the first injection within 2-4 weeks. In cases of severe injury or chronic wear, injections for ankle pain may need to be repeated using PRP within 2 weeks following the initial Stem Cell Injection. Most patients respond with resolution of pain between 1-3 sessions. Every treatment session includes an acupuncture treatment which has been shown to speed healing and recovery from the injection therapy.
KNEE PAIN
The knee is an excellent example of how different forces act upon it to cause pain. The bones of the knee include the femur and the tibia. The approximate one another and are attached on the inside by ligaments called the anterior and posterior cruciate ligaments. They stabilize the knee from moving too far forward or backward. Along the medial and lateral aspects of the knee and crossing the joint from top to bottom are the collateral ligaments. These help the femur and tibia from moving too much to inside or outside. Over the ligaments a connective tissue capsule surrounds the knee joint. Another layer called the menisci, lying inside the knee, serve as a non-liquid cushion keeping the bones from rubbing on one another. In addition, our body creates and maintains a fluid found inside the joint, that appears to “dry up” leading to increasing pain with use and normal aging.
Pain then arises when one of the following occur. First a tear in one or both of the cruciate ligaments, or menisci, strain or sprain of the lateral or medial collaterals, loss of fluid within the capsule joint, and development of trigger points within the attached muscle groups as a result of unstable joints.
The best treatment for the knees appears to be injections of stem cells into and around the joint capsule. The fluid within the capsule of the knee can diminish over time. At this point the menisci will begin to make contact, increasing inflammation and irritation, resulting in chronic knee pain and weakness. The addition of stem cells into the capsule can possibly regenerate the joint cartilage and fluid, returning the knee to a non-painful state. That means a patient can walk, run, and even jump without pain.
Stem Cell treatment of the knee includes injection of a volume of stem cell mixture into the joint itself, followed by injection in and around the stabilizing ligaments of the knee. We follow all treatments with acupuncture to support the natural healing phases of the knee and to reduce swelling. Patients are able to walk out of the office without any physical limitations and resume normal activity in 1-2 days.
Stem cell research supporting knee pain
Acta Biomater. 2015 Aug 3;
Authors: Martin JT, Milby AH, Ikuta K, Poudel S, Pfeifer CG, Elliott DM, Smith HE, Mauck RL
Tissue engineering strategies have emerged in response to the growing prevalence of chronic musculoskeletal conditions, and many of these regenerative methods are currently being evaluated in translational animal models. Engineered replacements for fibrous tissues such as the meniscus, annulus fibrosus, tendons, and ligaments are subjected to challenging physiologic loads, and are difficult to track in vivo using standard techniques. The diagnosis and treatment of musculoskeletal conditions depends heavily on radiographic assessment, and a number of currently available implants utilize radiopaque markers to facilitate in vivo imaging. In this study, we developed a nanofibrous scaffold in which individual fibers included radiopaque nanoparticles. Inclusion of radiopaque particles increased the tensile modulus of the scaffold and imparted radiation attenuation within the range of cortical bone. When scaffolds were seeded with bovine mesenchymal stem cells in vitro, there was no change in cell proliferation and no evidence of promiscuous conversion to an osteogenic phenotype. Scaffolds were implanted ex vivo in a model of a meniscal tear in a bovine joint and in vivo in a model of total disc replacement in the rat coccygeal spine (tail), and were visualized via fluoroscopy and microcomputed tomography. In the disc replacement model, histological analysis at 4 weeks showed that the scaffold was biocompatible and supported the deposition of fibrous tissue in vivo. Thus, nanofibrous scaffolds including radiopaque nanoparticles provide a biocompatible template with sufficient radiopacity for in vivo visualization in both small and large animal models. This radiopacity may facilitate image-guided implantation and non-invasive long-term evaluation of scaffold location and performance.
