For Those
Considering Doing Stem Cell Therapy Abroad
By
Dr. Anthony G. Payne
If you do a
Google search using “stem cell clinic”, you’ll come up with 5,730
websites (This and other searches done on August 24, 2008)
“stem cell treatment” -- 154,000 websites
"adult stem cell therapy" –69,100 websites
Only a
fraction of these listings are actual facilities offering some form of stem
cell therapy, but even so how does one figure out who is on the up-and-up? That
is, who is offering legitimate, safe forms of stem cell therapy, if any? And for which diseases or
conditions do the various kinds of stem cells being offered actually work, if any?
Critics,
skeptics, and many others are often quite strident in their denunciation of
just about every private, commercial outfit that offers stem cell treatments
– be it fetal cell, umbilical cord, or other adult stem cells. Many
academicians and university-based stem cell researchers in the US dismiss
reports of stellar clinical benefits in patients treated by private foreign
stem cell clinics or hospitals as being ”scams”,
“frauds” or the like.
Most argue that no one should be seeking out such treatments, at least
not outside of formal, government sanctioned clinical trials.
With regard
to the “scam” aspect, I would ask readers to keep this in mind
(This is a quote from an article by “yours truly” that concerns the
almost knee-jerk negative reaction of many stem cell experts to the ongoing
cord blood stem cell work of Fernando Ramirez Del Rio, M.D. in Mexico. The
entire article can be accessed by clicking this link: Is Something Amiss?)
In the world of
biomedicine, the question of whether a particular drug or procedure is
effective or not is settled in the arena of science – namely, well
designed and executed clinical studies. One doesn’t dismiss a treatment
or procedure that has a rational foundation (i.e., doesn’t violate
established scientific laws or principles) a
priori – which is to say, before conducting tests. But this has been
exactly what many experts in stem cell biology have done when it comes to the
observations and data collected and reported by SRI. Rather than suggest the
need for controlled studies to determine whether or not the clinically
significant improvements reported in scores of patients treated with purified
cord blood stem cells in Mexico for non-blood maladies pan out, many of these
scientists have dismissed the entire treatment as “a scam”.
This is not the
kind or degree of informed open-mindedness one would expect of highly placed
researchers in major institutes and universities.
Of course,
people with conditions or health challenges that can be managed, ameliorated or
such using extant standard medicines or therapies should steer clear of exotic,
experimental or unproved treatments, drugs, therapies or such. But what about
those wrestling with an intractable or terminal condition like ALS (Lou
Gehrig’s), metastatic cancer, end stage kidney disease,
Alzheimer’s, or the like? People for whom waiting to participate in
future clinical trials or to be treated with stem cell therapies approved in
the wake of such trials is not reasonable, as some will die long before their
particular malady has a scientifically proven method of treatment that will
slow or abort their descent? And while many of the intractably ill may not die,
they may be faced with a narrow biological window of opportunity for
improvement that will close if something isn’t done in the near-term. To wait might mean that what could have
been improved today, will be beyond remediation in a few months or years. Is it unreasonable or irrational for
them to reach out and embrace an experimental treatment or therapy (Provided it
has a rational basis – which is to say doesn’t violate known laws
of physics or chemistry, has already been disproved, or carries more risk than
benefit)?
I think not.
This creates
a perplexing, sometimes gut-retching situation in which the medical consumer
– the patient – or his caregivers – must sort through
treatments and clinics and come up with “a safe, best bet”. Even highly intelligent, educated
professionals who are artful in the use of logic and critical thinking can wind
up uncertain, confused, or even overwhelmed.
Are there
any guidelines that can help determine which stem cell therapy providers are
offering safe, substantively effective or at least promising treatments?
There are.
Disclosure
I am not a
stem cell expert or biologist, but rather a theoretician. In short, I spin
hypotheses and create inventions geared to improve human health or otherwise
benefit folks. But this said I have been involved in stem cell therapy as an
observer, a gatherer of patient responses, and a communicator of what
I’ve learned along the way (I coauthored Umbilical Cord Stem Cell
Therapy). From March 2003 to June 2007, I was resident theorist and
senior science writer with the Steenblock Research
Institute. SRI, in turn, was retained by Fernando Ramirez Del Rio, M.D. to
gather information on patients treated with adult stem cells at his clinic in
Mexico, generate papers and such concerning our findings, introduce innovative
treatment approaches, and talk with people considering undergoing treatment at
his facility. I left SRI at the end of June 2007 to join Weller Health
Institute. While I remain a technical consultant to Dr. Ramirez, a great deal
of my time is devoted to nutraceutical development
and promotion, creation of new health-related technologies and products, and
generation of hypotheses concerning novel ways to advance the human condition.
