Stem Cell Therapy in Autoimmune Disease and Long COVID

Health is very complex. Our body have so many things that's happening all at once. We're dealing with a web, the web of biology. The stem cells can go in and provide some fundamental shifts, but it's not covering all ground. I think it would be naive to think just because stem cell therapy is amazing, then I can just give you one treatment and then expect everybody to do amazingly well. The person could be deficient in amino acids and minerals, hormonally depleted, or have toxicity. I always try to give people a realistic expectation. I'm hoping for miracles, but I'm not expecting miracles. And then there may be a regimen that's needed. Like anything in medicine, there's a dose, there's a regimen, because we're dealing with biology. Biology has its own rhythm. I tell people, just like when you're sick with an infection, you don't take your whole bottle of antibiotics expecting that I'm cured. Right? You take it every four to six hours because you're respecting the rhythm of biology. Welcome to the Dr. Joy Kong PODC podcast. This is where I have a chance to share with you some of the latest developments in the space of holistic health, longevity and wellness. I've always honored intellectual curiosity and scientific rigor combined with real world practicality. My goal is that what you learn here will help you live longer and live better. Hope you enjoy the journey with me.

All right, so Joy Kong, MD, is a UCLA trained triple board certified. Triple board, wow. Certified Physician, American Board of Psychiatry and Neurology, the American Board of Addiction Medicine, and the American Board Anti Aging and Regenerative Medicine. I'm pretty sure you don't want to take any more tests at this point, but she is the president of the Thea center for Regenerative Medicine in Los Angeles where she specializes in stem cell treatments to improve the functions of diverse organ systems in the body, as well as for preventive and endless wellness purposes. And I will say that, you know, I like to consult with her periodically because I don't, you know, I don't have a, you know, like a super duper grasp on stem cells. She does some very interesting and unique things with her stem cells. She's also the medical director for Avalon Surgery Center. She oversees all regenerative medicine treatments and she founded the American Academy of Integrated Cell Therapy where she provides training. I probably need to go to that course. Clinical Evidence and Aspects of Clinical Practice of Stem Cell Treatments. She's developed unique stem cell treatment protocols, including patent pending intranasal and needle free male and female Sexual wellness protocols. She's the founder and CEO of Chera Biologics, a company dedicated to providing cutting edge regenerative medicine products in the US and the rest of the globe. She's also a board member of the American association of Stem Cell Physicians and is a proponent of conducting high quality clinical research and is a medical consultant for stem cell research projects. To be conducting projects. Okay. Dr. Kong is a firm believer in the therapeutic potentials of cell therapy. She's lectured nationally and internationally on stem cell treatments and has exchanged ideas with top stem cell scientists from around the globe. So, Dr. Kong, please give her a warm welcome. Thank you.

Thank you so much, Dr. Frank, for such a wonderful introduction. I'm so privileged to be here. I have really a particular fondness for this crowd because you guys are probably some of the most adventurous and courageous people because you believe in ozone therapy, you believe in the modality that's effective and it's safe and you're willing to use it despite certain oppositions. So I really love this group of doctors. So today I'm going to be talking about regenerative medicine in autoimmune diseases and long Covid. So use of stem cell therapy is very broad. You know, it's broad range of possibilities. So autoimmune disease is one of the places where stem cell therapy really shines. So I'm going to go over a few disease categories, then end with long Covid, which really is kind of a branch of this autoimmune dysregulation. The traditional route of using stem cell therapy for autoimmune disease is using hematopoietic stem cell therapy, which are usually from bone marrow. So that's the first stem cell therapy is using the bone marrow. Right. Bone marrow transplant. People, you know, in the 60s, they didn't know they were doing stem cell therapy, that they were just transplanting bone marrow. But then later on we realized that that's actually stem cell therapy. So using a donor's bone marrow, that's one of the, the first ways of doing stem cell therapy, but that kind of treatment. So the hematopoietic stem cells, those are the major, one of the major stem cell types in the bone marrow, but that has a lot of potentials for rejection. So you need immune suppressive medications and that can really take a toll on patients. Or you can use your own, but that is linked to a lot of morbidity and mortality, including infections and recurrence is pretty common. So MIC is kind of, is the newer cell type on the block and they realize, oh, oh my goodness. So they're this particular cell type that's derived from the