How is SVF deployed?

We refer to using the Stromal Vascular Fraction (SVF) as deployment. SVF can be deployed in several ways. The most commonly used deployment methods are:

  1. Into a specific joint such as a knee for arthritis in that joint. Most patients with osteoarthritis and other joint disorders are familiar with steroid injections in the joint. This process is similar.
  2. Into a specific joint under image guidance. This involves using x-ray, ultrasound, MRI r other imaging tools to insure the SVF is deployed directly into the joint. This is most commonly used in deep joints like the back, neck or shoulder.
  3. Directly into an area of soft tissue. This is common with disorders such as neuropathy or non-healing ulcers. It can also be done with imaging for muscle or ligament/tendon injuries.
  4. Intravenous (IV) deployment is common. This is used in many neurologic and auto-immune disorders along with others.
  5. More than one of these may combined in the same patient for diseases like rheumatoid arthritis or multiple disorders.

For what disorders are stem cells (SVF) used?
As stated above, stem cells are used for certain blood disorders in the United States. All other use of stem cells or SVF in the United States is considered investigational. Many disorders have investigational protocols. We can group them like this:

  1. Orthopedic problems such as osteoarthritis, post traumatic arthritis and soft tissue injuries.
  2. Auto-immune or connective tissue disorders such as rheumatoid arthritis and scleroderma.
  3. Neurologic disorders such as multiple sclerosis, Parkinson’s disease or stroke.
  4. Lung problems such as chronic obstructive pulmonary disease (COPD).
  5. Gastrointestinal disease such as Crohn’s disease or auto-immune hepatitis.
  6. Cardiac disease such as congestive heart failure (CHF).
  7. Urinary disease such as interstitial cystitis or erectile dysfunction.
  8. Eye disease such as macular degeneration, retinitis pigmentosa and diabetic retinopathy.
  9. Dermatologic conditions such as hair loss and lichen sclerosis.

In the near future, new investigational protocols will be added to this list. We will next talk about each of these deployments.

How are stem cells (SVF) used in orthopedic problems?
Orthopedic uses will probably see the most rapid advance of any area over the next few years. A number of high profile individuals such as governors and professional athletes have had effective stem cell deployment in the last year or two. The knee has probably been the most frequently done. Unpublished results show patients who have been recommended to have knee have an 85% reduction in pain and a similar improvement in function. So far, less than 5% have gone on to have knee replacement. It is important to remember that these are early results and will probably change over time, but they are encouraging. Other joints have included:

  1.  Hip
  2. Shoulder
  3. Elbow
  4. Ankle
  5. Wrist
  6. Fingers
  7. Back and spine
  8. Neck

Although encouraging, results are still too early to discuss on these joints. Some of these joints like the knee, hip and elbow can be done in the physician’s office using ultrasound or no visualization. Other joints such as the back and neck, are best done at an imaging center using CT or other techniques to assure the SVF is placed within the joint.

Soft tissue injuries are also seeing rapid expansion of stem cell (SVF) use. Soft tissue refers to things like muscles, ligaments and tendons that do not involve the bone or joint. Soft tissue deployments are being used in:

  1. Tendon injuries such as the Achilles tendon.
  2. Muscle injuries or tears such as a torn or sprained hamstring.
  3. Chronic tendonitis.
  4. Overuse injuries.

Soft tissue use also is too early along to report. Veterinary work is much more advance in the US due to fewer restrictions in use. The results of use in animals, especially horses, are very encouraging.

How are stem cells (SVF) used in auto-immune (connective tissue) disorders?
Auto-immune or connective tissue disorders are an exciting area for the use of stem cells or SVF. Many of these disorders have only a moderate or poor response to traditional treatments. Deployment protocols are available for:

  1. Rheumatoid arthritis.
  2. Scleroderma.
  3. Systemic Lupus Erythematosis.
  4. Relapsing polychrondritis
  5. Alopecia areata.
  6. Myasthenia Gravis.
  7. Fibromyalgia.

