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Offline Grove

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Where to get cultured stem cell procedure?
« on: May 14, 2017, 02:46:43 PM »
First post here, but I've read through hundreds of threads on this forum in the last months and have gotten great information, so thanks to all.

I have issues with several joints that have become painful in the last year. I've spent huge amounts of time researching, reading academic papers and looking through forums. I've gotten my MRIs and have consulted with many doctors.

I haven't done any treatment yet, so unfortunately I don't have much value I can add to this forum based on actual personal experience. Hopefully soon :-). But I'm now at the point where I at least know that 1) I definitely don't want surgery unless my pain becomes unbearable (many doctors have recommended multiple surgeries) and 2) I want to give stem cells a good try.

Based on the academic research I've read and the experiences of doctors I've spoken to, I'm pretty sure that I want injections of autologous cultured cells. I understand that people have gotten good, sometimes even great, results from same-day MSC procedures. But my reasoning behind wanting cultured as opposed to a same-day style procedure is that the number of cells makes a huge difference in increasing the odds of positive long-term outcome and regeneration potential. It obviously depends on the number of areas to be treated, size of each area, and damage, but as a rough figure I'm looking for at least 25 million for a smallish area and 100 million for a bigger one.

There's been a little research on the dosage size for stem-cell injections. Since this is a knee-focused forum, here are two recent papers I found testing dosage-size in knee injections:

  • 2014 Korean study compared 3 differently-sized doses of adipose-derived stem cell injection into osteoarthritic knees: high (100 million cells), mid (50 million) and low (1 million). The study has a small number of patients, but they found that regeneration and long-term pain was significantly better in high dose than low- and mid-, although all doses did have an effect on short-term pain reduction. (https://www.ncbi.nlm.nih.gov/pubmed/24449146)

  • 2016 Spanish study compared injection of hyaluronic acid (HA) only vs. injection of 2 differently-sized doses of bone marrow-derived MSCs into OA knees: high (100 million) and low (10 million). More patients than the Korean study, athough still small and not double-blinded. Main conclusion is that the stem cell injections of both sizes outperformed HA-only, but that after 1 year, patients who had the high-dose injections showed significant improvement while the low-dose group did not. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002157/)

So that's why I'm hoping for cultured cells. If anyone has any thoughts on this, definitely let me know. I'd love to hear any ideas on cultured vs. same-day procedures.

So for now, I'm pretty set on cultured. But I've hit a snag: where to do a cultured cell procedure?

Trials would be the best. They offer great care, well-done legit procedures, headed by both doctors and academic researchers, no need to jump through regulatory hoops as a patient since the trial directors have already done all that. Plus it'd be great to do something to help out science research, especially since I'm relying on these studies so much for planning my own care. And best of all, it's free.

But there are lots of problems with trials, at least in my case. Getting selected for a trial is hard, particulary if you don't live close to where it's being done. As an example, one doctor running a trial told me he got a hundred mails with MRIs from people around the world begging to be accepted, but at the end he only selected locals for both logistical reasons and for follow-up.

Another issue is that you have a good chance - maybe 50% or 66% or 75%, depending on the trial - of not getting the treatment you're hoping for. You get a lesser treatment or you get a sham. In some of the trials, after a year or two, they offer the full, good treatment to the patients who received a sham or lesser treatment. That's nice, of course, but for me that represents a wasted year or two with further degeneration and pain.

Finally, there's time and availability. There are lots of trials on stem cells, but not so many that are specifically doing orthopaedic, cultured stem-cell injections. Even if I get lucky and get into one, it could be a wait of 6 months or more before I finally get started. And if I get the sham treatment, that means I'd be looking at a total wasted time of 2-3 years of further degradation before getting the treatment I want.

So I've been looking at private treatment. The cost will probably wipe out my savings and then some, but I've realized that at some point, quality of life truly is worth more than any amount of money.

