Recent posts

Cost Effective Alternatives to Supartz or Chicken Fat Injections

As of April 1, 2018, Blue Cross and Blue Shield of Michigan will no longer cover any hyaluronic acid injections for arthritis. This includes injections better known as Supartz, Synvisc, Effflexa or sometimes referred to as roster comb and/or chicken fat injections. Medicare and Blue Cross products covering Medicare will still cover these injections. The rationale is not due to any adverse reactions or increasing cost of the injections, but rather due to a recommendation from the American Academy of Orthopedic Surgeons. Without insurance reimbursement, these treatments can cost up to $1600 which is a terrible burden for our patients. However, Advanced Orthopedic Specialists and Dr. Edward G. Loniewski have come up with some very cost effective treatment alternatives that are more effective, safer and less time consuming than the current hyaluronic injection series.

In summary, we have the following cost effective options:
Platelet Rich Plasma (PRP) injections – This uses the healing growth factors of your own blood to relieve pain and restore function better than hyaluronic injections with just one treatment.
Homeopathic Traumeel and Zeel Injections- Imported from Germany and clinically proven to reduce pain without any known side effects. Three injections given one week apart.
Joint Builder Ultra- This special combination of oral hyaluronic acid, glucosamine, boswellia and MSM provide relief of pain.
Multi-Waved Locked System (MLS) Laser- Medical grade dual laser therapy to reduce inflammation and pain without any injection or side effects.

Please contact our office at 810-299-8550 for the most current pricing.

This blog will focus on homeopathic injections as an alternative:

Homeopathic Injections- Samuel Hahnemann brought the idea that “like cures like” to the modern world in the early 1800’s and this was so popular by the late 1800’s that the University of Michigan opened its own homeopathic college in 1891. Homeopathy fell on hard times when many medical journals and standard medical organizations refused to recognize this form of medicine as legitimate theory.

However, this may change soon with the release of some recent studies by such institutions such as the Case Medical Center and the University of Miami. In addition, some basic science studies now show some significant positive biologic changes occurring with these preparations. The first study compared a homeopathic preparation called Zeel to two traditional arthritis medication called Celebrex (celcoxib) and Vioxx (refacoxib). Although there are some flaws in the design of the controls of this study and no use of a placebo, it did conclude that there was no statistical superiority of any of the medications in the treatment of mild to moderate arthritis of the knee. This meant that the homeopathic preparation performed just as effectively as two traditional medications The MOZArT study helped justify this concept by putting together a blinded and placebo controlled study conducted in the United States at Case Hospitals in Cleveland. Over 252 patients between the ages of 45-80 with moderate to severe osteoarthritis of their knee were enrolled to either receive 3 injections of Traumeel/ Zeel combination or a placebo of saline. They received one injection per week for 3 weeks. They completed pain and function scores as well as 50-foot walking test and a global physician assessment. Patients were accessed about every 2 weeks for 99 days. The homeopathic injection group with Traumeel and Zeel had statically significant improvements in all parameters.

Another interesting study evaluated the biochemical effect of Traumeel in vitro (in a test tube) on human T-Cells and gut epithelial cells. The researchers at The Center for Integrative Complementary Medicine in Jerusalem, Israel found that Traumeel had a profound effect on the pro-inflammatory production of Interleukin 1-beta (IL-1B), Tumor Necrosis Factor-alpha ( TNF-a) and Interleukin-8 ( IL-8). Traumeel reduced these toxic, inflammatory byproducts of cells by 50-70% in both active and resting cells and this effect had an inverse relationship to the concentration of the product thus proving the long-held concepts of homeopathy. In plain English this means that the homeopathic preparation dramatically reduced harmful biochemical markers which are important in the treatment of arthritis. These pro-inflammatory products especially Interleukin-1 beta are extremely important in joint homeostasis or the restoration of normal biochemical function of the knee. In addition, it appears that Traumeel has further effects on the activation of biochemical pathways which help with the repair of a damaged joint. Researchers at the University of Leipzig found that exposing chondrocytes (cartilage cells) to Traumeel caused an elevation of Transforming Growth Factor – Beta (TGF-B) as well as stimulating the basic function of cartilage cells while also reducing harmful chemicals called Matrix Metalleoproteinases (MMP-13). This study helped to solidify the previous study and it revealed that this homeopathic solution not only stimulated positive effects on cartilage cells, but also helped protect these cells.
Traumeel is a botanical mixture of approximately 14 biologic minerals and is designed for short term pain relief of inflammation caused by trauma, or arthritis. It can be used orally, topically or as an injection into a joint. Zeel is also a botanical mixture of 14 biologic minerals in differing dosing to provide longer term relief of pain caused by an arthritic joint and is proposed to slow down the degenerative process of arthritis. These preparations have been used by practitioners in Germany and Austria for over 30 years with excellent safety profiles.

