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Keeping Up with the Stem Cell Hype Machine Is a Full-Time Job

POSTED ON IN Latest News BY Chris Centeno

cendant stem cells

Another day, another stem cell clinic pops up! While I really can’t keep up with it all, I do like to take one of the more ridiculous ones every week or two and expose the insanity. Usually these clinics are created by physicians who barely know what they don’t know. Case in point is one featuring a nifty little graphic that’s pretty much 100% misleading or just plain inaccurate. So let’s get started; this should be fun!

The Telephone Game

Do you remember the game of telephone when you were a little kid? One person would tell another some fact, and then that person would tell another, and so on. By the time the fact got through four or five people, it was so macerated that it barely resembled what the original person said. This is a bit like the wild west of stem cells in 2017. There are few real orthopedic stem cell experts who have been doing this a long time and have published a lot of key original research. Then there are physicians who heard those physicians speak, and then those physicians became lecturers and taught other physicians, and so on. However, unlike other fields of medicine where standards for education are strictly enforced and everyone must learn one agreed-upon curriculum, 99% of physician stem cell education today is being handled by pay-for-play conferences, where the only educational criteria are who can pay to access the podium. Hence, it’s a bizarre game of telephone exemplified by today’s graphic.

The Exaggeration Game

Before I get to the graphic, I want to first point out some trends that I see. Most clinics and manufacturers offering stem cell treatments or products play it pretty straight. However, the problems begin when the exaggeration starts. We’ve seen this with the following:

Another common exaggeration is when clinics new to this space claim that large amounts of new cartilage can be grown in patients with no cartilage left (“bone on bone”). So instead of underpromise and overdeliver, we have overpromise and underdeliver.

The Graphic in Question

A colleague sent me this graphic from a website that just popped up claiming two clinics focusing on back pain:

cendant stem cell review

I’d like to take these claims one by one, as each is either not true or only half true and misleading. Let me explain.

Fiber Matrix Technology?

Huh? Given that there is no FDA-approved product called “Fiber Matrix,” I had to do some digging. The clinic appears to be using porcine (pig) bladder injected with the cells. There is a common form of this product that is commercially available called ACell. Any physician can buy a bottle of ACell, so there is nothing proprietary about it. The good news is that when we tested it in 2010, the stem cells seemed to like it; the bad news is that we don’t a have a single clinical trial or even case series published using this material with stem cells in spine care or for any orthopedic application. So does it work to improve outcomes? Your guess is as good as mine.

The rationale behind this concept is that stem cells used in tissue engineering are often used with a scaffold. This is something for the cells to grow on. However, given that bone marrow concentrate contains platelets that get activated by free collagen, every bone marrow concentrate injection already forms nature’s best scaffold: a marrow clot.

Fat and Bone-Marrow-Derived Stem Cells or Umbilical-Cord-Derived Stem Cells and Multiple Stem Cell Treatment Options

First, as we have seen these past few weeks with the FDA stem cell crackdown, a fat stem cell procedure, known as stromal vascular fraction, is illegal. More likely, what the doctors are talking about is a fat graft, which is not a stem cell procedure (i.e., there are no free stem cells). Bone marrow concentrate is a stem cell procedure. However, as you’ve read here, there is no such thing as an umbilical-cord-derived stem cell product that contains viable and functional cells. Meaning the products that the clinic uses contain dead tissues. Had they ventured to test these products themselves rather than just believing the hard sell from an orthopedic device sales rep, they would know that by claiming live and functional umbilical cord stem cells, they are misleading patients.

We Use Ultrasound Because We Don’t Want to Damage Stem Cells?

This is always a funny argument. For spine injections, while they can be performed with ultrasound imaging, they can’t be done well. Why? Ultrasound is incapable of showing where the cells are going into spinal joints and around nerves. This is because these areas are often blocked by bone, which ultrasound can’t penetrate. X-ray–based fluoroscopy can see where these cells will go because it can see through bone.

