In regenerative medicine, there are grades of “potency” that are generally accepted. Below is an oversimplified hierarchy, and some other options that can be used as adjuncts or on their own. This is not a comprehensive list of options but provides a simple structure to help think about the various choices available to patients.
1. prolotherapy – uses dextrose containing solution, an irritant, to stimulate the body to react and produce a healing response. Does not require a blood draw. Generally can be billed through insurance.
2. PRP – uses patient’s own platelet rich plasma which contains certain growth factors that stimulate a healing response.
3. Fresh frozen amniotic fluid or other amniotic growth factor products – uses live healthy birth babies’ residual amniotic tissue to isolate growth factors that are then isolated, preserved either by freezing or by a drying process, and then stored until it is time to inject. Contains different growth factors than PRP and therefore useful for specific indications that PRP may be as helpful for, or to augment efficacy of PRP for its intended use.
4. Autologous mesenchymal stem cells – otherwise referred to as medicinal signaling cells. Uses patients’ own extracted cells which are re-injected at different site where healing response desired. Reduce inflammation, exerts paracrine effect by stimulating body’s own healing response including the body’s own stem cells to cause a healing process, modulates the immune system towards favorable immune cell composition. Stimulates production of antimicrobial peptides. Long lasting response owing to immunomodulation. Derived from bone marrow which contains both hematopoetic and mesenchymal cells.
5. Allogenic stem cells – cells derived from umbilical cord blood/tissue from live healthy birth babies which are processed and frozen. Very controversial. Unclear if thawed cells are viable when injected into the body. The FDA considers these cells a drug when injected into a non-1st/2nd degree relative.
Other offerings that don’t necessarily fit within a specific hierarchy but can be used as adjunctive treatments. These are sometimes combined with above options or used on their own.
A2M/iRap – potentially useful for inhibiting cartilage degradation, reducing inflammation, or reducing neuropathic pain. Can be added to PRP or stem cells.
Hyaluronic acid – provides the same cushioning type material already existing within joints to improve pain. May also promote a healing response. Can be added to PRP.
Exosomes – granules containing stem cells’ signaling factors. Can be injected or even infused. Relatively new with much controversy still surrounding use including whether FDA considers them “drugs.”
Platelet Lysate – PRP that has undergone additional steps to cause platelets to release its growth factors and signaling proteins that are then isolated further. Sometimes used for treatments where avoiding platelet aggregation is desired or for neurogenic pain.
VSELS -very small embryonic like stem cells which can be found in bone marrow and peripheral blood. Special techniques for isolating a patients’ VSELs and activating a patient’s VSELS exist.
Adipose tissue – Unprocessed adipose tissue obtained via mini liposuction procedure. Provides scaffold and cushioning effect. Coincidentally contains large quantity of medicinal signaling cells.
O-zone – thought to invigorate mitochondrial function, encourages favorable NAD:NADH ratio, encourages favorable anti-inflammatory cytokine production, reduce oxidative stress.
NAD – thought to invigorate mitochondrial function.
Nitric oxide – thought to encourage stem cell release and stimulation.