Podcast

Foreign. Talk about stem cell therapy. It's been around for decades, largely originally used for certain types of cancers, where people have a type of blood cancer and we would give them drugs, we give them drugs to kill off the stem cells in their bone marrow, and then they get a stem cell transfer from somebody else to restore their ability to make certain blood cells. And in the past 20 years or so, we're thinking more about stem cells for regeneration. Regenerative therapy, particularly arthritis, is the low hanging fruit. But people are also looking at stem cells for treating other conditions such as heart disease, congestive heart failure, idiopathic pulmonary fibrosis, multiple sclerosis, brain injuries, spinal cord injuries, liver disease, and a myriad of other other conditions. Let's kind of go over stem cells where we're, we're at today. So there's different types of stem cells. There's hemopoietic stem cells, which are the ones that are in the bone marrow for blood cells. And we're mostly going to talk about something called a mesenchymal or mesenchymal stem cells. People pronounce it different ways, but these are stem cells that are for most of the tissues in our body, such as bone, skin, muscles, cardiac tissue, liver. And then there's stem cells that are maybe more specific for the brain and other neurologic tissues. Stem cells can be harvested from different areas. The most common form of stem cell therapy has traditionally been from the bone marrow. So they would make a little incision, they numb your skin up and make a little incision to say, your hip. Put a little drill into the hip bone and take out stem cells. That's painful. And there's not a lot of the type of stem cells we want. There's plenty of blood type stem cells, but not a lot of these tissue type stem cells in the bone mar not, not, not very rich. Most common source of stem cell we're using now is fat derived stem cells. So in your fat tissue, which most of us have plenty, we've got a very rich supply of stem cells. In fact, there's probably 20 times more stem cells per milliliter of fat tissue than there is per milliliter bone marrow, about 500 times more. So it's very rich supply on the type of stem cells that we want. The stem cells are harvested through a very simple liposuction procedure. So we're all familiar with that. It's easy to do. It could be done a week. And there's two ways this is approached. One is to use devices that break up the fat cells. There's different kits out there, pure graft and lipogems where you take the fat and the machine breaks up the fat cells, frees up the stem cells and it's injected directly into the joint or into the tissue we injected in the face. So that's a common way this is done. There's individual clinics that have their own lab where they harvest the stem cells out of the fat cells. We had been doing that for years. We had a. We'd use an enzyme and an incubator and we would add the en. Incubate the fat and then the stem cells will be broken loose and we centrifuge it and take the stem cells. It was really a complicated process, took a long time. What we're doing now is much easier on us and on the patient is that we go ahead and liposuction the fat. We ship it to a lab called American Stem Cell Banking in Florida and they do that for us. They have a lab, it's sterile and they can. They take the stem cells out of the fat tissue, discard the fat tissue, then they expand the stem cells or as they grow them and then they bank them. You can bank them for the rest of your life. So you can have your own source of stem cells on call for when you need them, where you just go ahead and call and then get your stem cells shipped to you. So that's what we're doing now in addition to using these lipogens kits and other kits. And then there's umbilical cord and placental derived stem cells. These are quite different than embryonic stem cells. Embryonic stem cells are not legal in the United States. That's where you have an aborted fetus and we take the stem cells from. From embryo. That's not done in the United States at all. There's some embryonic stem cell research going on from em, you know, 30, 40 years ago, but nobody's doing that clinically. It's not allowed and not ethical. But umbilical stem cells and placental stem cells certainly are. People right now, when they have a baby, they have an option of banking their baby's umbilical stem cells for use later on, or they can just donate them. And then manufacturers would take those umbilical stem cells and umbilical cords and extract the stem cells out, in some cases expand them so those are available and the doctor can order them and you can use them. And then there's something called Exosomes, which are a stem cell product. Now stem cells have A what's called exosomes in them. Exosomes refers to a basically a little balloon or little bubble of growth factors, stem cell factors. And what happens now is clinics or I'm sorry, companies get placental stem cells, then they grow them and then they get the stem cells to express exosomes and then they extract the exosomes and then they sell them to doctors who can use them on their patients. So the free three main forms of stem cells we. Marrow derived stem cells. That was the most popular, kind of falling in popularity because of this, the more simplistic way of getting fat derived stem cells, which is largely popular right now. Fat derived stem cells, very easy. We have rich supply in it and you can bank them umbilical or placental stem cells and then exosomes, which are an umbilical or placental, even amniotic fluid stem cell product. So what are we using stem cells for? I've written three books on stem cells and one is regarding ms, multiple sclerosis, one's regarding joints, and one is regarding cosmetic uses, mostly on the face. We're talking mostly about arthritis. And