By Phillip Steele, MD RMSK CAQ Sports Medicine
Performance Injury Care & Sports Medicine
With onset of trauma or injury to the body, the immediate cellular response is inflammation. A multitude of cell types including macrophages (M1 type) migrate to the site of injury mounting an acute response to help remove the damaged tissue. While also setting in motion a cascade of cytokine release (cellular signaling) to activate and recruit additional immune responsive cells to the site of injury. During the acute phase of injury the cellular response must be tightly controlled because persistence at the site of an unrestrained production of pro inflammatory cytokines can result in chronic inflammation and inability to heal properly. Thus, leading to chronic tissue damage.
In contrast some cells of the healing cascade are stimulated by another type of cytokine, which stimulates and initiates the constructive process and aids in wound healing and tissue repair. A particular type of macrophage (M2) releases a unique type of cytokine that turns off the destructive activation caused by the initial cellular response during the acute phase. It then subsequently enhances cellular proliferation to help with tissue repair. Failure to transition to the M2 type macrophage response perpetuates the non-healing state and chronic injury and pain.
Amniotic membrane (AM) is the innermost layer of the fetal membrane consisting of a single epithelial layer, a thin basement membrane, and avascular stomal tissue that serves a critical role in protecting the fetus from immunological insult and injury. If an injury to the fetus occurs, another function of placental tissue is scarless healing of the fetus as defined by an almost nonexistent inflammatory response at the site of injury. In the setting of injured fetal tissue, repair from a fetal regenerative healing process occurs. In adults, however, injury results in an inflammatory scarring healing response. Many studies are now showing the tremendous regenerative potential of amniotic membrane and umbilical cord derived cytokines and growth factors to promote tissue healing. This happens by suppressing the M1 phase of the inflammatory cascade and promoting the M2 phase.
Through extensive studies on amniotic and umbilical cord (UC) tissue we now understand another key to the puzzle. A critical component responsible for the amniotic membrane and umbilical cord tissue’s ability to reduce inflammation and scarring is a heavy chain-hyaluronic acid complex (HA). This complex is a covalent linkage between a heavy chain (HC) 1 inter-alpha-trypsin (protein) and the HA complex. Thereby creating a potent anti-inflammatory substrate that promotes tissue healing as well as blocking the chronic inflammatory effect of the M1 phase.
The bottom line is that a new injectable product is using a combination of amniotic and umbilical cord matrix, which is packed with cytokines, growth factors and HA-HC to block the anti-inflammatory cascade at the MI phase and promote the M2 phase of healing. We can now use these powerful regenerative properties to help heal tendons, ligaments, cartilage and help with osteoarthritis and other chronic injuries. Umbilical Cord-Amniotic Membrane (UC-AM) can also help restore nerve function to damaged nerves after prolonged compression or entrapment. This unique product is available as an injectable to help you heal. The UC-AM plus HC-HA is derived from healthy, full term and live born infants in the USA and is tested extensively. We are now offering this product as part of our regenerative medicine program at Performance Injury Care & Sports Medicine.