1)I've been told that antibiotics kill cells so would taking them after a stem cell treatment hurt the cells we just paid for - specific to lung and vascular system?

Antibiotics are designed to kill bacteria, not human cells such as stem cells. However, some studies have shown that exposure of stem cells to antibiotics under laboratory conditions can reduce the growth rate and differentiation of stem cell cultures. This could be relevant since many physicians routinely prescribe antibiotics to prevent infections after harvesting either bone marrow or adipose tissue from which they isolate stem cells. There is some good evidence that using antibiotics at these times does not significantly impact the viability of stem cells. Virtually all leukemia patients who undergo stem cell transplants receive antibiotics (often in very high doses for prolonged periods of time), yet we know that many stem cells remain viable. As a result, I do not feel that the relatively low doses of oral antibiotics that are prescribed at the time of stem cell procedures for lung or vascular procedures will significantly impair a successful outcome.

2) During a phone consultation with you, you mentioned that you would be conducting a clinical trial using adipose derived stem cells at the end of this summer. Is that still on track? If so, what condition(s) will be included in the clinical trial? How does one apply?

Yes it?s still on track. I am in the process of submitting an application to ICMS to perform pilot studies on five patients with COPD and five patients with IPF. I am hopeful that these trials will be approved and that the studies will be under way this fall. Patients need to meet the following criteria to be included in the COPD study: A prior diagnosis of moderate or severe COPD; FEV1/FVC ratio < 0.70; Age between 25 and 80 years. Similar inclusion criteria apply to the IPF study. The following conditions will exclude patients from both studies: Diagnosis of other lung disease (e.g., sarcoidosis, tuberculosis, bronchiectasis or lung cancer); Body mass greater than 330 lb or less than 88 lb; Active infection (pulmonary or other); Hospitalization requiring mechanical ventilation within 4 weeks of screening; An uncontrolled medical condition not associated with COPD; Clinically relevant heart condition such as, but not limited to, uncontrolled heart failure, severe pulmonary hypertension, atrial fibrillation or significant congenital heart disease; Evidence of active malignancy, or prior history of active malignancy not in remission for at least 5 years; Life expectancy of < 6 months. You can contact either ICMS (http://www.cellmedicinesociety.org/ ) or my office Frontier Medical Institute (www.fmiclinic.com ) for more information.

3) I have read that you are associated with Adistem. Is this still the case? Can you tell me if your liposuction technique uses local or general anesthesia and approximately how long the whole process takes? Are cells processed immediately and re-implanted or how does the process work? How many cells can be harvested using your method? Would a patient be hospitalized? Would there be recovery time, major bruising or any other after effects? Where is the fat removed from?

(There are at least 10 questions in your question above, which is why my reply is somewhat lengthy ? but thank you for asking!)

I initially learned about Adistem when I was lecturing in Thailand in November 2009. They invited me to come to Greece in February 2010 and I learned their technique for isolating stem cells from abdominal fat. In addition, I recently went to Florida where I learned a different technique for harvesting & isolating stem cells from fat from Dr. Sharon McQuillen at the Ageless Regenerative Institute.

My office has begun using patient?s own fat-derived stem cells to treat a range of orthopedic problems such as severe knee arthritis, cartilage damage, ankle, elbow and shoulder problems. The procedure begins with removal of a small amount of fat from either the abdomen or ?love handles? region by a mini liposuction procedure that typically takes about 30 minutes. This is done under local (?tumescent?) anesthesia and there is minimal discomfort. The fat is then taken to our laboratory where it is treated in a way that digests the fat cells so that the stem cells can be released and isolated. Then the stem cells are mixed with platelet rich plasma (PRP), which is obtained from blood taken from the patient. Finally, the stem cell:PRP mixture is injected into the affected joint. Patients have some discomfort for a few days, but normal activities are possible immediately after treatment.

The entire procedure from beginning to end takes between 2? and 3 hours. Stem cell yields from abdominal fat are much higher than from bone marrow and it is not unusual to obtain 100 million nucleated cells from about 3 or 4 ounces of abdominal fat. There is no hospitalization and patients are discharged home immediately after treatment. The stem cell technique can also be done for facial rejuvenation, hair regrowth, facial fat transfers and some other cosmetic applications.

