What Is Cellular Prolotherapy

Cellular Prolotherapy injection treatments uses cells that come from your own body.

As regenerative techniques advance, there are other methods that can be combined with basic Prolotherapy dextrose-based solutions and treatments to further aid a person’s own body, growth factors, and stem cells to aid in the healing processes.

Here at Regenera, we use several different types of Cellular Prolotherapy techniques to supplement basic Prolotherapy treatments. We refer to this as the regenerative ladder.

At Regenera, we only use what is needed. We have often found that simple treatments are effective enough without the need for more advanced and costly methods. However for those candidates who require it, we offer a range of cellular methods to get you the results you want and need faster.

The biocellular regenerative treatments involve a cascade of events. To make this simple, we have coined it “The Regenerative Ladder” The products used from simple dextrose all the way to stem cells, fall into this natural ladder, helping the ailing body to better do its job in healing.

The higher up the ladder, the faster, more robust the healing response.

  • Healing
  • Stem Cells
  • Growth Factors
  • Platelets
  • Dextrose

Cellular Therapies usually start with Platelet Rich Plasma Therapy

Platelet Rich Plasma (PRP)

PRP-Prolotherapy is an injection method designed to stimulate healing through the use of concentrated platelets. Blood is made up of plasma and cells that are contained within it. These cells are key to vital function and include red cells, white cells, and platelets. Platelets are best known by most for their importance in clotting blood. When we get injured platelets are the first to arrive at the scene to help to stop bleeding. “Platelet rich plasma” is defined as “autologous blood with concentrations of platelets above baseline levels. They deposit rich growth factors that start the cellular healing cascade.

PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets and of growth factors — can be 5 to 10 times greater (or richer) than usual in PRP.

Normal blood usually contains only 6% platelets. In PRP there is a should be a concentration of 94% platelets. Platelets contain a number of mediators that initiate and regulate basic aspects of natural wound healing, which occurs when platelets are activated. When platelets are activated, they send signals to attract distant repair cells such as adult stem cells, to the site of injury. A higher concentration of platelets results in more stem cells attracted.

Click here to find out more about Platelet concentration

CREATION AND ACTIVATION OF PRP

A small amount of the patient’s blood is drawn on site

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The sample is then processed by centrifugation to separate it into platelets, blood and plasma that concentrates the platelets.

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We then use this preparation and inject it into the injured area to initiate the healing process.

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Click here to find out about PRP activation
Click here to find out about the history of PRP

DEXTROSE VERSUS PRP

The use of hyperosmolar dextrose (Prolotherapy) has been shown to increase platelet-derived growth factor expression and upregulate multiple mitogenic factors that may act as signaling mechanisms in tendon repair. Therefore, both PRP and Dextrose Prolotherapy have been shown to stimulate natural healing and both can be effective and both should be considered in the treatment plan for connective tissue repair. However, PRP may be more appropriate in some cases. When PRP is used as a Prolotherapy “formula” for chronic or longstanding injuries, the PRP increases the initial healing factors and thereby the rate of healing. The Prolotherapy itself (irritation, needle microtrauma) is what is “tricking” the body into initiating repair at these long forgotten sites as well as the PRP, itself, which also acts as an “irritating solution.” This is especially important with chronic injuries, degeneration and severe tendonosis, where the body has stopped recognizing that area as “something to repair.” In these cases, PRP may be more appropriate, however this determination should be made by the physician on an individual basis. PRP can also be used preferentially over dextrose Prolotherapy in the case of a tendon sheath or muscle injury- areas occasionally but not typically treated with dextrose Prolotherapy where the focus is the fibroosseous junction (enthesis). It can also be used preferentially over dextrose Prolotherapy because of patient preference.

Dextrose prolotherapy is like planting seeds in a garden; PRP Prolotherapy is planting seeds with fertilizer.

CORTISONE VERSUS PRP

Cortisone inhibits inflammation. Again, inflammation is how we heal. Therefore use of cortisone in musculoskeletal injuries is controversial and the subject questionable. Netherland researchers published the results of a well-designed 100 subject, two year randomized controlled blinded trial in 2010 comparing corticosteroid use to an injection of concentrated platelet rich plasma without ultrasound guidance. The PRP injection was given to the lateral epicondyle area of “maximum tenderness,” and a “peppering” technique was used. The researchers indicated the importance of the “inflammation”, involving the migration of macrophages to the injured tissue site. Given that macrophages release additional growth factors, they cause further increased collagen synthesis on days three to five. The study concluded that “PRP reduces pain and significantly increases function, exceeding the effect of the corticosteroid injection.”

SAFETY ISSUES

Like Prolotherapy, PRP therapy has low risk and few side effects. Many have concerns regarding the adverse effects from growth factors, however there have been no documented cases of carcinogenesis, hyperplasia, or tumor growth associated with the use of autologous PRP. PRP growth factors never enter the cell or its nucleus and act through the stimulation of external cell membrane receptors of adult mesenchymal stem cells, fibroblasts, endothelial cells, osteoblasts, and epidermal cells. This binding stimulates expression of a normal gene repair sequence, causing normal healing – only much faster.

Therefore PRP has no ability to induce tumor formation. Also, because it is an autologous sample, the risk of allergy or infectious disease is considered negligible. Evidence also exists in studies that PRP may have an antibacterial effect.

