Stem Cell Orthopedic Blog | PRP Therapy | Dr. Joseph Purita

What Type Of Stem Cells Exists?

IRMO — Mon, 07 May 2012 13:28:33 GMT

This is a question that I am often asked, and something that I feel is very important to discuss when giving a lecture. In the field of stem cell medicine we deal mainly with five types of stem cells. These types of stem cells are given the following terms. 1. Embryonic stem cells 2. Hematopoietic stem cells 3. IPS cells or induced pluripotential stem cells 4. Adult mesenchymal stem cells 5. Various other (more specific) types of stem cells.

Each of these cells has their strong points and their drawbacks. Unfortunately since stem cell science is a relatively new field in medicine there are still many schools of thought as to which cells are the most important. These cells all hold the promise of a bright future in medicine. Eventually they will be used to control most disease processes. These diseases will span the gamut from diabetes, which has now become an epidemic in the world, to osteoporosis and degenerative arthritis. If these three problems can be reined in, it would save untold lives and billions of health care dollars. Just think what we spend on diabetic problems and their related deadly conditions (heart disease, kidney disease, strokes, and pre-mature death). As science progresses, things will shake out and we will see which cells are more important in regenerative medicine. Notice I said the word MORE IMPORTANT. The reason I make this distinction is that all types of cells will have a place in regenerative medicine. Learning how to use these cells properly and at certain intervals will spell success in the practice of regenerative medicine. I will be the first to say that this is a learning process. What has to be done in this field is to put differences aside and work for the common good. Academics and those of us in the clinical world need to bury our differences and work together. There is certainly interest by large Pharmaceutical companies to control the stem cell field, but at least for now that does not appear to be happing.

To see how this is an evolving field one can take a look at Mesenchymal Stem Cells (MSCs). These cells were named by Dr. Caplan in 1987. Dr. Caplan is one of the giants in the stem cell field. Interestingly enough, Dr. Caplan first proposed that MSCs were initially thought to be the most important cell because early technology was only capable of expanding and differentiating an MSC in vitro (in vitro refers growing conditions in a lab not real life). This led to an incorrect conclusion that MSCs were the drivers of tissue regeneration, and if we expanded enough of them and then transplanted them, we would have clinical success. In other words if we grew these cells in a lab and expanded their numbers it would repair the problem at hand. We now know that FDA randomized clinical trials using cultured MSCs have not been that successful, and recent presentations have shown a negative dose effect in cardiac disease. This study showed a high dose to be less effective than medium dose. These studies were performed by a biotech company called Osiris. Osiris also published and presented studies at the meeting of the American Academy of Orthopedic Surgeons in 2012, showing again in studies of cultured stem cells that more is not necessarily better. When looking at cartilage growth the higher number of mesenchymal stem cells was essentially ineffective in growing cartilage. So what we thought was the solution in regenerative medicine namely growing mesenchymal stem cells in a lab and transplanting them into a patient does not really work well. . These new concepts were published by Dr. Caplan in 2011. Essentially Dr. Caplan has done a complete about face. Caplan states “I would suggest that MSCs are powerful site-regulated DRUG STORES or dispensing sites that may serve as modulatory or curative agents for a variety of human maladies. Since the multipotency of MSCs is not the key aspect for their current therapeutic use, I herein propose a name change: MSCs = Medicinal Signaling Cells. This concept changes many of our thoughts on stem cells and their function.

We now see that in the grand scheme of things, a symphony of cells are needed. If we want to achieve success we need to use and depend upon many different types of cells. What I would like to do over the next few blogs is discuss each type of stem cell at length. Do not be scared off, as they will not be too technical.

Thanks Dr. P

Lecturing and doing cases in Seoul, Korea

IRMO — Tue, 27 Mar 2012 14:00:09 GMT

       Recently I just returned from a rather harried lecturing and surgical case trip. If left Miami airport on a Thursday evening arriving in Mexico City at approximately 12 pm midnight. The next day I gave two lectures to approximately 400 doctors who were attending a meeting of the Mexican Anti-Aging Society. By 2:30 that afternoon I was on my way to L.A. to catch a flight to Seoul Korea that evening. After a 14 hour flight I arrived in Seoul at 7:00 am Sunday morning. At 10 am I was lecturing to approximately 300 doctors at the 2012 Stem Cell Meeting. Unlike many of the meetings that I have lectured at this was a meeting that was mainly attended by orthopedic surgeons. Many of the physicians in the audience were professors at the leading medical schools in the Republic of Korea.   The faculty included physicians from the United States, the European Union, and Korea.
       This was more of a meeting that combines surgery and stem cells. I felt I was in my own element since I was dealing with many orthopedic surgeons. My lecture was over at approximately 11 am and by 12 noon I was in the impressive operating rooms of the Catholic University. These operating rooms seemed to be state of the art as did the entire hospital. As far as appearance is concerned I would put in it in the same category was any top notch university hospital in the United States. It certainly far exceeded any community hospital. Luckily I was able to sleep somewhat on the plane plus the adrenalin in my system let me perform some surgical cases that day with my Korean counterparts.   We did live demonstrations of the operations for the rest of the doctors attending the meeting.
      The first case which we performed involved a micro fracture technique combined with bone marrow stem cells and a fat graft injection. The case we performed involved a woman in her 50's with bad arthritis on the inside portion of her knee. What we initially did was make small holes in the areas of bone in the knee that were denuded of cartilage hence the micro fracture portion of the operation. When we do a micro fracture technique we are trying to stimulate area in the knee to grow new cartilage. The holes in the bone essentially allow some stem cells to leak out of the bone marrow and hopefully accomplish repair. This is a technique that has been around for at least 20 years. So in all honestly we have been using stem cells in orthopedics for at least 20 years without realizing it. As you can see stem cells are not as new as everyone thinks.   The problem with a micro fracture is that many times the results are not as good as we would like. It is felt that many times not enough stem cells are delivered to the area. The micro fracture technique has saved some professional sports careers and ended others. When we use stem cells with a micro fracture we are greatly increasing the chances of success due the extra stem cells we are adding with the bone marrow and fat.
     After showing my Korean fellow surgeons some of the surgical techniques I gave them some pointers on our postoperative care. These pointers included the use of an unloader brace, a DC stimulator brace, supplements and other pointers which make our facility have the success that it has. They were very intrigued by the other steps we take to try to improve our results. Unfortunately, many physicians and clinics feel that to inject stem cells or a PRP to the area is all that is needed. They do not realize that in addition to the proper techniques, supplements, dc current sleeves and other proprietary techniques are extremely important.
      After a rather whirlwind day I attended a banquet for the faculty of the stem cell symposium. The food was delicious. Some was familiar to me and some I had no idea what it was which a good thing was probably.
    The following day was a combination of lectures and cases. It was a give and take in that I also picked up me few ideas from some of the professors. Please see some of the accompanying pictures that highlight my time in Korea.
      The below picture represents the faculty at the meeting of the Korean Association of Stem cell and Tissue Regeneration.

