RENEWING HOPE

If you think self-generation of new cells, organs and body parts is just the stuff of superhero movies, think again. Pioneering research in regenerative medicine renews hope for us all, harnessing the power of our own biological make-up to one day make us all super-beings.

Regenerative medicine is an emerging branch of medicine in which therapies are applied to help cells and tissues heal, repair and regenerate themselves. Originally focused on using the body’s own cells and functions to heal itself, research now includes growing tissues and organs for transplant in cases where that’s not possible. It is found at the crossroads of tissue engineering and molecular biology, and includes treatments such as stem cell therapy, platelet-rich plasma (PRP), medical devices and artificial organs, tissue engineering and biomaterials. While some of its trials are a long way from being available at local hospitals, many treatments—particularly those that treat muscle and joint complaints and resulting pain—are available from specially trained medical practitioners in the U. S.

“Regenerative medicine is likely the breath of fresh air that has emerged in pain medicine,” says Rajat Sekhar, MD, interventional pain physician with Greenwich Hospital’s Center for Pain Management. The Center offers platelet-rich plasma (PRP) and stem cell injections to treat acute or chronic pain conditions related to degenerative spinal discs, joints, muscles, tendons and ligaments. “Recently, it has gained quite a bit of momentum, moving from an area of anecdotal medicine to more of an evidence-based approach. Its main premise lies in a reparative approach in which your own body potentially rebuilds/heals its own tissue versus the traditional prior approach of using steroid-based therapy aimed at decreasing inflammation.”

The goal of regenerative medicine is to heal injured tissue rather than just masking the pain. While stem cells from embryos, adult tissues and reprogrammed differentiated cells are used to generate increasingly sophisticated engineered tissues, we can better understand its application on a much more granular level, in stem cell and PRP injections, particularly for bone, joint and muscle repair to end chronic pain.

“Regenerative therapy that utilizes the patient’s own blood or stem cells and other biologic options can be considered as an interventional option for musculoskeletal injuries, joint pain and back pain,” says Roshni N. Patel, MD, medical director at the Center of Excellence in Pain & Regenerative Medicine in Farmington. Patel has reinvented how she treats pain, RENEWING HOPE Regenerative Medicine Upends Traditional Prognoses by Patricia Staino

Types of Regenerative Therapies Many types of treatments, therapies and devices collect under the umbrella term of “regenerative medicine.” While the idea of engineering skin tissue and other biomaterials has a certain cool factor, it’s much more relevant to look at less invasive therapies currently available to patients. These include injections and biologics that stimulate cell and tissue repair and regrowth, often used to treat muscle and joint pain, but which have shown results in treating hair loss and erectile dysfunction, among other conditions.

Stem Cell Therapy The Mayo Clinic website refers to stem cell therapy as the “next chapter in organ transplantation and uses cells instead of donor organs.” However, there’s more to stem cell therapy than growing organs outside the body.

“Our body has more than 200 different types of cells; not all are stem cells,” says Steven Geoffrion, co-owner of Optimum Regenerative Care in Bethel. The regenerative medicine clinic uses stem cells and other therapies to treat degenerative joint conditions, back pain, arthritis, peripheral neuropathy, plantar fasciitis, anti-aging issues and whole-body wellness. “Stem cells are called the ‘master cells’ of the body because they are in charge of healing and repair. The very reason we age is because we lose stem cells as we get older.” These “master cells” can transform into different types of cells to replace dying cells and repair damaged tissue. Stem cells can be derived from umbilical cords of healthy babies and moms, as in the treatments offered at Geoffrion’s clinic, but can also be derived from an individual’s own bone marrow: During the stem cell procedure, bone marrow is collected from the patient, which takes just a couple of minutes. Those cells are isolated with a

specialized centrifuge, then injected into the injured body part so healing and regeneration can begin. (This part of the procedure takes a couple of hours.)

Patients can usually return to their daily activities after a few days, but they may have some pain at the marrow aspiration site for up to a week.

“Stem cells are very intelligent, and they know where to go in the body,” says Geoffrion. “Inflammation is signaling to stem cells, so these healing cells will migrate to where inflammation exists and help the healing process.”

