Our Cutting Edge Stem Cell Facility
How does Institute of Regenerative Medicine differ from other facilities performing stem cell and PRP injections?
The Institute of Regenerative Medicine is very different from most all of the entities out there that are performing Regenerative Medicine treatments. We are taking a multifaceted approach in our treatment of the patient. Our differences start from the very beginning.
We are one of the few stem cell facilities in the world that is staffed by seasoned board certified orthopedic surgeons. Who can better handle orthopedic problems than a surgeon who is specifically trained to handle these problems from many different approaches? Seeing the anatomy first hand in an operating room setting is invaluable in knowing the anatomy and how to provide Regenerative Medicine treatments. If you have a Regenerative Medicine doctor who states he is an orthopedist ask him if he is board certified in Orthopedic Surgery. There are times when we can wear two hats and combine aspects of Orthopedics and Regenerative Medicine. Obviously, what sets us apart from other orthopedic practices is the fact that we also offer the use of Stem Cells and Platelet Rich Plasma (PRP) therapy as an alternative to formal surgery. We have strived to combine the latest technology to achieve the best result for our patients. We are constantly looking for ways to improve our outcomes rather than sitting on our past accomplishments.
In addition to having orthopedic surgeons on staff, we also utilize the latest techniques for imaging a problem such as fluoroscopy or ultrasound imaging. We are also one of only a few Regenerative Medicine practices nationwide that utilizes a flow cytometer to analyze the Stem Cells.
Our Methods are Simple but at the Same Time is Cutting Edge:
One of the main tenants of Regenerative Medicine is the following:
CELLS NOT DOCTORS HEAL PATIENTS!! HARNESSING THE POWER OF CELLS IS THE FUNDAMENTAL BASIS OF REGENERATIVE MEDICINE.
At the Institute of Regenerative Medicine we will utilize two major types of stem cells in addition to other regenerative cells. These are called mesenchymal (MSCs) and hematopoietic stem cells (HSCs). These cells are used in combination with other regenerative cells. We need to remember that the cells work like a symphony orchestra. Just as all the instruments in the symphony are important the various regenerative cells are important.
We Do Not Harvest or Use Embryonic Stem Cells
Many facilities outside the United States make use of embryonic stem cells, which outside of the United States are easy to procure. The problem with the embryonic stem cells are the many complications associated with them. Besides the ethical considerations, from a practical point of view, we are still a long way from being able to utilize these cells in a safe and consistent manner. When using embryonic stem cells, you are inheriting any potential diseases that the baby may have. For instance, the baby may have a gene that when past age 50 may cause a tumor. The embryonic cells themselves may act as a tumor since there is no natural check on these cells. Furthermore, these cells are foreign materials to the body, and the body will attack these cells in an immune response. This can sometimes result in a serious medical condition called graft versus host disease. For this reason, the patient may have to be placed on immunosuppressant drugs—much like any organ transplant patient. With our present technology, embryonic stem cells are not the answer to the orthopedic problems that we deal with. The FDA has also put significant restrictions on the use of this type of cell in humans.
We Do Not Culture Cells
There are some centers, which recommend taking the stem cells from the bone marrow and growing them in a laboratory and then injecting them back into a patient. This process may not be the best way to achieve repair of problems. There are studies, which suggest that once the stem cells are manipulated outside the body they lose their effectiveness. Furthermore, there is a suggestion that by reproducing these cells outside the body the genetic makeup of the cells may be altered leading to any number of significant problems. Among other factors, it is believed that the telomeres, or ends of the DNA strands, may be significantly altered. The FDA has ruled that cultured cells by and large can not be used in the United States. We further know that larger numbers of mesenchymal stem cells do not translate into greater success. In 2012, a biologics company called Osiris presented evidence at the American Academy of Orthopedic Surgery that when 50 million cultured stem cells were injected into patients 20% of the patients reported less pain while when 100 million were injected 0% of the patients had less pain
Utilizing Various Growth Factors To Enhance Our Procedures
Also, what sets the Institute of Regenerative Medicine apart from other facilities is the fact that we at one time were utilizing human growth hormone (HGH). We used HGH because the evidence is overwhelming that it can contribute to cartilage and tendon repair. We no longer use HGH. We are now using a variety of growth factors that are measured in nano doses. Some of these growth factors include IGF-1 (Insulin Growth Factor) which is the active form of HGH. IGF-1 is known as a substance, which directly stimulates cartilage formation and tissue repair. Other growth factors utilized include FGF (Fibroblast Growth Factor), Interleukin-10, Interleukin-1 antagonist, Interleukin 3 and 4 amongst other ones. These growth factors are utilized in a number of ways including an iontophoresis patches. An iontophoresis patch is like a band aid with a built in battery. The following diagram shows what the patches look liked.
The small electrical current drives the growth factors deep into the joint or tendon area. We are not able to use any these cytokines on our athletes including high school, college and the professional levels. The leagues would consider this performance enhancement even though the dose is only a portion of one day’s dose and actually only works on a molecular level in the micro environment. We do not make the rules, we follow them! Certain medical conditions will cause us to defer the use of IGF-1 and the other cytokines. You will need to check with our physicians. We feel that we have made a quantum leap in our regenerative practice by utilizing additional growth factors as part of the overall treatment for our patients. More can be read about this in our section concerning growth factors which are also called cytokines.
Other Important Aspects Of Stem Cell Regenerative Science
Our Orthopedists Recommend Supplements to Turn on Telomerase. Any clinic that is involved with stem cells, PRP and regenerative medicine needs to consider the Telomeres or the ends of the DNA strand. Below, we see a diagram of the Telomere or end of the DNA strand. On the left we see an embryonic (young) cell with a long telomere while on the right we see an adult (old) stem cell with a much shorter telomere.
