We have been hearing for many years that stem cells are the future of medicine. Great hope for effective treatment of diseases that we have not been coping well with so far. How are they used in medicine today? Dr. Marek Krochmalski, an orthopedic surgeon and traumatologist from Medical Magnus Clinic in Łódź, answers.
Treatments in whichstem cellshave been used so far confirm the hopes of doctors and patients. Currently, stem cells are used to treat about 70 different diseases. They also open up new possibilities for regenerative medicine, including orthopedics, for which the real challenge is the growing number of patients with degenerative changes in joints. We talk to Dr. Marek Krochmalski, an orthopedist and traumatologist from Medical Magnus Clinic in Łódź.
- What are stem cells and what are their possibilities?
Dr. Marek Krochmalski: Stem cells are non-specialized cells of our body capable of self-renewal (proliferation), self-differentiation (plasticity, potency) and reacting to various signals, such as genes, chemical compounds or physical interaction. Each tissue in our body has its own stem cell, which has the ability to repair any damage that has arisen there. When an injury occurs, the body increases its production of stem cells by "awakening" the local resting stem cells.
- What does this mean?
M.K .: The whole idea is based on the fact that a stem cell injected into another diseased tissue takes the form of a repair tissue cell. Stem cells divide. This division produces a replica cell and a second primary cell, which then takes the form of a normal cell of the tissue into which it was injected. Stem cells can repair anything that is broken in the body. Stem cell injected into the bone builds bone, injected into muscles builds muscle tissue.
- In 2009, just after the Beijing Olympics, you were met with athletes who needed treatment for severe overload lesions. It was the first time you used stem cells.
M.K .: It's true. I dared to put into practice the discoveries of scientists. Ten OlympiansI gave a stem cell called CD34 + (a cell surface marker) that was identified in the peripheral blood of humans and mice by one of the American scientists, the father of hematopoiesis, Irving Weissman. It turned out that all patients experienced a significant improvement and were able to return to full activity.
- Do stem cells obtained from different parts of our body have the same abilities?
M.K .: CD34 + cells obtained from bone marrow, the so-called hematopoietic, and those of peripheral blood have the same properties. Additionally, 133+ cells can be obtained from the marrow. Cells from adipose tissue are mesenchymal cells, slightly different from those mentioned earlier.
ImportantWhere can stem cells be obtained?
The greatest number of stem cells is found in the bone marrow and in the peripheral blood. They can be isolated from fat, cord blood and embryos. But the latter option is also not used for ethical reasons.
M.K .: The best cells can be obtained from the bone marrow, but it cannot be completely stripped of them. That is why I chose cells obtained from peripheral blood. These are mptipotent cells, i.e. cells with enormous potential. In addition, these are adult cells, i.e. fully mature cells, which are safe for the recipient. Embryonic cells are better than them, but these carry the risk of teratomas, i.e. the formation of places on the skin from which teeth grow. Moreover, a large amount of stem cells can be obtained from peripheral blood. The disadvantage of this method is that it can take up to 5 hours to harvest the cells. But on balance, it pays off, because 10 ml of concentrate contain about a million stem cells.
M.K .: From themselves, because it is the safest method. You can transplant stem cells obtained from another person, but then they must be additionally purified. There are stem cell banks. They can also be bred, but it's a complicated process.
M.K .: They are used, among others, in in the treatment of injuries of bones, articular cartilage, muscles or ligaments, diseases of the knees, hip and shoulder joints as well as ankle joints and feet. From the moment I dared to use stem cells to relieve one of our best strongmen from knee pain, I believe stem cells have tremendous repair potential.
M.K .: Because cells cannot reach everywhere or there are not enough of them. CD34 + cells circulate in the blood. You have to give them to the joints, because they won't get there on their own, because there is normally no blood in the joint. The mesenchymal cells contained in the synovium of the joint are too small to begin the repair process.
ImportantYou can't fool biology
The effects of treatments using stem cells don't appear overnight. Each tissue cell has a period of maturation, growth and death. Transformed stem cells are no different in this regard. They must have time. It's like a flywheel - at first it spins quickly and gradually slower and slower. It is similar with cells. Anyway, if they were to divide endlessly, there would be some sort of catastrophe. But the body is able to maintain homeostasis. Moreover, stem cells have the advantage that when they are abnormal, they undergo apoptosis - the body destroys them. Thanks to this, we avoid dangerous situations, e.g. when
an abnormal stem cell turns into a cancer cell
M.K .: We do it, but depending on the severity of the disease. If the joints are not badly damaged by the disease, then we can help them. But to be clear: not all, and not all, stem cells can help. We also quite often combine traditional methods of orthopedic treatment with the administration of stem cells. In people who have large degenerative changes in the joints, it is possible to operate the joint, give stem cells and, after thorough rehabilitation, count on the improvement of the joint efficiency by 50-60%, or even by 80%. By using only the rehabilitation itself, the mobility of the joint is improved by 10-15%. This is how you can treat hip, knee and other joints.
M.K .: In my experience there is no such need.
M.K .: The price depends on what has to be done, i.e. the scope of the treatment. The cost range is from PLN 12,000 to PLN 25,000.
M.K .: In a way, yes. Before deciding on a prosthesis, a patient can try stem cell treatment. Even ifsuch treatment was unsuccessful, he may still use arthroplasty. If you decide to have a prosthesis first, there is no point in treating with cells.
According to an expertDr. Marek Krochmalski, orthopedist and traumatologist from Medical Magnus Clinic in Łódźmonthly "Zdrowie"