The next picture is me getting an award from Dr.Jung –Man Kim Professor of Orthopedic Surgery Catholic Univ. of Seoul and President of the Korean Stem cell and Tissue Regeneration Society

The next few pictures show me in the operating room explaining some of the surgical techniques.

The above picture shows the bone marrow aspirate we have just harvested from the pelvis.

The next picture shows the preparation for obtaining the fat tissue via a mini liposuction

The next picture shows some of the fat we harvested from the liposuction.

The next picture shows that I sometimes go back to my roots of being an Italian-American who talks with his hands even in the OR.



Korea will always have a special place in my heart.   Dr. P

Why are Antioxidants Important?

IRMO — Mon, 05 Mar 2012 19:26:52 GMT

Everyone talks about antioxidants but few people really understand what they are and what they do. What antioxidants try to accomplish is to neutralize a free radical. The following diagram illustrates what a free radical is and how it functions.

A free radical comes from our use of oxygen. Unfortunately almost all life requires oxygen to survive yet this same oxygen causes us to slowly die. This slow death is caused the the production of what are called free radicals. A free radical is an oxygen molecule that is missing an electron in its outer shell. Although the electron concept brings many of us back to the basic chemistry courses we had in high school or college this is a most important concept. The free radical will most likely result in your death. The reason that we say this is that the free radical is responsible for many degenerative disease processes. These processes include diabetes, heart disease, and cancer. Like we said most of us are going to succumb to one of the diseases just mentioned. The root of almost all diseases lies in inflammation and the disruptions in the body that it brings about. The root of almost all inflammation lies in the damage that the free radicals cause.

These free radicals are the cause of inflammation. Inflammation rears it ugly head in many different ways. In general most disease processes can be traced back to chronic inflammation. These diseases include degenerative arthritis and the other already mentioned diseases. To further elucidate this fact it is well known that there is a direct link between poor mouth hygiene and heart disease. When the gums become inflamed the incidence and severity of heart disease increases.

Free radicals are cellular killers in that they alter DNA; they interfere with biochemical reactions and they will destroy the cell membrane. The most important damage that occurs is to the mitochondria or the powerhouse of the cell. When the mitochondria sustain significant damage the cell usually enters a death spiral. The following diagram comes from Popular Science magazine.

The article was about a friend of mine who is probably the leading science in the world concerning telomeres and their ramifications on cell and mitochondrial health. His name is Dr. William Andrews. I suggest that you go to his web site Sierra Science. We can see from the diagram that free radicals are intimately involved in the death spiral. The free radical damage both the telomere DNA ends ( please read my blog on Telomeres) and the mitochondria.

When we are trying to figure out what foods might be best to fight free radicals we need to look at the ORAC value of the food or supplement. ORAC refers to the following term " the oxygen radical absorption capacity". The higher the ORAC number the better the food or supplement is in fighting the free radical. The following diagram shows the ORAC value of various foods. The higher the ORAC value the better the supplement is in fighting off free radicals.

So what do we call foods and supplements with a high ORAC number? The answer is simple these are called antioxidant. What these supplements and foods are doing is neutralizing the free electron and thus eliminating the free radical damage. Now one can see what all the hype is about with the antioxidants. Another trick question is what common food typically has the highest antioxidant number? The answer to this question is dark chocolate as can be seen from the diagram. REALIZE DARK CHOCOLATE DOES NOT CONTAIN HIGH AMOUNTS OF SUGAR. The best type of dark chocolate is one that is at least 80% pure chocolate.

Many of the antioxidants are phytonutrients. They are derived from plants and are concentrated in the skins of fruits and vegetables. These are compounds that give smell, flavor, and color to fruits and vegetables. A good rule of thumb is to try to eat at least five different colors a day. One of the few times a lectured to a group of lay people I was asked the question if eating five different colors of M+Ms was in the spirit of five different colors a day?

How does this all tie in with stem cells? Well remember that stem cells are on some respects similar to other cells and thus they are subject to the same damages that other cells undergo. So if we can minimize damage on a cellular level we are going to be left with a stem cell that is functioning at its peak. For this reason we place all our patients on a variety of supplements such as Resveratrol, melatonin and a host of other supplements. If you are having a PRP or stem cell injection and you are not taking supplements you run the risk to possibly compromising the results. In another blog I will address how exercise, diet and other factors also affect free radical damage.

Thank you Dr. P

Mexico City Lecture

IRMO — Wed, 29 Feb 2012 14:13:34 GMT

I had the great fortune to address approximately 400 doctors on February 17 in Mexico City. The lectures were very well received by my colleagues. They seemed to soak up the information that was presented to them.

They were intrigued by the system that we use to treat our patients. These doctors are on the cusp on the newest advances of anti-aging medicine. What's presented at these meetings eventually becomes mainstream medicine.

Although many individuals are doing some type of stem cell procedures few address the whole patient like we do. I stressed the the importance of using supplements to enhance stem cell output from the bone marrow. As a matter of fact one entire lecture was devoted to the use of supplements and anti-oxidants. This can make the difference between success and failure. We must remember that stem cells that we inject into a joint will begin the repair process but can by no means complete the repair. Other stem cells must be sent to the area to achieve repair. These are the stem cells that come from the bone marrow. As I stated in my lecture the stem cells that we inject are much like a Navy Seal strike team. They secure the area and prepare it for the troops which in this case are other stem cells sent by the marrow.

They were impressed by the use of an electrical sleeve that we use on our patients. The science behind the sleeve was presented. The DC current acts somewhat like a magnet for the stem cells, it increases micro- circulation which is the vehicle that delivers the stem cells to the area, it also increases the release of growth factors that also attract the stem cells.

We also discussed the use of Regenerative Photonic Therapy. This is the process that utilizes a type of cold laser, LED lights, and Super diode light. This type of therapy can dramatically speed up the healing process. I was impressed when we were able to get an NFL player with a partial quadriceps tendon tear back practicing within one week and playing in an important game within two weeks of the injury.

Finally we talked about the pitfalls of various type of stem cells. I discussed why certain cells do not work in patients and why certain treatments to these cells may not be a good idea.

My only disappointment with the Mexico City trip was the small amount of time I spent there for I left that afternoon to fly to Seoul Korea to lecture and perform cases.

Thanks Dr.P

Hyperbaric Oxygen

IRMO — Mon, 27 Feb 2012 15:02:40 GMT

Hyperbaric oxygen is becoming more and more common yet it very much misunderstood. Typically when someone is asked how hyperbaric oxygen works the answer is almost uniformly that it increases the amount of oxygen to the tissue. This answer is given by both physicians and lay people. This seems to be a likely answer. It makes since that if we give more oxygen to an area it will increase healing. Well this is a trick question that almost everyone gets wrong. Although we need oxygen to survive, too much oxygen can cause damage to the tissues. So the question becomes what does hyperbaric oxygen do to the body that makes it so beneficial?