With this
background in mind – which yes, surely means I am not free of biases or
blind spots – I will now offer some of the ways medical consumers in need
of stem cell therapy can go about
whether a particular facility or treatment provides safe and effective
(or at least suitably promising) stem cell treatments. Mind you, this set of
guidelines and pointers is not slanted towards any particular clinic, hospital,
research center, doctor or group. In fact, I will not list a single facility or
stem cell provider by name. Instead, I will try to provide readers with a
fairly sturdy fishing pole and leave it to you to do the fishing.
Most of what
I have to share is informed by simple, good sense, critical thinking principles
widely articulated and embraced by skeptics and consumer advocate groups
everywhere on the Internet. A few of my pointers are derived from my own
experiences and insights gained from “being in the trenches” and
are thus unique to having “insider knowledge.”
Sorting Wheat from Chaff
Stem Cell
Types Used by Most Private Stem Cell Treatment Facilities
Private stem
cell clinics around the world by-and-large offer treatments involving adult
stem cells - typically fetal, umbilical cord stem cells, or various progenitor
or other adult stem cells taken from the patient’s peripheral circulation
or various tissues. If you are uncertain as to what is meant by the term
“stem cells” or are unacquainted with the different types, click
this link: Stem Cell Basics
Some stem cell clinics and treatment
centers provide autologous bone marrow stem cell
therapy, which in this context means bone marrow is removed from a patient and
either immediately re-infused with or without growth factors, hormones or such,
or else BM mesenchymal stem cells are separated from
a patient’s own marrow sample, are cultured and possibly treated to
differentiate (transform them into) special cell types, and then infused.
And there
are also clinics that take a person’s own stem cells from fat or other
body tissues, manipulate them in some instances so as to favor their becoming
specific cell types, and inject or infuse them for therapeutic or cosmetic
purposes (Some foreign clinics are using an automated stem cell removal system
developed by Cytori ).
I have not
mentioned use of embryonic stem cells because, to my knowledge, no private stem
cell clinic or center anywhere in the world offers genuine embryonic stem cell
therapy. Why? Embryonic stem cells can cause cancer when implanted. For
example, if you give embryonic stem cells to 10 rats, 1 of these rats will
develop a tumor celled a teratoma.
Critics
point out that most of these adult stem cells are limited as to what they will
become, meaning that (for example) a cord blood stem cell is not likely to
become a functional neuron (Unless manipulated in the lab and then infused into
the patient). However, there is evidence that some adult stem cells take cues
from the tissue milieu they engraft in and begin to assume characteristics of
their cellular neighbors. For instance, stem cell researcher, Dr. Paul R. Sanberg and his team at the University of South
Florida found that a specific type of hematopoietic cell from umbilical cord
blood “expressed nestin and doublecortin,
markers of endogenous neural progenitors” when transplanted into the
brains of rats” PMID
15048922 This finding gels with those of other animal studies.
However, it
is not even necessary for an adult stem cell that migrates (or is directly
implanted) into a diseased or injured organ to behave like the surrounding
cells in order to have a salutary effect. Many studies have shown that at least
some adult stem cells produce specific cytokines and growth factors that can
promote local repair or otherwise foster improved function PMID: 16730351.
Evidence
of Efficacy
People
looking into stem cell therapy tend (in my experience) to have an intractable
condition or an incurable one or else are a caregiver or relative or friend of
someone in that boat. This can lend folks to jump; to make decisions based on
hunches or hope informed by “Well, if that guy got better then maybe I
will too”. Desperation is surely the father of gullibility, something
that has transformed P.T. Barnum’s (or was it Joseph "Paper Collar Joe" Bessimer’s?) famous
observation that “"There's a sucker born
every minute" into both gospel and prophecy.
It’s
understandable that people find solace and hope in testimonials. Most of the
leading private stem cell clinics and treatment centers maintain websites that
“runneth over” with patient testimonials.
If you have non-familial ALS – and there are 4 case histories posted that
were written by people with non-familial ALS who did stem treatment y and saw
improvements – then isn’t that reason enough to believe you will
too?