In our proposed COPD:IPF study, the stem cell:PRP mixture will be suspended in 8 ounces of saline solution and given to patients intravenously. FDA guidelines for acceptable stem cell therapies include orthopedic applications such as joint injections and the cosmetic procedures described above, while the intravenous therapies are currently excluded. Therefore, we are only able to perform intravenous stem cell therapy as part of an approved trial or clinical study at the present time.

4) What are the differences in the types and quantities of stem cells derived from adipose tissue and bone marrow? Are the mesenchymal cells taken from bone marrow and adipose tissue basically identical, and if so, why do you think more clinics/doctors are not using adipose tissue as a source of stem cells?

There are differences and similarities between the types of cells found in bone marrow and in adipose tissue. The two main types of adult stem cells are hematopoetic stem cells, which are chiefly involved in the creation of blood forming elements such as red blood cells, white blood cells and platelets and mesenchymal stem cells, which form bone, cartilage, muscle and other tissues. Bone marrow has more hematopoetic stem cells while there are greater numbers of mesenchymal stem cells in fat, however both types of stem cells are found in each. In addition, hematopoetic cells seem to be able to change into mesenchymal cells, which is why bone marrow can be used to regrow joint cartilage and to treat bone problems.

There are many more stem cells contained within fat than in bone marrow. According to BioHeart, each gram of abdominal adipose tissue has 900 thousand nucleated cells. This means that the mini lipsuction we do of 100 grams (about 3 ounces) of abdominal fat would yield 90 million cells. Approximately 5 % of these (about 4.5 million) are mesenchymal stem cells with a smaller number of hematopoetic and endothelial progenitor cells. This is considered to be an adequate number of stem cells for therapeutic purposes.

The same 100 grams of bone marrow would contain between 6000 and 60,000stem cells [Compare this to 90 million from fat.]. This is far too few stem cells to have a clinical effect for many conditions. Therefore, in most cases, when bone marrow is used, the stem cells must be expanded in the laboratory between 10-and 100-fold. Even so, the absolute number of stem cells at the end of this expansion will still be less than obtained from adipose tissue. It is for this reason that many clinicians have begun to look favorably at the use of fat-derived stem cells.

I think that another advantage of adipose-derived stem cells over bone marrow stem cells is the greater ease in harvesting adipose tissue via mini liposuction than doing a bone marrow aspiration. I have done both liposuction and bone marrow aspirations on patients and feel that harvesting fat is less traumatic and painful for the patient than taking bone marrow. This is one reason many doctors are now using fat for their stem cell therapies.

5) How many stem cells of each type would you typically expect to get from a patient's adipose tissue? Approximately how many stem cells of each type would be re-injected into the patient? Can any of the stem cells be frozen or stored for later use?

For orthopedic and cosmetic purposes, we only need 30 - 90 grams (about 1 ? 3 ounces) of fat. This will yield anywhere from 20 to 100 million cells (or more). For intravenous treatments such as the COPD:IPF treatments, 200 ? 300 grams (7 ? 10 ounces) of fat are needed to produce 100 ? 600 million cells (or more). Yields are quite variable and can often be much higher. For example, I witnessed a 9 year boy get an intravenous stem cell treatment for autism in Greece. They took 90 grams of fat (3 ounces), which contained one billion cells!

Stem cells can be frozen for their future use. Like all of our cells, stem cells age. In particular, the telomeres (the endcaps on the ends of our chromosomes) shorten with age ? and short telomeres are associated with the aging process. This is why Dolly the sheep died of old age at a young age; she started life with short telomeres. By freezing stem cells now, individuals are able to ?freeze themselves in time? and have the youngest possible stem cells available to them whenever they might need them in future. In our clinic we say, ?You are only as young as your stem cells? and we offer adipose-derived adult stem cell storage to our patients.

6) I have been diagnosed with end stage COPD. My FEV1 is 27% and I am almost 70. My diffusion as measured by PFT's was 35% two years ago, the same time as my FEV1 was measured. I think diffusion has to do with the exchange of O2 and CO2 at the alveolar level. Is there anything I can do to maintain or improve this exchange? Thank you in advance.

I think a trial of inhaled glutathione might be of value for you. You will need a prescription, which you can get from a physician who practices complementary medicine that you can fill at a compounding pharmacy. Many late stage COPD patients receive benefit from inhaling glutathione by nebulizer once or twice daily. You might also consider applying for the COPD stem cell trial.

