Читать книгу The Stem Cell Cure - Kerry Johnson MBA PhD - Страница 10

CHAPTER 1

Welcome to the World of Stem Cells

The entire human body is a collection of cells; our cells are the fundamental unit of our life.

The Basics

We all start our journey as a single cell. This cell then specializes into different types of cells, which further develop into different organs. As we mature, our cells continue to multiply and replace themselves throughout our lifetime. The basic cells that make all of this possible are called “stem cells.”

Stem cells are an integral part of all our organ systems and practically govern our health, disease, and aging. Application of stem cells in the treatment of disease and injury is called “stem cell therapy.”

While our knowledge of disease and injury has improved over the past two decades, mainly due to sophisticated imaging techniques, our treatment methods have remained rather primitive.

Just as the resolution of your phone screen is dependent on the health of the pixels constituting it, your daily life depends on how well your cells are functioning. How your cells respond to disease and injury determines the symptoms you feel. Unless there is healing at the cell level, you are unlikely to feel better. Medications and surgeries, in most cases, have completely bypassed this scientific truth. While they may have a role to play in certain conditions, we have to focus on healing our bodies by healing our cells.

With this brief understanding, let’s answer some commonly asked questions (largely derived from patient consultations) you or your friends and family may have!

1. What are stem cells?

Stem cells are the basic cells that develop and differentiate into different organ cell types. Once our organ systems have matured, stem cells replace old dying cells with new ones throughout the course of our life.

2. What is the role of stem cells?

Cells within every organ of your body have their own life cycle. Stem cells replace those cells. This process is happening 24/7 in your life until your very last moment.

3. Why are stem cells important?

Stem cells make life sustainable. By constantly turning over and replacing old cells with new cells, stem cells make sure our bodies are functioning optimally. They maintain health. When disease or injury strikes your body, your stem cells remove damaged cells and replace them with new cells. This helps your body heal itself and you continue to function.

4. If my body is full of stem cells, why do I need help when I suffer from disease or injury?

Depending on the severity of your condition, your own stem cells may not be able to heal the damage on their own. When the condition is severe and damage is significant, your stem cells need extra help. That extra help so far has been in the form of drugs or surgery.

5. What is stem cell therapy?

If you have a significant disease or injury that your body cannot heal on its own, help is needed. Additional stem cells given to boost your local cells may potentially help you heal. That help (when more stem cells are introduced at the site of disease and injury in an attempt to heal) is called “stem cell therapy.”

6. What are the different types of stem cells?

There are many different types of stem cells. Each specialized organ has its own stem cells that help regenerate and repair local cells specific to that organ system. We are still learning about the different populations of stem cells and their functions. The most commonly studied cells are the mesenchymal stem cells found in most of our organ systems. These tend to reside along the blood vessels. Bone marrow, muscle, pancreas, liver, lung, kidney, fat, dental pulp, and joint lining (synovium) are some of the organs rich in mesenchymal stem cells.

7. What are the different sources of stem cells?

There are many different sources of stem cells. The main categories are your own stem cells (autologous) versus stem cells belonging to another individual (foreign). At any stage of your life, you carry your own stem cells. As an adult, your own body carries stem cells in virtually all your organ systems. These stem cells can be harvested from your own body. Stem cells can also be harvested from another person’s body at any stage of that person’s life. The most common sources are from babies such as embryonic stem cells (pure embryonic stem cells are banned and may involve sacrifice of life). Other sources commercially available are amniotic fluid (fluid surrounding the baby in the mother’s womb), the placenta (the site where the baby is attached to the mother in the womb), and the umbilical cord (the cord that attaches the baby to the mother). These are all sources foreign to your body since they belong to another individual. The big concern with foreign stem cells is whether your body will accept or reject them. Their ability to mount an immune reaction and cause other long-term side effects is largely unknown and poorly understood.

8. I am old; are my stem cells ineffective?

There is good news here. Your stem cells do not age at the same rate as your regular cells. Research has shown that a healthy lifestyle can help maintain the potency of your own stem cells. Your own stem cells can be very effective in tissue repair and regeneration despite your age. Studies have shown that we can slow down the aging process by watching the amount of food we eat, doing regular exercise, and managing stress. Having healthy habits makes your own stem cells stronger. This will help if you ever need them. Despite aging, currently your own stem cells are still your best bet when it comes to treatment. Your own cells can be harvested in large numbers, and they can be delivered fresh back into your body. So both the cell count and the number of live cells from your own source are much higher than most foreign sources can provide.