mesenchymal lineage, but they have very little surface markers and mark them as a foreign and they have this immune modulating properties. So you can give it to people sometimes completely unmatched. And people are doing great, you know, having all kinds of therapeutic responses. So, yeah, so even with mismatch, HLA mismatch, they can home into the damaged tissue and exert clinical benefit and the benefit tends to be much more sustained. This is the pilot study on allergenic MSCs for refractory lupus. Right. Sle. So what's interesting is that autoimmune diseases have been proposed as stem cell disorders. And there are functional abnormalities in the bone marrow MSCs in patients with lupus, including defectiveness in cytokine secretion with downregulation of different cytokines and RNA expressions. And here's a study actually looking at 16 patients and they saw by using umbilical cord derived MSCs that at one month after the treatment, these people had significant decrease in disease severity. And they also showed that these lupus patients had improved levels of disease markers, they improved their renal function. And clinically there seemed to be a shift, more of a balance between the TH1 and TH2 sites of the, of the immune system and increase in T Rex cells. And the significant reduction in disease activity was achieved in all these 16 patients with no recurrence in three years. So this is a very successful study. So this one is another study looking at 40 patients. And they use expanded umbilical cord derived mics. They were giving these patients intravenously on day 0 and 7 and there were no adverse reactions. So major clinical response was achieved in about a third of the patients. And there are also 40% of patients who have no clinical response. And at nine months the relapse rate was 12.5. At 12 months, 6.7. So they think that likely these people will require reinfusion in six months, so some kind of booster shot. So, you know, we do see this clinically. There are people who are doing amazingly well. I've seen people who have complete remission to the point where all their markers are, are normal. So basically they are disease free. But there are also people who needs more infusion. I think, you know, we're all this, you know, integrative kind of functional medicine crowd that we know the health is very complex. Our body is, you know, have so many things that's happening all at once. We're dealing with a Web the web of biology. So the stem cells can go in and provide some fundamental shifts in patients, but it's not covering all ground. I think it would be naive to think just because stem cell therapy is amazing, then I can just give you one treatment and then expect everybody to do amazingly well. Because a person could be deficient in amino acids, could be deficient in minerals, could be, you know, hormonally deficient, depleted, or have toxicity. So I always try to give people a realistic expectation that I'm not expecting miracles, I'm hoping for miracles, but I'm not expecting miracles. And then there may be a regimen that's needed. We may be looking at three treatments within, you know, four to six months. So I want people to be, you know, prepared mentally and not expect this to be a miracle because, because you know, like anything in medicine, you know, there's a dose, there's a regimen because we're dealing with biology. Biology has its own, this own rhythm. You know, I tell people, just like when you're sick with an infection, you don't take your whole bottle of antibiotics expecting that I'm cured, right? You take it every four to six hours because you're respecting the rhythm of biology. There's a way of helping the body repair. Here's another example. Just looking at a secondary pathology from patients with lupus. So this is secondary osteoporosis. So what's interesting is that one of the mechanisms of the MSC's benefits could be through IL17 suppression and that IL17 is an inflammatory cytokine that's implicated in autoimmune diseases. So and these can be defective in the recipient's bone marrow. So what happens is that the transplantation of MICs can promote healthy bone metabolism by establishing a new balance between the osteoblasts and osteoclasts. Here's another study using umbilical cord mics. They do have profound inhibitory effect on these particular cells, fibroblast like synovial sites and inhibitory effect on these cells and then on the overactivation of T cells can really help these rheumatoid arthritis patients. So we're moving on to rheumatoid arthritis. One of the ways they induce such effect is by inducing T Rex cell activation. And T Rex play a very important role in self immune tolerance. So umbilical cord mics can again shift the th1, th2 balance and the infusion, systemic infusion was able to reduce disease severity in mouse. Just a side note, you know, people say okay, so, you know, I give one person stem cells to another person is not a perfect match. Are the cells going to stay? So that's a question that's been asked many times. I've asked many experts from the field. Some say no, it's impossible for one person cell to say another, which is not true because bone marrow transplant, you know, is very successful. And some say, yeah, it's very small percentage, maybe 2 to 5%. But even human stem