7) I have been having the hardest time with depression because I lose my appetite. The problem is the new type of anti-depressants I am given are SSRIs which act as stimulants and do not sit well with me - from Prozac to Lexapro to Paxil, all are not good. The only one that really worked for me was Limbitrol but the doctors say it is bad for the heart. I have an irregular heart beat which I take medication for. Do you agree that Limbitrol is bad for the heart? I took a regular dose once a day. Can this really interfere with my palpitations which I have even without taking the Limbitrol? I've also taken Surmontil (trimipramine) but it belongs to the tryciclic anti-depressant class as well. I have COPD.

Among prescription drugs you might consider Wellbutrin. Some patients who are in tolerant of the SSRIs do well on Wellbutrin. There are a number of natural remedies that can help with depression as well. These include S-adenosylmethionine (SAMe), St. John's Wort, 5-HTP and adequate amounts of B vitamins.

8) There is a treatment center in Florida that is offering to treat hearing loss with stem cell therapy. They use bone marrow stem cells. They remove a small sample of your bone marrow and put it in a centrifuge, then re-inject the stem cell portion of the bone marrow through a long tube that flows to your head. You are under general anesthesia for this. The idea is the stem cells in your head make their way to your cochlea and differentiate into hair cells. They are not allowed to "expand" the small amount of stem cells into millions and they can't use other sources of stem cells since this is performed in the U.S. This procedure costs $9500 and is an outpatient procedure. 6 patients are scheduled to undergo the treatment in September. What is your professional opinion of this producing any type of success?

I haven?t heard of this particular trial in Florida and was unable to find out about it on the Internet. If you could provide further information I?d be happy to look at it.

9) In your book, "Transcend", you state that by 2034 nanotechnology will have begun to bring fundamental changes to our lives, altering almost every aspect of how we live. You also state that by 2023 stem cell therapies, bionic replacement parts, and cloned organs will all be realities. Considering the snail's pace that the FDA works at, do you still think this is possible? Some chapters in your book were like reading science fiction to me. Totally awesome. I enjoyed it very much.

I?m glad you liked the book, which I co-authored with inventor and futurist Ray Kurzweil. I think it is realistic that bionic human replacement parts such as hearts, lungs and kidneys as well as cloned organs will be realities by 2023, and I am certain that by then a wide spectrum of stem cell therapies will be commonly and inexpensively available to treat a whole host of disease conditions for which we currently have limited or sub optimal treatments. You are right that FDA works slowly but studies involving stem cell therapies are being done in thousands of locations throughout the world and this will propel these therapies into the mainstream. (I just checked www.clinicaltrials.gov for studies involving stem cells and more than 3000 are listed.)

10) Are you a member of ICMS?

Yes I am a member of ICMS and I want to offer my sincere thanks to Barbara Hansen for this opportunity to host this month's Stem Cell Pioneers.

About Dr. Grossman
Terry Grossman, M.D. received his medical degree from the University of Florida College of Medicine and has been in active medical practice in Colorado since 1980.
Grossman Wellness Center www.grossmanwellness.com in Denver, Colorado specializes in promoting wellness and longevity through a combination of aggressive health-sustaining lifestyle choices coupled with advanced noninvasive testing for early diagnosis of disease. He has also developed protocols for treating otherwise hard to treat chronic diseases and conditions including cardiac, pulmonary, neurological and infectious problems as well as malignancies.
He treats patients with their own stem cells derived from abdominal adipose tissue obtained by minimal liposuction. He uses stem cell therapies along with PRP (platelet rich plasma) to treat a wide variety of orthopedic conditions and for cosmetic indications such as hair re-growth and facial rejuvenation.
He is the medical director of Health Innovation, a 501(c) 3 tax exempt research foundation and is currently involved in a study of high-dose intravenous vitamin C in the treatment of patients with hepatitis C. He is planning to begin a trial of adipose-derived stem cell therapy in the treatment of moderate to severe COPD and IPF.
He is the author of three books, most recently TRANSCEND: Nine Steps to Living Well Forever (2009) co-authored with noted inventor and futurist Ray Kurzweil.
For further information about Grossman Wellness Center or to schedule a consultation please call (303) 233-4247 or 1 (877) 548-4387 or email info@grossmanwellness.com.