No it
isn’t.
Consider:
How many people with non-familial ALS did the treatment and saw no response?
And of those with a positive response, to what degree were they improved and
how long did it last on average? If 4 patients out of 100 saw minor
improvements that lasted only a few months – and the treatment cost (say)
$20K – would you say the balance sheet tallies up in favor of forging
ahead and doing it?
Well, maybe I’ll be one of the
lucky four? But what if 2 of the 4 were using a novel drug or regimen prior
and/or following their treatment (Something not picked up by the treating
clinic and reported)? Or these 4
happen to have a genetic variant of ALS that lends them to experience
remissions of a sort – minor improvements that last a short time? Yes,
the treatment would be credited for improvements it would likely have not
played a role in effecting. Indeed, some therapies and drugs kick in even after
being discontinued.
Keep in mind
that in the world of science, testimonials are the weakest kind of evidence. At
best they may point to something happening or working, which might justify
doing a formal evaluation (Controlled studies). I am not arguing that they be
discounted totally, only scrutinized. Resist lending them too much credence.
And ask your stem cell clinic contact to provide some figures on their failure
rate (number & type) of treated patients with your disease or
condition. If they don’t have
this information or state that there are very few or no failures, they are
likely either dishonest, mistaken or prone to filter out failures or narrowly
define them (An all too human failing that can only be overcome by well
designed studies that minimize human failings).
In my
dealings with various stem cell operations throughout the world, I have found
most providers to be genuinely and sincerely devoted to helping people get well
or better. Most are not scientists, but typically clinicians who feel that
their particular cell therapy approach is producing tangible healing responses
with respect to certain kinds of diseases or conditions. I have heard of, but
yet to chat with or meet any stem cell clinic administrator, provider or
clinician who makes claims that are genuinely extraordinary. They appear to be
few in number. Most I’ve interacted with admit they have “their
fair share of successes and failures.”
Many of the
stem cell therapists I‘ve informally surveyed define clinical success in
nebulous terms, but at the same time appear to have a genuine dilemma when it
comes to quantifying some kinds of improvement. For example, in some patients
with neurologic issues, a single improvement – say, slightly moving a
left pinky finger that didn’t move previously – is a substantial
gain; and this even if other paralyzed limbs or body parts remain as
“dead as a doornail”.
In light of this, yes, there is a
subjective element to patient responses that makes quantification in some
instances problematic. Especially if patients with specific conditions like
chronic stroke show responses that are clinically but not statistically
significant (And then, too many can show an improvement that is difficult to
measure – say, being able to make a vowel sound they couldn’t prior
to treatment – and for which no objective changes are detected on brain
scans or such).
But, and
this is a big but, stem cell providers should be willing and able to articulate
not only their failures, but also communicate some idea of general trends. For
example, were most of the motor skill improvements in children with cerebral
palsy treated with “stem cell z” minor (in the judgment of their
parents and physical therapists or pediatricians back home)? Or major? Both? (And if both, what was
the major improvement trends overall – as well as the minor?)
Also,
ideally the stem cell provider will maintain not just a roster of “good
responders” who are willing to phone or e-mail chat with inquirers, but
also a list of “poor or non-responders” who are willing to share
their experiences or lack of same. This isn’t an unreasonable thing to
expect of clinic operators, though granted some will not have been in operation
long enough to accrue this kind of information or (in the case of those that
have) may not have many “poor or non-responders” willing to step up
to the plate. There is an element here of weighing all considerations –
being skeptical – but not necessarily to the point of tossing the baby
out with the dirty bathwater.
One other
way to get a handle on any downside of a clinic’s treatment is to search
blogs maintained by patients, consumer advocates, specific disease associations
and foundations and such. I have seen patients, for example, with ALS treated
at various clinics in China post their thoughts – pro and con – on
various ALS foundation blog sites.
Does this
sound like a lot of digging, investigating, analyzing, comparing and thinking?
Well, it is. But you’d probably do no less when it comes to buying a new
or pre-owned car, right? You’d kick the tires, check under the hood, make
sure it’s mechanically sound, check out online reviews and comments from
folks who own a similar machine, and do some price comparison shopping to boot.
So would want to put less effort into evaluating a foreign stem cell operation
than they would the purchase of an automobile?
