blood oxygenation + ozonation is a protocol that begins with the placement of
two IV catheters. One of these catheters is used to pull blood out of the body,
run it through a dialysis filter, the blood then gets ozonated and infused into
the other catheter in the other arm. As the blood comes out it is typically a
dark color, but after it is filtered and ozonated, it becomes a clean bright
top 3 benefits of EBO2 are as follows:
stimulates a pathway in the body that dramatically decreases inflammation and
even continues to loosen up the inflammation hiding away in the tissues for
some time after the protocol! This inflammation can even be seen as foam in the
waste container. Yes, you'll be able to see the inflammation leaving your body!
This makes the protocol excellent for anyone with an autoimmune disease.
Lowers cholesterol & fat in
○ As the
blood comes out of the body, many times you'll be able to see the yellow globs
of fat leaving the body. These get trapped in the filter and leave your body
for good! Triglycerides and Cholesterol levels can be lowered significantly
with a number of treatments.
Kills Virus, Bacteria, &
has amazing antibacterial, antiviral and anti-fungal properties. To take this a
step further, we use an Ultraviolet light to further impose its antimicrobial
effect. This makes the protocol excellent for patients suffering with Lyme
disease and mold exposure.
Yes, you read that right.
An exciting form of advanced physical
therapy called Blood Flow Restriction Therapy (BFR) has proven to be especially
useful after a regenerative cell procedure to strengthen the muscles around an
The way it works is quite simple: after partially
restricting blood flow using a series of well-calibrated, inflatable Velcro
bands (tourniquets), patients perform muscle contractions to increase the size,
strength and endurance of healing muscles.
Its like lifting weights, but with tight
cuffs on your arms or legs.
Heres what you need to know:
BFR training can be performed 2-3 times a week for three weeks OR 1-2
times a day for less than three weeks
A good ratio for upper body and lower body is 40% arms to 50% legs (or
BFR is best used with four reps per set, in the following sequence:
Maximum wear time for the cuffs is 20 minutes
The ideal loads will be 20% to 50% of a patients one rep maximum lift
Repetitions should be slow, up to two full seconds for each positive and
Rest should be anywhere from 30 to 60 seconds between sets.
BLOOD FLOW RESTRICTION THERAPY (BFRT) IS AN INNOVATIVE
TRAINING METHOD FOR THE DEVELOPMENT OF MUSCLE STRENGTH AND HYPERTROPHY
Institute is always on the prowl to find new regenerative technologies. More
importantly, we are looking to combine these new technologies to add to our
uniqueness. One newer technique that we are looking at is Blood Flow
Restriction Therapy (BFRT). Blood flow restriction is becoming a new
modality in the world of Regenerative Medicine, Sports Medicine, and
performance enhancement. It is one of the hottest trends
in this years Tokyo Olympics. Actually, it has been around for a while.
In professional sports circles, BFRT is
becoming more and more accepted. The initial appeal for BFRT training was driven by studies demonstrating
rapid increases in muscle size, strength, and endurance capacity, even when
notably low intensities and resistances, which would typically be incapable of
stimulating change in healthy populations, were used. The incorporation of BFRT
exercise into the training of strength- and endurance-trained athletes has
recently been shown to provide additive training effects that augment skeletal
muscle and cardiovascular adaptations.
The above illustration shows the main
tools for blood flow restriction, namely a series of tourniquets that are used
during exercises. As we can see, the equipment is not extremely expensive or
flow restriction is a training method partially restricting arterial inflow and
fully restricting venous outflow in working musculature during exercise. This
technique seems to have originated in Japan by Dr. Sato in 1966. This technique
is called Kaatsu training which translates to training with pressure. The manipulation of blood flow in conjunction with skeletal
muscle contraction has helped us with the physiological understanding of muscle
fatigue, blood pressure reflexes, and metabolism in humans. BFRT and KAATSU
training differ by only modifying blood flow rather than stopping it. KAATSU
training uses expensive pneumatic tubes, cuffs and electronic monitors and
requires a certified specialist to monitor you during your workout. Blood
flow restriction solutions, such on the other hand, are simple to use and can
easily be added to your workouts to maximize results. BFRT training
allows you to adjust the pressure of the bands or straps
yourself. However, it is still not recommended that one attempts this
treatment on their own without first getting some guidance from a certified
The following illustration is an overall synopsis of
how to administer Blood Flow Restriction Therapy. I still recommend that this
not be attempted on your own. One needs instruction in this technique. This is
the practical aspect on how to do this therapy but the real question is how
does it work?
THE PROPOSED METHODS AS TO HOW BLOOD FLOW
RESTRICTION THERAPY (BFRT) WORKS
Recent interest in using intentional blood flow
restriction has focused on elucidating how exercise during periods of reduced
blood flow affects typical training adaptations.
The initial appeal for BFR training (BFRT)
was driven by studies demonstrating rapid increases in muscle size, strength,
and endurance capacity, even when notably low intensities and resistances were
utilized. These levels would typically be incapable of stimulating change in
healthy populations. The incorporation of BFRT exercise into the training of
strength- and endurance-trained athletes has recently been shown to provide
additive training effects that augment skeletal muscle and cardiovascular
adaptation. It has been
generally accepted that muscle hypertrophy requires high-intensity training
utilizing loads of at least 70% of 1-repetition max or lower loads until
failure. However, there is mounting evidence that now supports
low-load resistance training (20-40%RM) combined with blood flow restriction
can similarly induce muscle hypertrophy and strength gains. What we thought we knew and
understood about muscle cell physiology and hypertrophy has been
turned upside down through blood flow restriction research.
alters acute physiological stressors such as local muscle oxygen availability
and vascular shear stress which may lead to adaptations that are not easily
attained with conventional training. The above diagram is a good synopsis of
the various changes that occur with BFRT. We can see that there are three
categories, high intensity, low intensity with BFRT, and low intensity. There
are many similarities between high intensity and low intensity with BFRT. One
interesting fact is that the low intensity with blood flow restriction seems to
cause little muscle damage meaning that the recovery time is much quicker.
Also, there are significant increases in growth hormone, IGF-1, and mTOR in the
low intensity exercises with BFRT.
Actually, these increases outstrip those of high intensity training.
BFRT seems to be
a myostatin blocker. It will down regulate myostatin. Myostatin blockers are a holy grail for body
builders. Myostatin is a protein that blocks muscle cell growth and
differentiation. When you use BFRT, you get this unlocking ability to get more
muscle cell growth with minimal exercise load. Below we see a picture of a
steer who was born with genetic mutation which resulted as if a myostatin
blocker were utilized.
currently a great deal of research concerning myostatin blockers. A number of
compounds are currently being studied but there is still no truly effective
MORE ABOUT THE
BIOCHEMISTRY AND PHYSIOLOGY OF BFRT
The above illustration gives a better idea
of the aspects of the biochemistry/physiology involved with BFRT. We have already discussed the fact that
myostatin is blocked. In this diagram, we see there is formation of heat shock
proteins. Heat shock proteins normally are stimulated by subjecting the body to
heat or cold. However, other stresses, such as BFRT, can also stimulate their
production. There are a number of different types of heat shock proteins. Heat
shock proteins are important in that they help proteins fold properly into the
cells. Many degenerative diseases including Alzheimers are associated with
misfolded proteins. The following illustration shows the benefits of heat shock
proteins. They rescue damaged proteins and fix them which will hopefully slow
down aging and diseases.
Another important aspect of BFRT is the
generation of Nitric Oxide (NO). Nitric oxide is considered a signaling
molecule in the body. It has implications in many different biological systems
in the body. In the context of BFRT, the NO will have direct effect on muscle
growth. It will also stimulate the blood vessels and cause them to dilate
eventually increasing the blood supply. The illustration below gives us an idea
of the importance of the Nitric Oxide molecule. In our clinic, we recommend the
use of supplemental Nitric Oxide stimulators. By far the best one out there is
Another regulator of growth to consider is
called the mTOR pathway. The mTOR
pathway integrates the input from upstream pathways which are dependent upon insulin and other growth factors such as IGF-1 and amino acids. The mTOR pathway also
senses cellular nutrient, oxygen, and energy levels. It is a very important
pathway when it comes to cellular growth. One must realize that the m TOR
pathway is both good and bad. In some instances, stimulation of the m TOR
pathway may speed up aging. In controlled circumstances, mTOR pathway may be
beneficial. It will definitely contribute to cellular growth. But this can be a
double-edged sword. We must remember that when we are concerned with anti-aging
we wish to block this pathway with the mTOR inhibitors. Cellular growth speeds
WHAT IS THE PHYSIOLOGY INVOLVED IN BFRT?
Many of the findings of BFRT reinforce the
findings of the Nobel Prize in Physiology 2019 which describes how varying
levels of oxygen shape both physiology and pathology in the body.
In the case of BFRT, muscles are exercised
to fatigue in an environment that prevents (temporarily) the flushing out of
metabolites, and thus providing a metabolic environment more prone to stress
signaling, low oxygen etc. There are a variety of physiological mechanisms
thought to provoke a hypertrophic response in skeletal muscle following BFRT.
Although the exact mechanisms of BFRT are not completely known, most evidence
alludes to a muscle cell swelling response and an indirect effect of
metabolites. This will instigate an increased muscle activation through
fatigue. Regardless of the initial signaling mechanism, the intracellular
environment should favor a positive protein balance for muscle growth achieved
by an increase in muscle protein synthesis, a decrease in muscle protein
breakdown, or both.
