There are new frontiers now in arthritis therapy! Now, instead of just using medications to stop the body from sabotaging itself, we have modalities to encourage it to heal itself.
I have covered the ins and outs of laser therapy in much more detail elsewhere in this website, so I will just go over a brief synopsis here. Laser therapy:
- Turns on cell metabolism – All of the cell processes, including “clean-up”, synthesis of proteins, immune function, and growth and division, are put on “fast forward”.
- Opens up vessels: Both the blood vessels that are delivering oxygen and nutrients to the site, and the lymphatic vessels that are draining away the excess fluid that causes swelling.
- Blocks pain! (Yeah, Baby! My bad knees get immediate relief!) – Nerve cells become oversensitive in the presence of inflammation. The laser gets them to pump ions across their membranes and go back to a normal resting potential – no more “hair trigger” firing of the pain signal.
Stem Cell Therapy
This is the ultimate “heal thyself” approach. We are using the body’s own cells to orchestrate a grand symphony of healing.
The best summary description I have heard is by Dr. Arnold Caplan:
“ Stem cells are injury specific, perfectly choreographed pharmaceutical factories.”
Stem cells are undifferentiated cells present in nearly every tissue.
They are “pluripotent”, which is to say they have the potential to turn all sorts of different tissues.
For example, stem cells in the mesenchymal (connective tissue) family can become bone, cartilage, tendon or fat.
What Do They Do?
A list of their effects, with the first two being the most important:
1) Trophic Support – “Troph” means growth. Stem cells release a host of growth factors and cytokines that affect the cells around them. These effects include:
- Anti-scarring – they actually promote the clean-up of old scar tissue as well as discouraging the formation of new scar tissue.
- New blood vessel formation (angiogenesis)
- Shoring cells up against cell death after injury (cell apoptosis) – the stem cells can actually perform a sort of cellular CPR by transferring some of their mitochondria into the damaged cells to resuscitate them.
- Turning on the stem cells already present at the site.
As living, functioning cells, stem cells can engage in a sort of “cross-talk” with the inflammatory cells already present at the site. This lets them direct and regulate the inflammation.
3) Turning into tissue
This is the part where things get kind of “Star Trek”: these cells can differentiate into what an injury site needs. They have even been used to grow a new patch of bone in people who have a defect in their skull (Journal of Cranio-maxillofacial Surgery (2004) 32, 370-373)
4) Physically migrating to where they are needed
The microenvironment created by damage or injury at a site both calls in and turns on the stem cells.
5) Immune Modulation
Stem cells can moderate an overactive or aggressive immune response. In people, they have even been shown to prevent Graft vs. Host Disease, where a profound reaction to a transplanted tissue can kill the patient.
Where Do We Get Them?
To harvest stem cells for therapeutic purposes, we generally look to fat tissue. This is for several reasons:
- Stem cells from fat tend to grow really well – you can get a good harvest directly from the tissue, without having to culture them (unlike, for example, stem cells from bone marrow).
- These stem cells are from the right family, the connective tissue family;they can differentiate into cells to heal damage.
- They are easy to access – it is just a minor surgery to get fat from behind the shoulder blade or in the groin. If we are doing an abdominal surgery anyway (such as a spay) there is fat from inside the abdomen that we can harvest.
- Fat is a Renewable Resource (don’t I know it… sigh)
Then What Do We Do With Them?
The fat sample is sent to a special lab to collect the stem cells out of them. If there are more cells than are needed for this treatment, they can be frozen and saved. In human studies, the cells have been shown to be still viable after 14 years in the bank.
Getting them where they are needed:
In cases where the site is easy to get at, such as joints, tendons, or injuries, the best results come from putting the cells right there by injection.
Where the site of need is harder to get at, such as internal organs or the spinal cord, the stem cells can be injected into the blood stream. The damaged tissue microenvironment will call them in. Injection into the blood stream has shown some use for arthritis too, but in this case the pain relief does not last as long.