So
we’ve considered the issue of evidence (or lack thereof) of efficacy. And
yes, again, while a consensus derived from many randomized controlled clinical
studies is what is needed to reliably determine efficacy, this kind of proof
simply does not exist yet when it comes to private stem cell operations. The
best we typically see is a pilot study or clinical experiment such as Fetal Cells Given in Ecuador
Helps Mend Hearts - 2005 that may justify further, more formal
investigation by scientists. What we see by-and-large are patient testimonials
in written and video form. There is no surefire way to reliably determine
effectiveness of a particular stem treatment for condition x from these, but
with some “due diligence” (careful research and digging and such),
it is possible to detect whether that white stuff you think you see is smoke or
dust caught in a wind gust.
Issues
Related to Safety
The first
issue with respect to safety and any kind of stem cell treatment is disease
screening. Of course, this is not an issue when it comes to use of autologous (A patient’s own) stem cells. But for allogenic cells or those that come from a donor, screening
for major infectious disease-causing microorganisms such as HIV, Hepatitis A, B
& C, cytomegalovirus, and so forth is imperative.
Most of the
private stem cell clinics I have surveyed (since 2003) are careful to provide
only cells that have been rigorously screened by a reputable independent
laboratory. Some clinics that rely on cells from an affiliated hospital get
their testing done in-house – in a lab that utilizes the very latest
& best disease screening technology.
For medical
consumers, nothing can be taken for granted. Ask for a copy of the specific lab
test results for the batch of cells you are slated to receive. You should see a
lot # that corresponds to the vial(s) or IV bags that are to be used for your
treatment. There should also be a company or department name and phone number.
Call the lab and check things out. Look up the lab or department online or in a
business or phone directory to make sure the address and/or phone # on your lab
results matches that of the contact information in the directory listing.
Keep in mind
that some foreign stem cell clinics get their cells from an in-house lab or
independent one that imports cord blood or fetal material that was disease
screened in the exporting country. For example, clinic X in Mexico gets their
cord blood stem cells from disease-screened cord blood that’s imported
into Mexico from America and processed in an in-house, but FDA standards
compliant lab. In this instance, the clinic or its affiliated lab should be
able to show the US disease screening certification that accompanied the UC
blood that was used to produce the cells that will be used to treat a given
patient.
Naturally,
legitimate stem cell clinics and treatment centers are concerned about the
quality of care they provide their patients. In this day of ultra-quick
dissemination of information on the Internet, it doesn’t take long for a
lousy clinic or provider to be exposed, cussed and discussed. This is good for
patients and their caregivers, and also for the stem cell treatment providers
too – for it helps to keep them honest. If they fall off in terms of the
quality of their therapies or care, word gets around fast and their revenue
suffers (which, in turn, would tend to get their attention and motivate them to
remedy their deficiencies). Many clinics that refuse to provide disease
screening proof to their patients wind up having this show up on Internet web
& blog sites – making it easy for browsers to learn about their
recalcitrance with a simple Google search. This alone can save time and effort
when checking out a clinic or treatment provider.
Disease
screening is one major issue. The chance of rejection (Host vs. Graft or HvG) is another – at least with respect to allogenic (non-self) cell treatments.
When it
comes to matching donor and recipient in terms of HLA compatibility, this is a
must when it comes to a cord blood transfusion. However, this said it must be
pointed out that mismatched blood given intentionally to children with leukemia
had a salutary effect, as it is reported to have had in off-label use on ALS
patients.
But what
about pure cord blood stem cells? Well, some scientists have noted that pure
cord blood stem cells have a very low immunoreactivity,
which is to say they do not appear to set off notable adverse immune reactions
in recipient animals and humans.
For example,
in one animal experiment researchers found that when human cord blood stem
cells were surgically implanted into rats with induced spinal cord injuries, no
signs of rejection cropped up.
And so far
as I can tell from the world scientific literature, pure cord blood stem cells
seem to seldom trigger Host v. Graft reactions. This gels with my own
experience in which I tracked over 500 patients treated with cord blood stem
therapy by Fernando Ramirez Del Rio, M.D. from March 2003 to June 2007 and saw
virtually no adverse reactions (Not even many, many months after treatment).
This was true of both low dose infusions (1.5 million cells), as well as high
does (40 million cells+). Those that were seen -- mostly mild rashes -- were
found to be due to a failure to remove the stem cells from the growth
factor-rich media they had been cultured in. Once the cord stem cells used by
Dr. Ramirez were removed from the growth media prior to final processing, all
such reactions ceased.
