Adult Stem Cells for Peripheral Neuropathy

Introduction

The term peripheral neuropathy is frequently used interchangeably with the terms neuropathy and polyneuropathy. These terms describe a group of disorders that are characterized by a loss of function in the extremities and rarely other body areas. Overall, peripheral neuropathy affects about 6-7% of the population. There are at least 7 different types of peripheral neuropathy (see: What are the causes and symptoms of peripheral neuropathy? below). The purpose of this paper is to help readers gain a greater understanding of the use of adult stem cells for peripheral neuropathy. We also want to offer a framework for evaluating if stem cell treatment should be considered an option for you or your loved one.

The paper covers the following:

  1. What are the causes and symptoms of peripheral neuropathy?
  2. What are the current medical treatment options for peripheral neuropathy?
  3. What are adult stem cells?
  4. How are adult stem cells harvested from fat?
  5. How are adult stem cells deployed for peripheral neuropathy?
  6. What can I expect after deployment of adult stem cells for peripheral neuropathy?
  7. What is the future for adult stem cells in peripheral neuropathy?

Feel free to skip to sections that provide information that is helpful to you. For more information including definitions and descriptions of peripheral neuropathy visit:
http://www.nlm.nih.gov/medlineplus/spinalcordinjuries.html
http://www.spinalcord.org/

What are the causes and symptoms of peripheral neuropathy?

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Most commonly, peripheral neuropathy begins as loss of sensation or burning in the feet or hands. This tends to be fairly equal in both hands and feet. Weakness may be associated in some cases. The exact pattern by which the disease develops is determined by the underlying cause.

Stem Cell Treatment for Perpheral Neuropathy Dallas
Diagram of a peripheral nerve

The most common causes of peripheral neuropathy are:

  1. Diabetes mellitus. This is the most common cause. Studies show that about 42% of diabetics develop peripheral neuropathy.
  2. Other systemic. This includes vitamin deficiencies, hypothyroidism, HIV infection and others.
  3. Autoimmune. This category includes Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and Guillain-Barre’ syndrome.
  4. Toxic. The most common toxin in alcohol. Chemotherapy and lead exposure along with others are also in this category.
  5. Hereditary.
  6. Environmental. This is most commonly from injuries such as repeated vibrations or severe hypothermia.
  7. Idiopathic. This means the cause is unknown. Up to 25% of cases fit into this category.

Most of these disorders affect the sensory nerves causing loss of sensation and frequently pain or discomfort. Many of them, especially the autoimmune peripheral neuropathies, also affect motor function. Symptoms can vary from very mild (often diagnosed by accident while looking for other disorders) to severe and debilitating.

For more information see:
http://www.mayoclinic.com/health/peripheral-neuropathy/DS00131
http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm

What are the current medical treatment options for peripheral neuropathy?

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When possible, like with diabetes or vitamin deficiencies, treatment begins with treating the underlying cause of the peripheral neuropathy. Removing toxins such as alcohol or environmental factors like repeated vibration can also be instrumental in these disorders. Patients with autoimmune neuropathy are sometimes treated with aggressive therapies such as:

  1. Intravenous immune globulin.
  2. Plasma exchange.
  3. High dose steroids (glucocorticoids).

Stem Cell Treatment for Peripheral Neuropathy Dallas

Other treatments are directed towards helping the symptoms and avoiding complications. Several medications are used to help with the pain and discomfort:

  1. Gabapentin and other anti-epilepsy drugs like carbamazepine and topiramate.
  2. Tricyclic antidepressant drugs like amitriptyline desipramine .
  3. Pain medications like tramadol or ibuprofen.

Physical therapy is also very important to train in walking and balance assistance. Proper training and maintenance of routine foot inspection are essential to prevent or intervene early with foot and leg ulcers. If you are a person doing well using these options, this might not be the right time to consider adult stem cell treatment. However, if you are not doing well with current treatment, you may wish to consider adult stem cell treatment. For more information on the treatment of peripheral neuropathy please see:
http://www.mayoclinic.com/health/peripheral-neuropathy/DS00131/DSECTION=treatments-and-drugs
http://www.webmd.com/brain/understanding-peripheral-neuropathy-treatment

What are adult stem cells?

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Stem cells are special cells in our bodies that have two important characteristics:

  1. Stem cells have the ability to replicate. In other words, they can make new copies of themselves. Because of this ability, an infinite number of copies can be made from the same cell.
  2. Stem cells also have the ability to become other types of cells. A good example of this is that research labs have used fat-derived stem cells to make cartilage muscle, skin, and bone cells. This ability means that in theory the transformed can make an infinite number of the new cell type.

