Roberta Shapiro
Roberta Shapiro – TRANSCRIPT
I’d like to tell you a story today, a story of what I believe is, and a story of what could be. And I’m going to start this story with an image of this beautiful young woman that I’ll call Dania, who is 28 years old in this photograph.
Dania was brought to me at 14 years of age by her mother, from Jamaica, with a rare, progressive neuromuscular degenerative disorder called spinal muscular atrophy. Spinal muscular atrophy is a genetic disorder whose hallmarks are autoimmune disease and inflammatory types of reactions. It leads to progressive weakness in muscles and ultimately a decline or a collapse in the spine. That collapse crushes the heart and lungs and would have killed her very shortly. I found a very courageous spine surgeon in New York who was willing to try to reverse some of that curve and prolong her life in doing so.
And to give her more time, essentially, to spend with this miracle of hers, her daughter, who is now 11 years old Dania is 37, but she is declining from this disease. She has never walked by herself, she has never rolled over in a bed by herself, she has never bathed herself, she has never fed herself. She has been one of the most extraordinary and important influences in my career, and for the last 23 years, I can honestly say that there hasn’t been a day that’s gone by that I don’t think about ways to try to slow down progression of diseases like this. And I also know that if I knew 20 years ago what I know now, I could have done that for her.
So this is obviously a very extreme case, but I challenge you and say that we are all faced with autoimmune and inflammatory types of diseases in our lives, every day. Aging is hallmarked by a process of inflammatory reactions, altered blood flow to organs, tissues and structures that lead to degeneration. So, in fact, we could actually call aging a disease, if we wanted to. We’re faced with it in the form of thyroid diseases, cardiac disease, diabetes, lung diseases, dermatological type of diseases and arthritis, the most common of which is osteoarthritis. The prevalence of osteoarthritis is actually staggering, somewhere in the neighborhood of about 50 million people suffer in the US alone and about 15 billion in the world. We have a responsibility to try to slow down the progression and the suffering from diseases like this. We also have innate structures that are built in that help do this, in the form of stem cells.
Now, stem cells have a myriad of functions, but two of the functions that I am particularly interested in are inflammatory and something called angiogenic. Angiogenesis is just a fancy word that means to regrow blood vessels. And I just told you that two of the hallmarks of the diseases associated with aging are inflammatory and altered blood flow. This would be an amazing mixture, if we could just fit stem cells into the treatment of these types of entities that we all deal with.
Now, what are stem cells? What do they look like? This is a solitary, isolated stem cell. This is a stem cell going through cell division, or mitosis. These are stem cells attached to blood vessels. They flatten out and encircle the blood vessels; that’s where they live. Stem cells also produce over 3,000 different growth factors, or what we call trophic factors, which are proteins. And it’s these little bundles, or microvesicles, that are really this sort of worker bees.
These are the things that we’re looking for. But where do we isolate stem cells and these growth factors from? In fact, we can get these stem cells from almost any tissue in the body, but some of the most plentiful and potent sources are actually from postnatally derived tissue: umbilical cord, amniotic fluid, placental tissue. One single umbilical cord can treat hundreds of patients. This is staggering to me. There are a growing number of countries in the world that allow the processing of these forms of stem cells from post-natal tissue.
Some of them are listed here and include South Korea, Japan, Israel, India, Panama – the list goes on. Not yet in the United States, and I hope that’s coming very soon. I can imagine, therefore, a world where we can harness the power of these structures that we have available to us. One of the challenges that we face is that there’s an inverse relationship between our age and the number and potency of stem cells that we have. So when we’re born, you see we have about one stem cell for every 10,000 or so bone-marrow cells.
But by the time we’re 80, we have only one stem cell for approximately every 2 million. This is exponential attrition rate, and it really plays a big role when we’re trying to decide where we’re going to get the source of cells or tissue to treat different clinical conditions. Obviously, as is the case most of the time, younger is better. So we are inundated in our lives, through the internet and social media, with what I call “information overload.” How do we sift through all this? How do we know what’s true? How do we know what’s safe? I get articles almost every day from my patients, talking about cell types, cell safety, cell harvesting, cell culture, cell application, cell delivery, cell expansion, to cell or not to cell? I don’t know anymore; it’s very confusing.
Now, in the course of all this – in my career – about ten years ago, I got very sick. I was infected with Lyme disease, which invaded my central nervous system. I had severe cognitive changes, with short-term memory loss, word-finding difficulties – which I’m experiencing right now. I had severe burning muscle pain; I had joint pain. I had balance and coordination problems, I had low-grade fevers, I had fatigue.
