Thursday, August 19, 2010

Stem Cells: What does the Future Hold?

Dr. Robert J. Brueck, MD FACS regularly blogs about matters of health, medicine and cosmetic surgery. Learn more about Dr. Brueck at

"Bright, promising, exciting, cutting edge", are terms that we can use to describe what lies beyond the horizon in stem cell therapy.

There is much to be learned from stem cells derived from bone marrow and something most of us all have, stem cells derived from fat. Many of you have read one of previous blogs about my own encounter with stem cells.

As you know I had them injected into my severely arthritic left ankle about 4 months ago. The results, in my opinion, are nothing short of fantastic. It is still a little sore but going up and down the stairs is no longer cause for me to grimace in pain.

So where are we? Where do we go from here? There is no question that stem cells have applications across the whole spectrum of medical conditions/problems i.e. cardiovascular, arthritis, burn therapy, reconstructive surgery, breast augmentation, diabetes, strokes and the list goes on. The list is endless.

Plastic surgeons are heavily involved in stem cell research.

Stem cells are plury potent cells so they can differentiate down different cell lines. They may become bone cells, heart muscle cells, whatever. They are cells looking for an identity.

When they put my stem cells in my ankle once they “got home” they were surrounded by old bone and cartilage cells so they said why not become bone or cartilage cells.

There are still many mysteries to unravel.

What causes a cell to differentiate down a particular path? What turns it on? How can we control it?

There are some preliminary studies that show fat-derived stem cells may be stimulated to produce insulin. These are exciting advances.

Some researchers in Finland were able to direct fat derived stem cells to become and produce bone tissue. Plastic surgeons are on the forefront of this exciting new field of research.

The U.S. Department of Defense is funding research to see what influence stem cells may have on scars produced in war times. Also, how stem cells can be used to treat soft tissue injuries or defects created from war injuries, such as on the face.

Another exciting avenue of research concerns the use of stem cells as “carriers of drugs”. In essence the stem cells would be fitted with a certain drug and delivered to a part of the body where this drug is needed to treat a particular medical condition.

What causes a stem cell to become a bone cell? Or a heart muscle cell? Some researchers believe that a stem cell has a built-in DNA program (also, cells have DNA) and will manifest this program depending upon the neighborhood you put it in. For example: When I had stem cells put into my ankle the stem cells looked around and saw other bone and cartilage cells and decided to join the crowd.

Some researchers believe it’s not the DNA program in the cells but the “the environment” that it is put in. How a stem cell differentiates is based on outside factors in its new environment i.e. the environment will send signals to the stem cell to cause it to differentiate down a particular line.

Another area of research involves developing a scaffold to allow the stem cells to do their work.

The scaffold is like the steel girders of a building where the framework is and the stem cells are walls and the windows, etc. The idea is that you create a compatible scaffold, populate it with stem cells and let them grow over time – the scaffold dissolves or breaks down over time and we have a new organ.

Many questions remain to be answered.

For example: When we do stem cell facelifts we are not concentrating the stem cells i.e. it is a mixture of fat and stem cells. What would happen if we only injected concentrated stem cells and no fat? These are questions yet to be answered.

The use of autologous fat grafting has been around for years and years and in that fat there are stem cells as well. These fat grafts have been used mainly in facial rejuvenation. In my practice I employ fat/stem cell grafts more and more because one of the signs of aging is the loss of volume in our face. Also the sun damage created to the skin causes it to thin and loose its elasticity and sag. It’s a borrow-from-Peter-to-pay-Paul scenario.

We are not seeing autologous i.e. "your own” fat grafts to breast augmentation. You can use fat in the reconstruction of defects in the chest wall following breast cancer surgery. Dr. Scott Spear, who is chairman of the plastic surgery department at Georgetown University, uses fat in some of his breast reconstructions. He is ambivalent about it.

In some patients, fat grafting works well and in others it doesn’t.

There are no guarantees in life. Dr. Spear also said there is very experimental work that says fat grafting to the breasts may potentiate the growth of cancer cells. He said, “that doesn’t mean it’s happening but it would be naive to assume it’s not”.

The use of fat grafting in irradiated skin holds a lot of promise. Dr. Sydney Coleman of New York is one of the pioneers in fat grafting. He has had excellent results in using fat grafting for irradiated wounds. He also has used fat grafts/stem cells in treating scars, particularly scars that are depressed.

Dr. Gino Rigotti of Verona, Italy has been using fat grafts to irradiated skin. “Before we injected fat I believe the damage caused by irradiation was irreversible - that we would need to excise everything irradiated and replace it with a skin flap, but after using fat we have seen a transformation to normal tissue with normal sensation”.

Dr. Curry, a plastic surgeon in Miami, has even used autologous fat to treat Dupuytren’s contracture. He cuts the contracting bands and once that is complete he injects fat into the area and which prevents the bands from reconnecting. This transplanted fat along with the release of the contracting ligaments has given him outstanding results.

Exciting as the horizon is many questions remain to be answered.

What are the areas of the body are the best sites from which to harvest fat? How do we prepare the fat? What do we add to the fat to enhance its take? How do we control the differentiation of fat cells? These are just some of the many questions we need to have answered.

The journey has begun and the future indeed is bright.

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