View Full Version : Installment 40 - Ask the doctor with Dr Augusto Brazzini

03-31-2011, 10:20 PM
Ask the Doctor with the Brazzini Institute of Interventional Radiology

Q: Do adipose stem cells treat neuropathic pain from injuries/trauma/infection? I am looking into stem cell therapy. Are there any known risks?
A: The stem cells that are used from adipose tissue are Mesenchymal Stem Cells (MSC). From a small liposuction the MSC are separated from the body fat. We use adipose MSC for Orthopedic problems, and we know they are also used for aesthetic purposes. They can also be used for skin injuries, by placing them topically. Adipose MSC have a high immunemodulatory and paracrine (biochemical interactions between cells) effect.
A cosmetic surgeon does the liposuction, then the hematologist processes the sample obtained and separates the MSC cells, which he gives to the Orthopedic surgeon who place them into the damaged tissue (for orthopedic conditions usually the joint using arthroscopy).

We have no experience in neuropathic pain with stem cell treatment.

Q: Can you tell me the difference between a treatment with expanded stem cells and another one where the stem cells weren't expanded? I am thinking of a second inoculation of mesenchymal stem cells in my degenerated intervertebral disc and I wonder what is the difference and which would provide the best treatment. I was inoculated with the amount cultivated from 1200 ml of bone marrow last time.
A: The main difference is the quantity of stem cells that can be obtained. From the expansion you can get several times the amount obtained from the bone marrow. However, there is no evidence saying which is the necessary amount for treatment. We have seen very good results for the treatments we do, WHICH ARE ALL WITHOUT EXPANSION.

One other difference is that by not expanding them we are using the stem cells just like we found them inside your body, making absolutely sure they will have not mutated or will be of any harm. Even though an expansion is a very small manipulation, with less than 21 days of culture.

None of these procedures, expanded or not expanded, have shown to be of any harm; on the contrary, they have both shown amazing results.

Q: Which type of stem cells are better for neurological conditions e.g. cerebral palsy, brain injury and autism?
A: For these types of conditions, we think the best results will be obtained by delivering the cells intra arterially as close as possible to the damaged area. For this to be innocuous we need to use cells which will normally circulate in the blood stream, so we use whole bone marrow aspirate, which includes several types of stem cells like: HSC, MSC, MAPC, MIAMI, EPC and VSEL.

Q:These days a lot of clinics are doing stem cell therapy in India. Different clinics have different protocols. Some advise to give an injection of bone marrow stem cells every month for 3 months. But while talking to other doctors, they believe that repeated stem cell procedures can increase the risk of tumor. I believe that the higher number of stem cells the more effective the treatment, but at the same time I do not want to take any risk for my 3 year-old boy. As there is no standard or proved protocol, I am in a dilemma what to do. What are your thoughts?
A: What you are saying is very true, there is no proof as to the ideal quantity of stem cells needed for any kind of treatment and how often they should be applied. However, if your doctor is offering non-manipulated autologous stem cells I do not think there is a risk of tumor formation. Not even if there are several infusions over the course of a couple of months. These are cells taken from one part of your body and placed into another. More so if the infusion is done using the regular way in which these cells circulate in the body.

Q: Will using donated umbilical cord stem cells cause rejection? One treatment center claims by removing the antigens, the stem cells will not be rejected and there is no need to match.
A: We do not use umbilical cord stem cells, but our hematologist Dr.Antonio Carrasco (acarrasco@ictc-peru.com) has a lot of experience in cord blood and he says: Umbilical Cord stem cells are mainly mesenchymal stem cells (from Whartons´s jelly). They do not express class I HLA antigen and an allogenic rejection is unlikely, removing HLA type II will reduce to zero the rejection possibility.

Q: Do you treat or know of any success in treating sensory neural hearing loss with stem cells?
A:We do not have any experience with this.

Q: I suffered from low back pain for 18 months due to a herniated and degenerated L5-S1 disc. I decided to have stem cell treatment with mesenchymal cells June 10, 2010. I was inoculated directly in my L5-S1 disc after 23 days of culturing the stem cells. My low back pain has improved, it hurts less, but I still have some sensations in my legs and some pain. My doctors in Barcelona told me the bulge had improved in 6 months, but they seem lost about the pain and leg sensations.