J Med Case Reports. 2011;5(1):296
Authors: Pak J
UNLABELLED: ABSTRACT:
INTRODUCTION: This is a series of clinical case reports demonstrating that a combination of percutaneously injected autologous adipose-tissue-derived stem cells, hyaluronic acid, platelet rich plasma and calcium chloride may be able to regenerate bones in human osteonecrosis, and with addition of a very low dose of dexamethasone, cartilage in human knee osteoarthritis.
CASE REPORTS: Stem cells were obtained from adipose tissue of abdominal origin by digesting lipoaspirate tissue with collagenase. These stem cells, along with hyaluronic acid, platelet rich plasma and calcium chloride, were injected into the right hip of a 29-year-old Korean woman and a 47-year-old Korean man. They both had a history of right hip osteonecrosis of the femoral head. For cartilage regeneration, a 70-year-old Korean woman and a 79-year-old Korean woman, both with a long history of knee pain due to osteoarthritis, were injected with stem cells along with hyaluronic acid, platelet rich plasma, calcium chloride and a nanogram dose of dexamethasone. Pre-treatment and post-treatment MRI scans, physical therapy, and pain score data were then analyzed.
CONCLUSIONS: The MRI data for all the patients in this series showed significant positive changes. Probable bone formation was clear in the patients with osteonecrosis, and cartilage regeneration in the patients with osteoarthritis. Along with MRI evidence, the measured physical therapy outcomes, subjective pain, and functional status all improved. Autologous mesenchymal stem cell injection, in conjunction with hyaluronic acid, platelet rich plasma and calcium chloride, is a promising minimally invasive therapy for osteonecrosis of femoral head and, with low-dose dexamethasone, for osteoarthritis of human knees.
HIP PAIN
Hip pain is directly associated with sacroiliac joint. This is because the glutes and piriformis muscles that attach to the hip originate at portions of and near the sacroiliac junction. Some hip pain can be associated with the iliotibial band and hip flexors on the lateral and anterior portions of the thigh. Stem Cell therapy for hip pain can include direct injection into the hip joint, the sacroiliac joint, and the surrounding attachments of major muscle groups such as gluteus maximus, gluteus medius, piriformis, and the iliotibial band. Hip pain appears to be more common in those who are very inactive, but also in those who are extreme in activity such as marathoners and triathletes. Stem cell therapy and regenerative injection therapies are extremely effective in reducing pain and allowing a patient to return to full activity without limitations.
LOW BACK PAIN
The most common cause of low back pain is dysfunction in the sacroIliac joint located on both sides of the sacrum. This location may be the densest connective tissue layer in the body. Consider what it does, as it attaches or connects the upper torso to the lower limbs. This joint is a weight bearing joint that is sensitive to weight bearing activities. This includes walking, running, weights, jumping, and even pregnancy. Pregnancy can aggravate this joint obviously by the addition of 25-60 additional pounds gained during pregnancy, but also by the hormones that are produced that cause ligament laxity widening the birth canal. Lack of activity can also lead to dysfunction of this joint, due to weak muscles that attach near to this joint and function to help stabilize and support this transition point for forces applied above and below the sacrum. Consider the ligaments of the sacroiliac joint and their potential to become weak, frayed, strained and it is easy to recognize that Stem Cell Therapy can strengthen the sacroiliac joint returning it to full function.
We have found consistently, with acute and chronic low back pain, that the muscles that are near or stabilize the sacroiliac joint can develop trigger points that cause referred pain patterns resembling low back pain. For example the gluteus medius, gluteus maximus, and piriformis muscle groups tighten to help stabilize the sacroiliac joint. These tight areas will refer pain in a location away from their current location, making it difficult to diagnose the source of pain without a trigger point focused exam. Trigger points respond very well to acupuncture.
The treatment of low back pain includes injections into the stabilizing ligaments of the sacroiliac joint and attachments along the sacrum. In our clinic we apply both stem cell treatments along with acupuncture to stabilize the joint and reduce the trigger points. Often, the addition of specific stretches done daily or regular massage can also help reduce trigger point pain. The combination of these therapies leads to a elimination of low back pain.
