The information on this website is for educational purposes only. Do not act or rely upon the information on this website without seeking independent professional medical advice.  Prolotherapy is a medical technique. As with any medical technique, results will vary among individuals, and there is no guarantee that you will receive the same outcome as patient reports here. Prolotherapy injections may not work for you and as with all medical procedures there are risks involved. These risks should be discussed with a qualified health care professional prior to any treatment so that you have proper informed consent and understand that there are no guarantees to healing.

BIOCELLULAR PROLOTHERAPY: THE NEXT HORIZON 


Dextrose Prolotherapy and PRP Prolotherapy are designed to stimulate healing, however rely on the body having enough local repair cells available where the injury is.  If a joint area has been chronically injured and inflamed over a long period of time a phenomenon called "cellular depletion" occurs.  This means there are not very many local repair cells available, they have been used up over time.   If cellular depletion has occurred, local repair stem cells will not be available or the available ones will be used up within a few treatments of dextrose and/or PRP Prolotherapy. This is when Biocellular Prolotherapy is done, taking good repair cells from either the bone marrow or the adipose (fat) tissue, both known to contain adult stem cells, and using this as the “formula” to inject into the injury site.

Some researchers believe that stem cells exist in every tissue, with bone marrow and adipose tissue serving as the body’s main “reservoirs” from which extra repair stem/stromal cells are mobilized when needed.  It is well known that healing takes place more rapidly in children than adults, a fact credited to the increased number of these cells in children.  As early as 1998, researchers were studying the use of adult "Mesenchymal Stem Cells" (MSC's) in tendon repair, and 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.”  MSC's were deemed to be safe for human use in 1995 and, once safety was established, research efforts grew.  An interesting observation about these repair cells is their ability to “home in” and repair areas of tissue injury, including osteoarthritis and other injured types of tissue.  In certain degenerative diseases such as osteoarthritis, an individual's stem cell potency appears depleted, with reduced proliferative capacity and ability to differentiate.

 

Example of bone marrow aspirate concentrate machine. Adipose tissue-derived stem cell differentiation.

 

BONE MARROW DERIVED CELLS


Bone marrow has been studied over many years and is known to contain these adult stem cells.  Concentration of the bone marrow is an important element of efficacy and there are FDA approved devices which concentrate the bone marrow into what is called “Bone Marrow Aspirate Concentrate” (BMAC).   This autologous bone marrow aspirate contains not only mesenchymal stem cells but also accessory cells that support angiogenesis and vasculogenesis by producing growth factors and cytokines. There is increasing evidence that 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. Results of a huge five year study in India for non-reconstructable critical limb ischemia demonstrated that BMAC provided an amputation-free survival of 90%, with pain reduction of over 90%. Other musculoskeletal applications also exist with more studies planned.



ADIPOSE-DERIVED STEM/STROMAL CELLS


Human adipose tissue has been shown to be an abundant and rich source of adult stem cells with a population of cells that possess extensive proliferative capacity, and the ability to differentiate into multiple cell lineages. Most people do not mind giving up a little fat and, in fact, many electively undergo liposuction procedures, which yield large volumes of useable adipose tissue. 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 scafford to hold the essential “inflammatory boost” in a joint area. Adipose derived stem/stromal cells are similar but not identical to bone marrow cells.  

Adipose derived cells have been used with PRP and/or BMAC in the treatment of many musculoskeletal and vascular disorders. It is believed that the PRP fat graft is inducted by its environment to form the type of cell which surrounds it. For example, if it is placed with muscle cells it was differentiate into muscle and be incorporated there. Because of the increased simplicity of fat harvesting versus bone marrow aspiration, the use of autologous adipose tissue is gaining popularity for office use. Also, the yield of stem cells from adipose tissue is 500 to 1,000 times higher than with bone marrow.

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.  




FOR MORE INFORMATION  


Advances in Regenerative Medicine
High-Density Platelet Rich Plasma and Stem Cell Prolotherapy for Musculoskeletal Pain

Stem Cell Prolotherapy in Regenerative Medicine
History, Theory and Protocols. 

Regenerative Medicine in the Field of Pain Medicine
Prolotherapy, platelet-rich plasma therapy and stem cell therapy - theory and evidence.