This said,
it is possible that very low level immunoreactivity
goes on and that this conceivably inhibits the activity of the stem cells or
even prompts their gradual elimination (Possibly within days or week of
infusion). A prudent precaution against this might be for stem cell therapists
to place their patients on an immunosuppressant drug such as Cyclosporine
short-term. So far as I can tell, few if any private stem cell clinics do
this.
Fetal cells taken from early stage
aborted fetuses also appear to have a very low probability of causing a Host
vs. Graft reaction. This said, the
disease screening and documentation discussed above with respect to UC-derived
stem cells applies to any sort of fetal cell therapy as well, as do
precautionary use of immunosuppressants.
NOTE: Thanks
to modern computers and image-manipulation software it is relatively easy for
people to alter or create documents (This is adroitly illustrated in the
comedic movie “Accepted”).
It stands to reason that some clinics abroad may concoct certificates of
analysis (CofA) with respect to the stem cells they
offer or the like. In light of this possibility, I recommend that folks
considering going to a specific stem cell clinic (1) contact the Department or
Ministry of Health governing same and request verification of the clinics
license to operate, verification of theCofA issuing
lab’s existence and certifications, etc. (2) Send a copy of any and all
certificates of analysis to the issuing lab and request verification (Provided
the lab is an independent one and not an in-house operation).
Issues
Related to the Treatment Provider or Chief Physician + Medical Emergencies
In some
foreign countries that allow stem cell clinics to operate legally, it is
difficult to verify practitioner credentials or standing. It is difficult, but
not impossible. When asked for a copy of their degree and license, most foreign
doctors engaged in legitimate stem cell work willing provide this by mail, FAX
or such. Some post it to their website. And when it comes to documents in an
unfamiliar foreign language, this possesses no problem as they can be readily
translated to English using any number of free online or commercially available
translation software programs.
Schools can
be checked out using UNESCO’s list of accredited institutions of higher
learning throughout the world UNESCO Worldwide School
Database Mind you, this list is not necessarily complete. If a
school doesn’t appear, check with the appropriate accreditation agency or
authority in the country in which the degree in question was issued.
Once one is
satisfied that the treating physician is indeed a duly credentialed and
licensed physician, there is the question of qualifications to do stem cell
therapy. Now, while it isn’t necessary that a physician giving fetal or
cord blood stem cells to patients be a stem cell biology expert or hematologist
or such, a background that includes training in these areas or in cell or
tissue transplantation is obviously a plus. More importantly, a treating physician
should be trained and adept at spotting problematic reactions or side effects and
dealing with them using the appropriate, standard medical drugs or other forms
of intervention. If he or she is not versed in this area of medicine, then
certainly a physician should be on-hand or on call that is. This is a
legitimate concern and should not pose a problem for the treating clinic in
terms of providing evidence that satisfies the patient and his or her
caregivers and/or family.
Seriously
ill folks traveling to a foreign country for any kind of stem cell therapy also
need to ask about and look into the availability of local emergency hospital
services. While the odds of getting hit by a sudden medical crisis may be low
in most instances, it is reassuring and prudent to know there is a well
equipped ER in the vicinity should (God forbid) an existing health challenge
head south or a new one arise unexpectedly. The availability of English fluent
or near fluent doctors is a big plus.
Issues Related to Patient Pre-Treatment
Conditioning -- “To Prep or Not To Prep”
Among the
general trends that emerged from my own involvement in tracking cord blood stem
cell recipients and in the exploration & development of pre- and post-
treatment support protocols were these: (1) The younger the patient, the better
the healing response tends to be (overall); (2) Adult patients with acute
conditions treated early on have more vigorous responses than those with
longstanding (chronic) conditions, injuries or health challenges; and (3) Older
patients, especially elderly, often showed the least impressive responses. This
appeared to be especially true of those patients who had abused their bodies
and looked and had age-related biomarkers
indicating they were much older than their chronological age.
The impact
of aging and self-abuse on physiologic responses to cell therapy isn’t
really surprising. If one is planting seeds in a field, fertile soil will
always produce a better yield than soil depleted of specific nutrients or laden
with high levels of toxic compounds or substances. In terms of older candidates
for stem cell therapy, this comes down to identifying remediable factors that
might compromise stem cell integrity or activity and reducing or eliminating as
many of them as possible (I say “remediable” because there are some
antiproliferative or cytotoxic
compounds that accumulate in tissues over time that appear difficult if not
impossible to liberate and safely remove).