So where to do a treatment? I've learned what everyone here knows already: the whole area is a minefield of controversy, with different angles of politics, business, science, and personalities.

In the U.S., cultured cells are definitely not possible after the FDA-Regenexx ruling.

In Europe, I've had problems getting real information about the situation. In general, it seems that culture expanded cells aren't offered EU-wide, but it also seems each country has different loopholes that allow for exceptions. I'd really appreciate any info if anyone knows the real details about this, for the EU in general or any one European country.

I'm willing to go anywhere in the world. I've contacted many clinics and doctors in many countries, but I've only found two legit-seeming places that have confirmed they can definitely offer me cultured treatments on a private, non-trial basis:

- Regenexx, Cayman Islands
- Teknon Medical Center, Barcelona, Spain

I've also found 3 places - one in Thailand, one in China, and one in California of all places - which claim they can offer me culture expanded stem cells, but they don't seem very legit about their procedures, injection process, etc.

So that's the long-winded introduction to my question for the forum:

What clinics and doctors currently offer culture expanded orthopaedic stem cell treatment on a private basis?


Thanks!

Offline razuzin

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Re: Where to get cultured stem cell procedure?
« Reply #1 on: May 15, 2017, 09:21:35 PM »
Great question, I'd like to myself know more about available options, both in US and abroad.

Due to a tricky nature of culturing stem cells in US, don't think many clinics would be advertising it openly.
I did have an appointment with a doctor in NYC area who effectively described the above procedure as part of his process via a use of stem cell banks. Can provide details via PM.

Interesting research about duration of improvements.
I can attest from my own experience that the impact of same day stem cells seems to have a limited lifetime. I had a same day MSC injection arthroscopically about 10 months ago. I got great improvement within 3 to 6 months, by now feeling that effect of stems cells is dissipating, some of the symptoms which I had before the injection return.

Offline Grove

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Re: Where to get cultured stem cell procedure?
« Reply #2 on: May 16, 2017, 10:29:39 AM »
Razuzin - Your experience ties pretty well with the results from the trials I've seen testing dosage size for injections (no surgery, no scaffold), particularly for bigger areas. Low dosage leads to improvement after a few months, but then fades away after 6 months.

I've spoken to quite a few academic researchers/doctors who have experience with this. They all think that at least currently, there's no technique to get enough stem cells from a same-day, non-expanded procedure which could have a lasting beneficial impact through injection. They say the smaller numbers is clearly helpful as a massive anti-inflammatory, and in some cases maybe that's what's needed, but it doesn't seem to be enough for long-term outcome and regeneration. No one really knows how the stem cells work, but what is clear in the last years is that you need a lot of them. One researcher is so peeved by clinics offering this same-day injection option that he's thought to put together a simple, well-done trial to conclusively show that a same-day treatment, even with the maximum number of cells you can get from it, generally are not enough.

Of course, many clinics, doctors and their patients disagree (most obviously, Regenexx and Dr. Centeno). I'm truly happy for any patient who has gotten great long-term results from same-day procedures. And who knows, it's a wild world of unknowns, every patient's situation is different, and maybe someone has found better techniques than what's already published in the journals and currently experienced by academic researchers. But all the well-done evidence seems to be that you need 25, 50, or even up to 100 million for good effect in an injection procedure.

Regarding your NYC clinic: Personally, I'd be a little suspicious of any doctor in the U.S. who offers a private (non-trial) culture-expanded stem cell treatment. It's definitely possible that there's someone who is very capable, up-to-date on the procedures and research, and has all the equipment, and who disagrees philosophically with the FDA so strongly that s/he will do it in a legit, correct way... but it's a major risk for them, and I think most talented doctors wouldn't cross that line. One clinic kinda-sorta offered it by sneaking it in under an experimental basis, but they got shot down earlier this year as soon as it came to light. And there are a few others I've found in the U.S. who seem to be offering expanded procedures, but after some investigation you find that it's just marketing putting a shine on what turns out to be the standard same-day treatment. I'd be interested what you've found.

