Swedish Medical Center in Seattle is now marketing regenerative medicine therapies including some things that in my view are not really scientifically proven to work including via an infomercial. This is part of a bigger trend where more legit medical centers have begun selling regenerative medicine “treatments” that are still being developed. Sometimes they even engage in questionable marketing of this stuff too. The latest entry here is unbelievable in some ways.
https://www.youtube.com/watch?v=qm-W6Sk2dEs&feature=youtu.be
In the above segment sponsored by Swedish Medical Center on a show called New Day Northwest on King 5 TV in Seattle, Swedish provider Adam Pourcho, D.O. touts platelet rich plasma (PRP) and bone marrow stem cells as great options for those suffering orthopedic injuries. Here is a partial text version of the TV video segment.
While there is a lot of enthusiasm amongst some groups of physicians around the world about PRP, rigorous clinical trial results have varied, with some reporting better results with PRP versus standard care (new study here), but others (e.g. here) showed no significant benefit from PRP above standard care. So PRP could have some benefits in the orthopedics arena, but it’s not some kind of magic bullet.
Still, at this level this TV segment is not that surprising a development even if it seems a bit concerning. However, in my opinion some specifics of Pourcho’s statements on this sponsored TV show seem inaccurate and some statements seem mindboggling, at least to me. For instance, we have these claims:
- Platelets are the body’s natural healing particles.
- If you were to get a cut on your hands, blood would go to the area and bring with it the platelets those platelets would get there and release growth factors, hundreds of them.
- Those growth factors (released by the platelets) are the programming cells for your brain.
- Those “growth factors” give signals to your brain. They identify injured tissue like muscle, tendons, or ligaments.
- The growth factors tell the brain “please heal it” (meaning the injury) and what tissue is injured “so you don’t get eyeball in your hand.”
- Your platelets tell your brain what kind of stem cells to send to the area.
Really?
He appears to be claiming that the human body is able to heal local tissue injuries with the right, location-appropriate cells because platelets communicate with your brain via growth factors to tell the brain what kind of stem cells to then send to the particular damaged area.
This is how the human physiology of injury response works? Not that I know of. Furthermore, how does this explain how injections of PRP produced from systemically isolated blood help specific tissue injuries?
How would your brain send different kinds of stem cells to different tissues? And what happened to the established roles of local populations of stem and precursor cells already in the affected tissues? I have many other questions too.
Dr. Pourcho is extremely upbeat. He says he has gotten these treatments himself. One of his patients also reported feeling better on the show. New Day NW host Margaret Larson seems super excited.
Overall to me this sponsored TV segment (Swedish Medical Center paid?) almost had the feel of an unproven stem cell clinic infomercial.
I hope we don’t see more of these, but I bet we will.
Want an eyeball in your hand?
Dr. LaVallee, Thank you for being the voice of reason. Professor Paul doesn’t know what he’s talking about. Regenerative medicine is an amazing advance. It’s unfortunately that Paul and a number of orthopedic surgeons (who are irked that regenerative medicine is negatively impacting the volume of the surgical procedures they performing) are throwing non-fact-based shade on regenerative medicine.
Margaret, tell me which of my factual statements are incorrect?
Hey Paul,
Maybe you should open up a college level anatomy & physiology textbook to learn more about platelet function and the vast amount of “growth factors” they secrete to help stimulate healing and repair in the human body. PDGF, VEGF, TGF, EGF and literally hundreds more of these “cytokines” are secreted by platelets. Although it is a very complex process, we do have a good basic understanding how these cytokines can help stimulate & accelerate healing after an injury. Besides being involved with hemostasis, they are directly involved in cell proliferation, differentiation, chemotaxis and tissue morphogenesis during the acute healing process after an injury.
A quick 5 minute search on Pub Med looking into articles regarding platelet function yields many great articles looking deeper into how these cytokines can actually RECRUIT MESENCHYMAL STEM CELLS to an injury: “Another important mediator in healing and remodeling is platelet-derived SDF-1α which mediates CD34+ bone marrow derived progenitor cell recruitment to the injury site and their differentiation into endothelial progenitor cells. Inhibition of SDF-1α binding to its receptor CXCR4 was shown to retard diabetic wound healing in experimental models by impairing cellular migration while concomitantly prolonging the inflammatory response” (Platelet secretion: From haemostasis to wound healing and beyond.) Furthermore, platelets modulate inflammatory pathways and can decrease TNF-induced gene expression in neighboring cells (why PRP can decrease pain & inflammation in conditions like osteoarthritis).
