Advancements in Regenerative Medicine

Hi, Dr. Molk. Today's 2025 and I'd like to know how you're seeing the field evolving over the next five to 10 years in regenerative medicine practices.

Well, that's a great question. So the entire regenerative medicine is pretty much a recent specialty, a recent, recent concept. It's the idea of getting your tissues to self heal or restore things. And I think there's a lot of different ways we can think about regenerative medicine. The classic one is stem cell therapy or platelet rich plasma. But there's also other regenerative techniques that we offer. And a good example I think of regenerative medicine would be a woman goes through menopause, her ovaries are no longer functioning and we see a rapid decline in health. Weight gain, decreased energy, more brittle bones, more cardiovascular disease, more rapid onset of neurocognitive decline. And by simply putting a pellet in of testosterone and estrogen and maybe some progesterone. This is your body doesn't even know it's lost its ov and those tissues actually can regenerate. The metabolic syndrome can be reversed. It even estradiol actually reverses cardiac plaques and burden of atherosclerosis on your heart. It helps with weight, maintain weightness, helps with maintenance of weight, it helps with bone density, helps with energy, libido and sex drive. Same thing can be said for men. Nothing about weight loss is being regenerative because if you are metabolically unhealthy and you lose weight, your liver, your brain, your tissues, your kidneys, all these organs improve. In fact, even just taking somebody who's not diabetic, but maybe they're pre diabetic or maybe they don't even fit that criteria yet. And they take a medicine used to treat diabetes, they outlive their peers, taking nothing. Sometimes I hear the badge of honor of not taking any medicines. That's great if you're not taking any, but if you're on a borderline disease, your blood pressure is borderline, or your weight is borderline, or your diabetes is borderline, you should treat it as if it really exists because you'll live longer and that's regenerative. We do a vein procedure where people have sores in their legs and we react to blood with a vein surgery that's regenerative. We have people with sleep apnea and their airways changed over time. Maybe it's genetic, but you usually it's from years and sometimes weight and we can regenerate those tissues, open up the airway Allow people to breathe better, sleep better, have less sleep apnea. So those are all regenerative. And the classic one is both platelet rich plasma and stem cells. And that's the kind of the classic regenerative medicine. That's where most of the interest is right now. That's really what people, I think a lot of times think about when thinking about regenerative medicine. So we talked a lot about platelet rich plasma, which platelet rich plasma and platelet rich fibrin. The discussion between those two is not necessary in this video. But I would tell you that they're basically the same thing. Most doctors were using PRF and calling it prp. Some doctors were using truly a pure PRP which is not as effective as prf, but most of us were already using it. The term just came around more recently to differentiate activating or inactive platelets. When the platelets are inactive, it's technically prp. When they're active, it's prf. Doctors have been calling PRF PRP even though it's prf. So platelet rich fibrin versus platelet rich plasma. But that's most people are using platelet rich fibrin. And this has the ability to heal things such as cuts or wounds. When we do laser resurfacing at somebody's face, we put PRP on, they heal better and actually get a better result, faster healing. And now we're seeing a big world of PRP into joints for arthritis. And that's really exciting because years ago we knew it did something to help with pain. And now we're seeing restoration of cartilage, decreased inflammation, normalization of function with just simple prp, which is or prf, which is taking from your blood process in a very simple method through an FDA approved, FDA cleared device. And you can insert this stuff into the joints and if you have arthritis or tendon injury inflammation, they get better. Now the amount of treatments necessary joints that can or cannot be accessed vary by practitioner, but the number of treatments maybe vary based on how bad the disease is. Particularly one to three treatments over a year will give you about a 12 month response. Myself, I have, I did genetic testing, extensive genetic testing and I'm at risk for knee arthritis. And my mother had her knees replaced when she was her late 60s. Both of them, she had bad arthritis and I did an X ray ten years ago, my knees and they're really healthy and I want to keep it that way. So I was doing things preventatively such as photobiomodulation, extracorporeal Shockwave therapy and never really changed. And then about six years ago, five years ago, I started getting a little bit of inflammation. My knees, when I ran up the stairs and stuff. Can X rays still look good? No. No demonstrated evidence of arthritis. But of course it's in a. You don't just develop it one night, you kind of grow into it. So I did PRP back then, and then no more heat in my knees when I ran up the stairs for about three years. And then I did it again. And that was two and a half years ago. I'm about to do it again this fall because I've been starting to feel it a little bit again and again. In these 10 or so years, my knees have not changed, you know, at this genetic risk because I've been doing things to stop it. If we look at knee replacement surgery, the fastest growing group of people having their knees replaced are people in their 40s. Now let's think about that. A knee replacement is good for a certain number of years and it's really based on how active you are, determines how long they'll last. In other words, if you're more active, they last less time. They essentially wiggle loose. And once you had your knee replaced, technically running and jumping, it's, it's out, that's done. And we need active joints to be able to run and jump and be active to be able to live a longer, healthier life. There's a clear correlation between your activity and your lifespan. A study was done looking at the mortality rates in people with single joint arthritis versus