GLORIA: Hello! I’m Gloria Campos and I’m here at Innovations Medical with Dr. Bill Johnson.
You know, we’ve heard a lot about stem cells. You know, there’s been controversies surrounding it. There’s myth, mystery about stem cells, a bit of controversy. We’re going to separate the fact and fiction from stem cells, remove the mystery, and talk about the facts here and how stem cells and stem cell therapy is helping people heal.
And so, let’s start from the very beginning, Dr. Johnson. What is a stem cell? What does it do?
DR. BILL: Stem cells are cells within your body, within my body, that have two characteristics. We’re going to use these toys here to kind of demonstrate the characteristics because one characteristic of a stem cell is a stem cell has the ability to make more copies of itself.
Now, not all of our cells can do this. For instance, heart muscle cells have minimal, if any, to make new heart muscle cells. Brain neurologic cells, very poor ability to make new cells. Skin cells can make a lot of new cells.
Stem cells are cells that can produce new copies but the other thing that makes a stem cell unique is, if I have a stem cell that looks like a plastic ball, it can actually become a stretchy piece of plastic like this and it’s because it’s from the same cell. It can actually produce a different type of cell and become a different type of cell that’s a stretchy type of cell that you might want in a lung cell or a soft tissue. This is actually from recycled plastic and it’s a good example of what we need in our cartilage with our joints and stem cells are capable of becoming new soft.
GLORIA: New kinds of cells?
DR. BILL: New kinds of cells or real hard reliable cells like you want in a bone or in a neuron. And so, that’s what makes a stem cell – the ability to do those two things – make new copies and change from the type of cell it is to a different type of cell.
GLORIA: Wow. That’s incredible. And we all have this within our bodies, right?
DR. BILL: We all have stem cells and most of the healing that we do, when you cut your finger, it’s a stem cell doing the healing.
GLORIA: So, you’re doing some fabulous things here with stem cells and you’ve got a number of patients who are undergoing stem cell therapy to help them with joints that perhaps might need replacing or neuropathy and all of that.
How do you get stem cells and how do you put them where you need them?
DR. BILL: Well, a lot of the controversy over stem cells comes from where we get them because all the original work done with stem cells was done with embryonic stem cells and, in order to get embryonic stem cells, you have to get an embryo and there’s a lot of controversy there and rightfully so because we’re taking cells that could, if left alone, become a new individual human being and then using them to the benefit of others. And so, there is some real controversy. It’s very limited research being done here in the United States and really even across the Western world – a very limited amount of embryonic cell work is being done.
We can also get stem cells from cord blood. Stem cells from cord blood are limited by two things – (1) there aren’t a lot. If you empty a single umbilical cord, you can get 20,000 to 30,000 stem cells and that’s not very many, and they are a little bit attuned to that individual and his relative so there is a little bit of risk of using an unrelated donor of having a reaction.
The two areas that are used in the United States for getting stem cells for use are the blood and bone marrow which many people have heard of bone marrow transplants.
GLORIA: Of course.
DR. BILL: It’s really a stem cell transplant. We’re taking stem cells that are of blood origin and using them as stem cells to go to another individual to rebuild their ability to make blood. That and the other commonly used source of stem cells in the United States is your fat, and fat is becoming increasingly popular because there’s more stem cells in fat than in any given amount of blood and it’s easy to harvest. Most of us have enough of it to spare and it is a type of stem cell that maintains the numbers of stem cells as we age. Our bone marrow has a tendency to drop off pretty dramatically the amount of cells that are stem cells in the bone marrow wherein, the fat, it appears that the number of stem cells is pretty constant well into our 80s.
GLORIA: Wow! So, what’s inside the stem cell? Are there growth factors?
DR. BILL: The stem cell has the ability to go back on the clock and reactivate parts of its DNA. If you think of, for instance we’ll talk about a fat cell because that’s where we’re doing most of our work. We have a stem cell from fat – also known as a preadipocyte, just the name – and it has the ability to easily become a new fat cell. But we can also turn the clock back on a little bit and we know that this cell is capable of becoming a muscle cell, it’s capable of becoming a skin cell, it is capable of becoming a corneal cell, it is capable of becoming a heart muscle cell, a neuron. It looks like it’s capable of becoming a liver cell. It looks like we can take a fat stem cell and, from that, generate any kind of cell the body wants.
Now, we know that’s true for embryonic cells because the embryonic cells are going to become all of our cells. So, all we’re doing is turning back that embryonic clock on the adult cell to tell it, “Okay, back up, we need you to go back in your development to a time earlier and then become a mature cell in another place.”
GLORIA: And you’re harvesting this from the fat. How do the stem cells work in the healing process?
DR. BILL: Well, what we’ll do is take a little bit of fat that we harvest under a local anesthetic and we process that here in the office. It takes about an hour and a half to free the stem cells out of the fat. Then, we can utilize that in a number of ways to let it back into the body in a way to deliver it where there are no stem cells to do a job.
