The study and use of regenerative therapeutics has grown rapidly over the last 20 years. From Platelet Rich Plasma (PRP) in the 1990’s; Bone Marrow Aspirate (BMA) in the 2000’s; Stromal Vascular Fraction (SVF) in the 2010’s; Placental Tissue Allografts (first reported in 1910 with a resurgence in 2007); and being researched now, the possibility of cultivated manipulated stem cell therapies.
Following is a brief overview of each of these therapies including the pros the cons, potential benefits and risks.
PRP – platelet rich plasma
With this therapy, blood is drawn from the patient’s body, put in a centrifuge to spin down in order to separate the components. The portion rich with platelets is used, the other portions including the buffy coat (white blood cells) and the PPP platelet poor plasma are discarded. The platelet rich plasma is then typically activated with thrombin, forms a clot, and put on a wound. This causes the platelet cells to rupture and release growth factors into the wound. Alternatively the platelet rich concentrate can be injected into a joint or along a tendon or muscle in an attempt to increase the level of growth factors present at the site of injury and promote a healing response. Outcomes are variable. When blood is drawn, we capture a variable amount of platelets, therefore the dose given back to the patient is variable. There are no stem cells obtained with PRP, only platelets. Younger patients tend to do better with PRP then older patients.
Stromal Vascular Fraction
In this method a surgical procedure is performed to obtain about 60ml of fat, typically from the belly area. This fat is also put in a centrifuge and spun down to isolate the stem cells. Occasionally an enzyme is used to assist in isolating the stem cells from the fat. Many adult stem cells are obtained, they are adult, and their ability to generate a full spectrum of growth factors is limited, as is the ability to provide the appropriate exosomes, sececretomes, and microRNa. Extracellular matrix is not captured either. Only one section of the orchestra is captured in this process and it limits the ability to amplify or upregulate the recipient’s regenerative response. The FDA is not comfortable with this procedure since it uses an enzyme to separate out the stem cells from the fat.
Stromal Vascular Fraction
In this method a surgical procedure is performed to obtain about 60ml of fat, typically from the belly area. This fat is also put in a centrifuge and spun down to isolate the stem cells. Occasionally an enzyme is used to assist in isolating the stem cells from the fat. Many adult stem cells are obtained, they are adult, and their ability to generate a full spectrum of growth factors is limited, as is the ability to provide the appropriate exosomes, sececretomes, and microRNa. Extracellular matrix is not captured either. Only one section of the orchestra is captured in this process and it limits the ability to amplify or upregulate the recipient’s regenerative response. The FDA is not comfortable with this procedure since it uses an enzyme to separate out the stem cells from the fat.
Bone Marrow Aspirate
This method also requires a surgical procedure to put a needle into the center of your bone and pull out bone marrow. The bone marrow contains adult stems cells, and like the SVF above, is also put in a centrifuge and spun down to isolate the stem cells. Occasionally, an enzyme is used to assist in isolating the stem cells from the fat. Many adult stem cells are obtained.