In defense of Dr. Pourcho, he was using SIMPLIFIED terms and concepts of how PRP and the function of platelets can help accelerate healing and repair of damaged or degenerated tissue so that folks in the community without a medical education could better understand it. I find his comments to be an accurate representation of how platelets function in tissue repair after injury and I don’t understand why you think his comments were “concerning” or “mind boggling”. As Tracy Hoeg and Dr. Bodor pointed out, there are LOTS of compelling evidence based studies to support PRP for musculoskeletal conditions (better studies with mesenchymal stem cells are coming! Mayo Clinic, Emory University).
Although I agree that PRP/stem cells are not the “magic bullet”, these treatments WORK! and can be very effective for the RIGHT patient and condition. I would not be performing this type of medicine on my patients if it did not work. However, the patient’s age, general health, severity of injury/degeneration, quality/type of PRP, accuracy of diagnosis, using image guidance when injecting, post procedure guidelines can all GREATLY affect outcomes. This is why these treatments need to be administered by a qualified & experienced physician who understands the both the applications and limitations of this treatment.
The potential benefits of regenerative medicine is endless but there needs to be more education & research. Lets all do our best to educate the public and use sound science and evidence based practices to innovate and advance medicine.
The language was not just simplified. It was grossly inaccurate in my opinion. Plus, that inaccuracy was totally unnecessary. You can explain things to he public without saying stuff that makes no sense.
“…vast amount of “growth factors” [platelets] secrete to help stimulate healing and repair in the human body.”
And may promote cancer growth. A 5 min search in PubMed for growth factors AND cancer yields over 29,000 publications.
Any scientific hypothesis needs to be balanced in order to enable a fair conclusion – you cannot simply ignore the potential negatives. That´s called advertising 😉
Hi Paul, In their 2016 paper, Riboh et al made a major discovery figuring out why we have had such conflicting results with regard to PRP for knee osteoarthritis. They discovered that all the studies showing positive effects used leukocyte-poor PRP (LP-PRP), whereas the negative ones used leukocyte-rich PRP (LP-PRP). The two recent studies (2019) you provided links to above (paragraph 3) continue to fit that pattern. Many orthopedists and even authors of reviews are not aware of this https://www.ncbi.nlm.nih.gov/pubmed/?term=riboh+and+fortier
Paul, then I guess we basically agree. Though the “negative” PRP study you refer to did find PRP to be beneficial for knee OA, just not superior to hyaluronic acid, which was also beneficial. There is currently level 1 (excellent) evidence for PRP for mild to moderate osteoarthritis and for lateral epicondylitis. There is “good” but less than level one evidence for PRP for other tendinopathies and ACL and UCL injuries.
But specifically recent studies also for gluteal tendinopathy, the knee meniscus and the achilles have shown PRP to be beneficial compared with control:
Leukocyte Rich PRP Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-blind Randomized Controlled Trial with 2 year follow up. Fitzpatrick et al. AJSM. March 6th, 2019
(this is excellent evidence for PRP for greater trochanteric bursitis/gluteal tendinopathy)
And for the knee meniscus:
Short-Term Outcomes of Percutaneous Trephination with a PRP Intrameniscal Injection for the repair of Degenerative Meniscus lesions. A prospective, Randomized, Double-Blind Parallel Group, Placebo-Controlled Trail. Kaminski et al. Molecular Sciences. Jan. 2019.
Achilles tendinopathy
Boesen, A.P., Hansen, R., Boesen, M.I., Malliaras, P., and Langberg, H. Effect of high-volume injection, platelet-rich plasma, and sham treatment in chronic midportion Achilles tendinopathy: A randomized double-blinded prospective study. Am J Sports Med. 2017; 45: 2034–2043
And a few more from my collection:
Centeno C, Markle J, Dodson E, et al. Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study. J Transl Med. 2018;16(1):246. Published 2018 Sep 3. doi:10.1186/s12967-018-1623-3.
Centeno CJ, Pitts J, Al-Sayegh H, Freeman MD. Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series. J Pain Res. 2015;8:437–447.
Gobbi A, Whyte G P. One-stage cartilage repair using a hyaluronic acid-based scaffold with activated bone marrow-derived mesenchymal stem cells compared with microfracture: Five-year follow-up. Am J Sports Med. 2016; 44(11): 2846–54.
Hauser R A, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: A case series. Clin Med Insights Arthritis Musculoskelet Disord 2013; 6: 65–72.
