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:
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
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.
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
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.
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.
Natural Homeopathic Injections Provide Safe, and Cost Effective Treatment for Arthritis
Homeopathic preparations were developed possibly as early as 400 B.C. when Hippocrates claimed that very small doses of the Mandrake root helped treat mania when larger doses caused this condition. It was Samuel Hahnemann who brought this concept to worldwide acceptance with his concept of “like cures like.” Hahnemann’s theory was based on the concept that dilutions of a substance that may cause a symptom may in fact, stimulate the body to correct. He believed that deep seeded ailments or “misaims” can be removed or corrected with very diluted botanical and mineral preparations. Homeopathic concepts grew in popularity throughout Europe and even in the United States. The first medical college of Homeopathy was opened in Philadelphia in 1835, and even the University of Michigan opened its Homeopathic College in 1891. However, the popularity of Homeopathy faded after the establishment of the FDA and rigid government requirements for medical education. Over the years, homeopathic preparations have been studied for common ailments such as influenza, attention deficit disorders and arthritis. The major criticisms of these studies include the lack of blinded and placebo controls. Thus, many medical organizations such as the American Medical Association, United Kingdom’s National Health Service and Australia’s National Health and Medical Research Council claim that there was no “good quality” research to support the concepts of homeopathy.
However, this may change soon with the release of some recent studies released 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 [i] 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 time held concepts of homeopathy.[ii] 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.[iii] 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).[iv] 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. Finally, 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.[v] 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 except for the readings at day 29. There were no serious adverse events noted in any of the groups and there were no abnormalities noted in laboratory, electrocardiograms and vital signs between the groups.
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. There are studies in progress comparing these preparations to other common treatments for arthritis such as steroid injections or hyaluronic injections. However, from the studies we have reviewed, it appears this treatment may be a safe and effective for arthritis, tendonitis and bursitis. 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 way beyond what a traditional pharmaceutical product, the prices are naturally lower. A single injection is less than a night out at the movies and dinner. A ligament can be injected for $50 and the series of three injections is priced at $150. This is much lower than the costs for hyaluronic injections or platelet rich plasma. 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
[i] Birnesser H, Klein P, Weiser M.Treating osteoarthritis of the knee: A modern homeopathic medication works as well as Cox-2 inhibitors. Der Allgemeinarzt 2003;25(4):261-4.
Reduce Biochemical Imbalances; Restore Cell to Cell Communication and Regenerate New Tissue by: Edward G. Loniewski, DO, FACOS, FAOAO
A very common question asked by many patients and even well informed and educated doctors is how cell based therapies such as bone marrow derived stem cells may work. After years of researching and understanding this technology, we can reduce this answer to three simple steps. Although we could give you more than a hundred mechanisms, we chose three since most people can remember 3 steps. If we have more than three, everyone in our multitasking and attention deficit infused society begins to forget numbers one and two. Many philosophers such as Camus, Kierkegaard or even Aristotle suggest we narrow down our explanations of complex thought and systems down to three reasons, examples or theories. Following in this tradition, we can help simplify this very complex field of healthcare down to three major mechanisms of action for cell based therapies. These are;
Reduce- Cell based therapies help restore the natural biochemical balance. We normally have a complex set of biochemical byproducts of cellular maintenance in our joints. When this is in normal balance, it is called homeostasis. However, as we age, or when trauma or disease occurs in a joint, this balance is interrupted and mass destruction and pain occur. One of the most important biochemical markers is Interleukin 1-Beta ( IL-1 B) . Although this Interleukin is normally used to clean up cellular debris, arthritic joints produce too much, causing the destruction of the repair. Each time our body tries to repair itself, this abnormally high amount of Interleukin 1- Beta disrupts this process. At Advanced Orthopedic Specialists, we can produce a bone marrow derived product from your own cells to naturally reduce the abnormally high levels of the IL-B. We can filter and concentrate of a natural blocker found in everyone's own bone marrow called Interleukin 1- Beta Receptor Antagonist ( IL-1B Ra) . Your own body produces this within your bone marrow and in smaller amounts in your blood. We have found a way to concentrate this through a patented filtering process producing over 4 times the concentration found in any other preparation. Without this important step, it is very difficult for your joint to restore its natural biochemical balance or homeostasis.
Restore - Your joint is an organ just like your brain, kidney, liver or heart. An organ is made up of cells which perform a specific function necessary for life. These cells carry on their purpose by communicating efficiently between each other. This is called cell-to-cell communication or a paracrine signaling. When an organ such as your knee has arthritis, the cells begin to act abnormal and the communication between these cells breaks down. The result is a dysfunctional joint. This is what happens in a dysfunctional family. Nobody communicates effectively with each other and the family unit begins to break down. However, Mesenchymal Stem Cells (MSC's) can restore normal paracrine signaling of cells through the release of specific factors designed to restore function of the joint. Thus, when stem cells restore this normal communication, the normal functions of the joint return. A patented processing technology coupled with a significantly improved cell harvest technique can improve cell harvesting by over 345% and return of more than 90% of your cells back to your body. This provides the absolute highest number of mesenchymal stem cells to your joint to ensure that your normal cell to cell communication is restored.