The proposed mechanisms of occlusion in
BFRT indicate there are increases in blood lactic acid levels and alterations
in blood pH similar to High Intensity Training. Lactate is typically a waste
product produced by muscle metabolism in low oxygen situations. The increased
lactic acid will stimulate increases in serum growth hormone which in turn
promotes collagen synthesis for tissue repair and recovery. Ultimately, this
results in muscle satellite stem cell proliferation. Skeletal muscle satellite cells are considered to
play a crucial role in muscle fiber maintenance, repair and
remodeling. Satellite cells
are precursors to skeletal muscle cells. They are essentially a muscle stem
cell. They have the potential to provide additional myonuclei to their parent
muscle fiber, or return to a quiescent state. In response to mechanical strain,
satellite cells become activated and produce muscle. BFRT will increase the
number and activity of satellite cells.
In the above schematic of the muscle stem
cells, BFRT increases the number of satellite stem cells thus increasing the
number of muscle fibers. The following illustration demonstrates the various
conditions which diminish muscle fiber generation. These conditions, such as
diabetes, obesity, etc. can be benefited by BFRT.
technique of BFRT in the muscle using a pneumatic tourniquet system involves
applying an external pressure, typically using a tourniquet cuff, to the most
proximal region of the upper and/or lower limbs. When the cuff is inflated,
there is gradual mechanical compression of the vasculature underneath the cuff,
resulting in partial restriction of arterial blood flow to structures distal to
the cuff, but which more severely affects venous outflow from under the cuff
that is proposed to also impede venous return. Compression of the vasculature
proximal to the skeletal muscle results in inadequate oxygen supply (hypoxia)
within the muscle tissue. Furthermore, the diminution of venous blood flow
results in blood pooling within the capillaries of the occluded limbs, often
reflected by visible erythema. For safety purposes, its
important to understand were not cutting off blood flow all together for
extended periods of time, which is foolishly dangerous. For the most part,
were applying heavy circumferential compression. This is the reason why one
should not experiment on ones self. The following is a good synopsis of BFRT:
As of now I am not aware of any
restrictions from professional leagues or the World Anti-Doping Agency
concerning BFRT. There is little if any doubt that this technique will improve
There is no doubt about the validity of
BFRT and how it will benefit and change the practice of Regenerative Medicine
and performance enhancement. As time goes on, it will have even more influence
as it is combined with other modalities. We will start utilizing this therapy
and will hopefully make it an intrical part of our new state of the art
facility which we expect to move into early next year. What will make this more
unique is that we will combine BFRT with other modalities such as Hyperbaric
Oxygen, Ozone Therapy (EBO2), Xenon Therapy and a few other modalities. Our new
facility will be a one stop state of the art facility like nothing else around.
recently posted an article on LinkedIn about Vitamin C and how it affects
certain immune cells and stem cells in the body. Most of the articles I have
posted on LinkedIn are aimed more towards scientists and physicians. They are
fairly technical and my writeups have more of a technical blush than my blogs.
I have included this article at the end of this blog. My blogs also contain a
good bit of science but are not as intense.
thought this was an interesting article for everyone. The article discusses the
aspects as to how Vitamin C boosts our immune system and helps control actions
of our DNA. How Vitamin C works is a topic most of us think we know about but when
asked how Vitamin C really works the discussion becomes silent. The article discusses
the use of Vitamin C in increasing the health of a certain type of immune cell
in the body and how Vitamin C ultimately effects our DNA function by
controlling some of our genes. The diagram below shows the different immune
cells we have. All of these cells have their place and at times they can save
our life such as in the face of an infection.
cell we are most interested in this case is called a Regulatory T-cell or as it
is more commonly called a T-reg cell. T-reg cells are of the upmost importance
in that they help prevent autoimmune diseases. Regulatory T cells police the immune system and keep it in
check. Just as important,
T-regs promote tissue repair and
regeneration by modulating inflammation. Extra T-reg cells will do nothing but
improve results for a wide variety of conditions from the treatment of
autoimmune diseases to the treatment of osteoarthritis. The problem many times
is that we just do not have enough T-reg cells to go around. T-regs are not
easy to culture expand (grow them in a lab). What scientists are attempting to
do is get other immune cells which are more plentiful and convert them into
T-reg cells. This is called an induced T-reg cell
(i-T reg cell). In
another word, one type of immune cell is being coaxed to turn into a T-reg cell.
This is a newer realm in the stem cell world. The following illustration shows
Usually, when we are
dealing with induced cells we will take a skin or similar cell and treat it either
with a virus or enzyme to reprogram the cell. They are now doing this by
treating the cell with certain transcription factors. This treatment makes the
cell go back in time and act as much younger cell having the capabilities of
becoming many different types of cells. These are called induced pluripotential
stem cells or IPS cells. We see in the
above illustration that these induced cells act very similar to embryonic cells.
There is a great deal of research currently underway with these cells. The
problem with the induced T-reg cells is that they do not appear to be stable.
next portion of the article deals on how to increase the stability of the
induced T-reg cells and for that matter regular T-reg cells. This has possible
far reaching ramifications for our health. One important factor that affects
the T-reg cell stability is something called a TET protein. Actually, TET
stands for Ten-Eleven Transcription factor proteins. Transcription is the process where a gene's DNA
sequence is copied (transcribed) into an RNA molecule. Transcription is a key
step in using information from a gene to make a protein. The RNA will carry a
message and it is thus called messenger RNA (mRNA). This is the basis for many
of the Covid vaccines.
DNA contains all information that
cells in our body need to function by providing specific codes to produce
specific proteins. Not all parts of DNA are accessible in all cells at all
times. The regulated production of proteins ensures that different cells and
organs can be developed from the same DNA. Remember one cell has all the
genetic information to reproduce the whole body. What that one cell makes
depends upon how the cell is regulated. An important regulatory mechanism is
the reversible addition (methylation) or removal (demethylation) of certain chemical
bonds, so-called methyl groups, to segments of DNA. This modifies the readout
of the DNA segment. The next illustration demonstrates the concept of
methylation and how transcription works. We have now broached an important
scientific field called EPIGENETICS. Epigenetics deals with how certain genes get turned on or off. The illustration shows these concepts.
In the course of life, aging processes, environmental influences and lifestyle factors
such as smoking or diet induce biochemical alterations to the
DNA. Frequently, these lead to DNA methylation, a process in which methyl
groups (CH3) are added to particular DNA segments, without changing
the DNA sequence. This causes changes in how the DNA behaves.
Getting back to the TET Proteins, they can
decrease the production of certain proteins in immune cells. How TET proteins
play into the development of autoimmune diseases is still not completely
understood. TET transcription factors, a family of cancer
suppressive proteins, help regulate gene activity via their influence on
chromosomal architecture. TET enzymes facilitate DNA demethylation (
removal of CH3).
Methylation can change the activity of a DNA
segment without changing the sequence. When located in a gene promoter, DNA
methylation typically acts to repress gene transcription. Researchers
have linked abnormal DNA methylation to several human diseases. DNA methylation
is a commonly used epigenetic signaling tool that can fix genes in the off
position. Remember Epigenetics deals with how reversible changes in
DNA affect gene activity and protein expression. Disrupting this machinery can
have dramatic effects on cellular function and overall health.
What the article tells us is that Vitamin C has
the ability to enhance the enzymatic activity of the TET proteins. So far, the problem has been that the converted iT-reg cells did
not seem to function well. It has been very challenging to come up with the
right molecular ingredients to allow the induced cells to survive. Vitamin C
seems to change the dialog. The article discusses the symbiosis of Vitamin C and TET proteins and their
effects on T-reg cells. This technique involves the reprogramming of
effector or memory T cells into iT-regs. The bottom line is that the Vitamin C
and the TET proteins will induce a stable i-Treg cell. Hopefully, in the not
too distant future stable i-Treg cells will become a reality.
C is found to be a key mediator of the interface between genome and
environment. It regulates DNA demethylation as a cofactor for TET. It is shown
that vitamin C drives active removal of DNA methylation by enhancing TET enzymes. Thus, Vitamin C is not
just an anti-oxidant but has other powerful regulatory function. THIS IS A BIG DEAL!
Recent studies have shown that Vitamin C
potentiates the effects of DNA methyltransferase inhibitors. DNA methyltransferases are a family of writer
enzymes responsible for DNA methylation by the addition of a methyl group. Epigenetic
alterations, along with genetic mutations contribute to onset of cancer. It is
shown that Vitamin C drives active removal of DNA methylation by enhancing TET
enzymes. This helps to erase DNA methylation which allows epigenetic memory
encoded by it to improve reprogramming of differentiated cells to an embryonic-like
In the above illustration we see Vitamin C at
work. It is blocking a DNA writer. It is inhibiting the addition of the
methyl group to the DNA. Here is the proof that Vitamin C affects how our DNA
functions. The famous scientist, Linus Pauling, recommended mega doses of
Vitamin C. He was mocked for recommending large doses of Vitamin C for
preventing the common cold among other things. Ask your friends if they have
been taking large doses of Vitamin C to try to help prevent Covid. It looks
like Pauling will have the last laugh. It reminds me of a saying from Arthur
Schopenhauer Truth passes through three stages: First it is Ridiculed. Second,
it is violently opposed. Third, it is accepted as self-evident.