This perspective informed the development of screening recommendations
and dietary & lifestyle specific for older neurologic and non-neurologic
patients by staff members including myself at SRI during 2003-5. These included
bringing patient’s diet into conformity with our evolved nature (PALEODIET), as well as testing for heavy metals
toxicity, e.g., lead, mercury, cadmium, etc. and having the patient’s
doctor deal with this.
Older patients who religiously adhered to these protocols did, on a
whole, fare better in terms of responses to cord blood stem cell therapy than
those who didn’t. However, the difference was oftentimes marginal or
weak. This was disappointing and frustrating, of course. Something more was
– and is – needed; some factor or factors that will help
systemically rejuvenate the tissue milieu so that existing (or native) stem
cells can thrive as well as any stem cells introduced exogenously.
Or were my colleagues and I at SRI wrong altogether? After all, many stem
cell clinics and center state that no special dietary changes, lifestyle
adjustments or other bodily prepping is needed to help bolster post-treatment
response.
While it is too early to say
for sure which point-of-view is right, there is now published research that
seems to favor prepping the tissue milieu. Here are two:
Microenvironment and stem
cell properties for bone-marrow derived mesenchymals
“We
discuss here how the microenvironmental cues, and the
growth factors that physiologically govern commitment and subsequent
differentiation, influence the properties of bone marrow stromal
cells and modulate their engraftment into host tissues.”
Scientists determine stem
cells' 'age'
“Researchers at the
Salk Institute for Biological Studies said a stem cell's immediate neighborhood
-- a specialized environment also known as the stem cell niche -- provides
crucial support needed for stem cell maintenance. But scientists discovered
that level of support diminishes during aging, thereby affecting stem cells'
ability to indefinitely self-renew.
You can
manipulate stem cells and propagate them in a dish but many recipients of stem
cell replacement therapies will be older individuals. If the stem cell niche
has aged, it might not be capable of supporting the transplanted stem
cells" (Assistant Professor Leanne Jones)
Of course, even if the stem cell
niche is compromised in older folks, how does one rejuvenate it or otherwise
create a more stem cell favorable environment? The dietary measures and such
cited above appear to confer some marginal benefits – perhaps
“rejuvenating” to some small degree the stem cell niche – but
this alone is insufficient. Barring development of a time machine, de-aging a
person’s bodily tissues looks to be an almost Herculean challenge. But it
isn’t insurmountable. There is, in fact, experiments in-progress at
several private and public research centers in various countries that may pave
the way for systemically “de-aging” tissues in older adults such
that the stem cell niche will indeed become more youthful.
In the meantime, the issue of
prepping or conditioning older patients using techniques and lifestyle
modifications like special diets, heavy metals testing and treatment of those
found to have a heavy metal burden (toxicity), and such boils down to a
judgment call on the part of
physicians doing stem cell therapy. To prep or condition patients prior to
stem cell therapy seems a logical, straightforward, prudent measure, but this
doesn’t mean that doctors and stem cell treatment facilities that eschew
this are wrong. Those interested in doing stem cell therapy are certainly
encouraged to learn more and discuss this with those who will provide their
particular form of stem cell therapy.
Issues
Related to Mode of Administering or Implanting Stem Cells
According to
a survey I made during 2005, most private stem cell clinics or centers treat
their stem cell patients – regardless of whether they are utilizing bone
marrow or cord blood stem cells or fetal cells – by IV drip. This places
the cells into the body’s circulatory system where they presumably travel
about until they either lodge in a tissue or organ or migrate to same in response
to specific signals generated by diseased, injured or dysfunction tissues or
organs (such as stromal derived factor-1). Dr. Paul Sanberg’s
animal studies involving cord blood stem cells indicate that these cells tend
to migrate to newly damaged tissue, whether introduced in the peripheral
vascular system or directly into the afflicted organ (His studies focused on
CNS damage such as induce strokes).
Cells
administered by IV would not, however, necessary breech the blood-brain barrier that keeps most
chemicals with a molecular weight
higher than 500 daltons out
of the brain. One way to circumvent is to open up the BBB by use of a drug such
as mannitol,
which is what some stem cell clinics do. Another and most likely surer way to
insure delivery of cells to the CNS is by direct catheter infusion or direct
surgical implant. The catheter infusion method typically involves introducing a
catheter into the femoral artery in the leg and snaking it up through the
circulatory system into the brain. Cells can also be implanted in the brain by stereotactic surgery,
a process in which a patient’s head is locked in a special apparatus,
very small holes are drilled in the patient’s skull very thin needles are
scanner guided to target, and stem cells are injected. Cells can be introduced into certain
spinal regions by direct surgical implant and intrathecal injection.
