Don’t be fooled by bogus stem cell claims

Don’t be fooled by bogus stem cell claims

When it comes to cellular orthopedics, for me, it is a matter of honor and self-interest.

If you aren’t aware of the bogus stem cell claims or “false news”, read the LA Times article that appeared last week http://www.latimes.com/business/hiltzik/la-fi-hiltzik–oz-stem-cell-20170213-story.html

The article followed a Dr. Oz television expose where he focused on charlatans victimizing the public with false information at extremely outrageous fee schedules. The egregious behavior stemmed (no pun intended) from mostly California based clinics but Texas was another state exposed. For those who read this Blog, you are familiar with the false advertising of “Stem Cell Clinics” highlighting regenerative medicine via Amniotic Fluid for arthritis in Illinois, that I have repeatedly taken to task. To repeat, while there may be living cells when amniotic fluid is harvested, following collection, processing, sterilizing, irradiating, freezing and fast thawing, there are no living or viable stem cells in the pat being offered as a regenerative alternative. Dr. Oz took his expose a lot further calling attention to false claims without medical evidence wherein the so called regenerative medicine clinics he exposed offer treatment for every and any affliction of the human body.

Since the innovations introduced by Regenexx 10 years or so ago, interventional orthopedics has become an evidence based approach to sports medicine related injuries and as an alternative to a major surgical reconstruction or replacement for an arthritic or chronically injured bone or joint. I am a member of the Regenexx network and, have continued to compile and contribute scientific evidence to support the Regenexx mission. Our menu of surgical alternatives is directed to afflictions of the musculoskeletal system.

A patient attempting to postpone or avoid a major orthopedic procedure for an arthritic joint and return to a relatively symptom free functional quality of life may find legitimate, well intentioned and evidence based regenerative medicine and interventional cellular orthopedic initiatives. I am proud to be one of those clinical settings

Next week, I will complete my interview with Dr Mitchell Sheinkop, part two-focusing on common athletic injuries amenable to cellular orthopedics and joint condition amenable to stem cell intervention.

To schedule an appointment call (847) 390-7666
To visit my web site go to www.sheinkopmd.com
To watch my webinar visit www.ilcellulartherapy.com

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The case for a repeat Bone Marrow Concentrate intervention

The case for a repeat Bone Marrow Concentrate intervention

This week, I am repeating stem cell/growth factor interventions in two patients; one with arthritis of the
hip, and the other with osteoarthritis of both knees. Four years ago, at the initiation of my interventional
orthopedic practice, I spoke of adult mesenchymal stem cells alone but now we know that Bone Marrow
Concentrate has in addition to the adult mesenchymal stem cells, hematopoietic stem cells, growth
factors and platelets all playing a role in managing the symptoms and the altered functional impairment
attributable to osteoarthritis. The outgrowth is in new speak; namely, Bone Marrow Concentrate and not
just mesenchymal stem cells. When the two patients I alluded to were initially cared for, we had not yet
gained the understanding of the importance of platelets in the regenerative process. Platelets contain
the growth factors and those growth factors are responsible, in addition to Mesenchymal and
Hematopoietic Stem Cells, for regulating cartilage well-being. By having become aware of the
contribution following concentrated platelet rich plasma in conjunction with the bone marrow
concentrate intervention, I believe we are already seeing improved outcomes.

As well, subchondroplasty has been added to our menu of services and the latter is proving very
beneficial in the knee. To refresh your knowledge base, subchondroplasty is a procedure popularized in France where in bone marrow concentrate is injected into the bone marrow adjacent to a joint at the
same time that the stem cell, growth factors and platelet containing concentrate is intervention of the
joint itself is being completed. The value of intervening into the bone supporting the joint is the fact that
there is communication between the joint itself and the supportive subchondral environment. I have
addressed Adult Mesenchymal Stem Cells many times in previous Blogs as the orchestrater of the
healing process. Now we know that Hemopoietic Stem Cells from the marrow contribute as well. Growth
Factors such as Interlukin-1 Receptor Antagonist Protein (IRAP) are present in bone marrow and
circulating blood; It was IRAP alone that extended the professional basketball career of Kobe Bryant by
seven years for an arthritic knee. With an improved means of extracting and activating the growth
factors contained in platelets, the two patients I introduced in the opening sentences of this blog should
enjoy a very satisfactory return to function and recreation.