A combination of just 2 cc of Traumeel and 2 cc of Zeel with 1-2 cc of standard local anesthetic can be injected into almost any arthritic joint with little need for any time off work or activities. Most patients notice changes beginning after the second injection and most notice relief for at least 3-6 months. The injections of Traumeel and Zeel do not interfere with other medications, nor cause any changes in blood sugars which is a problem with corticosteroid injections. The injections can be safely injected into tendons or ligaments without fear of rupture or destruction. The treatments can also be repeated without concerns about resistance or further damage to the joint surface.

Because these are botanical minerals and they are diluted beyond a traditional pharmaceutical product, the prices are naturally lower. This is much lower than platelet rich plasma or even hyaluronic injections. Because this natural botanical preparation does not produce harmful effects on cellular preparations, this can be safely used in patients receiving stem cell or PRP injections for faster pain relief while helping to restore the normal biochemical environment of an arthritic joint. Advanced Orthopedic Specialists is excited to offer this option to our patients as we continually strive to provide “state of the art care in a friendly environment.” If you are interested in scheduling an appointment with Dr. Edward Loniewski to discuss this natural and cost effective treatment, call 810-299-8550 as we are always happy to help.

Cost Effective Alternatives to Supartz or Chicken Fat Injections

As of April 1, 2018, Blue Cross and Blue Shield of Michigan will no longer cover any hyaluronic acid injections for arthritis.    This includes injections better known as Supartz™, Synvisc™, Effflexa™ or sometimes referred to as roster comb and/or chicken fat injections.    Medicare and Blue Cross products covering Medicare will still cover these injections.   The rationale is not due to any adverse reactions or increasing cost of the injections, but rather due to a recommendation from the American Academy of Orthopedic Surgeons.   Without insurance reimbursement, these treatments can cost up to $1600 which is a terrible burden for our patients.  However, Advanced Orthopedic Specialists and Dr. Edward G. Loniewski have come up with some very cost effective treatment alternatives that are more effective, safer and less time consuming than the current hyaluronic injection series.

In summary, we have the following cost effective options:

  • Platelet Rich Plasma (PRP) injections – This uses the healing growth factors of your own blood to relieve pain and restore function better than hyaluronic injections with just one treatment
  • Homeopathic Traumeel™ and Zeel™ Injections- Imported from Germany and clinically proven to reduce pain without any known side effects.  Three injections given one week apart
  • Joint Builder Ultra™- This special combination of oral hyaluronic acid, glucosamine, boswellia and MSM provide relief of pain
  • Multi-Waved Locked System (MLS) Laser™- Medical grade dual laser therapy to reduce inflammation and pain without any injection or side effects

This blog will focus on Platelet Rich Plasma as an alternative:

Platelet Rich Plasma (PRP) is a treatment we have used at Advanced Orthopedic Specialists since 2005.  Dr. Loniewski has performed over 4,000 of these treatments with very good and safe results.    This is the most natural injection you can receive since it comes from your own blood.  Thus, there is no rejection or adverse reactions.   One single blood poke is all it takes to obtain about 40 cc of your own blood.  This is processed under sterile conditions and using good manufacturing processes to concentrate this down to about 5 cc of a concentrated platelet formulation.   Platelets are the part of your blood which forms a scab when you bleed.  These platelets contain many natural growth factors which help in the healing process to reduce pain and inflammation.    We use a special process to double spin and concentrate only the good growth factors.  One single injection given in a single office visit can provide pain relief that is superior to the results of hyaluronic acid injections and may last up to one year.   Approximately 80% of patients receive pain relief starting around 2-6 weeks after the treatment and this normally lasts for approximately one year.   A great review article entitled “The effects of platelet rich plasma in the treatment of large-joint osteoarthritis: a systemic review.[1] compared 13 studies of hyaluronic acid to PRP.  Twelve of these were for knee arthritis.  All the studies revealed that PRP had statistically significant benefit in knee osteoarthritis compared to hyaluronic acid.   Many professional athletes use this treatment to help accelerate their healing process.  For years, this was only available to the rich and famous or the elite athlete, but we have figured out a method to offer this to the general public. If you would like to learn more about the benefits of PRP, you can visit our web site here.   Advanced Orthopedic Specialists and Dr. Edward Loniewski has found ways to offer you treatments proven to be more effective and lower in cost than hyaluronic injections.   Call our office at 810-299-8550 to schedule an appointment and discuss these options.   Future blogs will discuss the other options in detail.