those that don't. When they adjust for other factors such as, you know, weight, hypertensive smoking, it's about 1.8 years. If you have arthritis in your joints that does have some limitation your activities and you don't deal with it, it's 1.8 years of lifespan. It'd be nice just to buy that back by getting some prf. If you're overweight and you have joint arthritis, let' obese and have joined arthritis three and a half years. We can reverse both of these. Now we've regenerated techniques and I'm often asked the difference, Ask the question, what's the difference between stem cells and prp? So there's a, there's the scientific aspect, which is they're different cells. So PRP people call it cell fragments. They only have a nucleus and they are the healing tissues in your blood. So when you get a cut, you start bleeding and some things happen. There's some little bit of vasoconstriction that happens from the calcium in the blood. And there's platelets rush in the area and they start creating clotting factors. And within a few minutes they start laying down something called fibrin to clot the wound up and then it gives out. Three important growth factors. There's probably others, but three important ones. One's called platelet derived growth factor that pulls cells into the area. It starts normalizing, healing, stimulating certain cells to start being active. There's something called vegf, vascular endothelial growth factor that breaks circulation in the area, something called neovascularization, new tissue in the area. And then transformative growth factor tgf, which causes cells to change into more mature cells. So these are all growth factors when we cut ourselves. So then we can harness the power of those platelets and put it in your knee and get those same growth factors. Now stem cells, on the other hand, these are immature cells that can alter into mature cells of different tissue types. Now there's various stem cells in your body. The most common ones we think about are called mesenchymal stem cells and hemopoietic stem cells. The mesenchymal stem cells are the ones we use for primarily for regenerative stem cells purposes. The hemopoietic ones are actually been around for since the 1960s. And these are in your bone marrow and they're used to do transplants to people who had say, bloodline cancer. So I'm not going to talk about that portion. And the bone marrow contains both mesenchymal stem cells and hemopoietic. The most common source of stem cells that we're using is fat derived stem cells is from your own fat tissue. There's way more stem cells per unit of fat space in the fat than in the bone marrow. But even though that's not the case, there's no compelling evidence that one form of stem cells is better than another. Not clear why, but there's clinically doesn't seem to be any difference. And a third form of stem cells is from umbilical cords from donated birth tissues. In these stem cells, they're called mesenchymal. It's a certain germ labor of our body. And they can stimulate growth of cartilage or growth of tissue in the area that they're placed. So the stem cells have something called exosomes in them. And we used to think that was little waste products from the stem cell, to which some degree they are. But they also carry many growth factors and messengers, chemical messengers to adjacent cells. So let's say you have knee arthritis, which is the prototypical one. That's really where most literature has been on stem cell therapy because it's such an easy target. So common. Millions of Americans suffer from that very easy organ to get to. And it's a very simple tissue versus say, the brain, the eyeball. So if you had knee arthritis, you have stem cells in your knee. Even if you're bone on bone bone, they're there, they're there. But because of the wear and tear on your cartilage, many of your cells have become senescent. That's like senile senescent. And they are sending out messengers. It's called sasp. They're saying these messengers to other cells to just kind of lay low for a while. Don't divide, don't grow, don't replicate and don't die. And when this happens, your stem cells become more or less paralyzed. They're not doing anything. Some people call them zombie cells. When we put the stem cells from another tissue that are not synthetic or not senescent, they wake those back up. They send out different signals, exosomes through the exosomes, different cytokines and stuff, and they wake them back up so they can start growing again and cartilage can grow back. This is what we understand to be happening scientifically. We have a long ways to go and understand all that's happening. So those are the two tissues. Now, what's the difference clinically between the platelets and the stem cells, be they from fat, umbilical cord, or bone marrow? The stem cells are typically kind of like a one and done, where you get the procedure done and a couple months later, typically funct starts improving, pain starts improving in the last three to five years, somewhere in that order. Whereas the platelets might have to do more services, more treatments, and it's probably gonna be more like nine months to a year. So there's a little difference in durability. And one time we were thinking people with more severe disease should go to stem cells and more mild disease go to platelet rich plasma. There's some truth to that, but there's a difference in cost. And if that's a concern or it's your first time doing something, you don't want to get the fat taken out. You can start with platelets. It's gonna typically work anyways, more than 80% effective. So it's a good option. I think really the message that I would like to say is if you have arthritis and you're thinking about knee replacement, you're probably gonna put that off for a while because there's major problems with knee replacement. And you can do platelets or you can do stem cells. Generally speaking, you're gonna get a response. Most people do. And you don't have the problems associated with knee replacement such as, you know, you can't go to the regular screening at the airport. Less risk of the complications associated with knee surgery. A lot less expensive. And it's an option for people. And I think the fact that it's not covered by health insurance turns a lot of people off. I think a lot of people love themselves more than their possessions and they