GLORIA: When you say “to do a job,” that means heal.
DR. BILL: To do healing, that’s correct.
GLORIA: The patients I saw earlier, one had neuropathy and the other one was a candidate for knee replacement. They’re both doing very well.
DR. BILL: They’re both doing very well. We’re actually working now with the FDA to get FDA approval for this process on knees because we’ve had such a broad, good experience with patients that have been recommended to have knee replacement instead have stem cell injection into the knee and now no longer require knee replacement.
GLORIA: Yeah, and both of them said it was not very painful at all.
DR. BILL: No, it’s a pretty simple process.
GLORIA: Wow. And so, where did all this come from?
DR. BILL: The work has been going on in the United States since the mid-1980’s. The original work started even earlier in the 50’s and 60’s when the government started understanding that, if we were going to have a nuclear war, we’d have to learn how to survive radiation poisoning and the only thing that would allow us to survive radiation poisoning was understanding stem cells and they’re ability to repopulate our blood and intestines, the linings that were lost from being exposed to radiation. That was really the genesis of the early studies in stem cells.
GLORIA: Wow, that’s unbelievable!
Now, you mentioned using these stem cells and that the stem cells in the bone marrow basically become more scarce the older you get, right?
DR. BILL: Yeah, the older you are, the smaller percentage of cells remaining in the marrow are stem cells.
GLORIA: When we’re talking about bone marrow stem cells, do we have a finite amount?
DR. BILL: Well, one of the characteristics of a stem cell is it can make new cells so it’s never a finite amount. As long as you have one stem cell, you can make more. When we’re talking about harvesting them, however, there’s only a certain number of cells that you can harvest from putting a needle in the area and pulling back with suction. As we age, a smaller and smaller percentage of those cells are actually stem cells. Fat, on the other hand, when you do the same thing and pull back on the fat and get fat cells into the syringe, it is a fairly constant amount of cells that remain in the form of the stem cells.
GLORIA: How did this discovery come about?
DR. BILL: The early work, again, was done at looking at ways to repopulate the bone marrow. In the 1980’s, after Nixon’s war on leukemia in the 70’s, it looked like one of the answers to leukemia would be to wipe out a person’s bone marrow because that would destroy leukemic cells. But then, you had a problem of they couldn’t survive without their bone marrow and that’s when the first transplants started being done early on without even a good understanding of it. It was only the stem cell portion of what was being transplanted that mattered. As it’s become more and more sophisticated, it’s more and more just the stem cell portion that are transplanted.
GLORIA: Now, injected in a knee, say, is it like super glue?
DR. BILL: It’s a liquid. The cells themselves would be just like individual cells. They’re very microscopic and we will have 100 million stem cells in 10 ccs and it looks clear because even 100 million cells is microscopically very, very tiny. So, we suspend it in salt water and normal saline and that allows us to keep the stem cells alive and gives us a medium by which we can put it in the knee or put it in an IV or inject it into a tissue.
GLORIA: And those are all the ways that you deploy it?
DR. BILL: Right now, that’s the main way we’re deploying it. We’re working on deployments and one of the more exciting ones is for neurologic patients. We’re in the pilot study in California of putting a port that goes into the hemispheres of the brain and allows stem cells to be injected directly into the cerebral spinal fluid in the same way as a person that has chemotherapy will have an IV that sits under their skin for getting their chemo – same with the port.
GLORIA: Now, the brain is a place that doesn’t readily have a lot of stem cells.
DR. BILL: The brain usually has none and that’s one of the reasons why diseases like Parkinson’s disease or multiple sclerosis tend to be progressive over time because, once the damage is done, our body has minimal ability to come back and heal that damage.
GLORIA: Or regenerate.
DR. BILL: Or regenerate, that’s correct.
GLORIA: Wow. Like, stem cells, that’s what they’re doing, basically.
DR. BILL: That’s basically what we’re doing.
GLORIA: They’re regenerating themselves into whatever cell you need.
DR. BILL: And so, when we put them in, right now, we’re putting just the stem cells themselves into the brain but you can foresee a day when we would actually pre-treat them and say, “Okay, go be neurons,” or even get more sophisticated because you’d go and tell them to be dopamine-producing neurons.
GLORIA: Now, just out of curiosity, when you inject it in the knee, how does the stem cell know what’s needed?