I really think about a longevity practice like ours. We have things that we help people look better on the outside with cosmetic services, but we also want to do something for our patients so they can look better on the inside, be healthier, have a more extended life. And studies have shown that if you have single joint arthritis, such as the knee, lower extremity arthritis, that has some impairment on mobility and it's not reversed in some way, it shortens your lifespan by 1.8 years if you're normal weight and 3 1/2 years if you're obese. That's substantial. You know, imagine if you could take a pill that could stand your life by 1.8 to 3.5 years. You know, we'd all be taking it. If we have somebody with arthritis that's severe, they do things like joint injections of steroids. Well, the steroids just accelerate the time at which the arthritis become problematic to get a joint replacement. So that's not a good practice, really. Not supposed to do that very often. It's just for cheat inflammation that doctors do it, but it's not. It actually accelerates the time which you'll get a knee replacement. Then they inject hyaluronic acid, works a little bit. Some people can benefit with that, but it doesn't really reverse the arthritis. Then we have stem cell therapy that is emerging as a very good alternative to joint replacement. I was in a group called the cell surgical network with a few hundred physicians. And we had done a long term IRB study, institutional review board study, mostly looking at the safety of stem cell use over many years. Think about a decade. We started about 2014 in our studies and others found that most people who had stem cell therapy for the joints did not need knee replacements, did not need joint replacements. The stem cells were sufficient. Something that might need to be repeated, I guess, like a joint replacement would fail over time. This can put off a joint replacement. So how do stem cells work? Well, it's ongoing investigation in terms of figuring out just what's happening. The presumption to some degree had been that the stem cells would implant on the diseased tissue and regenerate. Well, that's probably not the case. There might be some component of that, but probably not the case. Especially since we know we can take stem cells from another human being with a totally different DNA and get an effect on your DNA and I'm sorry, on your tissues. So what appears to be happening is that the stem cells in your joint that are supposed to be repairing the arthritis are quiescent. They're called senescent cells. Senescent cells is a process where cells reproduce over and over again. And because of things such as inflammation, trauma, injury, they get signals to stop growing and just kind of lay there dormant. And they're alive, but they're dormant. They get a little fat and they get little, what's called vacuoles in them and they stop reproducing. They become unhealthy and they even put out a liquid called S.A.S.P. secretory. There's an essential associated secondary phenotype that tells other cells in the area to stop growing. We might be something like cancer or some disease cells. We got to stop growing. And hopefully, you know, sometime in the next, you know, few days, our body will go through and clean us up through a process called autophagy or auto on yourself faith, which is eating well. That occurs very well when you're 18 years old, 20 years old, 30 years old, 40 years old, starts dropping off as we get older and off. Autophagy doesn't work as well when you're 70 as it does when you're 30. And then the joints start degenerating or tissues start degenerating. Regardless of the tissue, we start accumulating these senescent cells. When that happens, the cells are not being replaced and the joint space gets thinner and thinner and thinner to eventually wear bone on bone. Arthritis. But there's still some cartilage in the knee, it's just not in the area of the main wear points. And there's cartilage that's left in the knee does have stem cells in it. They're just not active. They're inactive because they are senescent. What appears that the stem cell injection reactivates your intrinsic stem cells to start working again because you're getting messages to stop growing from other sick cells. And you're getting messages from this umbilical stem cell or fat derived stem cells that start growing fix stuff. And the cartilage does to some degree regenerate. Now it regenerates to a point where people have reduction in pain. And we can see changes on an MRI or X ray. But the joint does not go back to normal. If there's some bone damage, that bone does not remodel into a normal healthy looking bone. But the space in between the bones gets thicker and the cartilage gets thicker. This has been seen on MRI and X ray studies. So we are having growth of tissue, regrowth of tissue in an area that previously was not able to regrow. Now what works better, umbilical or fat derived stem cell? There are no studies comparing the two directly. There's some logic that a very old person may benefit from umbilical stem cells. But other studies have shown older people still have stem cells in their fat that are working just fine. Sometimes it's a matter of cost. Sometimes it's a matter of thinking about using your own stuff versus you getting cells from another human being. They do screen the cells for known pathogens, viruses and prions and bacteria. There might be other stuff that's being transmitted because you are getting a blood bank type product. There have been studies showing that umbilical stem cells can have results lasting up to seven years. That drives stem cells probably more like five years. So perhaps they last a little bit longer. There might not be a material difference. Again, there's no head to head comparison. So I really can't comment on that. In our experience