Kanaya A, Deie M, Adachi N, Nishimori M, Yanada S, Ochi M. Intra-articular injection of mesenchymal stem cells in partially torn anterior cruciate ligaments in a rat model. Arthroscopy (2007) 23:610–7.10.1016/j.arthro.2007.01.013
Kim SJ, Kim EK, Kim SJ, Song DH. Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon. J Orthop Surg Res. 2018;13(1):1. Published 2018 Jan 3. doi:10.1186/s13018-017-0693-x
Moatshe G, Morris ER, Cinque ME, et al. Biological treatment of the knee with platelet-rich plasma or bone marrow aspirate concentrates. Acta Orthop. 2017;88(6):670-674.
Pascual-Garrido C, Rolón A, Makino A. Treatment of chronic patellar tendinopathy with autologous bone marrow stem cells: a 5-year-followup. Stem Cells Int 2012; 1–5.
Qian Y, Han Q, Chen W, et al. Platelet-Rich Plasma Derived Growth Factors Contribute to Stem Cell Differentiation in Musculoskeletal Regeneration. Front Chem. 2017;5:89. Published 2017 Oct 31. doi:10.3389/fchem.2017.00089
Raj M, Khan J, Suarez D, Bodor M. Full Thickness Anterior Cruciate Ligament Repair with Autologous Stem Cells. Poster Presentation. American Academy of PM&R. October, 2018.
Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002; Apr;36(2):95–101
Virchenko O, Aspenberg P (2006). How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks? Interplay between early regeneration and mechanical stimulation. Acta Ortho 77(5): 806-812.
Zhang J Y, Fabricant P D, Ishmael C R, Wang J C, Petrigliano F A, Jones K J. Utilization of platelet-rich plasma for musculoskeletal injuries: An analysis of current treatment trends in the United States. Orthop J Sports Med 2016; 4 (12): 2325967116676241
Thanks for bringing up a great topic of discussion. The medicine we practice should be evidence based and we should not be making promises to our patients based on weak evidence. I think we agree on that!
Best to you, too!
Tracy
Yes, I don’t think we are so far apart, but I’m definitely more skeptical. Thanks for the paper citations. I haven’t seen some of these.
Are you familiar with the stem cell clinic problem in the U.S.? There may be as many as 900-1000 for-profit clinics selling non-FDA approved stem cell offerings, sometimes combined with PRP. Note that some of your other studies listed above are from such for-profit stem cell clinics (potential bias there) that do not include placebo controls or blinding in some cases.
Best,
Paul
Paul,
Yes- I agree on both points. 1. The clinics that sell wharton’s jelly and umbilical cord supposed “stem cell” products are scamming their clients as these products do not contain any live stem cells (if they did, would they not have to be matched from donor to recipient like in hematologic treatments)? These clinics are a big problem. You are right. They give the use of “stem cells” a bad name.
Also, 2. For-profit entities that are sponsored such as the Centeno group I cited have a clear bias in their publications so I am quite uncertain how to interpret their results.
Overall, I think my main point is, PRP and BMAC treatments should not neessarily be viewed as a big scam when there is at least fairly solid evidence behind their use. You must understand that many of the conditions these treat are not treated successfully with steroid injections or surgeries, so PRP and BMAC can be better options.
PRP and BMAC treatments are done regularly at Harvard and the Mayo Clinic in Rochester, among other academic medical centers, including (gasp) UC Davis, because there is good to excellent evidence for them (especially strong evidence for PRP) for certain muskuloskeletal conditions. PRP and BMAC certainly don’t work for everything, but, Dr. Knoepfler, you should stay up to date on the literature and research done in this topic before you are so critical. Sincerely, Tracy Beth Høeg, MD, PhD University of California Davis.
Hi Tracy,
I don’t know about that “good to excellent evidence”.
What I’ve seen overall is mixed on PRP and BMAC when focusing on strong RCTs. Do you have particular studies in mind?
Did you see those 2 papers I cited in this post?
What I wrote about PRP in this post seems balanced to me, again linking to two different studies: one more encouraging and the other not so much, and writing:
“While there is a lot of enthusiasm amongst some groups of physicians around the world about PRP, rigorous clinical trial results have varied, with some reporting better results with PRP versus standard care (new study here), but others (e.g. here) showed no significant benefit from PRP above standard care. So PRP could have some benefits in the orthopedics arena, but it’s not some kind of magic bullet.”
How is that too critical?
I was more critical of the overall video itself with its outlandish claims.
Best,
Paul
I think it’s a safe bet we’ll see more of these. SMH.
A health care organization interested in practicing actual medicine would fire this individual for saying screwball stuff like this in public.
I’m afraid that this is just part of the trend for including quackery as a standard offering in many medical centers.
I´m disappointed – an eyeball in the hand would be so useful in my exams (or at parties).
And this is Seattle’s largest medical center organization…
Are they still teaching anatomy in med school? This is alarming.