How Many Stem Cells Do You Need for the Best Results?

If you get a lot of cells, unfortunately, I think a lot of times you are actually getting less benefit. And this has been shown in the US among doctors we've seen clinically, even though we're using much less number of cells, we're seeing just as good, if not better clinical results. Hi, welcome back Everybody, to the Dr. Joy Kong podcast. It seems been a long time. I did go back to China to visit my father, so that's why it feels like a long pause. But I'm so happy to be back here with you and continue to answer your questions. And one question is that how many cells do I need, Dr. Kong? Because a lot of people are hearing that they need to get 200, 300 million cells, at least a hundred million cells. So that's why they're going overseas to get that many cells. But we really need to understand what kind of cells you're getting before we decide how many you need, because it's a complex question. I always say there are two things that are most important in stem cell therapy. One is the cells. So where are you getting them? What kind of cells are they? You know, what's the type and. And what do you do with it? And the second is where to put it. So what does the provider do? And that will be the art of stem cell therapy. So let's address the cell source right now, because that's tightly connected with how many cells you need. First of all, if you manipulate the cells, which has been what's happening with a lot of research. So the research studies have been using expanded cells because there's a belief you need certain amount of cells. So that has been kind of the tradition. What's interesting is in the US partly because of the rule or FDA guidelines saying that you cannot use expanded cells without going under a clinical study. So that means if you start to grow the cells in a culture medium in the incubator to make them multiply for many generations to achieve a huge number of cells, then you are creating a drug in FDA's eyes. And they're saying that because changes can happen. So you are altering nature, and that means you're creating a drug. Then you need to conduct drug studies. But those studies are time consuming and very expensive. So a lot of companies want to just expand the cells and give you a cell. So they don't want to do clinical studies, which is one reason they're going overseas. Right. All these places in Central and South America, very popular way of providing stem cells. But in the us, partially because the handicap, I guess, that doctors only have access if they want to just give it to patients. What they have access to are these unexpanded cells. So which means that when you separate cells out from the body, so either from your own body, right, your fat or your bone marrow, those are the main sources. Or, or you get it from the younger source, like umbilical cord or amniotic membrane, et cetera, you can get cells from the very early, younger sources. Of course, comes from a healthy life. Birth is not something that, you know, you don't harm any babies to obtain those. So from the younger source, the FDA says you can separate out the cells using mechanical methods without using any enzymes or any chemicals. Because the moment you start using those, then the FDA says that you are creating a drug, then you need to conduct drug studies. So the cells that we are using in our clinic and in a lot of clinics in the US Are these native cells that have not been touched upon by any chemicals or any enzymes, which are meant to digest the connective tissue that are part of the matrix that's keeping the cells in the location. But if you digest those matrix, you can potentially digest some surface receptors of the cells and then you can alter the cells that way. But so in the US you do not use enzymes or chemicals when you obtain the cells, which means everything is obtained through mechanical methods. And once you obtain cells that way, and you do not put them in incubator, let them expand to huge numbers, then you are creating a native stem cell product and that can be given to doctors to be used for patients as a tissue transplant. So that's not a drug, it's a transplantation, just like a blood transfusion or organ transplantation. So that's governed by the American association of Tissue Banks. They are kind of regulating entity. Anyhow, when you are obtaining the cells without manipulation, then you are creating these native cells, which by study and research has shown to be more potent than cells that has been multiplied through many generations. So even with one passage, and I have a video on this subject, are expanded cells better? I went through some science showing what happens when cells are expanded. When they're expanded, they lose potency. They also grow surface receptors or surface markers that can mark them as foreign and then that can trigger rejection type of reactions. So just because you're getting more cells doesn't make the cells better. It actually can make the cells worse. So it's not just not making it better, but studies have shown that when you get a lot of cells but they're expanded, you can potentially lessen the effect of, you know, the benefit. You can reduce the benefit you observe, even if you're giving 10 times the number