and lure, we've been doing stem cell therapy since 2014. My brother had a spinal cord damage from a tumor and I investigated stem cells at that time. It was very new. He was my first patient. I did some cellular therapy on myself as well. I had a rotator cuff tear on my right arm. It was a subscapularis tendon. It was torn about 70% and I was scheduled for a surgery. Doesn't mean open surgeries. Had a big scar in my arm. They were short the biceps tendon and at that time, stem cells weren't quite right. But platelet rich plasma, which is another type of cell, starting to catch on. Some famous athletes were getting it done, so I learned how to do it, bought the equipment to make prp. I had a friend, this orthopedic doctor that is familiar with ultrasounds of the joints and he injected my shoulder with. Injected my tendon, sorry, my ligament, the subscapularis ligament. With PRP and a heel back actually 100% has been fine for all these years, 13 years. So it's been around a while. We don't have a drug form of stem cell therapy still like a surgical procedure or a blood product from another human being from a baby umbilical cord or a placenta. Our experience going back to 2014, we were in a registry. We'd follow patients along. We had one infection over the years, so there's always a concern of that. And fortunately healed without a problem, although there was intervention needed otherwise and just a huge number of cases on other doctors. It's a very safe procedure. We have a over 85% success rate. Success meaning that the pain is meaningfully improved. There's probably different factors why some people might not get as much success as others. And we learned how to select out the right candidates. People with a significantly crooked knee, we call it Genuvaris or Genu valgus. They have lower risk of good long term results because there's such a deformity that the injuries can occur over and over again. But in general this is a safe and effective procedure for most people. It's usually done as a one time service but you can repeat it to get say more better. We have a lot of people that get it done and they get, you know, 50 or 70% reduction in their symptoms and they said I'm going to do it a second time six months later to see if I can get closer to 90% better and that's okay. We also have people that want to do stem cells for wellness and anti aging. They get intravenous stem cells on their own stem cells. So we call the lab that stores their stem cells. They send us a bottle of stem cell that has 10 million stem cells and we infuse them through an IV and there's not good studies on showing what this is going to do. This is more of a out there part of medicine where we think it's going to give some benefit and target areas of senescent cells. And there's been studies demonstrating benefit, but it's not very well grounded in the science just yet. There's a study, for example, where they took stem cells and tagged them with a radioactive isotope which we use in nuclear medicine commonly. It's a very safe procedure. But they tagged these stem cells and they injected somebody that had two inflammatory conditions. One was called Duper's contracture, which is an inflammation of the tendon in the hand. Another thing is called Peyronie's disease, which is inflammation of the penis, where the penis is crooked, it's got inflammation going out of scarring. And they infuse a person, this person, in both these cond them with the stem cells and they did the nuclear scan. And the stem cells wind up honing in on those two organs, the hand and the penis. They do go everywhere throughout your body. When you get an injection, is that the best way to do it? Well, we've been doing that for years with patients with neurodegenerative disease, strokes, cervical spine injuries, autoimmune diseases. We get clinical results, we get definitive clinical results. I wrote the book on Ms. With stem cells. We found that people that have Ms. Using their own fat derived stem cells, they seem to go into, are close to remission or remission for about nine months to maybe a year. So there's a, there's an immunomodulation effect of stem cells on autoimmune conditions. We've had people with strokes that were remote or years ago, years old, they've been in this condition for many years, get clinical improvement after stem cells. And we have people with spinal cord injuries, you know, functioning in, such as going from totally immobile to being able to walk with assistance. So that is, that has, you know, been identified with stem cell therapy given intravenous. At one time we were giving a medication called mannitol prior to the stem cells to open up the blood brain barrier. We don't do that anymore. Appears that the stem cells get through the blood brain barrier without that benefit. And also one time we're doing intrathecal stem cells, we're injecting them into the spinal cord through a spinal tap. And that does not appear to be necessary anymore. Easier either. You can do it just intravenous. We've treated emphysema, advanced emphysema. We've had patients that would come in every nine months or so, which is a really severe debilitating condition. And they were able to survive, get out their oxygen and live longer than they would have otherwise. With emphysema you're still going to have a shorter lifespan, but you can get healthy years and live a little longer with health, health. Being able to breathe, that's beneficial. Stem cells have been used to treat congestive heart failure and heart attacks. They've been used to treat a variety of conditions. And where we're at right now is that the stem cells are in a medical and legal gray zone. So back prior to 2020, my group's cell surgical network, I'm not with them anymore. When I was. We were. Most of the doctors were making stem cells on their own in their own office, which is