Jun 12, 2019
TOBI is the largest yearly gathering of physicians, scientists and commercial interests in the emerging discipline of Orthobiologics. On the one hand, it is academic and advances the knowledge base of all participants and attendees. Clinicians present their outcomes of the many available approaches to deal with the painful osteoarthritic joint ranging from 20 or more varying Platelet Rich Plasma formulations, two different Bone Marrow aspiration and preparation options, and several Adipose Based methodologies. Next come the Growth Factor group categories of treatment and the individual Growth Factor possibilities. For the first time, the potential of Exosomes was highlighted while the Birth Tissue, Amniotic Fluid category almost ignored. The latter I assume owing to the recent actions by FDA and FTC in closing clinics that treat every imaginable malady without a scientific basis using Amniotic Fluid and Birth Tissue.
Given the above, what is on the horizon? It would seem that the Camp Followers and those offering “fake” news are finally being highly scrutinized by the FDA and FTC; in several settings even being criminally prosecuted. With the crackdown, a patient will no longer be recruited to attend a seminar with a free lunch and then be seduced into an amniotic fluid/stem cell scam. The overall quality and dependability of Regenerative Medicine will continue to evolve because of conferences such as TOBI. Another biologic option of particular interest to me are Exosomes. I recently dedicated a blog to the subject. The most recent advance is an Exosome recovered from voluntary Bone Marrow donors who are highly screened and that should eliminate or certainly reduce any inherent risks of using this Adult Mesenchymal derived cellular communication means.
This leaves us with a very exciting new approach to the subject of regenerative medicine, Personalized Stem Cells. As presented at the speakers’ podium, the initiative is waiting for FDA approval and it should be happening in weeks according to the PSC medial director. When approved, those who meet the inclusion criteria will be able to undergo a lipo aspiration and have that material sent to a laboratory in San Diego where it will be processed under stringent governmental oversight. The recovered stem cells and stromal vascular fraction will then be returned to the investigator clinician for injection into the arthritic joint. At the same time, an aliquot of the lipo aspirate will be placed in storage for subsequent use should there be said need. The processed will meet all FDA and FTC criteria and allow for injection of millions of cells rather than our present ability to provide thousands of stem cells. The announcement when the FDA approves the trial will appear on my web site and on this blog.
To learn more, call for a consultation (312) 475-1893. You may visit my web site at www.sheinkopmd.com
Jun 3, 2019
Exosomes are micro-vesicles involved in cellular communication being positioned as a new frontier in regenerative medicine. They are involved in direct cellular signaling. Exosomes are isolated from human mesenchymal stem cells; and bring a wide array of growth factors. The present understanding is that the exosomes activate the patient’s own regenerative process by influencing the cellular response just as a hormone effects a distant organ. Those who regularly read this Blog will be reminded that in order to meet FDA guidelines, orthobiologics must be autologous (come from the same individual in which they are used), and can not be expanded or mixed with other biologics. Exosomes may be a way of providing the patient with a very diverse and large quantity of growth factors and bypass the FDA guidelines regarding using cells from sources other than the patient.
Stem Cells work to heal, repair and restore the body. They do so by producing micro-vesicles called exosomes and thus signal nearby cells to change behavior. Since the FDA does not allow us to use stem cells from outside our own body, might the exosomes from stem cells outside of our body comply with FDA guidelines, and provide sought after outcomes? Could a patient with advancing arthritis experience and enjoy pain relief, improved function, postpone or avoid a joint replacement and enjoy a high degree of activity via a course of exosomes?
As you age, your stem cell numbers are known to diminish and that is why the orthobiologic quest is for approaches that will prove successful in any decade of life. As of this time in my practice, after the patient intake and review of images, I provide an informed consent as to what nature of intervention will best meet the needs of my patients. My mainstay has been Bone Marrow Concentrate; but from time to time I will introduce the option of Growth Factors recovered from your own circulating blood. Then there is the Micro-fractured adipose tissue option for those who I feel would be best served by the latter approach. Should I introduce Exosomes into my menu of services?
I am still in the Safety and Efficacy evaluation of the Exosome option so make sure you return to my Blog in the future to learn more. To schedule a consultation call (312) 475-1893. You may visit my web site at www.sheinkopmd.com
May 23, 2019
While this blog usually focuses on joint restoration, pain relief for the arthritic joint and improved functional capacity, I have condensed a recently published article as it would seem there is increasing need to stay active and I can assist those limited by arthritis.