Does anyone have any ideas where to go for these culture-expanded treatments? Some places I'm still trying to find out about: Poland (psny..?)? Other countries in Eastern Europe, like Czech Republic, Hungary and Lithuania? Israel (ankle_boneonbone...?)? Taiwan?

Offline razuzin

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Re: Where to get cultured stem cell procedure?
« Reply #3 on: May 16, 2017, 08:52:34 PM »
Grove - absolutely agree with you about my NYC clinic, that was the reason I walked away, aside of a high cost. The process of culturing is done remotely, with little knowledge about the facility which does it, also some shipping involved which is not desirable from what I read.
In particular, Regenexx does the full cycle off-shore now as far as I know, as opposed to taking the original sample in US and sending it to Caymans.

It would make perfect sense to me that a large amount of stem cells in a sample should have better results. I'm wondering whether having consecutive same-day injections would have a similar effect over a long term. Also what would be the optimal time interval between two injections?

In my case I first had an adipose same day stem cells procedure which also resulted in a big improvement in pain and inflammation, and then in about eight months the MSC injection. Overall, I'm in much better shape than prior to the first injection, hopefully over fairly long term, it's been about 1.5 years since the first injection.
However, I haven't seen any studies about optimal intervals between the injections if more than one is performed.

I'd expect in Korea and China culturing stem cells is done routinely, possibly in some Eastern European countries - but I don't have any specific info.


Offline db1984

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Re: Where to get cultured stem cell procedure?
« Reply #4 on: September 15, 2017, 10:14:46 AM »
Sorry to bump an old thread but I have relevant input. This discussion on the cultured cell data really struck a chord with me. I was dead-set on getting cultured cells based on the data I had seen in the published literature.

I'm currently approaching 5 months post-op for Regenexx-C in the Cayman Islands. My problem is mild-moderate (depending on who reads the MRI) patellofemoral OA with subchondral sclerosis and bone marrow edema. Left knee is worse, combination of post-traumatic OA from a patella dislocation as a teenager and overuse (I just turned 33). I also have patellar and quad tendinosis. I have problems in other body parts as well, such as early lumbar DDD and ligamentous instability in my low back, ligament laxity in my left shoulder, and Achilles tendinosis.

I had my bone marrow aspiration in March of this year. At the same time I had patellar/quad tendon hydrodissections with PRP. This is where they inject PRP to separate the tendons from the fat pad. At the same session I had lumbar ligament and epidural injections in my low back with platelet lysate.

I returned in April to have the cultured cells injected. In each knee they did 10 million MSCs into the trochlear groove and 10 million under the patella... so 20 million total intra-articular. They also drilled into my patellas and did intra-osseous injections of 8 million MSCs into each patella (to treat bone edema and subchondral changes). They injected MANY ligaments throughout my knees with MSCs, such as patellar/quad tendons, MPFLs MCLs, ACLs etc. I also had many lumbar ligaments and shoulder ligaments injected with MSCs. I had my Achilles tendons injected with PRP a couple months later by a Regenexx doctor in the US... which has really helped by the way!

20 million intra-articular is kind of on the low side relative to the published literature for cultured MSC knee OA injections, but at the same time they inject a combination of PRP and platelet lysate, which is actually what they use as their culture expansion medium. So "in theory" there should have been MSC proliferation in-vivo post injection, but that's hard to verify as a fact.

Now that I'm almost 5 months post-op I'm noticing some improvements, but nothing super dramatic yet. I'm moving up and down stairs more quickly and the frequency/intensity of chronic inflammation has reduced. I still have inflammatory flare ups though, which is frustrating. I had functional limitations squatting down, but that is gradually starting to improve. I definitely have a long way to go in terms of recovery. I think I'm going to wait until I'm 12 months out and if I'm not satisfied head to Regenexx headquarters in Colorado for a thorough re-evaluation. Before and after MRIs would be great!

