Athletes have been begging their doctors in the field of sport medicine to find new and innovative ways of treating their persistent sport injuries and get them back to tip top shape in less time. It was desperation and wanting all of this that led star NFL player for the Steelers, Peyton Manning to Europe, to treat his neck injury. It was to seek the promise of a new and innovative stem cell treatment. The treatment existed in the US but was limited in its offerings, so instead players sought treatment in countries like Japan, Russia, Germany, and Korea.
In popular medical shows such as House, stem cell treatment is fairly commonplace, however in the USA, it’s simply not so. Stem cells are your basic cells that are new and immature in their growth and development, they are building blocks in the body and so their properties can be harnessed to heal and promote growth. They can help an individual to regrow lost tissue and fend off the signs of aging and deterioration in the body, increase your chances of a healthy heart and even fight off damaging cancer cells.
The application of stem cell research is wide and varied which probably accounts for its growing popularity and the optimism and excitement of those in the medical sport arena. Mesenchymal stem cells can be harvested from bone marrow and fat tissue in great numbers. The theory is that these stem cells can be introduced back into the body at the site of the injury and repair damaged tissue, bones, tendons, muscle or cartilage and promote faster healing.
In the USA it’s a theory, but in the rest of the world clinics and other health facilities are doing the work and getting the job done leaving the USA behind. The treatments are gaining ground and rapidly becoming an approved way to repair torn ACL using the technique which is minimally invasive. Instead, politics, red tape and bureaucracy combined with good old fashion time wasting and some hesitance by scientists to embrace it, has severely hampered US doctors from taking advantage of the latest innovations and techniques in the treatment such as culturing or growing stem cells from samples taken.
A doctor who has had experience as a former player in the NFL for Penn State, feels that the USA could be as far back as ten years behind the rest of the world. He has some experience in the field of stem cell treatment as he treated Hines Ward’s knee injury, using a relatively new treatment at the time, PRP Therapy which is platelet rich plasma. Dr. Bradley took the stem cells from the platelets and plasma in Hines’s blood. He injected the stem cells back into the injured knee, using them to repair and rebuild the damaged knee.
The result is that instead of watching the game on TV or from the sidelines as would have been the case if he had gone the traditional route of physical therapy and rest, he was playing in the Super Bowl. Both Bradley and Ward give full credit for the fast recovery to the stem cell treatment. As a result of the success, athletes are lining up, but even though hailed as revolutionary the fact is that extracting stem cells from blood is very limited and almost archaic. Doctors in the rest of the world are extracting stem cells from stem cell rich, bone marrow and fat tissues, and using them to create an army of repair builders ready to repair and rebuild connective tissue and bone.
In fact, in Europe some athletes have already harvested their stem cells and cultured them, so that in case of the inevitable injury, they have a horde of healthy stem cells ready and waiting for their treatment and speedy recovery. People are comparing the excitement surrounding stem cell with as much suspicion and raised eyebrows as they did steroids. It seems at best an unfair comparison. Steroids were deemed to be performing enhancers while stem cell is aimed at healing and recovery. The question on many lips is how can your own blood be considered as illegal or a drug.
Those at the forefront of the cutting edge treatment have paid the price for being innovators in the field. Christopher Centeno, who owns and operates Regenerative Services, in Broomfield, Colo., a lab that was dedicated to culturing mesenchymal stem cells. The FDA moved swiftly to close down Centeno’s operation labelling it as “adulterating”blood in a way that they claimed transformed it into an unapproved new drug. One of the last benefactors of the culturing done at Regenerative Services was the NFL’s Jarvis Green.
Jarvis green turned to stem cell when he was faced with the imminent and premature end to his eight years in the NFL. The problem was his knees and after two knee surgeries that left him nowhere, he turned to stem cell and it worked. He was left singing its praises to anyone who would listen and even told one reporter that he could even climb stairs. After an incredible three weeks since the treatment he was present and participating fully in his NFL training camp every single day. He went on for another season with Houston’s, New England team.
Centeno’s fight goes on and he has spent upwards of five hundred thousand, fighting the FDA and moving his facilities offshore, to offer the treatment in Cayman instead. He still offers stem cell treatment at the centre in the US, but only the approved same day service where the stem cell is harvested the same day and re injected into the injured area. However, harvesting and culturing of stem cells is no longer available in the USA.
The FDA has offered no further comment, except to reiterate their position, which is that they will only allow stem cells that have undergone “ minimal manipulation” to be utilized. In this case minimum describes cells that have been harvested and reinjected into the injured area the same day without undergoing any process that can change or alter the relevant biological characteristics of the tissue or the cells.
Crapshoot vs Innovation
Skeptics of the treatment are wary of the stem cell therapy calling it a crapshoot, they maintain that after the cells have been manipulated there are no guarantees as to what the end results will be. They do say that it may grow new muscles or ligaments but they also maintain that maybe they won’t. There is no guarantee and not much evidence to support that the stem cell taken from elsewhere in the body and injected into a new site will cause new growth. In fact Dr. Friedmann one of the geneticists on the World Anti Doping Agency, whose job it is to advise WADA in the area of stem cell research, advocates that in most cases the stem cells will tend to do nothing at all and that most of them will simply die if injected into a new area of the body other than from where they were harvested.
Innovation, says Barton Colo who was struggling during the season due to a damaged rotator cuff. Surgery did not seem to help as he was still struggling to regain his form. In 2010 stem cell was used to treat the damaged shoulder. The surgery was performed in an hour in the Dominican Republic by his doctor, Orthopaedist Joseph Purita. He extracted stem cells from the bone marrow in Colon’s pelvis. In accordance with FDA guidelines he reinjected the serum into the damaged elbow and shoulder the same day, instead of waiting additional weeks to culture additional stem cells. Dr. Purita leads a team in Boca Raton, FL., at the Regenerative & Molecular Orthopaedics center.
Colon’s recovery and return to top throwing form has sparked questions and investigations in and outside of the league. They have thoroughly investigated the records of his surgery and questioned Dr. Purita as to exactly what was injected into the athlete. But the Doctor followed the law to the letter, only injecting the stem cells. He admitted to using a small quantity of growth hormone in similar surgeries done in Florida but none was used on the athlete in accordance with the FDA and league rules.
WADA and the MLB are not quite sure what to make of the treatment and what category to place it in, as it is unlike anything else that has come before it. The league struggles to define the treatment, is it performance enhancing or a therapeutic drug?
WADA initially banned what it referred to as “blood spinning therapies”, but has since withdrawn the banns, as more information about the treatments has become available and the results seen as non performance enhancing in comparison to other banned substances such as steroids.
For now the recommendation from advisors such as Dr. Friedmann is to do nothing. In his opinion, there is no need to anything as the treatment doesn’t work, he feels that in time the treatment will become valid and feasible, but not now. His opinion is certainly not stopping the rush of athletes lining up to be guinea pigs. Manning’s results were not what he expected and that is probably because the research has been used successfully in the past on cartilage, bone, tendon or muscle damage and not nerves as was the case with his injury. All are agreed that the treatment of sport injury and the promise of stem cell therapies as the solution is still a work in progress.