An international team of researchers representing several institutions in Japan and the United States has published promising findings that may stand to benefit people living with the specter of Alzheimer’s and other neurodegenerative diseases, as well as age-related cognitive decline.
In their paper published in PNAS, “Leptin in hippocampus mediates benefits of mild exercise by an antioxidant effect on neurogenesis and memory,” Yook and colleagues present results from a series of experiments—murine and in vitro—that elucidate the role of leptin in cognitive function. Leptin is a hormone that is produced in adipose tissue and in the hippocampus, the part of the brain where memory and spatial learning are processed.
The relationship between exercise and improved cognitive function is well established. Likewise, certain dietary supplements, for example, docosahexaenoic acid (DHA) have also shown promise in improving cognition and in slowing or halting cognitive decline. The effect of both exercise and supplementation with an antioxidant on plasticity and cognitive function within the hippocampus has until now been largely unexplored, however. Previous research has demonstrated that leptin in particular is a promising therapeutic target for neurodegenerative diseases such as Alzheimer’s.
Yook and colleagues sought to answer the particular question of whether mild exercise (ME) combined with the antioxidant supplement astaxanthin (AX) might confer benefit in terms of cognitive function and neuronal plasticity; and whether or not the two interventions—AX and ME together—could have a synergistic effect beyond the additive effects of either treatment administered separately. The investigators “hypothesized that ME-enhanced hippocampal neurogenesis and memory might be further improved with dietary AX via mediation by a neurotrophic factor such as h-LEP [hippocampal leptin].”.
For the in vitro experiment, the investigators used human neuroblastoma cell lines—cells known to endogenously synthesize leptin—to observe the effect of exposing them.
While the results shown here in murine models are certainly promising, what might this mean in a clinical context for humans? For one thing, mild exercise for humans has been characterized in this paper as that which is typical of a yoga or tai chi session, which puts it within reach of many people. Another factor is the ready availability of the relatively inexpensive nutritional supplement astaxanthin.
Ultimately, the authors conclude that “our findings advance the notion that ME combined with a dietary antioxidant such as AX, which induces endogenous h-LEP, may be an effective nonpharmacological strategy for preventing or improving cognitive function and brain health, and for slowing cognitive decline. This strategy may be particularly useful in vulnerable individuals, including the elderly.”
In simple terms, get plenty of rest, plenty of exercise and take the nutritional supplement astaxanthin. If injury or an arthritic joint prevent you from mild or even a full recreational profile, schedule a consultation by calling (312) 475-1893. You may visit my website at sheinkopmd.com.
May 8, 2019
As what has become usual and customary, this morning, in the Monday newspaper were the ads for stem cell therapy, stem cell recruitment, and pain relief instead of knee replacement; all allegedly covered by Medicare and insurance. If you repeat a lie enough times, it starts to be believed. Thanks to investigative reporter Pam Zekman, gone from the newspaper, at least for the time being, are the Stem Cell Institutes of America ads inviting readers to a seminar. For a free lunch without an examination or review of images, the attendee would be recruited for a procedure using amniotic fluid containing dead cells at prices approaching $8,000 per joint.
There is no science to support stem cell recruitment by any injectable available in the marketplace today. A year ago, a placental derived material was marketed to recruit your stem cells but subsequent outcomes studies resulted in the discontinuation of payment by third parties. Patients were and still are recruited by this fake news; there are still advertising schemes claiming stem cell recruitment. Reader, there is no such thing as purchasing stem cells from a provider. Living stem cells may be provided through autologous bone marrow concentrate, the latter containing stem cells, platelets, proteins, precursor cells, and growth factors. I have no issue with pain relief claims in the newspaper ads but the materials used by those institutes are hyaluronic acid based, do not contain living stem cells, and are available through any medical office. In other words, the hyaluronic acid gels are not regenerative; but the injection may diminish symptoms for several months.
The real question becomes what effective treatment will relieve the symptoms of osteoarthritis, improve function, allow you to reach your sought-after recreational goals with an outcome lasting years, not months? To answer the question, I was asked to participate as part of the Regenerative Medicine Training Institute Faculty this past weekend in Jupiter, Florida. My presentation focused on the indications and evidence-based outcomes for using Compounded Platelet Rich Plasma and Filtered Growth Factors; Bone Marrow Concentrate and Micro fractured Fat Graft. The outcomes evidence reinforces what I preach and how I practice. To learn more, visit my web site at www.sheinkopmd.com. To schedule an appointment and consultation call (312) 475-1893
May 2, 2019
“CHICAGO (CBS) — The number of clinics offering unproven stem cell injections is growing, despite FDA warnings and a federation of medical boards challenging state regulators to crack down on them.” April 25, 2019. Expose by investigative reporter Pam Zekman. She first reported about the scam last November and congratulations to her for the follow up. Hopefully, this will be the end of the fake news fostered by charlatans or will it?