The recent publications by the doctors at the Teknon Barcelona clinic are very impressive. By the way, I recently learned that they setup an operation in Switzerland:

www.medxcell.ch

A clinic in Santiago, Chile (Clinica Las Condes) recently published a couple papers on treating hip OA with cultured BM-MSCs. They didn't mention knees but they would probably do it if the price is right:

www.clinicalascondes.cl

I ultimately chose Regenexx Cayman because they were very helpful communicating with me during the planning phase, and I like their emphasis on biomechanics and treating all the areas of the body that need work, which in my case included not just my patellofemoral cartilage, but also the knee ligaments, bone edema and lumbar spine. I think if I were to just get a straight intra-articular injection in Barcelona it would help my cartilage but I would still have other issues.

www.regenexxcayman.ky
Jun 16: Patellofemoral OA, Lumbar DDD
Aug 16: Regenexx-SD left knee, PRP right knee
Mar 17: Bone marrow aspiration for cell culture
Apr 17: Regenexx-C both knees, lumbar spine, left shoulder
Jun 17: PRP both Achilles, right hip, both knees
Jan 18: Knees and back MUCH better, planning 2nd treatment

Offline diesiel

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Re: Where to get cultured stem cell procedure?
« Reply #5 on: September 15, 2017, 10:58:45 PM »
great post, thanks for the contribution!  i also have a few questions

1.) are all of your injuries as a result of some kind of acute traumas, or do you think you may have some kind of systemic inflammatory condition? 

2.) did they mention how long to wait until full results are realized?

3) were you charged extra for the ancillary ligament/tendon injections?

4) do you mind sharing what the cost was for all of your procedures?

thanks!

Offline db1984

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Re: Where to get cultured stem cell procedure?
« Reply #6 on: September 16, 2017, 05:29:10 AM »
Hi diesel:

1. I've pushed my body really hard working out, lots of weightlifting. Heavy squats, deadlifts, etc. That really took it's toll on my knees and back. Aside from my injuries I'm healthy. I've never been diagnosed with a systemic inflammatory issue, but I have had periodontal disease (which is now well managed) and that's an inflammatory condition... so maybe but not sure. My old patella dislocation has resulted in some post-traumatic OA, worse cartilage wear in the left knee vs the right.

2. They gave me some "guidelines" for rehab, activities that are okay at 1 month, 2 months, etc... but it's just an approximation. Frankly I think the guidelines are optimistic. They say that generally patients start to feel better between 1-3 months, but some take 6-9 months before they notice improvements. They explained the inflammation, proliferation, remodeling process and said remodeling usually takes 6-12 months. They make no specific claims on cartilage regeneration but I've read enough of the studies to know that it's real, the question is "how much" do you really get?

3. I was charged extra for the patellar tendon hydrodissections and bone augmentations (intra-osseous patella injections). I was also charged extra for the lumbar spine and shoulder work. Their clinic coordinator is a pretty reasonable guy though and gave me a discount on a few items.

4. Overall I paid about $30k for everything. Keep in mind I had A LOT of work done... they went to town on me! If you had OA in one knee and no other problems the cost would be $17k. I made sure to get a comprehensive cost breakdown before hand and I originally thought it would be $25k, but they modified the treatment plan a bit after my physical exam, which brought the cost up. Financially it was a tough pill to swallow but the Regenexx docs insist on fixing your problems, especially if you have spine issues, which I think is wise in the long run. I think most athletes with worn out bodies have one big problem they're panicking about and a few extra dormant problems they're in denial about... and they know that.
Jun 16: Patellofemoral OA, Lumbar DDD
Aug 16: Regenexx-SD left knee, PRP right knee
Mar 17: Bone marrow aspiration for cell culture
Apr 17: Regenexx-C both knees, lumbar spine, left shoulder
Jun 17: PRP both Achilles, right hip, both knees
Jan 18: Knees and back MUCH better, planning 2nd treatment

Offline db1984

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Re: Where to get cultured stem cell procedure?
« Reply #7 on: September 16, 2017, 07:27:37 AM »
I should clarify, I live in the US, so all the prices I mentioned are in American dollars.