Can’t you perform these injections with ultrasound only? Yes, but you can’t do them reliably and well. Who wants to blow big bucks on a stem cell procedure only to find that the cells never made it to the spot where they were supposed to be?

Will fluoroscopy damage your stem cells? Nope. We actually did these tests way back in 2007 and saw no difference in cells in monolayer culture flasks that we exposed to fluoroscopy versus not. Is there any research by anyone else showing that using fluoroscopy hurts stem cells? Nope. In fact, a US National Library of Medicine search under the terms “mesenchymal stem cells” and “fluoroscopy” shows 20 hits, all not on this topic. In fact, most of the human studies listed are ours. So where did this “fact” come from? It appears to be pulled out of thin air.

In summary, having ultrasound and fluoroscopy is a big deal as it lets you use what’s best about both technologies. Why wouldn’t a clinic have both? Cost! You can get a passable ultrasound unit for 20–30K. Having a high-end ultrasound unit and a super C-arm, high-end fluoroscopy unit in the same room ups that cost to about 200K! In addition, you also need a special room with custom drywall, which is two to three times as big as the usual size and an expert radiology tech to run the machine, which costs another 70–80K a year. So it’s 30K for a little ultrasound unit versus hundreds of thousands of dollars to do this right.

Parting Comments on Hype

As the first physician in the world to perform most of these orthopedic stem cell injections, it’s awful to see this happen to the field. Random claims being made with no substance have no place in medicine, let alone regenerative medicine. Taking on each one of these hyped websites is literally a full-time job. As a result, I can only expose a few of the crazy claims out there, writing blogs between patients or when it’s dark outside at 5:30 a.m., as I do have a real job!

The upshot? As you see, some of the above is true, some misleading, and some outright false. This is pretty much par for the course out there. So be careful as stem cell hype abounds on the web!

 

 

    *DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
    Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.

    comments

    Pamela Re says

    Dear Dr. Centeno:
    I enjoy your blogs. Thank you for being accurate and honest. I truly appreciate Regenexx and the professionalism, knowledge, skill and experience of their doctors. Dr. Schultz did a great job for me in June of 2016. I had a core decompression in the femur head of my right hip with my own stem cells and also in my left knee. Both were injured and had developed big problems subsequent to the injuries. I think the treatment helped a lot and I was elated to discover my bone marrow aspirate yielded 1.87 billion stem cells.
    Best Regards,
    Pamela Re

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    Chris Centeno says

    Pamela Re,
    Thank you - Great to hear you're doing so well! Agree about Dr. Schultz, he works on me as well!

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    Ralph Mason, Jr says

    I had PRP 10 years ago when both knees were bone on bone. I was walking with as Cane and not sleeping much. It worked beyond my expectations. I was 66 then. After 8 years, back to the same pain, but a little less. Found a group of Drs. that did Arthroscopy on both knees, Denervation, and Placenatal Stem Cells in January. The Orthopod sais the left knee was far worse than the right. Still had pain. Had a second Denervation in July, then another injection os Stem Cells last week. Almost pain free in the left. Not so for the right. Now they say I need to wait another 6 weeks for results. Do Placental Stem Cells work? Was I too old for Arthroscopic Surgery? Should I give up and have a knee replacement. Want to play Tennis again!

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    Chris Centeno says

    Ralph,
    Sorry to say, but PRP was the better plan. Placental "stem cells" don't contain live stem cells but do contain growth factors, so you could expect a response similar to your own PRP, but at approximately 5 times the cost. Arthroscopic surgery and denervation are generally a net negative.

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    Marshall Sorokwasz says

    Thanks for your honesty. I am scheduled to do a hip procedure at the Mayo Clinic (Rochester MN how do they rate?

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    Chris Centeno says

    Marshall,
    What type of hip procedure?

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    Luis Suarez says

    At first when I started looking into stem cell treatment for my osteoarthritis I felt regenexx was a bid overly critical of others in the field and it struck me as kind of a hard sell. But I am beginning to understand why it's important for regenexx to insure the industry is properly regulated etc. The expense of the procedure is the only thing that is still an obstacle for me.