of cells. So you're losing potency. This is a reason that I'm not a proponent of using expanded cells. Even though it sounds amazing, you know, you know, when you hear it, yeah, I'm getting 100 million cells, 200, 300 million cells. But at what cost? If you're decreasing potency and you're causing more potential side effects. So if you get a lot of cells, unfortunately, I think a lot of times you are actually getting less benefit. And this has been shown in the US among doctors that we've seen clinically, even though we're using much less number of cells for patients, we're seeing just as good, if not better clinical results than people who are going overseas and paying a lot of money, by the way, to get cells that are expanded. So I would say, you know, if we're looking at how many cells. So this is what I have seen clinically, and this is what. How I've been training other physicians, which is if we just looking at MSC's mesenchymal stem cells. So that goes the subject of, you know, what kind of cells, right? So one is whether or not it's expanded. The other one is what type of cells? Because there are many kinds of stem cells. It's not a single entity. There are, you know, probably thousands of shades of gray as far as what kind of cells. A stem cell, a particular stem cell is because you can have the early embryonic stem cell, which we're not using, but everywhere down the line, you have hematopoietic progenitor cells which can multiply into all these cells that replenish the all your blood cells, right? White blood cells, red blood cells, and then you have mesenchymal stem cells that are these masters of regeneration that's all over your body. Anywhere. You have blood circulation and vasculature. You have these cells that's sitting right on the wall of your blood vessels. But there are also fibroblasts, right, that can form new connective tissue. There's, you know, your heart cells, you have heart progenitor cells, and there are also immature or primitive immune cells that can generate your white blood cells, et cetera. So there are all kinds of different stem cells. So if we're looking at the major types that are used in the U.S. two types are the most common. The hematopoietic progenitor cells, which is the most common type in bone marrow transplants and in umbilical cord blood products. And the other one is mesenchymal stem cells, which is the most common in fat derived stem cells and also umbilical cord tissue derived cells. So these are the major sources, you know. Of course, the product I use is a combination of hematopoietic progenitor cells from umbilical cord blood and the mesenchymal stem cells from, from the umbilical cord tissue because they all have their own properties. So how many cells? So which one are we talking about? Are we talking about hematopoietic progenitor cells? Are we talking about the mononuclear cells that are kind of a primitive immune cells, and are we talking about mesenchymal stem cells? Because let me just break it down to you for you straight. When you get an umbilical cord blood product, let's say they tell you there are 30 million cells in 1 cc, which is a common dilution, common concentration. So those 30 million cells, the vast majority are those mononuclear cells. There may be about 1% that are hematopoietic progenitor cells, and there's less than 1%, way less than 1% that are mesenchymal stem cells. The core blood in composition as far as cell population is very similar to the bone marrow. And the bone marrow only contains 0.01 2.1% of mesenchymal stem cells. So out of 3 million, total cell number, you will be lucky to get, let's just give it, let's just say 1%, that's 300,000 mesenchymal stem cells. So you'll be lucky to get 300,000 mesenchymal STEM cells. But this is why I utilize umbilical cord tissue, which is full of mesenchymal stem cells. This is why in the product I use, the number of mesenchymal stem cells is so high, it can be 2 million mesenchymal stem cells. So the way I'm teaching physicians on how to calculate the dosage, and that's based on just lots of application, right? Lots of cases. What we've seen is that we can use a dose calculation of 2 million MSCs for every 60 pounds of body weight. Then we add 2 million into the count if a person's over the age of 65 because they're very much depleted in their own stem cell supply, Then we add another 2 to 4 million if somebody is severely ill, depending on how sick they are and how aggressive their condition is. So let's say a person comes in at £180, and the person will need 6 million mesenchymal stem cells. Right? So that's. That would be 3cc of the product that I use. And then we can add 1 cc if the person's older, right above 65, and add another 1 to 2 cc's if a person has a severe health issue. So that's how many cells we use. Of course, there are also other cells. So I'm just talking about mesenchymal stem cells, which is kind of the gold standard for therapy. But the umbilical cord blood cells can be very helpful too. But just know that there are very few, really not very many mesenchymal stem cells, but those hematopoietic progenitor cells and the mononuclear cells, those immature immune cells, they're all very helpful. And that's why I wanted to harness all of these potentials together. So that's