Stem cells are the future of regenerative medicine.
In 2000 I attended a conference for venture capitalists to learn about everything new and emerging. There was no mention of stem cells then but it was there that I learned about the hierarchy in medicine or as another attendees put it to me – the 4 Rs: Remove, Replace, Repair and Regenerate. The more scientists and medical researchers learn about how our bodies work the further along the 4R continuum medicine moves.
Regenerative medicine is becoming a reality.
Stem cells are part of that reality because they have the power to heal. Bone marrow transplants which have been done for 40 years are one example of how stems cells are used to treat blood disorders and certain cancers. Scientists are now testing other ways to use them in the treatment of blindness, MS, stroke and spinal cord injuries.
Sports medicine researchers are also testing ways to use them to regenerate cartilage, fix torn ligaments and damaged rotator cuffs and to speed recovery which is particularly important for professional athletes.
Stem cell research is still in the early days.
We spoke with Dr. Peter Gerbino to get his insights on stem cell research, the pros and cons of stem cell treatments available now and how stem cells could be used in the future.
Q+A with Peter Gerbino MD
Q/ What are the most promising uses of stem cells now?
Stem cells have the potential to regrow any damaged or missing tissue. They are one of 3 exciting “biologics” being studied in medicine. The other two are PRP (platelet-rich plasma) and BMAC (bone marrow aspirate concentrate). Experimental studies are underway trying to heal almost every tissue in the body. As yet, none are FDA approved and insurance covers nothing regarding biologics. In sports medicine, stem cells have had early success with growing cartilage
and helping heal tendons and ligaments.
Q/ What are the risks now?
The risks are mostly financial. Average cost for stem cell treatment for treating a single knee with osteoarthritis is $5000. Stem cells can come from donors or from the patient (usually from abdomen fat). Risk of infection is low. Risk of injury from fat harvest is very low. There is a large risk that there are opportunists fraudulently selling stem cell treatment implanting dead or non-existent cells.
Q/ How do you think they will be used in the future? 5 years from now? 10 years from now?
Impossible to predict. 10 years ago researchers predicted that we would be curing everything with stem cells by now. We are not.
Q/ Which countries are leading the way in stem cell research?
The FDA stringently restricts what can be done medically in the USA. Other countries are less strict. If one is looking for stem cell treatment and doesn’t want to pay USA prices, Mexico and some Caribbean countries are less expensive. On the other hand, it is more likely that opportunists will be working in those countries. China and South Korea are doing some of the most advanced research with stem cells at this time, but the USA has many ongoing studies. Locally, Stanford is heavily involved in stem cell research.
Q/ Is the US doing for-profit clinical trials similar to developing countries?
As soon as profit enters the picture, the science becomes suspect. There is a natural conflict of interest once the profit-motive is introduced. Conversely, stem cells show great promise, the medical risks are low and some patients have the money to take a chance on unproven interventions. The scientific proof always comes well after the procedure has been introduced. Some are willing to take the chance that it will work for them and are willing to pay. That is why for-profit clinical trials are currently underway in this country.
Q/ How will stem cells change the way you and other physicians practice?
That is difficult to predict. Ideally, we all will be using readily available stem cells to treat every injury. More likely, we will be using stem cells to treat injuries that do not do as well without stem cells.