We have previously discussed the different types of regenerative medicine that are currently available. As a refresher, these include Platelet Rich Plasma, stem cells from adipose tissue (fat) or bone marrow, mesenchymal stem cells from amniotic fluid, Wharton’s Jelly, umbilical cord blood, and exosomes. The type of product used does have some differences with efficacy but for this post, we will dive into the overall benefits of this class of new-age medications.
Before we dive into the benefits of regenerative medicine, let’s look at the traditional medication used for injections into joints, muscles, and tendon, steroids. There are a variety of steroids that can be used for these injections, some common ones are betamethasone, triamcinolone, and methylprednisolone. These medications reduce inflammation and thus can ease the pain but they are not without potential serious complications. Some common side effects are an increase in blood pressure and blood sugar, swelling, bone thinning, an increase in osteoarthritis progression, ligament and/or tendon rupture, and temporary changes in mood. The images below show a patient with hip pain who received a cortisone injection (left image is pre-injection). 4 months later the pain was significantly worse and you can see the increase hip degeneration in the middle (x-ray) and right (MRI) images. This patient had a total hip replacement 3 months after the x-ray and MRI images (7 months after the cortisone injection) were taken.
There are several cosmetic applications for regenerative medicine. Some uses are for hair restoration as well as for facial (either by an injection or as an overlay–think of a mask). The benefits include tighter skin, increase moisture retention, reduction of lines, and increased collagen. The cosmetic use of regenerative agents is outside of my scope of practice but it does offer a glimps into the ingenuity that is being used to help people not only look better, but feel better to.
The area that I am excited about, the area that I work in with regenerative medicine has musculoskeletal indications. This is important because data from 1996-2013 shows that the US spent $183.5 billion on musculoskeletal disorders. Mesenchymal stem cells (MSCs) stop the inflammatory effects of activated macrophages and aid in healing. They do this by secreting transforming growth factor-β, hepatocyte growth factor, prostaglandin E2, & others. An important step is that M1 pro-inflammatory macrophages are converted into M2 types that are anti-inflammatory. Other beneficial effects of regenerative medicine include angiogenesis (creation of new blood vessels) through platelet derived growth factor and vascular endothelial growth factor, long-term healing and bone regeneration through Transforming growth factor-β, cellular growth, proliferation, and differentiation via endothelial growth factor.
There a study completed that look at the effectiveness of PRP injections into the knee. The study put patients into two groups, placebo and the PRP group. This was a randomized and double-blind study. All the participant received an MRI of the knee before the study began and then again 32 weeks after treatment. The control group received physical therapy and a saline injection while the other group also did the physical therapy but also received a PRP injection twice, 1 weeks apart. The study concluded with the PRP group having a decreased visual analog pain scale score compared to the placebo group. What was even cooler is that in the PRP group, the post treatment MRI also showed significant healing of the joint and connective tissues. The image on the left show a patients MRI pre treatment and post treatment with PRP. What you see is an increase in cartilage volume and the medial and lateral meniscus disintegrity improved. Look at the 3D reconstruction of the patellofemoral cartilege. It went from ratty, frayed, and thin to thicker, full, and robust post treatment. Improvement like this does more that just relives the pain, it also helps to heal the damaged areas so that the pain stays away a whole lot longer.