Regenerative Medicine holds the promise of revolutionary changes in the way we treat many medical conditions, from heart problems to brain injury.  Stem cell technology is quickly expanding in the area of musculoskeletal conditions.  As physiatrists, we routinely treat musculoskeletal injuries and are therefore, perfectly aligned to be leaders in this new realm of medicine.

In this edition, we meet Dr. Centeno who is involved in stem cell research and clinical application, as well,  has the largest body of clinical data for the use of therapeutic stem cells for Orthopedic conditions, in the United States.  Also, he is active in the education of other Rehab Physicians through the AAPMR’s Regenerative Medicine course.

This is an excerpt from the full length article in the AAPMR CORE newsletter, for which I am editor.  In this section, Dr Centeno discusses his experience over the years with research and development of stem cells for musculoskeletal conditions.

Christopher J Centeno, MD

Co-medical Director of Centeno-Schultz Clinic   Boulder, CO

“‘The Centeno-Schultz clinic (CSC) has a research lab that looks like it should be sitting in a university. You can find PCR for cell RNA and DNA analysis, a fluorescence activated cell sorter for purifying various cell populations, flow cytometry for identifying cell types, fluorescent microscopy, etc…  This remarkably is all sitting in a private medical practice for one reason-to improve the lab bench to bedside clinical translation process. While a basic science research idea in a university may take decades to reach patients, here at CSC small tweaks in lab processing can quickly yield big clinical results.’

‘Centeno’s most exciting discovery while researching this topic was first failing and then succeeding in intervertebral disc regenerative medicine. CSC first began using same day stem cells for severe degenerative disc disease in 2005, but without much success. Cultured mesenchymal stem cells were then tried, replicating successful animal models of disc regeneration, but there was also little clinical success. Finally, extensive changes were made to the clinical procedure and culturing process to better target one condition (disc protrusion) and mimic the environment inside the degenerating disc in the lab. This ultimately lead to the successful remediation of disc bulges through a precise injection of specially cultured mesenchymal stem cells. This procedure and protocol is now the subject of an FDA clinical trial that begins this year.’

‘Centeno states that a current area of clinical research he’s excited about is measuring the micro-environment with stem cell treatment of osteoarthritis. He says that a good farmer would never plant seeds before knowing about the soil conditions and supplementing them accordingly. He believes that one of the reasons that animal models of orthopedic stem cell therapy don’t often directly correlate with human research is that the animals are all young, healthy, with acute artificially created acute injuries that are meant to be surrogates for middle aged Americans with OA. Those real patients don’t have the same micro environment conditions as the animal models. His goal is to quantify and find ways to maximize the local OA micro-environment (the soil) to maximize stem cell therapy outcome (planting the seeds).’

‘Dr. Centeno believes that the best advice that he can give young PMR residents who want to practice Regenerative Medicine is to find a high quality Regenerative Medicine fellowship. He believes that PMR is ideally positioned to launch a new medical specialty that he calls, Interventional Orthopedics. This new field will meld both interventional spine with sports medicine’s knowledge of peripheral joints and focus on an expanding array or biologic therapies and new tools to implant cells. He believes that the fellowship should have both lab and clinical research components so that fellows can learn from the ground up. Finally, he thinks that there is simply too much to learn to come out of residency and begin practicing regen med at a high level.'”

I had the pleasure of listening to Dr Centeno’s breakthrough research at my annual Academy meeting as well as at a recent Regenerative Medicine course, put on by my Academy.  Through great teachers and leaders, like Dr Centeno, I am confident that physiatrists will be at the forefront of using stem cells for many musculoskeletal conditions.

Good Luck,

Dr Ethan Colliver