The take away here is Vitamin
C is an essential micronutrient and a free radical scavenger. These are well
known facts. At the same time, it has functions such as blocking oncogenic
transformation induced by carcinogens by its effects on epigenetics. The
epigenetic effects of vitamin C and its effects on the health of the immune
system far outweigh it acting as an anti-oxidant. One final thought, in our
clinic we are able to offer multiple combinations of Vitamin C via an
intravenous route. The intravenous route insures better bioavailability.Thanks, Dr P
is the link to the article: https://scitechdaily.com/vitamin-c-is-a-key-ingredient-for-immune-cell-function-a-leg-up-in-treating-autoimmune-diseases/
Sometimes the government is the last to know. The U.S.
military is about to start testing anti-aging compounds. Guess which one? Hint: It begins with an 'N', ends with a 'D' and has an 'A' in the middle. The answer is NAD.
I was recently sent an article from a friend. It was
interesting in that it was discussing the fact that the U.S. military will be
testing NAD as an anti-aging supplement and performance enhancer. I looked up
this up and found that this information was reported on a number of different
sites. I happened to pick the Popular Science article and it is included below.
The military is doing something that we have known about in the real world for
some time. NAD supplements seem to act in an anti-aging fashion and seem to
improve performance, both mentally and physically. I suspect over time they
will also discover that giving the NAD intravenously with the oral supplements
will work even better. I suspect over time they will also discover certain
tricks to make NAD absorption better, more efficient and quicker. Finally, they
will also learn that they will need to act against Senescent cells when NAD is
given or we may have the opposite effect on the patient. These are treatment
protocols that we have developed in our clinic over time. Below is the link.
Enjoy the article:https://www.popularmechanics.com/science/health/a36905562/us-military-testing-anti-aging-pill/Thanks, Dr. P
If you move it, you will lose the cells/It needs rest
The biggest misconception around the injection of PRP or Stem Cells as it is related to physical therapy (PT) is that post injection PT shouldn’t happen. There is the common misconception that if you move the area that was injected you will somehow push the cells out and the money you spent will be wasted. This couldn’t be further from the truth. The most up to date research in the field consistently advocates for movement in the form of physical therapy post injection. By moving the area and stressing the tissue intelligently you are actually telling those injected cells what to do. The cells are placed in the area, and it is referred to as their “microenvironment”. If the microenvironment goes unaltered the cells will not serve their intended purpose. If the microenvironment is stimulated it will signal to those cells what tissue is needed and the cells will respond accordingly. In summary, physical therapy post-injection is a crucial component to getting the most out of your treatment.
Any PT post stem cell is good PT
Along the same lines as our first misconception is the falsehood that any PT after Stem Cell/PRP is good PT. Unfortunately, that isn’t the case. The most affective physical therapy after a stem cell injection will be one that targets the tissue type that the injection was given for (ie. Bone, tendon, ligament, muscle, etc.). Each tissue type responds to stimulus differently and that needs to be understood by the physical therapist providing the treatment. Stress the tissue too much, too little, or incorrectly can be detrimental to the patient’s outcomes. Stressing the target tissue the correct ways and with the correct dosage is going to greatly improve the benefits of the injection. Finding a physical therapist that understands regenerative medicine and can balance the active and passive components of care properly is a must for optimal results.
The Boost of Blood Flow Restriction (BFR) Training
This third point is less of a misconception and more of a secret weapon to boosting outcomes after a regenerative injection. Blood flow restriction training, when done properly, can greatly assist in the recovery and repair process following PRP/Stem cell injections. BFR training involves measuring the patient’s blood pressure and using an equation to determine a proper occlusion pressure for them to train under. Once this pressure is found, we are able to mimic training under a heavy load with high intensity under a very low load and intensity. Simply put, we can trick the body into thinking it is working harder than it truly is. This is important after PRP/stem cell because it influences the body chemistry in a way that can magnify the response. BFR training puts the body in “rebuild and repair” mode safely while those injected cells are trying to do just that. Simply put: if the PRP and stem cells are the construction workers, BFR training is the 2pm coffee that keeps them working hard through the end of the day.
Written by Dr. William “Bill" Kelley DPT, ATC, CSCSCo-Owner and Director of Physical Therapy:Aries Physical Therapy FTL1115 E Sunrise BlvdFort Lauderdale, FL 33304(o) 954-247-4929(f) 954-245-0697Aries Physical Therapy Boca807 N Federal HwyBoca Raton, FL 33432(o) 561-287-6486(f) 561-621-2944
We have recently obtained another key weapon in our
office. This weapon is a true Class 4 COLD LASER. But this is not like the
typical class 4 laser. Many people know about lasers but are not exactly sure
how they achieve their goals. The basic science of lasers is that they use the
principle of Photobiomodulation. The following illustration shows this concept.
Photobiomodulation is defined as a form of
light therapy that utilizes non-ionizing light sources. These include near ultraviolet, visible light, infrared, microwave, radio waves,
and low-frequency radio frequency (long-wave) are all examples of non-ionizing radiation. By contrast, far
ultraviolet light, X-rays, gamma-rays, and all particle radiation from
radioactive decay are ionizing
light sources. Photobiomodulation is a NON-THERMAL process involving endogenous
chromophores. The first law of photobiology
explains that for a low power visible light to have any effect on a living
biological system, the photons must be absorbed by electronic absorption bands
belonging to some molecular photo-acceptors, which are called chromophores.
Here is a good explanation of chromophores.
A chromophore is the part of a molecule
responsible for its color. The color that is seen by our eyes is the one not
absorbed by the reflecting object within a certain wavelength spectrum of
visible light hence the objects steal the objects from the wheel. Chromophores will elicit reactions at various biological sites. This process
results in beneficial therapeutic outcomes including but not limited to the
alleviation of pain or inflammation, immunomodulation, and promotion of wound
healing and tissue regeneration. We can see this principle in
the following illustration:
What we are able to see is that a very
important aspect of laser therapy involves the mitochondria. The mitochondria
produce ATP which is the body's energy currency. It does this by stimulating
the Cytochrome C Oxidase which is an enzyme in the electron transport chain of
the Krebs cycle. Laser therapy produces a
shift in overall cell redox potential in the direction of greater oxidation and increased Reactive Oxygen Species
(ROS) generation. In a biological
context, ROS are formed as a natural byproduct of the normal aerobic metabolism
of oxygen and have important roles in cell signaling and homeostasis. ROS are well known to stimulate
cellular proliferation of low levels, but inhibit proliferation and kill cells
at high levels. Nitric oxide is also involved in laser therapy. It may be
photo-released from its binding sites in the respiratory chain and elsewhere.
Nitric oxide will increase vasodilation and thus increasing blood supply.
Nitric oxide may also act as a neurotransmitter helping with pain control. Also,
not to be overlooked is the fact that the mitochondria have many important
tasks in many other aspects of cell biology and cell signaling pathways.
It has been proposed that
the redox state of a cell regulates cellular signaling pathways that control
gene expression. Modulation of the cellular redox state can activate or inhibit
signaling pathways. When we start affecting the various pathways and affecting
gene expression we have now crossed into the field of Epigenetics. Several
regulation pathways are mediated through the cellular redox state. Changes in
redox state induce the activation of numerous intracellular signaling pathways,
such as nucleic acid synthesis, protein synthesis, enzyme activation and cell
When all is said and done the application of a
therapeutic dose of light to impaired or dysfunctional
tissue leads to a cellular response mediated by mitochondrial mechanisms that
reduce pain and inflammation, speed healing, and cell hemostasis. These cellular mechanisms responsible for the effect of
visible light on cells include cytochrome c oxidase. Mitochondria are thought
to be a likely site for the initial effects of light, leading to increased ATP
production, modulation of reactive oxygen species, induction of transcription
factors, and possible changes in mitochondrial DNA. These effects in turn lead
to increased cell proliferation and migration particularly by fibroblasts.
Fibroblasts are responsible for the production of collagen which is a basic
building block for many of the bodys tissues including bone, cartilage etc. The
lasers overall effect is that it will
bio stimulate cells to increase cellular growth and regenerative activity,
while simultaneously deactivating 7 or the 9 enzymes that cause inflammation by
up to 70%.
Another unique aspect of lasers is that they are considered to be monochromatic,
coherent and collimated. Monochromatic means that there is a single wavelength
which stimulates particular human tissues that will only respond to that
specific wavelength being utilized. Coherent means that it minimizes the photon
scatter as light interacts with the tissue. Lastly, because lasers have a
higher power that works with a specific wavelength, they are collimated which
allows it to actually reach the deep tissues. The following illustration drives
home these points.
ARE LASERS CLASSIFIED?
One may ask how are the lasers classified? The FDA classifies lasers from I to IV. For instance, a Class IV Laser is any laser
device that the FDA has determined is powerful enough to pose a significant
risk of injury to the eye. Consequently, being Class IV does not necessarily
laser more effective, as that would depend upon
what you intend to do with it and how you use it. Some Class IV lasers are used
in health and medical settings for a wide range of therapeutic applications.
Others are used for construction, cutting, burning and by hobbyists such as
high-powered laser pointers.
