There is a lot of press these days about stem cells and stem cell therapy. Fully understanding stem cells and how they work in the body is at the forefront of medicine. Stem cells can be used for everything from orthopedics to scar revision and even diabetes. It seems like there is new data on stem cells published every day. To understand which therapies are most likely to work, patients need to understand some basics about stem cells.
Stem Cell Basics
A stem cell is simply an unprogrammed cell that can divide and develop into other types of cells. Adult stem cells play a major part in repairing damaged tissue. Many different providers talk about using stem cells in their therapy, but it makes a huge difference what type of stem cells are used and where they originate.
Types of Stem Cells
Embryonic cells can give rise to every cell type in the body, but due to legal constraints and ethical debates, these are not used often in day to day regenerative medicine.
Tissue-specific stem cells are often referred to as adult stem cells (or somatic) and can generate into specific lines of cells. The main adult types are:
- Blood-forming (hematopoietic) stem cells can become red blood cells, white blood cells, and platelets.
- Stromal (mesenchymal) stem cells are found in bone marrow and fat, these can become bone, cartilage, fat, and other soft tissues.
- Skin stem cells are located in the basal layer of the epidermis and at the base of hair follicles.
- Epithelial stem cells from the lining of the digestive tract give rise to a multitude of cells that create our GI tract.
- Neural stem cells found in the brain can become neurons, astrocytes, and oligodendrocytes.
Orthopedic Stem Cell Therapy
Stem cells are being studied as therapies for a multitude of medical issues. Here the focus will be orthopedic issues, which leads to the question: What is the best type of stem cell for orthopedic joint problems?
Because of their function in creating bone, cartilage, fat and other soft tissues, mesenchymal stem cells (MSC) are currently the best choice for healing joint problems. Although they can be obtained from the fat, bone marrow derived MSC consistently outperforms those from adipose. This may be because the bone marrow-derived cells contain larger amounts of certain anti-inflammatory compounds like IL-1ra (interleukin-1 receptor antagonist), which blocks certain inflammatory signals from being received by the cell. If you damage bone or cartilage, it is the bone marrow mesenchymal stem cells that help repair the injury. In many cases, there are not enough stem cells in that area due to poor blood supply for the tissue to heal properly. It is no surprise that isolating and concentrating these little powerhouses has been shown consistently in the medical literature to improve symptoms and promote healing in patients with damage to poorly vascularized areas in any joint. 1
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1 Chahla et al. Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee (Systematic Review of Outcomes), Orthoped J Sport Med, 2016 Jan; 4(1)