Chronic obstructive pulmonary disease (COPD) is an umbrella term encompassing a spectrum of different lung conditions, with chronic bronchitis at one end and emphysema at the other. Chronic bronchitis describes the chronic, ongoing inflammation of the lung’s airways with thickening and excessive mucus production and, perhaps, scarring; while emphysema describes the presence of pockets of air (cavities) that form within the lungs as a consequence of damage and breakdown of the walls between the air sacs (alveoli) making them coalesce into bigger spaces. In both conditions it becomes easier to breath in than out- hence the the obstruction.
Clinically, the severity of COPD is measured on a four-point scale based on performance during a pulmonary function test (spirometry) with ascending severity from Stage 1 (mild) to Stage 4 (very severe). Generally, stage one people are only short of breath on significant exertion; stage two individuals get short of breath with moderate exertion; stage three patients become short of breath on mild exertion; while the fourth and final stage indicates shortness of breath at rest.
Courtesy: National Heart, Lung, & Blood Institute
Long-term smoking plays a role in the vast majority of cases of COPD development although regular or severe exposure to airborne pollutants- for example within the workplace, can also lead to the condition. A small number of patients with COPD may have a hereditary deficiency of alpha-1-anti-trypsin. This is an interesting protein that helps neutralize the trypsin, which is produced by polymorphonuclear white blood cells (WBCs) to kill bacteria. Much of bacteria that reach the alveoli on dust or smoke particles are destroyed by the WBCs, producing the enzyme trypsin. If there is deficiency of anti-trypsin, the surplus trypsin may diffuse and “digest” the alveolar walls, resulting the much less efficient, much bigger sacs. Those cavities can coalesce further and result in blebs, then bullae, the size of large balloons.
COPD is the third largest cause of death in America; and, in 2008, the American Lung Association revealed that there were over 13 million cases of the condition in the United States alone. About 9.8million of those were chronic bronchitis. The true incidence of COPD is probably considerably higher due to its under diagnosis, especially of the mild cases.
COPD is twice as prevalent in the female population as in males. Further, women who smoke are 13 times more likely to die of the disease than non-smoking women; while male smokers are 12 times more likely to die of COPD than men who do not smoke.
Common signs and symptoms of COPD:
Patients with COPD experience a wide range of symptoms which tend to increase in severity as their pulmonary function deteriorates. However, symptoms do not exactly correlate with lung function and can fluctuate, depending on a number of factors including sub-clinical infections.
Stage 1 or mild COPD may be characterized by a persistent cough and excessive sputum production, and noticeable breathlessness (dyspnea) after significant exertion. The sputum may be yellow or greenish if there is infection. However, not all patients with Stage 1 COPD will experience all of these symptoms and a few cases of early stage COPD may be asymptomatic and difficult to diagnose.
As the condition progresses, wheezing in the chest may appear. Bouts of pneumonia and other respiratory infections may become increasingly frequent, accompanied by chest tightness, worsening dyspnea, insomnia and anxiety.
Fatigue is a common to most chronic disease, including COPD and can significantly restrict the patient’s ability to work, perform household chores, look after their own personal care and engage in family activities. Even climbing a small flight of stairs can be exhausting, particularly in the more advanced stages of the disease.
The end-stage (four) of COPD may brings additional features like headaches and blue lips and extremities (cyanosis)- owing to insufficient oxygenation, and complications caused by pulmonary hypertension, including tachycardia, chest pain and swelling of the legs.
Introducing Stem Cells
Cells are the body’s ‘building blocks’ and stem cells are particularly powerful in that they can differentiate into different kinds of cells. Stem cells are classified in terms of both their potency (degree if differentiation and the number of cell types they can form) and in their source.
Embryonic stem cells (ESCs) are the most controversial type of stem cell. They are pluripotent, meaning they can differentiate into almost any cell found within the adult body, but they are only found within the blastocyst (a four to five day old embryo). ESCs are usually obtained from consenting participants of in vitro fertilization programs but can also come from existing lines and genetically modified donor egg cells (using somatic cell nuclear transplant).
Another type of pluripotent stem cell is the induced pluripotent stem cell (iPSC), a genetically modified somatic stem cell which by-passes the above controversies. It is formed by “stressing” the cells back to immaturity.
Then there are the somatic stem cells of which there are many different types, with more being discovered all the time. All adult tissues contain their quota of stem cells. These are more restricted in their ability to differentiate and are therefore termed multipotent or, occasionally, unipotent. A prime example of a multipotent stem cell is the mesenchymal stem cell (MSC) which is found in bone marrow, adipose (fat) tissue and the blood. MSCs can differentiate into muscle, cartilage, bone and fat cells amongst others.
A recent discovery from the Brigham and Women’s Hospital in Massachusetts was that the lung also contains its own supply of stem cells. Mouse models have also demonstrated how healthy lung tissue can be cultivated from stem cells and successfully integrated with existing damaged lung tissue. However, this does not mean that the same procedure would necessarily work for humans with COPD.
There are a growing number of clinical trials focusing on exactly how stem cells might best intervene to halt the progression of COPD. We know that stem cells are anti-inflammatory, immuno-modulatory and regenerative. So those properties could calm inflammation, modify auto-immunity and regenerate damaged and effete cells, reducing scarring, slowing the development of disease and perhaps reversing certain changes resulting in significant improvement.
But what about now? Is there any hope for patients with COPD outside of the long-winded clinical trials process?
Current Alternative Therapy Options for COPD: the office-based Stem Cell Route
At the present time, COPD is classified as a progressive and incurable disease. However, giving up smoking and medications such as steroids, and treating flare-ups often help manage symptoms and slow disease progression; but there is currently no known way to reverse any existing lung damage.
One option which is currently available to many patients with COPD is autologous stem cell therapy. Unlike other forms of stem cell intervention, this utilizes the patient’s own dormant stem cells, releasing them from adipose (fat) tissue, concentrating them and reintroducing them, usually via intravenous injection (and via nebulizer, inhalation directly into the airways). Autologous stem cell therapy is a simple, minimally invasive process generating minimal, if any, side effects. As it does not require HLA donor matching, laboratory processing or other time consuming activities, autologous stem cell therapy is a very quick procedure with patients experiencing very little downtime.
Adipose tissue is the preferred source of stem cells for autologous stem cell therapy for two reasons: it is more comfortable for the patient than the alternative (bone marrow harvesting) and the stem cells are more plentiful. This eliminates the need for external cultivation (expansion) and allows specialist centers of repute, such as the Gulf Coast Stem Cell and Regenerative Medicine Center, to operate a minimally-invasive, surgical procedure using a highly sterile, closed system.
There is evidence that once redeployed in this way stem cells will be attracted to the sites of damage, as they pass through the lungs. There is evidence that they also migrate along cell signaling pathways to all sites of injury and damage all over the body. Once at the site, they begin the regenerative and reparative processes. However, as with any intervention, individual differences between patients will affect outcomes and autologous stem cell therapy may work more effectively and rapidly for some patients than others.
The Gulf Coast Stem Cell and Regenerative Medicine Center is currently involved in numerous investigational trials covering a range of conditions including pulmonary diseases and COPD. For current information about ongoing trials and whether you might be eligible as a patient, please call (866) 885-4823. For more information on our procedures and stem cell therapy in general, we encourage you to explore our website: www.gulfcoaststemcell.com.