I spent about a year digging through the published literature and agree with all the comments made here on same-day vs cultured cells. The Spanish doctors at the Teknon Barcelona clinic actually felt it was necessary to point out the false equivalency between same-day and cultured stem cells in one of their recent publications. Their opinion is that BMAC shouldn't really be considered a "true" stem cell procedure.

That being said, a lot of people are getting good results with same day stem cells, although it might have more to do with changing the chemistry of the knee than actually regenerating cartilage and bone. I tried same day cells and it didn't help me at all.

Regenexx is actually running a knee OA trial for Regenexx-SD in Chicago right now, although from what I've read they're using an untreated control group vs a blinded sham injection group. That might have to do with the ethics of performing a sham bone marrow aspiration to ensure blinding... but I'm just speculating.

The evidence for cultured cells is a lot stronger than many realize. I've found 5 randomized controlled trials testing cultured BM MSC's delivered via injection for OA. One was for post-menisectomy and another as an addition to MFX and HTO... the other three trials were just an IA knee injection for OA. But in every single trial the only difference between the groups is one got a cultured cell injection and the other got the placebo, and the cultured cell group always has better clinical outcomes and regeneration seen on imaging. That doesn't mean it's making knees "brand new" but the injections are definitely disease modifying and have regenerative effects. One of the findings of the Teknon doctors is that cultured cells improve cartilage quality... so that even if changes are hard to see on a standard MRI or X-ray there are still regenerative changes taking place. What's also interesting is that many of the studies are showing subchondral bone regeneration as well... not sure if that's improvements in cartilage protecting the bone or the biochemical "crosstalk" between cartilage and bone, or maybe some combination of the two. It's all very fascinating and I'm always on the lookout for new publications. Overall I think a cultured cell injection (especially bone marrow cells) is a wise investment for anyone with mild to moderate OA.

Sorry I'm rambling at this point... can't help it!
Jun 16: Patellofemoral OA, Lumbar DDD
Aug 16: Regenexx-SD left knee, PRP right knee
Mar 17: Bone marrow aspiration for cell culture
Apr 17: Regenexx-C both knees, lumbar spine, left shoulder
Jun 17: PRP both Achilles, right hip, both knees
Jan 18: Knees and back MUCH better, planning 2nd treatment

Offline diesiel

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Re: Where to get cultured stem cell procedure?
« Reply #8 on: September 17, 2017, 05:54:21 AM »
Another thing to consider is frequency of injections vs yield of each one.  I'd favor frequent treatments over a single potent one.  Although it's hard to weigh in, the data just isn't there yet.  There is a reason dr saw does multiple stemcell doses after his custom MFX.

Offline psny

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Re: Where to get cultured stem cell procedure?
« Reply #9 on: September 19, 2017, 12:40:58 AM »
I should clarify, I live in the US, so all the prices I mentioned are in American dollars.

I spent about a year digging through the published literature and agree with all the comments made here on same-day vs cultured cells. The Spanish doctors at the Teknon Barcelona clinic actually felt it was necessary to point out the false equivalency between same-day and cultured stem cells in one of their recent publications. Their opinion is that BMAC shouldn't really be considered a "true" stem cell procedure.

That being said, a lot of people are getting good results with same day stem cells, although it might have more to do with changing the chemistry of the knee than actually regenerating cartilage and bone. I tried same day cells and it didn't help me at all.

Regenexx is actually running a knee OA trial for Regenexx-SD in Chicago right now, although from what I've read they're using an untreated control group vs a blinded sham injection group. That might have to do with the ethics of performing a sham bone marrow aspiration to ensure blinding... but I'm just speculating.

