BPC-157 | A potential breakthrough in injury repair

What is BPC-157?

Studies suggest that BPC-157 may be beneficial in protecting organs - especially the stomach - and assisting with the healing of various injuries. Because of this many athletes are turning to BPC-157 to help recover from injury.

BPC-157, also known as Bepecin, is a synthetic peptide. A peptide is a small chain of amino acids, BPC-157 consists of a sequence of 15 amino acids. BPC-157 is derived from a protective protein found in human stomachs. As it is not found in nature it is considered ‘synthetic’, however it is derived from ‘natural’ components.

What evidence is there that it works?

The animal studies on BPC-157 appear very promising, it shows potential as a therapy to aid recovery in soft tissues, tendons and ligaments. In these same studies very few negative side effects have been observed, however these are not human studies, so caution should be exercised when extrapolating these results onto humans. Extra care should be exercised if consuming BPC-157 as the potential for negative side effects in humans is not fully understood (1).

For tendon and ligament repair

Due to low blood circulation, tendons and ligaments tend to not heal very well. In one study, the Achilles tendon in rats was cut and BPC-157 was administered to these rats. Healing in the group of rats administered BPC-157 was significantly improved compared to a control group (2). Another studs found similar results when the medial collateral ligament (MCL) of rats was cut and BPC-157 was administered (3).

Further studies have also demonstrated BPC-157 helps with tendon to bone repair (4).

For skeletal muscle healing

Skeletal muscle is the muscle we use in voluntary movement – and that which is most commonly injured in sports. It is one of the 3 major muscle groups, the other two being cardiac muscle (the muscle in the heart) and smooth muscle (muscle which is not under conscious control, such as those lining our intestines).  

In another rat study, the quadricep muscle in rats was cut and BPC-157 was administered. The rats given BPC-157 again showed significant improvements in healing (5).

In addition to healing muscle injury from trauma, studies suggest that BPC-157 may also be effective in healing other systemic muscle problems. Muscle wasting and damage can be caused by many factors including infection, certain diseases or medications. For example stomach lesions can be caused by taking too much ibuprofen.

Various animal studies have demonstrated BPC-157’s ability to assist in muscle repair processes in the instance of:

·         Stomach lesions (6)

·         Potassium overdose (7)

·         Inflammatory bowel disease (8)

·         Overdose of anesthetic (9)

·         Magnesium overdose (10)

·         Weight loss in cancer patients (11)

 

How does it work?

It is still not fully understood how BPC-157 works however it is believed to act on a number of pathways, including the nitric oxide pathway (12) , the FAK-paxillan pathway (13), and upregulation of growth hormone receptors (14).

What are the risks?

There is no known toxicity level for BPC-157 and significant negative side-effects have not been observed. In addition BPC-157 is derived from human gastric juices and therefore is potentially safer that other peptides or drugs which are derived from non-human sources. However caution should still be exercised.

There are only a small number of studies on BPC-157 and almost all of these have been performed in rodents, so the risks for humans are not known. The mechanism of action is also not fully understood.

Some concern has been raised that some peptides and growth factors may promote cancerous tumor growth, however no evidence has been shown to suggest this is the case with BPC-157. In addition BPC-157 has been shown to inhibit and counteract several tumor lines (15).

how is it taken?

BPC-157 can be purchased in many forms, as an injection, a cream and as a tablet.

One study compared the effectiveness of injection versus a local treatment using a cream. Both treatments were administered to two different groups of rats who had their muscles crushed, both methods of treatment proved effective (16). Additionally BPC-157 appears to be effective when taken by mouth (17).

BPC-157 is usually taken daily therefore taking by mouth is preferred by most. It avoids the need for a daily injection - and the associated risks which come with any injection - such as pain at the site of injection or possible infection.

The oral dose which was effective in rats translates to approximately 100-200ug for a person per day.

