Stem Cells - Frequently Asked Questions
What Are Stem Cells? | What is Bone Marrow Aspirate Concentrate (BMC) ? | What are Adipose Tissue Derived Stem Cells?
At the The Dallas PRP and Stem Cell Institute, we only use stem cells derived from the patient's own body in order to minimize the risk of allergic reaction or disease transmission. Embryonic stem cells and stem cells that are manipulated outside the body remain very controversial and in some instances illegal to use in the United States. We are able to get your own stem cells from bone marrow aspiration which is a procedure that can be done in the office with minimal discomfort. The two primary sources of bone marrow we use are the posterior iliac crest (posterior hip) and the proximal tibia below the knee. The bone marrow regenerates and multiple procedures can be done over time. After drawing out the bone marrow, the stem cells are then concentrated using FDA approved commercially available machine to create bone marrrow aspirate concentrate (BMC) which can then be injected into an area requiring stem cell therapy. The BMC concentrating process takes approximately 15 minutes in the office.
We do not obtain stem cells from adipose tissue (fat) for several clinical reasons. It has been shown in at least 13 published papers that bone marrow derived stem cells are significantly better than fat derived stem cells for cartilage repair (osteoartitis treatments as an example). You can read further on this topic at this link: CLICK ME.
Furthermore, the United States FDA has issued public guidance that is considers manipulation (enzymatic degradation) of fat to get stem cells to be equivalent to creating a drug, and therefore will fall under FDA drug manufacture guidelines. It is very unlikely that an office based system that obtains stem cells from fat without enzymatic degradation (ie. with centrifuge only) would produce sufficient yield of stem cells to be clinically useful, and even then they would not be as active for orthopedic applications as bone marrow derived cells.
Ultimately, the reasons we do not use stem cells derived from fat are as follows:
- Liposuction is a riskier procedure than bone marrow aspiration to obtain stem cells
- Office procedures creating fat derived stem cells to are likely to be considered illegal soon by the FDA as they have announced
- Fat derived stem cells just do not work as well bone marrow derived stem cells for orthopedic applications
- The treatment cost with fat derived stem cells is typically significantly higher than the cost with bone marrow derived stem cells.
Experimental data has shown that doctors can increase the amount of stem cells obtained in a bone marrow harvest by drawing smaller volumes from multiple sites. Typically we use 2-6 harvest sites and 10cc or less volume draws in order to maximize the number of stem cells we obtain.
Click the link below for a 2013 article by P Hernigou, a French orthopedic surgeon, that reports his results
Video showing the minimally invasive posterior iliac crest bone marrow harvest site which is one of the sites we use to get bone marrow.
The patient laying on the table and has minimal discomfort under local anesthesia!
Just one or two bandaids to cover up the harvest site(s) and the patient walks out of the office!
What growth factors and cytokines are in Bone Marrow Aspirate Concentrate (BMC)?
Some of the growth factors in BMC are listed below.
- platelet derived growth factor (PDGF
- fibroblast growth factor (FGF)
- vascular endothelial growth factor (VEGF)
- interleukin 8 (IL-8)
- transforming growth factor beta (TGF-b)
- insulin like growth factor 1, 2 (IGF-1,2)
- epidermal growth factor (EGF)
What are the clinical indications for using Bone Marrow Aspirate Concentrate (BMC)?
Stem cell therapy may be useful in the following clinical conditions
Tendonitis (Chronic tendonitis or partial-thickness tears)
- Rotator cuff
- Golfers/Tennis elbow
- Tendonitis around the thigh (Gluteus medius, hamstring, piriformis syndrome)
- Patellar or quadriceps tendonitis
- Tendonitis around the ankle (Peroneal, Tibialis posterior)
- Plantar fasciitis
- Ulnar collateral ligament injury of the elbow
- Medial collateral ligament injury of the knee
Degenerative Joint Disease
- Hip osteoarthritis
- Knee osteoarthritis
- Ankle osteoarthritis
- Shoulder osteoarthritis
- Elbow osteoarthritis
- Wrist osteoarthritis
- Cervical, Thoracic and Lumbar osteoarthritis
- Symptomatic articular cartilage injury
- Delayed union or nonunion fractures
What happens after the BMC injection in the office?
Depending on the specific area being treated, crutches or upper body immobilization may not necessary. If immobilization is necessary then typically it can be stopped after 2 days. Most patients will have some soreness for up to 48 hours that should decreases. Patient may use tylenol or other non anti-inflammatory pain medications. NSAIDs and other anti-inflammatories should be avoided in the post-procedure period because they block the response that leads to healing. Patients should refrain from significant physical activity or sports activities for about a week after the procedure. Patients are re-evaluated between 4-6 weeks after the procedure to evaluate their progress and to make further treatment recommendations.
What is the cost for BMC/Stem Cell Therapy?
In the United States, insurance plans and Medicare/Medicaid do not currently cover BMC/Stem Cell therapy. Patients interested in having BMC therapy are responsible for the full payment for the procedure.
A recent study found that the nationwide average cost for stem cell injection (from bone marrow concentrate) is $4000 (*data on file - MedRebels)
Our current pricing for most BMAC injections starts at $3450 per injection site, with discounts given for multiple injections or combination procedures with PRP injections. The price includes typical follow up care after the procedure. Your doctor will be happy to discuss the treatment plan and you will know all expected costs prior to instituting therapy.
Our doctors do not want cost to be a factor for patients who wish to have Stem Cell therapy and we have clinical specialists who can help with billing and payment concerns. We use MedRebels and Care Credit as two options for patients who wish to spread their payments over time. There are interest free financing options that can include no payments or minimal payments for 6-18 months.
Please call our specialists first at 214-385-4861 or 214-385-4860 for any questions on cost or payment plans.
For more information on MedRebels, please click on the link below:
To qualify for 12 month interest free financing or other payment options you may fill out the contact form at MedRebels website:
For more information on Care Credit , please click on the link below:
To apply for financing options with CareCredit, Please click on the credit application link below
Care Credit Financing Application