I recently was in Kuala Lumpur Malaysia giving some lectures for the American Academy and Board or Regenerative Medicine. This is an Asian chapter of the board. This was a combined meeting for it also featured a number of doctors throughout the world who were using Very Small Embryonic Like Stem cells. The doctors hailed from a variety of countries including Australia, Greece, Malaysia, Singapore, Pakistan, and the United States to mention a few. The best thing about the meeting was that I meet my good friend Dr. Bill Paspaliaris of Australia. Dr. Bill is one of the most knowledgable doctors that I know when it comes to stem cells. He spearheaded the meeting and he has made available to a select number of physicians his techniques utilizing Very Small Embryonic Like Stem Cells (Vcells) also called Adult Pluripotent Embryonic Like Stem Cells. I feel very fortunate that I am one of the select physicians who is able to utilize this technology. There is now no doubt in my mind that these cells will be game changers.
Let us take a better look at these cells. The following diagram gives us a better look at the hierarchy of the stem cell world. In the diagram we see the various types of stem cells. All of the stem cells in the body can be broken down into these subgroups. Most of the stem cells we are dealing with are in the multi potent subgroup. The V cells(pluripotent group) are above this group and thus represent a tremendous advantage in repairing tissue. One huge aspect of these cells is the they are your own cells. The fact that they are your own cells cuts the risk of using these cells to an extremely small number. The more exciting aspect of these cells is that they are probably the most powerful stem cell in the body. It might be best to consider them an emergency stem cell supply. They are found in everyone but typically they are not activated. The clinical tricks of dramatically increasing their numbers and activating them will remain something that I will not discuss.
When looking at the hierarchy of cells most of the stem cells we are dealing with in the stem cell field are thought to be multi-potent. This means the stem cell can form many different types of tissue. On the other hand the V cells are what we call pluripotent. When a cell is pluripotent it means that it could produce almost any type of cell. We are aware that embryonic cells can produce almost any type of cell. At one time the scientific community was very high on embryonic stem cells but that luster has worn off. We now know embryonic stem cells bring much baggage with them. One problem is that they have the potential to form tumors since there is no built in control of the cells. Another huge problem is that they may attack the body that they are transplanted into. When this happens it is called graft versus host disease. This is a serious problem where the body is at war with the graft. Unlike the embryonic cells, the V cells do not seem to have these problems. This is why the V cells seem to be such a great leap in the stem cell world. We now have a pluripotent cell which appears to be safe, has tremendous regenerative capacity, and can be obtained in large numbers.
Getting back to the conference, there were some excellent talks on some of the more intriguing clinical applications of the V cells. The one aspect that excites us the most is that these cells seem to have a tremendous curative effect on Osteoporosis the weakening of the bones as we age. I presented the results of some of our patients who had unheard improvement in their bone densities in less than a year. We are now launching a study on this very aspect. There were other excellent talks on other aspects of the V cells such as their effect on infertility. A talk centered on the use of these cells for aesthetic purposes including hair loss. Another intriguing aspect of these cells may be their potential effect on dealing with traumatic brain injuries. The size (very small) of these cells may allow them to penetrate the blood brain barrier. Once they penetrate the barrier they could potentially correct the damage of traumatic brain injury by repairing the damage. Remember these cells are pluripotent meaning they can repair any type of cell. By and large it was a great meeting where there was good give and take in scientific ideas. It was a quick trip (Thursday evening to Monday evening) half way around the world but I would do it again in a heart beat. When this type of knowledge is discussed it is a can't miss opportunity that comes along very infrequently. Surely more to come about the V cells. Thanks Dr. P
Hard to believe but this is a temporary stadium constructed just for the games!
Lecturing At The Rio Olympics
I just had the distinct pleasure of lecturing at the 2016 International Sports Medicine Meeting being held in conjunction with the Olympics at Rio de Janeiro. One could feel the electricity in the air. Before going there I was warned about the crime, terrorism, and the mosquitos. Well no crime, no terrorism and no mosquitos! I ran into people from every nook and cranny in the world. You might be in the elevator with someone from Croatia, and the next time from Gabon or the Ivory Coast. I had the good fortune of attending a few events. One which I found enjoyable was beach volleyball. Below was the Brazil vs Croatia match.