The real answer is that the hyperbaric oxygen process works with a few different mechanisms. The most important mechanism is that it produces Nitric Oxide ( the abbreviation is NO). Nitric oxide is a very potent stimulator to,the bone marrow. It causes the production of an enzyme that can dramatically increase stem cell output from the bone marrow. Over the course of twenty treatments the stem cell output can be increased by eight times the normal amount. This is a significant increase in stem cells and it is a very safe method of achieving the increase. We can achieve bone marrow stem cell output by stimulating the marrow with a medicine call granulocyte colony stimulating factor. This will make dramatic increases in stem cell output but it is very expensive and has some serious side effects associated with it. While hyperbaric oxygen has little in the way of side effects but it can be expensive and time consuming.

The main type of stem cell made from hyperbaric oxygen treatments in a blood stem cell called a hematopoetic stem cell. There is also an increase in some of the mesenchymal stem cells but this is small compared to the number of blood stem cells. However not all is lost because the hematopoetic stem cells can form into mesenchymal type cells and accomplish repair. There have been numerous studies some on which are ongoing as to what hyperbaric oxygen treatments might accomplish. There seems to be mounting evidence that these treatments might be very beneficial for the treatments of head injuries such as concussions. The US Army is interested in these treatments for some of our vets who have been wounded with head injuries in Iraq and Afghanistan. The NFL is also looking at these treatments as a means of treating concussions. We are now finding that concussions seem to lead to big problems down the road such as a predilection to Alzheimer's disease and other conditions such as possibly Parkinson's disease.

The problem with that hyperbaric oxygen treatments are costly and time consuming. There is no doubt that they work the scientific literature is overwhelming. For now we need to try to find some substitutes that may give a similar effect as hyperbaric oxygen but not have the cost in time and money that hyperbaric treatments require. There are a number of supplements that can achieve similar results that hyperbaric treatments attain but they probably are not quite as effective. Now if we combine these supplements with hyperbaric treatments we might be on to something.

Thanks Dr. P

Just As Was Mentioned In The Movie The Graduate "The Future Is Plastics"

IRMO — Mon, 30 Jan 2012 15:09:01 GMT

Many people out there may remember the movie THE GRADUATE. One of the famous quotes of the movie was when young Benjamin was told by Mr. McGuire that "the future is plastics". You might ask yourself what does this have to do with stem cells? Well plastics can pertain to the stem cell world on two different levels. We know that certain cells in the bone marrow are attracted to plastic. However in this case we are not discussing this aspect.

What we are discussing is the concept of plasticity. By this we mean that certain stem cells in this case the hematopoietic stem cells can change into other type of stem cells. The big deal about this is that the hematopoietic cells can change into mesenchymal stem cells which we think accomplish most of the repair work. The following diagram is a good diagram of this principle.

The preceding diagram shows this concept. We see that the hematopoietic stem cells can change into stromal stem cells. As we can see once they become mesenchymal (stromal) stem cells they have the ability to form other tissues. The key statement in the above diagram is that the hematopoietic stem cells augment the limited number of available stromal (mesenchymal) cells. The other important job for hematopoietic stem cells is that they help establish a blood supply. A blood supply is what delivers stem cells, growth factors, and other building blocks to accomplish repair.

So far you might say big deal but this is indeed a big deal. Bone marrow aspirate contains huge numbers of hematopoietic stem cells. The number of mesenchymal stem cells in the bone marrow diminishes as we age but the hematopoietic stay relatively constant. Actually it is probably the hematopoietic cells that are what actually cause things to heal. Remember your body reproduces itself every six years. When we are doing stem cell treatments it is not the cells that we inject into the joint that accomplish the entire repair. These cells act as so to speak like a Navy Seal strike team but the regular forces have to be sent in to finish the job.

When we take this approach it seems that we would want a combination of mesenchymal and hematopoietic stem cells injected into the area. Realize that the bone marrow also contains a number of primitive stem cells and growth factors that may be crucial to achieve repair. For this reason I am not a big fan of culturing cells including both bone marrow mesenchymal stem cells and fat stem cells. With culturing we are missing a large number of the hematopoietic stem cells. Some scientists also feel there are other problems with these cells. I feel a properly performed bone marrow aspiration concentration along with a fat graft (supplying fat stem cells) and PRP may work the best. This is especially true when we use post injection methods to stimulate the further release of stem cells. These methods include supplements, electrical stimulation, lasers and LED therapy.

If one is looking for some evidence how the hematopoietic stem cells work we need to look no further than that research from my friend in Malaysia Dr. Khay-Yong Saw, M.Ch.Orth. F.R.C.S.(Edin). Dr. Saw wrote a classic article”Articular Cartilage Regeneration with Autologous Peripheral Blood Progenitor Cells and Hyaluronic Acid after Arthroscopic Subchondral Drilling: A Report of 5 Cases with Histology”. This was published in the following journal: Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 27, No 4 (April), 2011: pp 493-506. The journal is listed for those physicians that read this blog. Dr. Saw showed by MRI and arthroscopic looks that he was able to grow new cartilage. What Dr. Saw did was make small holes in the bone hoping some stem cells would leak out of the marrow but he added large numbers of hematopoietic stem cells.

So the bottom line in the stem cell world is that it is not really a numbers game after all as long as the right steps are taken. With the right techniques it appears that success can be achieved with a variety of stem cells. As time goes on we will probably refine the stem cell recipe but I do believe this will include both bone marrow and fat stem cells to get things started.

Thanks Dr. P

Athletes that our center has treated!

IRMO — Wed, 25 Jan 2012 16:00:00 GMT

I thought the above headline might have raised some eyebrows. I have numerous requests by various news agencies such as HBO and ESPN wanting to observe us treating athletes. Well you will note that we have been conspicuously absent in allowing this to be done or even mentioning athletes we have treated. Other than Mr. Colon who the New York Times first broke the story and Mr. C.J Nitkowski who posted a blog, we have not mentioned any athletes we have treated nor do we intend to. We guard our patients privacy very strongly and athletes are no different. Although we follow strict guidelines imposed by the various leagues with all our players, if certain facts are leaked to the public this might have all types of ramifications. These include the athlete's contract negotiations, possible changes in betting lines and teams injury reports. We have treated some of the most famous players in various sports with excellent results. Many times we are working under a time deadline trying to get a player back ASAP. These players know who they are and I thank them for allowing us to treat them.

Dr.P

The Use of Regenerative Photonic Therapy

IRMO — Mon, 23 Jan 2012 16:37:23 GMT

Recently I had the honor of meeting with Drs. Norman and Natasha Salansky. This dynamic husband and wife PHD team are considered some of the world' leading expects in the use of lasers and photonics as they pertain to humans. This field is called laser medicine. They recently presented at "25 International Congress on Laser Medicine". They have been involved in the field of lasers for many years. They have taken the next step and applied their knowledge to Regenerative Medicine. They have researched the healing phenomena of low energy coherent lasers and non-coherent (LED) photons for 25 years.

Due to my work with stem cells Drs Norman and Natasha Salansky approached me about their techniques and protocols. Their idea was to incorporate their ideas with my work in Regenerative Medicine. After studying their protocols I feel this could be a very good marriage for all concerned.

Their protocols are called Regenerative Photonic Therapy (RPT). RPT uses a combination of Laser, LED, and Superluminous Diodes (SLD) photons to stimulate tissues inducing non-thermal photochemical alterations that improve and accelerate the regeneration of tissues and reduce inflammation. Translated in English this means that the combinations of different lights dramatically speeds up healing and and repair of tissue much like stem cells do.