Regenerate- Only after a joint has completed the first two steps of this process, can we move forward with the building of new tissue or regeneration. After we have reduced the levels of harmful biochemical byproducts in your joints to a reasonable or near normal level, and after restoring cell to cell communication, your joint may now begin the process of producing new tissue. Think about this scenario like a family with an alcoholic father. There is nothing like alcoholism as a source of family dysfunction. In fact. there are just about the same number of children with alcoholic parents as there are people with arthritis (about 28 million) in the United States. If this family is to survive, the first step is to reduce the chemical causing the destruction. In the family, this is alcohol. In the joint, this is Interleukin-1- Beta. The second step is to encourage the family to communicate and re-establish the lines of normal communication. In the family suffering from alcoholism, this is called therapy and in the joint this is called a paracrine event. Once the chemical in the family is reduced and the communication is restored, regeneration will be able to occur and the family will be able to function as a normal family and the children will be able to thrive. In the joint, we have reduced the harmful biochemical imbalance and restored cell to cell communication and new tissue can now regenerate. However, the actual amount of tissue needed for pain relief may be very minimal. There is no relationship between the amount or volume of new tissue formation and the level of pain relief or the restoration of joint function. Some people can produce very large amounts of new tissue and have very little change in their pain or function. However, many patients may have very little, if any, tissue regeneration and have significant pain relief and restoration of function. Why would this be true? Think about the last time you had joint pain and you took a simple over the counter medication to relieve this pain. Most people would have a reduction of their pain. However, this pain reliever did not grow any new tissue by any means. These medications are not injected into your joint, and your stomach does not directly connect to your joint. However, whenever you take a pill, your joint has a good chance that it will feel better and allow you to function at a higher level. Why is this true? The answer is the fact that these medications help to temporarily reduce some other minor players in the biochemical imbalance of your joint. Thus, new tissue is not necessary to reduce the pain and restores some of the function to your joint. Mesenchymal stem cells do this, but through a much more complex system and for a substantially longer period with a positive side effect of possibly growing more tissue.
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.
At Advanced Orthopedic Specialists we strive to provide you with cutting edge technology sometimes not even available at such stalwarts of medical innovation such as John Hopkins; The Mayo Clinic or even the University of Michigan. One of these advanced technologies involves the concept of concentrating the healing cells from your bone marrow or blood in the joint or area of damage. The simple filtering of your bone marrow or blood plasma to remove water and salts helps to naturally concentrate the important plasma proteins and growth factors found in this vital fluid found within each and every human. In the past, stem cell therapy involved spinning your bone marrow or blood at very high speeds to separate it into two to three different layers, namely the red blood cell layer, the platelet poor plasma (PPP) layer; and a platelet/ stem cell rich plasma ( PRP) layer.
In the past, many researchers or physicians would discard both the red blood cell layer and the platelet poor plasma (PPP) layer. However, this never really made sense to me since this PPP layer contains many of the growth factors and plasma proteins necessary for continued growth of these cells. In fact, one of the best growth mediums for mesenchymal stem cells is a special mixture called platelet lysate made from the layer we would normally throw away in the biohazard bag. The problem using this PPP layer in the past is that it would dilute the mesenchymal stem cells as well as the concentrated platelets we need to activate in your body by forming a clump or a clot. However, some very smart and practical scientists at Celling Biosciences (Austin, Tx.) used good old fashioned American ingenuity to figure out a simple filtering process which can easily remove water and salts from this PPP to produce a super clot forming; growth factor and plasma protein rich environment for harvested stem cells. The concept is extremely simple and safe using no drugs or chemicals. This filtering process is a patented technology only available through a US born and bred company in Austin, Texas. Celling Bioscience's PhD's have used this self contained filter to significantly enhance the retention and growth of stem cells within your joints. In fact, they have demonstrated that this technology can increase the concentration of very vital growth factors such as Alpha 2 Macroglobulin (A2M) by a factor of 5.22 , Platelet Derived Growth Factor (PDGF-bb) by a factor of 5.88 , Vascular Endothelial Growth Factor (VEGF) by a factor of 2.27 as well as the very important Interleukin 1 Receptor Antagonist Protein (IRAP) by over 3.77 times the normal amount. In addition, this concentrating process helps the cells clump in a manner to protect them from migration to other parts of your body and slowly release themselves over a prolonged period of time. If there is no clumping of these cells within the area of delivery such as within your joint, you may rapidly lose these important cells within minutes.