Let us look at some further
perimeters of the Class IV Lasers. Hot lasers are known as Class IV lasers. Class IV lasers
have a power output above 500 milliwatts (mW). At a lower power range, hot
lasers are used for therapeutic purposes. Class IV lasers can cut tissue during
surgical procedures. Most Class IV lasers are called hot lasers because they
can rapidly increase tissue temperatures. The one common tread with class IV
lasers is that they have higher power outputs and most translate the energy to
On the other hand, most, cold lasers are also known
as low-level lasers, they are among Class II and Class III lasers. Cold lasers
have a power output of less than 500 mW. These lasers are called cold because
they do not generate a thermal effect. But we must realize that the decreased
power will also decrease the penetration depth of the laser. The vast majority
of lasers in medical use are not true class IV cold lasers but class III
lasers. Many of them are advertised as a Class IV lasers but in reality, they
are Class III lasers. If they happen to a Class IV laser then most of the
energy is expended as heat. They may have some bells and whistles and other
gimmicks. But it does not make them any more effective. As we can see in the
following illustration, typically a Class IV laser will need much less
treatment time than a Class III laser. Also, we will obtain a much greater
depth of penetration with the Class IV laser. What most medical professionals
do not seem to understand is that a laser with many medical benefits produces
it benefits with LIGHT ENERGY NOT HEAT. Thus, when one is looking to
derive benefits from the laser, heat should not be a consideration. THE
PHOTONIC ENERGY IS WHAT ONE NEEDS TO BE CONCERNED ABOUT. The following
illustration will give an idea about the difference. The most significant
difference in the various types of lasers is the depth of penetration.
There is a misunderstanding
that a more efficient laser will produce heat.
This is simply not the case. Most of the time when we are utilizing a laser we
are interested in the depth of penetration. We also do not wish to subject the
patient to long hours of treatment. So, if we can eliminate the heat and get
penetration of depth than we may have something special. When all is said and
done IT IS THE PHOTONIC ENERGY WHICH ACCOMPLISHES THE REPAIR.
WHAT WOULD BE MY CHOICE FOR AN OPTIMAL LASER?
I have used lasers for many years. The use of lasers
for musculoskeletal conditions has long passed the point of being experimental.
There are many different types of lasers in use. In our clinic we have been
very happy with our laser sleeves and our original hand-held Class IV type
laser. The original Class IV laser which we have been using requires eyewear
protection and it will produce heat which could burn the skin. Nevertheless, it
was efficient but at the same time there was a risk of thermal injury and
because of the thermal considerations I believe the penetration was limited.
If I were able to design a laser I would want one to
be a Class IV laser that essentially did not cause any thermal damage. To be
effective, the laser would have to have a power output of greater than 500
milliwatts. It would need to be monochromatic and have a wavelength of
approximately 680 mM which is the ideal wavelength to stimulate the
mitochondria. This is the sweet spot in the red spectrum range.
It obviously requires eyewear. Also, it is cold laser. What are the differences
between and hot and cold laser? Again, Cold Lasers are therapeutic
lasers that produce an insignificant amount of heat and are extremely safe for
use by professionals.
us take a look at the specs of the new laser. The output of the new laser is
750 milliwatts. Remember, the energy output for the Class IV laser is above 500
milliwatts. So, we definitely classify as a Class IV laser by power output. The
new laser is monochromatic so it essentially stays on one wavelength and its
wavelength is 680 nM which is the sweet spot for mitochondrial stimulation etc. The
wavelength is 680 nm. This is the sweet spot in the red spectrum range. This
provides both a large safety margin and potent force. If
we were to lower the wavelength we could lower the safety margin. The last
aspect to an ideal laser is what is called lumen intensity. We need to look at
some physical aspects of light when looking at lumen intensity. There are three
terms we want to know when assessing lumen intensity. These are lumens, lux and
candela. A good way to remember the differences
between terms is:
are how much light is given off
how bright your surface will be
measures the visible intensity from the light source.
The lumen intensity of the new laser is 550 lumens per millimeter
of tissue radiated. The beam profile is one millimeter. This last spec will
allow the user to pinpoint targeting tissue. Example would be a meniscus tear
located posteriorly in the medial compartment, or a tear in the supraspinatus
located inferior to the acromion for example. This later spec you can only
utilize the function of when the laser is a true class four. You need the power
of penetration without the heat damaging aspect. This is a very important aspect
and the one important principle which needs to be conveyed and understood - not
easy to do! True photonic intervention is dependent on absorption of the light
force or energy. Not in the heat transmission normally incorporated into laser
modules. The light is the energy! Again, we see a picture of our new Class IV
laser. Notice it is a hand-held laser. It is battery powered. Many times,
simplicity is a goal strived for but many times seldom achieved.
The next illustration is a summation of all the
benefits our new Class IV laser is able to achieve while at the same time being
extremely safe to the patient as long as the proper eye precautions are taken. The
last two illustrations are videos comparing the new class IV cold laser with a
typical Class IV laser. The differences between the two are remarkable.
The last two items really drive home the point of what
makes this Class IV cold laser a truly unique laser. They are pictures and
videos on two types of Class IV lasers. One is a typical Class IV laser which
most medical professionals are familiar with. The other is the new Class IV
cold laser. I did an experiment with two Class IV lasers. The first
illustration is the typical Class IV laser. Now the wattage used with this
laser is in the 6-watt range. This would probably cause a burn to the skin at
this power especially if it were kept in the same spot. On the other hand, the
second image is the true Class IV cold laser. Notice the difference in light
I suspect this new Class IV cold laser may be a game
changer. The preliminary results in the office are quite impressive. We are
truly making use of photonic energy to make a difference. Time will tell, but
this seems to be exactly what we asked for.
Below is the Class IV hot laser shined into a container having a mixture and saline. We can see the red color from the laser is not vibrant. Realize that when the laser is being used on the body it will need to penetrate a mixture of saline and blood.
The next picture and video are of the new Class IV cold laser. Notice how vibrant the color is. The same will happen in your body. Realize that the only difference between these pictures is the lasers. The container is the same container.
This is an especially fascinating study as far as
aging is concerned. I left the article link at the end of my write up. What
this study looked at was the ability of long-lived people to repair DNA damage.
In this particular case they looked at inherited
and naturally occurring genetic changes in older people. They found in the
long-lived population two particular genes COA1 and STK17A. These are rather
esoteric names but the importance is there! COA1 is involved with energy
production and communication between the mitochondria and the cell nucleus.
COA1 performed three functions that are part of the blue prints for anti-aging
platforms. They directed cell response to DNA damage, they prompted badly
damaged cells to die off, and controlled the amounts of Reactive Oxygen
Species. I suspect these genes are stimulating the P-53 gene. P -53 is called
the tumor suppressor gene. Taking things one step further, remember that NAD+ is a substrate for DNA
repair proteins such as PARP1, PARP2 and PARP3 as well as
enzymes that can influence DNA
repair capacity such as SIRT1 and SIRT6. The PARP enzymes
typically get shut off when the body does not have enough NAD+ to go
around. Looks like there may be some
overlap here. Activate the DNA repair genes and you may live longer. At least
you are giving yourself better odds. This is why I feel it is of paramount
importance to take NAD supplements both orally and intravenously. Also remember,
there is much science out there that shows Ozone therapy can increase the NAD
levels in the body in addition to dramatically decreasing damage from Reactive
Oxygen Species. The moral of the story here is:
MAKE SURE YOU TAKE YOUR NAD TO
STAY YOUNG.Here is the article I am talking about:https://bigthink.com/surprising-science/semi-supercentenarians-dna-repairThanks,Dr. P
The more involved I become with stem cells and
the field of Regenerative Medicine, the more convinced I become of the
importance of the mitochondria. Many of us in clinical medicine seem to brush
over mitochondria. We now realize that many diseases are related in some way to
deficiencies of the mitochondria. Success in stem cell procedures may depend on
the health of the mitochondria. The above illustration shows the structure of
the mitochondria. Mitochondria
are rod-shaped organelles that can be considered the power generators of the
cell, converting oxygen and nutrients into adenosine triphosphate (ATP).
ATP is the chemical energy "currency" of the cell that powers the
cell's metabolic activities. Mitochondria
are often referred to as the powerhouses of the cell. They help turn the energy
we take from food into energy that the cell can use. But, there is more to
mitochondria than energy production. In
fact, only about 3 percent of the genes needed to make a mitochondrion go
into its energy production equipment. The vast majority are involved in other
jobs that are specific to the cell type where they are found. Here is another illustration of the inner
workings of the mitochondria
The mitochondria have two
membranes, an outer one and an inner one. Each membrane has different
functions. The Outer membrane allows small molecules to pass freely through the
outer membrane. This outer portion includes proteins called porins, which form
channels that allow proteins to cross. Most cellular stress
responses converge on the mitochondria. Consequently, the mitochondria must
rapidly respond to maintain cellular homeostasis and physiological demands by
fine-tuning a plethora of mitochondria-associated processes. The outer
mitochondrial membrane proteins are central to mediating mitochondrial
dynamics, coupled with continuous fission and fusion. These proteins also have
vital roles in controlling mitochondrial quality. When
cellular components like mitochondria become damaged or defective, they can be
recycled by cells through a process called autophagy, which literally means
self-eating. When mitochondria are degraded by autophagy, the process is
specifically referred to as mitophagy. Mitophagy often
occurs in defective mitochondria following damage or stress. This is
actually one of the important aspects of aging. As we age, mitophagy will
diminish resulting in increased damaged mitochondria. This has a snowball effect
in that it leads to increased reactive oxygen species (ROS), decreased
bioenergetics, and many age-related diseases. Mitochondrial damage may be the
seminal event in many different diseases. If we increase mitophagy we will slow
down aging. The following illustration shows the consequences of accumulated
The next structure to discuss is the inner mitochondrial membrane. It is
extensively folded and compartmentalized. The numerous invaginations of the
membrane are called cristae. Which are separated by crista
junctions from the inner boundary membrane juxtaposed to the outer membrane.
