Amniotic Stem Cells
For over a decade the concept of using stem cells for the therapy of various diseases has been in the public discourse and has been the subject of many investigations. There are now journals and professional societies worldwide devoted to this topic, along with a proliferation of international meetings, newspaper articles, named buildings and even taxpayer-funded initiatives, as in California. No wonder that local “stem cell” clinics are springing up nationwide to take advantage of the public’s enthusiasm for new medical approaches.
The question remains: does it work? Let’s examine why the jury is still out on this question, and what the present opportunities may include, and let’s do so without the hype and the overblown promises so common in our culture.
Firstly, there are several ways of getting at the pristine DNA inside a cell. What we want to accomplish is to use good DNA to replicate cells that are making abnormal DNA. This could be a function of disease, like cancer or inflammation, or it could be a function of aging. All of these processes are related.
Young DNA has fewer “mistakes” in its sequence; it is a bit like getting a computer code without the bugs. Stem cells have the ability both to reproduce themselves AND to differentiate into other cells- like heart cells, skin cells, cartilage cells. Cells with a variable degree of “stemness” can be obtained from embryos, from bone marrow, from fat and from ordinary cells like skin cells if they are treated with a “cocktail” of growth factors that convert them into stem cells. These are called “induced” stem cells. It is arguable which cells have the “best” DNA for the purpose we are looking for; one concern of the regulatory agencies is that all of these cells could have the potential of growing abnormally- although so far we have no evidence of this.
Working with stem cells is a bit like working with radioactivity- one has to know what one is doing.
FDA approved trials are now progressing with a variety of stem cell products for ailments that have no effective treatments with conventional methods. For example, bone marrow stem cells have been used for stroke (safe, but no improvement), Parkinsons (ongoing), meniscus tears (no response), paraplegia (perhaps some improvement in a few patients). Each study must be read carefully to convince yourself that the investigators really have stem cells, and that they are alive, and that they are put in the right place. In some cases, the stem cells may work by becoming part of the patient (engrafting) and in other cases they may work by secreting various growth factors that many other cells grow. Nature continues to be complex at all levels.
Using stem cells from another person- allografts- is attractive because- as long as immune or rejection problems do not occur- it does not require taking tissue samples from the patient, such as bone marrow or fat. Furthermore, a high density of stem cells can be assured and this can be monitored at the tissue bank for quality purposes. Amniotic fluid is one such source of cells that can be prepared under strict guidelines for safety. These cells are “immunoprivileged”; similar to other allo products, like cartilage. They do not elicit an immune response and do not need to be tissue typed to the recipient (unlike blood). Also, as these cells are derived from elective C-sections, they are young and their DNA is young. We have learned that the use of juvenile tissues, such as Denovo NT cartilage repair, is favorable.
Since PRP (platelet rich plasma) contains the growth factors that activate stem cells, it makes sense to consider the combination of amniotic stem cells and PRP.
Keep in mind that there is no present evidence- pro or con- that could help us determine the usefulness of this therapy. Therefore, at this point each patient must act as their own “control”.
Many patients have joint problems for which there is just no good solution with older methods. I am therefore offering the amniotic stem cell product to carefully selected patients who are fully informed, and for whom PRP alone has not resulted in an adequate response. In this way we will learn together if the stem cell component and the growth factor component synergize to product a good result.