That means that we publish our work in the peer reviewed research. We know of no other pain management practice in Colorado with more publications. The two citations listed with (++) are not indexed, so the PDF’s are supplied. Pre-publication data and before/after MRI case studies can often be found on the Regenexx blog.
Centeno CJ, Schultz JR, Cheever M, Freeman M, Robinson B, Faulkner S
Background: Current treatment options for stable non-union fractures represent major clinical challenges, and are a major health issue. Fracture treatment can take many forms, usually requiring bone grafting and/or revisions of the fracture with open reduction and internal fixation (ORIF). Conservative care options such as bone morphogenic proteins and bone stimulators are also available. The purpose of this study was to determine if culture expanded, autologous MSC’s injected into non-union fractures under c-Arm fluoroscopy could represent an alternative treatment modality in recalcitrant fracture non-unions. This paper reports on the findings of 6 patients with fracture non-union treated with autologous MSC’s. Patients and methods: We evaluated 6 consecutive patients with chronic fracture non-unions. Patients consisted of 4 women and 2 men with treatment intervention at an average of 8.75 months post-fracture (range 4- 18 months, one patient fracture not included in calculation was >100 mo.). All treated patients received autologous, culture expanded, mesenchymal stem cells injected percutaneously via fluoroscopic guidance into the site of the fracture non-union. Fracture union was evaluated with the use of follow up high-resolution x-ray and/or CT imaging. Phenotype of the culture-expanded MSCs was evaluated and quantified by flow cytometry of surface antigens.Conclusion: The results of this study support the hypothesis that autologous MSC’s delivered via percutaneous re-implantation may be an alternative modality for the non-operative treatment of recalcitrant non-union fractures.
The Centeno-Schultz Clinic, Broomfield, Colorado, USA.
Mesenchymal stem cells (MSCs) hold great promise as therapeutic agents in regenerative medicine. Numerous animal studies have documented the multipotency of MSCs, showing their capabilities for differentiating into orthopedic tissues such as muscle, bone, cartilage, and tendon. However, the safety of culture expanded MSC’s for human use has only just begun to be reported. Methods: Between 2006 and 2010, two groups of patients were treated for various orthopedic conditions with culture-expanded, autologous, bone marrow-derived MSCs (group 1: n=50; group 2: n=290-one patient in both groups). Cells were cultured in monolayer culture flasks using an autologous platelet lysate technique and re-injected into peripheral joints or into intervertebral discs with use of c-arm fluoroscopy. While both groups had prospective surveillance for complications, Group 1 additionally underwent 3.0T MRI tracking of the re-implant sites. Results: The mean age of patients treated was 53 +/- 13.85 years; 214 were males and 125 females with mean follow-up time from any procedure being 435 days +/- 261 days. Number of contacts initiated based on time from first procedure was 482 at 3 months, 433 at 6 months, 316 contacts at 12 months, 110 contacts at 24 months, and 22 contacts at 36 months. For Group 1, 50 patients underwent 210 MRI surveillance procedures at 3 months, 6 months, 1 year and 2 years which failed to demonstrate any tumor formation at the re-implant sites. Formal disease surveillance for adverse events based on HHS criteria documented significantly less morbidity than is commonly reported for more invasive surgical procedures, all of which were either self-limited or were remedied with therapeutic measures. Two patients were diagnosed with cancer out of 339 patients treated since study inception; however, this was almost certainly unrelated to the MSC therapy and the neoplasm rate in similar to that seen in the U.S. Caucasian population. Knee outcome data was collected on a subset of patients. Here, >75% improvement was reported in 41.4% while decreasing the improvement threshold to >50% improvement, 63.2% reported an improvement. At an average reporting time of 11.3 months from first procedure average reported relief in the knee sample equaled 53.1% (n=133 reporting). Conclusions: Using both intensive high field MRI tracking and complications surveillance in 339 patients, no neoplastic complications were detected at any stem cell re-implantation site. These findings are consistent with our prior publication and other published reports that also show no evidence of malignant transformation in vivo, following implantation of MSCs for orthopedic use. PMID: 22023622 [PubMed - as supplied by publisher]
