INTRODUCTION
Two years ago I had the privilege of attending a lupus symposium where Stem Cell Therapy pioneer Dr. Richard Burt was the keynote speaker. I marveled at his accomplishments in treating various diseases (from cancer to MS) successfully in his research. I sat quite perplexed as to why more doctors were not inclined to suggest this type of therapy, and why prescription medications seem to be not just the popular choice, but the only choice patients are given as treatment options in their doctors office.
The more I listened and learned, I discovered that he had successfully treated rheumatology patients as well, including patients with scleroderma, various forms of inflammatory arthritis, and even lupus. I tucked all of this information away in my frontal lobe in hopes of one day writing more about it for MTL.
Little did I know that a few years later I would not only be writing about stem cell therapy, but preparing to have a stem cell transplant myself.
This blog will breakdown my upcoming procedure, clarify what stem cell therapy is, what it does, and how regenerative medicine could possibly be a conversation to have with your doctor at your next visit.
WHAT ARE STEM CELLS
Decades ago, scientists discovered the potential of stem cell therapy for becoming a magnificent game changer in medicine. Back in the 1950’s scientists discovered that bone marrow contained as least two kinds of immature cells. “Stem cells” are found in humans and other multicellular organisms that are produced in the bone marrow and fat cells. Stem cells can divide, or ultimately mature, into white blood cells, red blood cells, and platelets. When this happens, stem cells act as a “fix-it” system in the body, repairing tissue and helping maintain cells and their function through cell regeneration.
There are two main types of stem cells: embryonic stem cells and adult stem cells. Embryonic stem cells are, as their name suggests, derived from embryos. Mainly from eggs that have been fertilized through in vitro fertilization, then donated to medical research. Adult stem cells are undifferentiated cells (cells that have not developed into a specialized type) found among differentiated cells (specialized cells such as a muscle, liver or heart cells). Unlike embryonic stem cells, which are named after their origin, adult stem cells are still somewhat of a mystery. Scientists over the years have discovered adult stem cells in more tissues than they ever knew existed. In 2006, a major discovery led to a turning point in stem cell therapy after scientists Shinya Yamanaka and Kazutoshi Takahashi discovered that it was possible to reprogram adult stem cells to their immature state. This meant there was now an alternative to the controversial use of embryonic cells. After this, a surge in stem cell research began to erupt, with adult stem cells being used from everything from anti-aging properties to regeneration medicine for diseases like cancer and arthritis.
TYPES OF ADULT STEM CELLS:
Mesenchymal stem cells or bone marrow stromal stem cells, are cells located in mature tissue (such as bone marrow or umbilical cords), that the body uses to replace other dying cells over the normal course of life. Since these are developed cells, and not fetal tissue, they do not raise the same limitations and ethical concerns that embryonic stem cells do. Most current lupus research through the LRA and LFA focuses on the use of mesenchymal stem cells. Mesenchymal stem cells or MSC’s have been studied in diseases such as rheumatoid arthritis, scleroderma and multiple sclerosis. The use of these types of stem cells has shown minimal side effects for patients, and through small research groups, has been an effective alternative treatment to other harsher immunosuppressants like Imuran, CellCept, Rituxan and prednisone.
Adipose stem cells are collected from fat tissue by way of an invasive liposuction-like procedure and are not the same as those found in cord blood or bone marrow. These stem cells show promise for heart and kidney disease, ALS, wound healing and some autoimmune diseases including scleroderma, RA, and lupus.
WHAT IS THE STEM CELL TRANSPLANT PROCESS?
Originally, the use of stem cell transplant therapy with lupus was similar to the process used to treat some cancers. Usually, MSC’s are harvested from the patient’s own bone marrow stem cells
and blood. The extraction, which involves the patient being sedated and a small portion of bone marrow being removed surgically, is a short and relatively simple procedure. After surgery, the undifferentiated cells are separated from the differentiated cells in the lab and preserved. Next, the cleansed stem cells are returned to the bone marrow to repopulate. The patient receives the stem cells through an intravenous blood transfusion. This process usually takes anywhere from 1- 5 hours. After the stem cells enter the bloodstream, they travel to the bone marrow and begin to make new white blood cells, platelets and red blood cells. This stage is called “engraftment” and usually occurs 2 to 4 weeks after transplantation. This allows the body an opportunity to regenerate cells and create a healthier immune system. As Dr. Burt – Former Chief Division of Immunotherapy for Autoimmune Diseases, Northwestern Memorial Hospital in Chicago and associate professor of Medicine at Northwestern University’s Feinberg School of Medicine said, in an article with ScienceDaily, “You turn back the clock and let the immune system heal itself.”
With some of the newer stem cell treatments, MSC’s are obtained from umbilical cord cells and given through a one time infusion for lupus patients. Thankfully, this process does not require surgery or ablation of the immune system.