9. What conditions can be treated with stem cells?

Current stem cell treatments have limited application in athletes and others with sports-related injuries, joint pain, or back pain. Treatments for heart failure, lupus, scleroderma, MS, stroke, macular degeneration, and autism are being offered to selected patients in clinical trials at academic centers. Additional specific stem cells required in conditions such as diabetes, kidney failure, Parkinson’s, ALS, lung disease, and several others are in the process of being developed. When it comes to stem cell treatments, “one type does not fit all.” Many conditions will require their own types of stem cells and their own treatment protocols. This can get very confusing very quickly. If there is no good mainstream treatment option for your condition, you should explore whether stem cell therapy can benefit you. However, beware of the snake oil salesman. Plenty of clinics advertise and claim they have stem cell treatments for various conditions, but there is no proof that the treatments work.

10. Are there conditions where stem cells may not be helpful?

Even though we would like to think of stem cells as the holy grail of medicine, they have their limitations. At such an early stage of stem cell knowledge, we are still trying to grasp their full potential. Also we have little understanding of their limitations. Our current understanding is that stem cells can help regenerate and repair your damaged cells. They are not going to fundamentally alter why you suffered from the disease in the first place. Clearly there are certain genetic or congenital conditions in which stem cells may not have a significant role to play. Future treatments such as gene therapy are investigating why some of us are more likely to suffer from a particular condition than others.

11. How are stem cells prepared for treatment?

A lot depends on the source. If they are your own stem cells, they can be harvested or collected from your body by doing a minor procedure. The next step is breaking your tissue down to filter out your own stem cells. They are then ready to be put back into your body. This entire process can be done in the same day at the same sitting. You have the ability to utilize your own fresh stem cells the same day. Alternatively your tissues can be collected and then sent to a laboratory for isolation. Sometimes this involves expansion and or programming of your own stem cells. Your own stem cells are then administered to you at a later date.

Stem cells from foreign sources (those obtained from sources other than your own body) are collected from another individual. This could be from a baby or even another adult. Stem cells acquired from foreign sources require laboratory processing, cleaning, and sometimes expansion and/or programming. Foreign stem cells are frozen in storage until needed for your treatment. Laboratory processing of foreign stem cells should be properly performed in order to minimize the risk of introducing any new disease into your body. Laboratory processing can kill many cells. The steps involved are critical to have enough live cells for an effective treatment.

12. How are my own stem cells collected from my body?

Every part of your body, every organ system, possesses stem cells. You can get your own stem cells from any part of your body. However, the goal is to collect them safely in a way that does not harm your body. Commonly used sites to collect your own stem cells are bone marrow, fat, muscle, tendon, dental pulp, lining of your joints (synovium), skin, and liver. It is hoped that in the near future many more sites will serve as a safe source of collection. Surprisingly, your blood does not contain stem cells. It is a good source of platelets (platelet-rich plasma or PRP) but not stem cells.

13. How are stem cells delivered into my body?

It depends on the intended site of delivery of stem cells, which in turn depends on the condition being treated. Precise delivery of stem cells at the site of disease and injury in your body is critically important in order for you to see results. Stem cells regenerate and repair. Although they secrete valuable growth factors, unless they make it to the site of damage, you are unlikely to see robust results. Currently most stem cells have to be delivered through a targeted injection using very small needles under imaging guidance such as ultrasound or X-rays, videoscope, blood flow, or a direct injection. The important goal is that a sufficient number of live stem cells reach areas where help is needed. Other potential routes such as intravenous, intranasal, intra-arterial, intrathecal (CSF), and inhalational are important to consider. The efficacy and the safety of each one of these routes are still being evaluated in clinical trials.

14. What are the potential risks of stem cell therapy?

Again, it depends upon what kind of stem cells you are getting and how the stem cells are delivered into your body. Your own stem cells carry the least risk. Any manipulation of stem cells in a laboratory or foreign source of stem cells can carry the risk of infection, disease transmission, rejection, and tumor formation. Delivery methods themselves can cause bleeding and additional trauma, although collateral damage is minimal when small needles are used.

15. How many stem cells do I need? Is there a specific number?

Not yet! Unlike the dosage of medications, the exact number of stem cells needed to treat a particular condition in a particular patient is yet unknown. Clearly the greater the extent and severity of damage, the more stem cells that would be needed. No matter what, it would be unreasonable to expect that a single treatment or injection will cure your condition completely. This also depends on how healthy you are otherwise. Several factors may play a role in determining the number of cells and/or number of stem cell treatments you may need.