The evidence for cultured cells is a lot stronger than many realize. I've found 5 randomized controlled trials testing cultured BM MSC's delivered via injection for OA. One was for post-menisectomy and another as an addition to MFX and HTO... the other three trials were just an IA knee injection for OA. But in every single trial the only difference between the groups is one got a cultured cell injection and the other got the placebo, and the cultured cell group always has better clinical outcomes and regeneration seen on imaging. That doesn't mean it's making knees "brand new" but the injections are definitely disease modifying and have regenerative effects. One of the findings of the Teknon doctors is that cultured cells improve cartilage quality... so that even if changes are hard to see on a standard MRI or X-ray there are still regenerative changes taking place. What's also interesting is that many of the studies are showing subchondral bone regeneration as well... not sure if that's improvements in cartilage protecting the bone or the biochemical "crosstalk" between cartilage and bone, or maybe some combination of the two. It's all very fascinating and I'm always on the lookout for new publications. Overall I think a cultured cell injection (especially bone marrow cells) is a wise investment for anyone with mild to moderate OA.

Sorry I'm rambling at this point... can't help it!

Since you cannot yet send private messages due to your post count I will ask here. Has PRP helped your tendon injuries such as your Achilles? I have Achilles and would like to know. I had the Tenex procedure along with PPR done by a very prominent ankle surgeon in Manhattan and I still have pain, intact, its not much if at all better then before. :(

Offline db1984

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Re: Where to get cultured stem cell procedure?
« Reply #10 on: September 20, 2017, 07:01:42 AM »
I should clarify, I live in the US, so all the prices I mentioned are in American dollars.

I spent about a year digging through the published literature and agree with all the comments made here on same-day vs cultured cells. The Spanish doctors at the Teknon Barcelona clinic actually felt it was necessary to point out the false equivalency between same-day and cultured stem cells in one of their recent publications. Their opinion is that BMAC shouldn't really be considered a "true" stem cell procedure.

That being said, a lot of people are getting good results with same day stem cells, although it might have more to do with changing the chemistry of the knee than actually regenerating cartilage and bone. I tried same day cells and it didn't help me at all.

Regenexx is actually running a knee OA trial for Regenexx-SD in Chicago right now, although from what I've read they're using an untreated control group vs a blinded sham injection group. That might have to do with the ethics of performing a sham bone marrow aspiration to ensure blinding... but I'm just speculating.

The evidence for cultured cells is a lot stronger than many realize. I've found 5 randomized controlled trials testing cultured BM MSC's delivered via injection for OA. One was for post-menisectomy and another as an addition to MFX and HTO... the other three trials were just an IA knee injection for OA. But in every single trial the only difference between the groups is one got a cultured cell injection and the other got the placebo, and the cultured cell group always has better clinical outcomes and regeneration seen on imaging. That doesn't mean it's making knees "brand new" but the injections are definitely disease modifying and have regenerative effects. One of the findings of the Teknon doctors is that cultured cells improve cartilage quality... so that even if changes are hard to see on a standard MRI or X-ray there are still regenerative changes taking place. What's also interesting is that many of the studies are showing subchondral bone regeneration as well... not sure if that's improvements in cartilage protecting the bone or the biochemical "crosstalk" between cartilage and bone, or maybe some combination of the two. It's all very fascinating and I'm always on the lookout for new publications. Overall I think a cultured cell injection (especially bone marrow cells) is a wise investment for anyone with mild to moderate OA.

Sorry I'm rambling at this point... can't help it!

Since you cannot yet send private messages due to your post count I will ask here. Has PRP helped your tendon injuries such as your Achilles? I have Achilles and would like to know. I had the Tenex procedure along with PPR done by a very prominent ankle surgeon in Manhattan and I still have pain, intact, its not much if at all better then before. :(

psny,

Yes, my Achilles tendons have definitely improved after the PRP injections. I had "Regenexx style" PRP with minimal red and white blood cells, 10x platelet concentration.

