Stem Cell Therapy

Overview of Dr. Berman's Stem Cell Therapy

ADULT (NON EMBRYONIC) MESENCHYMAL STEM CELLS

You may be considering stem cell therapy for a particular condition. Your physician may be treating you for a condition that he/she feels might respond to stem cell therapy. Or, if you don't have a primary physician caring for your particular concern, we can discuss your condition and offer a referral so you can be properly evaluated to determine whether stem cell therapy might be appropriate for you.

Stem Cells are tiny "progenitor" cells. They have the potential to recognize tissue injury and repair injured cells. For example, you might have a cartilage injury or erosion in a joint or ligament damage and stem cells might potentially help heal or repair your condition. There are many clinical trials going on right now with stem cells. In one example, patients suffering from heart attacks have been given their own fat derived stem cells intravenously so they could speed up repair of the heart muscle and indeed these patients have shown quicker healing compared to those not given real stem cells. There have been reports of improvements with multiple sclerosis and other neurological conditions. There are likely dozens of common conditions that may benefit from stem cell therapy.

Originally, it was felt that the best source of stem cells would be from human embryos as their stem cells could be taken at such an early point that they could repair any cell type in your body (pluri-potential). More recently, we've learned that your own fat is a great source for stem cells. Fat tissue is largely made up of adipocytes and pre-adipocytes. As adipocytes age and die, pre-adipocytes can recognize this and replace them. If you challenge your body by over consumption of calories, the pre-adipocytes can form additional fat cells to handle the challenge. If you remove the fat from your body, digest the fat cells and centrifuge the solution, the pre-adipocytes will "shake" free and settle to the bottom while the lighter fat rises to the top. It turns out that these pre-adipocytes are simply "mesenchymal stem cells." These stem cells can change (differentiate) into bone, cartilage, muscle, fat, collagen, neural tissue and blood vessels. They are considered "multi-potential" cells. There is some thought now that in the right environment they can turn into other tissues as well.

In recent times, the bone marrow has been a source for stem cells. Fat, however, contains many times more stem cells than bone marrow and is much easier and safer to harvest.

With our current technology, we can harvest your own fat cells, digest the fat cells and separate out the stem cells. The process takes about two hours. It can be done as part of a surgical procedure such as liposuction or fat grafting. Or, it can be done to harvest fat just for stem cell isolation to be used for therapeutic reasons. In cosmetic surgery, particularly in Asia and more recently in the U.S., stem cells can be isolated and added back to fat to "fortify" the fat grafts with additional stem cells to increase tissue viability. This has mainly been used in conjunction with breast augmentation using fat grafts. When doing the 3 dimensional face lift or "space lift" the fat is currently "lipo-condensed" without adding additional stem cells. Touch-up operations provide additional stem cells along with fat when necessary.

If you and your doctor (e.g. orthopedic surgeon, optimal health physician, etc.) believe you have a condition that can be improved with stem cell therapy, then we can coordinate a procedure in order to treat you. Once your doctor recommends trying stem cell therapy, we will coordinate a convenient time so we can harvest your fat, prepare your stem cells and then allow your doctor or an appropriate physician (e.g. a radiologist) to inject them as they feel would be most appropriate and useful. While there is growing evidence that stem cell therapy can be useful for a wide variety of conditions, much of the information is still anecdotal. In other words, there hasn't been enough scientific data and testing to support evidenced based hypothesis. Once we get a better understanding of some of the uses for your own stem cells, we can design studies that will evaluate our proposed theories for use. This will eventually allow us to prove scientifically that your stem cells work to improve various conditions and at the same time, allow us the opportunity to maximize the conditions of treatment, i.e. figure out the optimal treatment protocols.

It's not unlikely that stem cell therapy will represent one of the newest and most significant gains in medical therapy. Still, we're in the early stages of evaluating these potential treatments. Because it's your own DNA material, there can be no rejection and because these are such tiny cells they can be administered through injection into tissues, joints or even the blood stream. They can be mixed with your own fat to fortify fat grafts in cases where one wants to augment more difficult areas on the body such as the breasts or buttocks. As noted above, it's not generally added for facial fat grafting.