[1] Teitze DC et al The effects of platelet rich plasma in the treatment of large-joint osteoarthritis: a systemic review.  Physiology and Sports Medicine 2014, May; 42(2) 27-37.

New Options for Your Arthritis

CLICK HERE for PDF  Presentation:  Cell Based Treatments by Dr. Edward Loniewski

Advanced Orthopedic Specialists is now offering one of the most comprehensive arthritis programs in the country.   We now offer cutting edge therapies including surgical and non-surgical options to fit any lifestyle and severity of symptoms.   Dr. Loniewski has had more experience developing these therapies than any other physician in the area.  He has been continually improving these therapies since 1995 and acts as a consultant to many other practices across the country.   He has completed well over 4,000 of these procedures and can provide a customized therapy program tailored to your specific symptoms and conditions as well as your active lifestyle.   Just like no one drug is for every patient, no single cell based therapy is for every arthritic knee, hip, or shoulder.   We offer a comprehensive program with multiple state of the art therapies to match each patient's condition as well as the specific lifestyle demands.  Call 810-299-8550 for an appointment today.

Knee Arthroscopy Stem Cell Therapy by Laith Farjo, M.D.

Watch as Dr. Laith Farjo discusses what stem cell therapy is, and how it is incorporated into an actual knee arthroscopy surgery.

How Do Stem Cells Work?

By:  Edward G. Loniewski, DO , FACOS, FAOAO- Advanced Orthopedic Specialists - Brighton, MI 

This is a very common question asked not only by our patients, but also many educated physicians using this therapy.   After years and years of trying to understand this process myself, I have attempted to simplify this very complex and complicated system down to 3 easy to remember mechanisms.   The problem with simplifying a complex system is that it can leave out some other minor systems at work, but if we want to take a 10,000 foot look at this mountain of information, I believe that you can begin to make more sense of this process by boiling this down to a few basic mechanisms.   The goal is not to make anyone an expert, but rather just an informed consumer so you can make an educated and knowledgeable decision if this therapy may be a viable treatment for either yourself or your loved ones.    Many great philosophers in the past such as Camus, Kierkegaard and Aristotle have suggested we narrow down complex systems into three reasons, examples or theories because it allowed the student to understand the subject in a coherent manner.  Thus, I am following their suggestion to narrow this down to 3 main mechanisms.  But I think a more important reason is that I can’t remember more than three things at a time!

Before we talk about stem cells, we need to clarify that common stem cell therapies used in the United States contain a very small number of stem cells. Many treatment centers may only transfer a few thousand cells and thus, the mechanisms of action of these treatments are not due solely to the stem cells.  Rather, they are due to the other nurturing biochemical compounds found around these cells.  Therefore, bone marrow is  very important in this process.  Bone marrow is the natural home environment for stem cells in your body.  This is where they are born, raised and utilized.  Thus, we need to consider the contributions of the bone marrow products surrounding the stem cells such as Interleukin 1-B receptor antagonist (that was a mouthful) and Alpha 2 Macroglobulin as well as Transforming Growth Factor- Beta.  These are important to help set the proper environment for stem cells to conduct their work.   So, the title of this section is a bit misleading and should say “How does Cell Therapy Work?”

So, what are these three mechanisms of action?  They are very easy to remember since they all start with R.   This is what we call a pneumonic because they sound similar and are easier to remember.   These mechanisms are:

  • Reduce
  • Restore
  • Regenerate

We will take each one and explain how this mechanism relates to cell based therapies.

Reduce-  Cell based therapies reduce the harmful biochemical storm in your joint.   We normally have nice balance of specific biochemicals in our joints.  They serve to help maintain the normal cell function of the joint.   However, as we age, or with trauma or with specific inflammatory diseases of the joint, this chemical balance is upset and we have too many pro-inflammatory chemicals causing continued destruction.  One of the most important biochemical families are the interleukins and especially interleukin-1-beta.  This is normally used to help regulate our response to infection or inflammation.  However, the production of this biochemical begins to rise and cause widespread inflammation and destruction of both cartilage and bone.   Interleukin 1-B is the “Kingpin” or “Godfather” of these biochemicals and REDUCING IL-1 B will help restore this normal balance.  Many biochemical pathways lead back to Interleukin-1 B and just like the Corleone family, when we start to investigate who is causing all this crime and destruction, many pathways lead back to the “Godfather” biochemical.  Interleukin-1B controls the judges, the newspapers, and the police in New York City just like Don Corleone.

