Friday, December 26, 2008
Sunday, November 30, 2008
Thursday, August 14, 2008
The first potential break through is in cancer research. A researcher at Wake Forest is convinced that cancer is caused by white blood cell suppression. In other words, our WBC's fail to do their job of picking off the cancer cells that brew in our bodies every day. However, this researcher believes that by taking healthy WBC's from donors he can cure cancer (at least in mice). This has so upset the traditional oncologic research community that he has been unable to get grants for his work. As a result, he is asking patients to self-fund the first human trial.
The major development other involves rheumatoid arthritis. In this treatment, researchers from the U.K. take white blood cells, reprogram them using a chemical cocktail, then inject them into joints with rheumatoid arthritis. This has been effective in animals in curing the disease and early human trials are beginning now.
What's the upshot? If you can take someones cells and miniammly modify them or provide healthy cells from a donor and cure these horrible diseases, the big pharma business plan will be in disarray. Basically, these are blood banking or minimal culture treatments that combined, would eliminate hundreds of billions in cancer and RA treatment.
All this brings us back to an age of autologous biologics where the idea of using drugs and pharmaceutical cocktails to achieve results may be changed forever, or at least the playing field altered. Already we are seeing biologic approaches such as platelet rich plasma that are gaining popularity among interventional pain physicians and those who treat acute and sub acute sports injuries. In addition, autologous stem cell approaches are allowing the treatment of chronic joint diseases. All of this points in a direction where the future will have a myriad of hybrid treatment approaches. In the end, we may all be using bits and pieces of ourselves as therapy.
Monday, August 11, 2008
The take home message? We Americans have gotten used to low activity levels that not only promote obesity by reducing our caloric burn, but also increase the tendency of our stem cells to turn into fat when they should be bone (and likely muscle, cartilage, tendon, ligament, etc... )
Tuesday, July 8, 2008
This general theme is also consistent with our research showing this drug class inhibits the growth of mesenchymal stem cells. In fact, our own research is suggesting a rather dismal picture for prescription drugs in general, many of which seem to inhibit adult stem cell growth. While it's been known for years that all of these drugs can have direct toxicity effects on the liver or kidney, or both organs, what has not been generally known is how they might impact the other side of the equation, namely how they might hamper the local repair effort. Until recently, modern medicine didn't understand that almost any tissue in the body is a balance between killing off cells in daily wear and tear and replacing those cells with local stem cells. While many drugs negatively impact cells of various types (organ cells or in this case cells that maintain tendons), what's also likely happening is a negative impact on the cells who replace these dead or stressed organ cells (adult stem cells). If this data holds up (we have been collecting this for the past few years), it will have wide reaching effects on modern allopathic medicine, namely many prescription drugs are not only directly hurting certain cells, but also killing off the repairmen who are supposed to fix that damage.
Friday, June 20, 2008
Friday, June 6, 2008
Tuesday, April 22, 2008
“ADULT STEM CELLS are the BEST-KEPT SECRET in today’s wellness…” boasted a flyer for a dietary supplement called VitalStem. Take it and increase “the number of circulating stem cells in your body.” Not only can it “replace diseased cells with healthy cells” and provide “anti-inflammatory and immune system support” but also give users “mental clarity and mood elevation.”
But the products are really just a repackaging of a supplement that has been marketed aggressively since the 1980s, a form of blue-green algae called aphanizomenon flos-aquae. The science behind the claimed benefits for aphanizomenon is slight — whether the claim is for immune boosting as it was 20 years ago, or stem-cell enhancement as it is today. In fact, there has long been concern about the presence of toxins in blue-green algae products, though you wouldn’t know it from the marketers at the trade show.
Brian is describing some of the claims being made at the A4M conference in Las Vegas this week. Click here for full story.
As I have blogged before, stem cells and other autologous biologics are no different than Penicillin. First, a procedure must be put in place to ensure that the autologous biologic is in fact what it claims to be. This procedure would at least need to involve isolation of that cell and culture expansion to a much higher number. Then, dosing needs to be figured out. Finally, how the cell is applied to the area becomes a whole area of study in itself. For example, applying the cell to fix bones is likely different than trying to fix cartilage or tendons.
So again, there is no easy lunch here. These cells have great promise, but simply slapping the phrase "stem cells" on a bottle of ancient supplements from the 1960's or a process using otherwise dangerous chemicals to bump up circulating blood cells isn't enough...
Wednesday, April 9, 2008
1. Pills or drugs to mobilize stem cells: There are new supplements claiming to regenerate every tissue in the body from muscle to brain to liver to kidney. The best of these have actually had blood samples tested using Fluoresence Activated Cell Sorting to show some increase in circulating blood stem cells. The problem? The types of stem cells mobilized into the blood stream are cells destined to produce more blood, not repair tissues. In particular, one of the MVP's of the adult stem cell world (MSC's) don't circulate in the blood, so they stay put where they're located. These supplements might help if you had anemia, but not much else.
2. Embryonic stem cell injections or cord blood injections: These are stem cells from someone else injected IV. Most of this is happening in third world countries. A few issues. One question is how these stem cells were isolated, as there has been at least one significant allergic reaction (which should never happen with a true stem cell) reported on a California company offering embryonic stem cells in Mexico. Assuming they are stem cells, the second issue is disease transmission. First, there are the common diseases such as HIV, Hepatitis, and other viral infections we can detect. Second, there is the issue of stem cells being able to transmit genetic disease such as an increased risk for osteoporosis (see earlier post). Finally, there isn't much data that shows that if you have a bum knee, a bad kidney, and liver spots on your skin, that these cells will be able to home to one of these areas to allow repair. In fact, most studies show that even in severe injury models (where a severe life threatening injury is created like a heart attack or a lung injury) direct infusion of cells to the damaged area results in more repair than placing the cells in the blood stream.
