Below are the most common questions we receive concerning stem cells, as well as a short glossary of stem cell terms. If you do not see your question below, please contact us or feel free to send Dr. Shehadi a message.

FAQ

Stem cells are multi-potent cells that have multi-differentiation capability. They are widely considered to be the future of medical applications and are useful for various cell therapies for numerous patients with incurable diseases and conditions. There are several sources of stem cells: embryonic stem cells, umbilical stem cells, and adult stem cells. Embryonic stem cells are controversial due to ethical considerations and therefore, Cedar Stem Cell Institute will never use embryonic cells. Adult stem cells are the least controversial and most widely available. Adult stem cells include peripheral blood stem cells, and bone marrow stem cells. Read more >>

Stem cell therapy is the process of harvesting stem cells and injecting them into the patient's blood or an area of the body with pain or cancer cells. Here at Cedar Stem Cell Institute in Columbus, Ohio, we utilize stem cell therapy to treat neurological and orthopedic conditions.

Adult stem cells can be found all over the body, from the brain to bone marrow to even cells found in the lining of the nose. Adult stem cells are most commonly harvested from bone marrow, amniotic fluid, placenta, and platelet-rich plasma (PRP).

Embryonic stem cells come from three- to five-day-old embryos, also called blastocysts. These stem cells are pluripotent, meaning they have the ability to develop into any type of cell in a fully developed body. Cedar Stem Cell Institute will never use embryonic stem cells. Read more >>

Platelet-Rich Plasma (PRP) is defined as an autologous concentrated preparation of platelets and their associated growth factors in a small volume of plasma. Platelets are a natural source of numerous growth factors in their natural and biologically-determined ratios. Plasma is the liquid aspect of our blood which contain all the cellular components such as red and white blood cells, as well as platelets.

In simple terms, platelets naturally make up only 10% of our blood's cellular components. In PRP, the platelet ratio is increased to 90% platelets. Therefore, PRP is plasma rich in platelets. Using PRP offers an innovative and promising approach to tissue regeneration and healing in general. There are many clinical indications for PRP.

Upon activation, platelets release growth factors and other molecules that are stored in their granules, and which are part of the natural healing process. These growth factors are signaling molecules that promote regeneration. Signaling molecules include Platelet-Derived Growth Factor (PDGF), Transforming Growth Factor (TGF), Epidermal Growth Factor (EGF), Vascular Endothelial Growth Factor (VEGF), and Fibroblast Growth Factor (FGF). These molecules initiate and regulate the healing cascade of inflammation, cell proliferation, reepithelialization, angiogenesis and tissue remodeling.

PRP stands for Platelet Rich Plasma and is a non-surgical healing treatment used in many fields including sports medicine and orthopedics. In the field of non-surgical orthopedics, PRP is injected into the affected region to stimulate and enhance healing. PRP is your own blood modified in a way to produce high doses of your body's own healing "ingredients" that are stored in our platelets.

Based on current research, a whole host of aliments, conditions can potentially benefit from PRP. However, soft tissue injuries are usually the most responsive to PRP. These includes tendonitis, tendinosis, tendon tears, ligament sprains or tears, and muscle tears. PRP has also been effective in treating cartilage degeneration such as arthritis as well as labrum tears in joints.

Very Simple. First, the patient's blood is collected and then spun in a centrifuge specifically designed to concentrate platelets for PRP purposes. Local anesthetic is then provided to the affected region. A small needle is advanced into the target area, sometime with the aid of ultrasound guidance.

Growth Factors are released from large quantities of activated platelets at the site of injury. This leads to an induced inflammatory reaction that initiates a powerful effective healing cascade. Growth factors stimulate blood flow, promote matrix formation, restore proteins found in soft tissues that may have been previously compromised, and strengthens cartilage to become more firm and resilient.

Patients typically tolerate the procedure very well. One can expect a minor amount of post-injection soreness as PRP induces an inflammatory response.

One to three treatments are needed depending on the degree of injury, the duration of the injury and the response to the treatment.

BMC stands for Bone Marrow Concentrate. Bone marrow is the flexible tissue found in the hollow interior of bones. In adults, marrow in large bones produces new blood cells, including regenerative cells. These cells can be extracted from the patient's hip bone and then concentrated and used for BMC injection therapy.

Unlike other cells of the body, bone marrow cells are undifferentiated, which means they have the ability to replicate themselves into a variety of tissue types. Our body is in a constant state of repair and regeneration. Unfortunately, as we mature with time, the quantity of regenerative cells declines.

BMC therapy is a non-surgical treatment used to treat various orthopedic injuries. BMC is a concentrate of regenerative cells obtained from a patient's own bone marrow. The physician removes a small amount of the patient's bone marrow and spins it in a centrifuge in order to generate a powerful concentrate that will be injected in the injured area. In the past, these types of cells were often very difficult and expensive to obtain from the body. With newer techniques and technological improvements, regenerative cells can easily be obtained and concentrated by a simple office procedure.