Interventional Orthopedics is a dynamic process and I continue to learn from the integration of clinical
research and my clinical practice. On Thursday, I will host two very interested scientists dedicated to
customizing biologic preparations and together we will explore how to further leverage scientific
advancements in creating autologous biologic preparations thereby optimizing the practice of
Regenerative Medicine.
Call 312 475 1893 to schedule your consultation

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The role Growth Factors play in Regenerative Medicine

The role Growth Factors play in Regenerative Medicine

Growth factor, any of a group of proteins that stimulate the growth of specific tissues. Growth factors play an important role I promoting cellular differentiation and cell division,” and they occur in bone marrow as well as your circulating blood.

“When investigators began studying the effects of biological substances on cells and tissues in culture, they discovered a group of peptide-hormone-like substances that were distinct from any previously known hormones. Because these substances were active in stimulating the growth of cells and tissues, they were called growth factors. Some growth factors are similar to hormones in that they can be secreted into the blood stream, which carries them to their target tissues. However, whereas the production of hormones is limited to glandular tissue, growth factors can be produced by many different types of tissue” and cells for that matter.

When a patient presents for a Bone Marrow Concentrate procedure for an arthritic joint in order to prevent, perhaps even avoid a joint replacement, the understanding to date is that it will be Mesenchymal Stem Cell that will serve as the key factor in reducing pain, increasing motion, improving function and influencing the progression of arthritis. The latter is only partially true but fails to address the role Growth Factors play in Cellular Orthopedics (Regenerative Medicine). When your orthopedic surgeon tells you that Stem Cells won’t work for your arthritis, schedule your joint replacement, that physician doesn’t understand that Stem cells are only part of what Bone Marrow concentrate provides us in assisting the patient with an arthritic joint, return to an active life style without surgery.

We now have several proprietary means of not only concentrating adult Mesenchymal Stem Cells but Growth Factors as well when addressing your arthritic joint with Bone Marrow Concentrate. While stem cells may be impacted by age, Growth Factors do not seem to be adversely impacted accounting for several recent successes with patients in their 90s. Since we have been concentrating stem cells with growth factors and combining the approach to the joint with subchondroplasty, we continue to document improving outcomes

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“Whoever can supply them with illusions is easily their master”

“Whoever can supply them with illusions is easily their master”

This past Thursday, I was reading the Steve Chapman article in the Chicago Tribune and in the article, he quoted French Sociologist Gustav Le Bon who is best known for his 1895 work The Crowd: A Study of the Popular Mind. While Chapman was trying to explain the Trump phenomenon, I saw an explanation as to why patients with arthritis make decisions as to how to proceed with care. At the recent Orthopedic and Biological Institute meeting in Las Vegas, speaker after speaker including napropaths, chiropractors, and non-board certified physicians presented a show and tell as to how they approach arthritis in this day of expanded access to orthobiologics. The explanations given approached the realm of fantasy; missing from the several day event were science, outcomes and results.

In the past several months, I have watched the entry of large orthopedic companies, with whom I have had a 40-year plus joint reconstruction relationships, into the growing specialty of Orthobiologics. These companies not only bring research support into our specialty of cellular (interventional) orthopedics, they carefully scrutinize those with whom they partner so the net result is evidence based patient care, research and education; not unfounded claims by “Camp Followers”. Witness the ad in a suburban newspaper placed by chiropractors offering stem cell containing amniotic fluid for the treatment of arthritis. I have written about this scientifically unfounded claim in this Blog before and I will emphasize it again, there are no living stem cells in amniotic fluid after processing, irradiating and fast thawing.

Assume if you would that you have an arthritic joint wherein your symptoms and limitations are no longer responsive to cortisone injections, anti-inflammatory medications, physical therapy, hyaluronic acid injections and the like. Your choices historically have been to either wait until end stage arthritis and then have a joint replacement or have a joint replacement early on and risk the potential adverse life changing consequences versus the potential benefits. Today there is an alternative option that will help postpone a joint replacement or possible help avoid one; it falls within the emerging discipline of Regenerative Medicine. Warning though, don’t be a victim of illusion; seek out a consultation and opinion from a board certified specialist who integrates cellular orthopedic patient care with research and education.

Call (847) 390-7666 to schedule your Orthobiologic consultation.