I was really, really sick. I had developed an autoimmune form of a thyroid condition that I was told was triggered by the Lyme disease. So, I underwent almost a year of very conservative management, with both intravenous and oral antibiotics and a slew of other drugs to treat my symptoms, my side effects. At the end of that year, I was definitely improved. But I had residual symptoms that I knew were inflammatory in origin.
I had persistent muscle pain, joint pain – the things I hear from my patients every day. I still have my thyroid condition, which was autoimmune, and I knew from all my years of research that the answer for these types of inflammatory conditions was in the world of stem cells. So I decided, finally, to put my body where my mouth was, and I went off and received intravenous infusions of stem cells. My recovery over the next weeks to months was nothing short of remarkable. Almost all of my symptoms had abated – and wow! look at that – I returned to a normal function of life.
But my bigger challenge following this was how do I apply this, then, to my patients? How could I clinically apply it? So I started researching; I knew I wasn’t going to start with the big diseases in my practice. I wasn’t going to start with muscular dystrophy, multiple sclerosis, Parkinson’s disease, Alzheimer’s, ALS – I knew those would require large doses and infusions of cell stems that we could not yet apply in this country, systemically. So I knew I was going to start with the smaller diseases: the joint pathology, tendon and ligament types of problems. So I was researching the regenerative therapies available to us in this country, in the United States, and while I was doing this, a friend of mine happened to call me.
He’s 54 years old, and he said, “I fell off my bike a couple weeks ago, and I can’t lift my arm. The MRI says I have a complete tear of one of my rotator cuff tendons.” – something I see every day. Two top orthopedic surgeons in New York told him the only way to fix this was to surgically repair it. And they were right. When you have complete tear of a tendon, you have to surgically reattach it.
My friend was obviously looking for a non-surgical option. So I looked at his MRI first, and I thought I saw a tiny strand of tendon still attached. This was important because it would give me the substrate to work with. So I went back to my research, and I started looking at the hierarchy of regenerative treatments available to us. The first one is something called “platelet rich plasma,” which, very simply, is drawing blood from a person, spinning it to concentrate the growth factors, and then you reinject that into the same person.
This had promise, but I didn’t think it was going to be strong enough for this magnitude of injury. So, the second level in the hierarchy of treatment is what we call either fat- or bone-marrow-derived stem-cell treatments. It’s a same-day treatment; we’re allowed to do it in the US. You extract a small amount of fat or bone-marrow from the person, you put that product through a sophisticated centrifugation process, which concentrates the stem cells and the growth factors, and then you reinject that into someone.
And I thought, “This is getting a lot closer to what might work for him.” But then I remembered – what I said – that inverse relation between age and the number and potency of the cells. And I thought 54-year-old cells – that might not work. So I went to the next level in the hierarchy of treatment, which is very different, and it’s the use of postnatally-derived tissue: amniotic or placental or umbilical cord. Labs around the US are permitted to isolate the growth factors from that hours-old product, and then we can inject that into somebody. And I thought, “Hours-old product versus 54-year-old stem cells” – it was kind of a no-brainer, in my mind.
So I went back to my friend, and I said, “Look, there is this product from – I’m going to use – from amniotic tissue growth factor. I’m very comfortable with the safety profile of it, but I have to tell you it’s super expensive, it will likely not be reimbursed by insurance, and it may not work. What do you think?” And so my friend laughed, and he said, “Sure, let’s try it. What do I have to lose?”
So I injected him with these growth factors, and within two weeks, he had 30 degrees of movement. Within six weeks, he had full range of motion. This is unheard of in the world of sports-type injuries like this. But it was only a single case, and I had to repeat this in other cases.
So the next case I did was a gentleman in his 70s – that I’ve treated for many years – with polio, who had end-stage, bone-on-bone osteoarthritis of both of his knees. And he was facing joint replacements. We both knew that with his history of polio, he would end up in a wheelchair if he had these surgeries. So, again we looked for a non-surgical option I did the same thing with him, and within weeks, he was walking pain free, and he continues to walk pain free three years later.
I have since repeated this in dozen of cases with pretty remarkable results. So I just want to say, before I conclude, that, first of all, every tissue and cell structure that I’ve been talking about today is harvested from after birth. These are products that would be thrown in the trash, they would be discarded. So there should be absolutely no ethical dilemma with the use of these tissues or cells. The last thing I want to say, in summary, is that I absolutely believe that the future of medicine lies in the use of biologic agents to regenerate, not synthetic agents to palliate.
I also believe that we can ease the aging process, and I believe in what could be, and I’d like to leave you with one quick video. This is a patient of mine with muscular dystrophy, who a year-and-a-half before two stem cell treatments had no balance and coordination and was quickly losing her ambulatory ability. This – this is what could be. Thank you very much.
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