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New Jersey Stem Cell Therapy
Dr. Silberman trained under one of the pioneers in the field of regenerative medicine while a fellow at the Crozer Chester Medical Center Sports Medicine Institute. Dr. Silberman now teaches attending physicians, fellows, residents, and medical students from around the country how to harvest stem cells from bone marrow for the treatment of orthopedic musculoskeletal conditions. All injections are performed under Ultrasound Guidance.
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Dr. Silberman's novel MARROW-STEM™ method, uses a disposable bone marrow needle specifically designed for orthopedic stem cell procedures that requires only a single puncture, 20cc or less of bone marrow aspirate, no manipulation, centrifugation, or addition of any substances, and no processing off the sterile field (reducing the risk of infection) and no discarding or filtering of any of your stem cells.
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Dr. Silberman delivers pure bone marrow aspirate direct from your pelvis with no need for any processing, additives, or spinning.
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The cost of injecting a bone marrow aspirate stem cell injection in one joint or tendon/ligament at New Jersey Sports Medicine is $2500. Two joints or locations cost $2800. Multiple locations are discounted.
Other stem cell bone marrow systems produce aspirates contaminated with peripheral blood lowering the stem cell count, that require multiple puncture sites (or drilling of bone), excessive removal of more than 60cc of marrow aspirate (which has to be manipulated, filtered, and spun with additives), and ultimately, the discarding of most of the aspirate, and hence with it, the discarding of your stem cells and progenitor cells.
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Compared to Regenexx, no pre-treatment with prolotherapy is required the day before your bone marrow aspiration stem cell treatment, only one needle entry site for your bone marrow aspiration is required versus two, no centrifugation is required, the aspiration may take 10 minutes start to finish compared to 30 to 60 minutes for Regenexx, the complete stem cell procedure (bone marrow aspiration and injection of stem cells) may take 30 to 45 minutes door to door (from the time you enter the office to the time you leave) versus up to 8 hours with Regenexx, and there is no need to return for a third day for PRP injections as injectable Platelet Rich Fibrin (iPRF) may be injected the same day as your bone marrow aspirate stem cell injection.
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PRF (platelet rich fibrin) has been shown to produce a higher cumulative yield of growth factors than PRP (platelet rich plasma), making it ideal for regeneration and growth stimulation. PRF (platelet rich fibrin) acts as a scaffolding for your stem cells to adhere to and serves as a reservoir of growth factors that may be released for up to two weeks.
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Stem cells derived from adipose tissue (lipoaspirate) is another process used by other regenerative institutes. While you may have read that adipose tissue hosts more stem cells than bone marrow, this only holds true in the manner in which your fat tissue is processed. To obtain a high stem cell yield, your fat must be enzymatically broken down and expanded and cultured outside the body, not currently approved by the FDA. The addition of chemicals makes your fat a drug which have to be rigorously studied for human use prior to market. These toxic chemicals used in the process have not been studied in humans. To bypass the FDA, companies have come with ways to mechanically process your fat without chemicals, such as shaking them in a bag of marbles, but these methods yield contaminated, low, variable stem cell counts.
Dr. Silberman's method of stem cell delivery using bone marrow aspirate concentrate means less cost, less time, less pain, less risk of infection, less risk of allergic reaction, less waste, and better numbers.
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Dr. Silberman's closed system yields 3290 CFU-f per ml.
Harvest BMAC yields 1270 CFU-f per ml.
Arteriocyte Magellen yields 510 CFU-f per ml.
Biomet BioCUE yields 134 CFU-f per ml.
Traditional trocar yields 356 CFU-f per ml.
Source: marrowcellution.
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What are mesenchymal stem cells or multipotent stromal cells (MSCs)?
Mesenchymal stem cells, or MSCs, are multipotent stromal cells that can 1. differentiate into a variety of cell types including: osteoblasts (bone cells), chondrocytes (cartilage cells), myocytes (muscle cells) and adipocytes (fat cells), 2. modulate oxidative stress, 3. have immunomodulatory, anti-inflammatory, and anti-aptoptic effects.
(Strioga et al. Stem Cells Dev. 2012 Sep 20;21(14):2724-52).
Osteoarthritis is a mesenchymal disease in which the activity of MSCs are altered leading to an absence of repair and increased degeneration of cartilage. (Jo et al. Stem Cells 2014; 32:1254-1266).
MSCs are known to stimulate chondrocytes to proliferate and synthesize extracellular matrix, to induce anti-inflammatory cytokine production, and to possess immunumodulatory properties, resulting in anti-inflammatory activity, regeneration, and pain relief.