Physiologically, among other things, RPT activates cell and tissue metabolism. This activation results in proliferation of cells, increased synthesis of ATP which is the basis of all cellular energy, and increased micro circulation to the area. Throughout many of my blogs we see recurrent themes such as micro circulation and ATP production. These are very important in stem cell science and help us achieve our goals of tissue repair. The products that Regenerative Photonic Therapy produces can be called photoceuticals. These are compounds that are produced by the effect of light.

Pharmaceuticals are medicines that we use to help us with some type of health problem. Nutraceuticals are supplements that we take to maintain and improve our health. Photoceuticals and electroceuticals (those effects and compounds produced by the phenomena of electrical currents) work similar to pharmaceuticals and nutraceuticals improving our well being. These compound work many times on a molecular level. When these photo-chemical phenomena are properly sequenced etc., this technology can have significant therapeutic effects that are drug free and without side effects.

The Salanskys have discovered that medical conditions respond in different ways to different forms of light. The form of light depends upon the wavelength, power, irradiance, dose, frequency and duty cycle. The combinations of these parameters are defined as Therapeutic Optical Windows also known as TOWs. To induce a specific therapeutic side effect, a unique set of TOWs are required to control the required tissue healing 3-D photon distributions. TOWs are programed, sequenced and adjusted according to the patient being treated: young, old, elite athletes, and the condition of injury and the phase of healing in the tissue's pathology. The protocols not only deal with symptoms of pain but also address the root causes.

Regenerative Photonic Therapy differs greatly from current laser therapy. Current therapeutic lasers can produce healing with a single photonic source but they don't have the ability to adjust optical parameters that are needed for diversified applications nor do they provide the required 3-D Photonic distributions to the tissue. In general the results with lasers have been spotty.

There have been over 100,000 patients that have been treated RPT with success wing anywhere from 75-95% success. Although RPT alone seems to work well when used in combination with PRP and stem cell injections there seems to be some great synergy. RPT seems to have a very beneficial effect on the inflammatory phase in the healing cycle. It helps to reduce oxidative stress, increase availability of antioxidants, increase ATP production and achieve pH balance. When we are talking the "healing cycle" we are including four distinct phases. The first phase is the coagulation phase. The second phase is the inflammatory phase. The third is the fibroblastic repair phase and the fourth is the maturation or remodeling phase. At each phase of tissue repair specific goals are accomplished by key cells which are controlled by specific cellular messengers. For instance the inflammatory phase requires substantial ATP which in chronic injuries may not be readily available. Many times injuries get stuck in the inflammatory phase and thus go on to be chronic injuries. RPT allows the proper environment to deal with the inflammatory phase and actually speed up it's course. RPT helps clean up the cellular debris allowing the body to move on to the fibroblastic or repair phase.

Many times when someone has a painful reaction to the PRP or Stem Cell injection it is due to the cellular debris and the cytokines or inflammatory factors that are released. To get a bit more technical RPT reduces what are called Reactive Oxygen Species ( ROS) which cause cell damage on multiple levels and at the same time helps increase Nitric Oxide (NO) which helps increase circulation, stem cell output and a host of other important things.

I feel that Regenerative Photonic Therapy will help revolutionize Regenerative Medicine. I think it will make both PRP and Stem Cell injections much more effective and speed up the time before significant improvement is seen. I feel fortunate that we are one of the few centers in the world that is offering this therapy with PRP and Stem Cell injections. I think the sky is the limit with this combination therapy. I feel fortunate to be working with the Salanskys. More to come about this therapy.

Thanks

Dr.P

Electricity and Stem Cells

IRMO — Wed, 04 Jan 2012 14:54:44 GMT

Does electricity make a difference for stem cells? We have been intrigued by electricity and its use in the body for centuries. I first became aware of the use of electricity in the field of stem cells with my work with the Bionicare brace. The Bionicare brace was created at Johns Hopkins Univ. and the Univ. of Pennsylvania. The research was performed by Dr. Carl Brighton and Dr. Hungerford. Dr. Brighton initially taught us the concept of electrical stimulation will cause bones to heal which typically were slow to heal. The mechanism of action for the Bionicare brace involves turning on certain genes in chondrocytes and increasing the cell wall permeability of the chondrocytes.

What does this all mean in English? Well first of all the chondrocytes are those cells that produce cartilage that is found on the ends of the bone. The cartilage acts as a shock absorber and allows our joints to glide smoothly. We develop osteoarthritis when the cartilage becomes damaged. When the cartilage is damaged than joint begins to hurt and the function is diminished. We now have an osteoarthritic joint that causes pain, swelling and somewhat disables the patient. The reason why the joint becomes damaged is that the chondrocytes have lost the ability to repair the damage. As we become adults the genes of the chondrocytes become silenced. A silenced gene is a gene that at one time was functional but at reaching a certain age the gene is programed to stop functioning. When the gene stops functioning damages continues to accumulate. We know if the gene can be turned back on the chondrocytes might than try to repair the damage. The trick is to get the genes to turn back on. We know that stem cells can affect chondrocyte genes in that they can recruit the chondrocytes to accomplish repair work. The Bionicare brace was one of first to utilize electrical current but like all things in life new and improved advances always come along.

We are currently utilizing braces( stimulators) made by Prizm Medical. The Prizm brace is not actually a brace but a sleeve. It is not designed per se to support the joint but encase the joint in a micro DC electrical field. The sleeve has silver fibers throughout the fabric. These silver fibers conduct a micro electrical DC current around the joint. These sleeves are described as a pacemaker for micro-circulation around the joint. In the past, electro therapy has been difficult to administer because of a lack of precision in where to apply the electrodes and a loss of conductivity over a period of time.

Research shows that the micro-amperage delivered falls precisely within the narrow "biological waveband " of the body's electromagnetic energy. These sleeves do not mask the pain but instead the micro amperage electrochemically fuels the body's natural healing mechanism. This is done in a variety of ways including improving cell function and increasing micro circulation to the involved area. The good thing about these sleeves is that unlike the Bionicare brace they come in several forms including gloves, sleeves, stockings with new ones being developed all the time including ones for the shoulder and hip.

The interesting fact that drew my attention to these stimulators is the fact that much research has been done with them in regards to diabetic wounds. What I noticed was that the results with diabetic wounds were similar to what was seen with stem cell injections. The wounds would heal dramatically quicker than would otherwise happen. When studying the effects on DC current on the body we see many of the same phenomena that occurs with stem cells and PRP injections. We see an increase in one of the most important growth factors which is called VEGF or vascular endothelial growth factor. This growth factor is extremely important in that it helps establish a blood supply. Think of stem cells as an advancing army. Like any army supply lines are needed. In this case the supply lines are the blood vessels. VEGF helps to establish this supply by causing angiogenesis or the formation of blood vessels. Logic says that something that increases growth factors is a good thing. Growth factors attract stem cells and cause stem cells to become more active and help them actually recruit other cells to help in the repair process. The stimulator braces certainly do this. Also the brace increases micro circulation to the area. Other studies have shown an increase of approximately 500% in ATP production. ATP is what gives the cells energy. If we can increase ATP production we will increase healing by allowing cells to be healthier and more efficient. When ATP production is down cells age more rapidly and may simply die from the lack of mitochondrial function. The same studies show that the DC current at 500uA greatly enhanced amino acid production and protein synthesis. Amino acids and proteins are the building blocks of the body and repair cannot occur without them.

