Biologic shots: Stem cell injections (bone marrow signaling cell)

Biologic shots: Stem cell injections (bone marrow signaling cell) and Treatments for Knee pain and Arthritis-How and why they work.

Austin Yeargan III MD

 

No therapy is currently available to completely prevent the initiation or progression of organic joint disease partly due to poor understanding of the mechanisms of the disease pathology. However, our understanding of the molecular mechanisms underlying the clinical features of organic joint disease, arthritis and pain continue to improve, paving the way for the development of novel biologic treatments like signaling cell based therapies (CBT), which are often over-simplified as “stem cell treatments”. We have over a decade of experience with the technique we originally designed. We developed a protocol for the procedure in 2006 that is clinically durable and predictable.

 

Inflammatory signals that lead to clinical symptoms like pain and swelling are, by nature, beneficial to the organism. During injury swelling forms an internal splint and fibrinous scaffold for new clonal cell growth, proliferation and maturation. The pain sensation prevents the organism from premature weight bearing and impact. Artificially blocking these clinical symptoms with non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and corticosteroids like betamethasone is ultimately to the detriment of the biological organism’s repair of the physical machine. Following the inflammation phase, a proliferation and maturation phase follow to complete tissue healing.

 

It is likely that pathologic mechanotransduction signals initially give rise to pathologic changes at the molecular level that cause chondrocyte migration and clustering. Due to loading features, the extracellular matrix undergoes reactive remodeling that increases tissue stiffness and leads to progressive disease as loads are no longer evenly or adequately distributed. Chondrocytes produce more collagen, adding tensile stiffness and produce less of the shock absorbing, hydrophilic proteoglycan aggrecan.

 

Cell based treatment protocols work by physically removing the pathologic load distribution and allowing the subchondral bone and extracellular matrix to remodel favorably, restoring tissue elasticity. Once the biomechanical compromise is removed, the molecular component of the treatment takes over through modulation of the immune response and anti-inflammatory measures. Requisite cells are aspirated from the bone marrow (BMA) and concentrated prior to delivery in scaffold similarly derived from activation of structural proteins present in serum and platelet granules.

 

Signaling cell concentrates, or “stem cell injections”, take advantage of marrow stem cell and other nucleated cell signaling to promote tissue health and healing. In addition, plasma fractions containing soluble signaling proteins undergo an ultrafiltration step to remove low molecular weight pro-inflammatory biochemicals and retain anti-inflammatory, anabolic biochemicals and growth factors.

Author
S. Austin Yeargan III, MD Orthopedic Surgeon Molecular Immunobiologist

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