According to Henry Sobo, MD, of Optimal Health Medical in Stamford, stem cells are being studied worldwide for their effectiveness in treating an ever-increasing variety of medical conditions. “The conditions for which stem cell therapy may be effective include disorders such as Alzheimer’s, MS and many others, for which, at present, there are no effective medical treatments,” Sobo says. These also include COPD, Type II diabetes, Epstein Barr, heart disease, Parkinson’s and autoimmune diseases.

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Sobo, who employs a nutritional and holistic approach to medicine, includes stem cell injections (as well as PRP and peptides) in his practice because he is committed to treating the cause of disease, not just the symptoms. His office participates in ongoing research studies in this field of therapy, following treatment protocols designed by an institutional review board, to help his patients augment the body’s natural repair process.

Platelet-Rich Plasma (PRP) Sobo sees a big demand for platelet-rich plasma therapy—“popularized” by its use in orthopedics and sports medicine— among his patients. “PRP is produced from a person’s own blood,” he explains. “It is a concentration of the type of cell known as platelets. Platelets and the liquid plasma portion of the blood contain many factors that are essential for the cellular functions that are required for healing.” It sounds similar to stem cell injections, but bone marrow contains hundreds of growth factors that PRP cannot deliver, so stem cell injections are used for more se vere degenerative conditions for which PRP may not provide sufficient growth factors. After a blood sample is obtained from a patient, the blood is put into a centrifuge, which separates the blood into its many components. Platelet-rich plasma then can be collected and delivered to the area of the body that needs treatment. This procedure concentrates the platelet count in a patient’s centrifuged blood so that when returned to the body, it contains many times the natural concentration of platelets along with the regenerative healing factors they produce. Because PRP is created directly from a patient’s own blood, neither allergic reactions nor rejection of the platelet cells can occur. This is a safe treatment that can be performed and completed in an office setting in approximately one hour from start to finish.

Peptides Another treatment growing in popularity is peptides therapy, used to improve skin care, prevent heart disease and stroke,

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and treat immune system issues and chronic infections like Lyme disease. Peptides are chains of amino acids, which are the building blocks of the body’s proteins. Peptides are like little messengers who facilitate cell-to-cell communication, telling cells when to turn certain functions on and off. Some peptides occur naturally in the body, while others can be created in a laboratory. When administered to a patient (in place of a hormone or drug), they enhance the body’s own natural abilities to produce hormones or other healing proteins. Peptides are used to produce a specific reaction in the body, so an injection could be intended to assist with weight loss by stimulating the breakdown of fat, while others are meant to reduce inflammation. Some peptides stimulate production of human growth hormone for anti-aging therapies or to build muscle mass. According to Sobo, some of the most important peptide treatments currently are approved by the FDA-equivalents in Australia, many European countries and other governments around the world. “The human body possesses over 250,000 peptides, and we are only beginning to classify and understand them, to harness their power in the practice of medicine,” he says. He notes that in other countries, peptides have shown promise in treating sleep disorders, libido issues, fibromyalgia, cancer and aging.

Exosomes Similar to peptides are exosomes, which also help cells communicate. Sekhar finds the research around these little messengers exciting and hopes there will be an FDA announcement in the coming year regarding approved biologics for patient treatment.

“Exosomes are cell-derived vesicles containing what is believed to be the regenerative components released from mesenchymal stem cells, yet they are acellular,” he says. “They provide transmitting and honing device functions between cells when the body initiates the healing process. They have been attributed to the spread of cytokines, proteins, hyaluronic acid and growth factors. Exosomes have the potential to treat a wide variety of conditions.” Research has shown that when an older organism is exposed to a younger organism, the exosomes from the young stem cells appear to rejuvenate the older cells. By introducing exosome injections, the external exosomes could support stem cell functions by providing additional information that can spur the healing process. Geoffrion offers exosome therapy to his patients to promote overall well-being, as the FDA prohibits practitioners from promising to cure specific ailments through the treatment: “We now offer exosome therapy because many consider it to be the next generation of stem cells,” he says. “Exosomes are much smaller than stem cells and will allow us to better treat the body for anti-aging and whole-body wellness and healing.”