DR. BILL: That’s a very good question. We have excellent evidence that stem cells grow where growth factors call them. Growth factors are the chemical messengers that our body cells use to talk to each other. So, if I cut my finger, the way the rest of my body knows the finger is cut is those growth factors that are released. Those growth factors in my cut skin example call in platelets to stop the bleeding, they call in white blood cells to chew up the damage and any infectious material, and they call in stem cells and activate stem cells that are in the area to grow new skin cells to heal the damage. If I have a knee, on the other hand, ligaments really can’t heal. They have no growth factors. They have no stem cells; they have minimal ability to heal themselves. The cartilage has minimal ability to heal themselves and the cartilage has no blood flow. It’s nourished from the fluid around it so it’s very difficult for stem cells to get there. So, when we are doing a knee, we’re injecting stem cells directly into the knee where it can intermix with the ligaments intermixed directly with the cartilage and it’s a mechanism of delivering your own healing ability in a place where your body normally can’t deliver it.
GLORIA: Okay. So, there’s ligaments and cartilage and all of that have no stem cells or very little.
DR. BILL: Very little.
GLORIA: Once you introduce and deploy your own stem cells to this location, does it trigger all this other chain reaction that you’re talking about?
DR. BILL: We are now seeing that we’re starting to have really good indirect and some direct evidence meaning indirect evidence would be x-rays, MRIs that cartilage is re-growing in response to stem cells; direct evidence would be autopsy or surgical evidence when you go in and actually see new cartilage in the knee. So, for obvious reasons, there’s not a lot of direct evidence but there is a lot and an increasing amount of indirect evidence that we are growing new cartilage.
The veterinarian world is way ahead of us in this, by the way, because they don’t have a lot of the FDA restriction.
GLORIA: So, yeah, we’re talking about injecting knees and it appears, because these cartilage and ligaments can’t rebuild themselves, they don’t have stem cells, you’re seeing some evidence that, once you introduce or deploy the stem cells, that not only does it heal but it rebuilds that ligament.
DR. BILL: We’re having a lot of indirect evidence in humans but the vet world is way ahead of us because they don’t have FDA restrictions and they can do things on animals that we would consider unethical in humans.
A great story is one of the British equestrian teams. The horse injured its ankle, tore a ligament in its ankle in February before the September 2012 Olympics and they said they wanted to put the horse down. The rider said she could get another trained in time for the Olympics so they sought another vet and said, “Well, we can try to harvest its fat and use some stem cells.” So, they did basically the same process we’re doing in humans. They harvested that horse’s fat, got the stem cells, injected it in the ligament. The ligament regrew, healed itself, and the horse went ahead and they got the bronze in the 2012 Olympics. So, we have direct evidence in mammals that this can regrow cartilage, it can regrow and heal ligaments and tendons in animals that that’s not part of what they naturally can heal.
GLORIA: So, right now, here in your office, what kind of disorders are you using the stem cell?
DR. BILL: What we’re way head on now are arthritis because in osteoarthritis, knees, hips, shoulders, elbows, wrists, we’re really seeing really nice results and getting to the point of having enough data where we can feel fairly confident recommending this to people. We’re also treating a lot of emphysema patients, COPD patients – not as solid evidence yet. We just don’t have as much of a database and we’re seeing a lot of folks that have a really nice response and others that are not as good a response. So, we know we’re moving in the right direction because, being an intern having treated emphysema patients many years, it’s a very frustrating thing because there’s nothing you can do for the underlying disorder and this is the first treatment out there that speaks to the underlying disorder.
We’re treating a lot of neurologic diseases, doing really well with neuropathies – painful neuropathies, especially ones that are what is classically called the idiopathic group that we don’t know what caused the neuropathy. Historically, those have been really hard to do anything for and now, with stem cells, we’re making a real difference so we’ve got some folks that are pain-free for the first time in years after their stem cell deployments.
We’re doing a lot of other neurologic conditions. We’re doing post-stroke and trying to see some improvements for post-stroke.
GLORIA: In what way?
DR. BILL: The folks that we’ve seen have seen increased mobility and decreased spasticity in their stroke area. Overseas where they’re more aggressive, there are some remarkable stroke recoveries from stem cell treatments.
We’re doing some work with ALS and MS. We’re doing work with spinal cord injuries and started seeing some results there. We’re even starting to play with some patients with anoxic brain injuries – people that have had injuries where they had brain damage – and seen some help with those as well.
So, I think we’re just at the beginning of what’s going to be a true revolution in what we can treat. We’re doing a lot of work with neurologic disorders like male erectile dysfunction.
GLORIA: I saw that in your notes.
DR. BILL: And Peyronie’s disease which is a disorder where the penis has a curve to it and can be quite uncomfortable. We’re having some real good treatments with that.
We’re having some good work with interstitial cystitis which can be a debilitating condition for men and women that have it. We’re doing some good work with heart disease and, actually, some of my first interest was in heart disease and seeing people have real improvement in their heart failure with doing stem cells.
GLORIA: Well, obviously, there’s a procedure and, from what I’ve heard from your own patients, it’s not that scary and painful. No pain, in fact – both of them said. So, in a moment, we’ll talk about how you go about doing this.
DR. BILL: Sounds good.
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