Mesenchymal stem cells have a high affinity to blood vessels and travel to your spleen, lymph or circulatory system and away from the area of damage. Sometimes, stem cell clinics or researchers use artificial clotting agents such as human recombinant (meaning made from DNA taken from another human) or bovine (meaning from horses) thrombin to create this clot. The problem is that a percentage of patients react to this drug, and repetitive use of this drug can have an autoimmune response causing pain and swelling and possible cell death. On the other hand, you should never develop a reaction to a concentrate of your own cells. In a recent, trial conducted at Celling Biosciences, Matthew Murphy, PhD. was able to demonstrate that the super healthy clot formed from the concentrated plasma proteins allowed the clot to continue to hold it's shape for an amazing 14 days with very high cell counts. On the other hand, the clot formed by the drug thrombin had started to deteriorate only after 6 days with a much lower cell count. Dr. Loniewski, has worked with Celling Biosciences to help develop state of the art protocols using this technology and the most advanced stem cell therapies. No other center in the United States offers this advanced technology on all of their patients. This is why we can claim that at least 85% of our patients improve with little to no side effects. Not all patients respond to these treatments, and not every patient is a candidate for cell based therapies. If you are interested in cell based treatments, call our office at 810-299-8550 or you can download our on-line stem cell questionnaire to understand if you may be a candidate for this therapy.
We treat numerous patients for arthritis of their joints with cell based therapies including bone marrow derived stem cells. Most our patients improve and lead more productive lives, and some do not improve as much as they hoped and we work on alternative methods such as joint replacement to help these patients. Joint replacement is a very reliable, reproducible and durable solution for advanced arthritic joints. Close to 90% of the patients receiving a total joint replacement have pain relief and over 80% of these patients will still have this same joint functioning fine 20 yrs. or more out the date of their surgery. However, almost 30% of these patients are unsatisfied with their joint replacement. Issues such as pain with kneeling can be painful and descending stairs can feel unnatural. In addition, there is up to a 16% complication rate with these surgeries which concerns patients and families if this is the most appropriate and safest decision.  On the other hand, cell based treatments such as bone marrow derived stem cells or platelet rich plasma have a success rate ranging from 80-90% and a 1% or less complication rate.
One patient who refused to consider joint replacement and needed to have a high functioning knee for his career was Kim Sticker. He is a world renown professional fisherman who produces, edits and stars in a nationally syndicated fishing show called Hook n’ Look on the Outdoor Channel. Kim is an accomplished professional fisherman winning the prized Bassmaster Michigan Top 100 tournament at Lake St. Clair, Michigan and thus had high demands on his knees. Kim was a very compliant patient and did everything we asked him to do to try to salvage his knees including therapy, injections, proper shoe wear, glucosamine sulfate and even arthroscopic surgery. When we exhausted all our conservative measures, we suggested partial knee replacements. However, Kim pointed out that it would be very difficult for him to continue to fish with knee replacements since he needed to kneel throughout the day. Joint replacements can produce significant pain with any sort of kneeling or squatting. Thus, we agreed to try a stem cell procedure to salvage his knees and allow him to get back to fishing, kneeling and squatting without fear.
Kim underwent this procedure and slowly and carefully he returned to a lifestyle he was accustomed to. As he states in his testimonial video, he is not 18 yrs. old again, but his knees are reliable and not painful. His recovery did take some time to take effect, but now he is back to fishing and enjoying his new grandchildren with little to no pain.
At Advanced Orthopedic Surgeons, we strive to provide you with ethical and effective treatments for your orthopedic conditions. We only recommend treatments with proven benefits that we would only use on ourselves with or our cherished family members. In fact, I received a stem cell procedure back in November of 2016, and I have also used these same treatments on my own father with great results. We provide you with an honest and comprehensive evaluation of your condition. You can find out if you are a candidate for stem cell therapy by taking our free and easy Stem Cell Questionnaire and you can call us for an evaluation at 810-299-8550.
Patients rightfully ask this question. Here is some evidence to show that this is not a short-term solution, but hopefully a long-term solution. First, many of the studies using stem cells for arthritis have results at 2 years and some as short as 6 months. However, this does not mean that the treatment stopped working at this interval. This merely means that the study was designed to stop at this point. If you look at some of these studies, there are some promising results showing positive structural reversal of the arthritic disease. For example, Koh et al in his arthroscopic second look study revealed reversal of the arthritic changes on visual inspection of the knee through arthroscopy. This finding was confirmed by the South Korean dosing study. In addition, Khanh Hong-Thien Bui and colleagues found positive structural changes on serial MRI’s.  Thus, we can conclude that this is not just a band aide type of treatment, but this evidence helps point us in the direction of positive reversal of the underlying destructive process of arthritis. This is unlike many other current treatments available in orthopedics.