3. Adult stem cell injections IV: I have seen clinics beginning to use various marrow concentrate systems to inject marrow nucleated cells into the veins (IV). Again, the issues with IV infusion as discussed above apply here as well. The other big issue that that MSC's make up about 1 in 50,000 to 1 in 500,000 of these marrow nucleated cells. This means a very very dilute stem cell population is actucally being injected. As an example, 50 cc of bone marrow might contain trillions of cells, but only less than 0.0002% (in some older patients) are actually stem cells capable of tissue repair.
4. Bone Marrow concentration via bedside centrifuge: There are companies advertising systems (as above) that take whole bone marrow and magically produce millions upon millions of stem cells. Actually, the stem cells they refer to are CD34+ heme progenitors (stem cells that make more blood products) and not MSC's which can repair tissue. So the same issues as above apply.
So as you can see, there's allot of hype. We at RSI continue to work hard to do the following:
1. Isolate and culture expand true mesenchymal stem cells (MSC's) from the same patient where they are harvested (meaning we can harvest a few hundred thousand stem cells and culture expand them to between 5-200 million in just a few weeks). This is done without exposing the cells to potentially harmful drugs or recombinant growth factors.
2. Test various procedures to place MSC's into the area being regenerated. As an example, the procedure for regenerating disc tissue is wholly different than the procedure that targets cartilage in the knee. As more examples, regenerating a partially torn rotator cuff is different than regenerating bone. We then use patient reported outcomes ("I feel great!") as well as before and after 3.o T MRI (the best quality MRI technology currently available) to convince ourselves that we have repaired the target tissue. We are also constantly pioneering new techniques to get the cells to the target area via injection (such as MRI planned fluoroscopy-this is where we use the MRI image to guide the placement of cells).
Stem cells have great potential, but with that opportunity comes the hype...
Saturday, April 5, 2008
Let me use myself as an example of this new paradigm. I injured the cartilage under my knee cap while jumping on a trampoline with the kids. Rather than improving over time, the area worsened over the next year until I had difficulty climbing stairs. Since I had failed conservative care, the next step in the traditional surgical paradigm would be to "debride" the area. This means that a surgeon would go in and cut out some of the cartilage around the area already missing some cartilage. Removing those pieces may have felt better for awhile, but ultimately would have lead to more arthritis in the area. Another option would be micro fracture, but that would mean 12 weeks on crutches, which for me, given the amount of disability wouldn't have been worth it. Since this was a small lesion, I had my one of my partners inject a patent pending Regenexx mixture which consisted of the growth factors isolated from my blood platelets and a component to cause a small micro-injury to kick off a healing cycle. Several days after this injection I was able to climb stairs without pain and to go back to trail running. What happened? A small micro injury was created by the injection at the specific site of the cartilage lesion. The growth factors then went to work to help increase my natural cartilage repair capabilities and lubrication.
As you can see, these new technologies now allow us to get ahead of the problem through promotion of repair rather than cutting out the broken parts. The new paradigm, heal before you consider cutting!
Friday, March 7, 2008
This problem with Epogen again brings up a big problem with our big pharma approach. Any drug designed to systemically ramp up one system is likely to have unintended side effects. In the end, the only way to treat many problem is a local approach, such as placing stem cells in an area in need of repair via needle guidance.
So in the end, there is no free stem cell lunch...
Monday, January 28, 2008
Monday, January 21, 2008
Big Pharma now spends two dollars on ads for every dollar it spends on research. Big pharma has also retreated from the development of one time use drugs like antibiotics. Why? Big pharma has become intoxicated with big business plans. The best long-term biz plan is a "lifetime" drug, or one where the patient needs to take the medication every day forever. The big block buster categories of these drugs have become pain medications, anti-inflammatory medications, and cholesterol medications. The focus on marketing over science has created a problem that is evident from these drugs periodically being pulled from market. In these cases, the business plan trumps the science.
How does all of this fit into stem cells? Over the past few years we've seen an explosion of ways to modify cells to become stem cells, modify stem cells with gene therapy, expose stem cells to experimental drugs and cytokines, etc... While these efforts are to be applauded on a basic science front, there is also a plurality of data documenting multiple types of tissue repair using adult mesenchymal stem cells without such modifications. The Regenexx procedure is an example of this type of minimal manipulation, meaning deploying the repairmen of the body in various ways to repair diseased or damaged tissue. While we may be able to eventually build a better stem cell, these approaches where cells are modified are a bit concerning. Watching the Will Smith movie "I am Legend" this weekend was a great example of what can happen with these approaches. In this movie, a cure for cancer is developed by modifying a virus. The innocuous virus cures cancer, but then mutates into a deadly disease which kills 90% of the world population. While this is a bit severe, the more we manipulate cells to get them to do what we want them to do, the more likely we'll produce unintended consequences. Big pharma is learning these lessons now, with drugs being yanked off the market every few months.
With adult stem cells, we have an opportunity to teach big pharma and modern medicine that the next block buster drug is already within us.