KEY TERMS

Regenerative medicine; Cord blood; Growth factors; Mesenchymal stem cells (MSCs); Vascular enothelial growth factor (VEGF); Fibroblast basic growth factor 2 (FGF-2); Stem Cell Factor (SCF); Interleukin 1 receptor antagonist (IL-1ra)

Regenerative medicine offers much promise for those suffering from several disease states. It is a method of using your own natural healing properties to assist in living a better quality of life. Stem cells are presently the largest target in the regenerative medicine arena.

Stem cells are naïve cells that have the ability to divide indefinitely. They may functionally change into any cell in our body and can integrate to the target tissue, either in the presence or absence of damage. (1) Stem cells may be isolated from several locations including the blastocyst, fetal tissue (various organs of such), umbilical cord blood/tissue and adult tissues (bone marrow, liver, fat, brain, muscle, and other tissues). There are various classifications of stem cells.

1. Totipotent, able to produce all embryonic and extra-embryonic tissue, i.e., all tissues that form us.
2. Pluripotent, which have the ability to change into any tissue from all three embryonic layers except placenta.
3. Multipotent, which have the ability to change into two or more different cell types.
4. Unipotent, only give rise to one cell type.

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Meets and Exceeds Governmental Requirements
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Strict Adherence To Maintaining The Highest Level Of Quality
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Thorough Aerobic And Anaerobic Microorganism Testing
100%
Infectious Disease Tests Are Performed on All Donors in Accordance With Regulations
100%

STEM CELLS IN THE BODY

We can find stem cells throughout development and in our adulthood. In adulthood, they are easily accessed from our bone marrow and fat tissue. Adult stem cells are considered multipotent stem cells. There are many drawbacks to using your own stem cells. First, to remove stem cells from your body requires a surgical procedure, which as in every procedure, carries some form of risk, pain, and discomfort. Second, stem cells age as we do and their numbers decline substantially with age. Finally, there is scientific evidence illustrating that stem cells from a diseased patient are not as effective as those from a healthy one. (3)
There are different types of stem cells in our bodies. There are hematopoietic stem cells (HSCs) or blood stem cells as these are the stem cells that give rise to all components of blood. The other stem cell is called a mesenchymal stem cell (MSCs). These particular stem cells have shown much promise in various disease states as they give rise to a multitude of cell types found throughout our body such as fat, bone, cartilage and muscle. 

MESENCHYMAL STEM CELLS (MSCS)

MSCs have the ability to migrate and target specific tissues. This property called homing is an event that allows cells to migrate from a remote area in the body to find a damaged organ or tissue in a specific site. (4) This is the mechanism by which MSCs are infused intravenously and reach the affected areas of the body to perform its regenerative functions.
Experimental models have shown that MSCs have several important functions. They are able to regenerate damaged or injured tissues. In vitro and in vivo studies illustrate the plasticity of MSCs ability to give rise to non-hematopoietic cells such as myocytes, tenocytes and nerve cells. MSCs can modulate immune responses because of their specific properties. They are nonimmunogenic cells that express few major histocompatibility complex class I antigens (MHC I) and do not express either major histocompatibility complex class II antigens (MHC II) or costimulatory molecules, rendering them incapable of activating a T-cell response.(6).
They regulate the immune system by increasing the response of regulatory T-cells and decreasing pro-inflammatory mediators such as TNF-α, and IFN-γ. Thus, MSCs may be used from an unrelated donor. MSCs have been approved for pediatric graft vs host disease and are in clinical studies for adult indications of such. The use of MSCs for graft vs host disease clearly demonstrates that MSCs are safe for allogeneic use.
MSCs work in a paracrine manner to aid in host endogenous repair. MSCs release growth factors and proteins to communicate and effect neighboring cells. Studies illustrate a host of cytokines, chemokines and growth factors released by MSCs such as VEGF, FGF, PDGF, SCF to name a few. Growth factor release such as that of VEGF helps in the formation of new vascularization or angiogenesis while release of IL-1ra aid in suppressing the pro-inflammatory response of TNF-α. Hence, MSCs work in various methods to aid in healing and natural repair.
Liveyon Regenerative Medicine product contains stem cells and growth factors which may be beneficial for repair, growth, and healing. Here, independently completed in-vitro studies illustrate the quantity of cells and cell surface markers indicative of MSCs. More importantly is the release of the growth factors that aid in the formation of new blood vessels, activation of endogenous stem cells, modulation of the immune system, and growth of cells and tissue. 

RESULTS

Liveyon regenerative medicine product was delivered and maintained at -80°C until ready for testing. Various vials of regenerative medicine product were tested with consistent results as described below in (Fig 1a-b). Product was thawed using a passive thaw method where the individual just placed the frozen vial into their hand and thawed the product.