cells can stay in an animal's body. So these are different species. So even with that much difference in the HLA marker, cells can stay. So I think there's a really good chance that cells can stay. And when you use younger cells, the cells have a better tendency to adapt to the host environment. So if you are transplanting bone marrow stem cells, even if it's perfectly matched, perfect HLE matching, there's still a chance rejection. But if you're using young umbilical cord blood stem cells, umbilical cord blood composition is very similar to bone marrow composition. So in those cases, there's very little rejection, even when it's completely unmatched. So that's how different young cells are and versus older cells. And when cells are younger, they get into the host body, there's much better chance that they will adapt. So when you're older, it's almost like, you know, they, they got their own thing, they have their own, you know, ideas, their own, you know, ways of doing things. Some things are set, but when they're younger, they're more malleable, they're more able to adapt to the host environment. So in this study, they saw good response in animal model. And here's a fairly large study for humans. 172 patients with active rheumatoid arthritis. And they had two groups. So they used the disease modifying anti rheumatic drugs in both groups. One they added placebo, the other one they added umbilical cord MSCs. So only 40 million cells per infusion. And they were able to see that after two weeks post infusion. There's significant remission in the group that used MSCs. And the improvement was not seen in the group that had placebo. And joint pain and swelling were alleviated within 12 hours and maintained throughout the study. And that's pretty common. I had one patient, she was a surgical nurse, and she began to have rheumatoid arthritis symptoms and she was not able to work. So during the infusion, this is within 30 minutes of starting the infusion, in the middle of the infusion, and she did this, she closed her fist and she started crying and she said, I have not been able to close my fist for two months. So it can happen that fast. And I, you know, I hear that quite a bit, you know, swelling, you know, within a couple of hours the swelling, the hands go down. So the anti inflammatory effect can happen very fast. So I tell people that there are different stages of healing with stem cell therapy. So when people say when can I expect benefit? Well let's look at what the cells are doing and what are the stages. The first stage is the anti inflammatory stage. So that can happen very fast to the point where I, you know, I treated a Alzheimer's patient. She was so stuck in her, I think it's the neuroinflammation that she had not been able to feed herself for a month. She was not eating. The food would be in front of her, she would not her brain. There was no signal coming through. She could not pick up a knife and fork. Even though she's hungry, she couldn't. But the next day after the stem cell treatment, the food was in front of her, she picked up knife and fork and she fed herself. And her husband was looking at her, you know, in shock and she looked up at him. It's like, what's your problem? So yeah, so it can happen that fast and that's an anti inflammatory effect. But the second stage is the tissue rebuilding and that takes time. So whatever you are trying to do, you know, if it's musculoskeletal issue or systemic autoimmune issue or you know, any organ repair, there is a stage of slowly the cells is going to tell the local tissue to start to divide or the cells could differentiate locally and that take, and that takes weeks to months time. And the last stage is the, the genetic modification because the cells do send out micrornas which could go into the cell nucleus and make genetic changes and produce long lasting benefits. And these cells also, you know, can conduct mitochondria transfer so it can give the recipient cells fresh new mitochondria so elevating the cellular energy. And that could have, you know, much longer benefit. Another condition, psoriasis, that I've seen good results clinically. This is an animal study. The TH17 cells and their related cytokines are pretty important in the pathogenesis of psoriasis. And MSCs can inhibit these, the TH17 cells and induce the T Rex cells and they've shown some defect in the patient's cellular composition. Right. So in psoriasis patient, in Their skin, they could, you know, the MSCs from their skin, their ability to inhibit the T cell proliferation is much decreased. So that's another reason, you know, sometimes when you try to use a person's own stem cells, you know, genetically they're just not as, as effective. You know, there's something that's, that's different in the disease patient cells. It's another reason that I'm a proponent at using healthy donor sources. There are many other reasons. I have a lecture, I've in a few conferences about different cell sources is, is not just that that these cells are young and healthy, they're more potent, they secrete more anti inflammatory factors, they have longer telomeres, they have more generations left, but they also are safer. So I, I'll talk a little bit about that later. So this is study on severe psoriasis. So the background was that, you