A few weeks ago, a Colorado Regenexx provider had a funny story to tell about amniotic stem cell treatment. He had told an OB-GYN colleague about some of the crazy claims being made by medical providers that amniotic fluid contained live stem cells. What the doctor told him next will make you both laugh and cry.
Amniotic fluid is what surrounds the baby. When the mother’s water breaks, this is the fluid that ends up on the floor. While amniotic fluid likely contains helpful growth factors and some “extracellular matrix,” it is not a stem cell product. However, when orthopedic sales reps tried to sell this stuff as what it is, it didn’t sell well. So the reps, based largely on the fact that the amniotic fluid and membrane have a low content of stem cells when fresh out of the obstetrics ward, began to tell physicians that the stuff was loaded with stem cells. Never mind that freeze drying or processing the living membrane made sure it had no remaining living cells of any type, let alone stem cells. Most doctors, who were new to the concept of stem cells anyway, bought this marketing ploy.
After I was told by a seemingly knowledgeable sales rep about the rich stem cell content of amniotic fluid, we decided to test the products of some of the companies making these claims and have found no viable stem cells in amniotic fluid. I have blogged many times over the years about the false claims regarding amniotic stem cell treatment.
So why do sales reps keep pushing amniotic stem cells? Last week, when I talked about amniotic stem cells lowering the stem cell bar, I explained the profit the amniotic stem cell treatment business generates: Given that the price this morning for gold is about $1,200 per ounce (28 grams) and a ml of fluid weighs about 1 gram, this baby piss costs about 25 times the price of gold! Also, considering that the average baby has 400–1,200 ml of amniotic fluid at term, if we use the 800 ml number, that makes each delivery worth about $800,000 retail! That doesn’t include the amniotic membrane or chorion (which make up the sac that holds the fluid). Add in an easy $200,000–$400,000 more for those tissues and we easily have a million-dollar delivery.
When our physician relayed to the OB-GYN specialist that people were receiving amniotic stem cell treatments despite there being no stem cells in these products, he chuckled. When asked why, he relayed, “Amazing, given the amniotic fluid in that last trimester is mostly baby piss…” My colleague was stunned. Was it really true that most of the amniotic fluid during that last trimester was in fact baby urine? Not being in that field, like myself, we both thought that we recalled this factoid from medical school, but I hunted it down this week. Here’s a quote from a text on the topic:
“By the second trimester…At this time, a fetus contributes to amniotic fluid volume and composition almost exclusively through urination. Urine has been observed in the fetal bladder as early as 11 weeks transabdominally2 and 9 weeks transvaginally.3 Because fetal urine is hypotonic (80–140 mOsm/ liter), it results in progressively hypotonic fluid (250–260 mOsm/liter near term) that contains increasing concentrations of urea, uric acid, and creatinine as the fetal kidneys mature. By term, a fetus produces on average from 500 to 700 ml/day with a slight decline in hourly fetal urine production after 40 weeks’ gestation.4, 5, 6“
Wow! The descriptions above confirm our OB-GYN colleague’s opinion. Amniotic fluid is mostly composed of baby piss. In fact, given that the average term delivery has between 400–1,200 ml of amniotic fluid and the baby produces 500–700 ml of urine a day, the amniotic fluid is, on average, 75% by volume baby piss. No wonder it contains few stem cells to begin with at term and even fewer viable cells, as urea and uric acid are not what one would consider the perfect environment for cells to thrive.
So what’s in this stuff that could be regenerative? It does also contain helpful growth factors and cytokines, basically similar to a much cheaper platelet rich plasma shot. It also contains collagen and other extracellular matrix proteins that may be useful as a scaffold for regenerative medicine. In the end, it’s a net positive to the growing baby. However, as far as viable stem cells that survive processing and the freeze-thaw cycle that make up an amniotic fluid product—that’s clearly not happening.
The upshot? It was interesting to hear an OB-GYN’s perspective on amniotic fluid. After all, only in America can companies bottle baby piss with no viable cells and hawk it to doctors gullible enough to believe it’s a stem cell treatment for $1,000 a milliliter! You gotta love capitalism!
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…