Stem Cell and PRP for Regenerative Therapy

Foreign. Talk about arthritis and regenerative therapy and different options which would mostly be regenerative of stem cells or prp, prf. And I've spoken before about PRP and prf. What the differences are, they're almost the same. We usually either activate the PRP to make a PRF or you get straight prf, platelet rich plasma, platelet rich fibrin. And then stem cells typically are either adipose drive means comes from your fat cells or derived from the bone marrow. We have clinically only used adipose derived stem cel last 10, 11 years. Bone marrow stem cells been around for a long time as well. Some people feel bone marrow stem cells may be inferior because there's less mesenchymal stem cells per say centimeter of bone marrow than there's a fat. However, there's not good clinical evidence to show there is much of a clinical difference. Large meta analysis, which is a grouping of multiple studies showed superiority of fat derived stem cells. But I can also find papers that showed that they work about the same. So let's talk about, you know, somebody has arthritis. It's a big common problem in America about if you look at people over 60, it's, it's about 35 of women and 15% of men have clinically significant arthritis, most commonly knees. And this does impair activity which impairs health span and lifespan, longevity and mostly because of more limited activity as we get older, we want to be more active versus less active to stave off disease. Pretty much every disease is more associated with inactivity. So being mobile is crucial. And you're only as good as your worst joint. So if we have a knee arthritis, we want to address that. And surgery is certainly one option. Now there's some concerns regarding surgery with the big downtime and how long the surgical implies implants last. A lot of people are looking for regenerative therapy to try to use their own cells to heal their tissues. And we've been doing this for over 10 years at Allure. So I'm gonna go kind of over the different options and what might be the pros and cons of each. So step one would be, and again, I'm not talking about the conventional medical treatment, which is not regenerative, that is using steroids which actually hasten or accelerate the time when you'll need an arthritis. Arthritis surgery or hyaluronic acid, which is a lubricant. It's not really an acid, it's more of a sugar. Alcohol, but it's more of a sugar. But It's a lubricant for the jo, does reduce symptoms but does not put off surgery substantially. So we're looking at regenerative therapy which is using your body's cells to heal the tissue, potentially increase the cartilage and decrease the inflammation and pain. So PRP and prf. You know, I've spoken about this before, this is really like a. The mainstay of regenerative medicine is using your body's own platelets, which are designed to heal. And they have three key growth factors. Transformative growth factor, beta 3, VEGF or vascular endothelial growth factor and PDGF, platelet derived growth factor. Each of these has something to do with making the tissues healthier. The VEGF that helps bring circulation in again the nutrients needed and the oxygen needed for tissues to rebuild. The platelet derived growth factor recruits surrounding cells to heal and grow back tissues. And the transformative growth factors has those multiply and grow. Clinical studies have shown that typically a prp, PRF injection, I use those terms interchangeably. They're basically the thing in the way we use it in 20, 24, 25 gives you relief for some number of months to a year. And it's something that could be done repeatedly, it could be done every year. It's very simple. You take the blood and do an injection. It works. There's been studies mostly with more mild to moderate arthritis, but recent studies in more advanced arthritis show it works there as well. Maybe not as well, but it works there as well. About 80% success rate over three years. So that's really a good option for us. And we're doing now is doing usually three stem, I'm sorry, three platelet rich plasma platelet rich fibrin injection in the first year and then about one a year after that for, for maintenance. So that's, that's a good option for people. You can do it more than that, but that'd be pretty typical. And then there's stem cells using fat or bone marrow. And there's also something called micro fragmented or nano fat, which is basically a stem cell type procedure. Well, it's technically not called that. That's what it is. So the nano fat or micro fragmented fat, that's where fat's extracted in a kit. There's a few kits out there, one's lipogems that we've used. There's also different, different devices using venturi effect where you can break the fat out. So we suction fat out of somebody's body, out of your stomach or something. They only need about say 10 teaspoons. And it's basically put in a device that pulverizes the fat, breaking the actual adipocytes, which frees up the stem cells, frees up the mesenchymal stem cells, which are abundant in your fat tissue. You have about 500 times more stem cells in your fat than in your bone marrow of mesenchymal. That's the type we want, which is for the tissues we're looking the heel and the knee per. Per se, per teaspoon. Okay, about 500 times more. So we take the fat, basically grind it up and inject