know, so back in 2002, four patients under went autologous hematopoietic stem cell treatment. So using cells from their own bone marrow re infused and they all relapsed within 21 months. And then so in the literature between 1990 and 2002, nine patients had allogeneic, the hematopoietic stem cell transplant. The longest time for remission was four years. And there's one patient actually remained. So there's a psoriatic rash. The rash remained absent for 17 years after two treatments. And this case study was a 29 year old guy with extensive psoriasis since age 13 and also polyarthritis. So he later on found out he also had gold induced aplastic anemia and he received allergenic treatment at that point for the anemia. Not you know, I'm sure that they weren't doing it thinking that they were trying to treat psoriasis. So he received allergenic hematopoietic stem cells from a, you know, compatible female sibling. And they, there was some acute graft versus Holtz reaction. So they had to use medications, you know, including steroid for seven months. But there was rapid improvement of psoriasis and no major disability 20 years after the transplant. And so I'm going to move on to inflammatory bowel disease. Stem cell transplant has definitely been used for inflammatory bowel diseases. And again where it started was hematopoietic stem cells and they used autologous stem cells. The first study, 900 patients, so they did a cohort study. The survival rate of using a person's own hematopoietic stem cells was 85% at five years so that's pretty good. And 43% progression free and 30% had complete response. But the problem is again, these people are on chemotherapy regimen. They had to take antibiotics and steroids, so that's really not an ideal kind of treatment. And they could also use allergenic hematopoietic stem cells, which, which usually means bone marrow transplant, unless they were using umbilical cord blood cells. But I think these are bone marrow transplant patients. So the allogenic hematopoietic stem cell transplant can potentially correct the underlying disease genetically. Right. Using a healthy donor cells. But that also is associated with complication and mortality rate because hematopoietic stem cells still there's a, you know, chance and tendency for mismatch and people have to use, again, use certain medications to help prevent that. This study, even using umbilical cord blood, there's still some chance because umbilical cord blood have almost no MSCs in it. Well, it has very tiny fraction. So bone marrow has about 0.1, 0.01 to 0.1% MSCS in the, in the bone marrow self and very similar in the umbilical cord blood. So you very few MSCs which modulate immune system, prevent graft versus host disease and really help to calm the system. So when you have very little MSCs in the cord blood or bone marrow, you have much higher chance of having these reactions. And this is why Joanne Kernsberg, who is in Duke University, she's doing autism study using umbilical cord blood is much easier and I think safer, more effective than bone marrow transplant. But she still has to premedicate all these kids with these medications and steroids, which I'm really, I'm still not a fan of. When there's ready source of mesenchymal stem cells that can really prevent these kind of rejections, then we come to mesenchymal stem cell transplantation. So these are, you know, the newer treatments because all we knew were bone marrow before, but now we know much better. So you can do local injection of these mesenchymal stem cells. So this, this study, they looked at perianal fistulas and they were using 30 million MSCs and that was more efficacious than 10 million versus 90 million. So it's very interesting. I've seen that quite a bit that there's a dose response doesn't mean more is better. Sometimes you have a dose range that's much more ideal and if you go outside the range, maybe it's going to be less efficacious. So pretty good. They did local injection of these stem cells. 85.7% success rate at week 12, and placebo only 33%. And then you can also infuse these cells systemically. So the first Human trial was nine patients with active Crohn's, and they received the IV bone marrow MSCs, and three out of the 10 patients achieved clinical response by day 14. You can also do IV, so there's an IV study, IV bone marrow MSCs for moderate to severe Crohn's preliminary study, 148 out of 207 patients reached remission in 28 days, which is pretty good. 148 out of 207, but it's still not 207. And so clinically, you know, that's why I give. I tell patients to, you know, temper your enthusiasm. We're hopeful, but we're. It's not guaranteed. Nothing is guaranteed in medicine. I would love to guarantee patients of complete healing. You know that. You know, that 60 some patient out of 207 to me is still a lot. And it's, it's, you know, it's very uncomfortable for me as a clinician. But the fact is that I'm offering hope, so much Hope for those 148 patients. Here's another study on Crohn's. 82 patients diagnosed with Crohn's disease, and they're on steroid maintenance. They were given IV infusion, so 41 of those were selected to receive infusion. And you will see this dose range. You know, one million per kilo. That's pretty standard. But just remember that this dose range is