Some more recent studies from Iran show further long term success. Eighteen patients were treated with a bone marrow concentrate in multiple joints including knee, ankle and hip and followed for 30 months with careful laboratory, radiographic and MRI studies. The research team reported the “All” patients received therapeutic benefits confirmed by pain and function scores and were confirmed by MRI. Researchers at the University of Paris followed 534 patients up to 18 years after a bone marrow stem cell treatment for avascular necrosis of the hip which is an arthritis caused by the lack of blood supply to the hip. This long-term study revealed that only 15.7% of the patients went on to receive a total hip after this treatment and many of the x-rays and MRI’s of the hip stabilized.
We also have a “white paper” result from a very interesting long term study comparing bone marrow stem cell therapy to our traditional total knee replacement in elderly male patients. A white paper is a study which is not yet published and thus it has not been peer reviewed and one must be careful in using this data because it has not yet been validated. However, this same researcher, Philippe Herniguo, M.D., PhD, has published hundreds of peer reviewed studies and is a very respectable source. This study took 60 elderly male patients all 85 years old or older. Group A was treated with the standard total knee replacement for both knees. Group B was treated with the bone marrow stem cells to both knees injected directly into the bony part of the knee next to the joint. Group C had one knee injected with the stem cells and the other knee replaced. After an average of 6 yrs. (ranging from 2 to 15 yrs.), the patients in Group B (stem cell group) had the following:
Improved knee function scores (Knee Society Scores)- A 16.3-point improvement for the stem cell group vs. only an 8.9-point improvement for total knee group.
Faster Functional Recovery- At 9 months, the stem cell group had faster recovery than the total knee group.
Lower Complication rates- Blood clots occurred in only 2% of the stem cell group compared to 12% in the knee replacement group. None of the stem cell patients required a blood transfusion and 29.3% of the total knee group required blood transfusions. Higher use of analgesic medications such as narcotics were used in the total knee group.
Lower Re-operation rate- None of the stem cell patients required further surgery or conversion to a total knee. However, 5% of the total knee patients required further surgery.
Higher Overall Satisfaction- When patients were asked to point to the knee which they preferred, 70% of the patients pointed to the stem cell therapy knee.
A large multi-national, multi-center study evaluating patients of all ages with all levels of severity gives us some further evidence that this is a longer term treatment for arthritis. In the study by Michalek J, et al. entitled “Autologous adipose tissue-derived stromal vascular fraction cells in patients with osteoarthritis,”(Cell Transplant, 2015 Jan 20. doi: 10.3727) followed 1128 patients for up to 54 months (over 4 yrs). A majority of these patients (63%) had at least 75% improvement of pain and function and 91% had at least 50% improvement. However, obese patients and patients with more severe arthritis took longer to respond. This is one of the largest and longest term study showing promising positive results in the longer term. Our own experience confirms this result. Our own unpublished evaluation of pain and function using a visual analog scale and the WOMAC on hundreds of patients receiving a similar procedure for over 3 years reveals similar results with an excellent safety profile and no serious adverse events.
Although some of these studies are not controlled, blinded, or randomized, but they do show a common pattern of:
This is a safe procedure with very low rates of complications.
Consistent reduction of pain.
Consistent restoration of function.
High rate of patient satisfaction.
Improved MRI or physical findings (microscopic or arthroscopic).
Midterm and long term relief of symptoms
Superior results to other orthopedic conditions such as hyaluronic injections and even joint replacement.
Advanced Orthopedic Specialists offers this state of the art care in a friendly environment with skilled surgeons and staff. Dr. Loniewski has developed a simple questionnaire to determine if you may benefit from cell based therapies. This only takes about 3-5 minutes to complete. You can read more and download the questionnaire at: http://www.advancedortho.net/candidate-stem-cell-therapy.php
If you would like to schedule an appointment , please call our office at 810-299-8550.
 Koh YG et al, Mesenchymal stem cell injections improve symptoms of knee osteoarthritis. Arthroscopy, 2013 Apr; 29(4) 748-55.
 Khanh Hong-Thien Bui et al , Symptomatic knee osteoarthritis treatment using autologous adipose derived stem cells and platelet-rich plasma: a clinical study, Biomedical Research and Therapy, 2014 (1):02-08
 Emadedin M., et al, Long-Term Follow up of Intra-articular Injection of Autologous Mesenchymal Stem Cells in Patients with Knee, Ankle or Hip Osteoarthritis, Arch Iran Med. 2015, Jun;18(6): 336-44
 Hernigou, P, et al, Cell Therapy of hip necrosis with autologous marrow grafting , Indian J Orthop.2009 Jan-Mar; 43(1): 40-45
 Michalek J et al., Autologous adipose tissue-derived stromal vascular fraction cells in patients with osteoarthritis, Cell Transplant, 2015 Jan 20. doi: 10.3727