Another thing to consider is frequency of injections vs yield of each one.  I'd favor frequent treatments over a single potent one.  Although it's hard to weigh in, the data just isn't there yet.  There is a reason dr saw does multiple stemcell doses after his custom MFX.

diesiel,

Check out these studies, they're seeing significant improvements in cartilage after a single injection of culture expanded cells. This kind of data doesn't exist for the BMAC injections that 99% of people are getting:

https://www.ncbi.nlm.nih.gov/pubmed/25822648
https://www.omicsonline.org/open-access/treatment-of-knee-osteoarthritis-with-autologous-expanded-bone-marrow-mesenchymal-stem-cells-50-cases-clinical-and-mri-results-at-one-year-followup-2157-7633-1000285.php?aid=54989
https://www.ncbi.nlm.nih.gov/pubmed/26783191

These are some of the papers published by the Teknon Barcelona doctors mentioned above. One of them (R Soler) also runs the clinic in Switzerland.
Jun 16: Patellofemoral OA, Lumbar DDD
Aug 16: Regenexx-SD left knee, PRP right knee
Mar 17: Bone marrow aspiration for cell culture
Apr 17: Regenexx-C both knees, lumbar spine, left shoulder
Jun 17: PRP both Achilles, right hip, both knees
Jan 18: Knees and back MUCH better, planning 2nd treatment

Offline db1984

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Re: Where to get cultured stem cell procedure?
« Reply #11 on: September 20, 2017, 07:51:52 AM »
Also... Dr. Saw's results are very impressive, but there needs to be a "middle ground" treatment for mild to moderate OA vs. the bone-on-bone lesions Dr. Saw is treating. Cartilage damage is a spectrum disorder, it's not binary. Injections of culture expanded stem cells are the most promising option right now for early to mid-range OA. A few more studies:

http://www.celltherapyjournal.org/article/S1465-3249(14)00064-4/abstract
https://www.ncbi.nlm.nih.gov/pubmed/22724879
https://www.ncbi.nlm.nih.gov/pubmed/26058927
http://www.celltherapyjournal.org/article/S1465-3249(13)00152-7/abstract
https://www.ncbi.nlm.nih.gov/pubmed/18523506
https://www.ncbi.nlm.nih.gov/pubmed/18786777
https://www.ncbi.nlm.nih.gov/pubmed/24430407
Jun 16: Patellofemoral OA, Lumbar DDD
Aug 16: Regenexx-SD left knee, PRP right knee
Mar 17: Bone marrow aspiration for cell culture
Apr 17: Regenexx-C both knees, lumbar spine, left shoulder
Jun 17: PRP both Achilles, right hip, both knees
Jan 18: Knees and back MUCH better, planning 2nd treatment

Offline psny

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Re: Where to get cultured stem cell procedure?
« Reply #12 on: September 26, 2017, 11:08:06 PM »
I should clarify, I live in the US, so all the prices I mentioned are in American dollars.

I spent about a year digging through the published literature and agree with all the comments made here on same-day vs cultured cells. The Spanish doctors at the Teknon Barcelona clinic actually felt it was necessary to point out the false equivalency between same-day and cultured stem cells in one of their recent publications. Their opinion is that BMAC shouldn't really be considered a "true" stem cell procedure.

That being said, a lot of people are getting good results with same day stem cells, although it might have more to do with changing the chemistry of the knee than actually regenerating cartilage and bone. I tried same day cells and it didn't help me at all.

Regenexx is actually running a knee OA trial for Regenexx-SD in Chicago right now, although from what I've read they're using an untreated control group vs a blinded sham injection group. That might have to do with the ethics of performing a sham bone marrow aspiration to ensure blinding... but I'm just speculating.