Stem cells can come from a number of sources including embryos, umbilical cord blood and adult cells. Adult stem cells come from adult individuals, not embryos or umbilical cord blood. Stem cells obtained from mature adult tissues are referred to as adult stem cells. Adult stem cells are believed to have the potential to become any type of cell.

Stem Cell Treatment for Peripheral Neuropathy Dallas

The two most commonly used sources of adult stem cells are fat and bone marrow.

Adult stem cells from fat are called adipose-derived adult stem cells. For most purposes, stem cells from fat are easier to obtain and more abundant than from other tissues.

For more information on stem cells visit:
What is tromal Vascular Fraction (SVF)?

How are adult stem cells harvested from fat?

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Harvesting adult stem cells from fat is very safe. The procedure has little discomfort and fairly easy recovery. First, an area such as the stomach or leg is picked to remove the fat. We then take you to the procedure room and sterilize the area. A local anesthetic is then injected into the area. Fat is suctioned using special syringe and cannula. Typically we suction about 50 ml (about 1 1.2 oz.) of fat.

Stem Cell Treatment for Peripheral Neuropathy Dallas

Swelling and bruising is common following the procedure at the harvest site. Swelling and bruising typically resolves within 2-3 weeks after the procedure. Most patients receive a prescription for pain medications for use as needed. We give a dose of antibiotics before the procedure but no antibiotics are needed afterward.

Nest we take the harvested cells and use a centrifuge and incubator to do some simple processing. The processing isolates the adult stem cells from the other fat cells. The final product is called Stromal Vascular Fraction (SVF). SVF obtained from fat can contain up to about 25 million adult stem cells from 50 ml of fat. SVF also contains a large amount of growth factors. Growth factors are chemical “text messages” our cells use to communicate with each other. After we have obtained the SVF, the next step is to deploy the SVF for your peripheral neuropathy.

Read more about Stromal Vascular Fraction (SVF).

How are adult stem cells deployed for peripheral neuropathy?

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Once the process of removing adult stem cells/SVF from fat is complete, we then deploy them for peripheral neuropathy. All types of peripheral neuropathy are treated with IV deployment. For the autoimmune peripheral neuropathies, we often give a special IV medication known as mannitol which is believed to enhance adult stem cell/SVF penetration into the brain. We know that the damaged areas are releasing growth factors. These growth factors attract the adult stem cells/SVF to the area of the area of the injury or disease activity.

Stem Cell Treatment for Peripheral Neuropathy Dallas

In treating the non-autoimmune peripheral neuropathies we also deploy the adult stem cells/SVF into the soft tissue around the area of nerve involvement. We use a small needle and inject the adult stem cells/SVF about 1 centimeter deep every few centimeters in the areas of the involved nerves.

What results can I expect after deployment of adult stem cells for peripheral neuropathy?

Currently, the treatment group is not large enough to give a conclusive answer to this question. It is important to note that the Food and Drug Administration (FDA) has NOT approved the use of adult stem cells/SVF for any disorder. This includes the use of stem cells/SVF for peripheral neuropathy. Fortunately, we have enough early experience to talk about trends in therapy. The number of patients treated increases weekly, so the total depends on when you are reading this article (initial writing October 2013). The majority of patients with toxic, autoimmune and environmental peripheral neuropathy respond well. Responses usually begin in a few weeks to months. Some patients do have a second deployment, typically between 3 and 12 months depending upon their response. Patients with diabetic or idiopathic peripheral neuropathy only respond about one-third (1/3) of the time. Performing the second deployment may help this percentage somewhat, but does not appear to dramatically increase response rates.

What is the future for adult stem cells in peripheral neuropathy?

Many people believe that that stem cells hold a great potential for treating and reversing the effects of peripheral neuropathy. The type of stem cells best to use (embryonic, bone marrow or fat derived) and how to best utilize them is heavily researched and debated. Adult stem cells have a good chance of becoming the treatment of choice because of their safety, availability and lack of controversy. It is likely that in the future, we will see further preparation done to the adult stem cells/SVF in order to prepare them to more readily become neurons. Over the next few years, we have some real hope in seeing therapy develop that could restore large amounts of function to patients with peripheral neuropathy.

We hope we have answered the majority of your questions. If you have others or wish to schedule a consultation please call 214-420-7970.