INTRODUCTION: Neurologic diseases are some of the most dreaded in existence. Like most human afflictions many of them involve inflammatory changes. For this reason stem cell treatment, which is anti-inflammatory, has shown excellent promise in treating a significant number of the most feared neurologic disorders. Often times immunosuppressive drugs are used for treatment. However these drugs have a high side effects profile. In contrast stem cell treatment has no significant side effects.
TYPES OF CELLS: Most of the available stem cell treatments use adult mesenchymal stem cells. These cells may be derived from adipose (fatty) tissue, bone marrow, umbilical cord or elsewhere. In addition hematopoietic stem cells found in the blood have also been found to be effective. Embryonic stem cells are not used.
SAFETY: Adult mesenchymal or hematopoietic stem cell treatments are some of the safest in existence. Systematic reviews of the literature from our center and elsewhere have found an almost complete absence of serious adverse events when stem cells are properly used. Unlike pharmacologic drugs they do not have side effects. Unlike surgery they do not produce pain or surgical complications. Minor discomfort at the site of stem cell harvest or injection may be seen. Infections can be seen theoretically as with any injection but stem cell treatment reports have been remarkably free of infection overall. There are also no convincing reports of tumor formation from stem cell injection.
TYPES OF STEM CELL TREATMENT
- CULTURED UMBILICAL CORD STEM CELL INJECTION: Umbilical cords from live births or cesarean sections are donated and the mesenchymal stem cells are isolated. They are then expanded in tissue culture and frozen. They are shipped in liquid nitrogen to be used when they are needed. The cells are thawed and then injected where they are needed.
- CULTURED AUTOLOGOUS ADIPOSE TISSUE (FAT) DERIVED MESENCHYMAL STEM CELL INJECTION: A small amount of fat is removed by a lipo-aspiration procedure in the office. The fat is flown to a tissue bank where the mesenchymal stem cells are isolated, expanded in culture and then frozen. When they are ready for use they’re flown to the destination in liquid nitrogen and injected after thawing.
- CULTURED AUTOLOGOUS BONE MARROW DERIVED MESENCHYMAL STEM CELL INJECTION: a small amount of bone marrow is aspirated in the office. The aspirate is flown to a tissue bank where the mesenchymal stem cells are isolated, expanded in culture and then frozen. When they are ready for use they’re flown to the destination in liquid nitrogen to be used.
- NEUROTROPHIC-GROWTH-FACTOR-CULTURED AUTOLOGOUS BONE MARROW DERIVED MESENCHYMAL STEM CELL INJECTION: This is the same as number three above except that the cells are cultured with growth factors which differentiate the cells along a neurologic line and increase their effectiveness.
- STROMAL VASCULAR FRACTION: Fat is removed in the office by lipoaspiration. It is processed in the office with an enzyme called collagenase which separates out the mesenchymal stem cells and other immune cells. These cells are then directly injected in the office.
- APHERESIS, IMMUNOSUPPRESSION AND LATER REINJECTION OF CELLS: Hematopoietic stem cells are removed over a period of a few hours via a catheter in a peripheral vein. The stem cells are then frozen. The patient is admitted to a hospital for three or four days where immunosuppressive drugs are given. A few weeks later the previously removed stem cells are re-infused.
All of these treatments have been associated with at least some degree of success in various neurologic diseases. Data is significant but not abundant. We follow this research closely and modify our recommendations for treatment based on the latest data. Most importantly we provide an accurate representation of results available to our patients without exaggerating the likelihood of success.
NEUROLOGIC DISEASES FOR WHICH STEM CELLS HAVE PROVEN EFFECTIVE
MS (Multiple Sclerosis): All of the stem cell treatments described above have reports of efficacy for MS. This is not surprising because MS is an autoimmune disease in which the body attacks the myelin sheets of its own nerves. Mesenchymal stem cells inhibit or block this destruction. Reversal of symptoms is seen in some cases.
PARKINSON’S DISEASE: Evidence of efficacy in Parkinson’s disease is much more limited than for MS. But definite efficacy has been seen with stromal vascular fraction. It is not entirely clear why it works but efficacy is likely due to suppression of an auto immune process that is at least partially driving the disease.
AUTISM: Due to the variegated nature of the disease autism is an unlikely candidate for stem cell efficacy. Nonetheless reliable reports of effectiveness do exist. Due to the difficulty of harvesting autologous tissue from these fragile patients, autologous treatments are not practical. Good results have been reported using umbilical cord stem cells.
CERBRAL PALSY: Umbilical cord, mesenchymal, and hematopoietic stem cells all have been reported to show good efficacy for cerebral palsy.
STROKE: Meaningful improvement after stroke has been reported but so far only with intracranial or carotid artery injection. We believe that intrathecal, that is lumbar puncture, injection is likely to be effective and are beginning a study of that procedure.
ALS: Simple injection of mesenchymal stem cells has been ineffective. However two groups have had some success injecting bone marrow hematopoietic stem cells cultured with neuro- tropic growth factors. We are in the process of partnering with one of those groups to offer this treatment. Overall the best results have involved arresting the progress of the disease without meaningful reversal.
PERIPHERAL NEUROPATHY: Stem cell injection into the blood vessels of the lower legs of diabetics has resulted in meaningful improvement in healing of leg ulcers. We believe that peripheral diabetic neuropathy can be similarly improved and are initiating this as a treatment.
SPINAL CORD INJURY WITH PARALYSIS: Case reports have shown meaningful improvement of motor function with injection of cultured autologous adipose derived stem cells. Better results are seen with earlier injection after injury. We believe that umbilical cells are likely to be effective with fewer logistical difficulties than cultured autologous fat and are setting up a treatment protocol using these cells.
TECHNIQUES AVAILABLE AT THE PRODROMOS STEM CELL INSTITUTE
All of these techniques are either available now or are in the process of being made available at our Nassau or Cyprus Greece centers. None of these treatments are available now in the United States except as part of placebo controlled studies. We are participants in some of these studies but offer these treatments in Nassau and Cyprus now since United States availability is it at least several years away and for some of the treatments much longer if ever.