The meeting which I lectured at mainly focused on Sports Medicine. Some of the lectures centered on traditional aspects and than some such as my talk were more cutting edge. The doctors come from Europe, Asia, the Mid East, and South America.
One of the lecturers discussed his success in treating chronic spinal conditions with extra corporal shock wave therapy (ECSW). This type of therapy utilizes acoustic waves generated by the shockwave machine. This type of therapy triggers a number biological effects which lead to faster and long-term healing and regeneration of the tissue. One way in which this technique works is by calling stem cells to the area. The process of calling stem cells to the area is called homing. Shockwave therapy (SWT) covers a wide range of orthopedic indications. We have used this therapy in our office for a few years with excellent results. It is one of the tools in our armamentarium. We occasionally use this therapy as the primary therapy. When checking on a regenerative medicine clinic this should be a question that is asked. Does the clinic use ECSW therapy?
My lecture covered various aspects of Regenerative Medicine including the use of PRP and Stem Cells. I shared with the doctors a good synopsis of the Regenerative Medicine field as it pertains to Orthopedics. They were very intrigued with the Arthrolavage technique. The Arthrolavage technique is totally unique to our clinic. It consists of "washing out" the knee with a solution that has certain growth factors in it. The types of growth factors and their ratios are the "secrete sauce". This mixture works on disabling the growth factors which cause pain. The Lavage technique works essentially all the time in eliminating pain in a large joint. We are still not sure how long the relief will last. We do this technique in conjunction with our stem cell procedures. In a study we are doing we have found that the joints treated with lavage got better quicker and the patient had less pain while they were recovering from their procedure. You can read more about this in the blog about Arthrolavage.
Other aspects were discussed such as the use of a pluripotent cell that is found in our body but it is essentially asleep. The trick is to awaken the cell and have it active in helping to correct problems. Our clinic has the good fortune to have utilized these cells for some time now. Also the use of various growth factors were discussed. This seems to give us an advantage in our quest to conquer our patient's pain. These are just some of the aspects that continue to separate our clinic from the pack.
Finally, we have a personal pride in the Olympics since we have treated number of athletes who are participating in these games. Most are from the United States but we have a sprinkling from another country or two. Thanks Dr. P
When I was a child I remembered about reading how cows were considered sacred and they would roam the streets. Well I can now attest that this is indeed true. I just returned from a trip to India. I had the good fortune to be invited to lecture in Chennai India. The meeting topic was an exciting one. This was the first annual ArthroPreserve Meeting. The concepts were quite fascinating. The meeting was about how we can preserve the joint rather than replace it. The meeting concerned methods that included surgery many of which I have done and some that were new to me. Unlike, some of the meetings that I have lectured at this meeting was essentially attended by orthopedic surgeons. I certain felt at home since I have practiced Orthopedic Surgery for the last 34 years.
Many people need to realize that Orthopedic Surgery unlike other surgical specialties involves treating patients outside the operating room. A good portion of an orthopedic surgeon's practice involves non-operative orthopedics. This is inherent in our training. I chuckle when I read an idea espoused by some that there is a new field called "interventional orthopedics". Hello, the last I checked the field of orthopedics surgery was built on intervention. Giving an injection into a joint or tendon could be considered "intervention" but I think calling it interventional orthopedics is misleading to patients. It gives the patients perhaps a false sense of expertise concerning the doctor. There is only one recognized board of medical specialties that has the word orthopedics and that is the American Board of Orthopedic Surgery (or equivalent in other countries).
Does this mean that non orthopedic physicians who are performing regenerative medicine using PRP and Stem Cell injections are not competent. The answer is absolutely not! Some of the best minds I have met in the PRP and Stem cell field are not orthopedic surgeons yet I hold them in the upmost esteem. They are not calling themselves interventional orthopedists. They are calling themselves regenerative medicine physicians.