Conditions that can be treated with PRP

PRP can be carefully injected into the injured area. For example, in Achilles tendonitis, a condition commonly seen in runners and tennis players, the heel cord can become swollen, inflamed, and painful. A mixture of PRP and local anesthetic can be injected directly into this inflamed tissue.

PRP may also be used to improve healing after surgery for some injuries. For example, an athlete with a completely torn heel cord may require surgery to repair the tendon. Healing of the torn tendon can possibly be improved by treating the injured area with PRP during surgery. This is done by preparing the PRP in a special way that allows it to actually be stitched into torn tissues.

PRP is currently being used in a variety of conditions which include

  • Torn Ligaments
  • Torn Tendons
  • Injured Muscle
  • Osteoarthritis
  • Facial Rejuvenation
  • Hair Loss

Treatment with platelet-rich plasma holds great promise. The studies looking at PRP efficacy in the treatment of musculoskeletal injuries seems to differ in opinion. However, one needs to keep in mind the differences in PRP preparation used during these studies, because not all PRP are created the same. The biocellular process of how platelets work speaks volumes of its potential, especially when it has the potential to regenerate without the need for surgery or unhelpful and often harmful medications.

PRP has indeed been shown to be effective in the treatment of chronic tendon injuries about the elbow, however the general medical community is waiting for more costly robust scientific evidence before it changes its overall practice.

Even though the success of PRP therapy to many in the medical community is still questionable, the risks and complications are rare. Simply put, PRP method uses your cells, and cells heal.

BIOCELLULAR PROLOTHERAPY: THE NEXT HORIZON

Dextrose Prolotherapy and PRP Prolotherapy initiate the body’s natural healing mechanisms, but rely on the body to deliver the cells needed for repair of the injury. In the cases of chronic inflammation a phenomenon termed “cellular depletion” occurs. This is when all the repair cells have been exhausted and the presence of new cells is diminished, meaning stem cells needed to heal are not readily available or limited. At this point every consideration should be made to supplement therapy with a biocellular approach using adult derived stem cells, which takes cells from either the bone marrow or the adipose (fat) tissue, both known to contain adult stem cells.

To many, stem cells exist in every tissue. Bone marrow and adipose tissue are the main sources of these cells. Stem cells are attracted to the site of repair after platelet growth factors are deposited. Stem cells are like wildcards, allowing them to differentiate into any cell, giving them limitless versatility in healing. Adult “Mesenchymal Stem Cells” (MSC’s) are harvested and used on site. Specifically, studies of stem cell use in tendon repair, concluded that the use of implanted adult stem cells delivered to tendon defects can “significantly improve the biomechanics, structure, and probably the function of the tendon after injury.” Stem Cells have the ability to “home in” and repair tissue of all types. Mesenchymal stem cells were deemed to be safe for human use in 1995 and are being used in a vast number of applications both locally and systemically.

BONE MARROW DERIVED CELLS

Bone marrow which has been used for years is known to contain adult stem cells. The FDA has not only approved the use of Bone Marrow stems cells but also approved devices which concentrate the bone marrow into what is called “Bone Marrow Aspirate Concentrate” (BMAC). This autologous bone marrow aspirate contains both mesenchymal stem cells and accessory cells supporting new vessel growth through growth factors and cytokines. Evidence reveals that the combined use of bone marrow aspirate and PRP show equivalence to autologous bone grafting. “BMAC has also been shown to be a safe and effective treatment for tibial nonunion, metatarsal nonunions and Jones fracture, osteonecrosis of the hip, osteochondral defect repair, and limb ischemia.

ADIPOSE-DERIVED STEM/STROMAL CELLS

There is growing evidence that Human adipose tissue has been shown to be a rich source of adult stem cells with a vast population of cells of extensive proliferative ability into multiple cell lineages. Adipose-derived stem/stromal cells can differentiate to ligaments, tendon, muscle, cartilage, bone or fat. Fat grafting has been popular in cosmetic procedures for many years and this lipoaspirate is now being used in musculoskeletal medicine-either with or without PRP-to create a gel matrix or bioactive scaffold to hold the essential “inflammatory boost” in a joint area. Adipose derived stem/stromal cells are similar but not identical to bone marrow cells.

There is growing evidence that Human adipose tissue has been shown to be a rich source of adult stem cells with a vast population of cells of extensive proliferative ability into multiple cell lineages. Adipose-derived stem/stromal cells can differentiate to ligaments, tendon, muscle, cartilage, bone or fat. Fat grafting has been popular in cosmetic procedures for many years and this lipoaspirate is now being used in musculoskeletal medicine-either with or without PRP-to create a gel matrix or bioactive scaffold to hold the essential “inflammatory boost” in a joint area. Adipose derived stem/stromal cells are similar but not identical to bone marrow cells.

In Biocellular Prolotherapy the formula then is autologous tissue either from adipose (ones’ own fat) and/or bone marrow and/or PRP. If the fat is used, this is called “Lipoaspirate Prolotherapy” because the method used to extract the fat is a type of liposuction. If the bone marrow is the formula, the term used is “Bone Marrow Prolotherapy”. Both are forms of Biocellular Prolotherapy. With Biocellular Prolotherapy cells are not manipulated, and no additives are used. The cells are taken from the same patient and put back in the same patient on the same day in the same procedure.

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For more information about Cellular Prolotherapy, contact Regenera now, or feel free to continue exploring and reading other sections to learn more about Prolotherapy regenerative injection treatments and what benefits it could provide you.

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