 

 

How is this done? Our own bone marrow contains a natural inhibitor of IL-1 B called Interleukin 1-B receptor antagonist.  This is the antidote for the toxic effects of IL-1B and it is found intimately wrapped in the environment of your stem cells throughout your bone marrow.   When we take your own bone marrow, there is a nice concentration of this natural inhibitor already present and connected to your stem cells. Race horses have used Interleukin 1-B Receptor Antagonist for the past 12 years to treat arthritis and improve their performance.   In fact, this therapy is so effective and popular, one horses in the 2017 Kentucky Derby was named IRAP which stands for the IL-1 B receptor antagonist.   As humans, you only require a small amount of interleukin-1 B receptor antagonist in a ratio of 100:1 for it to be effective in REDUCING its activity.

Thus, Bone Marrow Concentrate taken from your own pelvis can REDUCE the biochemical storm happening in your joint naturally and effectively.  Without this reduction, there is little hope that any cartilage cells will survive and continued destruction will occur.

Our next mechanism involves Restoring the normal cell to cell communication of a joint.

Your joint is an organ just like a kidney, brain or heart.   An organ is a group of specialized cells working together to perform a specific function.   For example, your kidney cells function together to filter out toxins in your blood and help maintain healthy blood pressure. Your joint has specific cells designed to allow smooth and efficient movement of your body.   To accomplish this goal, the specialized cells need to talk to one another through a special communication mechanism for one cell to talk to another local cell.  This is called paracrine signaling.    A diseased joint has a dysfunction of this signaling due to guess who….”The Godfather.”   In a normal joint, cartilage cells need to talk to other cartilage cells to help with their normal function. Bone cells need to talk to other bone cells to do the same.  When Interleukin 1-B is elevated, tunneling through the diseased bone next to your joint occurs and bone cells start to talk to cartilage cells rather than other bone cells through a mechanism called “cross talk”.

 

This cross talk is just like someone trying to give you directions to a restaurant when everyone else is talking very loudly in the background.  Both parties on the line become frustrated and eventually hang up.  Your bone and cartilage cells do the same and become dysfunctional unable to perform the specialized functions they were born to do because they cannot communicate effectively with each other.  The bone marrow concentration helps RESTORE this normal cell to cell signaling by reducing the Interleukin-1 B and shutting down the tunnels between bone and cartilage.  Over time, the small tunnels are shut down and cartilage cells now talk only to cartilage cells so they can function like a normal organ.   Normal tissue function returns which in turn RESTORES the normal function of the joint as an organ.

Finally, we can discuss Regenerate as the third, but least important mechanism of cell therapy.    Although many so called stem cell clinics  claim the regenerative properties of their therapy is the most important mechanism, as we can see from the two previous mechanisms, unless you have a stable environment first, there is no reason to regenerate any tissue because it will be either destroyed by the biochemical storm caused by the Godfather or if by some miracle, there is tissue growth, the cells won’t be able to function as a normal organ because of the loss of paracrine signaling or cell to cell communication.    So, cell based therapies REDUCE this biochemical imbalance and RESTORE normal cell to cell communication setting the stage for proper REGENERATION.

Think about this process compared to another very common disease in our country.  Alcoholism is very prevalent in our society.  I don’t really need to remind anyone of it’s prevalence.  Ironically, just about the same number of people in the United States are affected by Arthritis as Alcoholism which is about 28 million.   If we look at one of the most effective treatments for alcoholism, we can see a parallel to the three mechanisms of cell based therapies.  Alcohol recovery programs normally begin with the removal of the harmful chemicals, or alcohol, causing the problem.    In cell based therapies, we remove the harmful biochemical causing continued destruction.  Without the removal of alcohol, the destructive process continues and this is the same for your joint.   Next, critical relationships are restored through personal, family and marriage counseling.  During counseling, broken lines of communication are restored. 

In cell based therapy, broken and dysfunctional cell to cell communication is restored.   Once the harmful chemical has been REDUCED and the communication RESTORED, now the family can thrive and function again and grow in a stable, non-toxic and loving environment.  Your joint is the same with the REDUCED toxic chemicals and in a stable RESTORED environment promoting the REGENERATION of new tissue.   The amount of new tissue may be very small in relation to the dramatic effects of reducing the toxins and restoring the normal function of the cells, but it is still a property of the mesenchymal stem cells delivered in the bone marrow concentrate.  There is little relationship between the amount of tissue regenerated and the relief of your pain.  However, there is a direct and linear relationship between levels of Interleukin-1 beta and the severity of your arthritic symptoms.   Thus, reducing this harmful biochemical is paramount to the restoration and regeneration of your joint.