The procedure is done under local anesthetic. While there is some slight discomfort, most patients tolerate the procedure very well and with minimal pain. Post-injection soreness in the injection site is sometimes present given the BMC-induced inflammatory response. This soreness usually resolves on its own within a few days after the injection.

BMC accelerates the body's natural healing mechanisms. Unlike other cells, bone marrow concentrate cells have the ability to replicate themselves into a variety of tissue types. When injury occurs, the usual number of regenerative cells needed for tissue regeneration is often inadequate. With BMC, the concentrate of regenerative cells will provide a more robust healing of the damaged tissue and aid in growth and repair. While the full benefits of BMC are still unknown, it has been shown to reduce swelling, relieve pain, and enhance healing of articular cartilage and bone.

Based on current research and clinical experience, moderate to severe cases of osteoarthritis and severe tendon injuries show promising results. In general PRP may be more appropriate for mild to moderate osteoarthritis or tendon injuries in an active patient. BMC may be reserved for more challenging cases when more potent effects are desired.

First, regenerative cells are obtained by harvesting bone marrow from the back of the patient's hip bone under X-ray guidance. The bone marrow is then placed in a machine called a centrifuge, which separates the regenerative cells and platelets from the rest of the blood products. Second, a very small amount of local anesthetic is provided to the affected region to numb the area. Third, a needle is advanced in under ultrasound guidance until the problem target site is reached and the BMC is injected. Once introduced at the site of injury, the platelets release growth factors that tell the regenerative cells what to become, thereby initiating the regenerative response.

Unlike cortisone shots which mask symptoms and can damage tissue, BMC targets the root of the problem and attempts to heal the tissue.

Most patients require only a single BMC treatment depending on the degree of the injury. This is usually followed by a single PRP injection 6 weeks later to give the body a boost. However in challenging cases, if a patient experiences significant relief that plateaus, they may consider a second BMC injection months or years later.

For the first 48-72 hours, swelling and discomfort are typical in the injected area. By day 5, these symptoms usually begin to resolve and physical therapy is started to optimize BMC effects and facilitate recovery. Patients have responded to BMC treatment at varying timeframes.

Bone marrow cancers (such as lymphoma), as well as metastatic disease that spread to the bony spine, as well as any active systemic infection are all contra-indications. Furthermore, blood thinning medication like Coumadin must be discontinued and managed appropriately prior to procedure.

Unfortunately, BMC is considered experimental by insurance companies and is not covered.

Most patients notice some level of improvement by 2-6 weeks post BMC. Increased stability and strength are typically reported with the decrease in pain. A second wave of benefits may be obtained between 6 weeks and 3months. Patients are encouraged to remain active, strengthen surrounding muscles, lose weight, achieve a proper diet and sleep routine.

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The amniotic membrane is the innermost layer of the placenta and protects the fetus along with the amniotic fluid. The membrane and fluid contain stem cells that have the ability to become many different types of cells and accelerate healing.

Cells from the amniotic membrane are obtained by physically breaking down the tissue and using enzymes. Additionally, stem cells can be obtained from the amniotic fluid by using a hollow needle without harming the fetus.

No. The placenta and amniotic membrane are normally discarded after birth, so obtaining stem cells from these tissues does not harm the mother or the baby. Obtaining stem cells from the amniotic fluid does not harm the fetus. For these reasons, the amniotic fluid and the amniotic membrane are considered ethical sources of stem cells.

 

Glossary of Terms

  • Adult Stem Cells - multipotent stem cells that can develop into various types of cells, but are tissue-specific
  • Amniotic Fluid - the fluid that surrounds and helps protect an unborn baby during pregnancy
  • Amniotic Membrane - the innermost layer of the placenta; contains stem cells
  • Bone Marrow - spongy tissue containing stem cells that is found inside certain bones of the body
  • Embryonic Stem Cells - stem cells originating from embryos (i.e. fertilized eggs)
  • Growth Factors - protein signals that stimulate cell division and growth of specific tissues
  • Mesenchymal Stem Cells - a type of stem cell that can give rise to many different types of cells in the body and promote healing
  • Oswestry Disability Index - a questionnaire used to determine a patient's level of disability resulting from low back pain
  • Plasma - the liquid component of blood that holds blood cells and platelets
  • Platelet Rich Plasma - plasma with a high concentration of platelets that contain many growth factors and promote healing
  • Platelets - a component of blood that promotes clotting and secretes growth factors beneficial for healing
  • Stem Cells - undifferentiated cells with the potential to develop into many different cell types during growth and healing
  • Undifferentiated Cells - a cell that has yet to differentiate into its final form and type

Neurosurgery Associates