kind of how many number cells you need. I showed a graph before that. Let's say we give a person. What is it? So let's say 180 pounds, age 70, with a severe health issue. So that will be about. So three cc's for body weight, one CC for age, and let's just say one cc for the health issue, right? Let's say, you know, cardiac issue, diabetes, or some kind of brain condition. And then that's 5ccs total. That's 10 million MSCs. What I've seen with 10 million MSCs, that I'm getting better results than 100 or 200 or 300 million MSCs overseas. And this was shown in the study that demonstrated at 10 times the number of stem cells, but when they are expanded, the efficacy is actually decreased. So more cells led to decrease in efficacy. Also, just so you know, there's kind of a Goldilocks zone of stem cells. So too much doesn't mean it's better. And it could be not as good, because there are some studies showing that a higher dose is not as good as the median medium dose or at very, very low dose is also not as good as the medium dose. So in. In the middle, there's somewhere that's the appropriate dose. Like a lot of things in medicine, of course I'm talking about using the stem cells through an intravenous route. So that's the dose I was talking about. But the other aspect is really, are you putting the cells into your system systemically into the veins or arteries, or are you actually putting it locally? You can do it many ways. You can put it In a joint, in soft tissue like the skin or muscles, you can put it into different organs. We can put it into the vagina, the penis, or you can inject into different organs, which we're not doing because we are actually able to utilize technologies that are non invasive, using laser technologies to guide stem cells into a particular area. You can use sound as well. We use that in our clinic as well. So there are more elegant ways of bringing the cells to an area. But for larger joints like the knee, the hip, you probably want to inject into the joint capsule because the perfusion rate, so whatever that you put in the blood for that to get into the joint itself, the substances you put into the blood, that's going to take a long time to really fully permeate what's in the joint, the fluid that's in the joint. So you want to put directly into the joint. So if we're talking about how many cells we're using, if you're putting it locally, you need less number of cells to exert same benefit. When you put it systemically, you need larger numbers. But when you put it systemically, it brings about benefits that's hard to, to, to get when you just put it locally. Because systemic circulation brings the cells into contact with your immune system, with your spleen and your peripheral lymphoid system. And that can have profound effects in how you heal locally. Not only the cells are attracted during the time that they're circulating the body, they're attracted to the local areas that are screaming for help. So inflammation and injury, they're asking for help, they're sending signals. The cells tend to get to those areas to exert their effects. But also they're interacting with your immune system. But if you're just putting cells locally, then we know you're putting this many cells into the local area, we know how many cells that we're getting. But if you put the cells in the systemic circulation, there's really no guarantee. We know a lot of cells can get to a particular area because it inflammation and injury. We can also use laser to guide those cells. But if you have a lot of inflammation and injury throughout your body, they're going to be diverted, right? So they're going to be spread out, so you won't get as much in a particular local area. So for those organs, there may be times it's good to inject right into those areas. So I hope that helps give some perspective about this question of how many cells do I need. Dr. K. It really depends on of course, your body weight, your age, your health issues and depends on the source of the cells you're looking at. Are we getting mesenchymal stem cells or hematopoietic progenitor cells or all these mononuclear cells. But the standard is to calculate the dose based on mesenchymal stem cells. So that is what we are providing patients. And of course overseas they're also using mesenchymal stem cells, but then they are basing it on clinical studies which are all using expanded cells. So we've yet to really do more studies on native cells on cells that have not been expanded. So I'm hoping that I will be part of that, those clinical research and then we can really say more definitively, then we can do side by side study. Right? Native cells versus expanded cells. And then so there's just, you know, the field is expanding, right. It's progressing rapidly and just stay tuned. But as far as what we are using these days, I think we've got a really good thing going because we've seen incredible results for our patients and that's what's been really inspiring. It's really heartwarming to hear these stories from my patients and then also from the doctors who who are using have developed. So anyhow, so that's it for today. I hope you found this interesting and helpful and that gives a little bit of context to the question. So that's it and I will see you next time.