Recently a patient e-mailed me that he discovered an article ( http://www.ncbi.nlm.nih.gov/pubmed/23694810 )that stated fat stem cells ( AT-MSCs) were much more effective than bone marrow stem cells (BM-MSCs). It seems that this has been an ongoing controversy for years. The patient felt relieved that he could get a treatment to improve his knee by only using fat and bypassing bone marrow stem cells. I told him otherwise.
When looking at this article at face value the uninitiated would think the fat derived stem cells would give much better results than the bone marrow. There is no doubt that fat contains much more in the way of mesenchymal stem cells when compared to bone marrow. In this study the mesenchymal stem cells from bone marrow were compared to those derived from fat. The perimeters that were looked at were the immunomodulatory effect of the cells. The immunomodulatory effects concern getting the stem cells niche (environment) more conducive allow other stem cells to help repair the tissue. Without the immunomodulatory effects repair will not take place and damage will continue unabated.
Now comes the very interesting aspect of this study. When compared in equal numbers the mesenchymal stem cells from fat showed more potent immunomodulatory effects as compared with the bone marrow derived stem cells. When comparing the two cells, assays of the cytokines produced were studied. Remember that the cytokines are growth factors and interleukins which help accomplish repair. They can turn off inflammation and help form collagen and other important tissue. The comparison between the two types of cells showed that the mesenchymal stem cells derived from fat were more metabolically active. From these studies we conclude that the immunomodulatory capacities of bone marrow and fat derived mesenchymal stem cells are similar, but that differences in cytokine secretion cause fat mesenchymal stem cells to have more potent immunomodulatory effects than bone marrow derived stem cells. Therefore, lower numbers of AT-MSCs evoke the same level of immunomodulation. Here is a quote from the article ” these data indicate that AT-MSCs can be considered as a good alternative to BM-MSCs for immunomodulatory therapy”.
There is no doubt that the fat stem cells win out on the aspect of immuomodulation but that is only half the story. We must remember that this does not imply that fat is a good alternative to bone marrow for regeneration. On the contrary, they are both needed for regeneration to occur. Bone marrow supplies the much needed hematopoietic stem cells which are the drivers of tissue regeneration while the fat provides the mesenchymal stem cells which drives immunomodulation which is the step needed before regeneration. Together they are a powerful army.
What other aspects can be learned from this study? One thing that is for sure is that fat derived stem cells may actually work better for many of the auto immune inflammatory diseases. I myself stick to musculoskeletal conditions and let some of my colleagues treat these diseases. It seems to make sense to use these cells to treat a condition where the body is essentially attacking itself. In another words the inflammation that the body is experiencing is causing damage. If the damage is turned off than the patient will feel better. Many of the medicines used today to treat Rheumatoid arthritis basically try to quell the the immune response. The problem with these drugs is that they can quill the immune response in the body so much they can leave the patient open to a number of serious problems including certain types of infections and cancers. On the other hand fat stem cells seem to be more target specific. They will affect the inflammatory process but not at the cost of sacrificing the body’s immune defenses for a variety of problems.
Right now we are only touching the tip of the ice berg. Fat offers some exciting possibilities in treating a variety of diseases but I feel bone marrow will be needed also to eventually cure the disease. If I had to go to a deserted island and I could only take one or the other I would make some type of deal so that I could have some of both.
Thanks Dr. P
I am just returning from a very successful Stem Cell Workshop in Melbourne Australia. I had the good fortune to help organize the workshop. It was a day that began around 8:30 and ended a bit past 6:00 pm. The lectures were very encompassing and touched on many subjects in the stem cell arena.
I was very much intrigued by the lectures of my good friend Dr. Bill Paspalaris who just so happens to live in Melbourne. Some of the items that Dr. Bill is working upon extend beyond the cutting edge. He is doing a quite a bit of work on Exosomes. The Exosomes are basically the vehicles that transport the the cytokines (growth factors )from one cell to the other. We now know that these Exosomes are extremely important in the overall functioning of the body. There are different exosomes for different functions. Some of the Exosomes are bad since they are secreted by cancer cells. Luckily we are interested in those cytokines which are important in musculoskeletal problems. It might be that the cytokines eventually may be produced in a lab and thus we might not have perform stem cell aspiration from either bone marrow or fat. Time will tell.
Bill is also working on something also beyond the cutting edge. He has used cells from a new born and cultured them. These cells are usually very powerful in secreting growth factors. The problem becomes that they can be recognized as foreign material and thus cause an allergic reaction in the body. Dr. Bill has devised a way to encapsulate the cells so that the body does not recognize them. Basically they remain in the body as stealth cells. Here comes the interesting part. The membrane allows the cytokines to leave the cells and interact with the body. The cells can be programed to secrete certain cytokines. These might be IGF-1 or some other cytokine. Remember the cells will secrete a variety of cytokines. The membrane will also allow nutrients to enter the cells and thus keep them alive. If you think this is pie in the sky technology the US Army is looking at this technology to try to make a “super solider”. This could revolutionize the stem cell world. Dr. Bill also has some intriguing inventions which he has spoken to me about which will offer some dramatic advances in the stem cell field. I look forward to using one in the not too distant future.
I myself gave two very comprehensive lectures. The first dealt with the basics of stem cell and PRP science. This included some of the new classifications of PRPs as presented by Dr. Alan Mishra of Stanford University. Dr. Mishra proposed a classification of PRP including high and low white bold cell counts, high and low PRP counts and activated and non activated PRP. Basically the classifications go from 1A and B to 4 A and B. I have proposed a fifth classification which includes Photo activation. I will do another blog concerning these classifications.
Another intriguing aspect of my first talk centered on on the use of a relatively new type of stem cell derived from the blood. This is called a Stembios cell which can probably be classified as a V cell or Very Small Embryonic Like Stem Cell. I am not at liberty to discuss these cells to any great extent since I have signed a non- disclosure agreement with the company. However I will shortly write a blog about these cells. They are potent stem cells that are found in the blood.
The one portion of my next talk centered on the use of cytokines and science of cytokines. At least for now cytokines may be the missing factor or the X factor. We know that many times a PRP may be deficient in certain cytokines. Also we need to realize that the PRP has a half life of about one week. At the one week mark the bad cytokines start to rear their ugly head. I did discuss the various ways we are using these cytokines. We are using them as injectables, orally and as a cream. We use the cytokines to manipulate the system and make our clinical results better. I feel that this is what separates us from most clinics out there.
The second portion of my afternoon talk centered on the the use of lasers in the field of Stem Cell and PRP Therapy. I believe that the use of lasers will be the next game changer. We have known for some time now that the laser has been used with great success in the field of hair restoration. Just look up the use of a laser comb on line and we can see how lasers are starting to be utilized. The use of the laser in our clinic goes far beyond the use of a laser comb. We are utilizing lasers to stimulate acupuncture points, we are using lasers directly into the joint in an intra-articular fashion, and we will undertake an IRB study on the use of intra-venous lasers. These are all cutting edge uses of lasers for PRP and Stem Cell Therapy. Another blog will be devoted to the use of laser in Regenerative Medicine. In closing, I will mention what is getting to be one of my favorite slides. The slide says ” THE MORE YOU KNOW THE MORE YOU DON’T KNOW”. This idea came to me a few months ago when I was preparing a talk on some new material I learned about. I realized that I had leaned a good bit about some new material but for all the info I learned about this there was a plethora of new material about that subject that I did not know about it. Perhaps put another way the more I learn the more I need to learn.
Thanks Dr. P