established using expanded cells. There's a lot of difference between unexpanded and expanded cells. There's a bit of a controversy. There's people overseas who are doing a lot of these cell expansions. And, you know, people seem to believe that more is better and even, even when the cells are not expanded. Right. Same type of type of cells. More doesn't mean it's better. But when you start to expand the cells, you're changing the characteristics of the cells. Um, it's, it's unavoidable, especially after about three, four or four passages. But just remember, when you expand the cells, you're putting them in the petri dish, you know, in some kind of container in the incubator. The cells that's well adapted to this environment, to this particular artificial environment are going to be the cell that divide. So. And they tend to gain more characteristics. So as they divide, they will express surface Markers that show them, you know, their characteristics as whoever the donor is. So you will get these further differentiated cells that will express more surface markers. They tend to bring bring about more rejection type of reaction. But also they're losing capabilities and characteristics of the younger stem cells. Many of them are no longer stem cells. So just remember the dose calculation and just because in the study says 1 million per kilo, just remember these are expanded cells. Native cells that have never been expanded will act differently. So these people received infusions one week apart, four infusions total. At 12 months they show the disease scores decrease. So the first one it was the score decreased by 62.5% compared to the placebo. That's 23. And another disease score is decreased by 3.4% compared to 1.2 in the control group. And their steroid doses were decreased. The placebo group only decreased the dose by 1.2 milligrams per day. But this treated groups were able to have the dose decrease by 4, 4.2 mg. So significant reduction in the amount of steroid that they have to use. And here's just a visual of the changes at 12 months in their mucosa. And then I, you know, mentioned a couple diseases briefly. So sclerodoma. So you know, the, you know, because the certain diseases are more rare, the cases are, you know, a lot less. So it's harder to find studies. So we're still so new in the stem cell field. As time goes on, there's going to be more and more studies. But this is scleroderma, which is this tough disease. So they are using umbilical cord MSCs. So they obtained these using collagenase and cells expansion. So in the case in FDA's eyes, then you are creating a drug. So a lot of stem cell and blood core stem cell products used in the country, the labs are not supposed to use collagenase to free cells from the matrix and they're not supposed to expand them. Right. If you do any of these two things, then you're creating a drug in the FDA's eyes. And then you need to conduct an investigation. New drug IND study, which is why so many of these companies go overseas, because the study is costly both in time and money. So they don't want to do that. In this study, that's what they did. They freed the cells using collagenase and expanded them. And then they use 2 million per kilo treatment. So two patients the first time when they treated these patients, they give them four Plasmapheresis followed by rituximab and then they give them IV stem cells. So they were able to achieve sustained remission for 12 months and 16 months for these two patients. And the second time they didn't even pre treat them. I think they were just being cautious. They weren't sure. And the second time they forgot about you. They took out the plasmapheresis and the medication and they both achieved improvement in their mobility and function. And here's a case about sarcoidosis. And so this is actually somebody that had sarcoidosis for, for, for some time and tried all kinds of medications. You can see the list of medications. Methotrexate, tetracycline, and with limited success. And they were using systemic corticosteroids and they couldn't really reduce the dose. So she was stabilized on the low dose steroid and methotrexate. So eight years after the diagnosis of sarcoidosis, she was diagnosed with AML leukemia. And after chemotherapy she was able to receive umbilical cord blood stem cell transplantation. So five months after the transplant she. So all the immunosuppressive drugs were stopped and she did not have any recurrence. And four years later she's still asymptomatic. So that this is kind of another incidental. They were treating something else and they have to give her this hematopoietic stem cell transplantation and then it cured her of sarcoidosis. Now we come to the subject of long Covid. So just kind of, you know, overview, research, statistics. Still there's not, you know, not that much. We're still new in this. But I just want to give your overview, you know, about long Covid and then, you know, show you one case. So long Covid has many names, you know, there's, I don't know why they come up with so many names. Long haul Covid, post acute COVID 19, you know, there's PASC long term effect of COVID anyhow. So the long names, the definition is that these symptoms, there are symptoms and conditions that continue after initial infection. And generally