If you and your doctor decide you are a reasonable candidate for this procedure and would like to try stem cell therapy, then it's important that you understand the process.

In our office we're currently using the Lipokit and Maxstem units developed in South Korea in order to process stem cells from your fat cells. Like any surgical procedure, you would meet with Dr. Berman in order to take a history and physical evaluation. If you are considering stem cell therapy for a medical or orthopedic condition you will either be referred for evaluation to the appropriate specialist or you will have already come from the appropriate physician that requested you consider stem cell therapy. Assuming that you are a good candidate, the procedure will be scheduled. We may require no laboratory work-up, some lab work, or even a medical clearance depending upon your current health condition. Like any other operation you'll be asked to come in on an empty stomach - meaning nothing to eat after midnight or at least 6 hours prior to surgery. You may be given an antibiotic as a prophylaxis and a pain medication for after the operation.

The procedure can be performed under local anesthesia alone or combined with an intravenous sedation. This can be decided during your consultation. Fat can be harvested from any area on your body that has adequate fat supply. We generally prefer to harvest it from the area or areas that will give you the best cosmetic result. If that option doesn't exist, then we look for a spot that will give you the most acceptable result possible. Ultimately, we simply need to get a sufficient supply of fat. This is done with the special Lipokit machine. Once an adequate amount of fat is collected it is "lipo-condensed" in the special Lipokit centrifuge. Then the Roche Laboratories collagenase solution (Liberase) is added in order to digest the fat cells. The solution must be incubated for 40 minutes, then the stem cells are separated from the ruptured fat cells. The entire process takes about two hours. Once the stem cells are isolated they can be used as planned. Extra stem cells can be sent to a special storage facility that will preserve them in a special deep freeze unit until further needed. Current facilities are few but we anticipate this will be a growing industry with more facilities popping up locally in time. Of course, there is a price for storing your cells should you want this option.

Likewise, there will be a fee for harvesting and preparing your stem cells. I suspect there may be an additional fee for the injection of the cells. In the early stages of evaluation, our goal is to charge a reasonable fee for our time and expense. Once solid data is available the prices may fluctuate accordingly. Please understand that there are areas around the world, such as the Ukraine, where people pay $35,000 for embryonic stem cell injections regardless of what type of ailment or health condition they have. In fact, there are areas closer to home where "stem cell" therapy has been provided, usually with stem cells taken from bone marrow and then cultured to increase numbers. We will be able to provide you with your own stem cells in large quantity without having to culture them to increase numbers.

Since this is your own fat and stem cell tissue it can not be rejected. Of course, that doesn't mean the operation is completely without risk. There should be very little risk, of course, but nonetheless risks need to be considered. Because we are doing a mildly invasive procedure, you'll want to consider the level of anesthesia and the attendant risks. Today, intravenous sedation and local anesthesia is very safe, done in an accredited operating room suite, and provides maximum comfort. The procedure is done under complete sterility and the fat and stem cell solutions are prepared in a closed system that is not even exposed to the air. You may be started on prophylactic antibiotics, but surely, if you had an active infection or dental condition, you would want those cleared up before embarking on an elective procedure. Minor irregularities from the fat harvesting are possible though attempts will be made to improve your appearance if at all possible.

As we learn more about the effectiveness of stem cell treatments we will apprise you. We will monitor your situation and even consider additional treatments based upon your response to treatment. Nonetheless, we've had a lot of experience with both fat harvesting, stem cell/fat grafting and stem cell preparation and it's exciting that those tools are now available for both therapeutic and cosmetic uses. Stem cell therapy with your own stem cells may very well be the next significant advancement in medicine, but your decision to proceed with treatments will need to be made between you and your doctor understanding there are no guarantees for success at this time.