Luga Podesta, MD, is a sports medicine and regenerative orthopedic specialist at Bluetail Medical Group in Naples, Fla. He was the lead author in a 2013 study in The American Journal of Sports Medicine which demonstrated that platelet-rich plasma can effectively treat partial UCL tears in athletes. In a recent interview with Becker's Spine Review, Dr. Podesta spoke about the possibilities and pitfalls of stem cell therapies in orthopedics and trends in regenerative medicine.
Question: Is there a potential problem with the proliferation of stem cell clinics?
Dr. Luga Podesta: Some stem cell clinics market their products as cures for everything. The FDA cracked down on intravenous stem cell treatment in 2017, coming out with stricter regulations and guidelines to improve patient safety.
We know musculoskeletal stem cell treatments can improve function and quality of life, reduce pain, and prevent further injury; however, we can't boast that we can cure everything. There are a lot of variables that go into this.
You have to really do your homework with stem cell clinics. When we treat point of contact orthopedic problems, the risk is very minimal. When we use intravenous stem cell treatments, the risk can be very substantial. Not all stem cell treatments are created equally.
Q: How are patients and providers responding to increased regulation?
LP: We are seeing a number of clinics popping up offshore in places like the Cayman Islands, Mexico, Central and South America, where there's much less or no governmental regulation. With international medical tourism, patients don't know what they're actually getting, especially when the providers are not using the same types of cells or are manipulating the cellular contents. People will go where they think they can get the best treatment; they've lost hope here.
Q: What should patients know about stem cell treatments for orthopedic issues?
LP: We now have level 1 data on the efficacy of using platelet-rich-plasma for joint therapy. It decreases the inflammatory response in osteoarthritis, can improve range of motion and reduce the risk of fall by decreasing pain and improving knee joint function.
Patients should try to weed out unqualified providers. They should seek providers with training in regenerative medicine. Patients should know that IV stem cell treatments are strictly forbidden by the FDA.
We can't treat everybody. Some patients have arthritis that is too advanced, a lot of comorbidities, or they're simply too old. Providers have to determine who is an appropriate candidate for these therapies and who is not.
The more severe or catastrophic the injury or condition, the less likely stem cell treatment is to be effective. The best patients can expect is decreased pain and better function, but to promise to make them 'normal' is a flat-out lie.
Q: What trends do you see in regenerative medicine?
LP: Stem cell treatment is a cash-based treatment and can cost a significant amount of money. With increased favorable research and as treatments are performed more frequently, insurance companies are going to have to eventually cover it, and I think they will within five to 10 years.
Stem cell treatments may be able to help worker's compensation patients. We will see increased applications for treating chronic neurological and degenerative processes like stroke and spinal cord injury. We will also see stem cells increasingly being used to improve cardiac function.
In plastic surgery, stem cells can be used to aid breast reconstruction after breast cancer.
In orthopedics, we will see stem cells being used as the primary source of treatment for ligament, tendon, muscle and bone healing, or they will be combined with surgical techniques to enhance healing. I expect to see greater adoption of stem cell-based therapies for treating arthritic conditions of the spine. It really is a new and emerging frontier in medicine.
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