REFERENCES

1) https://link.springer.com/article/10.1007/s00441-019-03016-8

2) https://pubmed.ncbi.nlm.nih.gov/14554208/

3) https://pubmed.ncbi.nlm.nih.gov/20225319/

4) https://pubmed.ncbi.nlm.nih.gov/16583442/

5) https://pubmed.ncbi.nlm.nih.gov/16609979/

6) https://www.sciencedirect.com/science/article/abs/pii/S0928425799001205

7) https://pubmed.ncbi.nlm.nih.gov/23327997/

8) https://pubmed.ncbi.nlm.nih.gov/24304574/

9) https://pubmed.ncbi.nlm.nih.gov/27060013/

10) https://pubmed.ncbi.nlm.nih.gov/28210905/

11) https://pubmed.ncbi.nlm.nih.gov/29898649/

12) https://pubmed.ncbi.nlm.nih.gov/23755725/

13) https://pubmed.ncbi.nlm.nih.gov/21030672/

14) https://pubmed.ncbi.nlm.nih.gov/25415472/

15) https://journals.lww.com/melanomaresearch/Citation/2004/08000/BPC_157_inhibits_cell_growth_and_VEGF_signalling.50.aspx

16) https://pubmed.ncbi.nlm.nih.gov/18668315/

17) https://pubmed.ncbi.nlm.nih.gov/27895400/

Stem Cell Therapy for Sports-Related Injuries

In the last 5 years, we have seen an increasing number of professional athletes turning to stem cell therapies to recover from injury. Tiger Woods, Rafael Nadal, and Max Scherzer have all been reported to have undergone stem cell therapy for their sports-related injuries. 

While stem cell therapy was once prohibitively expensive for most, prices have come down significantly, making it more accessible. In this article we will discuss what stem cells are, the various treatments available and their efficacy and cost.

What are stem cells?

Stem cells are cells in the body that have the potential to self-renew, develop into other types of cells, or divide into identical cells. When there is an adequate source of resources and the right environment, stem cells have the ability to change and become cells with highly specialized functions. Moreover, stem cells are the cells that are responsible in tissue repair and injury recovery in the muscles, liver, kidneys, and lungs (1). There are several types of stem cells:

• Pluripotent stem cells could become progenitors of any type of cell in the body. For example, embryonic cells could become stomach, lung, skin, or brain cells.
  
  
  
  

• Multipotent stem cells develop into different specialized cells of a specific tissue. Unlike pluripotent cells, the fate of multipotent cells is limited.
  
  
  
  

• Mesenchymal stem cells (MSCs) are an example of multipotent cells that can develop into bone cells, cartilage cells, and muscle cells. MSCs are currently very significant in stem cell therapy because they can readily be harvested from adult donors, unlike the other types of cells.
  
  
  
  

• Unipotent stem cells have the ability to become only one type of cell. For example, the satellite cells of the skeletal muscle are limited to becoming mature skeletal muscle cells (2).

What is stem cell therapy?

Stem cell therapy is a treatment approach that utilizes stem cells grown in the laboratory. These cells are used to replace lost tissues or to assist existing tissues in performing specific functions. 

Current techniques of stem cell therapy commonly utilize MSCs because they can be derived from various adult organs and tissues, making it easier to be acquired as compared to pluripotent cells. MSCs can be harvested from the placenta, fat cells, liver, lung, or blood vessels (3). 

Stem cells are first harvested or isolated from the donor tissue. The cells are then grown or cultured in the laboratory. When successfully cultured, stem cells are then injected to the recipient and are expected to home to the target organ, in most cases, to the injured site. The recipient is then monitored for possible inflammatory reactions following the injection of stem cells (3).

Stem cell therapy for injury repair

The US Department of Health and Human Services estimates that the average annual number of sports and recreation-related injuries is at 8.6 million per year (4). The ability of MSCs to become mature bone, cartilage, or and other connective tissues make them ideal sources of regenerative tissues for injury repair, especially for sports-related injuries. MSCs could function as regulators of growth and maintenance in these tissues (1). In addition, MSCs release different substances that stimulate the existing cells in the injured tissue to undergo cell division, hence increasing the number of cells and promoting tissue survival (5).