If you repeat a lie often enough, it starts to be believed. Witness the three phone calls directed to my office in the last 72 hours “how much are stem cells?”. Blog reader and potential patient, please be aware up until now, there is no means of directly providing stem cells in the care and treatment of arthritis. When you call my office with the question “how much are stem cells”, our response begins with an education of the caller as to the nature of Regenerative Medicine. There are basically three FDA compliant vehicles for providing stem cells to a patient; bone marrow, adipose tissue and circulating blood. In order to be FDA compliant and pass FTC scrutiny, the stem cell source must be autologous; that is come from your body, and can only be minimally manipulated. The unproven alleged stem cell treatments exposed by Pam Zekman used amniotic fluid derived from human donors and contained no living cells. In my office, a medical history and physical examination are required followed by a review of images. Most recently, on occasion, I will ask the patient to undergo an office based diagnostic needle arthroscopy. Only after a full evaluation, am I willing to make a regenerative medicine recommendation. That treatment will either be a compounded Platelet/Protein intervention, an adipose derived Micro-fractured fat procedure or a Bone Marrow aspiration/concentration and injection into the arthritic or problematic joint. At no time will I use tissue derived from birth product as the latter does not contain living cells once processed, stored and thawed nor is such tissue FDA compliant.
Regenerative Medicine or as I like to call it, Cellular Orthopedics, is a dynamic discipline and next generations advances are continuous; so follow my website at www.sheinkopmd,com to stay current or call for a consultation (847)390-7666
Apr 25, 2019
Back pain will affect athletes of all ages and in every sport; though you don’t have to be an athlete to experience a debilitating back ache. Causes may be traumatic in nature or just the wear and tear of the aging process. If you break down the ergonomics of every human activity, from lifting and carrying to the mechanical loading and torque on the spine during tennis, golf, swinging a baseball bat etc.; it is easy to see why the vast majority of humans at some time will be plagued by a limiting back ache. The problem may be secondary to a congenital deformity, a developmental condition, trauma, infection, inflammation, lifting and carrying or following a cough and sneeze. That back ache may be accompanied by sciatica as seen in conjunction with a herniate disc earlier in life or with pain down the leg later in life associated with spinal stenosis. In between are the myriad of causes such as the sudden twist, the motor vehicle accident or the fractures associated with osteoporosis.
In most settings, the pain will resolve over time, and with guided rehabilitation including stretching and core strengthening, you will recover and return to your full athletic and fitness profile. In the interim though, what can be done in addition to pain relieving analgesics and anti-inflammatory medications? If after several days of onset, you see no improvement, it is time for a doctor’s visit to make sure the pain is not resulting from a here-to-fore undiagnosed medical issue. Once an underlying medical causation is excluded, it is time to head to the physical therapist as the Sate of Illinois provides for direct access. In the event that the therapist does not see improvement, you will be referred to a spinal specialist; but there is something more now available to help you deal with acute or chronic back pain. Regenerative Medicine interventions for the herniated disc, the inflamed facet joints or as a superior agent to the standard epidural steroid injections are now available at pain management centers in the Greater Chicago region. However, before you decide to go that route, let me tell you about the LeanRite.
Over a 40-year span, I experienced recurrent bouts of low back with and without referral to my leg. At one time, I developed a drop foot that fortunately resolved after six months and a lot of Pilates core strengthening and stretching. 18 months ago, I was introduced to the LeanRite. Initially introduced to accompany a standing desk, grounded in orthopedics and ergonomics, the design and benefits are such that the lumbar support and seat allow me to function in my office place and home whether I am in the standing, sitting or leaning position and I rarely experience back pain any longer at the end of a long day. Then there are those with a herniated disc who have to rethink sitting. When it comes to your knees, hips, shoulders and ankles, I am able to relieve pain and restore function so you can return to all of your recreational interests with a needle and not a knife using Bone Marrow and Adipose derived stem cells or by compounding Platelet Rich Plasma. When it comes to low back pain, don’t sit or stand, rather perch on a LeanRite. You can find it on the Desirelist.com website; it is also available on Amazon