might prefer to take care of themselves first. I think there's also skepticism because of insurance on the COVID It must not work. It doesn't really work that way. There's a couple reasons why insurance coverage will not be coming soon. One is it's a little too new to be standard of care. Number two is there's multibillion dollar companies making medical devices that really aren't going to promote something like stem cells. That's got to come from somewhere. Thirdly stem cells and platelets come from your own body. And none of us have the money to spend billions of dollars to get or at least tens of millions, hundreds of millions dollars to get FDA approval for a certain type of procedure or to get insurance coverage. It's very hard to do. So it's not like a conspiracy thing. It's just that it's a perfect storm where this is not going to happen. Now we see certain state governments are offering their employees regenerative therapy therapies. Certain countries are. But in general we're not going to see Medicare Blue Cross cover this anytime soon. So it is out of pocket. Fortunately, it's not that expensive right now. And even though it was expensive at one time, with more rapid, say, acceptance of this, doctors are able to do more procedures, get more efficient, really bring the cost down. Remarkably, given the cost of us preparing the platelet rich plasma has dropped by over 90% in the past five years from the kits that were available than the ones that are now. So it's really been a, been a game changer. How much fat do you need to get a stem cell treatment? It's not very much. A few teaspoons and we have the ability to send your fat to a lab with a bank and store your stem cells for rest of your life for a fee that you pay the stem cell lab. Then we order them, they send us a little bottle of say 10 million stem cells. So that's the state where we're at now. And I've been involved with this for about 14 years. I was a first patient. I had a rotator cuff tear, subscapularis. 70% is supposed to be repaired. And a friend of mine's orthopedic surgeon was gonna do the surgery and there's gonna be open surgery shortening the bicep tendon. And I read about different athletes getting prp, so I learned how to do it. I had a friend, another friend of mine, this orthopedic guy, inject my shoulder into the tendon and it grew back 100%. It's been 14 years, perfectly normal, no symptoms at all. I'd have to re injure it. In other words, just fix forever. I had an injury that hurt in the first place. So this has been something that's been with us for a while. Very excited about the impact it has on longevity. And I think regenerative medicine does tie into longevity. Now it's not going to give you a better epigenetic age or change other factors of aging that we can measure. But if you look at measurements of aging, we can look at, there's blood screening tests, biologic aging, there's companies like Function Health and Inner Age. You can pay for blood tests and see how your chemistries are aging compared to other people. Your age group. I'm like 13 years younger than my age in terms of my blood chemistry industries. There's something called epigenetic age that measures the age of your DNA. I've been working on reversing that age. You can measure your, what's called VO2 max, your ability to say, perform endurance or high intensity exercise. There's a way we measure that. The higher that is, the longer you will live. Muscle strength relative to your weight. The more strong you are for your weight, the longer you'll live. More metabolically healthy, which you'll measure through this biologic test. And if you're having immobility issues where you can't really go out and take a brisk walk or ride your bike, you're going to shorten your life materially. Yesterday I took a hour long 18 mile bike ride. This morning I got my elliptical. It's kind of like an elliptical, but it's actually got wheels on it. They're really aggressive, 40 minute high intensity workout. And I'm able to do that because I don't have any knee pain even though my mother was impaired at this time. I don't have a rotator cuff pain anymore. And that was really through regenerative medicine. So very bullish on it. And I want to get this to a price point where virtually any anybody can do it. And you'd be silly not to. If you have that condition, it's kind of a no brainer. Again, doesn't work for everybody. But high degree of effectiveness. There was a study done in Thailand where they looked at what they called survivability and they measured. They had people that were scheduled for total knee replacement because these are people with advanced arthritis. And they were scheduled for surgery and they put them into a program where they do PRP into the joint. They actually PRF and they put it into the joint. And at the end, two or six months, I can't remember exactly when they would measure their pain scores. And if it was improved by less than 50%, they went on to surgery. If improved 50 to 70%, they gave him another shot of PRP. It was proved 70% or more. They said, okay, let's just see how you do. And you can get another injection whenever you want to fall below that 80% at the end of three years. Three years, right. About 80% of the people that were scheduled for surgery never had surgery. 80%, four out of five did not have in their threshold. Threshold was so low. If somebody had a 40 improvement, I would have given another shot. In this case, they actually did surgery on them because they were trying to figure out from a public health standpoint could they save money on a public health or universal healthcare in that country. So even with that low threshold 80% success rate, that translates probably in real world a little higher success rate. But could four out of five knee replacements be avoided for at least three years? That's really good math. And of course you can continue to study on as long as you want to. What happened is that the people that failed usually failed in that first round. Instead of giving them a shot, they just did surgery on them. But the average person got something like two shots over the three years. So really good success. And the studies that are coming out are really numerous and they're generally all showing benefit versus anything else. With VAL steroid shots, the HA injections, these are actually regenerative versus just palliative.