Taking this concept one step further, I was approached by a few individuals with the idea of forming a board called the American Academy and Board of Regenerative Medicine (AABRM). We have gone ahead and took this idea to fruition. The board is now up and running. It is a non profit organization and none of the board members receive any type of salary. It is also non political.
Unfortunately, the world of Regenerative Medicine has taken on some politics of its own. Unlike many boards, the AABRM has moved into the 21th century. This organization recognizes the importance of PHDs in the field of Regenerative Medicine as it pertains to stem cells etc. The PHDs give us the concepts to use in the real world. Without the PHDs our progress would be stymied. The Academy welcomes PHDs to be part of this growing field of medicine. Also, the current board members have written approximately a 120 question examination. In order to become a member a candidate would have to pass the examination. The questions were designed to stimulate thought and at least show some acquisition of a fund of knowledge. Also one needs to show some experience in this field. We have designed a syllabus. The other interesting aspect of the organization is its willingness to help the industry. We would offer training programs to sales people of all companies selling items to the regenerative physician. Unfortunately, a poorly trained sales person is sometimes the first contact a new regenerative medicine physician has. The last thing we want is to have bad science perpetuated. If the sales person has a good fund of knowledge that will do nothing but help the field. The other concept that the Academy wrestled with was should only physicians in the United States be members. We feel that there should be chapters outside the United States but they must maintain our rigorous standards. We have been contacting various physicians and PHDs to become founding members and the actual Academy launch should come shortly.
I realized that I may have strayed from my original topic a bit namely my India trip. Perhaps it is because I am at the end of an 18 hour plane ride. My lecture was well received and then I did a few cases in India. I did a demonstration of the new Marrow Cellution needle from Ranfac. This needle is a quantum leap in bone marrow aspiration in that it takes samples from a new geographic area as the aspiration is being performed. This will dramatically increase stem cell yields and in the end better outcomes. I had the honor of doing one case with Dr. E. Kon of the Rizzoli Institute of Italy. It is a world famous facility known for its strides in orthopedics and regenerative medicine. The needle was well received. This was my second lecturing trip to India and I must say I have cultured many more friendships there. In India they are no different than the United States. They are seeking what works and what doesn't while staying within the guidelines of what is allowed.
I am just returning from a very successful Stem Cell Workshop in Melbourne Australia. I had the good fortune to help organize the workshop. It was a day that began around 8:30 and ended a bit past 6:00 pm. The lectures were very encompassing and touched on many subjects in the stem cell arena.
I was very much intrigued by the lectures of my good friend Dr. Bill Paspalaris who just so happens to live in Melbourne. Some of the items that Dr. Bill is working upon extend beyond the cutting edge. He is doing a quite a bit of work on Exosomes. The Exosomes are basically the vehicles that transport the the cytokines (growth factors )from one cell to the other. We now know that these Exosomes are extremely important in the overall functioning of the body. There are different exosomes for different functions. Some of the Exosomes are bad since they are secreted by cancer cells. Luckily we are interested in those cytokines which are important in musculoskeletal problems. It might be that the cytokines eventually may be produced in a lab and thus we might not have perform stem cell aspiration from either bone marrow or fat. Time will tell.
Bill is also working on something also beyond the cutting edge. He has used cells from a new born and cultured them. These cells are usually very powerful in secreting growth factors. The problem becomes that they can be recognized as foreign material and thus cause an allergic reaction in the body. Dr. Bill has devised a way to encapsulate the cells so that the body does not recognize them. Basically they remain in the body as stealth cells. Here comes the interesting part. The membrane allows the cytokines to leave the cells and interact with the body. The cells can be programed to secrete certain cytokines. These might be IGF-1 or some other cytokine. Remember the cells will secrete a variety of cytokines. The membrane will also allow nutrients to enter the cells and thus keep them alive. If you think this is pie in the sky technology the US Army is looking at this technology to try to make a “super solider”. This could revolutionize the stem cell world. Dr. Bill also has some intriguing inventions which he has spoken to me about which will offer some dramatic advances in the stem cell field. I look forward to using one in the not too distant future.
