Stem Cell Medicine (an update)
by David M. Odom, MD
Before discussing available stem cell medicine, let’s briefly review what are stem cells.
Cells are the smallest living components of the body collected together as groupings of similar specialized cells into tissues and organs, such as fat or the liver.
Cells are organized on noncellular lattices referred to as “scaffolds”, which can be made of malleable protein material or stiff bone.
Organs are made of cells specialized for particular function. Typically, they do not divide and have a definite life span.
The body regenerates organs by providing new specialized cells created from generalized cells, called stem cells. Stem cells have the capacity to divide into two daughter stem cells or to divide into one daughter stem cell and one specialized cell, such as a muscle cell or a nerve cell.
The stem cell newly created by division of a parent stem cell, is renewed, but not perfectly. Since birth, stem cells in an individual can collect damaging mutations over time.
As well, stem cells have a life cycle, being able to divide between 50 and 70 times before dying. This “Hayflick” limit on the number of times that a stem cell can divide determines the life span of the human in which it resides. With each cell division, the end cap on the chromosomes in the cell become shorter. When the end cap or “telomere” reaches a critical short length, then the stem cell can no longer divide.
So, you can see that stem cells from a younger individual are more capable than stem cells from an aging person.
The most popular type of stem cell transplant in the US at this point in time is “autologous”, that is, stem cells are harvested from a patient, concentrated, activated, and then given back to the same patient, many times into a joint, but sometimes intravenously. 
Certain tissues have more progenitor or stem cells than other tissues.
The bone marrow is a good source of stem cells that can be obtained by introducing a needle into the pelvis bone to suck out progenitor cells to be inserted into a problem joint, for example. The stem cells then go to work reorganizing the damaged joint.
Even more popular than bone marrow as a source of stem cells is fat. We are programmed to be able to increase our stores of fat. So, we have progenitor (stem) cells in fat allowing us to create more fat cells and blood vessels to feed the newly stored fat. Actually, half the cells by number in fat are stem cells, but tiny compared to the bloated fat cells. Rendering stem cells from fat has become easier in recent years due to the invention of a machine that allows newly harvested fat to be placed into one end of a machine and the mass of stem cells comes out the other side. The mass of stem cells replete with surrounding scaffolding tissue is termed, “stromal vascular fraction” (SVF). This table top device resides in the operating room to allow immediate production of stem cells and immediate reintroduction into the same patient.
You can see that the distinct advantage of using a patient’s own stem cells is prevention of reaction and rejection (“graft - host disease”).
This means taking stem cells from one human being and administering them to another. 
But, isn’t that a bad idea, risking graft- host reaction?
Not likely if the grafted cells come from the umbilical cord, usually discarded, after the full-term birth of a baby! Such cells are “immunologically privileged” with very low levels of HLA-DR and other problematic antigens. The cells are derived from the inside wall of the umbilical cord, tissue that has the name, “Wharton’s Jelly” or “umbilical cord matrix”. (Such cells are very young “adult stem cells”, not having the same problematic issues as “embryonic stem cells” or “fetal stem cells”.)
As this is written, May of 2018, stem cell products derived from umbilical cords gathered after a live, term birth, are investigational. That is, their use is still being studied, and is being monitored by the FDA, but they are not “FDA approved” to treat any disease, disorder, or condition. Still, testimonial evidence shows that these cells are more potent than the older stem cells extracted from an adult’s fat. Their activity is stronger and their effects last longer.
Two types of stem cells derived from umbilical cords
The inner lining of the umbilical cord, or Wharton’s Jelly, provide so-called “mesenchymal” stem cells, which are “multipotent” and can differentiate into cartilage, muscle, bone, and skin.
“Hematopoietic” stem cells can be derived from umbilical cord blood. These cells can differentiate into red blood cells, white cells, and platelets. This is why some hospitals in the US are prepared to store umbilical cords in a frozen state in order to allow a person, years after birth, to replenish bone marrow with fresh, healthy cells should leukemia occur.
Stem cell therapy, the current situation
Currently, people who suffer from chronic degenerative conditions, not well treated by modern western medicine, seek unconventional treatments, using devices or substances not approved by the US FDA. The FDA is charged with protecting the public from unsafe and unscrupulous drugs, supplements, and devices. However, the FDA is not to regulate the practice of medicine.