The evidence for cultured cells is a lot stronger than many realize. I've found 5 randomized controlled trials testing cultured BM MSC's delivered via injection for OA. One was for post-menisectomy and another as an addition to MFX and HTO... the other three trials were just an IA knee injection for OA. But in every single trial the only difference between the groups is one got a cultured cell injection and the other got the placebo, and the cultured cell group always has better clinical outcomes and regeneration seen on imaging. That doesn't mean it's making knees "brand new" but the injections are definitely disease modifying and have regenerative effects. One of the findings of the Teknon doctors is that cultured cells improve cartilage quality... so that even if changes are hard to see on a standard MRI or X-ray there are still regenerative changes taking place. What's also interesting is that many of the studies are showing subchondral bone regeneration as well... not sure if that's improvements in cartilage protecting the bone or the biochemical "crosstalk" between cartilage and bone, or maybe some combination of the two. It's all very fascinating and I'm always on the lookout for new publications. Overall I think a cultured cell injection (especially bone marrow cells) is a wise investment for anyone with mild to moderate OA.

Sorry I'm rambling at this point... can't help it!

Since you cannot yet send private messages due to your post count I will ask here. Has PRP helped your tendon injuries such as your Achilles? I have Achilles and would like to know. I had the Tenex procedure along with PPR done by a very prominent ankle surgeon in Manhattan and I still have pain, intact, its not much if at all better then before. :(

psny,

Yes, my Achilles tendons have definitely improved after the PRP injections. I had "Regenexx style" PRP with minimal red and white blood cells, 10x platelet concentration.

Another thing to consider is frequency of injections vs yield of each one.  I'd favor frequent treatments over a single potent one.  Although it's hard to weigh in, the data just isn't there yet.  There is a reason dr saw does multiple stemcell doses after his custom MFX.

diesiel,

Check out these studies, they're seeing significant improvements in cartilage after a single injection of culture expanded cells. This kind of data doesn't exist for the BMAC injections that 99% of people are getting:

https://www.ncbi.nlm.nih.gov/pubmed/25822648
https://www.omicsonline.org/open-access/treatment-of-knee-osteoarthritis-with-autologous-expanded-bone-marrow-mesenchymal-stem-cells-50-cases-clinical-and-mri-results-at-one-year-followup-2157-7633-1000285.php?aid=54989
https://www.ncbi.nlm.nih.gov/pubmed/26783191

These are some of the papers published by the Teknon Barcelona doctors mentioned above. One of them (R Soler) also runs the clinic in Switzerland.

How many times did you have PRP on the Achilles? Is it pain free? Can you elaborate on the technique? Was the tendon fenstrated with the needle while injecting to breakup scar tissue and increase damage?

Offline db1984

  • MINIgeek (20-50 posts)
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  • Knee OA, going all out with cultured MSCs!
Re: Where to get cultured stem cell procedure?
« Reply #13 on: September 27, 2017, 06:36:24 AM »
psny,

I had the Achilles PRP injections done in one doctors visit in June, so a little over 3 months ago. It was 4 or 5 injections at multiple spots along each Achilles with ultrasound guidance. I don't think he "fenestrated" it. I would say they improved about 60%, so significant improvement. Most noticable change was a decrease in morning stiffness. They're not perfect though.

The clinic is called Columbia Pain Management, it's in Hood River, Oregon. They're a Regenexx affiliate.
Jun 16: Patellofemoral OA, Lumbar DDD
Aug 16: Regenexx-SD left knee, PRP right knee
Mar 17: Bone marrow aspiration for cell culture
Apr 17: Regenexx-C both knees, lumbar spine, left shoulder
Jun 17: PRP both Achilles, right hip, both knees
Jan 18: Knees and back MUCH better, planning 2nd treatment

Offline dex

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Re: Where to get cultured stem cell procedure?
« Reply #14 on: September 27, 2017, 02:45:57 PM »
Anyone has tried, or knows someone who tried, a cultured cell treatment to an articulation?

Teknon and MedXCell seem quite interesting. I tried googling and searching the forum for testimonials but found none. MedXCell claims that over 700 patients have been treated and would really be interesting to know how it turned out for them.