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Cartilage repair revisited

Articulate cartilage has little to no capacity to undergo spontaneous repair because it has no blood supply nor is it able to regenerate across a physical gap. In order to restore cartilage in a skeletally mature patient, there is a need for outside help. In some settings, osteochondral transfer (bone with cartilage) may be harvested from elsewhere in a damaged joint and repositioned or relocated in that joint. In other settings, fresh cadaveric tissue (allograft) may be used. More recently, attempts have been directed at “engineering” cartilage. For engineering to take place, there are three requirements. First must come a matrix scaffold necessary to support tissue formation. Second are cells such as mesenchymal stem cells either from bone marrow or synovial membrane lining the joint. Third comes signaling molecules (cytokines) and growth factors. Platelet Rich Plasma is a source of signaling molecules. While Bone Marrow Concentrate doesn’t meet every need for tissue engineering, to the best of my knowledge at this time, there is nothing superior for a long term successful outcome either as an adjunct to a surgical procedure for a small defect or as a primary intervention for an arthritic joint.
There are several ways to measure success after an attempt at cartilage repair. For a contained or global defect, MRI is the primary outcome measure; whereas for osteoarthritis, the Outcome objective metrics I use have proven statistically significant and reproducible. I write this Blog in between presentations by the faculty at American Academy of Orthopedic Surgery Program: Articular Cartilage Restoration-The Modern Frontier. I came here to learn and learn I did about surgical procedures for contained injury. When it comes to osteoarthritis, I learned little but contributed much. No, I am not being egotistical, I am reporting what transpired at the meeting and what is transpiring in my practice. Of interest is the universal agreement by those treating the global defect with surgery and those of us who treat osteoarthritis with stem cells; including the supporting bone ( bone marrow edema)in the therapeutic algorithm via subchodndroplasty is paramount.
“He, who has data, need not shout”

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Stem cells and Statin recommendations during stem cell procedures

Owing to the broad indications for statin medications, an ever increasing number of patients are using these therapies. Certainly, there is a benefit to statin use as a means of decreasing cardiovascular disease; but by the same token, there is the observation of decreased athletic performance, muscle injury, myalgia (muscle pain), joint pain, and fatigue. The type of statin, the dose, drug interactions, genetic variants, coenzyme Q10 deficiency, vitamin D deficiency, and underlying muscle diseases are among the factors that may predispose patients to intolerance of statins.  When it comes to those seeking Cellular Orthopedic interventions, their fitness and exercise endeavors may result additionally in an intolerance of the combined approach decreasing and treating cardiovascular disease.

Although in general, statins are well tolerated, they can affect skeletal muscle producing symptoms that range from myalgia (muscle pain) to creatine phosph kinase (CPK)-muscle enzyme marker- elevation and rhabdomyolysis (rapid breakdown of skeletal muscle). These statin associated musculoskeletal side effects can be exacerbated by physical activity. Now comes a recently published study reinforcing previous findings that certain types of cholesterol lowing drugs called statins, inhibit Mesenchymal Stem Cells. As you know, MSCs are the body’s reservoir of regenerative potential and are capable of orchestrating regeneration of a wide variety of skeletomscular tissue. In the laboratory and now documented in patients, statins not only interfere with MSC function, the drug increases the aging and death rate of Adult Mesenchymal Stem Cells.  Basically, statins are a kind of stem cell poison.

It is important for you, the potential patient to understand that those undergoing a bone marrow aspirate concentrate intervention for arthritis are not only receiving stem cells. The bone marrow concentrate contains in addition to the mesenchymal stem cell, a category of anti-inflammatory molecules called Cytokines and another category of cellular messengers termed Growth Factors. Recent science suggests that latter two groups may be equally or perhaps more important than stem cells in introducing pain relief, increased motion, improved function and reversal of the arthritic progression.

For those of you considering a Bone Marrow Aspirate Concentrate procedure for an arthritic joint, please don’t act without discussing the use of statins with your physician. Strategies include a reassessment of the need for statin prescription, a decrease in dosage, a change to a hydrophilic statin, a statin holiday prior to and after the Cellular Orthopedic intervention followed by a rechallenge after six weeks, vitamin D replacement, coenzyme Q10 supplementation and/ or L-carnitine supplementation.

There are alternatives for those who are statin dependent  and in whom a holiday might be contraindicated.  To learn about our full menu of Cellular Orthopedic options, make an appointment

847 390 7666

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