Hi this is dr. John Shim and today I'm gonna talk about a very important topic
and that's the use of stem cells. A very common question that comes to my office,
"Doctor do you use stem cells?" Well let's explore that. What exactly is a stem cell? Well
basically they're unspecialized cells in your body that through division can
differentiate into various tissues. In other words a stem cell can become bone,
muscle, teeth and so forth. Scientists are trying to understand how
to trigger these cells into differentiating into specific cell types.
For example, if you can use these cells for a bad heart can we trigger the stem
cells to produce new healthy heart muscle cells to repair the damaged one.
The controversy can be about where we actually get to stem cells. Embryonic
cells have been researched but very controversial so we'll not discuss that
really we're going to focus on adult stem cells. The two main sources are your
own red bone marrow and also from your adipose tissue or fat layers. But the
question still remains do stem cells work and do they help you? Well we have used
stem cells and we've been using them for a while for bone marrow transplantation
for conditions such as leukemia and myeloma. It's very successful and we've
been using it for quite a long time but using it for myeloma and cancer of the
blood is a very different story than using it in orthopedics. In orthopedics
research studies are trying to determine the safety and the efficacy of use in
arthritis and back and neck degenerative conditions. Some clinics have offered
these treatments and reported improvement in pain levels with
decreased inflammation and some restoration of cartilage lining but the
treatment is still considered experimental and has not been
FDA-approved for any musculoskeletal condition. While there's promise it's too
early to know if there is a long-term benefit at this time. So the
question is do stem cells work for back pain? As stated above no FDA-approved
stem cell for back pain at this time, there are some ongoing studies, a few of
them have been completed. There have been some reports of success but much of the
reporting has been on a very small series with no long term follow-up to
assess long-term benefit. So what remains to discuss is what are the controversies
of using stem cells or back pain? Well the first question we must understand is,
what is the source of the back pain? Now if we believe is disc degeneration then
the use of the stem cell is try to reverse or correct that degenerative
process. At this point is still not clear that we really have a good handle on
what is a pain generator in a degenerating disc. We know many people
age with no significant back pain at all, others however incapacitated by minor
degenerative findings. If we determine that disc degeneration is the cause how
do we attack the disc degeneration with the use of stem cells? We have to first
determine what kind of cells we need to help this degenerative process. Do we
need more cartilage lining? Do we need more cells to produce a protein called
proteoglycan that actually imbibes or collects water? Do we need cells that
improve the endplate and allows better disc nutrition? Do we create a stronger
annulus or the cottage on the outside of the disc to improve the disc? Those cells
have to, or can potentially, repair or achieve these functions but we still
don't know if that's the proper way to make people better
when they have disc degeneration. There are controversies still remained over
what kind of cells can be used. Do we take it from your own body? Can we use
cells that are donated from other people? If we take the cells, are the cells from
your bone marrow better than the cells from your fat tissues? Can other cell
lines such as cells taken from umbilical cords of babies, does that also provide
the same kind of differentiation properties that we think stem cells need
to have? How do we trigger the stem cells that produced the right new cells? What
is the right cell type that must be formed? For example when you put stem
cells in somebody spine should that cell then be triggered to produce a certain
type of cartilage cell or certain type or protein producing cells or certain
type of collagen? Is age a factor? If you use stem cells from older people do
these stem cells still have the same potential to change and differentiate? Do
transplanted cells stay alive? In the back and in the knee or in the hip these
joints and the discs are actually pretty hostile cell environments. Do these
transplanted cells stay in the location of transplantation? How many cells are
necessary to achieve a good result? We have to understand that there are also
potential side effects that we still don't really understand. What are the
side effects when do they occur how long do we need to follow these folks? There's
a tremendous excitement for stem cells and biologic solutions for arthritis and
back pain. Like any person I truly hope stem cell
therapies will prove beneficial for many conditions, but as a physician and a
scientist I have concerns that we still do not know the answers to many
questions about the use of stem cells. More unbiased research needs to be done
before we can fully answer the many questions about this evolving field. If
you are considering the options of stem cells, make sure you do your homework.
Understand the experimental nature of its use in orthopedic conditions and be
prepared to pay for the costs as these treatments are not yet approved for use
by most payers. This is dr. John Shim discussing stem cells. It's a very
exciting concept and at this time I'm convinced that the more we learn the
more we realize there are more questions that need answering in this topic. Thank
you for listening.