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View Full Version : Installment 49 - Ask the Doctor with Dr. Amit Patel



Jeannine
03-27-2012, 05:35 PM
About Dr Patel
Amit Patel is the Director of Cardiovascular Regenerative Medicine at the University of Utah. He is internationally recognized as a pioneer of adult cardiac stem cell research and therapies. Dr. Patel’s patients come from a diverse population and he provides options in his Optimist Clinic to patients that have been told there are no other options available. In the past decade Dr. Patel has provided cardiovascular care utilizing stem cell treatments for heart conditions, such as restoring strength and function to heart muscle with adult stem cells. Dr. Patel has performed and taught over 300 adult stem cell surgeries worldwide and has receive U.S. Food and Drug Administration approval for trials using a number of biologics in a multitude of diseases and ailments. He has been the principle investigator in many “breakthrough” research trials, as wells as being a national and international principle investigator. Dr. Patel focus with stem cells includes a multi-disciplinary team which provides patients new options for other conditions such as, critical limb ischemia, chronic chest pain, burns, orthopedics, and wound healing.


Q: How much does a person's age contribute to their positive responsiveness to (or effectiveness of) stem cell treatment? Comparing for instance, someone in their early 30's to a person over 50. Also, is a positive response more sustainable if younger in age?
A: Currently, there is no indication that age plays a role in the success of stem cell treatments. Younger cells can be better but certain diseases do not necessarily respond to just “younger cells.” We have seen that patients are better responders to certain stem cell treatments but at this time we do not know what the corresponding factor is.

Q: Does the effectiveness of one form of stem cell therapy depend on what condition it is treating? I am specifically interested in what type of stem cells (bone marrow, peripheral blood or adipose) would be best for pulmonary fibrosis.
A: Yes, effectiveness of one form of stem cell therapy depends on what conditions is being treated. Research is currently in progress for various pulmonary diseases. Currently, Mesenchymal Stem Cells (MSC) have been shown to help with some fibrosis remodeling, however complete resolution of the fibrosis has not been seen. Over some remodeling might occur and worsening of the condition might be suppressed.

Q: Would an autologous stem cell treatment infused through an IV in your arm allow cells to cause some improvements for pulmonary hypertension?
A: Research early on showed that IV autologous stem cell treatment might help with pulmonary hypertension; however larger trials are still being conducted. There are some promising results from the PHACeT Trial utilizing Endothelial Progenitor Cells (EPC’S) and eNOS plasmid transfection in Canada.

Q: Has anyone followed the journey of stem cells after they've been injected into a person's body? What is their path of travel through the body and how long do they remain capable of regeneration after injection?
A: Research has been conducted using TK Reporter Genes to determine the journey stem cells follow post-injection. If stem cells have been injected it shows that the cells stay at the site of injection for about 6 months until the cells integrate into the lymphatic endothelium. As for IV infusion of stem cells they migrate through the lungs, liver, and spleen post infusion. Further discussion of this is outlined in the following paper; Imaging Long-Term Fate of Intramyocardially Implanted Mesenchymal Stem Cells in a Porcine Myocardial Infarction Model (http://cpt.sagepub.com/content/10/4/225.short).

Q:I keep reading that many clinics offer stem cell treatment for an improvement in one's life, but they offer this for virtually every disease. Does each treatment for each disease differ - meaning, if a child has retinal eye damage, does the stem cell treatment differ from a child with hearing loss? If so, do they put other chemicals, medicines, etc. in to achieve positive results? Also, whatever kind of stem cell is used by a clinic (umbilical cord, marrow, etc.), do the clinics add their own "recipe" to make the stem cells work? I have read that stem cells are only part of the cure, the rest is other medications, is this true? How can we know they are not just putting in any old nonsense in a child?
A: Treatments and stem cells do differ for each disease that is being treated. The only way you can determine if any chemical, medicines etc has been added if the clinic has documented such additives in any publications. If there is no documentation by these clinics then there is no way to determine if any additives are in the stem cell product or what recipe they are using. Stem cell therapy has not been linked to curing anything except for cancer, so yes if you have stem cell therapy you will be on medication to also help your disease. You do not know what is being put into your body at these stem cell clinics. Due to a rising and mostly unregulated trend of marketing stem cell treatments for an increasing variety of diseases and conditions, the US Food and Drug Administration (FDA) early last month issued a warning advising patients to ensure they are receiving federally approved stem cell therapies.