that slurry into the joint. And that gives relief. Typically on order of body, it compares well to prp. So if somebody does PRP or nanofat, microfat lipogens lasts about the same, about a year, people get a similar improvement. There's a potential for the PRP to be done a second time easier than the nanofat because the nanofat requires, you know, liposuction. But they're somewhat comparable. So we could say those are comparable. But then taking that a step further, if we're getting the fat out, we can take another 10 teaspoons and send it to a lab to extract your stem cells out and then bank them. So there's banks that bank say placental stem cel from your baby. You can also bank the stem cells out of your fat. So we send the fat to a lab. In our case we use lab in Florida. They process the stem cells out and then they culture them and grow them to expand them and then they bank them for the rest of your life. You can have bank fresh life. This is an annual fee, but it's very minimal. And then when you want stem cells, we send them a fee and they send us 10 million stem cells. It's not really for two joints and it can go into your joints. So that's the type of thing we're doing now. Now we used to have our own lab to make our own stem cells. There's been a lot of government regulation making that more difficult. So now we just use an outside lab. And then there's bone marrow derived stem cells which we don't use in our clinic. Nothing wrong with them, but we don't use those. Bone marrow hurts more to obtain it and I'm not familiar with that. But we have a more of a plastic surgery business. So we know how to get liposuction and hurts less easy for us to do. And there's more stem cells and it works at least as good, if not better. Than, than bone marrow. So again, I say the least good. If not, if not better, probably works better in some studies. Other studies that shows the same. So bone marrow is fine. Okay, so what is something that, how should you approach this? Well, first off, we can grade the arthritis from 1 to 4, and the closer you are to a 4, which is bone unborn, we might more be thinking about stem cells perhaps doing PRP to get you along until you're doing your stem cells or see how you respond to that. But you might be more of the stem cell patient to put off knee replacement longer off, longer, further off, or maybe potentially putting it off forever. In a large study of people that had more Advanced Arthritis Level 4, which is the highest arthritis, they found ro just below 80% of people were able to get three years without needing a surgery. In other words, their pain was reduced at least, you know, 50% or more where they didn't functionally need to do a surgery. So that's, that's pretty good. Four out of five people. That being said, stem cells have been shown to relieve arthritis symptoms as well as prp, not necessarily better relief because they both relieve symptoms quite well. Typically we'll see a 50 to 80% improvement of symptoms. With us with a first PRP injection. You can do more, get better results. We can see that with stem cel well, but the stem cells seem to have more durability. They last longer. Studies have shown people out five to seven years having still better than their baseline. You know, they might have decided to do it again to get more better, but they're better than their baseline five to seven years later. What about fixing the knee? So we might use radiographs or MRI to see is the knee cartilage growing back. So the jury's out on PRP and cartilage regrowth. I have found papers that showed some improvement of radiologic imaging where the cartilage did appear to improve over time. And there's other papers saying man, not so much changes. It just stabilizes symptoms and makes it not get worse, but doesn't actually reverse it. Where there's been numerous papers showing with stem cells that there's more cartilage regrowth, the space gets bigger, so there's a bigger cushion between the bones. The MRI looks better, the X rays look better. So you're functionally improving in addition to be symptomatically improving. So where are we at today? So we're going into 2025. We've been doing this for over 10 years. A lot of experience with it. I was part of a big stem cell group, so we were part of a research paper. So a lot of background and my personal thoughts are the PRP is a very low expense and if it's going to work for you, that's fantastic. If you get significant relief, you can continue to do periodic injections. Very simple. You basically are just like doing a blood test to get your blood, then we inject it in your knee. It's not painless, but it's almost painless. And if that's working, that's great. And high probability. You put off doing surgery if you're a cannabis surgery for years, if not, hopefully forever. But you're not going to turn the clock back on the appearance of the knee very much. So long term, we might think that the PRP platelets may fail eventually. In fact, in the longest study I've read on PRP, it's a three year study. You know, year one it was like a 90 plus percent success rate. Year two, about 90%. Year three, about 80%. So people were sort of falling off and needing to, you know, do other interventions. So still good long term success with advanced arthritis. But that's, that's maybe the limitation is that it's more advanced. You know, you might need