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
We are pleased to announce that Dr. Laith Farjo has been selected as an Hour Magazine Top Doc for 2016, his fifth year in a row to receive this honor! Every year, Hour Magazine polls physicians in Southeast Michigan and asks them to rate physicians they feel are exceptional - the highest ranking of these doctors are rated a Top Doc by the magazine.
Plastic Surgery Hybrid Hip Incision Combines Minimally Invasive and Safe Approach Along with Stem Cells for Best Outcome
Some patients will call about what type of incision or approach used for hip replacements. Most of these calls come from patients who were told by another friend or family member that there is a newer, less invasive approach from the front or anterior aspect of the hip. Here are some facts about this anterior or front approach:
The anterior approach is not new. Many orthopedic surgeons used a similar longer incision called the Smith-Peterson approach over the same area in the 1960’s and 1970’s but abandoned it due to an increase in complications.
The anterior approach is not without potential complications associated just with the incision choice alone. This includes increased blood loss; nerve damage and loss of sensation over your thigh; and a higher fracture rate of the femur.
The anterior approach normally requires the use of intra-operative x-rays exposing the patient and the staff to increased risk.
There is normally a greater length of time required, and a higher incidence of need for blood transfusions during this longer and bloodier surgery.
Studies comparing most of the popular surgical approaches has shown no difference in function, pain or outcome 6 weeks after the surgery.
Dr. Loniewski normally use a hybrid incision for total hips with a proven track record and an excellent safety record. This utilizes the benefits of an anterior approach, but with a better safety profile.
Dr. Loniewski use a minimally invasive anterior-lateral approach. This mini incision allows the surgeon to enter into the hip with minimal damage to any muscles or tendons. There is no use of skin staples or removable sutures. This is a plastic surgery type of closure. It also allows complete access a larger area of the hip allowing for proper visualization of the important parts of a hip replacement. The result of this improved visualization and lower surgical time is a lower rate of complications such as fractures of the bone, nerve damage, and bleeding. The anterior-lateral approach allows for a quicker operative time and no need for x-ray radiation. Many of our patients get up and walk the same day of surgery and an overwhelming majority of our patients are able to be discharged one day after surgery to the care of their families. In addition to this minimally invasive approach without any visible sutures or staples, Dr. Loniewski uses the patient’s own stem cells to heal the wound quicker and reduce the chances of infection. Bone marrow is aspirated at the same time of the surgery and this is concentrated down into a special paste used at the time of closure to promote healing, and reduce complications.
Regenerative Medicine At Advanced Orthopedic Specialists
The National Institute of Health (NIH) defines regenerative medicine as the process of creating living, functional tissues to repair or replace tissue or organ function lost due to age, disease, damage, or congenital defects. This field holds the promise of regenerating damaged tissues and organs in the body by stimulating previously irreparable organs to heal themselves.
Osteopathic medicine tends to fit perfectly within the concept of regenerative medicine. Andrew Taylor Still founded the first college of osteopathic medicine in Kirksville, Missouri in 1892 when he declared that there must be a better philosophy of medical care. Dr. Still felt physicians needed to trust the body’s innate ability to heal itself and to avoid toxic and misdirected treatments aimed to treat the effects rather than the cause of the disease.
Thus, the tenants of regenerative medicine fit well within the philosophy of an osteopathic physician and surgeon. Our Comprehensive Arthritis and Recovery and Education program otherwise known as the C.A.R.E. program utilizes these basic principles to help your body heal itself. We use an ancient concept of homeostasis that is still used today to treat chronic diseases such as heart failure, calcium metabolism and arthritis. Ancient Greek philosophers such as Heraclitus (540–480 BC) first described this concept when he theorized that static, unchanging states of the human body was not natural, and that ability of the human body to undergo constant change and to respond to the change was “intrinsic to all things.” Hippocrates (460-375 BC), considered to be the father of medicine, further refined this concept and compared health to the harmonious balance of the elements, and illness and disease to the systematic disharmony of these elements. We have simplified this into modern terms of damage and repair.
We can simplify your arthritis into a mathematical formula. Every day, your joint makes cells and every day, your joint looses some cells. Over time, your joint has just lost more cells than what it can make and the net result is the loss of cartilage. This loss of cartilage is the definition of arthritis. When we lose cartilage, we have pain, swelling, and deformities ultimately causing a dysfunctional joint. If you want to think of this in a practical manner, consider the City of Detroit. For years, they spent more money than they took in. They barely survived for years limping along, but the truth was that they spent more than what they made. This eventually led to a declaration of bankruptcy and a long process was started to reduce the spending and increase the revenues. This is not usually enough. The bankruptcy court also corrects any underlying functional deficiencies to keep the city functional and out of bankruptcy. Most of the times, this means facing reality and making some dramatic, yet helpful changes. This eventually led to a balanced budget and the emergence out of bankruptcy.
When we look at your joint, we use the same concept to get your joint out of bankruptcy. We need to lose less cells and make more cells while correcting some underlying deficiencies. We look at both ends of the formula helping you identify why you are losing so many cells and we correct these deficiencies. We can also look at what you need to do to increase the production of cells. We look at weight control, shoe wear, joint alignment and muscle or ligament deficiencies and correct all that we can correct. On the other end of the formula, we encourage the correction of some nutritional deficiencies, and supplement these deficiencies. We can also increase gentle range of motion exercises that can stimulate repair and have a discussion about cell-based treatments.
Cell-based treatments include using your own body’s cells to help in this reparative process. Some examples of this include platelet rich plasma (PRP), bone marrow concentrate (BMC) and adipose derived stem cells (ADSC). Each one of these has specific indications and, most importantly, contra-indications. Not everyone responds the same way to these treatments, so it is very important that the physician treating you understands who and what conditions are best treated with these treatments. We have the most experience using these treatments in the area. Dr. Loniewski has been using PRP since 2005 and has performed this on thousands of surgical and non-surgical patients. Dr. Loniewski has conducted research on PRP and presented the results at scientific meetings. He was also one of the first physicians in the Midwest to utilize adipose derived stem cell (ADSC) for hip and knee arthritis since 2013 and he has since performed this on nearly 100 patients. This experience helps us understand the best methods and the best patient selections for these treatments. It also helped us identify patients who may not respond as favorably, which is sometimes more important.
We just don’t offer these treatments, we help correct the underlying deficiencies and customize what type of treatments may offer the best overall outcome with the greatest chance for success while reducing the risks of treatment. Thus, Dr. Loniewski has followed the basic tenants of Andrew Taylor Still and Hippocrates by restoring homeostasis while reducing harm to the patient.