Stem cells for Back Pain
Hi this is dr. John Shim and today I'm gonna talk about a very important topic and that's the use of stem cells. A very common question that comes to my office, "Doctor do you use stem cells?" Well let's explore that. What exactly is a stem cell? Well basically they're unspecialized cells in your body that through division can differentiate into various tissues. In other words a stem cell can become bone, muscle, teeth and so forth. Scientists are trying to understand how to trigger these cells into differentiating into specific cell types. For example, if you can use these cells for a bad heart can we trigger the stem cells to produce new healthy heart muscle cells to repair the damaged one. The controversy can be about where we actually get to stem cells. Embryonic cells have been researched but very controversial so we'll not discuss that really we're going to focus on adult stem cells. The two main sources are your own red bone marrow and also from your adipose tissue or fat layers. But the question still remains do stem cells work and do they help you? Well we have used stem cells and we've been using them for a while for bone marrow transplantation for conditions such as leukemia and myeloma. It's very successful and we've been using it for quite a long time but using it for myeloma and cancer of the blood is a very different story than using it in orthopedics. In orthopedics research studies are trying to determine the safety and the efficacy of use in arthritis and back and neck degenerative conditions. Some clinics have offered these treatments and reported improvement in pain levels with decreased inflammation and some restoration of cartilage lining but the treatment is still considered experimental and has not been FDA-approved for any musculoskeletal condition. While there's promise it's too early to know if there is a long-term benefit at this time. So the question is do stem cells work for back pain? As stated above no FDA-approved stem cell for back pain at this time, there are some ongoing studies, a few of them have been completed. There have been some reports of success but much of the reporting has been on a very small series with no long term follow-up to assess long-term benefit. So what remains to discuss is what are the controversies of using stem cells or back pain? Well the first question we must understand is, what is the source of the back pain? Now if we believe is disc degeneration then the use of the stem cell is try to reverse or correct that degenerative process. At this point is still not clear that we really have a good handle on what is a pain generator in a degenerating disc. We know many people age with no significant back pain at all, others however incapacitated by minor degenerative findings. If we determine that disc degeneration is the cause how do we attack the disc degeneration with the use of stem cells? We have to first determine what kind of cells we need to help this degenerative process. Do we need more cartilage lining? Do we need more cells to produce a protein called proteoglycan that actually imbibes or collects water? Do we need cells that improve the endplate and allows better disc nutrition? Do we create a stronger annulus or the cottage on the outside of the disc to improve the disc? Those cells have to, or can potentially, repair or achieve these functions but we still don't know if that's the proper way to make people better when they have disc degeneration. There are controversies still remained over what kind of cells can be used. Do we take it from your own body? Can we use cells that are donated from other people? If we take the cells, are the cells from your bone marrow better than the cells from your fat tissues? Can other cell lines such as cells taken from umbilical cords of babies, does that also provide the same kind of differentiation properties that we think stem cells need to have? How do we trigger the stem cells that produced the right new cells? What is the right cell type that must be formed? For example when you put stem cells in somebody spine should that cell then be triggered to produce a certain type of cartilage cell or certain type or protein producing cells or certain type of collagen? Is age a factor? If you use stem cells from older people do these stem cells still have the same potential to change and differentiate? Do transplanted cells stay alive? In the back and in the knee or in the hip these joints and the discs are actually pretty hostile cell environments. Do these transplanted cells stay in the location of transplantation? How many cells are necessary to achieve a good result? We have to understand that there are also potential side effects that we still don't really understand. What are the side effects when do they occur how long do we need to follow these folks? There's a tremendous excitement for stem cells and biologic solutions for arthritis and back pain. Like any person I truly hope stem cell therapies will prove beneficial for many conditions, but as a physician and a scientist I have concerns that we still do not know the answers to many questions about the use of stem cells. More unbiased research needs to be done before we can fully answer the many questions about this evolving field. If you are considering the options of stem cells, make sure you do your homework. Understand the experimental nature of its use in orthopedic conditions and be prepared to pay for the costs as these treatments are not yet approved for use by most payers. This is dr. John Shim discussing stem cells. It's a very exciting concept and at this time I'm convinced that the more we learn the more we realize there are more questions that need answering in this topic. Thank you for listening.
Lately, I am seeing more and more advertisements on the use of stem cells to cure almost everything. This is concerning to me as the science (or the FDA) is not yet behind many of the treatments now being offered by many clinics and physicians. The FDA is now “cracking down” on many of these businesses for everything from improper handling of the cells, false advertising, and no regulation of treatment.
To simplify what we currently know, stem cells are cells that have not yet transformed to perform a certain function. Most cells in your body have already changed, or differentiated to do certain things. To give an example, muscle cells are specifically designed to elongate, and contract. This allows you to move the bones, and the attached ligaments and tendons in a specific coordinated manner. Once changed into a muscle cell, that cell will always be a muscle cell.
Stem cells are different. These are cells that have not yet changed. Scientist believe these cells will transform when placed into a certain environment to accommodate a certain need. As in the example above, if the stem cell is located near the bones, and there was a need to develop muscles, the cells will transform to become muscle cells.
Three types of stem cells have been identified:
adult stem cells
human embryonic stem cells
induced pluripotent stem cells
All three of these cells are capable of surviving for long periods, and dividing to make additional stem cells. They are unspecialized and can become specific types of cells and can be developed into specialized cell types. The only stem cell product that is actually approved by the FDA is Hemacord, a cord blood-derived product manufactured by the New York Blood Center and used in patients with disorders affecting the body’s blood forming system.
In the past few years, there has been much excitement, using various adult stems cells from fat, skin, etc and placing them in diseased areas, hoping for transformation, and healing of certain conditions. The areas of research includes work related to heart muscles, spinal cord nerves, eye corneal tissue, diabetes, etc. The cells are “manipulated” to hopefully transform into the appropriate cell.
In the spine, there is much work being done to see if certain cells can differentiate into cartilage producing cells, and help reverse the disk degeneration process. For the spine patients, we are still not certain what type of cells work best in the very low oxygen environment of a diseased disk. Also, we are still struggling with the need for any other environment modifications such as compression reduction, nutrition supply, vascular supply, and stem cell survival in the processing, and manipulation stages.
While all the science seems promising, we are still far from actually knowing if some of these techniques will actually work, and help in the long run, without causing unintended complications. For patients who want to consider these treatments, the FDA recommends you ask your physician if FDA approval has been obtained or if you will be a part of a FDA regulated clinical study (my recommendation). Also check out this article http://www.cnn.com/2017/08/28/health/fda-stem-cells-bn/
Even if the cells are your own ,there are safety risks, especially if they are put in an area where they are not performing the same biological function as in their original location. Cells in a different environment may multiply, form tumors or migrate somewhere else. We don’t know.
Still, if interested, many academic centers throughout the country are currently enrolling study patients.The technology looks promising, but the results are still unknown, and the costs currently, are significant and not covered by any insurance entities. Beware of the hype, and learn the science before you jump in.
- Yousef MAA, LaMaida GA, Misaggi B. Long-term Radiological and Clinical Outcomes after Using Bone Marrow Mesenchymal Stem Cells Concentrate Obtained with Selective Retention Cell Technology in Posterolateral Spinal Fusion. Spine (Phila Pa 1976). 2017 Jun 1; PubMed PMID: 28574883
- Khazaei M, Ahuja CS, Fehlings MG. Generation of Oligodendrogenic Spinal Neural Progenitor Cells From Human Induced Pluripotent Stem Cells. Curr Protoc Stem Cell Biol. 2017 Aug 14;42:2D.20.1-2D.20.14. PubMed PMID: 28806852