Cristae significantly increases the total membrane surface area compared to a
smooth inner membrane and thereby the available working space. The inner membrane is also loaded with proteins involved in electron transport and
ATP synthesis. This membrane surrounds the mitochondrial matrix, where the citric
acid cycle produces the electrons that travel from one protein complex to the
next in the inner membrane. The crista membranes contain most, if not all, of
the fully assembled complexes of the electron transport chain and the ATP
synthase. The following illustration demonstrates this concept. We see the two
membranes and subsequent ATP production. In review, at the inner mitochondrial
membrane a high energy electron is passed along the electron
released pumps hydrogen out of the matrix
space. The gradient created by this drives hydrogen back through the membrane,
through ATP synthase. As this happens, the enzymatic activity of ATP synthase
synthesizes ATP from ADP. This whole process is called oxidative
phosphorylation (OXPHOS), which is the main method and most efficient method
the body uses to make ATP. The more efficient this process the better in shape
Another structure present is the
mitochondrial ribosomes. Mitochondrial
ribosomes (mitoribosomes) perform protein synthesis inside mitochondria.
Throughout evolution, mitoribosomes have become functionally specialized for
synthesizing mitochondrial membrane proteins. Mitochondrial ribosomes resemble bacterial ribosomes and both bacteria
and mitochondria ribosomes share a slightly different genetic code from that in
the nucleus. Actually, we see that ribosomes have two parts, a large and a
Although most DNA is packaged in chromosomes within the nucleus, mitochondria also have a small amount of their own DNA. This genetic material is known as mitochondrial DNA or mtDNA. Mitochondria are a trans-kingdom enigma. At the molecular level, the components of Human mitochondria are assembled from viruses, bacteria, and other organisms. As such, the organelle we see in human cells today is called a trans-kingdom mixture that doesn't fully resemble any of its ancestors.
genome is built of
16,569 DNA base pairs, whereas the nuclear genome is made of 3.3 billion DNA base pairs. In keeping with its bacterial ancestry, mtDNA
is also circular and multicopy with hundreds to thousands of copies present in
every cell. mtDNA is very genetically compact and encodes only 13 proteins, all
of which are core subunits of the oxidative phosphorylation (OXPHOS) complexes.
These OXPHOS complexes, found only within mitochondria, are unique in human
biology as they are the only cellular structures formed of proteins encoded by
genes from the two separate genomes. The nuclear DNA provides around 90% of the
required proteins for OXPHOS, and the mtDNA provides the remaining 10%.
Remember that the OXPHOS complexes are responsible for ATP production.
Mitochondria are the only organelle to have their own DNA. Mitochondrial
DNA (mtDNA) is more susceptible to damage (including mutations) than nuclear
DNA. The reason for this is many folds. Most likely this is due to a lack
of histones to protect the DNA from damage. The below diagram gives a brief
explanation of histones. Histones package and order the DNA into structural units called nucleosomes. They
act as spools around which the DNA gets coiled and thus a very long strand of
DNA can be fit into a much smaller space. This is demonstrated in the
DNA damage is also caused by the proximity of mtDNA to
Reactive Oxygen Species (ROS) production. We must remember that the
mitochondria are engaged in oxidative phosphorylation which means that they are
using oxygen to produce energy. The by-product of the energy production is the
ROS. Also, mtDNA has limited DNA repair systems and limited proofreading
capacity during replication all of which can lead to accumulated mitochondrial
DNA damage. Furthermore, the mitochondrial DNA is ever changing. When a cell divides, its
mitochondria are partitioned between the two daughter cells. However, the
process of mitochondrial segregation occurs in a random manner and is much
less organized than the highly accurate process involved in nuclear DNA
division during cell replication commonly called cell mitosis. As a result,
daughter cells receive similar, but not identical, copies of their
WHAT REGULATES THE
MITOCHONDRIA? THE SIRTUIN FAMILY OF PROTEINS
Sirtuins are a
family of proteins that regulate cellular health. Sirtuins play a key role in
regulating cellular homeostasis. Homeostasis involves keeping the cell in
balance. Sirtuins can only function in the presence of NAD+,
nicotinamide adenine dinucleotide, a coenzyme found in all living cells. NAD+
is vital to cellular metabolism and hundreds of other biological
processes. Humans contain
seven sirtuins (SIRT1-7) that modulate distinct metabolic and stress response
pathways. Three sirtuins, SIRT3, SIRT4 and SIRT5, are located in the mitochondrion.
The others are found in the nucleus and one in the cytoplasm. The basic role of sirtuins, however, is that they remove
acetyl groups from other proteins. Acetyl groups control specific reactions.
They are physical tags on proteins that other proteins recognize will react
with them. Sirtuins work with acetyl groups by doing whats called
deacetylation. This means they recognize theres an acetyl group on a molecule
then remove the acetyl group, which tees up the molecule for its job. One way
that sirtuins work is by removing acetyl groups (deacetylating) biological
proteins such as histones. When the histones have an acetyl group, the chromatin is
open, or unwound. When the histones
are deacetylated by sirtuins, the chromatin is closed, or tightly and neatly
wound, meaning gene expression is stopped, or silenced. This is not that common
for the Sirtuins in the mitochondria.
Mitochondria regulation is where things get interesting. If we start
manipulating the regulation of the mitochondria then there are a whole host of
conditions from aging to chronic neuro-degenerative conditions which we might
be able to impact. Recent findings have shed light on how the mitochondrial
Sirtuin functions in the control of basic mitochondrial biology, including
energy production, metabolism, apoptosis, intracellular signaling and perhaps
most importantly mitochondrial genesis. The following diagram shows some of
What these Sirtuins
do is help in the generation of cellular energy. As high-energy
electrons derived from glucose, amino acids or fatty acids fuels are passed
through a series of protein complexes (I-IV), their energy is used to pump
protons from the mitochondrial matrix through the inner membrane into the
inner-membrane space. This is referred to as the electron transport chain.
Ultimately, the electrons reduce oxygen to form water, and the protons flow
down their gradient through ATP synthase, driving the formation of ATP from
ADP. Reactive oxygen species (ROS) are a normal side-product of the respiration
process. ROS are essentially free radicals. During cellular stress or damage,
mitochondria release a variety of signals to the cytoplasm and the nucleus to
alert the cell of changes in mitochondrial function. In response, the nucleus
generates transcriptional changes (stimulates certain genes) to activate a
stress response or repair the damage. The main function of mitochondria is to metabolize or
break down carbohydrates and fatty acids in order to generate energy.
In review, ATP
generation occurs within the mitochondrial matrix, though the initial steps of
carbohydrate (glucose) metabolism occur outside the organelle. Glucose is first
converted into pyruvate and then transported into the matrix. Fatty acids on
the other hand, enter the mitochondria as is.
ATP is produced
through the course of three linked steps. First, using enzymes present in the
matrix, pyruvate and fatty acids are converted into a molecule known as
acetyl-CoA. This then becomes the starting material for a second chemical
reaction known as the citric acid cycle or Krebs Cycle. This step produces
plenty of carbon dioxide and two additional molecules, NADH and FADH2,
which are rich in electrons. The two molecules move to the inner mitochondrial
membrane and begin the third step: oxidative phosphorylation. In this last
chemical reaction, NADH and FADH2 donate their electrons to
oxygen, which leads to conditions suitable for the formation of ATP. As an
interesting aside, the optimal ratio of NAD+ /NADH is 700/1. Greater
amounts of NADH lead to aging. NADH is considered a marker of aging. A
secondary function of mitochondria is to synthesize proteins for their own use.
They work independently, and execute the transcription of DNA to RNA, and translation
of RNA to amino acids (the building blocks of protein), without using any
components of the cell.
Another aspect that the Sirtuins control is the control of
Apoptosis. Apoptosis is a cellular process of programmed cell death. This
occurs when the mitochondrial outer membrane allows much more permeability than
normal. This will ultimately commit the
cell to death. Mitochondrial
sirtuins act in synergistic or antagonistic ways to promote respiratory
function, antioxidant defense, insulin response and adipogenesis all of which
can protect individuals from aging and aging-related metabolic abnormalities.
If these cells are not dealt with they might become senescent cells. A
senescent cell is one that should have died but continues to remain alive. The problem
with the senescent cells is that they will release a number of inflammatory
growth factors which can cause havoc in the body.
HOW DO WE KEEP OUR
We have seen the ins and outs of the mitochondrial structure and
function. The question that begs is how do we keep the mitochondria healthy? More and more research
articles demonstrate the foundational importance of optimal mitochondrial
function for health. There is a growing body of research
showing that mitochondrial dysfunction is surprisingly common and associated
with most chronic diseases. The above and below illustrations give us an idea
of how to keep our mitochondria running smoothly. The first illustration shows
some supplements which keep things running smoothly:
The second illustration shows not only specific supplements but also
classes of supplements such as polyphenols (Polyphenols are micronutrients that we get through certain
plant-based foods) and proanthocyanidins (these are chemical
compounds that give the fruit or flowers of many plants their red, blue, or purple
colors). It also stresses some lifestyle factors that can increase mitochondrial
efficiency. The specific supplements that enhance mitochondria function are
evident in the list. Let us talk specifically about some of the polyphenols. They are included in many supplements, though they're also
easy to get in your diet from foods like fruits, vegetables, teas, and spices.
There are more than 8,000 types of polyphenols. A lack of polyphenols isnt associated with specific
side effects. However, they are regarded as lifespan essentials'' for
their potential to reduce the risk of chronic diseases. This is especially true
based on their effects on the mitochondria. Research suggests that supplementation with
pyrroloquinoline quinone, also known as PQQ, can improve the number of
mitochondria in the body while enhancing their functionality. This research
also suggests that effective treatment for many diseases caused
by mitochondrial dysfunction may rest at least partly in this
coenzyme. PQQ is readily found in the soil, so it
makes sense that the best dietary sources are fruits and vegetables grown in
that soil. Fermented foods are rich in these molecules. One of the best sources of PQQ is very dark chocolate.