The other intriguing aspect of the micro z stimulator is that it is mainly used at night while one is sleeping. The human body goes into a natural state of healing when it is in a sleep cycle. The body produces 70% of it growth hormone durning sleep. Fibroblasts are more active durning sleep. When all these factors are taken together we start to see some significant improvement with the micro Z stimulators. My experience with these stimulators so far has been excellent. They seem to make patients get better quicker. I have used these braces on a number of professional athletes with excellent results. It dramatically speeds up their recovery from an injury. The reason for this is that the stimulator is increasing circulation and stem cells locally to the area. In this case we are not just talking about joint injuries but soft tissue injuries as well.

I feel that these stimulator braces are going to become a significant part of Regenerative Medicine. It appears that these stimulators will enhance stem cell performance with essentially no risk to the patient. Typically I have the patients use these braces overnight. Interestingly enough we will many times get insurance coverage for these braces including Medicare. More to come

-Dr.P

Dominican Republic Lecture

IRMO — Wed, 28 Dec 2011 15:00:00 GMT

I just returned from a short trip to the Dominican Republic lecturing to over 300 orthopedic doctors on the use of stem cells and PRP for orthopedic problems. I must admit that the interest was overwhelming. Apparently stem cells and PRP is a hot topic in the D.R. We must realize that baseball is the king in the D.R. I would say that the interest in baseball far surpasses the interest for the NFL in the US. I have treated a number of baseball players from the D.R. with PRP and stem cells with good results; thus the interest in treating athletes with stem cells is quite high. If we can get a player back sooner or resurrect his career this is a good thing.

I was invited back to lecture in the D.R. again in June of 2012 and was approached to be involved in a clinic in the D.R. We will see how things play out with no pun intended. I will leave for Las Vegas this week to give 2 lectures at the American Academy of Anti-Aging Medicine ( A4M). One lecture is will be on the use of PRP in Aesthetics on Dec.7 and the other lecture is on Dec. 9 on stem cells and PRP to the general meeting. I am looking forward to the to the A4M meeting to discovered what new technique or item might be out there to improve the results on my patients. I will keep everyone posted on what I discover out there.

Thanks Dr.P

FAT STEM CELLS

IRMO — Tue, 27 Dec 2011 14:12:31 GMT

FAT STEM CELLS WERE NAMED BY TIME MAGAZINE AS ONE OF THE 50 BEST INVENTIONS OF 2011

This comes as no surprise when one considers all the research that has been done with fat stem cells. When a mainstream periodical such as Time magazine considers something as one of the fifty beat inventions of the year that says something. Fat is finally making it to the big time. The only thing I would question is the fact of naming fat stem cells as one of the best inventions of 2011. Fat stem cells have been used for many years now with excellent and safe results. Perhaps we should say that fat stem cells finally have been recognized for their potential. Just a few weeks ago there was news about fat stem cells being used to regenerate heart muscle in heart attack victims with good results. This is just one of many different examples where fat stem cells cause repair.

Why all the fuss about fat stem cells? If we analyze fat we realize that it a gold mine of mesenchymal stem cells. These are typically the most important cells that accomplish repair to bone, tendon, cartilage, and muscle. These are the four structures we are very much involved with in the repair of orthopedic problems. Even if you have conventional surgery you are depending upon stem cells to finalize the repair. These stem cells from fat are initially derived from bone marrow stem cells and thus they act very similar to bone marrow stem cells. The fat cells are harvested the same day as they are used and thus they do not lose the potency.

The main reason why the fat stem cells are so important is the sheer number of stem cells that are contained in fat tissue. As we age the number of mesenchymal stem cells diminishes dramatically in our bone marrow. In the meantime the treasure trove of mesenchymal stem cells stays relatively constant in our fat tissue. By no means do I mean to reduce the importance of bone marrow since it contains large numbers of other type of cells we need in addition to all the growth factors that are found in stem cells. When we use bone marrow aspirate ( that liquid that is removed from the bone marrow ) and combine it with fat and the stem cells that fat contains we have a cocktail that can do some excellent repair work.

My final thought about the Time article is that I don't consider fat stem cells as an invention. An invention is something that is created. Fat stem cells have been there all the long. They were discovered. It just might turn out that at least in medicine fat stem cells might be one of the most important discoveries of all time. The potential is there we just need to learn the tricks of harnessing it.

Thanks Dr. P

Stem Cell Tests on ALS

IRMO — Mon, 12 Dec 2011 13:30:00 GMT

At Emory University in Atlanta two weeks ago, stem cells were injected into the upper spinal cord of a patient, Richard Grosjean, for the first time as part of a clinical trial. The 50-year old Grosjean received stem cell injections in his neck as a new experimental treatment of amyotrophic lateral sclerosis (ALS), widely known as Lou Gehrig's disease. According to reports, the clinical trial at Emory is being used to test the safety of injecting stem cells into the spinal cords of patients suffering from ALS. Mr. Grosjean was diagnosed with ALS more than two years ago. The majority of ALS sufferers die from respiratory failure within five years of being diagnosed.

ALS is a late-onset motor neurone disease that affects approximately 1 in 50,000 people. Grosjean's procedure took over 4 hours and consisted of five separate injections into the cervical region of the spine. Each injection consisted of more than 100,000 individual stem cells.

The current clinical study in stem cell therapy began in January 2010 and is classified as a phase I trial designed to assess the safety of the transplantation method. The first 12 patients in the trial have already received stem cell therapy in the lumbar region of the spine, and now the trial has advanced to the final 6 patients, with all 6 slated to receive injections in the cervical region of the spine.

This trial, as well as other similar clinical research, is controversial primarily because it utilizes material from human embryos, which are destroyed after use. Many in the medical community believe that once more tangible results have been gleaned from this stem cell research, the controversy surrounding it will ease as well.

Stem Cells Make The Heart Grow...Fonder

IRMO — Wed, 07 Dec 2011 16:37:53 GMT

A new study in stem cell therapy has yielded some very tangible results for the potential of this cutting edge medical field. Dr. Robert Bolli and a team of researchers injected stem cells into the hearts of patients who had suffered extreme heart damage, and the results were phenomenal. As hoped, the stem cells grew into new heart cells to act as replacements for the damaged heart cells. This brings a smile to the medical community that has hoped since the advent of stem cell research that one day, stem cells would be able to help doctors replace damaged internal organs like livers, kidneys...even spinal cords.