To prove this point, think of the last time you took a pill for your arthritis pain. Not everyone responds to these pills, but most people have some relief for a brief period of time after taking such a medication.   Pills such as Aleve or Motrin have absolutely no effect on regenerating new cartilage tissue. Yet, you may have experienced some relief for about 4 to 6 hrs.   Have you ever wondered how this happened?   From a biochemical perspective, this medication reduced one of the biochemical pathways causing pain in your joint.   Yet, this is pill in your stomach and not in your joint and it did not regenerate any new tissue and may have contributed to some further tissue destruction, but it provided some relief!    Bone marrow concentrate stem cell therapy provides long term REDUCTION of the most important “Godfather” biochemical pathways for years and it RESTORES normal cell to cell communication leading to an optimal environment for the icing on the cake which is REGENERATION of some tissue.

I hope this simple explanation has accomplished its goal of making you a more informed and educated consumer and hopefully you can now understand if this therapy may be helpful for your our your loved one’s joint.   The use of cell therapy can help your body naturally reduce a harmful chemical imbalance; restore cell to cell communication; and regenerate new tissue all adding up to a joint with lower pain and higher function without side effects or the inconvenience and risk of major surgery.  

 

Safe, Effective and FDA Allowed Cell Therapy at AOS

Recent news articles in the Wall Street Journal and radio and TV reports of FDA issuing warnings to illegal stem cell clinics have generated a well deserved concern from the public and the media regarding unfounded and potentially unsafe stem cell treatments in the United States. The warnings were issued to unscrupulous and unregulated stem cell clinics in California and Florida. These stem cell therapies have nothing to do with the current therapies available at Advanced Orthopedic Specialists. We are, and always have been compliant with the FDA definitions of regulated cells. This is why we only offer bone marrow derived products as outlined by the FDA Code of Federal Regulations, Title 21, Volume 8 and recently revised as of April 1, 2017. Within this code under section 1271.3, paragraph D and section 4, bone marrow is permitted for use of cellular products. This ruling can be reviewed by clicking onto: FDA Ruling.  Thus, our goal of providing safe, effective, ethical therapy to our patients is within full compliance with the FDA. We have been extremely careful and cautious in offering these therapies only to patients who may benefit from these treatments and have tried to provide the safest and most effective protocols to ensure the safe harvesting, processing and delivery of this therapy. We make no wild claims and only treat conditions that may benefit from this therapy. The result is a treatment where over 82.5% of our patients improve with most receiving over 50% improvements from baseline. This still means there are some patients who do not respond, and we try our hardest to identify these patients and recommend another form of treatment. However, we strive to provide all of our patients with the safest, most effective and compliant therapies. As we continue to improve these therapies, we are hopeful that this will provide relief to our patients suffering from bone and joint disease.  But, we will always do this in a safe and compliant manner.

New Study Proves Benefits of Bone Marrow Stem Cells for Knee Arthritis

By:  Edward G. Loniewski, DO, FACOS, FAOAO

A very recent publication in the International Journal of Rheumatic Diseases (Int J Rheum Dis. 2017 Jul 27. doi: 10.1111/1756-185X.13139) revealed that a single dose injection of bone marrow stem cells taken from the pelvis provided statistically significant improvement in function and reduction of pain which continued to improve in greater degrees as time progressed. This was a controlled study meaning that it was compared to a similar group of patients who received another commonly accepted treatment for arthritis and in this study it was compared to acetaminophen otherwise known as Tylenol. What was interesting was the fact that the patients who received the stem cell injection into their knee had improvements in their ability to complete normal activities of daily living such as dressing; exiting a car; shopping and bathing at each measurement point and the differences continued to improve as the study progressed. Thus, a difference was noted early in the study and this difference improved more and more as the study went forward. This response is unlike many other treatments provided in medicine especially when it relates to pain relief. Most of the medications or treatments we provide have a "leveling off" effect, but this treatment seems to have a "progressive " effect. The differences in the two groups started very early at 1 week after treatment and continued to improve at 1 month and 6 months after the treatment. Some of the criticisms of this study is that 6 months is still considered to be short term , and there was a lack of reporting how many of the patients did not respond. In addition, this was not a blinded or placebo controlled meaning that both the patient and the physician or researcher knew who received which treatment. Furthermore, this study utilized a pre-treatment drug designed to stimulate stem cells to move from the bone marrow into the bloodstream. This is known as a Granulocyte Colony Stimulating Factor (G-CSF) sold under the trade name Biofilgran. This same medication is used when a stem cell transplant is used for certain blood born cancers. The patients in this study who received this treatment prior to the stem cell harvest tolerated the treatment well with only some minor and temporary bone pain. Despite some of these criticisms, this study is an honest attempt to demonstrate that a simple treatment of stem cells and bone marrow taken from the same patient can provide statistically significant  superior relief of pain and an improvement compared to the use of acetaminophen. This effect continues to improve over a prolonged period of time. Every month, new studies like this one helps justify the use of your own stem cells to help you recover from the pain and disability of arthritis. If you would like to read this study yourself, you can find this at: STEM CELL STUDY 

