Why a Bone Marrow Stem Cell Procedure Should Keep More of the Good Stuff Around
POSTED ON 7/8/2017 IN Regenerative Medicine Education BY Christopher Centeno
There are three main parts to a stem cell procedure—the bone marrow aspiration (BMA), processing the BMA to isolate the stem cells, and the reinjection. Today, we're going to explore part of the processing step, but it's important to understand that every step must be performed with high-quality techniques and precision to achieve the best results. There are a couple of ways BMA is processed, or concentrated, that you need to be familiar with. One is the automated bedside machine, and the other is by hand in a lab.
With a state-of-the-art lab facility on site that is dedicated to orthopedic stem cell research, another way that Regenexx is very different is that our lab gives us the capability to use the patient's whole bone marrow from the bone marrow aspirate (BMA) rather than only one part of the marrow that a simple bedside machine would provide. In other words, we can isolate the highest possible number of stem cells, and we don't throw the good stuff away. Let me explain.
How Most of the Other Clinics Do It
Most clinics use automated bedside machines to concentrate bone marrow aspirate and isolate the patient's stem cells. This is a one-size-fits-all approach to obtaining stem cells, and all the machines out there pretty much do the same thing. The doctor inserts the BMA into the bedside machine and presses the “ON” button. The machine centrifuges (or rapidly spins) the BMA, separating the elements of the BMA into three layers—plasma, buffy coat, and red blood cell—in order to isolate that stem-cell-rich buffy-coat layer.
Typically, the buffy coat layer contains about 1–2 cc out of a 60 cc whole bone marrow sample. This can vary by patient depending on hydration levels and other factors, so most bedside machines account for this by taking not only the buffy coat but a portion above and below the buffy coat as well, to equate to about a 10 cc sample. Besides the fact that this creates a concentration problem, with the 1–2 cc buffy coat now diluted in 5-10 cc, they then throw the remaining 50 cc, containing the plasma and a whole bunch of other good stuff, away.
Our Stem Cell Procedure: How Regenexx Does It
As I've mentioned before, our stem cell processing for our stem cell procedures is very different from anything else out there. First, it's important to understand that that there are other stem cell fractions (e.g., stem cells, platelets, and key cytokines) present in the bone marrow that are routinely discarded by these automated systems. We discovered this in our lab a few years ago when we found a second source of mesenchymal stem cells (MSCs) in the BMA that was being discarded. We also found the discarded stem cells to be more chondrogenic (this means cartilage producing) and more rapidly proliferative than the stem cells that are present in the buffy coat. When we used those cells and added them into the bone marrow concentrate, we got better clinical results for knee osteoarthritis. You can read more about our lab findings and see our supporting data at “Why Is Regenexx the Best That's Out There?”
So why would we want to throw this good stuff away if it can benefit our patients? It may be more convenient for a doctor to use an automated bedside machine since all he or she has to do is press a button, but, unfortunately, there's no way to capture all of those good chondrogenic MSCs the machine throws away, platelets, and cytokines present in the whole bone marrow. This, regrettably, is the price the doctor (and his patient) pay for convenience.
By concentrating BMA and isolating stem cells in our lab, we produce a bone marrow concentrate (BMC) that has a stem cell content 5–20 times higher than what automated bedside centrifuges are capable of producing. We also create our high-dose platelet rich plasma (PRP) and fourth-generation platelet lysate directly from that bone marrow. This last part is critical as well.
How do bone marrow stem cell treatments work? First, there is early clinical research that shows that the stem cell number or total cell count of the sample used to treat the patient matters. We published a research paper that showed this as have a few others. Second, bone marrow has platelets that can be used to help stimulate stem cells in the same way an espresso shot gives you a boost. We keep all of those platelets and healing growth factors, while the bedside machine set throws them away. Finally, and perhaps most importantly, the serum in bone marrow contains molecules that can help reduce cartilage breakdown. These include A2M, TIMP, and IRAP. Again, our Regenexx process keeps these helpful cytokines, while the bedside machines discard this serum.
How do we know that our process is really keeping these helpful chemicals around? When we take synovial fluid samples from our patients' knees after our same day stem cell treatment, the level of A2M, which is the cytokine that helps to prevent cartilage breakdown, is higher than before the procedure, and it's greater than the amount necessary to inhibit cartilage breakdown. This is very good thing based on the existing research, and it's why we never throw away the good stuff that could help our patients!
The upshot? Everything we do at Regenexx is very different. From our BMA that takes more of the doctor's time, but that maximizes the stem cell yield, to concentrating BMA in our lab in a way that allows us to utilize the highest number of stem cells from the whole bone marrow and to keep the good stuff can help, to reinjecting under imaging (fluoroscopy and ultrasound) guidance to precisely place the cells. While our stem cell procedure might not be the most convenient and easiest for the doctor, when it's you on the table, all you care about is getting a procedure that gives you the best shot at recovery!
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