I myself gave two very comprehensive lectures. The first dealt with the basics of stem cell and PRP science. This included some of the new classifications of PRPs as presented by Dr. Alan Mishra of Stanford University. Dr. Mishra proposed a classification of PRP including high and low white bold cell counts, high and low PRP counts and activated and non activated PRP. Basically the classifications go from 1A and B to 4 A and B. I have proposed a fifth classification which includes Photo activation. I will do another blog concerning these classifications.
Another intriguing aspect of my first talk centered on on the use of a relatively new type of stem cell derived from the blood. This is called a Stembios cell which can probably be classified as a V cell or Very Small Embryonic Like Stem Cell. I am not at liberty to discuss these cells to any great extent since I have signed a non- disclosure agreement with the company. However I will shortly write a blog about these cells. They are potent stem cells that are found in the blood.
The one portion of my next talk centered on the use of cytokines and science of cytokines. At least for now cytokines may be the missing factor or the X factor. We know that many times a PRP may be deficient in certain cytokines. Also we need to realize that the PRP has a half life of about one week. At the one week mark the bad cytokines start to rear their ugly head. I did discuss the various ways we are using these cytokines. We are using them as injectables, orally and as a cream. We use the cytokines to manipulate the system and make our clinical results better. I feel that this is what separates us from most clinics out there.
The second portion of my afternoon talk centered on the the use of lasers in the field of Stem Cell and PRP Therapy. I believe that the use of lasers will be the next game changer. We have known for some time now that the laser has been used with great success in the field of hair restoration. Just look up the use of a laser comb on line and we can see how lasers are starting to be utilized. The use of the laser in our clinic goes far beyond the use of a laser comb. We are utilizing lasers to stimulate acupuncture points, we are using lasers directly into the joint in an intra-articular fashion, and we will undertake an IRB study on the use of intra-venous lasers. These are all cutting edge uses of lasers for PRP and Stem Cell Therapy. Another blog will be devoted to the use of laser in Regenerative Medicine. In closing, I will mention what is getting to be one of my favorite slides. The slide says ” THE MORE YOU KNOW THE MORE YOU DON’T KNOW”. This idea came to me a few months ago when I was preparing a talk on some new material I learned about. I realized that I had leaned a good bit about some new material but for all the info I learned about this there was a plethora of new material about that subject that I did not know about it. Perhaps put another way the more I learn the more I need to learn.
Thanks Dr. P
I recently returned from giving a few lectures at the International Biologics Orthopedic Meeting in Mumbai, India. This was an excellent meeting with many superb speakers from both India and international. The air trip is not much fun (20 hours each way) but the camaraderie makes up for it. This was a meeting essentially for Orthopedic surgeons of which I am one. Many of the topics dealt with a blending of procedures. By this I mean that some form of surgery was performed but these procedures were enhanced with some type of biologic preparation. The vast majority of the time these biologics were either a PRP and/or stem cell preparation. The majority of cases involved procedures typically done for osteoarthritis. These included micro-fracture techniques for areas of osteoarthritis of the joints. A micro-fracture is performed by making holes in an area where the cartilage has been worn away. In past times this was all that was done. This was a primitive stem cell technique. By making holes in a bone it was hoped that some stem cells would leak out and create some articular cartilage. This would happen but the cartilage was not a good quality cartilage. This cartilage is called fibro-cartilage or “scar tissue” cartilage. It was better than nothing but did not have lasting power. When the micro-fracture technique is combined with stem cells there was formation of what is called hyaline cartilage. This is normal cartilage which has lasting power.
A number of the talks centered on the use of PRP and stem cell injections into the joints. As would be expected the results were excellent. I was able to share with the doctors many of my tricks and techniques on doing these regenerative procedures. I forged many new friends and colleagues. I am sure there will be further give and take and sharing of ideas. In the field of Regenerative Medicine we have to have sharing of ideas to further along the field. I look forward to sharing these ideas with my new friends from India. Thanks Dr. P