Advanced Orthopedic Specialists offer a similar treatment and Dr. Loniewski is offering a pre and post treatment protocol designed to improve your results. We have the most experience providing these treatments than any other stem cell group in the State of Michigan and have been providing cell based therapy to our patients since 2005. We only offer this to patients who fit specific criteria since no single treatment provides optimal results for every patient. Our goal is to provide you with the best treatment for your condition because not all patients are candidates for cell based therapies. To find out if you may be a candidate please download our stem cell questionnaire at: AM I A CANDIDATE FOR CELL THERAPY 
and call our office at 810-299-8550 for a comprehensive evaluation.

Stem Cell Newsletter

By:  Edward G. Loniewski, DO, FACOS, FAOAO

Advanced Orthopedic Specialists was the first orthopedic office to offer stem cell therapy to patients in Michigan.  We have always attempted to provide the highest quality, cutting edge technology to our patients in an ethical and effective manner.  We have patients coming from all over the country to have this treatment done right here in Brighton, Michigan.  Thus, we have developed a cutting edge newsletter to keep you informed on the latest developments in cell based therapies as well as providing you with practical tips on how to maximize the benefits of cell therapy.  The newsletter will contain short, to the point articles on:

  • Latest updates on stem cell therapy
  • Brief reviews of stem cell research
  • Tips on exercise
  • Local chefs' share cell friendly recipes
  • Patient stories
  • Frequently asked questions from Dr. Edward Loniewski

If you are interested in receiving this first of it's kind newsletter, just click on the link below.

Advanced Orthopedic Specialists Stem Cell Newsletter

* indicates required



View previous campaigns.

Simple Exercise Improves Stem Cell Therapy

20 minutes a day can make a difference

Simple cyclic low stress exercise for only 20 minutes per day helped improve the results of stem cell therapy. Researchers at the Sapporo University School of Medicine in Japan and Yale University have found that adding simple walking exercises to rats who received mesenchymal stem cells for a chemically induced stroke not only significantly reduced the size of the stroke lesion in the brain but also stimulated more brain activity and improved their ability to recover from the stroke compared to rats who received stem cell therapy alone. Another study conducted at the Yamaguchi School of Medicine found that simple eccentric muscle exercises of your thigh muscles such as performing wall squats activated stem cell proliferation for up to 5 days after the exercise. So, it does appear that we may be able to improve the number of stem cells activated and the overall results of stem cell therapy with simple, motion and stretching exercises. We encourage our patients to participate in a 20 minute per day exercise program such as 15 minutes of stationary bike riding and 5 minutes of thigh muscle exercises. Advanced Orthopedic Specialists offers one on one therapy with a registered and certified physical therapist if they prefer a more personalized instruction.

Synergic Effects of Rehabilitation and Intravenous Infusion of Mesenchymal Stem Cells After Stroke in Rats. Sasaki Y, Sasaki M, Kataoka-Sasaki Y, Nakazaki M, Nagahama H, Suzuki J, Tateyama D, Oka S, Namioka T, Namioka A, Onodera R, Mikami T, Wanibuchi M, Kakizawa M, Ishiai S, Kocsis JD, Honmou O. Phys Ther. 2016 Nov;96(11):1791-1798. Epub 2016 May 12.

Effect of eccentric contraction on satellite cell activation in human vastus lateralis muscle.
Imaoka Y, Kawai M, Mori F, Miyata H. J Physiol Sci. 2015 Sep;65(5):461-9. doi: 10.1007/s12576-015-0385-4. Epub 2015 Jun 27.

How Do Stem Cells Work?