In this latest study, the patients injected with the stem cells saw their heart health improve. The researchers collected a minimal amount of tissue from each individual patient’s own heart, as well as purified stem cells from the heart tissue. The patients’ heart function was measured to determine how much blood was being pumped through the left ventricle. At the onset of this research, the test subjects had an average Left Ventricular Ejection Fraction (LVEF) of 30.3%, which represents a very severe case of heart disease. Four months after the stem cell therapy, the patients who received the stem cells saw their LVEF increase to 38.5%. After a year, the patients' LVEF had improved to 42.5%. The patients involved in the control group who didn’t receive the stem cells showed virtually no movement in their LVEF.

The researchers used magnetic resonance imaging to gauge the heart tissue damage in seven of their patients, and discovered that the damage decreased by 30% after only one year. In a concurrent medical trial conducted at Cedars-Sinai Heart Institute in California, equally impressive results were achieved. According to the researchers at Cedars-Sinai, the patients grew roughly 600 million new heart cells after the procedure, which is approximately the number of cells that die during a serious heart attack.

This study shows convincingly that the human heart contains stem cells that can re-grow into new heart cells. Many medical experts once believed that heart damage was irreversible, but now are seeing that someday, hearts may be completely repairable.

Obviously, the results are premature at best, due to the limited smple sizes of the studies conducted to this point, but there is no doubt that this study stands as a major triumph for stem cell research.

Supplements to Enhance Stem Cell Output

IRMO — Tue, 15 Nov 2011 03:03:38 GMT

What we hope to accomplish with supplements is to enhance the output of stem cells from the marrow so that the body has them at its disposal accomplish repair. This seems simple yet it can sometimes prove to be a daunting task. We are fairly certain that there are certain supplements out there which enhance stem cell output. What we observe is that most supplements which improve our health seem to do so by a variety of mechanisms.

Certainly many of these supplements work by their antioxidant properties. The body produces free radicals which antioxidants neutralize. When large numbers of free radicals are circulating in the body steps must be taken to neutralize these or damage will occur. By providing antioxidants a large burden is taken away from the body. The body can better shift it's resources to repair itself. The body repairs itself by the use of stem cells. All of the cells in your body were not there six years ago. Your body has replaced every cell in your body over the last six years. If we can somehow speed up the bodies output of stem cells we will increase repair and probably slow down aging in the same process. What we are now finding is that many supplements have multifaceted effects on the body. I have given many lectures all over the world on the effects of supplements on PRP and Stem Cell injections. I am firmly convinced that supplements do make a difference. They allow the body to repair itself quicker and maintain good health longer. I have dealt with a number of professional athletes and it is not uncommon to see some of take 50 or more supplement pills per day.

Most of our patients are told to purchase a product called StemX cell. The research on this product is fairly solid in that it comes from the Univ. of South Florida by Drs. Bickford and Sanberg. These two doctors are very well respected stem cell scientists. They have shown that the components in this supplement seem to dramatically increase stem cell output from the bone marrow. We recommend that this medication be taken at a dose of 4/day for the first month than 2/day afterwards. The reason that we recommend this is due to its convenience. We are certainly not opposed if one wishes to take the components of StemX cell individually. With this in mind, I would recommend 4,000-5,000 units of Vitamin D3 per day, Carnosine dosage should be 1500mg a day. Carnosine is so important in that it appears to help the body produce a compound called Nitric Oxide. It is documented the Nitric Oxide will have a direct effect on the bone marrow causing bone marrow to dramatically increase stem cell production.Green tea dosage should be approximately 500mg, blueberry extract should also be taken on a daily basis. What is interesting about these supplements is that they probably also slow down aging by stopping the degradation of our telomeres. The telomeres are found at the end of our DNA strands. Every time the cell reproduces it loses a small snippet of DNA. When the DNA length reaches a certain critical length the cell is programed to die. By slowing this down we slow down aging and allow our stem cells which will have to undergo a number of cell divisions to weather the DNA damage better. Remember less teleomere damage results in a more effective cell. We know that Vitamin D, glutathione, astragalus are important in telomere preservation. Remember we want the stem cells to reproduce ( which obviously requires cell division) but we want to maintain their integrity of the DNA. A simple way of increasing glutathione is by ingesting whey protein. Whey protein comes milk products. It should be considered "superfood". A bit needs to be mentioned about Vitamin D. Vitamin D should be considered a hormone rather than a vitamin. It has far reaching effects throughout the entire body. There are receptor sites throughout the body in various tissues including brain,prostate,breast pancreas, that have Vitamin D receptors. We know that Vitamin D deficiency seems to make the body more prone to cancer. The research on this is rather conclusive. Vitamin D also seems to boost our immunity and helps fight off viruses and infections. Although you are getting some vitamin D with StemcellX there is not enough in there to suffice. One should take a total of between 4-5 thousand units per day. Remember to do you math because some other products may also contain Vitamin D.

Another important weapon that we will use is omega-3-fish oil. Omega-3-fish oil is extremely important for our well being. It acts on many different levels. It has potent anti-inflammatory properties and it also seems to have an effect on the teleomeres. When considering the dosage of Omega-3-fish oil one needs to only be concerned with two components. If you look on the bottle you will see these listed. They are called EPA and DHA. These two components together need to add up to 3,000mg/day. Also put the fish oil in the freezer and take it directly frozen. This will eliminate the regurgitation and fishy taste. The fish oil seems to effect the cell membrane in a very positive way. The cell membrane (remember all stem cells contain cell membranes) contains the receptors for growth factors and signaling factors. Think of the cell membrane as the brain of the cell in addition to acting as the cell's eyes and ears. Unfortunately, due to our poor diets much of our cell membranes are composed of omega-6-fatty acids which effect the integrity of the membrane. The omega-6-fatty acids are typically the bad hydrogenated fats. These should be avoided. It will typically take the body 4-6 weeks to accomplish an"oil change"in the cell membrane. You will also need to get an assortment of omega -9- fatty acids which are typically found in olive oil and various nuts such as almonds.

Other supplements that we use include those that stabilize mitochondria which are the power houses of the cells and other supplements which increase stem cell output. It is now felt that many diseases result from the mal -functioning of the mitochondria. This improbably a combination of telomere damage and free radical stress. Melatonin seems to have a special property of helping to repair some DNA damage in the mitochondria. Another important supplement is Co Q10. The dosage of Co Q 10 that we recommend is quite large. The CoQ10 will help stabilize the mitochondria of the cells. Briefly the mitochondria are the powerhouses of the cells. They help produce energy for the cells. When your mitochondria are in trouble you are in trouble.

Another important supplements in the stem cell world includes. Resveratrol. Typical one should take between 250mg and 500/day of Resveratrol. This seems to turn on certain longevity genes in the body called Sirtuin 1 genes. These genes mimic starvation and exercise. At the present time the only scientifically proven method of extending life is starvation. This is by and large not practical. For this reason stick with the Resveratrol.

Finally another important supplement to take is Alpha Liopic Acid. Alpha Lipoic Acid helps recharge the various antioxidants that you body utilizes. It is quite important that you take antioxidants to neutralize the damage done by the bodies' use of oxygen. The best antioxidants came from phytonutrients of plant and fruit by products. One of the best antioxidants one can take is dark chocolate which is approximately 85% pure (low sugar content). Try to eat at least 5 different colored foods per day.

