Birth tissues products such as membranes, cells, and fluids donated by the mothers when they give birth are the new fountain of youth used in many fields of medicine. Here is a brief, biased guide to what you may hear at your next orthopedic (and almost every other medical) office visit.
Nothing grows faster than the fetus. The tissues, cells, and fluids that provide protection for the fetus are rich in growth factors, stem and unique fetal and maternal progenitor cells, lubricants, and a variety of other bioactive factors. The FDA currently does not even know how to regulate these therapies. Are they drugs? Local devices? Do they have systemic effects in the recipients? What are the risks?
Doctors don’t know all the answers to these questions either. But the use of these factors is expanding rapidly, as there appears to be a tremendous benefit for many patients with only very rare complications—and those are seen only with intravenous or intraocular use.
One major differentiator between birth tissue choices is the presence or absence of maternal cells, fetal cells, or growth (and other) factors. Maternal cells may be more likely to induce a rejection response or carry other unwanted characteristics. Fetal cells and amniotic fluid by themselves, on the other hand, have remarkable immunomodulatory characteristics. It is believed that the reason the mother’s body does not reject the fetus—even though the fetus embodies only half the mother’s DNA—is because these cells and factors shut down her body’s inflammatory and rejection response. Used as therapy, these growth factors—whether injected or released by cells—treat injured tissues and recruit the recipient’s own healing cells to the site of the injection.
Some of the most popular injections are:
Wharton’s Jelly. This thick, gelatinous fluid, which surrounds the umbilical cord, is rich in growth factors and cells from both the mother and the fetus. For the cells to remain alive, the jelly must be stored in liquid nitrogen and defrosted immediately before injection.
Amniotic membranes. The two layers of the amniotic membrane have different cell types and functions. The chorion (the maternal side of the membrane) is loaded with maternal cells, while the amnion (which faces the fetus) has fewer cells—but they are unique ones, believed to function as fetal stem cells. Companies that procure these membranes provide different products: chorion alone, chorion plus amnion, and amnion alone. The processing of the tissues determines whether or not the cells themselves stay alive, or only the growth factors. Cryopreserving the tissues (keeping them in extremely cold conditions in liquid nitrogen) keeps the cells active, while freeze-drying only keeps the growth factors active.
Amniotic fluid. This is the most potent, cost-effective anabolic injection we have. Depending on how it is processed, amniotic fluid may have 2 to 50 times the major growth factors found within a patient’s own blood platelets. It contains a few unique fetal stem cells. If the fluid is obtained during a C-section and filtered through a 0.25-micron filter, it is sterile and immediately available for use. With little processing required, amniotic fluid is the least expensive product and the one we prefer to use at this time.
Exosomes. These extracellular packets of growth factors and cytokines, released by the cells of the birth tissues, are also being packaged for therapeutic use. Their great potential is that specific packets of stimulating compounds may be selectively harvested for targeted therapies.
Cord blood and other placental tissues are currently not used in orthopedics. They most likely retain too many characteristics of the mother, rather than those of the rapidly growing fetus, and thus risk rejection.
If you are not yet confused by this plethora of choices, you are well ahead of the game. But don’t think that these treatments are new. General surgeons have known since 1900 that amniotic membranes could be used to reduce adhesions in abdominal surgery. It was only the AIDS/HIV epidemic in the 1980s that reduced the use of allograft (donor) tissues until tissue banks developed tests to screen out potentially infected donors. They are a remarkably safe alternative to cortisone, which damages tissues and shuts down healing. In contrast, the birth tissue derivatives stimulate healing, act as anti-inflammatories and antibiotics, help prevent scarring, and provide lubrication. Maybe not an actual fountain of youth—but certainly a potent therapy as we wait for more studies to define their optimal applications.
In the “do no harm” mindset of medicine, the use of birth tissues—once cost-effective—appears to be well within those boundaries.
Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco.