Yesterday I flew down to Grand Cayman to once again allow some of my patients access to advanced cultured stem cells. This morning I would also like to compare and contrast what we do here from what’s done in Panama. Hence, this will be one of my first official Panama stem cell clinic reviews.
What’s Offered Outside the US with Regard to Stem Cells?
The cell therapies offered in the US are either autologous (from the patient) or allogeneic (from a donor). The only therapy in the US that has real stem cells and that’s currently permitted by US law is bone marrow concentrate. All other donor cell offerings such as umbilical cord or amniotic tissue have no live and functional mesenchymal stem cell content (1-3).
Outside the US, the big difference is that the cells can be grown to larger numbers in a process called culture expansion. This means that the stem cells are grown over days to weeks in culture. They can also be saved for future use in cryopreservation.
What’s Close to the US with Regard to Stem Cells?
There are three places close to the US that allow cells to be culture expanded and that have been around and stable for years. They are:
- Regenexx Cayman in the Cayman Islands
- The Stem Cell Institute in Panama (Riordan Institute)
- CellTex in Cancun, Mexico
Today I will compare and contrast Regenexx Cayman with the Stem Cell Institute in one of my first Panama stem cell clinic reviews.
Regenexx Cayman vs. The Stem Cell Institute in Panama
So why did I fly down to the Cayman Islands yesterday to treat my patients versus fly to Panama? As I have blogged before, the problem with Panama and Mexico and many Latin American clinics is that these countries don’t usually permit US physicians to get a medical license. US patients have become very accustomed to the level of training we have in the states, but those US physicians can’t be found in Latin America. Hence, one reason is that US physicians can and are licensed in Grand Cayman.
Another big difference is the technology offered. In Grand Cayman, the focus is on using the patient’s own stem cells from bone marrow and growing those in culture. In Panama, birth tissue cells are culture expanded. If we look at the amount of data published in human clinical trials on the use of cultured stem cells for orthopedic problems, there’s simply much more safety and efficacy data published using bone marrow than birth tissues.
Finally, as I always discuss, precise injections of stem cells into specific areas require advanced training and tools. Meaning, the doctors in Cayman (including myself) are all US physicians who have additional training (certifications through IOF) on the use of fluoroscopy and ultrasound in how to place cells into the damaged musculoskeletal system. Having treated patients who were first treated in Panama, what you tend to get is blind and not image-guided advanced injections.
A Real World Example From this Morning
Here’s a real patient stem cell order form the Cayman clinic this morning:
- Cervical facets with overfill into the epidural space
- Cervical ligaments
- Cervical segmental muscles
- Right shoulder rotator cuff tendons
- Right shoulder glenohumeral joint
- Right shoulder AC joint and supporting ligaments
- Right knee popliteus tendon
- Right knee medial meniscus
- Right knee MCL
- Right knee medical compartment
- Right knee femur and tibia intraosseous injections (into the bone marrow lesions)
- Bilateral hand CMC thumb joints intra-artcular and capsular ligaments
These are highly complex injections using both ultrasound and C-arm fluoroscopy. They can’t be performed by an orthopedic surgeon or neurologist who doesn’t have additional and advanced interventional training and there is no way to replicate these in Panama. In fact, from the patients that I’ve treated who have also been treated there, the best that they could do would be blind injections in the knee, hand, and shoulder joints and to start an IV.
The upshot? I’m here in Cayman instead of Panama because it’s the most advanced site close to the US to get orthopedic stem cell therapy. It allows US physicians to get licensed and only permits doctors who have advanced image-guided injection training to staff the clinic. Finally, there are the tools here that I need to do my work.
(1) Berger D, Lyons N, Steinmetz, N. In Vitro Evaluation of Injectable, Placental Tissue-Derived Products for Interventional Orthopedics. Interventional Orthopedics Foundation Annual Meeting. Denver, 2015. https://interventionalorthopedics.org/wp-content/uploads/2017/08/AmnioProducts-Poster.pdf
(2) Becktell L, Matuska A, Hon S, Delco M, Cole B, Fortier L. Proteomic analysis and cell viability of nine amnion-derived biologics. Orthopedic Research Society Annual Meeting, New Orleans, 2018. https://app.box.com/s/vcx7uw17gupg9ki06i57lno1tbjmzwaf
(3) Panero, A, Hirahara, A., Andersen, W, Rothenberg J, Fierro, F. Are Amniotic Fluid Products Stem Cell Therapies? A Study of Amniotic Fluid Preparations for Mesenchymal Stem Cells With Bone Marrow Comparison. The American Journal of Sports Medicine, 2019 47(5), 1230–1235. https://doi.org/10.1177/0363546519829034