There are other supplement that we use that will be for another discussion. One of which we have started using is velvet deer antler which stimulates IGF-1 which is the active form of HGH. This supplement is typically not given to professional athletes since there is a question of it being restricted by their leagues.

No one can say with absolute certainty how important the supplements are but it is fairly well established that these supplements due make a difference in regenerative medicine. It is unfortunate that many centers that are working with PRP and Stem cells ignore the importance of supplements. All I can say is shame on them.

Dr. P

Resolved Knee

IRMO — Fri, 11 Nov 2011 15:00:00 GMT

The above pictures represent pictures of an MRI scan from one of our patients. What we are looking at are pictures of a knee (both front ways and sideways views). The bottom four pictures are from an MRI scan in 2008. At that time our patient was in severe pain on the inside (medial) portion of his knee. He was able to walk only with crutches. In the bottom four pictures the second and fourth pictures going from left to right show significant problems. In these two pictures we see areas of a white color. This white color on the MRI scan represents dead and dying bone. This condition is called avascular necrosis of the bone. Perhaps a simplistic way of looking at this is to consider this condition similar to a heart attack of the bone. There are many different causes of avascular necrosis such as cortisone usage, scuba diving but by far the most common cause is idiopathic or unknown etiology. In this case the cause was idiopathic. The patient sought a number of opinions. He was told by two separate orthopedic physicians that he needed a knee replacement. We now have a patient in his 40’s, previously very active and having a well-paying job that required him to be active but he was having great difficulty doing these things. One thing this patient did not want was a total knee replacement at his young age.

Not responding to conservative measures (of which there are very few for this condition), the patient was facing a knee replacement. The patient than sought a consult from our clinic. The patient was told we thought there was a good chance we could arrest the process and possibly reverse it. He felt he had little to lose by trying our techniques. He was told that our techniques were unique and not the same as other clinics using stem cells and or PRP. Our approaches are unique in all facets of the patient’s treatment including that time before, during, and after treatments. We began treatments in Dec. of 2008. The patient received 3 treatments total from us. He became progressively better, gave up his crutches and resumed full duty work within 2 months. He became progressively better until he became totally asymptomatic a few months later. He did not follow up with us until Sept. of 2011. At that time he twisted his knee playing tennis. He now plays tennis 5 days a week. I suspected he might have torn a cartilage and ordered an MRI scan. The top four pictures represent the new MRI scan from Sept. 2011 (Remember look at the second and fourth pictures where the arrows are). What we see in this scan is that the white area of the bone has completely resolved. His MRI scan is completely normal. He was back playing tennis within a week of seeing us.

This case shows one of the most visually impressive MRI pictures I have ever seen in the field regenerative medicine. What we can also take from this case is that we obviously had more than enough stem cells to accomplish the repair negating the need to try to artificially increase the number of stem cells. Secondly, we have shown that the patient’s own stem cells did the job. Even more surprisingly is the fact that we have refined our techniques since 2008 and added other treatments such as electrical stimulation. As time goes on we will be showing more cases which demonstrate our healing of orthopedic conditions with very dramatic evidence that will be evident to the lay person. This case is currently being submitted to a number of journals for publication.

Dr. P

The Korean Connection

IRMO — Wed, 09 Nov 2011 15:00:00 GMT

Recently I was honored to have Dr. Jae-Do Kim, M.D., Ph.D. Professor, Department of Orthopaedic Surgery, Kosin University Gospel Hospital Busan, Republic of Korea. Dr. Kim visited with his lovely wife who is a radiologist at Kosin University. Dr. Kim had met me while I was lecturing in Korea earlier this year. Prior to that time he had not done much with bone marrow stem cells. He came to my office and spent a few days learning our techniques and indications for the use of stem cells and PRP injections. It was certainly a give and take learning experience for the both of us.

Although my knowledge of the Korean language is very limited Dr. Kim spoke perfect English. He was very intrigued by our use of combination therapy of bone marrow stem cells, fat stem cells and various medicines for variety of orthopedic conditions. We also showed him some of our proprietary techniques to enhance our results. Dr. Kim seems quite interested in the use of stem cells and PRP in the treatment of spinal problems. He also is interested in the use of stem cells and PRP in the treatment of osteoarthritis. I feel doubly honored that I was invited by Dr. Kim to lecture to his residents, fellows and medical students at Kosin University sometime next year. Hopefully we will continue our collaboration efforts.

Dr. P

Peyton Manning

IRMO — Tue, 27 Sep 2011 20:33:00 GMT

In the last few days I have received a number of requests for interviews concerning stories related toMr. Peyton Manning and subsequently Mr. Terrill Owens. Both of these gentlemen are exceptional football players. My answer to these requests was that I am not able to make a worthwhile comment since I do not know all the particulars of these cases. Although I may wear a few different medical hats I am first and foremost an Orthopedic surgeon. In Mr. Manning's case, I can call upon my thirty years of orthopedic experience including 100's of laminectomies. Each case is very different and requires different treatment protocols. Spine problems are some of the most vexing problems in medicine.

I like everyone out there have read conflicting stories as to what was done, the type of cells used and why the procedure failed on Mr. Manning. THE BOTTOM LINE IS WE DO NOT KNOW WHAT WAS DONE!!! To say a certain type of cell that was used was the cause of the failure has no credence to it since again we do not know the facts. So my comment about Mr. Manning and Mr. Owens is NO COMMENT other than I wish them the best.

Dr. P

Dallas Talk

IRMO — Tue, 27 Sep 2011 17:30:47 GMT

Just recently I flew back on a plane to Florida after giving a 3 hour lecture in Dallas. In the last month my paths of lecturing have gone from Melbourne, Australia to Toronto, Canada to Dallas, Texas. It has been a rather hectic few weeks.

In Dallas, I had the honor of lecturing for the American Academy of Anti-Aging Medicine Stem Cell fellowship. This is a very unique program in that it will bring forth most of the science that we know in the stem cell field and present it in an unbiased fashion. I think this was the first time I lectured for three hours straight. My lectures concerned stem cells as they pertain to musculoskeletal problems. The enthusiasm of the audience was great. I would have thought that most people would leave the room after having one speaker talk for three hours straight. Most people remained in their seats and asked questions after the lecture. The fellowship handles all aspects of stem cells from the treatment of diabetes to musculoskeletal problems. There appears to be great strides being made on all fronts using a variety of treatment programs to hopefully solve what recently was considered to have no solution. I am not about to say that we have cracked Parkinson's disease or cured ALS but I feel that these conditions may be significantly helped by the use of stem cells in the not too distant future.

