There is a fascination among some patients with umbilical cord, amniotic fluid/membrane, and placenta membrane as a means of getting the best, or the most stem cells, in stem cell therapy treatment.
In the opinion of researchers cited in this article, that fascination and the supportive claims are unfounded. Further, the treatments mentioned and advertised in some doctors office as amniotic stem cell therapy is in fact not even stem cell therapy.
I am going to discuss amniotic stem cell therapy, which is in fact amniotic tissue treatment, placenta treatments and umbilical cord stem cell therapy in this article.
Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions about stem cell therapy using the contact form below.
The Interventional Orthopedics Foundation is a non-profit that provides CME-accredited courses that teach simple to advanced injection skills.
In a December 2015 press release, the Foundation issued a warning about faulty stem cell products after testing placental tissue-derived products. The warning: The products contained no live stem cells.
Here are the five key points published in that press release:
Every day here in Los Angeles, you can see advertisements for seminars and webinars for LIVE amniotic stem cell therapy. What do they base this on?
It is based on research saying one thing and amniotic stem cell therapy marketers saying another. Here is an example of one study:
On the release of a 2012 study examining the theory that Amniotic stem cells derived from donated amniotic fluid could be stored in banks, shipped to doctors and researchers, and used for various therapies, study author Dr. Pascale Guillot of the Department of Surgery and Cancer at Imperial College of London described amniotic stem cells this way:
Amniotic fluid stem cells are intermediate between embryonic stem cells and adult stem cells. They have some potential to develop into different cell types but they are not pluripotent.
Pluripotent cells can give rise to all of the cell types that make up the body. To make amniotic cells pluripotent they have to be genetically modified. Genetically modified stem cells are drugs and must be approved by the Food and Drug Administration (FDA).
Dr. Guillot and her research team in fact were trying to turn stem cells from amniotic fluid into pluripotent stem cells by way of culturing. The purpose was to get them to a point where they could replace embryonic stem cells for laboratory testing. That they succeeded lead some in the amniotic/stem cell therapy business to believe that donated amniotic stem cells, taken from a caesarian section delivery donor, could be persevered, freeze-dried, and then shipped out to doctors offices as stem cell therapy injections for osteoarthritis.
So as mentioned, this often cited 2012 study was not about joint degeneration but as Dr. Guillot pointed out . . . We are particularly interested in exploring their use in genetic diseases diagnosed early in life or other diseases such as cerebral palsy, and further replacing the need for embryonic stem cells. Of course embryonic stem cell research is fraught with ethical challenges and limited supply.
Dr Paolo De Coppi, from the UCL Institute of Child Health in London, who jointly led the study with Dr Guillot, said: This study confirms that amniotic fluid is a good source of stem cells. The advantages of generating pluripotent cells without any genetic manipulation make them more likely to be used for therapy.
Read again This study confirms that amniotic fluid is a good source of stem cells, BUT FOR research looking at genetic pediatric disorders and how these stem cells can be harvested and stored for future research for genetic engineering.
We are often asked if we can use stored cord blood in our treatments. Umbilical cord blood is different from bone marrow stems cells. Cord stem cells are hematopoietic stem cells (which can differentiate only into blood cells), and not pluripotent stem cells (such as stem cells from bone marrow, which can differentiate into any type of tissue).The research surrounding the use of Cord Blood centers around blood and immune diseases such as leukemia, certain cancers and anemia. Speculation that cord blood stem cells may help with brain trauma injuries, cognitive disorders, and autism is being tested in the medical research.
This is the gray line with Amniotic/Placenta stem cells.A company the markets amniotic stem cells as injections and as mail order service says this:Researchers have discovered that the amniotic fluid has an extremely high concentration of stem cells, even more than bone marrow in adults. When processed at an FDA regulated lab, the biologic material ends up containing significant regenerative properties, such as growth factors, hyaluronic acid and stem cell activators.
Now on the same website the treatment is called: Amniotic derived stem cell activator injections
There is no argument that amniotic fluid contains stem cells, perhaps more so than bone marrow derived stem cells, BUT, from placenta to your joint pain the stem cells get lost along the way.
By name they are something that activates stem cells. But how? According to the makers of oral supplements sold as stem cell activators, they are protein building blocks that rejuvenate aging stem cells by way of DNA telemore support. The claim is you may live longer.
In stem cell therapy, stem cell activators are the building block or the scaffold which the stem cells begin its repair.
We are going to examine a 2013 study produced by MiMedx Group, Inc., a company that describes itself as the global premier processor, marketer, and distributor of human amniotic tissue.This study was also produced in conjunction with the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, the Georgia Institute of Technology. And the Angiogenesis Foundation. It was published in the International journal of wound healing.This is not a light-weight study.
Where are the stem cells in this study?
The researchers never say that the processed amniotic membrane have any. What they do say is that they stimulateHuman bone marrow mesenchymal stem cells already present in the body to multiple. (So does dextrose Prolotherapy and Platelet Rich Plasma).
Q. So what are stem cell activators? A. They are growth factors that help your own bone marrow mesenchymal stem cells multiply.
Q. So where are the amniotic stem cells? A. There are none
Researchers have discovered that the amniotic fluid has an extremely high concentration of stem cells, even more than bone marrow in adults. When processed at an FDA regulated lab, the biologic material ends up containing significant regenerative properties, such as growth factors, hyaluronic acid and stem cell activators. They do not survive the processing, only the remnants of their ability to activate bone marrow stem cells.
But isnt this still a great selling point for amniotic stem cell activator therapy?
No because there is already a well proven stem cell activator that works well and is a fraction of the cost, Platelet Rich Rich Plasma and dextrose prolotherapy.
Doctors from George Washington University and the University of Southern California went into this question with an open mind. Lets point out that we are NOT talking about stem cell therapy we are talking about placenta tissue preparation.
Here is what their study suggests: A review of the small number of reported studies revealed a high degree of variability in placental cell types, placental tissue preparation, routes of administration, and treatment regimens, which prohibits making any definitive conclusions. Currently, the clinical use of placenta is limited to only commercial placental tissue allografts, as there are no placenta-derived biological drugs approved for the treatment of orthopaedic sports medicine conditions in the United States.1
This April 2017 study is not very robust in its clinical recommendations.
So where did all this hype come from?
Doctors at Rush University School of Medicine wrote this in 2016 in the American journal of sports medicine:
Alter their biological properties?
With these type of research I would find it difficult to convince my patients, who are always eager for research to support their decision to undergo our treatments that the scientific community is as excited about amniotic/placenta stem cells as a potential help for their osteoarthritis.
1 McIntyre JA, Jones IA, Danilkovich A, Vangsness Jr CT. The Placenta: Applications in Orthopaedic Sports Medicine. The American Journal of Sports Medicine. 2017 Apr 1:0363546517697682.
2 Riboh JC, Saltzman BM, Yanke AB, Cole BJ. Human Amniotic MembraneDerived Products in Sports Medicine: Basic Science, Early Results, and Potential Clinical Applications. The American journal of sports medicine. 2016 Sep;44(9):2425-34.
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