How Do Stem Cells Work?

By: Edward G. Loniewski, DO, FACOS, FAOAO

This is a very common question asked not only by our patients, but also many educated physicians using this therapy.   After years and years of trying to understand this process myself, I have attempted to simplify this very complex and complicated system down to 3 easy to remember mechanisms.   The problem with simplifying a complex system is that it can leave out some other minor systems at work, but if we want to take a 10,000 foot look at this mountain of information, I believe that you can begin to make more sense of this process by boiling this down to a few basic mechanisms.   The goal is not to make anyone an expert, but rather just an informed consumer so you can make an educated and knowledgeable decision if this therapy may be a viable treatment for either yourself or your loved ones.    Many great philosophers in the past such as Camus, Kierkegaard and Aristotle have suggested we narrow down complex systems into three reasons, examples or theories because it allowed the student to understand the subject in a coherent manner.  Thus, I am following their suggestion to narrow this down to 3 main mechanisms.  But I think a more important reason is that I can’t remember more than three things at a time!

 

Before we talk about stem cells, we need to clarify that common stem cell therapies used in the United States contain a very small number of stem cells. Many treatment centers may only transfer a few thousand cells and thus, the mechanisms of action of these treatments are not due solely to the stem cells.  Rather, they are due to the other nurturing biochemical compounds found around these cells.  Therefore, bone marrow is  very important in this process.  Bone marrow is the natural home environment for stem cells in your body.  This is where they are born, raised and utilized.  Thus, we need to consider the contributions of the bone marrow products surrounding the stem cells such as Interleukin 1-B receptor antagonist (that was a mouthful) and Alpha 2 Macroglobulin as well as Transforming Growth Factor- Beta.  These are important to help set the proper environment for stem cells to conduct their work.   So, the title of this section is a bit misleading and should say “How does Cell Therapy Work?”

So, what are these three mechanisms of action?  They are very easy to remember since they all start with R.   This is what we call a pneumonic because they sound similar and are easier to remember.   These mechanisms are:

  • Reduce
  • Restore
  • Regenerate

We will take each one and explain how this mechanism relates to cell based therapies.

Reduce-  Cell based therapies reduce the harmful biochemical storm in your joint.   We normally have nice balance of specific biochemicals in our joints.  They serve to help maintain the normal cell function of the joint.   However, as we age, or with trauma or with specific inflammatory diseases of the joint, this chemical balance is upset and we have too many pro-inflammatory chemicals causing continued destruction.  One of the most important biochemical families are the interleukins and especially interleukin-1-beta.  This is normally used to help regulate our response to infection or inflammation.  However, the production of this biochemical begins to rise and cause widespread inflammation and destruction of both cartilage and bone.   Interleukin 1-B is the “Kingpin” or “Godfather” of these biochemicals and REDUCING IL-1 B will help restore this normal balance.  Many biochemical pathways lead back to Interleukin-1 B and just like the Corleone family, when we start to investigate who is causing all this crime and destruction, many pathways lead back to the “Godfather” biochemical.  Interleukin-1B controls the judges, the newspapers, and the police in New York City just like Don Corleone. 

 

 

How is this done? Our own bone marrow contains a natural inhibitor of IL-1 B called Interleukin 1-B receptor antagonist.  This is the antidote for the toxic effects of IL-1B and it is found intimately wrapped in the environment of your stem cells throughout your bone marrow.   When we take your own bone marrow, there is a nice concentration of this natural inhibitor already present and connected to your stem cells. Race horses have used Interleukin 1-B Receptor Antagonist for the past 12 years to treat arthritis and improve their performance.   In fact, this therapy is so effective and popular, one horses in the 2017 Kentucky Derby was named IRAP which stands for the IL-1 B receptor antagonist.   As humans, you only require a small amount of interleukin-1 B receptor antagonist in a ratio of 100:1 for it to be effective in REDUCING its activity.

Thus, Bone Marrow Concentrate taken from your own pelvis can REDUCE the biochemical storm happening in your joint naturally and effectively.  Without this reduction, there is little hope that any cartilage cells will survive and continued destruction will occur.

Our next mechanism involves Restoring the normal cell to cell communication of a joint.

