Regenerative medicine refers to medical treatment that attempts to regenerate tissues and organs lost due to disease or injury and restore their functions. Until now, medical treatment has used artificial limbs, artificial joints, and transplants using other people’s organs, but these methods have many problems, such as rejection after organ transplant and ethical issues. On the other hand, researchers around the world are currently working hard on regenerative medicine, which overcomes the challenges of conventional medicine and opens up new treatment possibilities. In 2014, the world’s first transplant surgery of retinal pigment epithelial cells created from iPS cells was performed, a major step forward in opening the door to the next generation of regenerative medicine. Clinical studies are planned for Parkinson’s disease and heart failure patients, and there are high hopes that in 20 years it will be possible to create the heart, kidneys, and other organs themselves. One particularly promising area of recent regenerative medicine is the use of specialized cells called stem cells, with particular focus on somatic stem cells, which exist in the living body. Treatment with somatic stem cells has shown great promise because it is said to be highly safe and there are no ethical issues involved.
Our body is composed of 37 trillion cells, and stem cells are the source of producing those cells. They are present all over the body and produce each organ, blood, skin, etc. Stem cells have two unique abilities: the first is the ability to replicate cells exactly like themselves (self-renewal capacity), which allows stem cells to be maintained for long periods of time. Another is the ability to differentiate into various types of cells (pluripotency), which allows stem cells to generate new cells and regenerate tissues that have been damaged by disease or injury. At present, there are three main categories of stem cells that are being studied with an eye toward regenerative medicine. (1) Embryonic stem cells (ES cells), which are stem cells produced from fertilized eggs and have the ability to become all types of cells.
(2) “iPS cells,” which are established by inserting specific genes into cells extracted from body cells, such as skin, and can become any type of cell, just like ES cells. (3) Somatic stem cells, which are found in each tissue of the body and have the ability to differentiate into specific cells.
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High potential Adipose stem cells
Stem cells have the ability to differentiate into various cell types
Of these stem cells, somatic stem cells are the most advanced in terms of practical application. Unlike artificially created ES and iPS cells, somatic stem cells actually work within our own bodies. For example, “hematopoietic stem cells”, which produce blood cells such as red blood cells, white blood cells, and platelets; “neural stem cells”, which produce nerve cells; and “mesenchymal stem cells”, which are believed to be capable of producing various tissues such as bone, cartilage, fat, and nerve.
Among mesenchymal stem cells, the discovery of adipose hepatocytes in adipose tissue in 2001 proved that adipose hepatocytes are 100-1000 times more easily obtained than bone marrow stem cells, and that they have the ability to differentiate into bone, cartilage, cardiac muscle cells, and blood vessel forming cells as well as adipose tissue. The main functions of adipose stem cells include injured wound healing, differentiation, immunomodulation, and neovascularization, and they have already been applied to the treatment of various diseases such as diabetes, myocardial infarction, cerebral infarction, liver dysfunction, allergic diseases, degenerative inflammatory diseases (knee osteoarthritis), autoimmune diseases (rheumatoid arthritis), and lung fibrosis, and their therapeutic effects have begun to be reported. Adipose stem cells are safer because they are the only autologous transplant, unlike umbilical cord, dental pulp, and amniotic stem cells, which are discussed below. Other mesenchymal stem cells would include umbilical cord stem cells, dental pulp stem cells, and amniotic stem cells. Umbilical cord stem cells are more difficult to obtain stably than adipose stem cells, but they contain more cytokines with strong cell proliferative and anti-inflammatory effects than adipose stem cell culture supernatant solution. We are planning to adopt these cells at our clinic, although they will be transplanted from another family. Dental pulp stem cells are taken from deciduous teeth of children and are said to have high regenerative proliferative ability because they produce a lot of cytokines related to cell proliferation. It is said to be particularly high in cytokines involved in nerve regeneration, and is particularly good for cerebro-periodontal infarction, vascular disorders, and periodontal disease. Of course, they are transplanted from another family. Amniotic stem cells are also transplanted from other families, but they are said to be highly proliferative and immunosuppressive among mesenchymal stem cells. Their effects on inflammatory diseases are particularly noted. Our clinic plans to adopt them in the future. Bone marrow stem cells have a strong property of differentiating into nerve cells and are said to have a high capacity for nerve regeneration. However, because of the skill and experience required to collect bone marrow, the low content of stem cells, and the difficulty of stem cell culture techniques, they are not widely used in general clinics. They are mainly used as hematopoietic stem cells for the treatment of blood disorders.
Thus, mesenchymal stem cells other than adipose stem cells are transplanted from other families, and the risk of rejection reactions such as anaphylaxis is assumed, so their practical use in Japan has not progressed very far. However, since fetal and infant tissues are used, they have low immunogenicity and are in a state of immunological tolerance, so they are relatively safe and are expected to be used in Japan in the future.
In November 2022, our clinic submitted to the Ministry of Health, Labor and Welfare a Type 2 Regenerative Medicine Provision Plan for the treatment of osteoarthritis of the knee using cultured mesenchymal stem cells derived from autologous adipose tissue, and obtained a plan number.
（NA8150002）At our clinic, cell processing is outsourced to Bio-master, an affiliate of Kaneka Corporation, which is a trusted company.
The flow of this treatment is described below.
Flow from initial consultation to treatment
- Before this treatment, patients must first be tested for infectious diseases (hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), human T-cell leukemia virus type 1 (HTLV-1), parvovirus B19, treponema pneumoniae (TPHA, RPR), mycoplasma, cytomegalovirus (CMV), Epstein Barr virus (EBV)) and if all tests are negative, this treatment is available. If the results of the blood test show that processing work cannot be performed, the patient will be charged only the initial consultation fee and the cost of the blood test. (See below for the fees).
- Patients with malignant tumors are not eligible for this service.
- In some rare cases, we may not be able to perform the procedure if the patient is not in good physical condition or if the blood is in poor condition. In such cases, you may be asked to have your blood drawn again.
- Patients are required to bring X-ray and MRI images of the knee joint to the initial examination. Patients who do not have the images available, or who have not had any of these tests performed within the past 6 months, will be asked to take them to our affiliated Minato Shiba Clinic or a nearby medical facility specializing in imaging tests (no co-payment) at the time of their first visit.
1X-ray examination
- confirms that the patient has osteoarthritis of the knee, grade 2-4 of the Kellgren-Lawrence classification.
2MRI (nuclear magnetic resonance)
- evaluates the degree of cartilage and meniscus damage in the joint.
3
- The joint cavity is confirmed under echography to ensure that adipose stem cells are administered.。
4Postoperative examination, MRI (nuclear magnetic resonance)
- Postoperative course is evaluated.
Cost (including tax)
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| Initial medical examination fee | 5,500yen |
|---|---|
| Infectious disease test | 16,500yen |
| Imaging test fee | X-ray Available free of charge with no co- payment at the Minato Shiba Clinic, an affiliated facility (but only for health insurance card holders). |
| MRI One side 33,000 yen | |
| Intra-articular injection Number of cells | 30 million cells 1 time 1,300,000 yen 100 million cells 1 time 1,500,000 yen 30 million cells 3 time 1,800,000 yen |
As a rule, payment is due on the agreed upon date.
Please use credit card.
