Installment 48 - Ask the Doctor with Mark Berman,MD,FACS,California SC Treatment Ctr

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Jeannine

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Ask the Doctor with Mark Berman, MD, FACS

Q: I have read that lymphoid stem cells are responsible for wound healing and are capable of healing lung damage. I also read that they are located in your bone marrow. Is there any procedure available at this time to identify this type of cell so it could be taken from bone marrow, separated from the other cells and cultured and then released into a person’s bloodstream to heal the lung damage? Also, would a lung infection or lung damage trigger their natural release from the bone marrow?
A: Your bone marrow produces mesenchymal stem cells. Honestly, I haven't read that there is a specific "lymphoid" stem cell responsible for healing lung damage. The mesenchymal stem cells produced in bone marrow can differentiate in a host of different tissues - one of which could be to repair damaged lung tissue. Stem cells are progenitor cells - meaning they are activated by tissue injury, inflammation or degeneration. Anyway, bone marrow can be extracted, but since the cell counts are generally in the 50,000 ballpark (more or less), most groups believe they need to be "cultured" over a number of days to increase the numbers to over 3 million cells to be effective for therapeutic treatments. It turns out your fat is loaded with mesenchymal stem cells and just 25cc of fat can yield 10 - 30 million stem cells in less than two hours. These cells appear to be as effective as those from the bone marrow. Empirically, we're seeing positive results. Obviously, we need to continue treating patients and ultimately perform some blinded placebo studies.

As for your question about how the stem cells are signaled to be released - I honestly don't know the answer. I suspect that the cells are continually made (with decreasing frequency with increased age) and they seek out areas of injury. The more cells that are available, the easier it is to heal your wounds. Perhaps this is why we tend to heal quicker when we're younger.

Q: Is it possible to treat a teenager with brain injury caused by severe illness (not trauma) with stem cells from adipose tissue? This teenager also has peripheral neuropathy. This illness was due to Guillan Barre's syndrome as a result of vaccination.
A: Because stem cells are progenitor cells, they should be activated by injured tissues - however, I would be speculating about this condition. Assuming the cells see that there is an active degeneration in progress, one would think they might be useful. If damage had occurred resulting in scarring, then I'm not sure how the cells would be able to help repair the condition. I don't really know and suspect that specific cell therapy would ultimately be available and of some help.

Q: Hundreds of clinics claim to treat diseases globally using adult stem cells. However, everyone of these clinics will treat their patients differently for the same disease; ie. number of cells injected, procedures, etc. seem to all be different. So which one of these clinics is the right one for a patient (correct procedures, etc.)?
How can I tell which clinic is genuine and using actual stem cells and not just placebos? What questions would I need to ask to justify paying thousands and thousands of dollars?

A: Great question. This is the difficulty of trying to get treated during these times. While there appear to be a number of conditions (many orthopedic ones, for example) that respond with one or two treatments, there are a myriad of conditions that require multiple courses of cells. The protocols for these various conditions have been offered by numerous clinics around the world, and you're right, it's difficult, if not impossible to know which protocols are actually valid and work. We've (CSCTC) been working with our sister organization WA- Stem Cell in Shanghai, China on a number of different protocols that often require monthly treatments, especially for some of the neurologic conditions. These protocols have been reviewed by a number of specialists, but frankly, we don't really know if they will be successful. We're definitely seeing progress in treatments, but even if we had several successful treatments, it will take a lot of numbers and different trials to hammer out the best possible protocols. Even the optimal number of cells for a particular treatment may be a lot less than the numbers we've been providing, but this will take time to figure out. Right now, we believe it is prudent to offer investigative treatments with the understanding that gathering enough empirical data will allow us to develop optimal treatment plans.

Q: Is it safe to get repeated stem cell treatments? I am talking about several times a week for a month or two. This was recently suggested to me by a company. What would be the purpose anyway if enough stem cells were given to begin with?
A: Depending on the type of injury/disease you have it could very well take repeated treatments in order to optimize your results. We just don't have firm, fixed data for all the different possible treatments utilizing stem cells. Once different organizations publish their data and other groups are able to repeat their "success" then we'll have a better handle on the most optimal treatment plans.

Q: There seems to be so much risk with the stem cells not going to the part of the body that needs them. How does your treatment work to get the stem cells to the needed area?
A: You can deliver the cells by various routes so that you get them as close to the injury / disease as possible - directly into a joint, directly injected into affected tissues, via intra-arterial catheterization, into the spinal fluid, into the bloodstream from an intravenous route, or even via nebulization into the lungs. Regardless, the cells get into your system and tend to hone into areas where there is inflammation or tissue damage.

Q: Do you use other therapies, medications or supplements in conjunction with stem cell treatment to enhance the treatment?
A: We haven't been as we want to see the result of the cells without influence of other medications. Of course, a number of our patients are already on other medications and we can't discontinue those medications. Also, it may be more optimal to use supplemental hormones as a way to boost the healing process, but we (I) just don't know for sure (though I suspect it could be helpful). Having said that, we've found that your stem cells can actually activate your hormonal systems to increase your hormone levels that typically drop off with age.