REGENERATIVE STEM CELL THERAPY:
As I mentioned above, in a few weeks I will be undergoing stem cell therapy. This is different from the traditional intravenous blood transfusion. Regenerative stem cell therapy is a minimally invasive procedure, done in the outpatient setting under local anesthesia, that has been shown to be very effective in delaying or completely preventing a patient’s need for surgical intervention.
I have arthritis in my neck, as well as degenerative disc disease, and stenosis. I have been told after having several epidural spinal injections that surgery to fuse and remove part of my disc was my next option. Being young(er), I have been apprehensive to commit to such a surgery when I have heard that it can lead to potential problems and the need for more surgeries later. After discussing my concerns with my rheumatologist she referred me to a regenerative medicine clinic that specializes in stem cell transplant therapy.
There is evidence to suggest that stem cell therapy can help promote healing and recovery from acute and/or chronic musculoskeletal disorders. Furthermore, stem cell therapy can be used all over the body, so anyone suffering from an orthopedic injury or disorder could be a candidate for one of these procedures. Some of the conditions that might benefit from a regenerative medicine procedure:
Arthritis;
Rotator cuff tears;
Labral tears of hip or shoulder;
Meniscus tears of knee;
Spine disorders, including sciatica and degenerative disc disease;
Ligament or tendon tears; and
Many other muscle injuries.
For my procedure, my doctor will be harvesting mesenchymal stem cells from my fat (adipose) and from bone marrow taken from my hip while I am under light sedation. Once my stem cells have been extracted and processed, they will be reinjected directly into my neck - intradiscally, around the tendons, into the facet joints, nerves, and damaged tissue in my cervical region. This is done with the aid of ultrasound and/or fluoroscopic guidance. Since these are small and delicate areas, this allows the doctors to ensure the stem cells are being delivered precisely where they are needed.
After the procedure is over, I will be discharged and advised to take it easy for a week. I will wear a neck brace for 5-7 days and will have 4 weeks of physical therapy. From what I am told, I may experience stiffness and pain for two weeks following the procedure.
Once the stem cells begin to replicate, the regeneration process begins. This is a slow and steady process where a patient will see improvement even years after the procedure.
To me, that gives me hope and confidence that I am making the right decision to heal my compromised cervical spine.
WHAT YOU SHOULD KNOW
The Benefits:
There are promising signs with the use of stem cells with regenerative medicine and lupus. A 1997 study by Dr. Burt at Northwestern University, was the country’s first stem cell transplant specifically for lupus. It included a small group of 50 participants. In this study Dr. Burk and his team concluded that if done at an experienced center, stem cell transplant may be performed safely and result in disease stability, improvement and even remission in the majority of patients.
Those with kidney disease or nephritis may particularly benefit from stem cell transplantation therapy. One study in particular showed that lupus patients remained symptom free or improved continuously after stem cell transplantation therapy. Autologous adult stem cell transplantation has been a successful therapy in cardiovascular disease, which is also reassuring to lupus patients since cardiovascular disease is the number one cause of death with SLE.
The Risks:
One of the most serious risks involves the use of anesthesia during the bone marrow extraction procedure. Anytime anesthesia or sedation is used, there is risk involved. However, the procedure is short, and only a small amount of bone marrow is removed, leaving the patient to feel a little stiff or sore for a few days. Another risk is infection during the “conditioning” process that some stem cell transplant therapies use. The immunosuppressive and chemotherapy given to weaken the immune system before transplantation. The medications given to stimulate the stem cells may be difficult to tolerate as well. Some symptoms include muscle aches, headaches, fatigue, nausea and vomiting. If you are not receiving an autologous transplant, there is always a risk of rejection. Graft-versus-host disease is another risk as well, where the donor cells can actually attack the recipient’s cells.
Cost and Convenience:
When considering this therapy, the cost can be a major factor. Because it is not currently approved by the FDA for treatment of lupus, most stem cell procedures are not approved by health plans. This therapy can be costly, and is only done at certain hospitals. Talk to the doctors office about payment options - many offer care credit with 0% interest.
CLOSING
While stem cell therapy has the potential to provide relief from a number of conditions, it is not a one-size-fits-all treatment. If you think you might benefit from stem cell therapy, the first step is to talk to your doctor about it.
I will keep you updated about my stem cell journey and hope this blog was helpful if you are considering it as part of yours.
Written By:
Kelli Roseta
**All resources provided by this blog are for informational purposes only, not to replace the advice of a medical professional. Kelli encourages you to always contact your medical provider with any specific questions or concerns regarding your illness. All intellectual property and content on this site and in this blog is owned bymorethanlupus.com. This includes materials protected by copyright, trademark, or patent laws. Copyright, More Than Lupus 2021.
Sources:
Purified umbilical cord derived mesenchymal stem cell treatment in a case of systemic lupus erythematosus:Christopher D. Phillips, 1 Pornpatcharin Wongsaisri,2 Thein Htut,2 and Terry Grossman3,4, 1Phillips Neurological Institute, LLC, Christopher D. Phillips
Received 2017 Jun 28; Accepted 2017 Jul 27. Copyright © The Author(s) 2017
April 2021