16. Besides the number of cells, what else is important in a stem cell treatment?

Viability—how many stem cells are alive at the time of your treatment. You can have a high total cell count, but if a significant number of stem cells are dead, you may not see results. This is especially important when a foreign source of stem cells is being used or if the stem cells are being processed in the laboratory. Whenever laboratory processing and cleaning are involved, a certain number of stem cells are bound to be lost. How many live stem cells you get at the time of treatment is important. Another important aspect is the quality of the stem cells. Testing can determine their quality. The hope is that we will also be able to detect any changes in the structure of stem cells and predict how they will behave in your body. The count, quality, and structure of stem cells are all important criteria in minimizing risks and predicting a desired outcome.

17. How many stem cell treatments will I need?

It comes down to what your condition is and how much help your local cells need. For example, an 18-year-old kid playing basketball and suffering his first knee injury is going to heal very differently compared with a 60-year-old skier who has suffered a knee injury and has endured multiple previous knee surgeries. Furthermore, those 60-year-old skiers with similar multiple prior knee injuries and surgeries will heal differently from each other. We are just starting to learn how our cells behave and why patients don’t heal the same way. How your stem cell treatment was performed will also determine how many treatments you will need. There are many variables that can affect the efficacy of a stem cell treatment.

18. What is the success rate with stem cell treatment?

This depends on your condition, the source of the stem cells, and the way they are delivered. There are so many different ways of doing stem cell treatments that there can be no apples-to-apples comparison. At least not yet. Due to a lack of standardization, the results are varied. When the treatments are performed correctly for the right reasons, success rates can be around 60% to 70% for joint pain, back pain, and sports injuries. For other conditions, very little is known about how effective the treatments will be. Ongoing research will provide answers in the near future.

19. Why don’t some patients see results after stem cell therapy?

No single treatment of any kind is effective in all patients with the same condition. We believe the same is true of stem cell therapy. Our hope is that, in time, as more knowledge is gained, the failures will be minimal. We already know that there is a small group of patients who do not respond to stem cell therapy no matter what. The cause is unknown. But the answer could be genetic in nature.

If all other factors remain the same, outcomes from any procedure depend on three factors:

• Your general health, both physical and mental

• Your environment

• Your genetic makeup

While we don’t have much control over the latter, we can do a lot to benefit the first two. Our body’s capacity to heal from most conditions is dependent on how healthy we are. With similar conditions, two patients undergoing the same procedure using a physician possessing excellent technical skills can have very different outcomes. Medical treatments aid your body in healing. But ultimate healing takes place from within. No treatment can work unless your body and mind have the ability to heal. With so much emphasis on physical appearance, we have forgotten that the mind controls the body. Thoughts become actions. Our actions in turn determine our life. Everything that makes up the environment we live in, starting with the air we breathe, to the people that surround us, has an impact on our ability to heal.

20. Are stem cell treatments approved by the FDA?

Not yet. With so many different treatments under the “stem cell” umbrella, it has become difficult for any regulation to be formulated. Governments, providers, and commercial suppliers are equally to blame. There is a lack of understanding of the science of stem cells, especially the power of your own stem cells. Some providers manipulate desperate patients. Commercial suppliers are hungry for profits. Many have taken advantage of suffering patients. Many patients are getting fake stem cell treatments or denied a stem cell therapy that could have greatly helped. Either way, many patients end up paying a price. Unfortunately, ignorance and greed often overtake science.

21. Does insurance cover stem cell treatments?

Not yet. Some commercial manufacturers and clinical practices may offer insurance coverage. Generally this is through manipulation of a billing code that may be fraudulent. Unfortunately insurance companies are tied to government regulation. Yet insurance providers have a wonderful opportunity to conduct their own internal studies between patients receiving mainstream treatments and those undergoing recognized forms of stem cell therapy. Isn’t the purpose of your health insurance to offer you the best possible treatment?

22. How much does it cost for stem cell treatment?

The overall cost depends on the condition that is being treated, the source of the cells being used, and the number of treatments involved. The average cost of a treatment, for example, in a patient with joint pain is between $2,000 and $8,000 per stem cell treatment. We also hear numbers as high as $15,000 to $20,000 per treatment. This wide variation in cost tells us that stem cell therapy is all over the place. There are several ways of doing the treatment. Greed complicates things further. So beware! The lack of standardization makes it difficult to compare results. Further, none of these treatments or protocols have been approved. Published data are sketchy, and robust studies are lacking. We recommend that you look into clinical trials at academic centers. Google should not be your only source when it comes to stem cell treatments!

