Using embryonic stem cells in medical research is a controversial topic. Using adult stem cells to cure disease has nothing to do with embryos, and is showing great promise for curing a wide variety of chronic conditions. Now, doctors are using a patient's own stem cells to heal without surgery.
Elsa Rosa can't walk without pain. Doctors say she needs two knee replacements. Instead, she's trying something new, stem cells harvested from her own body to heal her knee.
Rosa told Ivanhoe, "I would like to be active again. I'm young at heart."
Doctors use liposuction to extract fat cells from Elsa's abdomen. The cells are separated, concentrated and treated. The doctor injects her own stem cells back into Elsa's knee, where they will grow and hopefully, heal the damage.
Bill Johnson, MD, Internal Medicine Specialist of Innovations Medical in Dallas, Texas said, "It's a great option for Elsa, because we're seeing about 85 percent of knees respond."
Stem cells harvested from your own body have the ability to reproduce and become cartilage, bone and muscle.
"Well, it is remarkable. I think that we're seeing some really remarkable changes in responses in a lot of our patients," Dr. Johnson told Ivanhoe.
Rosa said, "I think I've gone through enough pain, so I don't need any more."
Elsa is just hoping to walk again pain-free, without going through the discomfort of knee replacement surgery or the inconvenience of rehabilitation.
Adult stem cells are being used in clinical trials all over the country to treat everything from chronic pain, joint problems, erectile dysfunction and COPD. The FDA still considers the stem cell therapy investigational, and insurance companies typically will not cover the procedures.
Contributors to this news report include: Cyndy McGrath, Supervising Producer; Don Wall, Field Producer; Cortni Spearman, Assistant Producer; Jamison Koczan, Editor and Mikon Haaksman, Videographer.
BACKGROUND: Pain in the knees is a very common problem that can result from a number of injuries and medical conditions. Knee pain can affect people of all ages and is usually accompanied by some sort of physical restriction such as difficulty walking, limping, and locking of the knee. The severity of knee pain can vary from a minor ache to severe and disabling pain. Knee pain can be divided into three major categories: a broken bone or acute injury, a medical condition such as arthritis, and chronic use/overuse conditions such as osteoarthritis. Some of the more frequent causes of knee pain can be due to fractures, ligament injuries, and dislocations of the knee. Elsa Rosa's pain was so bad she said she couldn't walk or stand much, and she was in constant pain even when she was sleeping.
(Source: http://www.medicinenet.com/knee_pain_facts/article.htm)
TREATMENT: The traditional treatment for knee injuries is medication and physical therapy. If the pain is still interfering with everyday life, a patient may consider a total or partial knee replacement. During a partial knee replacement, a surgeon will replace the damaged parts of the knee with plastic and metal parts. This procedure may be shorter and have a shorter recovery time than a total knee replacement. In a total knee replacement the entire knee is replaced with an artificial joint. Knee replacements come with many risks. It is an invasive surgery, requires a lot of rehab and can be a hard recovery. Artificial knees also wear out after about a decade in many patients.
(Source: http://www.medicinenet.com/knee_pain_facts/page9.htm)
NEW TECHNOLOGY: Bill Johnson, MD, Internal Medicine Specialist of Innovations Medical in Dallas, Texas is working with stem cells on patients with knee injuries. Doctors are able to take stem cells out of a person's own fat tissue and insert the cells back into the knee. "If we put your stem cells back into your knee, they can heal the elements that have been damaged," Dr. Johnson said. Dr. Johnson says with this treatment, patients that needed to have knee replacements, which can have a long and debilitating recovery, no longer need one. He says that stem cell procedures can also be helpful for patients suffering from erectile dysfunction, peripheral neuropathy and COPD. With the stem cell procedure there is no down time for recovery but there is still research needed to see how long the procedure will last. The procedure costs between $5,000 and $7,000.
(Source: Dr. Bill Johnson, MD)
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Bill Johnson, M.D., Internal Medicine Specialist at Innovations Medical explains how using your own stem cells can help heal damaged areas in the body.
Interview conducted by Ivanhoe Broadcast News in April 2015
Can you explain a stem cell and the procedure you are working on?
Dr. Johnson: Stem cells are cells that have two special properties that are unlike most other cells. One, they have the ability to produce copies of themselves. So, if you have one stem cell you can in theory grow an infinite number. The other important characteristic of a stem cell is it has the ability to become other types of cells. So, in our case, we're using what's called adipose derived fat stem cells. This is where we harvest some fat using a little bit of liposuction, then do some centrifuge in a couple things of fat so we get the stem cells out. Those stem cells can become many other types of cells. They can become muscle cells, bone cells, neurologic cells, cartilage cells, many different types of cells. You can get into a long discussion about all the various types of stem cells because there is a large amount, but what we're doing and what we're working with are adult stem cells derived from fat.
Does this have anything to do with embryonic stem cells?
Dr. Johnson: In the United States, we really think there are three types of stem cells people discuss. The first are embryonic and they do come from human embryos, or babies that if they were implanted, have the potential of growing in to a full human being. That has been controversial and very tightly regulated here in the United States. That is not what we're doing in this context. In fact, it's completely unrelated to what we're doing. There are cord blood stem cells, where companies will harvest the cord blood and preserve it for children that are being born. There may be some advantage to that individual child to have some of his stem cells or her stem cells in storage. But, in this country, we're doing very little work with using those stem cells on other individuals. What we're talking about is taking your stem cells as an adult out of your own fat tissue and giving your tissue back to you.
This sounds remarkable. How would this work?