they don't diagnose people with long Covid until four weeks after the initial infection. And the estimated incidence is about 10 to 30% of non hospitalized cases, but 50 to 70% of hospitalized cases and 10 to 12% of vaccinated cases. The prevalence as of January this year, 15% of all adults in the US had reported some kind of long Covid symptom, and 6% had recurrent symptoms. Highest percentage is in the age group of 36 to 50 and most are in the non hospitalized patients. And they have, you know, because they had milder acute illness because that's a majority of the COVID 19 cases. And there's even disability, I guess assigned to long Covid back in July 2021. So the symptoms are, you know, wide range. Over 200 symptoms have been identified, you know, involving many organ systems and so common new onset symptoms including cardiovascular, thrombotic, cerebral vascular diseases, diabetes, type 2 diabetes, major, you know, chronic fatigue, dysautonomia, including the pot syndrome. So there are general symptoms, fatigue, malaise, fever, respiratory symptoms, of course, and heart symptoms. And there's neurological difficulties, digestive issues and some other symptoms like joint pain, rash and changing menstrual cycle. And the proposed mechanism for long Covid is that there are many potential mechanisms. So some think that there are reservoirs of the virus in different tissues. And other proposed mechanism include immune dysregulation with or without reactivation of other pathogens in the body like EBV or herpes virus. And also another proposed mechanism is that there's some kind of effect on the microbiome caused by the virus or there's this new autoimmunity that's triggered by the virus. Or you know, we all know about the clotting, microvascular clotting with endothelial dysfunction, that's another mechanism or even dysfunctional signaling in the brainstem or vagus nerve. So MSCs for long Covid. So we've seen MSCs having therapeutic efficacy in patients with acute lung injury and an ARDS. What's interesting, I was very encouraged back in March 2020 when everything was starting already there were six studies in China of using stem cells, MSCs to treat patients with acute Covid and was very encouraging. Multiple studies, they all showed that these people were on ventilators, they were in severe conditions. Within six days these people are out of the hospital. So a lot of elderly patients, so pretty drastic. And then there are a lot of studies also have shown MSC benefits in improving lung function for post and long COVID patients. So these are the main mechanisms of MSC's function. And you know, a lot of times people ask me, you know, can stem cells help me with this condition? And you know, some of the conditions are obscure, so there's no studies. Then I, you know, sit the patient down, we talk about the pathophysiology, you know, what happened? What, what's this condition about? How does it come about? What, what's the underlying mechanism of Your disease. So then I see and I look at how MSCs work and then I'll see if we can dovetail if the, the way MSE works can actually target how the disease is coming about. So anti inflammatory action is a huge, so one of the biggest ways that these MSCs function and immune regulation. So almost all chronic illnesses will have inflammation and immune dysregulation as part of the picture. And you know, I don't care. Even if you have genetic diseases, a lot of times the gene is not giving you the disease, it's a downstream dysregulation and damage to your organs that's causing you the dysfunction. So if we can look at the end organ, yes we can. You know, there's a rescue function from these MSCs. So that's the anti apoptotic properties. So on top of the immune regulation, immune modulation and anti inflammatory actions, there's also the anti apoptotic function where the stem cells can rescue damaged or semi damaged tissue and reverse the damage. Stem cells can also help break down scars. So anti fibrotic properties are really important. I've seen great results in my own patient with COPD and liver cirrhosis. They can break down the scar tissue or even testicular nodules I've seen in that disappear. So you know, the cells never fail to surprise me. And the cells also have pro apoptotic properties in cases of senescent cells or pre cancerous or cancerous changes. So MSCs have been used for, as a treatment for cancer because it does have the capability to send signals to tumors and to trigger program cell death. So in cases where they, they can detect cancer cells. One interesting fact is that as we get older, even though we have our MSCs, our MSCs are having reduced capability of recognizing cancer. So that's why you hear this circulating fear that MSC treatments or stem cell treatment can promote cancer. That's really mostly happening when you use a person's own stem cells because your own stem cells have lost some capabilities of recognizing cancer. I call it cellular senescence or cellular dementia. You know, it's lost certain abilities to tell that this cell doesn't belong here. Whereas if you use young cells like from an umbilical cord, they are much better at detecting cancer and getting rid of the cancer. So not all MSCs are the same. When you age, your MSCs age with you. And the MSCs also have