Do you think it is normal that some pain remains? Would it be reasonable to have a second inoculation of stem cells? Do you think that my leg pain is due to loss of height in the degenerated disc? Is it reasonable to think that the disc could get back height?
A: I do not do these type of treatments however I can tell you that regenerative medicine is not a cure for every disease, I think it is normal for you to still have some pain and leg sensations. Every patient reacts differently to this procedures, their own cells are used and their own bodies heal themselves, there is no way to make sure EXACTLY what will happen to each patient. We can tell you what has been the experience so far with other patients.

A second treatment seems reasonable, especially since you had good results the first time. I would recommend you to take a second opinion from Dr. John Shultz (JSchultz@centenoschultz.com) who has experience in this subject.

Q: My son has cerebral palsy. He was born in June 2008. We banked his cord blood but the final report showed that it was contaminated with E-coli. He was rejected from a study at Duke University due to this. We are trying to move forward with an infusion along with antibiotics, but we can't find any information on the effects of antibiotics and a cord blood infusion. Any information would be appreciated.
A: I have no information regarding this, however I know CP patients are more prone to infection than most children and I would not recommend using the banked cord blood as it is contaminated. I would rather use autologous bone marrow - a whole bone marrow aspirate infused intra-arterially to make sure the administration route is harmless. As these bone marrow cells usually circulate in the blood stream.

We have good experience in the treatment of CP with adult autologous bone marrow stem cells. In my personal opinion I highly recommend this safer procedure.

Q: Can you tell me if you are having success treating Parkinson's Disease? Can you describe your treatment? Thank you.
A: We started treating Parkinson´s patients in 2006. So far we have had 90 patients; a few have had a second treatment. We have a very good follow up of the majority of them.

Of these patients, the average improvement in symptoms, as seen using the Unified Parkinson´s Disease Rating Scale (UPDRS), is 57%. More than half of our patients get more than 50% improvement in their symptoms. Some have extraordinary improvements; however they are not disease free. Regenerative medicine is not a cure for Parkinson because it is a degenerative disease so it will start doing harm again, taking slowly away the improvements. We have some patients that improved extraordinarily and kept their improvements for more than 2 years and now, at 3 years after treatment, their symptoms have never been as bad as when they first came to us. But not all patients react equally, some get very little improvements (less than 15% in the UPDRS scale). There is a published paper in the Journal of Vascular and Interventional radiology from December 2009, that shows our detailed results up to then.

We have separated our patients into 5 groups: very little improvement (less than 15% improvement in the UPDRS scale), little improvement (15 to 30%), good improvement (30 to 50%), very good improvement (50 to 80%) and extraordinary improvement (80 to 100%).

In the chart below you can see the latest statistics of our patients; of the 54with a good follow up, including only those we are able to follow (quite a few do not live in Peru). We use the UPDRS value previous to the stem cell treatment and the best result obtained for each patient during their follow up.

90 Patients
6 patients or 7% saw less than 15% improvement
8 patients or 9% saw between 15-30% improvement
18 patients or 20% saw between 30-50% improvement
36 patients or 40% saw between 50-80% improvements
22 patients or 24% saw extraordinary improvements between 80-100%

For any additional information, please contact us at www.brazzini.com.pe

About the Brazzini Institute
The Brazzini Institute of Interventional Radiology is an institution with more than 15 years of experience, pioneer in this field in Peru and Latin America, founded by Dr. Augusto Brazzini, Director of the Institute and Vice President of the Peruvian Society of Cell Therapy (APTECEL). Dr. Brazzini has participated as a member of the Scientific Advisory Board of the ICMS (International Cell Medicine Society).
Dr Brazzini is a Radiologist with a Fellow in Interventional Radiology at the University of Minnesota. He has worked at the Louisiana State University (New Orleans) as a Professor and as an attending physician from 2001 to 2005.
The Institute has led the medical field with innovations for patients for several years. It is on that path of innovation that we started the application of adult stem cells from bone marrow to treat chronic diseases for which there are insufficient conventional therapies.
Brazzini’s Institute, has been a pioneer in treating Nervous System Diseases, particularly Parkinson's Disease, for which they have a certification of the ICMS. In this field, they help improve the quality of life of patients suffering from other diseases such as Advanced Peripheral Vascular Disease, Type 2 Diabetes Mellitus, Stroke, Multiple Sclerosis, Osteoarthritis & Degenerative Joint Disease.
Brazzini Institute has specialized in performing invasive procedures to solve complex problems with a multidisciplinary group of physicians, to give the patients the best medical view for their condition. They want to give patients the opportunity to improve their quality of life with their own capacity of auto renewal using and enhancing the miracle of adult stem cell therapies with the best quality of service and professionalism you will find.
Visit us at: www.brazzini.com.pe

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