As the
saying goes, “the right tool for the right job”. For patients, say,
with a specific brain injury, this
may mean foregoing an IV approach – as this would probably result in few
cells reaching their injured tissues – and having a catheter or direct
implant done.
So far as I
have been able to ascertain, only a handful of private stem cell clinics and
centers in the world have the personnel, equipment and experience to safely
perform catheter infusion and direct implant procedures. If you happen to find
yourself or a loved one faced with needing this type of intervention, look for
a clinic that has qualified, experienced medical personnel and the proper
surgical room equipment. For example, the surgical team needed for doing a
catheter infusion typically consists of an interventional radiologist,
an anesthesiologist,
possibly a neurosurgeon, and an OR (operating room) nurse and sometimes several
other techs or nurses. The
operating room should have suitable surgical scanning equipment for guiding the
catheter through the circulatory system, a proper anesthesia set-up, vital
signs monitoring devices, and equipment for resuscitation and other emergency
intervention should a medical glitch or problem arise.
Concluding
Remarks
This look
into the issues and concerns that confront those seeking treatment with adult
stem cells abroad is obviously far from exhaustive. It is hoped, however, that
it will ably serve as a basic template or framework readers can use to help shape
their own queries into this fascinating and controversial subject.
Nota Bene: Readers are encouraged to share
their findings with me by e-mail. Those who have gone abroad for any kind of
stem, progenitor and other forms of cell
therapy are also welcome to send me their accounts – responses (if
any), impressions of their treating facility and doctor or doctors, any
problems or side effects that cropped up, and so forth. My e-mail address is biotheoretician@gmail.com
© 2008 by
Dr. Anthony G Payne. All rights reserved.
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Accreditation (Educational): Accreditation Issues -
Wikipedia Entry
“Despite the
widely recognized benefits and accountability of accreditation, some
institutions choose, for various reasons, not to participate in an
accreditation process. According to the United States Department of Education,
it is possible for postsecondary educational institutions and programs to elect
not to seek accreditation but nevertheless provide a quality postsecondary
education.”
Anti-rejection drugs: Anti-rejection drugs
Biomarkers of aging: Biomarkers of Aging -
abstracts (Commerical Site)
Critical Thinking:
Carl Sagan's "The Demon
Haunted World" DR. CARL SAGAN - Wikipedia entry
Operation Clambake presents:
Baloney Detection Kit
The Critical Thinking
Community
Free online Critical
Thinking Test
Dr. Paul R. Sanberg’s
Cord Blood-Related Papers – Selected Sample (from PubMed)
Shytle RD, Ehrhart J, Tan
J, Vila J, Cole M, Sanberg CD, Sanberg
PR, Bickford PC.
Oxidative
stress of neural, hematopoietic, and stem cells: protection by natural
compounds.
Rejuvenation
Res. 2007 Jun;10(2):173-8.
PMID:
17518694
El-Badri NS, Hakki A, Saporta S, Liang X, Madhusodanan S, Willing AE, Sanberg
CD, Sanberg PR.
Cord
blood mesenchymal stem cells: Potential use in
neurological disorders.
Stem
Cells Dev. 2006 Aug;15(4):497-506.
PMID:
16978054
Newman MB, Willing AE, Manresa JJ, Sanberg CD, Sanberg PR.
Cytokines
produced by cultured human umbilical cord blood (HUCB) cells: implications for
brain repair.
Exp
Neurol. 2006 May;199(1):201-8. Epub 2006 May 30.
PMID:
16730351
Bickford PC, Tan J, Shytle
RD, Sanberg CD, El-Badri N,
Sanberg PR.
Nutraceuticals synergistically promote proliferation of human stem cells.
Stem
Cells Dev. 2006 Feb;15(1):118-23.
PMID:
16522169
Newcomb JD, Ajmo CT
Jr, Sanberg CD, Sanberg PR, Pennypacker KR,
Willing AE.
Timing
of cord blood treatment after experimental stroke determines therapeutic
efficacy.
Cell
Transplant. 2006;15(3):213-23.