The head of the stem cell fellowship is my good friend Dr. D. Maharaj. Dr. Maharaj is one of the leading stem cell scientists in the world. I have the good fortune of working with him on a few projects because luckily for me he is in my own backyard. He practices in Boynton Beach, Florida. Dr. Maharaj has some very unique methods of using stem cells for a variety of aliments. In a nut shell he uses various potent medications to stimulate the body to produce tremendous numbers of stem cells. The main stem cells that are produced are called hematopoietic stem cells. The name of this medication is granulocyte colony stimulating factor or GCSF. The more well know name for this compound is Neupogen. When these large number of stem cells are produced they may significantly alter the course of many diseases such as diabetes and Parkinson's disease. His preliminary results seem to be very encouraging. What we are thinking of doing is to apply this technique for the treatment of musculoskeletal problems. I still think that we will need some type of stem cell seed be it from fat or bone marrow or a combination of both. This stem cell seed when placed in the joint will act as a using a military term a" forward assault team". The stem cells will become established in an area and than try to call more stem cells to the area. Hopefully these cells will call upon the great number of stem cells produced by the Neupogen to come to the area. We will probably also inject the area with some of the bone marrow stem cells that will be harvested. Another friend of mine Dr K Saw in Malaysia has produced some amazing results using blood stem cells in knee operations to regrow cartilage. He recently published his results in a very prestigious Orhtopedic journal in April 2011.

Some people will comment that blood stem cells are not really the stem cells that we need to accomplish a repair. To a degree these people are right. However one must realize that blood stem cells do some very important things. First and foremost they help to establish a blood supply to the area. Without a blood supply available the stem cells will not work as well. Think of the stem cells as an army and the blood vessels as supply lines. If an army outruns it supply lines it typically it will not function that well. The same hold true with stem cells. The other important factor about the blood stem cells are their ability for a process called plasticity. The term plasticity refers to the ability of the blood stem cell to turn into another type of stem cell. This type of stem cell is called a mesenchymal stem cell. The mesenchymal stem cell is the bodies' repairman. Typically there are not too many of these mesenchymal stem cells in the circulation. This is where the blood stem cells come into repair. Perhaps the beat analogy is to consider the blood stem cells as the national guard that has now been activated to become part of the regular army. Once they become incorporated into the the army the stem stem cell will act like a regular solider. Certainly this is a very basic way of looking at stem cell science but I think one gets the concept. Thanks

Dr. P

What PRP and Stem Cells Do

IRMO — Wed, 21 Sep 2011 20:24:45 GMT

Many physicians that visit me typically ask me if all PRP injections are the same. The answer is a resounding NO!

Some tell me that they can perform a PRP injection in their office for about $15 or 20 dollars. Quite honestly that is about all it is worth. I have been dealing with regenerative medicine for a number of years and have learned the old adage you get what you pay for is especially important in the PRP world. There are a number of companies out there. I have tried many of them but I consistently stick with one company. Their prices may be more expensive but the product that they produce is much higher in growth factors, signaling factors, white blood cells, and platelets. These are truly what makes PRP work. Each is instrumental in the healing process. Remember without the growth factors and signaling factors the stem cells will remain dormant. If any of these components are lacking than the results may be lacking. Typically when a short cut is taken with a PRP product the result is usually a platelet poor plasma. This is the problem we are currently having with various studies on the effectiveness of PRP. Some studies have shown that PRP works exceptionally well while other have shown little effectiveness. Unfortunately these studies are not comparing apples to apples. Some of the studies are using a platelet poor plasma while others are utilizing a platelet rich plasma. This is probably why there is a discrepancy in the studies. As time goes on this should correct itself. Make sure that if you have a PRP it is a high quality PRP.

This brings us to the next tantalizing question. That question is what exactly do the stem cells do? Do they do the repair work themselves or do they help to facilitate the repair by their influence on other cells. The answers to these questions are not completely understood at this time. The correct answer is that the stem cells may do some of the work but most likely have significant effects on some of the surrounding cells. Stem cells can work in many different manners. They may have an endocrine effect in that they will produce various factors which can influence cells at a distant site. This is much in the same fashion that our endocrine system works. Certain organs in our brain such as the pituitary gland effect distant organs. They may work in an autocrine fashion in that they effect themselves to actually turn into other type cells.

For instance they may form muscle cells or cartilage cells. They may have a paracrine function where they effect neighboring cells. Many times these neighboring cells are quiescent but are awakened and start performing repair work. A good example of this is how stem cells seem to work for osteoarthritis in a joint. The cartilage cells are initially not able to reproduce but the stem cells turn them on to allow reproduction and subsequent repair.

We can see that PRP and stem cells are intertwined and dependent upon each other. What we have presented in this blog is a very simplified picture of what is occurring.

The Use of Fat

IRMO — Mon, 19 Sep 2011 19:44:11 GMT

When I am giving lectures most physicians and lay people are intrigued by our use of fat. What was once a tissue that was scorned has now become a valuable ally in our dealing with musculoskeletal problems. I am certainly not condoning people becoming overweight. As a matter of fact obesity is one of the leading causes of musculoskeletal problems. The extra weight put stresses on the joints hastening the development of arthritis and the degradation of tendons and ligaments. There is an epidemic of obesity in the United States. In addition to musculoskeletal problems obesity causes diabetes and all of it's problems which dramatically speed up aging.

Now I would like to get back to the topic at hand namely utilizing fat for musculoskeletal problems. IRMO has been utilizing fat in our procedures for a number of years. We have learned much about fat from the veterinary world. Fat has been utilized in the treatment of race horses and dogs for years. These treatments centered around arthritic joints. Initially, we utilized fat as a scaffold and as a source of stem cells. This seemed to work fairly well for us. This is called a simple fat graft. The important feature of the fat graft is that it acts as a scaffold or as we also call it an extra cellular matrix. We think stem cells may do better when they have some sort of extra cellular matrix to initially latch on to. Fat tissue seems ideally suited for this purpose. It gives us both stem cells and a scaffold or matrix at the same time.

Another big benefit is the there is essentially zero rejection factor with fat since it is the patient's own tissue. There are a number of facilities that are now doing fat grafts with PRP injections. What is interesting is that more and more facilities on now jumping on the fat bandwagon after they previously condemned it. The simple reason for this is the number of mesenchymal stem cells in fat is much greater than in bone marrow. However, bone marrow still contains large numbers of growth factors and stem cells which contribute to repair. To compare the two types of tissue we look at some studies from Stanford Univ. These studies have shown fat has possibly 500 x more mesenchymal stem cells than bone marrow when like amounts of tissue are measured. What is even more dramatic is that the number of mesenchymal stem cells in the marrow significantly drops with age. One of every 10,000 cells in the marrow of a newborn is a mesenchymal stem cell while 1 in every 2,000,000 is a mesenchymal stem cell in an 80 year old. Hence, the need to supplement the marrow with additional stem cells which fat can easily provide.

The next challenge is to maximize the number of stem cells from the fat. One way of doing this is by proper preparation of the fat. We have come up with quite a few tricks which dramatically increase our stem cell yield. The way we prepare our fat now is different than we did a few years ago. I am working with a few companies to try to refine this process even more. Another quantum leap involves the separation of the fat stem cells from the fatty tissue. There are now techniques available that let us extract 150,000,000 stem cells from the fat. These cells are called Stromal Vascular Fraction or fat stem cells. When we combine the Stromal Vascular Fraction with bone marrow aspirate and a fat graft we feel that we are offering one of the best combinations available for musculoskeletal problems. The fat cells will survive in the joint for many months going about doing there work. Hopefully this bit of information better explains why we use fat and how we differ from other clinics. Thanks Dr. P