antimicrobial properties. They can secrete antimicrobial peptides directly. They promote angiogenesis. So they help with vascular Formation to supply the tissue with nutrients. And they of course have this local, what's called paracrine effect, conducting this local regenerative activities to tell local stem cells. So so much of what MSE does is not to differentiate and become your own tissue cells, is actually to talk to your locals, you know, population, let's say liver, you know, I'm talking to the liver cells. There are liver stem cells. So MSCS is going to tell the liver stem cells it's time for you to divide and replenish the tissue. So that's what's happening a lot of, even in musculoskeletal conditions, telling the cartilage stem cells to, to regenerate and, and start to rebuild the cartilage. So that's, that's really one of the things that I think a lot of people have the misunderstanding. They think these cells are just go in and start to become the cells of different tissues is not. That has been kind of disproven, you know, in the scientific community over and over again. If you start reading articles, it just becomes, you know, it's the same, you know, it's a repeated theme. And then the mitochondria transfer, which I think is super cool because you actually are giving fresh new mitochondria. And we all know how crucial mitochondria is for our, for our cellular function and health of the body. So how do MSCs help in long Covid? So I talked about how MSCs work. So MSCs do exhibit immune suppressive properties, so they can suppress the over activation, the overreaction of the immune system from the COVID 19 and that's the one thing that people fear, is this drastic overreaction. MSCs can also locate to the inflamed lung tissue and they can secrete factors that modulate the immune system, prevent the oxidative damages and fibrosis of the lung. I want to dispel this myth about stem cells when given iv, that they're trapped in the lungs, I think is naive because later studies have shown that when you put mesenchymal stem cells into the IV route systemically, yes, initially they're going to be in the lungs. But within three days, you can't detect them in the lungs because they're gone. They're back into systemic circulation. And to just look at the size of the cells and then looking at the size of the vasculature in the lungs, I think it's really underestimating what these cells can do. You know, they can squeeze through different places. So you know, the size. They don't just, you know, I'm this big, so I can't go anywhere. I think it's just. Yeah, the cells travel in your capillaries, it goes to various tissues and it traverse out of the, your capillary and go into your neighboring tissues. So they go in and out of the blood vessels. So there's a lot more fluidity. So I think it's time to dispel that myth that, you know, when we give somebody IV stem cells and they just going to all sit in the lungs. If you have a lot of lung pathology and fibrosis and inflammation. Yes, you bet they're going to sit there because they're really attracted to, you know, the presentation of the area. But if you don't have any lung problems. No, they're going to get out of there. M also exert the immune modulation. Right. So we talked about. So they exert this through the paracrine interaction. So local tissue, local signaling or even cell to cell contact. The mscs can put their, they have like this tentacles. They can put their, their, you know, their foot, you know, on another cell and start to talk with other cells directly. They can do this exosome, right. Extracellular vesicles. So they're, you know, their exosomes are vesicles of certain size, only 50 to 200 microns. But there are also other larger extracellular vesicles. There are a lot of these packets the cells can send out and they can also, you know, they can affect your immune system through, you know, affecting many cell types. And they're capable of repairing and regenerating epithelial and endothelial tissues in the alveoli in the lungs. MSCs can also attract functional cells to a niche in the wounded area of the lungs. So that's the, this, this I call them the conductor in the symphony regeneration. They, they're able to, to call upon different cell types and they can replenish stem cell pool by endowing stemness. This is really exciting. This is, you know, really fun that they can endow differentiated cells with stemness. So getting them to go back kind of in their lineage and become more flexible and more primitive. So they can transfer their own stem cell characteristics to, for example, they showed in. They can transfer that characteristic to differentiated alveoli, epithelial cells in lung environment when it's damaged. And. But MSCs can also differentiate into lung tissue themselves. So that is one thing they can do. They do differentiate and they've shown MSCs differentiation not just, you know when people think of MSCs? Yes. Okay. You can show that they're MSCs by seeing whether or not they can differentiate into fat, muscles or cartilage. But that's, you know, that's just one potential, especially if you use adult MSCs. But when you use younger MSCs, they have a lot more potential to differentiate into different cell types, including neurons, including liver cells. And so here