He notes that some research has shown exosomes to be effective in reversing symptoms of rheumatoid arthritis, MS, lupus, Parkinson’s, Alzheimer’s, Lyme disease, fibromyalgia, heart disease, diabetes and more.

What to Expect As with any medical treatment, doctors and patients may vary as to when a therapy should be deemed “successful.” Sekhar warns that patients need to temper their expectations, and be patient as they wait to see results, particularly when the condition for which they are seeking relief is causing pain. “Managing patient expectations is important because the onset of healing can take months, and patient pathologies can vary amongst patients, hence restoration of damaged tissue from autologous/allogenic tissue will differ from one patient to the next,” says Sekhar. “There is quite a bit of variation in clinical practice amongst pain physicians. It is important to ensure FDA-approved guidelines are adhered to and that patient expectations are accurately managed.” Additionally, Patel stresses patients should research their doctors and the procedures thoroughly, while Sobo suggests they ask friends and family for recommendations, which are often the most reliable and accurate picture of what to expect. If you do a little digging, you can find reliable information that can educate you further, from organizations like Pew Research, the Mayo Clinic, and, yes, even the FDA (which issued a report in November 2017 to clarify the distinctions between products that are subject to the agency’s full drug approval requirements and those that are not; and to streamline the review process for new therapies and reduce some of the regulatory requirements on product developers).

“I am hoping for primary care providers to become more aware of therapies, so they can accurately guide their patients in seeking out the right medical professional for these treatments,” says Patel. “Patients must be well-informed on the limitations of regenerative medicine and not be gullible. While advances are being made in the field of regenerative medicine, we all have to be patient when it comes to the right treatment and approach for a given medical condition.”

Local Resources: Center of Excellence in Pain & Regenerative Medicine Roshni N. Patel, MD 55 South Rd, Ste 120, Farmington 860-397-6179 • RoshniNPatelMD.com Greenwich Hospital Center for Pain Management 5 Perryridge Rd, Greenwich 203-863-3579 • GreenwichHospital.org/services/pain-management Optimal Health Medical Henry Sobo, MD 111 High Ridge Rd, Stamford • 203-348-8805 • DrSobo.com Optimum Regenerative Care 2 Stony Hill Rd, Ste 208, Bethel 203-917-4474 • OptimumRegenerativeCare.com

Why Choose Regenerative Therapies? M ost regenerative therapies are considered experimental, and most insurance plans don’t cover them. They can be pricey, and for all of these reasons, patients should thoroughly research these therapies and consult with a qualified medical professional before deciding if the treatments are right for them.

Why would a patient choose a stem cell or PRP injection? Those who do often are suffering from chronic pain due to degenerative conditions that have baffled their doctors for years. Many have few options left, and often it is a choice between an invasive surgery or trying the injections.

“Studies have shown that steroid injections or opioids, which are conventional therapies that promote pain relief, are detrimental in the long run, whereas surgical intervention often means a longer recovery period, pain and opioids,” says Roshni N. Patel, MD, medical director at the Center of Excellence in Pain & Regenerative Medicine in Farmington. “Regenerative therapy offers less invasive procedures and shorter recoveries. It is a less risky treatment option that can help patients avoid invasive, risky and expensive surgeries.”

According to Greenwich Hospital’s website, the benefits of PRP and stem cell injections include a same-day procedure as opposed to a lengthy hospital stay, and often the treatments reduce the necessity for major surgery down the line because they treat injured tissues before the damage progresses further.

Additionally, regenerative therapy has been proven to accelerate healing for osteoarthritis, ligament injuries, rotator cuff tears, tennis and golfer’s elbow, tendonitis and plantar fasciitis. Many patients see improvement in pain levels and mobility within four to six weeks after treatment, and they may continue to see improvement for up to 12 months.

Patricia Staino is a freelance writer and the managing editor of Natural Awakenings’ Hartford and Fairfield County editions. She can be reached at PatriciaStaino@gmail.com.

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