Once product was in a liquid form it was evaluated. Average time of thaw took approximately 3-4 minutes. An aliquot of Liveyon regenerative medicine product was taken and stained using acridine orange (AO) and propidium iodide (PI) followed by quantification using the Nexcelom Cellometer Auto 2000.
The remainder of the product was evaluated for flow cytometry using BD Accuri C6 Flow Cytometer (Fig 2). Briefly, the cells in the Liveyon regenerative medicine product were stained with FITC or PE directly conjugated antibodies to CD34, CD45, CD90, HLA-DR and HLA-ABC. These markers were chosen as they are standard markers used for MSCs11.
Figure 2: Flow cytometry illustrates the presence of mesenchymal stem cells (MSCS) which are identified by the marker CD90. Most importantly is the demonstration of the lack of HLA-DR (MHC-II) which is consistent with MSCs ability to be immune privileged (evasive). CD34 cells were not detected in samples tested.
Figure 3: Cytokine/ Chemokine determination in cell lysates. ELISA was performed to detect and quantify FGF-2, VEGF, SCF, and IL-1ra. The average result of each assay is shown. IL-1ra was present at a much higher concentration than the other targets and is represented by a secondary vertical axis. Error bar = ± standard deviation.
Table 1: Cytokine/ Chemokine concentration in cell lysates

Average Stdev
Header
VEGF     33.6   3.7 pg/mL
FGF - 2       5.4   2.0 pg/mL
SCF       6.9   0.8  pg/mL
IL - 1ra 1974.0 63.7 pg/mL

DISCUSSION

The umbilical cord serves as a conduit of nutrients for a fetus. Oxygenated nutrient rich blood is carried from the placenta to the fetus until the baby is born. This cord blood is rich in primitive stem cells, growth factors and immune cells that are naïve as they have to be compatible for baby and mother (12). Moreover, the use of allogeneic cord blood has been used for decades in greater than 500 patients with diseases such as Hurler’s syndrome, Duchenne muscular dystrophy and Krabbe’s disease. Most importantly it is safe. (12).
Liveyon Regenerative Medicine product consists of cord blood that has been isolated in a sterile environment and rigorously tested. The product contains cells as demonstrated by AO/PI staining (Fig 1) as described on the
label of the vial, it is positive for MSCs marker CD90 and negligible amounts of HLA-DR as defined by the ISCT (Fig 2). Most importantly, Liveyon regenerative medicine product contains growth factors and cytokines such
as VEGF, SCF, FGF-2 and IL1-ra (Fig 3) page 7.
Basic fibroblast growth factor (FGF2) is a growth factor involved in many aspects of growth development, and healing. It is what maintains stem cells in growth and an unchanged state. In addition, it plays an important part in the enhancement of bone and cartilage formation. Thus, the Liveyon regenerative medicine product, which contains FGF-2, may aid in repair of degenerative joint disease.
Interleukin 1 receptor antagonist (IL-1ra) is a protein released by cells and is a natural inhibitor of the pro-inflammatory state. IL-1ra plays a key role in immunomodulation, and inhibits production of the protein TNF-α, which has been indicted in several autoimmune diseases. In addition, there is a direct correlation with increased TNF-α and disability, death, and cognitive decline. Hence, the importance of IL-1ra release from cells and its ability to control the inflammatory response which occurs following many disease and trauma states. Liveyon
regenerative medicine product contains IL1-ra in higher concentrations than other growth factors.
Vascular endothelial cell growth factor (VEGF) is a signaling protein produced by cells that stimulates Angiogenesis. VEGF is part of a system that helps restore oxygenation to tissues and cells when bloodsupply is inadequate (16). When cells are deficient in oxygen, VEGF release helps stimulate angiogenesis. This is of importance especially in tissues that are avascular such as chondrocytes in joints. In a study where VEGF was neutralized using an antibody, blood vessel was completely suppressed, along with impaired trabecular bone formation and expansion of hypertrophic chondrocyte zone. The recruitment and/or differentiation of chondroclasts and resorption of terminal chondrocytes decreased (17). Thus, the importance of VEGF in cartilage formation and repair.
Stem cell factor (SCF) may help direct HSCs to their stem cell niche and it plays an important role in HSC
maintenance. In addition, it has been found to mediate cell survival, migration, and proliferation depending on
the cell type (18). SCF plays a crucial role for such things as hematopoiesis, pigmentation, gut movement, and
some aspects of the nervous system (18).
In summary, Liveyon regenerative medicine product contains many factors that may aid in host repair and healing. The data provided demonstrates that following thaw there are cells that fall into the ISCT criteria of MSCs as shown with flow cytometry. Liveyon regenerative medicine product contains growth factors that play a role in angiogenesis, growth and repair of cartilage, and bone tissue which should serve well in orthopedic disease.