Q: I know you have experience with heart and limb ischemia. Would endometrial stem cells be a good type of stem cell for Global Brain Injury due to hypoxia?
A: At this time there is no data on global brain injury due to hypoxia in adults. Any model where you need vasculogensesis, Mesenchymal Stem Cells or EPCs or stromal vascular fraction could potentially work, but no human research has been conducted.

Q: Is it advisable to stop taking the inhibitor-based medication called Pirfenidone (also called Pirfenex or Esbriet) during stem cell treatment, or would the drug actually promote the effectiveness of the treatment? I would also like to get your perspective in general about stopping other medications (whether allopathic or naturopathic/Aryuvedic/Homeopathic) prior to and during stem cell treatment.
Coming back to my first question regarding Pirfenidone, because Perfenidone is an anti-fibrotic and anti-inflammation drug that inhibits the synthesis of TGF-beta and TNF-alpha, I would think that this medication should actually contribute to the effectiveness of stem cell treatment since the suppression of TGF-beta, IFN-gamma, TNF-alpha, and macrophage chemoattractants is apparently a major factor in stem cell therapy's effectiveness. So wouldn't Perfenidone in fact support/increase the effectiveness of stem cell therapy?
A: Although this drug is not yet FDA approved nor available in the U.S., my family member with pulmonary fibrosis is in India and has been taking Pirfenidone for about 14 months. He has seen positive results from taking this drug (no increase of fibrosis during this time), so he is quite reluctant to discontinue its use for an extended period during stem cell treatment.

Based the on the information you have provided and the fact that we have no experience with the drug – it is reasonable to assess the synergistic effect of both cell and drug therapy as long as it is provided under the care of a pulmonologist – and followed closely with pulmonary function tests along with blood gases at 3 months intervals to assess safety along with possible other effects.

Q: I was told when I got an adipose treatment for COPD, that 80% went to my lungs (IV infusion), the rest to my other organs. I also was given a figure in the millions for the number of stem cells that would be administered. How accurate is this information and how does a doctor come to this conclusion? I know there are ways to count stem cells, but how on earth would anyone really know what they got?
A: There is a formula to determine the approximate number of cells administered – it can be done using a radiolabelled tracer. This is performed by the lab after viewing a small sample of the cells being injected.

COPD treatment with stem cells via IV access: studies have consistently shown that adult stem cells delivered in via intravenous route are subject to being trapped in the lungs referred to as pulmonary first pass effect. Intravenous (IV) stem cell delivery for regenerative tissue therapy has been increasingly used in both experimental and clinical trials. Data suggests that the majority of administered stem cells are initially trapped in the lungs. 80% would be an estimate. There is currently no objective way to assess long term cell follow-up in the lungs.

Q: Are there some people that simply are too sick or too old or too young to have stem cell treatment? It seems like some clinics will take anyone that has a wallet and a pulse. If someone gets stem cell treatment and has no results for the first couple of months or so, how likely is it that the treatment will produce any type of improvement down the road?
A: Age is less of a factor in stem cell treatment than is overall health status. Stem cells are not a general panacea for multiple ailments but rather slated towards specific disease entities. Individuals with numerous co-morbidities are at risk for not receiving the benefits they are seeking depending on the severity and types of health risk factors in addition to the disease they are seeking treatment..
FDA has posted warnings regarding scams related to stem cells. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm286155.htm

It is not uncommon to have several months elapse before seeing noticeable improvement from the stem cell therapy received. How long the effects of stem cells will last remains unclear and are under investigation