MIGRAINES and HEADACHES
Many patients suffer from ongoing headaches or migraines. The most common type of headache is a tension headache. Most tension headaches arise from tight muscles in the upper back, neck, and the temporomandibular joint. Trigger points develop and persist causing a shortening of muscles which attach at the base of the skull. These tight muscles radiate pain either over the top of the head, across the forehead, or around the temples. This type of headache is relieved with stem cell and trigger point injections to the posterior attachments of the neck muscles at the base of the skull. Acupuncture also helps to relax the muscles and reduce trigger point influence.
Migraines on the other hand or more complex. In having helped many patients eliminate migraines we have discovered that most migraines have multiple triggers. One trigger is tension headaches. Any hx of head or neck trauma can damage tendons and predispose toward more complex migraines. We have also found many different aggravators for migraines over the years. For example IgG food allergies, dehydration, exposure to solvents, cleaners, and perfumes, and candida overgrowth. Clues are gathered during an intake to the other potential triggers. Once these are discovered, eliminated, or treated, migraines become nonexistent. Most patients respond within 1-3 visits with a minimum 90% reduction in pain.
NECK PAIN
A significant number of patients with chronic neck pain have in their history an injury such as whiplash from sports, auto accidents, and falls. Often, a few tendons, of the multitude of the tendons in the back of the neck, become stretched and lax due to those injuries. Symptoms may not show up until years later. Small injections at the sights of injury provide considerable relief over a few weeks. The addition of acupuncture, massage, and stretching also help to improve the function and activity of the muscles leading to reduced pain.
OSTEOARTHRITIS
Arthritis is a common debilitating condition affecting the quality of life for many patients. The treatment of acute and chronic arthritis with alternative medicine and stem cell therapy has proven beneficial when compared to the treatment of pain with standard medications, steroid injections, or surgery. Arthritis is not a condition that needs to be tolerated and great relief can be found through treatments offered by Naturopathic Medical Doctors.
Arthritis is caused largely by uncontrolled inflammation in the body, the largest percentage being derived from the diet. Gaining control of inflammation requires reducing inflammatory foods in the diet. The most reliable approach to determining inflammatory dietary foods is through performing IgG Food Intolerance Testing. Research continues to substantiate the fact that particular foods can aggravate every type of arthritis. Your physician will also discuss with you specific dietary guidelines that help improve inflammatory control. Candida cleansing or detox has also been shown to be very beneficial, when discovered to be present through lab testing.
In addition, our bodies produce small amounts of its own steroid, called cortisol, to keep inflammation under control. With aging and stress, this normal physiological output of cortisol can decline leading to impaired inflammatory control. Adrenal Function Testing measures the strength and output of cortisol, thus providing information allowing for customized anti-inflammatory therapy.
A significant amount of pain arises from ligament and tendon weakness with the resultant instability in joints. When joints are unstable they fail to perform optimally and cause premature wear and tear. When the wear and tear becomes significant enough, inflammation becomes apparent and patients notice swelling, limited movement, and localized pain. Stem Cell Therapy may be the best treatment for weak ligaments and tendons. One of the applications provided at Global Health consists of stem cell injections in worn, painful, or injured joints and tendons that cause proliferation of connective tissue and fluids within the joints. The increase in fluid and ligament proliferation leads to increased density, strength, improvement in joint stability, and less pain.
Another effective therapy for the treatment of chronic pain includes acupuncture. Acupuncture works by clearing meridians or channels to allow improved circulation and support to the body’s innate ability to heal. Although acupuncture is new to western medicine, it has been a mainstay in eastern medicine for over 3,000 years. Acupuncture is extremely effective with helping muscles relax and reducing joint inflammation and pain.