Some might classify the last two disorders elsewhere, but we have classified them here for deployment protocols. Results of treatment of these disorders have also been encouraging. Early results suggest that repeat treatments may be required every 6-12 weeks. It has been postulated that this may be due to the anti-inflammatory effects of the growth factors present in SVF. This area has several types of deployment use. All of them use IV deployment. However, inflamed localized joints can receive joint injections. Localized soft tissue injections can also be done in areas of involved skin, muscular trigger points or scalp.

How are stem cells (SVF) used in neurologic diseases?
Perhaps the area that has generated the most interest in stem cells (SVF) is their use in neurologic disease. The ability to treat spinal cord injuries, Parkinson’s disease or multiple sclerosis is truly exciting. The neurologic diseases with a SVF deployment protocol available are:

  1. Parkinson’s disease.
  2. Multiple Sclerosis.
  3. Stoke.
  4. Muscular dystrophy.
  5. Neuropathy
  6. Spinal cord injuries.

Most of these disorders receive IV deployment. In addition, neuropathy and spinal cord injuries receive soft tissue injections into the area of concern/injury. In the case of spinal cord injury, this is usually done under CT imaging. Early results are encouraging but no numbers are available. Many studies are underway to determine the most effective method to treat these disorders using stem cells. We will continue to see advances in the neurologic use of stem cells for years to come. Some patients require repeat treatments in 6-12 weeks depending upon response.

How are stem cells (SVF) used in urologic disorders?
Stem cells (SVF) are used in several urologic conditions. Interstitial cystitis, which can be frustrating and difficult to treat conventionally, shows promising responses to SVF deployment. Male incontinence has also had encouraging results with SVF deployment. Cases of erectile dysfunction resistant to other treatments are now being treated with stem cells plus therapy with extra-corporeal shock treatment (ESWT). This combination has exciting potential. Peyronie’s disease has also been treated with positive results by this combination of stem cells and ESWT.

How are stem cells (SVF) used in cardiac disorders?
One of the most exciting potentials for stem cells and SVF is in the area of cardiology. Stem cells are being deployed after heart attacks (myocardial infarction) to decrease the amount of hear t damage and regenerate heart muscle. Stem cells have also been used to help patients with heart failure. Early results for both areas have been exciting. Deployment in the United States has been primarily IV. Overseas, other deployments such as into the heart muscle have also had exciting results.

How are stem cells (SVF) used in lung disorders?
Lung disorders are seeing some successful use of stem cells. Chronic Obstructive Pulmonary Disease (COPD) patients have seen improved breathing. Asthma patients have also seen improvement. Deployment is typically given intravenously and as an inhaled nebulizer. Many patients benefit from retreatment in 3-6 months. Patients have seen benefit when the origin of their was from smoking, alpha-1 anti-trypsin deficiency and other lung disorders.

How are stem cells (SVF) used in skin and hair disorders?
Some skin disorders such as Lichen Sclerosis have seen benefit using stem cell/SVF. Restoring hair loss is another area of frequent use. Most skin disorders are treated by a combination of injections of SVF into the affected area intravenous deployment of stem cells/SVF. When hair loss is the issue, hair transplant is sometimes also done. This is one of the more popular uses of stem cells/SVF.

How are stem cells (SVF) used in eye disorders?
Some of the newest deployment protocols for stem cells/SVF are for eye disease. Eye diseases for which SVF has been deployed include:

  1. Macular degeneration
  2. Retinitis pigmentosa
  3. Diabetic retinopathy
  4. Retinal detachments
  5. Leber’s optic neuropathy
  6. Optic neuritis

All of these protocols are fairly new and therefore include limited numbers of patients. Early results appear very promising, especially considering the typically poor response from other therapy options.

Bibliography

  1. Cell Tissue Res. 2012 Nov;350(2):277-87. doi: 10.1007/s00441-012-1453-1. Epub 2012 Jun 5. The comparition of biological characteristics and multilineage differentiation of bone marrow and adipose derived Mesenchymal stem cells. Zhu X, Shi W, Tai W, Liu F.
  2. Clin Lab. 2012;58(9-10):897-903. The comparison of multi-lineage differentiation of bone marrow and adipose-derived mesenchymal stem cells. Zhu X, Du J, Liu G.