Why do we take an extra step to use your clotting proteins instead of cow proteins?

Key Concepts

Why do we take an extra step to use your clotting proteins instead of cow proteins for signaling cell procedures? Why do we use calcium to pop open platelets? Do you have to do that?

 

Modern, advanced signaling cell procedures include construction of a customized autologous fibrin scaffold for the signaling cell fraction to set up in at the time of injection. Autologous means everything that gets delivered during the procedure comes from you. All of our procedures are autologous marrow signaling cell based management strategies that have been proven to work. We have successfully translated our bench and clinical laboratory work to a rigorous treatment algorithm for arthritis and rotator cuff disease since 2006, when we wrote the first technique guides in the United States for what have unfortunately become dubbed “stem cell” treatments.

A fibrin scaffold is like a thick glue that holds cells together, it’s really helpful in achieving the result you are trying to accomplish. Scaffolds provide a hypoxic environment that stresses signaling cells and hyperactivates them, which is desirable in this clinical treatment setting. Most clinics that make claims to expertise in regenerative medicine have none and their techniques are first or second generation. Using our own intellectual property and working with the Cleveland Clinic and the Steadman Clinic, we have arrived at a 7th generation application that works through micro core of diseased subchondral bone, where arthritis starts. By stimulating the stiff bone to remodel and regain cancellous material properties, the cartilage tissue in the knee is able to recover. Mechanoreceptors play a large part in the progression of arthritis and must be controlled to achieve a successful result.

In order to achieve this scaffolding effect, clotting factor 2, or thrombin, is necessary to produce an interosseous lock of the subchondral nanoplasty injectate in the proximal tibia. There is no Thrombin produced in the knee and fibrin clots do not form outside of the injury setting. Thrombin is a natural circulating clotting factor made in the liver and can be isolated from bone marrow aspirate. While the processing step is independent of the cell processing, the harvesting maneuver is identical and does not require additional intervention. The final marrow aspirate should be used to limit heparin exposure to the sample. The Arthrex® Thrombinator® processor is used to process the autologous clotting proteins.

Platelet rich plasma, or concentrated platelets are part of any signaling cell marrow procedure but this fraction must be optimized to take advantage of the growth factors that are sequestered in platelets. Failure to add a calcium product like calcium chloride or calcium gluconate (dose[3xCaCl]) renders the dense platelet granules unable to release growth factors like insulin like growth factor 1, platelet derived growth factor, vascular endothelial growth factor and ADP plus other clotting factors. All modern, advanced signaling cell procedures should include these two critical steps to optimize signaling cell product and delivery. Anything else is barbaric at this point. So far there has been no role for platelet rich plasma and it still struggles for indication in spite of widespread use and recommendation. Of course, the costs we incur to perform the procedure are far greater when the procedure is done right. We only use the best and safest instrumentation available. All instrumentation is FDA cleared for safety.

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

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