Bone Marrow Derived stem cells are obtained in the office via bone marrow aspiration with a needle inserted in the iliac crest of the pelvis. Adipose derived mesenchymal stem cells (AD MSCs) are obtained in the office via lipoaspiration of fat from your abdomen or buttock.
Postulated mechanisms of MSCs for the treatment of arthritis are:
1. Direct differentiation into chondrocytes (articular cartilage) or more likely, 2. Paracrine effects of secreted bioactive materials, modulating inflammation and providing an environment for tissue regeneration, by controlling cytokine and growth factor production from endogenous cells or through secretion of bioactive materials.
Conditions that Bone Marrow Aspirate Stem Cells may be used for at New Jersey Sports Medicine:
Stem Cells for arthritis, degenerative or osteoarthritis
Stem Cells for articular cartilage defect, when considering the MACI procedure
Meniscus Tears
Floxed Quinolone induced tendinopathy, arthropathy, neuropathy
Rheumatoid arthritis and similar arthropathies, lupus, psoriatic arthritis
Osetochondral cartilage defects, degeneration, injury or wear, OCDs
Chondromalacia Patella
Labral Hip and Shoulder Tears
Ligament Sprains
Tendon Tears, Tendonosis, Tendonopathy
Painful neuropathies and nerve pain
Failed surgeries and chronic pain
Lyme Disease arthritis
AVN and Osteonecrosis of the knee, hip, other joints
What to expect? For Bone Marrow Aspirate Derived Stem Cells at New Jersey Sports Medicine:
An FDA approved bone marrow harvesting needle is used by Dr. Silberman, which is a minimally invasive, high yield, low volume aspiration, with NO manipulation, centrifugation, or addition of any substances. Your skin overlying your iliac crest (pelvis) and the lining of your pelvic bone will be anesthetized with a small injection. An access needle is then inserted through the cortex of your ilium into the medullary cavity and with a syringe 10 to 20ml of marrow will be aspirated. The bone marrow aspirate is then injected into your joint, tendon, or ligament. This system is much less painful then what you might have heard about 'bone marrow biopsies'. Some patients do not feel any pain. A typical patient visit is 30 to 45 minutes.
For Adipose Derived Mesenchymal Stem Cells:
The skin on your abdomen or buttock is anesthetized with a lidocaine injection. Using your thigh yields low numbers of cells. A blunt tip cannula is inserted into the fat layer and a mixture of 250cc of sterile saline and lidocaine and epinephrine is infiltrated, which can be dangerous. When adequate anesthesia is achieved, a harvesting cannula is inserted and your fat is sliced, diced, and aspirated. If done incorrectly, "dimpling" may result. About 60cc of fat is removed, not enough to give you a look of 'liposuction'. The lipoaspirate then has to be manually processed and manipulated, either mechanically which yield low cell counts and a high blood mononuclear cell count, which you do not want, or enzymatically, with the addition of proteolytic chemicals, which you do not want. This type of visit may take 3 hours.
Read more on bone marrow aspirate derived stem cells versus adipose derived stem cells from liposuction or lipoaspiration.
Is bone marrow aspirate or adipose tissue stem cell injection for everyone?
No. I have seen many athletes and patients come from other locations treated with stem cell therapy, prolotherapy, ozone, prolozone, and/or PRP when they should not have been treated with these often expensive out of pocket treatments. Dr. Silberman has treated failures from the "Kobe" Clinic in Germany where stem cells are cultured outside of the body, patients treated in Columbia, Panama, and Mexico, patients seen at the Hospital for Special Surgery (HSS), and patients from the Cleveland Clinic. Nobody is bigger than medicine so don't be fooled by regenerative institutes and stem cell centers. Be wary of testimonials, as they do not constitute science.
Studies:
Intra-articular Injection of Mesenchymal Stem Cells for the Treatment of Osteoarthritis of the Knee.
Stem Cells 2014; 32:1254-1266.
http://www.ncbi.nlm.nih.gov/pubmed/24449146
Adult Human Mesenchymal Stem Cells Delivered via Intra-Articular Injection to the Knee Following Partial Medial Meniscectomy
A Randomized, Double-Blind, Controlled Study.
J Bone Joint Surg Am, 2014 Jan 15; 96 (2): 90 -98.
http://jbjs.org/content/96/2/90
Mesenchymal Stem Cell Injections Improve Symptoms of Knee Osteoarthritis.
Arthroscopy April 2013Volume 29, Issue 4, Pages 748–755
http://www.arthroscopyjournal.org/article/S0749-8063(12)01884-1/abstract
A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions.
International Orthopaedics August 2016, Volume 40, Issue 8, pp 1755–1765
http://link.springer.com/article/10.1007/s00264-016-3162-y