–Journal of American Physicians and Surgeons Volume 16 Number 2 Summer 201
Christopher J. Centeno, M.D., Stephen Faulkner, B.A
Mesenchymal stem cells (MSCs) show promising clinicalpotential as multi-potent therapeutic agents in regenerativemedicine, including a number of orthopedic applications. Acomprehensive review of the medical literature regarding thepre-clinical and early clinical use ofMSCs demonstrates that theyare likely to be effective cellular repair agents for cartilage andjoint injuries.Cultured MSCs were injected into the knee joints of 153patients with moderate to severe osteoarthritis (OA) of the knee.The study included 24 untreated patient candidates who wererecruited as controls. At a mean follow-up of 11.3 months, kneepatients reported mean pain relief as +53.1% (n=133), and -5.0%relief was found in the untreated control (n=25 at 12.0 monthspost-op) ( <.001 for control vs. knee comparison). Significantdecreases were seen in four out of five of the Visual Analog Scale(VAS) score metrics and in most functional metrics in the kneegroup.There were no serious complications reported.MSCs may reduce the need for joint replacement in kneeosteoarthritis. Despite the great potential of the use ofautologous MSCs as the practice of medicine, the Food and DrugAdministration (FDA) has attempted to regulate MSCs as a drug.This policy is inconsistent with its policy on other mattersincluding tissue re-implantation and in vitro fertilization, and will delay the development ofthis type oftherapy
Regenerative Medicine Article: Osteoblastic differentiation of human and equine adult bone marrow-derived mesenchymal stem cells when BMP-2 or BMP-7 homodimer genetic modification is compared to BMP-2/7 heterodimer genetic modification in the presence and absence of dexamethasone.
Regenerative Medicine Article: Safety and complications reporting on the re-implantation of culture-expanded mesenchymal stem cells using autologous platelet lysate technique.
Regenerative Medicine Article: -Prolotherapy under C-arm Fluoroscopy. Journal of Prolotherapy. 1(4). pp 232-242 (++)
Regenerative Medicine Article: -Regeneration of meniscus cartilage in a knee treated with percutaneously implanted autologous mesenchymal stem cells. Med Hypotheses. 2008 Dec;71(6):900-8. Epub 2008 Sep 10
Regenerative Medicine Article: -Increased Knee Cartilage Volume in Degenerative Joint Diseased using Percutaneously Implanted, Autologous Mesenchymal Stem Cells, Platelet Lysate, and Dexamethasone. The American Journal of Case Reports. 2008; (9) pp 201-206 (++)
Regenerative Medicine Article: Sclerotherapy of Baker’s cyst with imaging confirmation of resolution. Pain Physician. 2008 Mar-Apr;11(2):257-61
Regenerative Medicine Article: Partial regeneration of the human hip via autologous bone marrow nucleated cell transfer: A case study. Pain Physician. 2006 Jul;9(3):253-6
Regenerative Medicine Article: Fluoroscopically guided cervical prolotherapy for instability with blinded pre and post radiographic reading. Pain Physician. 2005 Jan;8(1):67-72
Traumatic Injury Article: A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash). Brain Inj. 2010;24(7-8):988-94
Interventional Pain Article: How to obtain an SI Joint arthrogram 90% of the time in 30 seconds or less. Pain Physician. 2006 Apr;9(2):159
Interventional Pain Article: Radiofrequency Lesioning of the Cervical Medial Branches. Techniques in Regional Anesthesia and Pain Management. 2004 8(1), pp 10-16 (++)
Miscellaneous Article: The presence and utilization of psoas musculature despite congenital absence of the right hip. Man Ther. 2004 May;9(2):109-13