For this reason, a licensed medical doctor can use an FDA approved drug to treat maladies for which the pharmaceutical company cannot advocate. This practice is commonly referred to as “off label”, and accounts for over 30% of prescriptions written in the US. I have no problem with such prescribing. My considerations are: Is the treatment safe? Is the treatment generally effective? Do the likely results justify the inherent risks? It’s an issue of balancing risks vs. benefits.
The use of adipose derived progenitor cells, SVF, for therapy crosses the line according to new regulatory attempts by the FDA. They are saying that the process of manipulation of fat to extract the stem cells is in itself the production of a new, unapproved drug, and is not allowed to be produced by doctors.
The doctors engaged in this practice say that autologous use of adipose derived SVF is entirely a surgical procedure and is not to be regulated by the FDA. The FDA filed suit against two organizations of doctors, one in California  and the other in Florida, to stop the practice of giving patients back their own cells.
Why would the FDA bother to do this? We all know that government agencies tend to aggrandize regulatory power. One thought is that the FDA is attempting to protect those pharmaceutical companies engaged in the new industry of producing allogeneic stem cells from competition. After all, doctors producing autologous product are not clients of the FDA as are pharmaceutical companies.
Currently, we have patient testimony that stem cell therapy has benefitted such disparate medical problems as arthritic joints, chronic heart disease, and peripheral neuropathy.
However, at this point in time, we cannot say that we have proof, reflected in the medical literature nor substantiated by regulatory agencies, that use of stem cells will produce clearly defined benefit for specific health problems, nor how long any perceived benefit will continue to last after treatment.
Doctors worry about attacks upon their reputations and licensure, whether by media, litigation, or regulatory agencies. Many younger doctors seek refuge as employees of large clinics, spending their professional lives advocating conventional treatment protocols for patients. The old adage in medicine, “do not be the first to accept the new, nor the last to discard the old” becomes a survival tactic.
In my opinion, doctors should seek to benefit patients first, not clamber for personal safety.
Still, this issue is the reason why most stem cell therapy in the US, although available, is not advertised. This is also why American citizens continue to seek stem cell therapy at well-known clinics outside the US. In this unstable milieu, people do not come to the US for the latest and best.
The goal of current stem cell therapy
The only specific health problem more or less agreed upon as amenable to stem cell therapy is osteoarthritic joint deterioration and pain, especially of the knees and shoulders. Still, we don’t have a handle on how long such benefit lasts after treatment. Does use of umbilical cord mesenchymal stem cells bring longer relief of symptoms than use of adipose derived SVF? We really don’t know. So, the patient, seeking therapy for joint pain should go into this with the experience that nothing else has worked, and the realization that even with benefit, treatment may need to be repeated over time. Prices are in the several thousands of dollars to treat joint pain. Of course, as more doctors provide service, the price will come down. Insurance does not cover stem cell therapy, so you can forget that.
When it comes to heart disease, neurological problems, and other chronic disorders associated with age related decline, the phrase commonly heard is: rejuvenation therapy.
There are many testimonial reports of relief of chronic health problems using mesenchymal stem cells. Umbilical cord products are usually administered intramuscularly (IM) as an injection. Use of the product intravenously is thought to be less effective. The cell product comes as small vials containing several millions of cells each, frozen and kept so in liquid nitrogen. After removal from storage and thawing, the cells are immediately injected. The survival rate after freezing and thawing is some 60%. Still, if the cell count is of mesenchymal stem cells and not of other, non-stem cells, the treatment capacity is significant.
So, for problems of age related decline, including atrial fibrillation, peripheral neuropathy, COPD, chronic heart failure, changes of bowel habits, osteoarthritis, and many others, stem cell therapy MAY provide benefit.
- Mark Berman MD; Elliot Lander MD. The Stem Cell Revolution. AuthorHouse.(2015)
- Kalaszczynska I, Ferdyn K. Wharton's jelly derived mesenchymal stem cells: future of regenerative medicine? Recent findings and clinical significance. Biomed Res Int. 2015;2015:430847 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377382