We hope that these questions and answers satisfied some of your curiosity. And also that you will have even more questions that we can address. That will be the true success of this endeavor. To further your understanding, let’s look at some clinical case reports.

CASE STUDY: NICOLE

Nicole, a 19-year-old college freshman, was riding on the back of her boyfriend’s motorcycle. They were headed to the dorm returning from a late-night party. As they merged onto the freeway, an out-of-control pickup truck hit them. Nicole was ejected into the air, hitting a utility pole. No drugs or alcohol were involved. Nicole became paralyzed from the neck down suffering a severe spinal cord injury. A life brimming with hope came to a halt. A day earlier, she could eat, bathe, dress, text, play, and engage in all the normal activities any other teenager could do. That ended. The psychological and emotional impact on both Nicole and her family was profound. Her younger brother was having a hard time coming to terms with her injury and hospitalization.

Luckily for Nicole, she gained access to a recently developed clinical trial. Stem cells had recently been programmed to grow into nerve cells. They could successfully be implanted into her damaged spinal cord.

Nicole underwent the new treatment. Over the next few weeks, she regained motion in her arms and hands. For the first time in months, she was able to write and even use her phone. This was a huge recovery. Only time will tell whether this was spontaneous. Did she actually benefit from the experimental stem cell therapy, or was it just luck?

Cases like this create faith in the power of stem cells. Although such treatments are now limited to just a handful of patients enrolled in high-powered clinical trials, there is tremendous hope for the future.

CASE STUDY: SEAN

Sean was a rising high school football star. He was recruited by a very successful college football program while in 12th grade. He was hoping to eventually transition to the pros. Sean suffered an injury to his knee causing a complete ACL tear with associated meniscal and ligamentous injuries.

It is not uncommon for the knee to suffer extensive damage when an ACL is completely torn. As Sean lay on the field with his leg twisted, his professional career hopes faded. Despite surgical repair and a robust rehab, Sean was unable to play football at the same level. He needed prolonged rest to recover, ruining his chances of landing in the pros. Having a profound love for the game, he now focused his energies on developing younger players. A couple of years out of college, Sean became the head coach at his alma mater high school. He was ecstatic about his new position and looked forward to being a good coach.

Now barely 36, and approximately 17 years after his original surgery, Sean began to notice pain in his treated knee, which progressively became worse. He especially felt discomfort after he ran drills with his players. The pain became persistent. It interfered with his daily life and job. He had always stayed in great shape. There was never any drug or steroid use. But now the pain was unbearable. Since Sean’s meniscus was torn and removed at the time of his ACL repair, he did not have much space left between his bones. He would need a knee replacement.

Sean was in the middle of rebuilding his career. Now the thought of undergoing such a major surgery frightened the hell out of him. He had a two-year-old daughter at home. With surgery, there are risks of blood clots, infections, and even future revision surgeries. Sean wanted to save his knee. He shied away from cortisone and gel injections that offered temporary relief. Sean started looking for alternative options. He was able to discover the promise of stem cell therapy. His own stem cells could be drawn from his tissues, and the procedure would be done on the same day at the same sitting.

After his own stem cells were separated, they were injected into his knee. Within the next few weeks, Sean noticed a significant reduction in pain that gradually improved mobility. After the therapy, he was able to get back to his coaching duties without pain meds. He continued to improve. Sean will possibly require additional treatments as time goes by. But he successfully avoided the debilitations of surgery.

These two case histories lay out the current scientific possibilities. However, keep in mind that the term “stem cells” has become a fad. As we noted earlier, it is the latest pitch among snake oil salesmen. It is important to ignore the hype. This craze encompasses a host of treatments, some of which may not even involve true stem cells. The only connection is that they are loosely labeled stem cells. These fad treatments often lead to poor outcomes, unwanted side effects, and complications.

Using fresh stem cells from your own body is a procedure that has been around for more than a decade. It has primarily gained popularity in Europe and Japan. Stem cell treatment is now being performed in some shape or form all over the world. A significant amount of published data have supported many of these treatments. But due to a lack of standardized protocols, these treatment methods have not yet been approved by the FDA and are not currently covered by health insurance. We firmly believe that stem cells will be a major treatment tool in the near future. This book will help separate fact from fiction.

WHAT TO EXPECT

The field of stem cell research is evolving. Different perspectives and ideologies exist. The current lack of standardization further complicates understanding. We hope that the knowledge shared in subsequent chapters will provide a fertile ground to build on. This in turn will help you to make better decisions when seeking stem cell treatment either for yourself or for your loved ones and to become more aware of its potential.