The above illustration shows some of the main peptides produced by the
mitochondria. Mitochondria derived peptides (MDPs) are a series of peptides encoded by mitochondrial DNA, and have similar
functions to mitochondria. They are new metabolic regulators of human body, and play a
cytoprotective role in maintaining mitochondrial function and cell viability
under pressure. Peptides
are biomolecules comprised of amino acids which play an important role in
modulating many physiological processes in our body. Peptides are
short strings of amino acids, typically comprising 250 amino acids. Amino
acids are also the building blocks of proteins, but proteins contain
more. Peptides may
be easier for the body to absorb than proteins because they are smaller and
more broken down than proteins.
Mitochondria produce numerous small polypeptides from their short open
reading frame (sORF) regions of mtDNA that have significant biological
activity. These include humanin, six small-humanin like peptides, and MOTS-c
(mitochondrial open reading frame of the 12S rRNA type-c), together termed
mitochondrial derived peptides (MDP). MOTS-c is a peptide which is called an exercise mimetic. Exercise
Mimetics are novel ways
of getting the benefits of exercising, without having to exercise. Multiple
studies have demonstrated MOTSc's ability to enhance lipid
beta-oxidation, increase thermogenic brown fat, decrease fat gain on a high-fat
diet, and improve glucose uptake during glycolysis. Various mitochondrial
peptides are produced but their use is not allowed in the USA under the current
regulations. Hopefully, this will change with time.
As time goes on we are discovering more and more about the importance of
the mitochondria and their ramifications to our health lifespan. We see that
methods to boost mitochondria efficiency are varied. But when all is said and
done. Some of the most important factors are exercise especially intermittent
high intensity training, intermittent fasting, a variety of supplements
including NAD. Low levels of oxidative stress such as is produced by
intravenous ozone therapy are also important in the proper function of the
mitochondria. We must remember that mitochondrial decay is inevitable; it cannot be prevented, at least with todays technology.
What is not inevitable is the rate of decay. The mitochondrial rate of
decay is determined by one thing: oxygen efficiency. Perhaps the following
diagram sums it all up:
We see many bad things happen when our mitochondria are not working
Nrf2 is also called the Nuclear factor erythroid 2-related factor 2. NRF2 is a transcription factor that activates over 500 genes. The main reason NRF2 is so highly sought, is because it is a key transcriptional regulator of several antioxidant and anti-inflammatory enzymes. Nrf2 is now recognized to be involved in the cellular response to multiple stressors including foreign substances, excessive nutrient/metabolite supply, inflammation, and the accumulation of misfolded proteins. The Nrf2 protein, known as a transcription factor because of its ability to control genes, is the key component of a pathway (a sequence of biochemical reactions in a cell) that senses and responds to changes in oxidative balance. Nrf2 is one of the body’s major pathways. We need to think of the pathways as the body’s computer software and the cells and organs as the computer hardware. Nrf2, in fact, regulates many hundreds of genes that have nothing to do antioxidant enzymes per se, but rather provide protection from a broader range of stress-related events that are encountered by cells, organs, and organisms, under both normal and pathological circumstances. The Nrf2 pathway is under tight control. When the Nrf2 protein in bound in the cytoplasm it is essentially inactive. The following illustration shows this concept. This illustration is essentially the essence of how the Nrf2 pathway functions. We must remember that Nrf2 is a protein. Proteins, although they are typically confined within the cell or on a cell, have a complicated life cycle. The illustration shows the complicated cycle of the Nrf2 ecosystem. It actually demonstrates its actions in the cell. For example, soon after NRF2 is made by ribosomes in the cytoplasm, it is normally sequestered by KEAP1, which quickly loops the Nrf2 protein with ubiquitin ligase Cullin3 for transport to the proteasome. Here, the ubiquitin is stripped off and NRF2 is degraded and recycled. If all is well in the cell, this process gives NRF2 a half-life of about 20 minutes. Remember, if all is well in the cell Nrf2 is typically not active. Looking at the diagram in a different manner we see that the Nrf2 is held “prisoner” in the cytoplasm. The “prison guard” is called Keap1. If given the opportunity Keap1 will go on and destroy the Nrf2 protein. This is called proteasomal degradation. Given the right conditions (in this case a stress to the body) the Nrf2 protein breaks the stranglehold that the Keap1 proteins maintain. The Nrf2 protein then makes its way to the nucleus where it can eventually react with certain genes and produce certain beneficial compounds. A major mechanism in the cellular defense against oxidative or electrophilic stress is activation of the Nrf2-antioxidant response element signaling pathway. This explanation is basic but it gives the essentials of how the Nrf2 protein functions. WHAT ARE THE STRESS CONDITIONS THAT STIMULATE THE NRF2 PATHWAY?The Nrf2 pathway senses the need for antioxidant enzymes and regulates their production to maintain metabolic balance. The sensing components of the pathway chemically modify and release Nrf2 so that it may diffuse into the nucleus of the cell where the DNA resides. Once in the nucleus, the Nrf2 will start reacting with a variety of genes found in the DNA of the nucleus. It can then “switch on” or “turn off” the genes it controls (often termed survival genes) to produce the protected state within the cell. Our DNA encodes about 20,000 genes, each representing a “blueprint” for the production of a protein or enzyme necessary for a healthy existence. Each of these “blueprints” requires a regulating control called a “promoter” that determines precisely how much of each product is produced, and under what circumstances. By binding to one specific type of these switch-like promoter regions called the “Antioxidant Response Element (ARE)”, the Nrf2 factor controls the rate of production from hundreds of different genes that allow cells to survive under stressful conditions.NRF2 is part of a group of transcription factors called nuclear receptors. Transcription factors are proteins involved in the process of converting, or transcribing, DNA into RNA. Transcription factors include a wide number of proteins that initiate and regulate the transcription of genes. Once the Nrf2 translocates to the nucleus, it results in the production of Anti-Oxidant Response Elements. There are a number of these elements including Glutathione, Catalase, and a number of other anti-oxidants. We should think of these as endogenous antioxidants. Meaning they are made by the body. These are quite powerful. The next illustration shows more of the whole picture of the Nrf2 pathway. From the Nrtf2 stimulators to the actual response elements to the blocking of the reactive oxygen species (ROS) by the response elements. Ultimately, like many pathways in the body, the Nrf2 pathway targets the mitochondria. The illustration shows certain agents which block the Nrf2 and others which encourage its activation by disabling the stranglehold the Keap1 protein has on the Nrf2 protein. The following is a diagram of transcription factors:The illustration shows how Nrf2 handles the inflammation caused by the ROS. Inflammation is the most common feature of most chronic diseases and complications. Several studies have demonstrated that Nrf2 contributes to the anti-inflammatory process by orchestrating the recruitment of inflammatory cells and regulating gene expression through the antioxidant response elements (ARE). These genes produce a large variety of antioxidant enzymes that create a network of protection by neutralizing primary and secondarily generated oxidants and by cleaning up the toxic byproducts they leave in their wake. Also, they help to repair the damage the oxidants have caused. This is especially important for mitochondrial health. Mitochondria help produce free radicals (Reactive Oxygen Species=ROS) and at the same time are very susceptible to their damage. Oxidants such as the superoxide radical (O2-) and hydrogen peroxide (H2O2) are produced by the process of “burning” the foods that sustain us. The Nrf2 pathway senses the need for these antioxidant enzymes and regulates their production to maintain metabolic balance. Several things can upset this delicate balance, the most significant one is aging. Unfortunately, aging slowly tips the balance toward the oxidative side resulting in “oxidative stress.” Disease processes can also result in overproduction of oxidants. Many major diseases associated with aging, such as heart attacks, stroke, cancer, and neurodegenerative conditions such as Alzheimer’s disease also increase production of oxidants thus creating oxidative stress and inflammation. When our immune cells are stimulated they can produce reactive oxidants (O2-, H2O2, OH, and HOCl) to deal with both bacteria and viruses. This can result in the destruction of the viruses and bacteria. But the problem with these compounds is that our otherwise healthy cells get caught in the cross-fire and sustain collateral damage that we see and feel as inflammation. Unfortunately, we have seen this phenomenon in patients with a Covid 19 infection. They get such a vigorous immune response it is called a cytokine storm. Cytokine storms are one of the contributing factors to the high numbers of Covid deaths.HOW CAN WE HELP STIMULATE NRF2?The above diagram shows many of the moving parts of the Nrf2 pathway and its stimulation and resulting end products. In this illustration we see the arch villain of the Nrf2 pathway. This villain is called the NFkB pathway. This pathway is the opposite of the Nrf2 pathway. It is the thermostat of inflammation. It is a very important pathway. We must remember that some inflammation is essential. It is when the NFkB pathway gets over-stimulated that problems arise. Recent research has identified certain processes to be very effective at stimulating our body’s natural mechanisms for creating antioxidants through NRF2 activation. NRF2 activation can be achieved thru exercise, calorie restriction (including fasting) and ingestion of natural nutrients that are NRF2 activators. In our office we have found that intravenous Ozone is a potent stimulator of the Nrf2 pathway. The intravenous Ozone is part of a protocol called the EBO2 protocol. The intravenous Ozone momentarily produces Hydrogen Peroxide. The Hydrogen Peroxide is quickly converted into compounds called Ozone Messengers. These Ozone Messengers result in the stimulation of the Nrf2 pathway. They ultimately