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    ANTONIO T QUION says

    Hello Dr Centeno,
    I have tears of meniscus, ACL ,among others, and have been researching and reading a lot of publications including Regenexx. Is it true that the stem cells from bone marrow of a 79 years old are weak even when centrifugated so that it needs more than one injection?
    Secondly, will stem cells injected into knees be effective also for neuropathy?
    Thank you.
    Tony Quion

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    Chris Centeno says

    Antonio,
    We can only comment on our own stem cell procedures, as they are very different than others. For Regenexx HD-BMC, which is our same stem cell procedure, age is not a factor. Please see: https://www.regenexx.com/hd-bmc-highly-concentrated-cells-doohickey-vs-lab-approach/ The "stem cells are too old" concept is a marketing plan of amniotic, umbilical, cord blood, and placental stem cell clinics, which is only humorous when you realize that no live stem cells have been found in any of those products. Both meniscus and ACL tears require very specific precise image guided injections into the tears in order to be effective. These are not issues that will benefit from a simple injection into the knee. Please scroll down to see an actual ACL procedure: https://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/ We've done exciting work with nerves. Please see: https://www.regenexx.com/nerve-regeneration/. If you'd like to see if you'd be a good Candidate for a Regenexx procedure, please submit the Candidate form.

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    Sue says

    I had Regenexx stem cell procedure (4,583,000 from my own bone marrow to be exact) done in my bone on bone shoulder May 2017. I am happy to report that I feel 80-90% better and have a life again. Before finding Regenexx, I almost made the mistake of using a local doctor who would rent an ultrasound machine and have frozen cord blood stem cells waiting for me, and would be guessing at placement and no idea how many stem cells I would be getting. The Regenexx team I had was the most professional I've ever seen. Yes it hurts to be worked on, but that is necessary. I would do it again. Couldn't be more pleased. Thank you!

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    Chris Centeno says

    Sue,
    Congrats on the impressive number - Great to hear you're doing so well! Switching to your own live stem cells was a great decision!

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    Alyse Dunlap says

    Hello Dr. Centeno,
    Our son, age 27, received the Regenexx stem cell procedure on his left hip in July 2017. Only an ultrasound was used for guidance, even though I had asked prior to the procedure about the use of fluoroscopy, I was assured that an ultrasound was adequate for stem cell placement. I am concerned, of course, after reading your comments above. I am interested in your response. Thank you.

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    Chris Centeno says

    Alyse, for certain indications and in certain areas (like the hip and knee), the use of ultrasound only is fine. Our example here is in the spine, where I believe it's inadequate for most indications

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    Dan Klasen says

    Hey Doc,
    I just recently had DDD round of shots for my l4/l5 and l5/s1 in the facet joints as well as muscles, ligaments and tendons and the platelet lysate injections into the nerve roots at l5/s1. (All in all I think it was 20 injections)This was in August of this year in Vermont at a Regenexx location.
    My situation may be a little strange but my symptoms present in my ankles and I feel like they are sprained when nerves are pinched. Can't even walk or stand.
    Not good at all but these injections have helped tremendously. No chiro and no more nsaids since my first round. I have started to feel the cramping and pain starting to return and hope that the second round helps even more. I can say that my facets feel very good.
    I would just like to tell you that please continue with your blogs and articles because I spent months researching before I met my doctor in Vermont and would have hated to get some garbage injected into me without any results.
    I'm sure there are many people out there with worse problems but my next option is steroid injections and I'd rather not detroy my back any further.
    I've had a pretty bad week as far as pain goes but I guess it's part of that cycle(2 steps forward/ 1step back).
    I'm telling anyone I can about your research and procedures so far as they have helped. I just hope it continues to heal.
    I just wanted to tell you thanks and keep doing what you are doing and that your doctor's in Vermont are outstanding. Fingers crossed for continued improvement.

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    Chris Centeno says

    Thanks Dan, I'm glad that Dr. Fenton is taking good care of you, he's a great doc!

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    About the Author

    Chris Centeno

    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.…

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