Current regenerative medicine techniques for sports-related injuries include 3 methods:

·       Platelet-rich plasma

·       Bone marrow concentrate

·       Direct grafting of stem cells

The use of BMC and PRP injections have been effective in addressing failed healing or delayed healing fractures. Other recent developments also show BMC and PRP to be effective in rib and mandibular fractures (6). Meanwhile, through the direct grafting of tissue-specific stem cells, MSCs that have matured into the desired tissue type can be integrated into the target tissue (5). Let’s take a quick look at each of these methods.

Platelet-rich plasma

PRP contains a high concentration of platelets and various biologic substances such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), and many others. As the cells are derived from the patient the potential for adverse reactions and infection is very low. PRP is not made up of stem cells, but the use of PRP has been found to stimulate MSC proliferation. Thus, PRP is a vital component of stem cell-based therapy in sports-related injuries (7). 

A study published in 2012 showed that the local application of PRP in the repair of rotator cuff injury in patients reduced the pain after surgery. In addition, long-term results showed that PRP aided in the healing of rotator cuff injury in patients (8).
 

Bone marrow concentrate

Bone marrow concentrate (BMC) is another tool that is used for sports-related bone injuries and other lesions. BMC is a rich mixture of MSCs, different bioactive molecules, white blood cells, and platelets. Just like PRP, BMC is also harvested from the patient. This reduces the risk of infection and immune reactions. BMC is used to deliver stem cells to damaged bone, thus initiating repair and healing.

A clinical study done in 2016 showed that treatment of discogenic back pain with BMC injections provided relief of pain and disability improvement. BMC was delivered via disc injection to 26 patients, which showed improvement over the span of 2 years. This will not only benefit athletes with back injuries, but also the general public who could be chronically experiencing back pain (9). Another study published in 2015 reported that the use of BMC for open Achilles tendon repair resulted to excellent outcomes, characterized by early mobilization and zero re-ruptures (10).

Direct grafting of stem cells

Emerging biotech research studies have used the direct grafting of stem cells to focus on the production of tissue engineered bone bioscaffolds. These bioscaffolds are meant to function as a porous and permeable solid structure for stem cell attachment, growth, and migration. Such scaffold material would make it easier for stem cells to adhere to the injured tissue and promote growth of new cells (5). Most of the current studies on the use of stem cells on grafts to repair bone and muscle injuries are still experimental. No clinical trials have been reported so far.

How much does stem therapy cost?

The cost of stem cell therapies depends largely on the specific type of stem cells and tissues involved and the extent of injury. In the US, stem cell therapy for knee injuries range from $3000 to $5000 but the most expensive ones can reach up to $50,000. The same type of treatment costs as low as $2000 in Mexico and in Asian countries such as Thailand.

References

1. Stem cells and the evolving notion of cellular identity. Daley, G. 1680, 2015, Vol. 370.

2. Adult stem cells: hopes and hypes of regenerative medicine. Dulak, J., et al. 3, 2015, Vol. 62.

3. Browne, C., Chung, T. and Atkinson, K. The Biology of Mesenchymal Stem Cells in Health and Disease and Its Relevance to MSC-Based Cell Delivery Therapies. [book auth.] L. Chase and M. Vemuri. Mesenchymal Stem Cell Therapy. New York : Humana Press, 2013.

4. American Physical Therapy Association. Sports and Recreation-Related Injuries Top 8.6 Million Annually. APTA. [Online] January 4, 2017. https://www.apta.org/PTinMotion/News/2017/1/4/SportsInjuries/.

5. Young, M. and Doran, M. Mesenchymal Stem Cell Therapies for Bone and Tendon Conditions. [book auth.] L. Chase and M. Vemuri. Mesenchymal Stem Cell Therapy. New York : Humana Press, 2013.

6. Siddiqui, I., Mazzola, T. and Shiple, B. Techniques for Performing Regenerative Procedures for Orthopedic Conditions. [book auth.] G. Malanga and V. Ibrahim. Regenerative Treatments in Sports and Orthopedic Medicine. New York : Demos Medical Publishing, 2018.