help to reduce inflammation. Other in office Nrf2 stimulants include intravenous Curcumin, Quercetin, and Resveratrol. Intravenously, these are very potent Nrf2 stimulants. Since they are given intravenously they become very bioavailable compared to their oral formulations. The question becomes what else can we do stimulate the Nrf2 pathway without a trip to the doctor’s office? We have already mentioned the usual suspects such as exercise, calorie restriction, modified keto type diet etc. However, we can still help to supplement Nrf2 stimulation with some oral compounds. In an ideal world one would first get some supplements intravenously and then proceed with lifestyle changes and oral compounds. Common NRF2 activators include Curcumin which is a widely studied and potent Nrf2 activator. The problem with Curcumin is its bioavailability. Not all Curcumin compounds are the same. Other stimulators include Pterostilbene and its weaker cousin Resveratrol. The problem with oral Resveratrol is also its bioavailability. Other stimulators include Quercetin (from onions) and sulforaphane (from broccoli) and antioxidants found in green tea, chocolate, and other sources. Different nutrients may activate NRF2 by different mechanisms and, when taken together, may be synergistic. I have taken the bull by the horns and designed a supplement which I feel will be unlike anything out there. The propriety blend of ingredients are:Fumaric AcidBrassicaUltracurAlpha Lipoic AcidQuercetinResveratrolPterostilbeneSome of these are well known while others may be new. One of the common threads with these particular compounds is that by and large they have much better bioavailability then their similar counterparts. Brassica is a broccoli derivative. Ultracur is a Curcumin derivative. They both have much higher bioavailability then competing products. One interesting item in this list is Fumaric acid. Fumaric acid is the “Crown Jewel” of this formula. A derivative of Fumaric acid has been approved by the FDA in the treatment of relapsing forms of Multiple Sclerosis. It is also used in the treatment of psoriasis. Currently I am not aware of any Nrf2 supplement blend that is utilizing Fumaric acid derivative mixed with other supplements to stimulate Nrf2. This product should be available shortly. By raising Nrf2 levels, we are able to tap into one of nature’s most powerful mechanisms for the maintenance of good health. Regular consumption of these Nrf2 stimulating foods and supplements may substantially lower many of the health risks of modern living and increase our resistance to many diseases.IN REVIEW WHAT ARE THE PRACTICAL BENEFITS OF THE NRF2 ACTIVATORS?Recent research has found that “NRF2 activation” is very effective at stimulating our body’s natural protective mechanisms including promoting endogenous (natural) antioxidant production. Activation of NRF2 is believed to provide many health benefits including:REDUCING SYSTEMIC INFLAMMATIONLOWERING OF OXIDATIVE STRESS (REDUCING CELLULAR DNA, RNA AND PROTEIN DAMAGE)IMPROVING MITOCHONDRIAL FUNCTION (CELLULAR ENERGY PRODUCTION) ALL ROADS LEAD TO THE MITOCHONDRIANrf2 activation may have a positive impact on chronic inflammation and oxidative stress and so may be useful in the prevention or treatment of many common chronic disease processes including obesity, high blood pressure, reducing the risk of diabetes, cardiovascular disease, stroke, and the list goes on and on. NRF2 activators have been shown to protect the liver in conditions of chronic hepatitis and fatty liver. Let’s look at some more specific conditions that are directly affected by the Nrf2 pathway. Nrf2 ACTIVATION AND OBESITY AND INSULIN RESISTANCEObesity is now thought to be a systemic disease characterized by increased systemic inflammation and oxidative stress. As a consequence, obesity is clearly understood to be a major contributor to the development of hypertension, heart disease, stroke and some cancers. The importance of Nrf2 in obesity and insulin resistance is clearly evident and the potential use of an Nrf2 activator as a treatment method will continue to be an exciting area to advance. Nrf2 ACTIVATION AND PAINNrf2 activation is thought to reduce pain related to many conditions. The muscle pain and fatigue associated with fibromyalgia is believed to respond to NRF2 activation. Nrf2 activation may reduce the central sensitivity associated with many chronic pain conditions including chronic headaches, chronic back pain, and fibromyalgia etc. Nrf2 ACTIVATION AND ADDICTIONMany of the brain’s neurotransmitters and neurochemical processes are impaired in conditions of chemical and behavioral addiction. NRT2 activation may play a role in facilitating restoration of these neurochemical processes and facilitate addiction recovery. Nrf2 ACTIVATION AND STEM CELLS ACTIVATION AND SURVIVALAs a cellular metabolic and stress sensor, Nrf2 is a pivotal regulator of stem cell self-renewal, proliferation, and differentiation. Nrf2 displays cell type-specific and/or stage-dependent impact on stem cell biology in response to various environmental cues. Nrf2 maintain ASCs self-renewal, quiescence, and regenerative capacity while protecting against ASC depletion in response to stress and aging.I suspect this will take on increasing importance in Regenerative Medicine stem cell procedures. We have seen this concept already in organ transplants and rejection. As time goes on, we may depend more on allogeneic sources of stem cells which exhibit immune evasive rather than privileged responses to the immune system.Thanks,Dr. P
constantly pushing the envelope to come up with methods to improve our results
clinically. We think that our new cytokine formula may be such a game changer.
Our new formula makes use of Velvet Deer Antler. But the formula is much
different from those formulas out there both in strength and the formula
itself. It is a proprietary mix.
illustration represents the growing portion of the antler. Deer Antler Velvet
has been used in traditional Chinese medicine for thousands of years but has recently
gained popularity in Western medicine. Deer antler can enhance immune system
function, improving athletic performance, increasing muscle recovery, enhance
sexual function, improve disease recovery, enhance cardiovascular function, and
a host of other conditions.
Antler Velvet covers the growing bone and cartilage that develops into deer
antlers. The growing antler
contains a number of necessary cells, including fibroblasts, chondroblasts,
chondrocytes and osteocytes. The tips of the antlers begin as undifferentiated
mesenchymal stem cells which are transformed into cartilage. Later, the
cartilage is turned to bone, due to the effects of testosterone. Deer antler
velvet is antler that is still in its cartilaginous stage.
of the problems with Velvet Deer Antler is the purity and concentration of the
product. Our antler product is sourced from a very reliable source. Typically,
there is a concentration of 1500 mg of velvet extract per bottle. Honestly,
that will have some effects but it is not exactly what we are looking for. We
have sourced a concentration of 4500 mg of Velvet Deer Antler per bottle. This
concentration would not be legal for any professional athlete and thus we would
not use it on them. Typically, these higher concentrations will help balance
hormones and promote tissue repair. In addition to this we have actually added
certain supplements to this very potent formula. These supplements will
increase stem cell efficiency and output from the bone marrow. This combination
is totally unique to our practice and network and it is proprietary in
WHAT ARE THE MAIN COMPONENTS OF
above diagram gives some idea of the many benefits of deer extract. An
important concept that is a common theme of many research papers is that the
combination of all components of velvet antler provides a synergistic effect
that is greater than the total effect that would be achieved by the separate
use of each of its individual constituents. That means that if velvet antler is
broken down into its constituents that are used separately, their combined
effect is significantly less than the effect realized when the nutrients are
provided in the naturally combined form of velvet antler. In summary, the
effect of the complete product is greater than the summed effect of all
Let us take a
better look at exactly what is found in the antler products. Most of the antler
product consists of protein. The active ingredients include collagen, lipids,
glycosaminoglycans, minerals, and various growth factors. We will take a look at the major subgroups of
components. The first component to take a look at are the glycosaminoglycans
are complex carbohydrates.
Glycosaminoglycans (GAGs), have widespread functions
within the body. GAGs play a critical role in Regenerative Medicine. They play
a crucial role in the cell signaling
process, including regulation of cell growth, proliferation, promotion of cell adhesion,
anticoagulation, and wound repair. They are an integral component of what is
called the extracellular matrix. The extracellular matrix (ECM) is the non-cellular
component present within all tissues and organs, and provides not only
essential physical scaffolding for the cellular constituents but also initiates
crucial biochemical and biomechanical cues that are required for tissue
morphogenesis, differentiation and homeostasis.
shown GAGs exist in velvet antler in several forms including:
Chondroitin Sulphate a carbohydrate that
helps protect and rebuild degenerating cartilage and is regarded as a potent
Glycosphingolipids are compounds
involved with growth and metabolism of cells and with memory and learning
Glucosamine Sulphate is a component of
Chondroitin Sulphate and is a major component of cartilage and synovial fluid
Hyaluronic acid a substance that binds
cartilage cells together and lubricates joints. It also acts as a signaling
molecule in many biological processes.
Phospholipids the major structural lipid
of most cell membranes
Here is a good illustration of the ExtraCellular Matrix. It is the substance between the cells.
Antlers grow by endochondral
ossification, the same way that long bones do. A major non-collagenous protein,
proteoglycan, a protein substituted with glycosaminoglycan chains, occurs in
the cartilaginous tissue of antler. While its use in the antler is not
understood, it has been shown that proteoglycan in cartilage, also called
aggrecan, regulates differentiation of chondrocytes and may control calcium
concentration in the growth plates where endochondral ossification occurs. This
may have important implications when we are treating joints with regenerative
the next two illustrations show the ramifications of the ExtraCellular
Matrix and repair of various tissues. We can see why enhancing the ExtraCellular Matrix is so important in Regenerative Medicine. We can
see that these represent the pillars of regenerative cell therapy. There are
few if any other products which have these effects on the extracellular matrix.