Your joint is an organ just like a kidney, brain or heart.   An organ is a group of specialized cells working together to perform a specific function.   For example, your kidney cells function together to filter out toxins in your blood and help maintain healthy blood pressure. Your joint has specific cells designed to allow smooth and efficient movement of your body.   To accomplish this goal, the specialized cells need to talk to one another through a special communication mechanism for one cell to talk to another local cell.  This is called paracrine signaling.    A diseased joint has a dysfunction of this signaling due to guess who….”The Godfather.”   In a normal joint, cartilage cells need to talk to other cartilage cells to help with their normal function. Bone cells need to talk to other bone cells to do the same.  When Interleukin 1-B is elevated, tunneling through the diseased bone next to your joint occurs and bone cells start to talk to cartilage cells rather than other bone cells through a mechanism called “cross talk”.

 

This cross talk is just like someone trying to give you directions to a restaurant when everyone else is talking very loudly in the background.  Both parties on the line become frustrated and eventually hang up.  Your bone and cartilage cells do the same and become dysfunctional unable to perform the specialized functions they were born to do because they cannot communicate effectively with each other.  The bone marrow concentration helps RESTORE this normal cell to cell signaling by reducing the Interleukin-1 B and shutting down the tunnels between bone and cartilage.  Over time, the small tunnels are shut down and cartilage cells now talk only to cartilage cells so they can function like a normal organ.   Normal tissue function returns which in turn RESTORES the normal function of the joint as an organ.

Finally, we can discuss Regenerate as the third, but least important mechanism of cell therapy.    Although many so called stem cell clinics  claim the regenerative properties of their therapy is the most important mechanism, as we can see from the two previous mechanisms, unless you have a stable environment first, there is no reason to regenerate any tissue because it will be either destroyed by the biochemical storm caused by the Godfather or if by some miracle, there is tissue growth, the cells won’t be able to function as a normal organ because of the loss of paracrine signaling or cell to cell communication.    So, cell based therapies REDUCE this biochemical imbalance and RESTORE normal cell to cell communication setting the stage for proper REGENERATION.

Think about this process compared to another very common disease in our country.  Alcoholism is very prevalent in our society.  I don’t really need to remind anyone of it’s prevalence.  Ironically, just about the same number of people in the United States are affected by Arthritis as Alcoholism which is about 28 million.   If we look at one of the most effective treatments for alcoholism, we can see a parallel to the three mechanisms of cell based therapies.  Alcohol recovery programs normally begin with the removal of the harmful chemicals, or alcohol, causing the problem.    In cell based therapies, we remove the harmful biochemical causing continued destruction.  Without the removal of alcohol, the destructive process continues and this is the same for your joint.   Next, critical relationships are restored through personal, family and marriage counseling.  During counseling, broken lines of communication are restored.

In cell based therapy, broken and dysfunctional cell to cell communication is restored.   Once the harmful chemical has been REDUCED and the communication RESTORED, now the family can thrive and function again and grow in a stable, non-toxic and loving environment.  Your joint is the same with the REDUCED toxic chemicals and in a stable RESTORED environment promoting the REGENERATION of new tissue.   The amount of new tissue may be very small in relation to the dramatic effects of reducing the toxins and restoring the normal function of the cells, but it is still a property of the mesenchymal stem cells delivered in the bone marrow concentrate.  There is little relationship between the amount of tissue regenerated and the relief of your pain.  However, there is a direct and linear relationship between levels of Interleukin-1 beta and the severity of your arthritic symptoms.   Thus, reducing this harmful biochemical is paramount to the restoration and regeneration of your joint.

To prove this point, think of the last time you took a pill for your arthritis pain. Not everyone responds to these pills, but most people have some relief for a brief period of time after taking such a medication.   Pills such as Aleve or Motrin have absolutely no effect on regenerating new cartilage tissue. Yet, you may have experienced some relief for about 4 to 6 hrs.   Have you ever wondered how this happened?   From a biochemical perspective, this medication reduced one of the biochemical pathways causing pain in your joint.   Yet, this is pill in your stomach and not in your joint and it did not regenerate any new tissue and may have contributed to some further tissue destruction, but it provided some relief!    Bone marrow concentrate stem cell therapy provides long term REDUCTION of the most important “Godfather” biochemical pathways for years and it RESTORES normal cell to cell communication leading to an optimal environment for the icing on the cake which is REGENERATION of some tissue.

I hope this simple explanation has accomplished its goal of making you a more informed and educated consumer and hopefully you can now understand if this therapy may be helpful for your our your loved one’s joint.   The use of cell therapy can help your body naturally reduce a harmful chemical imbalance; restore cell to cell communication; and regenerate new tissue all adding up to a joint with lower pain and higher function without side effects or the inconvenience and risk of major surgery.

 

Say No To Pain Request an appointment

Important: Please include non-medical questions and correspondence only.