to do something else. We're talking about micro fragmented fat. Okay. So if we're going to do stem cell therapy, might as well do the micro fragmented fat at that time. It's very simple. It's the same procedure. We take your fat out, grind it up, we add PRP to it if we want to, we can do it alone and put that into your knee while we send your stem cells, your fat basically to a stem cell lab that'll extract your stem cells out, expand them or grow them, and then spank them, you know, indefinitely for you, if you choose to pay for that. This is a good option for the person that wants to turn their joints around, improve the radius and actually make their joints appear younger than they are today. So PRP will make them stabilize stem cells, potentially makes them younger. Plus you have the ability to do that for other joints. You can order more stem cells from the bank and do that. Of course you can prp, you've got your own bank and your blood system. The way I'm approaching this now is somebody with grade one through three arthritis. Let's start with doing PRP and see how you do. Then consider at some point making the investment into the stem cell bank because there's an expense. You got to do the procedure to get the Fat out doesn't really hurt much, anything like that, but there's a cost to it. And then we've got to ship the fat down to a bank that extracts the stem cells and grow, grows them. Again, there's an expense to that. And then you, then you bank them, which is really not that expensive. That's something that is really easy to do right now. Was not easy to do 10 years ago. Again, we had to build our own lab at that time. Now there's an outside lab we can use. And if your arthritis is advanced now you could do that and then keep those stem cells and you get more durability out of the injection. So when you decide to treat the other knee or your hip shoulder, you've got a more robust treatment. Again, not more robust in terms of reducing symptoms necessarily, but more robust in terms of durability. How long is it going to last? On the order of years versus six months to a year and remodeling the joint in a stable way. So these can be used in combination as well. We have a program where you can do the stem cell membership which is, allows you to, I'm sorry, the PRP membership which allows you to do a series of treatments, very, very low cost. And then the stem cells, you can get those at a reduced rate as well. Where you would ship your stem cells down to the lab, get them isolated and then they can ship them to us and we can inject them into your knee. So that's the story of, you know, what, what are your best options? I think you know, the combination therapy is going to be platelet rich plasma with, with hyaluronic acid. I think at some point hyaluronic acid is a good structural benefit. If you're not doing stem cells. If you are doing stem cells, the ha hyaluronic acid is not needed. If you're not sure if you want to do stem cells, you can start with the prp. Now just get yourself some relief and then give you a chance to think about it and you know, put the economic might behind it when you're ready. Again, banking them is relatively inexpensive and retrieving relatively inexpensive. A lot of people are going to Panama and other countries do this, you know, you don't need to anymore. The government has been trying to regulate stem cells mostly because the FDA is, I won't say in the pocket of big pharma, but they work for big pharma. They're trying to approve drugs. They essentially are trying to make drugs safe for consumers. But we can see Several times where they approved drugs that really didn't work, that got the backing of the fda as if they did work. And this does happen. And stem cells, you know, we consider this more of a surgical procedure. And there's currently a company, Cellularity, that's trying to make a stem cell product FDA approved so they can sell it at a, at company a. A gajillion dollars. And I think that's led the FDA to maybe start looking at stem cells. So there's a time that they were going after doctors for enzymatically processing stem cells and went to court. Government ultimately lost. They did a, and they did an appeals and something happened with that. So right now we're just using outside lab. That does it. Because I'm not sure we're. We're allowed to process your stem cells in the office anymore like we did 10 years ago. It's here to stay. Not going away. In spite of the FDA's best efforts to make it go away, it's still available. Umbilical stem cells are available too. I didn't really talk about that during this meeting much. We do have umbilical stem cells. The logic being that, you know, they're younger stem cells and they're from. But they're from somebody else. They're from a healthy baby donor mother donated her baby's umbilical cord or placenta. That's an option as well. Bone marrow. We're not doing that here at Allure, but that's, that's an option for you as well. But what I would say is overall, before you consider a joint replacement or living with the pain, look at doing some regenerative therapy. Living with the pain, if it's impairing your mobility, it does have a negative effect on your quality of life. And your longevity does shorten your lifespan. We want to be active as we get older, not inactive. And this is something that's available to you now. Thank you.