Q: If someone had cancer and did not know it and got stem cells injected, could that make the cancer grow quicker?
A: I don't know, but don't believe the cells would increase cancer growth. The cancer cells are made by their own stem cells that continue to produce cancer cells. Other stem cells shouldn't recognize those cells as inflammatory or diseased tissues so I don't know why they would directly affect the cancer cells. They could, possibly, by enhancing your hormonal system, somehow impact the way your cancer grows, but I don't know that we really know this - I don't. It's unlikely that your own cells would cause cancer on their own. So far there hasn't been any significant evidence that this has occurred.

Q: What conditions are you finding that respond best to your treatments? I know there are no cures, but have you had better success treating some kinds of diseases over others?
A: We've been investigating cell therapy (technically stromal vascular fraction or SVF - this includes your stem cells, growth factors, endothelial cells, white blood cells and some red cells) for a year and a half now. We've seen terrific improvements with a number of orthopedic conditions - particularly involving joint inflammation from cartilage or tendon damage. Many of our patients have had surgical intervention and still have positive responses though I suspect cell therapy would be more beneficial if you get to a wound before surgery - but don't get me wrong - I don't have the information to support this and there are likely many times that surgical intervention would be necessary - fractures, and other difficult tears, etc. - Still, the orthopedic conditions seem to respond well. We've seen pretty good responses with pulmonary and nasal respiratory conditions. Cardiac conditions seem to respond well and this is one area where there has actually been some good evidence based studies to support advanced wound healing with cell therapy. My partner, Dr. Lander, is a urologist and has been getting pretty good results treating Interstitial Cystitis, renal failure and Peyronies disease while still looking for answers to general erectile dysfunction. There are a host of autoimmune / neurologic conditions that seem to be responsive also. Some areas, where would expect good response, are still more diffiult to positively effect.

Q: After treatment, how long might it be before any improvement is seen? If I don't feel any different after 6 weeks or so, is it safe to say that the stem cells did not help me? I got treatment at a clinic and actually felt much worse for awhile. After 6 weeks, I still felt no improvement. Then they said give it 3 months and suggested I should come back at that point. I am beginning to think they really don't have a clue. I am not going back for more.
A: It depends on your condition. Some people with inflammatory changes - joints, respiratory even, may feel some sort of relief almost right away or within a few days. Stem cells are highly anti-inflammatory so they may reduce pain quickly in some cases. Actual tissue repair to improve various conditions may take a series of treatments, may takes several weeks or may just not work. Thus, for someone like yourself, it can be frustrating, let alone expensive. I suspect a lot of well-meaning doctors would rather wait until we have firm, repeatable, verifiable data to support a planned treatment. This makes sense. Unfortunately, we have to start somewhere and that's what many of us are doing. There are some countries and clinics that make claims that are just not supported or repeatable and this becomes a problem because doctors and clinics don't want to offer you "snake-oil" treatments. On the other hand, there is so much empiric and in some cases, evidence-based, evidence of the utility of these cells, that it is reasonable to use them if they are available (your own autologous cells). There are likely to be conditions and patients that just don't respond or have too much damage to get an effective response. Two people could have the same kind of condition, but one might have less damage and actually improve while the other may have so much damage and scarring, for example, that cell therapy is just too late to be effective. And, quite likely, there will be a number of conditions - yours possibly - that may indeed, require multiple treatments over a course of time. These protocols simply need to be worked out.

About Dr Berman
  • Mark Berman, MD, FACS
  • Diplomate – American Board of Cosmetic Surgery
  • Diplomate – American Board of Otolaryngology
  • President - American Academy of Cosmetic Surgery

Mark practices cosmetic surgery in Beverly Hills. He’s the 2010 President of the American Academy of Cosmetic Surgery. Although he’s a UCLA graduate, he’s currently a clinical instructor in facial plastic surgery at the University of Southern California. He’s well known for his longtime work with fat grafting – particularly to restore the three-dimensional volume of the aging face.

In 2011, he and Elliot Lander, MD, started the California Stem Cell Treatment Center to provide investigational cell therapy for patients that could potentially benefit from stem cells. He’s also the first surgeon to use Gore-Tex materials in cosmetic surgery – not only pioneering their use in facial surgery, but he also holds a patent on an e-PTFE breast implant device – the Pocket Protector® – used to repair or prevent capsule contracture in breast augmentation. He’s developed nasal tip techniques, in particular the double columellar strut. In January 2010 he received an award – the Best Scholarly article of 2010 in the American Journal of Cosmetic Surgery – for a paper on this technique. He invented the SAF-T-VAC (smoke and fluid tube evacuator) that fits onto any cautery pencil allowing for easy visualization and function. He has also authored a novel – Substance of Abuse – a controversial sexy thriller that suggests a solution to the war on drugs. He and his wife, Saralee, have a 21 year-old son, Sean, who attends Amherst College.

Mark Berman, MD, FACS
2010 - President - American Academy of Cosmetic Surgery
California Stem Cell Treatment Center
http://www.stemcellrevolution.com
http://www.whoisjohngaltstemcells.com - will also take you to our site for the admirers of Ayn Rand.
Rancho Mirage - 800-231-0407
Beverly Hills - 310-274-2039
 
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