Understanding the Stem Cell Hype

Plastic Surgeon Serving Orlando, Winter Park and Nearby Areas of Central Florida

In the last 5-10 years, there has been a lot of hype about Stem Cell Therapy to treat all sorts of medical conditions. Unfortunately true Stem Cell Therapy is not yet practical for many reasons. In my own personal opinion the word Stem Cell is used excessively by many doctors and clinics to try to sell miracle medical procedures to the uninformed and unsuspecting potential patient. As has always been my philosophy it is very important to explain exactly how treatments work, what they mean, and to try to cut through the hype and create reasonable expectations. True Stem Cells are very specialized cells, called pleuripotent cells that can change into different types of tissues like bone or muscle or skin or nerve tissue when stimulated to do so. These can either be embryonic ( from fetal tissue) or adult stem cells. Fetal stem cells are of course vey controversial for many people because of ethical issues, and though showing promise in the lab, there are few, if any, true fetal stem cell derived therapies in clinical use in the United States. Most of the 'Stem Cell Therapies' advertised refer to adult stem cells that are found in fat, bone marrow, and in fact everywhere in your body. The problem is that with the emphasis only on Stem Cells, most advertising and recommendations do not explain the true nature of these therapies as we currently understand them, and relies on the hype and sexy nature of the word 'Stem Cell'. In reality there are a whole number of cells in our bodies, which are not true Stem Cells, that are probably as important or more important than true Stem Cells in the treatment of many conditions. These cells are called Regenerative Cells, they are known by many names such as MSC's, Adipose Derived Stem and Regenerative Cells etc.

These Regenerative Cells have many functions, and can be considered like little floating drug stores, that can go where needed to stimulate blood supply (neovascularization) fight inflammation (antiinflammatory) prevent other cells from dying (anti-apoptotic), help with wound remodeling, block damaging immune responses (immunomodulatory), and generally secrete substances that help the body fight of diseases and repair itself. (Paracrine signalling) One of the most striking things about these cells is that they have the ability through chemical signalling, to home to injured and diseased parts of our bodies. They are like little smart bombs that know where to go.

So when most clinics and doctors overhype 'Stem Cells', the truth is that only a very small percentage of the cells used in current 'Stem Cell' treatments are actual true stem cells, only from 5-15%. The remaining 85-95% are actually these regenerative cells, and which are probably of much greater importance.

In order for our bodies to heal and repair itself, throughout life, we must have both these Regenerative Cells, as well as some Stem Cells in order to survive. This is whether we heal a cut, fight off an infection, recover from surgery, continue to grow hair or skin, etc. Unfortunately as we age these cells lose some of their capacity, or as certain parts of our bodies become diseased - say our bones or joints in arthritis - these parts of our bodies become overwhelmed, and do not have enough of these stem and regenerative cells easily available nearby to repair the damaged tissue. For the most part our Stem and Regenerative Cells are also bound to the little blood vessels in our tissues and can only work in the general area in which they are found.

Fortunately, there are areas of our body where these Stem and Regenerative Cells are found in very high numbers, these include our fat stores and our bone marrow. The trick, from a therapeutic perspective is to transfer some of these cells from where they are not immediately needed and where they are stuck (attached to the small blood vessels), and allow them to be used in areas of our body where they are needed. Depending on the situation, these cells can be transferred quite simply by transferring some fat from one part of the body to the other, and thus place a higher number of stem and regenerative cells in or close to the area in which they are needed. Examples of this include treatment of scars and radiation injury, burn treatment, and even treatment of osteoarthritis of the hip, shoulder and other joints. In other situations such as chronic heart failure, it is of course dangerous to simply inject fat into the heart or the bloodstream, and the Stem and Regenerative Cells within the fat have to be separated from the fat, so they can be safely injected in a liquid suspension. 

In the United States, the FDA has placed restrictions on the use of highly purified Stem and Regenerative Cells from fat, as the claim is that by performing this separation process, doctors are creating a drug which must be regulated by the FDA. This is even though these are your own unchanged cells, simply freed up to do what they do naturally. The most interesting aspect about these cells when they are freed up, is that they are either signalled to perform their natural repair functions and go to it, or they are not. In which case they simply disappear back into the tissues and become dormant again. Except in the case of active cancers, where these cells can of course stimulate cancer growth by stimulating blood vessel growth, there are no know other adverse effects. Despite the restrictions in the US, thousands and thousands of such purified cell therapy treatments have been provided around the world, with no known adverse effects. In fact it can be argued that compared to traditional drug and surgical treatments, these cell therapy treatments are exceptionally safe. Of course there is the question of how effective these treatments are, and this is to some extent variable, depending on the disease, nevertheless when one considers the safety of the treatment the risk to benefit ratio is far superior to almost any drug or surgical therapy available for any disease. Where I believe the hype and dishonesty arise, is where unrealistic expectations are created in advertising by many 'stem cell clinics' in the US and around the world, and a failure to educate potential patients on how these treatments work, and of course that there is great variability of response depending on the disease, and the individual patient. There is of course also excessive use of aggressive and unethical sales techniques that take advantage of vulnerable patients, particularly by overemphasizing the word 'Stem Cells' and failure to truly educate how our cells work. 

Essentially the goal of current regenerative medical and surgical techniques, is to use your own tissues and cells as far as possible to allow the body to heal itself to the greatest possible degree, with the lowest possible risk of adverse effects. For the most part the methods available to us include various natural and unmanipulated tissues such as your own fat, bone marrow or blood (PRP or Platelet Rich Plasma) to achieve these goals, and there are many, many safe and efficacious applications that are easily accessible to patients in the US. Certainly this is a rapidly advancing field despite the restrictions imposed on physicians by the FDA in the US, and we are hopeful that over time we will continue to see the expanded use of these relatively simple techniques currently avalable, with the addition of complementary medications, or surgical techniques as they develop and become approved. For those interested in understanding this in more scientific detail, some of the best explanations are provided by Arnold Caplan PhD in some of his You Tube Presentations