Arthritic pain has been linked to derangements in biomechanics, inflammation, injuries, food intolerances, nutritional deficiencies, and even the normal process of aging. Determination of the underlying causes of pain begins with an appropriate assessment, including labs and physical exams. Once the underlying causes have been determined, a specific and directed approach to pain treatment or management will be prescribed including Stem Cell Therapy.
Stem cell research supporting osteoarthritis
Stem Cells Transl Med. 2015 Aug;4(8):945-55
Authors: Bar-Or D, Thomas GW, Rael LT, Gersch ED, Rubinstein P, Brody E
Osteoarthritis (OA) is the most common chronic disease of the joint; however, the therapeutic options for severe OA are limited. The low molecular weight fraction of commercial 5% human serum albumin (LMWF5A) has been shown to have anti-inflammatory properties that are mediated, in part, by a diketopiperazine that is present in the albumin preparation and that was demonstrated to be safe and effective in reducing pain and improving function when administered intra-articularly in a phase III clinical trial. In the present study, bone marrow-derived mesenchymal stem cells (BMMSCs) exposed to LMWF5A exhibited an elongated phenotype with diffuse intracellular F-actin, pronounced migratory leading edges, and filopodia-like projections. In addition, LMWF5A promoted chondrogenic condensation in “micromass” culture, concurrent with the upregulation of collagen 2α1 mRNA. Furthermore, the transcription of the CXCR4-CXCL12 axis was significantly regulated in a manner conducive to migration and homing. Several transcription factors involved in stem cell differentiation were also found to bind oligonucleotide response element probes following exposure to LMWF5A. Finally, a rapid increase in PRAS40 phosphorylation was observed following treatment, potentially resulting in the activation mTORC1. Proteomic analysis of synovial fluid taken from a preliminary set of patients indicated that at 12 weeks following administration of LMWF5A, a microenvironment exists in the knee conducive to stem cell infiltration, self-renewal, and differentiation, in addition to indications of remodeling with a reduction in inflammation. Taken together, these findings imply that LMWF5A treatment may prime stem cells for both mobilization and chondrogenic differentiation, potentially explaining some of the beneficial effects achieved in clinical trials.
Arch Orthop Trauma Surg. 2015 Oct 15;
Authors: Buda R, Castagnini F, Cavallo M, Ramponi L, Vannini F, Giannini S
INTRODUCTION: Ankle osteoarthritis (OA) is a challenging pathology, often requiring surgical treatments. In young patients, joint sparing, biologic procedures would be desirable. Recently, a few reports have described the efficacy of bone marrow stem cells in OA. Considering the good outcomes of one-step bone marrow derived cells transplantation (BMDCT) for osteochondral lesions of the talus (OLT), we applied this procedure for OLT in concomitant ankle OA.
MATERIALS AND METHODS: 56 patients, with a mean age of 35.6 years (range 16-50), who suffered from OLT and ankle OA, were treated using BMDCT. All patients were clinically checked using AOFAS score, in the pre-operative setting until the final follow-up of 36 months. Weight-bearing radiographs and MRI evaluation using Mocart score were performed, preoperatively and postoperatively.
RESULTS: The whole clinical outcome had a remarkable improvement at 12 months, a further amelioration at 24 months and a lowering trend at 36 months (77.8 ± 18.3). Early OA had better outcomes. 16 patients required another treatment and they were considered failures. Clinical outcome significantly correlates with OA degree, BMI, associate procedures. Radiographs were in line with clinical results. MRI evaluation showed signs of osteochondral repair.
CONCLUSIONS: BMDCT showed encouraging clinical and radiological outcomes at short-term follow-up. This procedure should be applied in young and selected patients, excluding severe ankle degeneration, where the results are critical. Longer follow-ups and larger case series are needed to confirm these results and if this treatment could be effective in postponing end-stage procedures.
LEVEL OF EVIDENCE: IV.