PMID:
16719056
Human
umbilical cord blood progenitors: the potential of these hematopoietic cells to
become neural.
Stem
Cells. 2005 Nov-Dec;23(10):1560-70. Epub 2005 Aug 4.
PMID:
16081669
Anti-inflammatory
effects of human cord blood cells in a rat model of stroke.
Stem
Cells Dev. 2005 Oct;14(5):595-604.
PMID:
16305344
Newman MB, Willing AE,
Manresa JJ, Davis-Sanberg C, Sanberg
PR.
Stroke-induced
migration of human umbilical cord blood cells: time course and cytokines.
Stem
Cells Dev. 2005 Oct;14(5):576-86.
PMID:
16305342
Nan Z, Grande A, Sanberg
CD, Sanberg PR, Low WC.
Infusion
of human umbilical cord blood ameliorates neurologic deficits in rats with
hemorrhagic brain injury.
Ann
N Y Acad Sci. 2005 May;1049:84-96.
PMID:
15965109
Borlongan CV, Hadman M, Sanberg CD, Sanberg PR.
Central
nervous system entry of peripherally injected umbilical cord blood cells is not
required for neuroprotection in stroke.
Stroke.
2004 Oct;35(10):2385-9. Epub
2004 Sep 2.
PMID:
15345799
Infusion
of human umbilical cord blood cells in a rat model of stroke dose-dependently
rescues behavioral deficits and reduces infarct volume.
Stroke.
2004 Oct;35(10):2390-5. Epub 2004 Aug 19.
PMID:
15322304
Do
hematopoietic cells exposed to a neurogenic
environment mimic properties of endogenous neural precursors?
J Neurosci Res. 2004 Apr 15;76(2):244-54.
PMID:
15048922
Saporta S, Kim JJ, Willing AE, Fu ES, Davis CD, Sanberg PR.
Human
umbilical cord blood stem cells infusion in spinal cord injury: engraftment and
beneficial influence on behavior.
J Hematother Stem Cell Res. 2003 Jun;12(3):271-8.
PMID:
12857368
Garbuzova-Davis S, Willing AE, Zigova
T, Saporta S, Justen EB,
Lane JC, Hudson JE, Chen N, Davis CD, Sanberg PR.Intravenous
administration of human umbilical cord blood cells in a mouse model of
amyotrophic lateral sclerosis: distribution, migration, and differentiation.
J Hematother Stem Cell Res. 2003 Jun;12(3):255-70.
PMID: 12857367
Willing AE, Vendrame
M, Mallery J, Cassady CJ, Davis
CD, Sanchez-Ramos J, Sanberg PR.
Mobilized
peripheral blood cells administered intravenously produce functional recovery
in stroke.
Cell
Transplant. 2003;12(4):449-54.
PMID:
12911133
Lu D, Sanberg PR, Mahmood A, Li Y, Wang L, Sanchez-Ramos J, Chopp M.
Intravenous
administration of human umbilical cord blood reduces neurological deficit in
the rat after traumatic brain injury.
Cell
Transplant. 2002;11(3):275-81.
PMID:
12075993
Zigova T, Song S, Willing AE, Hudson JE, Newman MB,
Saporta S, Sanchez-Ramos J, Sanberg
PR.
Human
umbilical cord blood cells express neural antigens after transplantation into
the developing rat brain.
Cell
Transplant. 2002;11(3):265-74.
PMID:
12075992
Expression
of neural markers in human umbilical cord blood.
Exp
Neurol. 2001 Sep;171(1):109-15.
PMID:
11520125
Stem Cells
Stem Cell Basics - Clearly
Explained.com
The Paleodiet:
“According to author Loren Cordain,
modern health and diet problems didn't start with the advent of packaged snack
food, but much earlier--back at the dawn of the agricultural age many thousands
of years ago. As humans became less nomadic and more dependent on
high-carbohydrate diets, we left behind the diet we had evolved with, which is
based on low-fat proteins and plenty of fruits and vegetables. Sugars, fats,
and carbs were rare, if they were present at all, and
survival required a steady, if low-key, level of activity.
Cordain's
book The Paleo Diet blends medical research
with a healthy sprinkle of individual anecdotes, practical tips, and recipes
designed to make his suggestions into a sustainable lifestyle, rather than a
simple month-long diet; he even includes cooking recommendations and nationwide
sources for wild game.“ (Amazon.com Review)