As more providers are offering stem cell options, more patients are becoming aware of the wonderful opportunities forhealing provided by stem cell injections. However, not all stem cells are equivalent. It is helpful to review a few pointsthat will help patients decide which type of stem cell therapy offers the best chance of achieving their particular healthgoal.
1) Autologus versus Allogenic
Stem cells are living cells that serve a particular purpose in the body. When injecting (transplanting) these cell into atreatment area, we are asking them to perform their usual function in an area of the body different from where theymay have been obtained.
Allogeneic stem cells are cells derived from a person other than the patient into whom they are being transplanted.These might be derived from bone marrow, placenta, fat or any other tissue of another individual that are thentransplanted into the patient. Given that we are asking living cells to perform their usual function, it is understandablethat they are sensitive to changes in their environment that can affect their comfort level. The greater the change inenvironment, the greater the challenge for cell survival and efficacy.
It is important to consider that an individual acting as a tissue donor for stem cell isolation most likely has a verydifferent physiologic milieu than the patient receiving the stem cells. The donors gender, dietary habits, hormonalstatus, exposure to environmental and dietary toxins may differ from the patients status. Thus, the cells beingintroduced into the patients body are not in familiar territory and are more likely to suffer stress and may not survive,let alone function well.
Hence, it seems natural that the most logical choice between Autologous or Allogenic should be Autologous, i.e. thepatients own cells for transplant.
2) Bone Marrow versus Adipose derived
Stem cells are born in the same fashion as other blood cells. Therefore, it is not surprising that they are born in bonemarrow where other blood cells are generated. It is also not surprising that bone marrow was one of the first placeswhere stem cells were first discovered as well as the source used by many in bench science and applied medicine forisolating stem cells. However, stem cells are only born in bone marrow that is not their final destination.
Stem cells are involved in the healing cascade that is required for repair of most bodily injuries that occur in the courseof normal life. That healing cascade seems to be stimulated by bleeding, which makes a whole lot of sense. There canbe very little injury to the body that does not induce bleeding. That is because there are small blood vessels throughoutour body, and mechanical injury should necessarily involve damage to these vessels. Blood, while it is in the vascularsystem, is a normal thing for the body blood outside of blood vessels is not: it indicates injury. And there appear to bea number of systems activated by bleeding, all of which lead to healing.
One of these is the response of platelets. Many have learned in High School Biology that platelets induce clotting when there is bleeding. As noted above, bleeding seems to be a signal in the body that indicates injury. So it is not surprisingthen that science has found that platelets ALSO release a host of growth factors when they are activated to form a bloodclot growth factors being signaling molecules that signal to other cells the need for healing processes to occur. Thesehealing processes lead to repair of damaged structures including bone, ligament, cartilage, skin and other tissues.
Stem cells, back to the subject at hand, are also part of this bleeding-induced healing process. Once born in bonemarrow, stem cells migrate out of the marrow and circulate in the blood, leaving the blood to take up their position aspericytes. Pericytes are cells that are located on the outside of blood vessels. They literally attach themselves to theoutsides of blood vessels, both small and large. These cells then wait for activation by processes that affect the bloodvessels including disruption/injury that leads to bleeding. When bleeding is induced, stem cells on adjacent/affectedblood vessels are activated. Once activated, their contribution to healing is that they will generate NEW CELLS of thesame type as the tissue that has been injured. They literally replace the damaged tissue with new cells as they performthis process.
It is not surprising to find that there are MANY small blood vessels in adipose, or fat tissue. This tissue is a storage organ.It requires blood vessels to transport fat to it from the body if there has been an excessive supply of nutrients in dietaryform for deposition as stored fat. It ALSO requires lots of blood vessels to supply fat for use if and when the bodyindicates a need for the fat that has been stored. Not surprisingly then, there are LOTS of small blood vessels in fat. Andall of these are lined with stem cells.
According to Stem Cell Scientist Kristin Komella, there are 500 times more stem cells available from the same amount offat as there are from bone marrow.But wait it gets better (in the case of adipose derived stem cells). As it turns out, not all stem cells act the same. Thereis a specific line of stem cells, CD34 cells that seem to be the most beneficial in terms of the healing in which mostpatients are interested. The proportion of those cells in adipose-derived stem cells is far higher than that in bonemarrow. Bottom line: not only are there 500 times more stem cells available from adipose as compared to bonemarrow, but there are vastly higher proportions of the most active stem cells in adipose derived stem cells as comparedto bone marrow derived.
Bottom line: autologous and adipose-derived stem cells would seem to be the obvious choice when considering stemcell transplant therapy.- Patrick Mallory DO
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