we see lung cells, epithelial tissue and mics can also prevent certain responses. That's driven by the viral injury, by educating macrophages in the lung environment. So I guess educating them to go into a more pro angiogenic type and the macrophages will in turn, after being educated, will increase the secretion of various growth factors to promote tissue regeneration. So they're telling other cells to do their work. And MSCs can also adopt certain types when they are exposed to inflammatory cytokines. So there, there are two types of MSCs, there's type one and type two. So type two is, is more anti inflammatory. So when they are affected by all this inflammation, they can go into this more anti inflammatory phenotype which is, you know, very interesting. So this is one case study is a 72 year old female, history of excellent health, but had COVID infection in 2022 in September that lasted for 15 days, no big deal. And then in October and November she noticed significant fatigue and headache that wasn't going away. So what happened was that she received two weeks of IV therapy that included ozone therapy and exosome infusion. So, so, so there's a lot of study done in exosomes. So this is one way the stem cells work. So it's through these exosome secretions. So these exome infusions were given a 1cc along with, you know, after ozone therapy, 1cc along with Myers and Glutathione IV push and the treatment, you know, so these were done twice a week. And at end of the one week, first week, she was able to run errands already and within six to eight weeks she, you know, reached 100% recovery. So two weeks of twice a week. So that means she did four sessions total. And then there's some other adjunct treatment including low dose naltrexone and nebulization of hydrogen peroxide, glutathione and Quinton water. So that's the case. I welcome you. If any of you have other cases, any other successes, I'd love to hear about that. This patient reached really good results with four sessions. Just last thing, I just want to talk A little bit about the tissue source. You can use bone marrow or fat or umbilical cord to get stem cells. So they are all good candidates. And I just want to talk about. I am partial to umbilical cord stem cells because I have delved into the subject for so long. When I first started seven years ago in this whole stem cell field, I just wanted to find the best source for patients. You know, I don't care what it is, I don't care what kind of training I have to do, what kind of equipment I have to acquire. I just want whatever that works the best. So I delve really deep into different studies, looking at different sources. And so I have actually have, you know, I put my lecture on, on YouTube. It's called r o mse created equal. So I went into lots of studies comparing these tissue sources. So I do believe the umbilical cord source is superior because of many, many reasons. I list it there. So first of all, high cell viability and they have great abilities to proliferate. They have anti inflammatory, higher anti inflammatory activities, more immune regulatory capabilities, they have promote more angiogenesis, they're more neuroprotective, they can differentiate into more cell types, they have longer telomeres and higher telomerase activity levels. And they have more generations left. They're just, they're going to be around longer and they have less potential to promote cancer growth. So that's the one I kind of hinted at. There was one study looking at fat derived mics versus umbilical cord derived mics. They put these two types of mics next to glioblastoma. So this very virulent form, brain cancer cells, they put them next to these cancer cells either in a petri dish or on the live animal's body. So in both cases, the fat derived mics made the cancer grow more and more. Yet the umbilical cord derived mics make the cancer shrink and go away. So this is another reason why I think it's important as a provider. You know, I want to give people treatments not only effective, but also safe. The last thing is I, I think as a precaution, you know, probably avoiding the vaccine, you know, as far as donor that had been vaccinated, you know, because there's too many unknown aspects. You know, this could be, you know, could go down the whole rabbit hole about this subject. But the product I use and I insist on will be from young healthy mothers. These are all u. S Based mothers that have never been vaccinated. So yes, it's getting harder and harder but that's one of the principles I have. So like Dr. Frank mentioned, I have Booth char biologics so you're welcome to come talk to me but that is one philosophy I have, you know, that I'm going to stick to it because I'm not willing to put that in my own body or my patient's body or anybody's body, you know, anyone other doctors that's treating so is important to me. So that's yeah, I just think there are too many things that are unknown. So that's it. Thank you for listening to this episode. Hope you enjoyed the content and if so, please rate and follow this podcast to learn about everything I do, including my memoir, Tiger of Beijing. You can go to www.and if you'd like to reach me, simply send in a contact form. You can also subscribe to my YouTube channel, Joycong MD. I'll see you next time.