There has been very few turning points in medical science. Once can count those on the fingers of one hand. Discovery of Penicillin, Aspirin, and DNA are the most notorious. These were defining points in medicine. Each of them changed our understanding of physiology, pathology, and therapeutics.
Biological treatment, which includes Regenerative treatment, Stem cell therapy, and Platelet Rich Plasma (PRP), is undoubtedly a monumental turning point in Medicine.
Today we are treating conditions that up to now, had no treatment or cure available. Orthopedic surgeries are fast becoming a thing of a past. People who have arthritis and even if they are in need of knee or hip replacement, now have non surgical options.
There are a couple of different ways to classify biological treatment. One classification is based on what we treat:
- Treating the root cause of the condition.
- Treating the symptoms.
A more detailed and descriptive classification would be based on the source of the biological used. This is as follows:
- Autologous source:
This is when we use patients own body to heal itself. We simply take your own cells, from fat or bone marrow, and/or your own platelets from your blood. The process is very simple and minimally invasive. The tissue is minimally manipulated, meaning we only use centrifuge to separate different cells and obtain the ones that help healing. It is then injected into the damaged site. Through a series of cell signaling and cell reproduction, the damage is repaired, thus resolving the symptoms as well.
This source is completely safe. There are no side effects because simply your own body is used to heal the problem.
The procedure is one step longer. We have to obtain the cells from abdominal fat or bone marrow.
- Heterologous Source:
This is when the cells are obtained from another person. Currently there are several options available. These include: Umbilical cord blood, Wharton Jelly, Amniotic fluid, and Placenta. Another biologic that belongs to this group but has no cells are Exosomes, which I will explain later.
Benefits: The cells and/or growth factors are obtained from another source. There is no need for an extra step, as above, in the procedure.
These cells are from another person. Therefore, there is possibility of getting infections and other diseases. You have to make sure that the cells were obtained from a reputable company and that the doctor did his homework to truly look at all the aspects of the company. As an example, recently a Blood cord provider company that had a large market share, caused serious infection in several patients due to poor screening and handling of the products.
Another disadvantage is that the product may have no live, viable cells in them. In that case yiou may still get some result but it could be minimal.
- Xenograft source:
This is when biologics from another species is used. A very classic example of this is antibodies against Tetanus and Snake venom that were obtained from horses. Now a days they are produces by genetically modified Rats or Bacteria. Sometimes a piece of human gene is transplanted into the rat or the bacteria in order to produce the antibody needed.
This method is mostly used by big pharmaceutical companies. Usually there are no cells in the preparation and they have no regenerative properties what so ever. Some of the newer examples of these biologics are:
Aimovig, Emgality, and Ajovy for migraine prevention
Humira for Rheumatoid Arthritis
Benlysta for Lupus
Cosentyx for Psoriasis
They are much safer than traditional medications which are chemical based. They have less side effects than traditional drugs. However, it is not true that they do not have side effects.
They are symptomatic treatment and do not address the underlying cause. They are from another species, so there is chance of allergy. They block needed proteins in our body; therefore, they prevent the needed functions of those proteins. For example, those used in Rheumatoid, Lupus, and Psoriasis will suppress the immune system. Therefore, the patient is much more prone to infections and even cancers. The Migraine biologics block CGRP which is a protective protein. It protects heart, arteries, lungs, kidneys, Pituitary gland, brain, and nerves. Once CGRP is blocked there will be damage to these organs that it protects; how much and how bad is to be seen because the clinical trials are only 5-6 years long. We need linger time to see the serious side effects of these medications.
Another very important point to remember in biologics and regenerative treatment is the delivery method, the techniques used, and the training of the doctor or the provider who is injecting the biocellular solution.
In general, regenerative treatment works where you inject the cells. For example, if someone has kneed pain and instability due to the MCL (Medial Collateral Ligament), injecting the biologics in the joint will not repair the root cause of the problem. For that reason, it is extremely important that the provider be very well trained in diagnosis of the problem and injection techniques of the Biologics.
At this time I would like to explain the basics of Exosomes because a lot of promising advances is being seen with this type of biologics.
Exosome is defined as a vesicle that is secreted by a cell containing intercellular communication material. Depending on what type of cell the vesicle comes from, dictates what type of results we will get. An Exosome that is secreted from skin cell (Epithelial Cell), tells other skin cells to reproduce. An Exosome that is secreted from a stem cell contains RNA and growth factors that stop the ongoing damage and stimulate cell reproduction, repair, and growth.
Currently there are 2 sources where Exosomes can be obtained. Either from donated Umbilical cord blood or from donated young adult sources, Bone marrow or Fat. The outcomes seem to be better with the Bone Marrow or Fat source. The biggest advantage of Exosome treatment is that they are completely acellular and they are small enough to be able to cross the blood vessel barriers in the nervous system. This makes them very useful in treatment of neurological conditions such as Parkinson’s, Alzheimer’s, Multiple Sclerosis, Autism, CIDP, etc.
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