Cell Biol Int. 2011 Sep 22;
Authors: Guercio A, Di Marco P, Casella S, Cannella V, Russotto L, Purpari G, Di Bella S, Piccione G
Autologous adipose-derived mesenchymal stem cell (AD-MSC) therapy involves harvesting fat from the patient isolating the stem and regenerative cells and administering the cells back to the patient. The aim of this study was to evaluate the production of canine AD-MSCs and the possible application of cellular therapy in dogs. In order to assess whether cellular therapy can replace the drug therapy, the clinical effect of a single intraarticular injection of AD-MSCs was evaluated on four dogs with lameness associated with osteoarthritis (OA) of humeroradial joints. The study demonstrated that the mesenchymal stem cells (MSCs) can be readily isolated in adult dog from adipose tissue confirming their ability to form colony and to differentiate into a variety of cell phenotypes. AD-MSCs expressed OCT4, NANOG and SOX2 at mRNA level, pluripotency markers usually ascribed to embryonic stem cells. These results suggested the stemness of the cells isolated from canine fat and good results of quality controls ensured the availability of AD-MSCs for clinical and experimental use. Follow-up studies, designed to evaluate the effects of AD-MSC therapy, showed that treated dogs’ osteoarthritis of the elbow joints improved over time. In conclusion, the cumulative data indicated that this cellular therapy shows a significant potential for clinical use in the treatment of lameness associated with osteoarthritis. Considering that cellular therapy showed substantial promise in the treatment of osteoarthritis it should be applied before the injury becomes severe.
OSTEOPOROSIS
Osteoporosis prevention and treating has its foundation in non-medical treatments. The supplementation of Calcium, Magnesium, Vitamin D have proven mildly beneficial, at least to slow this process. Naturopathic Medical Doctors strive to improve immune function, reduce inflammation, and support bone remodeling through detox programs for yeast, heavy metals, and solvents. Other factors such as hormone therapy and exercise have been shown to be helpful. Stem Cell therapy to support and regenerate the body may also be helpful according to some limited research. Treatment would be a whole body treatment.
Stem cell research supporting bone disease
Biomaterials. 2011 Oct 31;
Authors: Ravichandran R, Venugopal JR, Sundarrajan S, Mukherjee S, Ramakrishna S
Tissue engineering and nanotechnology have enabled engineering of nanostructured materials to meet the current challenges in bone treatment owing to rising occurrence of bone diseases, accidental damages and defects. Poly(l-lactic acid)/Poly-benzyl-l-glutamate/Collagen (PLLA/PBLG/Col) scaffolds were fabricated by electrospinning and nanohydroxyapatite (n-HA) was deposited by calcium-phosphate dipping method for bone tissue engineering (BTE). The abundance and accessibility of adipose derived stem cells (ADSC) may prove to be novel cell therapeutics for bone repair and regeneration. ADSCs were cultured on these scaffolds and were induced to undergo osteogenic differentiation in the presence of PBLG/n-HA for BTE. The cell-biomaterial interactions were analyzed using cell proliferation, SEM and CMFDA dye extraction techniques. Osteogenic differentiation of ADSC was confirmed using alkaline phosphatase activity (ALP), mineralization (ARS) and dual immunofluorescent staining using both ADSC marker protein and Osteocalcin, which is a bone specific protein. The utmost significance of this study is the bioactive PBLG/n-HA biomolecule introduced on the polymeric nanofibers to regulate and improve specific biological functions like adhesion, proliferation and differentiation of ADSC into osteogenic lineage. This was evident from the immunostaining and CMFDA images of ADSCs showing cuboidal morphology, characteristic of osteogenic lineage. The observed results proved that the PLLA/PBLG/Col/n-HA scaffolds promoted greater osteogenic differentiation of ADSC as evident from the enzyme activity and mineralization profiles for bone tissue engineering.
