Traumatic Brain Injury (TBI) is the most common injury that service members experience in the combat settings of Iraq and Afghanistan, especially in those sustaining multiple exposures.
The mechanisms of injury included blasts or explosions, falls, motor vehicle accidents, and fragment, shrapnel, and bullet wounds. In one survey of more than 2,000 army infantry soldiers, performed three to four months after their return from a one-year deployment in Iraq, 5% reported injuries with loss of consciousness and 10% reported injuries with altered consciousness.
Symptoms of TBI
Acutely, the symptoms of concussion are confusion and amnesia, sometimes with, but often without, preceding loss of consciousness. These symptoms may be apparent immediately after the head injury or may appear several minutes later. The alteration in mental status characteristic of concussion can occur without loss of consciousness. Seizures are uncommon in mild TBI, and problems such as limb weakness do not occur with mild TBI.
The majority of mild TBI patients develop headache, dizziness, neuropsychiatric symptoms, and cognitive impairments, which may continue for weeks to months with up to 25% of patients for over six months.
Individuals with a history of chronic (>1-year prior) mild TBI often develop emotional and cognitive dysfunction, including disturbances in mood (depression, suicide) and alterations in sleep (i.e., poor quality, changes in sleep-stage proportions), often culminating in inability to carry out ordinary daily activities, work responsibilities, and standard social relationships. Sleep complaints often occur, including insomnia, difficulty maintaining sleep, early morning awakenings, and nightmares.
Despite considerable research and substantial changes in the acute care of combat-related TBI in U.S. military personnel in recent years, trends in clinical outcomes have changed very little.
There is no effective treatment or pharmaceutical intervention in the daily clinical practice for TBI. Intensive therapy and rehabilitation programs are considered essential for maximizing quality of life, but are often only partially successful. Various novel approaches such as hyperbaric oxygen have demonstrated potential but remain unproven, thus highlighting a significant unmet need. The intensive search for new methods to provide sustained relief affected patients continues.
Using Stem Cells to Treat TBI
The mechanisms of stem cell-related repair in TBI have been studied with various types of cells, including those taken from adipose tissue and bone marrow. Over the last seven to eight years, clinical studies of stem cell-based TBI treatment have been few, most targeting patients either in the acute stage with intravenous infusion, injection into the spinal canal, or direct injection into the brain (requiring surgery). Fewer have addressed the chronic mild TBI patient.
Increasingly, patients seek treatment options outside of their traditional healthcare environments, many to receive stem cells. Stem cell clinics vary with respect to types of patients treated and types of cells used; most do not specify doses and the means of administration and do not follow guidances or common standards for stem cell product production. The development of stem cell clinics is increasing globally. Concerns have been expressed regarding marketing of services and implementing and monitoring safety standards and outcomes.
A significant shortcoming of most stem cell clinics is the failure to collect follow-up data, a result often ascribed to logistical and financial constraints of having patients return for multiple visits from geographically remote areas. The commitment to assessing long-term outcomes is of critical importance. To our knowledge of the clinics cited above, few if any incorporate structured mechanisms for long-term patient follow-up in TBI patients.
Clinical Treatment Program Plan at Okyanos Center for Regenerative Medicine
The primary mission of the Okyanos Center for Regenerative Medicine program is to assess the risks and benefits of the adult stem cells it provides, utilizing data collection and analysis methods based in scientific rigor.
Since 2015, Okyanos Center for Regenerative Medicine has utilized IV administration in patients with chronic ischemic injury and neurodegenerative conditions without any safety concerns. Therefore, in that the efficiency of cell delivery and effects are felt to be acceptable to other patient populations, their Center has chosen the IV route for stem cell administration.
In contrast to other approaches used in treating similar patient populations with stem cell products, theirs utilizes:
Autologous stromal vascular fraction (SVF)
Rigorous 12-month data collection and analysis
Okyanos Center for Regenerative Medicine is committed to following patient progress well after they leave the Clinic to return home.
Clinical Treatment Program and Follow-Up
The pre-treatment screening period is the time between the the initial referral and the clinical treatment process. The Center works closely with the patient to explain the clinical treatment program, answer questions, and assist in gathering necessary information.
No procedure will be performed until the patient has been completely informed of the details of the clinical treatment program including its nature, risks, and procedures; has reviewed and accepted the program and followup plan; and has signed and dated an informed consent form.
The following will be obtained during screening:
Medication history and concomitant medication review
Physical exam, including vital signs and body weight
Blood and urine collection
On the day prior to treatment, patients will come to the Center for pre-procedure assessment of clinical status, including history, physical examination, BrainCheck, PRO: SF-36 (if not performed previously) and evaluations by the anesthesiologist and plastic surgeon (for liposuction).
The patient will undergo two sequential procedures: liposuction and IV infusion mannitol prior to that of ADRCs.
During the liposuction, a doctor will remove a small amount of fat tissue from your belly or thigh, about 60ml, that’s about a-half stick of melted butter. This fat tissue contains your unique one-of-a-kind adult stem cells. There are a lot of them but they are trapped in fat. So over the next two hours, you’ll relax in a private patient suite while your stem cells are isolated.
IV Infusion of Mannitol SVF
Mannitol is given first to increase the number of cells that enter the brain tissue, followed by infusion of SVF. During the infusion and for three to six hours after, frequent assessments of how patients are feeling, physical examinations (vital signs) and clinical assessments will occur. After this, patients will be discharged from the Center.
Days 3, 6 and 10
Phone calls will occur on Days 3, 6 and 10 to assess symptoms, medications and any adverse event occurrences, along with a visual assessment with photographs of liposuction and access sites.
Patients will return to their primary care providers for limited physical examination, medication review, BrainCheck, and a few questionnaires.
Months 6 and 12
Patients will return to their primary care providers for a physical examination, medication review, BrainCheck, questionnaires, blood test, and urinalysis.