REFERENCES

1. Gonzalez R, Woynarowski D, Geffner N. (2015). Stem Cells Targeting Inflammation as Potential Anti-aging Strategies and Therapies. Cell & Tissue Transplantation & Therapy 7 1–8.
2. Guillot P.V., O’Donoghue K., Kurata H., Fisk N.M. (2006). Fetal stem cells: Betwixt and between, Semin. Reprod. Med. 24 (5) 340–347.
3. Gislane L, et al. (2015). Bone Marrow Mesenchymal Stromal Cells Isolated From Multiple Sclerosis Patients Have Distinct Gene Expression Profile and Decreased Suppressive Function Compared With Healthy Counterparts. Cell Transplantation, Vol. 24, pp. 151–165.
4. Prockop D. (2007). “Stemness” does not explain the repair of many tissues by mesenchymal stem/multipotent stromal cells (MSCs). Clin Pharmacol Ther. 82(3):241-3.
5. Caplan AI. (2007). Adult mesenchymal stem cells for tissue engineering versus regenerative medicine. J Cell Physiol. 213(2):341-7.
6. Le Blanc K, Ringden O. (2007). Immunomodulation by mesenchymal stem cells and clinical experience.
J Intern Med.262(5):509-525.
7. Aggarwal S, Pittenger MF. (2005). Human mesenchymal stem cells modulate allogeneic immune cell responses. Blood. 105 (4):1815-1822.
8. Amorin B, et al. (2014). Mesenchymal stem cell therapy and acute graft-versus-host disease: a review. Human Cell. 27:137-150.
9. Burdon TJ, et al. (2011). Bone Marrow Stem Cell Derived Paracrine Factors for Regenerative Medicine: Current Perspectives and Therapeutic Potential. Bone Marrow Res. 2011:207326.
10. Murphy MB, Moncivais K, Caplan A. (2013). Mesenchymal stem cells: environmentally responsive therapeutics for regenerative medicine. Exp Mol Med. 45:e54.
11. Dominici M, et al. (2006). Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy. 8:315-317.
12. Riordan N, et at. (2007). Cord blood in regenerative medicine: do we need immune suppression? J Trans Med 2007, 5:8.
13. Ribatti D, et al. (2007). The discovery of basic fibroblast growth factor/fibroblast growth factor-2 and its role in haematological malignancies. Cytokine & Growth Factor Reviews. 18 (3-4): 327–34.
14. Lee TJ, et al. (Jan 2013). Enhancement of osteogenic and chondrogenic differentiation of human embryonic stem cells by mesodermal lineage induction with BMP-4 and FGF2 treatment. Biochemical and Biophysical Research Communications. 430 (2): 793–7.
15. Perrier S, Darakhshan F, Hajduch E (November 2006). IL-1 receptor antagonist in metabolic diseases: Dr Jekyll or Mr Hyde?. FEBS Lett. 580 (27): 6289–94.
16. Palmer, Biff F., Clegg, Deborah J. (2014). Oxygen sensing and metabolic homeostasis. Molecular and Cellular Endocrinology. 397: 51–57.
17. Gerber HP, et al. (1999). VEGF couples hypertrophic cartilage remodeling, ossification and angiogenesis during endochondral bone formation. Nat Med.5(6):623-8.
18. Lennartsson J, Rönnstrand L. (2012). Stem Cell Factor Receptor/c-Kit: From Basic Science to Clinical Implications. Physiol Rev. 92(4):1619-49.

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Medical Professional Viewing Only (Disclaimer)


This site was intended for education purposes only and strictly for use by medical professionals. The FDA recently re-confirmed, there is only one registered stem cell product, and while there is enormous promise in stem cell therapies, and thousands of ongoing experimental applications trying to establish efficacy, these are not at the point where they would meet the scientific standard.

The FDA has stated:

Stem cells, like other medical products that are intended to treat, cure or prevent disease, generally require FDA approval before they can be marketed. FDA has not approved any stem cell-based products for use, other than cord blood-derived hematopoietic progenitor cells (blood forming stem cells) for certain indications.

http://www.fda.gov/AboutFDA/Transparency/Basics/ucm194655.htm

This site is not intended for consumers.

If you are considering stem cell treatment in the U.S., ask your physician if the necessary FDA approval has been obtained or if you will be part of an FDA-regulated clinical study. This also applies if the stem cells are your own. Even if the cells are yours, there are safety risks, including risks introduced when the cells are manipulated after removal.

“There is a potential safety risk when you put cells in an area where they are not performing the same biological function as they were when in their original location in the body.” Cells in a different environment may multiply, form tumors, or may leave the site you put them in and migrate somewhere else.

If you are considering having stem cell treatment in another country, learn all you can about regulations covering the products in that country. Exercise caution before undergoing treatment with a stem cell-based product in a country that—unlike the U.S.—may not require clinical studies designed to demonstrate that the product is safe and effective. FDA does not regulate stem cell treatments used solely in countries other than the United States and typically has little information about foreign establishments or their stem cell products.

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm286155.htm

Stem cell therapies have enormous promise, but the science in each use is still in the developmental stage.  Professional judgment and expertise is needed in using stem cells for any therapeutic use, and we urge anyone embarking on the use of stem cell therapies to consult the national health data bases to evaluate current information from clinical trials and the FDA websites on human tissue should also be consulted to get its current evaluation of any therapy.