considered legal to do. You can take the fat. You know, we can say take cartilage from a rib and fix a nose. There's things we can do moving tissues from one spot to the other. And the FDA started suing doctors, saying, well, you know, you're manipulating the tissues, therefore it's not a surgical procedure. You're actually making a drug. And they sued doctors 20 or 30 times and lost every time. Then finally they went after a doctor in Florida who was doing this, who had a problem. He had a serious problem with the stem cell patient. So there's an injury. And the judge sided with the fda, said, yeah, this is definitely a drug. We have to prohibit doctors from doing this procedure. That was about three years. And in 2022 or two years, 2022. I mean, it's 2023. It was relatively recently. A Joe Judge overruled that, and he noted that the FDA had made up the law that they used to shut the concept down. They inserted some language into the FDA's charter, which is given by Congress, and they changed the law to suit the fda, which the FDA is not allowed to do. In other words, the FDA is part of the executive branch that's supposed to carry out laws, but they're not supposed to write them. And in this case, they had written laws themselves and tried to enforce them. And then of course, the judge had called them out that you're not allowed to break the law like that. So stem cells. Right now, the legal milieu would be that a doctor can do this manipulation with, with the enzyme where they take the fat out, get the stem cells out, inject them. We've chosen not to do that just because of the harassment that the government has done to doctors in the past. And we're just using a lab that does it for us. So we either take the fat out, we use an FDA approved device to do it, and then we alter the fat tissue that gives us stem cells and inject it in the joint directly, or we send it to a lab that is certified to take the stem cells out and store them and bank them. So we no longer separate the stem cells out with this process that appears to be legal now. But again, this harassment from the government, we decided not to, not to do that. The government can definitely harass people. So that's the state of the stem cells in our practice. It was really something we're doing quite commonly in 17, 18 and 19. And when the FDA started raiding doctor's offices for doing stem cell therapy, we backed off on it because there was no legal precedent. But this is again, all changed in the past, I think a year and a half ago when, when the judge ruled that the FDA had been more or less cheating. So stem cells are getting a resurgence. Now. The real holy grail will be when a person makes or a company makes a stem cell drug, which there's some companies working on right now. There's one called Cellularity, I think they're out of Georgia. There's a neurosurgeon who runs the company and they're taking placenta stem cells and growing them. So they're calling, expanding them and they're working on getting FDA approval for their form. Right now we're just buying it from a lab. But to get an FDA approved drug will pave the way to more acceptance because once it's FDA approved, then maybe a decade later could be potentially covered by insurance. There's no way it'll be covered by insurance anytime soon because it just takes a long, long, long time. Or first up, FDA approval, new drug, and then for insurance companies to accept that this has a meaningful improvement on people's lives, even though clinically we know what's happening. So right now it's self, it's self pay versus a knee replacement that's technically free if you got great insurance. But these are very expensive. The average cost is somewhere around 70,000, all in physical therapy and everything. And a knee replacement has a high morbidity rate, complication rate about 2%. And there's a substantial amount of post procedure pain, nerve injuries and other things that occur which we don't see typically with stem cell therapy. So I propose stem cell thera is a reasonable alternative to certainly to getting steroid injections, which are probably not a good idea. Much better than the hyaluronic acid injections and better than platelet rich plasma for people with advanced arthritis, mild arthritis, PRP is a good, good option and you can do it on your own. Find a clinic that does it. The type of stem cells you use, whether you use umbilical, placental fat, dried bone marrow, they probably all work to some degree. I favor fat and umbilical because they're richer sources of stem cells. Pretty easy to get. Not painful to. Not as painful. Anyways, liposuction is less than a bone marrow aspiration. So the stem cell therapy for arthritis, I, I'd say that, you know, if this is something that you can afford and you want to live a longer, healthier life, you have arthritis. We know that, that the immobility is sort of decreased mobility associated with arthritis. The less exercise and stuff leads to a shorter lifespan, 1.8 years for people with normal weight and 3.5 years of people that are obese in a clinical study. And we want to get those years by reversing the arthritis and maybe that a knee replacement is not the cards for you. So with that risk that a stem cell is something you can, you can undertake, the cost is all over the place. You know, people are going to other countries to get stem cells because again, the harassment the FDA was doing on American doctors and it was costing upwards of 25,000. I think you can get way, way less than that, maybe five times less than that in the United States right now. Again, the government is not hassling doctors anymore because they were kind of smacked by the judicial department for breaking the law. So your doctors are re entering this space again. We'll see this become more of a mainstay treatment for arthritis in the future. Thank you.