J Tissue Eng Regen Med. 2011 Jun 28;
Authors: Mirsaidi A, Kleinhans KN, Rimann M, Tiaden AN, Stauber M, Rudolph KL, Richards PJ
Adipose tissue provides for a rich and easily accessible source of multipotent stromal cells and thus offers the potential for autologous cell-based therapy for a number of degenerative diseases. Senile osteoporosis is characterized by a reduction in bone quality, which is associated with inadequacies in bone marrow stromal cell (BMSC) differentiation. In the present study, we have characterized adipose-derived stromal cells (ASCs) isolated from aged osteoporotic mice and evaluated their suitability as a source of osteogenic precursor cells. Significant reductions in both tibia bone quality and telomere length in liver tissue were observed in the senescence-accelerated mouse prone 6 strain (SAMP6), as compared to the control age-matched senescence-accelerated mouse resistant 1 strain (SAMR1), thus confirming osteoporosis and accelerated ageing traits in this model. ASCs isolated from inguinal fat expressed mesenchymal surface markers and were capable of differentiating along the osteoblast, adipocyte and chondrocyte lineages. Telomere length was not compromised in ASCs from SAMP6 mice but was actually found to be significantly increased as compared to control SAMR1 mice. Furthermore, ASCs from both strains were comparable in terms of telomerase activity, p21 mRNA expression, SA-β-gal activity and proliferative capacity. The overall osteogenic and adipogenic potential of ASCs was comparable between SAMP6 and SAMR1 strains, as determined by quantitative molecular, biochemical and histological analyses. In conclusion, adipose tissue may represent a promising autologous cell source for the development of novel bone regenerative therapeutic strategies in the treatment of age-related osteoporosis. Copyright © 2011 John Wiley & Sons, Ltd.
J Cell Mol Med. 2011 May 5;
Authors: Chen HT, Lee MJ, Chen CH, Chuang SC, Chang LF, Ho ML, Hung SH, Fu YC, Wang YH, Wang HI, Wang GJ, Kang L, Chang JK
Aging has less effect on adipose-derived mesenchymal stem cells (ADSCs) than on bone marrow-derived mesenchymal stem cells (BMSCs), but whether the fact holds true in stem cells from elderly patients with osteoporotic fractures is unknown. In this study, ADSCs and BMSCs of the same donor were harvested and divided into two age groups. Group A consisted of 14 young patients (36.4 ± 11.8 years old), and group B consisted of 8 elderly patients (71.4 ± 3.6 years old) with osteoporotic fractures. We found that the doubling time of ADSCs from both age groups was maintained below 70 hrs, while that of BMSCs increased significantly with the number of passage. When ADSCs and BMSCs from the same patient was compared, there was a significant increase in the doubling time of BMSCs in each individual from passages 3 to 6. Upon osteogenic induction, the level of matrix mineralization of ADSCs from group B was comparable to that of ADSCs from group A, while BMSCs from group B produced least amount of mineral deposits and had a lower expression level of osteogenic genes. The p21 gene expression and senescence-associated β-galactosidase activity were lower in ADSCs compared to BMSCs, which may be partly responsible for the greater proliferation and differentiation potential of ADSCs. It is concluded that the proliferation and osteogenic differentiation of ADSCs were less affected by age and multiple passage than BMSCs, suggesting that ADSCs may become a potentially effective therapeutic option for cell-based therapy, especially in elderly patients with osteoporosis.
SHOULDER PAIN
The shoulder joint is the most mobile and thus most at risk joint for injury. It is attached or held on the body mostly by muscles including the pectoralis, deltoid, rhomboids, latissimus dorsi, infraspinatus, supraspinatus, subscapularis, and a few others. Often shoulder pain develops immediately following reaching out or up after a fall or to grab something above the head. Treatment involves examining every attachment of the shoulder for strains that then are easily treated with stem cell injections. Stem cells are also injected into the capsule of the shoulder for regeneration and stabilization of the joint from the inside out. Often trigger points have developed that cause severe referred pain patterns. These have to be identified and treated also using trigger point injection, acupuncture and stretching.
