Dr Steven Sampson was accepted as a guest speaker at the 3rd Annual World Congress of Regenerative Medicine & Stem Cells 2010. The event is Dec5-7, 2010 & will feature speakers from all over the world. We expect more & more of these regenerative summits to gain momentum in participation & frequency. The Chinese have been very progressive in promoting the growth of regenerative medicine & this conference will feature some of the most innovative physicians and scientists.
I just returned from Palm Springs where I spoke at the 20th annual Practical applications in Sports medicine conference. There were over 200 in attendance which was terrific. The crowd made up mostly Athletic Trainers who work for universities, local schools & sports teams as well as Physical Therapists & Orthopedic Surgeons plus one cadaver. There were a few interesting points of note.
After meeting at the Orthohealing Center in Los Angeles, Dr Ryu went on to treat a prolific basketball player, Choo Seung-Gyun. More recently Dr Ryu compiled data on his PRP injections & presented it at T-cell Bio Inc Stem cell Conference in Seoul Korea attended by 500 physicians. We look forward to more international collaborations to share our experiences to advance the field of stem cell therapies and biologics including PRP . 
Mimicking Human Cartilage to Repair a Knee
According to the New York Times, Orthomimetics, developed a scaffold approved for use in Europe from a collaboration between the Massachusetts Institute of Technology and the University of Cambridge.The scaffold is off the shelf & allows stem cells to be absored to regenerate cartilage.
My former colleague Bert Mandelbaum MD was quoted. This treatment may lower the expense typically involved and may be available to more patients because of less preparation time. This is just an example of the progress being made in cartilage repair. Ultimately I feel there will be a trend towards more injection based cartilage repair with less invasive surgery. As technology is advancing with improved live imaging, doctors wont have to open up a joint or insert an obtrusive scope to properly treat it.
My PRP review article is now published in the Current Reviews in Musculoskeletal Medicine. http://www.springerlink.com/content/5708408818n30275/ The online version is available, and the printed version is coming soon. The article includes nearly 50 literature sources and provides a comprehensive overview regarding platelet rich plasma usage in orthopaedics and sports medicine. Also, the review discusses the promising realm of orthobiologics and describes experiences with using platelet rich plasma for cartilage disorders and osteoarthritis.
I have been conducting research on arthritis with encouraging results so far. I am planning on collaborating with other leading physicians and publishing many more articles to advance the field of orthobiologics.
Perhaps the next frontier beyond PRP is Stem Cells. While the topic is the subject of much controversy politically, technology now allows us to utilize adult stem cells opposed to embryonic cells to treat disease.
Stem Cells are the birthplace of platelets rich in healing properties, which can potentially program cells to regenerate tissue & cartilage. Currently stem cells can be retrieved via embryo (controversial in US), umbilical cord, bone marrow, peripheral blood, & in the near future adipose (fat) cells via liposuction.
Peripheral blood, or simply drawing blood from a patient’s arm is the least invasive & most promising method. Patients require a shot or medication to release stem cells from the marrow to the blood stream. It can then be processed & used for injection. In the future patients may have the option to store unused stem cells for future use as well.
Stem cells are being used in the US mostly for cancer patients to assist in recovery from the ill effects of chemotherapy. A few practitioners are using them orthopaedically with reportedly good results in arthritis. Internationally there are centers where patients seek alternative treatment to serious diseases like spinal cord injury, multiple sclerosis, and ALS.
There is an adult stem cell organization which lists numerous articles & personal stories.
In a Jan/Feb 08 issue of Practical Pain Management, the authors describe PRP use in tendon injuries, spine conditions, as well as hip & knee arthritis. The article emphasizes a need for agreed upon nomenclature.
An interesting concept addressed is whether a gel matrix is needed for the platelets to adhere to the target site. Because of their structure tendons & ligaments may not require the gel, however it is not known if adding calcium chloride with thrombin to the PRP is needed in joint spaces like knee & hip arthritis. Further data needs to compare the usage with gel versus without.
The article showed x-rays post prp injection with subtle smoothing of a previously arthritic femoral head (hip bone). It is not clearly known how PRP acts on arthritis, however a particular growth factor found in PRP, TGF-B has been linked to cartilage growth (chondrogenesis). Furthermore, another study showed that PRP influences hyauloronic acid production which balances cell proliferation (angiogenesis). Also, the authors suggested a possible role in serotonin decreasing pain. Lastly, utilizing “stem cells” (the birth place of platelets and their precursors)may offer the most ultimate potential.
http://www.ppmjournal.com/abstract.asp?articleid=P0801F01
http://prpinjection.blogspot.com/2007/11/new-article-on-osteoarthritis-and.html
In a recent study from October 2007, a group from China was the first to document platelet rich plasma’s ability to support chondrogenesis (cartilage cell growth). They took cartilage from the rabbit’s ear, & mixed it with PRP and calcium chloride & thrombin (to form a matrix). Two months later, hard knobbles were found and seen on MRI, as well as histological analysis (cellular) and staining confirmed cartilage growth. Interestingly, there was no cartilage growth with the control group that received PRP alone. This study demonstrated successful formation of new cartilage with an injectable graft using PRP and cultured chondrocytes.
Another subset in “biologics” is the use a (ACS) Autologous Conditioned Serum. This treatment primarily used in Europe, invlolves production of a substance known as IL-1Ra that attacks the effects of arthritis. While this specific treatment is not approved in the U.S., similar treatments using PRP (Platelet rich Plasma) are being used here to address knee arthritis.
A recent study from Colorado State University published in The American Journal of Veterinary Research; demonstrated significant clinical improvements of Horse osteoarthritis affected joints with ACS compared to placebo.
The process like PRP, involves drawing blood and spinning it down in a machine called a centrifuge. However, afterwards the blood is incubated at 37 degrees Celsius for 24 hours. The serum is then frozen until use.
This system, is used throughout Europe in professional race horses to treat arthritis. Also, it is used in Dusseldorf Germany on humans for osteoarthritis.
We are using a modified treatment performing a series of 3 PRP injections into the human knee joint under ultrasound guidance at 3 week intervals. We will be reporting on our findings.
Platelet Rich Plasma provides a potent delivery of the body’s healing properties, called growth factors. However in some patients with severe cartilage loss and less viable cells, a stronger pool of healing properties lies in obtaining adult “mesenchymal stem cells” from the hip (iliac crest). In this procedure, Bone marrow is taken from the hip and like PRP is prepared for injection into an arthritic hip or knee. While further studies are needed, preliminary reports are encouraging. PRP is probably a more reasonable first line treatment, given it’s ease of use. However particularly challenging cases may consider the marrow application. A blog on bone marrow aspirate is: http://www.autologousadultstemcells.org/blogs.html