The telomeres are disposable buffers blocking the ends of the chromosomes. They are consumed during cell division meaning every time a cell reproduces it loses a small snippet of DNA. When the DNA reaches a certain critical length the cell is programed to die. This explains the basis of most diseases and aging in general. A good practical example of this phenomenon concerns Dolly the Cloned sheep. Dolly was produced from an adult cell which was induced to reproduce. A new sheep was reproduced or cloned but Dolly died of old age at a young age because her DNA was old. If we can stem the tide on telomere degradation we will dramatically increase stem cell effectiveness. There is an enzyme which eliminates telomere damage and it is called telomerase. The problem is that most cells have the ability to produce telomerase but this ability is turned off or silenced and thus damage continues relentlessly. If we turn telomerase back on or at least slow down the degradation then stem cells will be more effective. We do know certain supplements can help achieve this goal. Our clinic prides itself in recommending these supplements. This may be one of the most important new frontiers in stem cell science and probably all of medicine.
Stem Cell Harvesting of Bone Marrow Cells and Fat Cells
We have solved the problem of small numbers of bone marrow derived mesenchymal stem cells by utilizing mesenchymal fat cells. What was one time thought of as a worthless tissue is a virtual gold mine in regenerative medicine.
Stem Cells in Fat VS Stem Cell in Bone Marrow
Adipose tissue is as important as bone marrow for like bone marrow aspirate it contains a cornucopia of regenerative cells. These cells include adipose-derived mesenchymal stem cells, hematopoietic stem cells, adipocytes (fat cells) and attached progenitor cells, T regulatory cells and monocytes, and perivascular cellular components. The following diagram shows types of cells obtained from fat.
This may seem a bit technical but it is important to understand about these cells. The adipose derived mesenchymal stem cells exist in such high numbers that it is not necessary to grow these cells in a lab eliminating many of the problems associated with growing cells in the lab. Like other stem cells these adipose stem cells reduce inflammation and cause cells to grow in number and turn into different types of tissues. The hematopoietic stem cells accomplish repair. The fat cells in the fat graft will die and release signals which stimulate other cells to become metabolically active. These metabolically active cells stimulate the microenvironment allowing for cellular regeneration. T regulatory cells are a component of the immune system that suppresses immune responses of other cells. This is an important “self-check” built into the immune system to prevent excessive reactions. Many experts in the stem cell field feel fat may be the ideal regenerative tissue since it has everything we need including growth factors, regenerative cells, and the fat itself acts as a 3-d matrix. However, when we look at the science we realize that we need to use both bone marrow and fat to achieve the proper numbers of cells top accomplish repair. Fat is very rich in mesenchymal stem cells while it is somewhat lacking in hematopoietic stem cells. On the other hand we see that bone marrow is very rich in hematopoietic stem cells but as can be seen in the following diagram the numbers of mesenchymal stem cells diminishes with age in bone marrow. When one understands the science it is quite evident that we need to utilize both in order to accomplish repair.
Other Differentiators for the Institute of Regenerative Medicine’s Stem Cell Treatment Facility
Another major difference of our facility is the use of certain supplements. These supplements can significantly increase stem cell production in the body. This is done in a safe and efficient manner with over the counter supplements. This is based on research performed at medical schools by world famous stem cell scientists (one of these facilities is the University Of South Florida School Of Medicine). These supplements have essentially no side effects and can actually surpass medications which cost thousands of dollars and have some serious side effects. If anyone thinks supplements are not important this is a foolish notion. We take care of many professional athletes and it is not unusual for them to take between 50 and 100 supplement pills a day. We have noticed that when we harvest stem cells from patients who have been on our supplement regimen their yields are much higher even after a few weeks. The reason why we are so concerned with supplements is that they can have a profound effect on the stem cell niche (environment). In the diagram below we can see picture of a stem cell membrane. The membrane is the eyes and ears of the cell. It will interact with its environment. More information about supplements can be found in our supplement section.
Another aspect, which we are looking at, is the use of hyperbaric oxygen. We know that hyperbaric oxygen cans dramatically increase stem cell production. A huge misconception is that hyperbaric oxygen causes healing by increasing oxygen to the involved areas. Oxygen is actually toxic to the tissues in high doses. Hyperbaric oxygen will actually work by increasing a compound called Nitric Oxide (NO). What the Nitric Oxide does is stimulate a certain enzyme which dramatically increases the stem cell output from the bone marrow. It is the increased stem cells in the circulation that causes the beneficial effects of the hyperbaric oxygen not the oxygen. The stem cells are causing the repair. These concepts were presented by Dr. Thom at the Univ. of Penn. One of our ideas is to use supplements which increase Nitric Oxide in the body. Interestingly enough we know that Viagra and Cialis will increase nitric oxide and thus probably stem cell output. We think that Nitric Oxide will be an increasingly important topic in stem cell medicine and PRP injections. Further discussion about this topic will be discussed in the near future.
The other fields which we feel are very important concern the use of light therapy and electrical current therapy. More can be learned about this in the sections on these entities. As one can see, the institute has tried to cover all bases. We have combined ideas and entities from different disciplines to create what we call our biological cocktail. We have combined conventional medicine with its foundation in the basic science of HGH, stem cells and platelets with alternative ideas such as supplements. Our treatment plan is a hybrid of a number of different successful approaches, which have caused tissues to heal when typically they did not in the past. We have taken these ideas and refined and improved them to create a far superior protocol than anything out there. Our success speaks for itself. We have performed well over 4000 cases and are still counting. We are approaching results of approximately 85% significant improvement in conditions treated. We do not rest on our laurels but strive to be the cutting edge of the cutting edge.