This is certainly a huge benefit that comes with the Velvet Deer Antler
Glycosaminoglycans have a hand in all of the above repair processes. Most
products are only addressing the cellular portions of repair while the antler
products are more comprehensive in their approach.
next illustration shows how the Glycosaminoglycans are involved in the new
field of tissue engineering. In the case of tissue engineering we call the
synthetic ECM a scaffold.
GROWTH FACTORS: THE CLONES OF WHAT STEM CELLS PRODUCE
we look at velvet antler growth factors, we see a list of whos who in
the growth factor universe. Growth factors, which are generally considered
as a subset of cytokines, refer to the diffusible signaling proteins that
stimulate cell growth, differentiation, survival, inflammation, and tissue repair. The major
growth factors which are found in deer antler include Insulin Like growth
factors (IGF-1), Bone morphogenetic growth factors (BMPs), Transforming growth
factor family (TGF), Fibroblast growth factor (FGF), Platelet derived growth
factor (PDGF), Vascular endothelial growth factor (VEGF), Epidermal growth
factor (EGF), Interleukins, and a variety of other factors. When looking at the
various growth factors we realize that this appears to be similar to what is
found in a Platelet Rich Plasma (PRP) product, and for that matter stem cells
Another aspect of deer antler deals with
its Amino acid contents. Remember that amino acids are natures building blocks. Amino acids, often referred to as the
building blocks of proteins, are compounds that play many critical roles in
your body. They're needed for vital processes like the building of proteins and
synthesis of hormones and neurotransmitters. These are broken down to essential and
non-essential amino acids. Another type of amino acid is the free form amino acid. These
amino acids aren't joined together with any other amino acids in a
protein 'string'. This allows the individual amino acids to be
instantly absorbed and used by the body without digestion. All of o
Of all the growth factors the most
consequential might be IGF-1. IGF-1 is a banned substance in the world of
professional sports. The precursor of IGF-1 is Human Growth Hormone (HGH).
IGF-1 is actually the active form of HGH. It is considered performance
enhancing. In the smaller doses this is typically not an issue but in the higher
doses we are using this is a problem and across the board we will not give this
formula to any athlete in the high school, college, or the professional sports
arena. Putting this aside, why do we like IGF-1? We can see some of the
Perhaps more importantly, we need to look at
IGF-1 on the basis of cell biology. IGF-1 has been shown to enhance
the migratory response of stem cells. We must realize that the IGF-1 supplied
by deer antler is a natural form. It seems to be safer than taking the
synthetic anabolic agents which can have disastrous consequences to ones
health. The following diagram is somewhat complicated but we see the importance
of IGF-1. It will interact with the stem cell and cause the cell to go on to
repair tissue or differentiate into that tissue.
and the other growth factors can also result in a number of other health
benefits. These extra health benefits may include preservation of a persons
muscle mass, improving the functioning of the immune system, increasing bone
density thus helping to improve Osteoporosis, a valid treatment for
fibromyalgia conditions, and lastly it may help in weight loss. The bottom line
is that these growth factors are all very important in treating damaged tissue.
This tissue could be a tendon, a joint, or muscle. Remember, with the antler we
are complimenting the growth factors that are supplied by the stem cells and
the Platelet Rich Plasma. Also, by taking these supplements on a daily basis we
continue the repair process. The one small caveat that we follow is that in
those patients who have a history of certain cancers we will typically
recommend a lower dose of the antler product. We should also keep in mind that
antler products also contain small amounts of the sex hormones testosterone and
estrogen. In the right doses these are also important for regeneration.
Another related factor found in
the antler is Prostaglandins.
They are substances with varying physiologic effects, acting as a
vasodepressor, smooth muscle contraction or relaxation, inflammation and
uterine stimulation. As components of deer antler velvet, prostaglandins may
assist in the capacity of the extract to reduce the swelling associated with
arthritis and injury. They also have physiological responses in lipid
metabolism, as seen in the cholesterol-lowering effects of deer antler velvet
on laboratory animals.
antler contains many different types of amino acids. Amino acids, often
referred to as the building blocks of proteins, are compounds that play many
critical roles in your body. Amino acids are organic compounds composed of
nitrogen, carbon, hydrogen and oxygen, along with a variable side chain group.
Your body needs 20 different amino acids to grow and function properly. Though
all 20 of these are important for your health, only nine amino acids are
classified as essential. These are histidine, isoleucine, leucine, lysine,
methionine, phenylalanine, threonine, tryptophan, and valine. Unlike
nonessential amino acids, essential amino acids are those that cant be made by
your body and must be obtained through your diet. Another type of amino acid is
a Free-form amino acid. This
refers to single amino acid that is already in a pre-digested form and ready to
be used by your body. Some nutritional products, especially amino acid blends,
contain whole proteins and large peptides (chains of amino acids), which the
body must first break down into smaller peptides and individual amino acids
before use. For faster utilization and better bioavailability, look for
free-form amino acids. We can see that all the various different types of amino
acids work synergistically. They all have their purpose.
WHAT SUPPLEMENTS ARE ADDED TO THE FORMULA TO ENHANCE THE EFFECTS?
In addition to the Velvet Deer
Antler which provides all the aforementioned compounds. There are a host of
other compounds which enhance the efficacy of the product. These include a natural matrix of herbs bounded by research and science
to help ones stem cells become more active and body supportive. The following
compounds highlight these ingredients.
found in the cell walls of certain seaweed species that is has been used
medicinally for a wide variety of health purposes. Okinawa inhabitants have a diet rich in Wakame seaweed,
which contains the highest concentrations of Fucoidan. Okinawa is also known
for its high concentration of centenarians (people who are at least a century
old), which researchers believe is linked to their fucoidan-rich diet. The
anti-aging effects are associated with Fucoidan's remarkable ability to
facilitate tissue regeneration, immune function as well as improving cell-to-
cell communication. Not only is fucoidan known for its anti-aging effects, it
is also believed to combat cancer, metabolic syndrome and other degenerative
disorders. With stem cell therapy, there is always the risk that the adult stem
cells could migrate to other areas of the body unintentionally. However, the
daily use of fucoidan has been proven to increase mobilization of stem cells to
the appropriate area/ site of injury. Not only can fucoidan point the stem
cells in the proper direction, it has also shown to improve the stem cells'
survival during the differentiation process.
PTEROSTILBENE is a stilbene molecule and demethylated
derivative of resveratrol ( it is more bioavailable than resveratrol) that is
found in antioxidant-rich foods like blueberries, cranberries and grapes. These all help to slow down
the aging process. It is an antioxidant that helps fight free
It is known to stimulate a series of pathways in the body called Sirtuin gene
pathways. The sirtuin genes have effects on a variety of other pathways in the
body. Ultimately, the Sirtuins are involved in the regulation of the
mitochondria and subsequent ATP production. Research has shown Pterostilbene
protects against memory loss, high cholesterol, high blood
and even certain types of cancer.
CARNOSINE is an important nonessential amino acid
that helps support brain, heart, and eye health. It offers antioxidant
protection from free radicals and oxidative stress, boosts endurance, aids in
the recovery process, and offers electrolyte support.
BLACK RASPBERRY EXTRACT, one of
the least known, but yet strongest anti-oxidants that insures chromosomes
retain their health and rebuild themselves to optimum health.
RHODIOLA an adaptogenic herb that can elevate your mood and
mental stamina, reduce the stress hormone, cortisol and fight
depression due to its protective effects on key mood
neurotransmitters. Rhodiola rosea extracts have recently demonstrated its anti-aging,
anti-inflammation, immuno-stimulating, DNA repair and anti-cancer effects in
different model systems. An adaptogenic herb helps the body adapt
to and resist physical, chemical, and environmental stress.
ASTRAGIN is a 100%
natural compound which is patented and promotes a healthy gut lining reducing
inflammation in the intestinal lining and increasing absorption of nutrients. AstraGin has the ability to increase the assimilation of
important amino acids which increase nitric oxide levels in the human body,
making it the perfect performance enhancer when taken
pre-workout. Higher levels of nitric oxide result in enhanced blood
flow to the muscle which leads to better pumps, muscular contraction, and
improved nutrient transportation. AstraGin also aids in glucose absorption so
having this pre-workout ensures that you have sufficient energy levels whilst
THE FINAL QUESTION HOW DOES THE ANTLER PRODUCT GET TO
WHERE IT IS NEEDED?
have the absolute best formula on paper but the question is will it work? When
we evaluate medications and supplements a very important aspect to consider is
what we call the pharmacokinetics of the product. This concerns the science of
how the drug moves around in the body. Unfortunately, on paper many compounds
seem very promising but in real life are a failure. The main reason for this is
that they cannot be absorbed by the body.
The mode of
absorption of the antler product is what is referred to as sublingual. This
means it is absorbed under the tongue. This is many times a very effective mode
of absorption. It bypasses the gut and goes directly into the bloodstream where it is needed. The components are not broken down.
Also, in the saliva are very small particles called exosomes which can be
considered a rising star in drug delivery. Saliva is a very rich source of
exosomes. Thus, we have a very efficient method of delivering the velvet
components in a safe and reliable manner.
If we were to
undertake the task of trying to design a complete supplement to utilize in
Regenerative Medicine and Stem Cell therapy, Velvet Deer Antler would be at the
top of our list. It has most of the ingredients needed for success.
Furthermore, there is a very efficient way to deliver the goods to the cell
where they are needed. Deer antler will not be the only modality we will use,
but it certainly has an important place on our mantle. We are constantly
working to push the envelope and I suspect more advances will come.
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