Dr. Johnson: The idea is if you have a damaged knee that has either been injured in the past or has been worn out with osteoarthritis, we put your stem cells back in to that knee so those cells can turn around and heal the elements that have been damaged. We're seeing some really remarkable changes and responses in a lot of our patients. The stories in the veterinary world are really impressive and they're more and more where we're seeing good documentation of nice responses in humans.
What has your research shown so far?
Dr. Johnson: Everything we're talking about right now is in really small numbers and because of that, it's difficult to draw scientific conclusions. There's also a real small amount of data because of lack of funding. It would cost a lot to do this study and the big drug companies have looked at this technology and they're having trouble figuring out how to charge you. And, the federal government has been reluctant because its stem cell work.
However, you are seeing promising results?
Dr. Johnson: We're seeing people that need to have knee replacements, no longer requiring it. We're seeing with peripheral neuropathy, folks that have chronic pain that can't be treated, getting to be pain free and seeing a return of function and sensation. We're also seeing really nice results in erectile dysfunction.
In Elsa's case, you're working on her knee with stem cells. Do you have other patients using the stem cells to treat some of these other things?
Dr. Johnson: Yes. Each of these things we're talking about, we have a protocol that has been developed that tells us how to treat that particular patient. We collect the cells about the same way in everyone. We process the cells exactly the same way in everyone. But, how we deliver them back depends upon the disease process we're working with. Orthopedics is the most advanced and sports medicine is rapidly behind it. We're seeing enough early, and what you would call, easy return. Someone that can't walk without a limp that now walks without a limp, that's pretty easily measurable. We're starting to see some improvement with things like COPD and peripheral neuropathy that had no prior treatment. We're also working to try and improve how we do brain injuries, spinal cord injuries and those sorts of things. We're early on in that, but we are seeing some signs that we're headed in the right direction.
What do you think is the potential for stem cells?
Dr. Johnson: If you look at the history of medicine and what men and women have been able to do to help their fellow person or individual with an illness, there are several great landmarks. But, the two that immediately come to mind was the development of the effective anesthesia, where you could actually do surgery in a controlled manner rather than having four guys hold them down. Then, the next one was the development of penicillin as the first antibiotic where we were able to fight infections. Stem cells have the potential of eclipsing both of those, allowing us to do things and treat diseases that have remained resistant to any efforts for all of our history.
What is the recovery time frame?
Dr. Johnson: With most of the joints we do, like the knees, we see kind of a two part response. Most patients get an early response and that starts within a day or two with a pretty rapid increase in function and a pretty rapid fall off in pain. So, typically by a week or two you see a real improvement. Then, that tends to plateau and you quit getting any better. It will typically stay on the plateau or sometimes they'll go back down a little bit. Then, in about three months, they start improving again and that improvement goes on for at least twelve months. We've starting collecting information that may go on for as long as twenty four months.
Is this for one procedure?
Dr. Johnson: Yes. What we believe is happening is the product that we're working with is properly referred to as stromal vascular fraction, or SVF. SVF has many, many stem cells in it but it also has a large amount of chemicals called growth factors, which are the chemical messengers our body cells use to talk to each other. Those growth factors are highly anti-inflammatory, so that immediate response that we're seeing within a day or two is almost certainly due to the growth factors. They go away in a few hours, but their effects last for several weeks. We also know that it takes a stem cell about three or four months to recognize where it is, change in to that kind of cell that's needed and start growing. What we believe is happening is at three months when we start seeing things improve more slowly, we now are seeing the effect of stem cells and they continue to do work and repair for twelve to twenty four months.
Will she have to have this done again?
Dr. Johnson: We don't know the answer to that yet. I would say about fifteen percent of patients within the network are having a second one done at about a year. Most of those will tell you I'm doing better, but I just want to see if I can do better still. The real problem we have right now is no one is more than three to five years out. You would think that eventually this new cartilage is going to wear out like the old cartilage, but at this point in time, we haven't been doing this long enough to know how enduring the response is going to be.
Elsa is also working to lose some weight. How does that factor in and where does she go from here?
Dr. Johnson: Weight loss with knee disease is always important if the patient's not inside their ideal weight range. Those kinds of things become really important. Having a good exercise program to maintain muscular strength is important. Really, all of the things that result in healthy joints are still important even though we may have really helped the damaged joint.
What would you recommend we all should know about the politics of stem cells?
Dr. Johnson: The big thing about that is these are your own stem cells taken from your own tissue. So, there's no controversy. Don't get hung up on the thought that some other person or baby died, or you have to worry about another person's cells. We're not talking about that. Those procedures are out there, but what we're talking about is using your own cells and giving them back to you.
Is the idea that these stem cells can change, or mutate and become other cells, necessary? How does that happen?
Dr. Johnson: They aren't mutating because mutation is when you develop abnormal DNA. They are transforming. The fat stem cells look and say; hey we need some synovial lining here, so they look around and become synovial lining. If you think about when you cut your finger, stem cells do that healing. But, you don't have skin cells running around in your blood stream. The stem cells migrate to the area and look around and say, oh, we need new epidermal and they become the outer layer cells. It's the body's normal healing process. What we're doing is gathering it together, concentrating it, and then delivering it to places that don't have the ability to heal well.
Are these procedures covered by insurance?
Dr. Johnson: They are not covered by insurance because they're investigational. That's probably going to be true for a few more years because we're going to have to get enough numbers to really show and convince insurance companies. Eventually, it probably will become a covered service.
Is there anything else you would like to add?
Dr. Johnson: The other thing that's real important is this is a really easy recovery. We're doing a small amount of liposuction. The patients usually get a little bruising or swelling in the area but most people don't even have to limit their activity very much. You probably don't want to exercise for a week or so, but otherwise the procedure itself is very safe and has a very short recovery.