Adult Adipose Adult Adipose Derived StemDerived Stem Cells (h-ASC):Cells (h-ASC):

William W. Ehrlich, M.D., FAACSWilliam W. Ehrlich, M.D., FAACSBaker, Holloman & EhrlichBaker, Holloman & Ehrlich

14000 N. Portland14000 N. PortlandOklahoma City, OKOklahoma City, OK

Uses in Ophthalmology Uses in Ophthalmology & Human Medicine& Human Medicine

Since my first facial fat graft 12 years ago, almost all of Since my first facial fat graft 12 years ago, almost all of my patients have noticed remarkable improvement of my patients have noticed remarkable improvement of their skin texture. First reported in 1989 their skin texture. First reported in 1989 (Chachir/Benzaquen)(Chachir/Benzaquen)

the reason for this improvement was a mystery.the reason for this improvement was a mystery.

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In 2001, Zuk discovered stem cells in adult adipose In 2001, Zuk discovered stem cells in adult adipose tissue, and these improvements began to make more tissue, and these improvements began to make more

sense. sense.

““Revolutions, alas, are almost always messy” Revolutions, alas, are almost always messy” ...when the first human embryonic stem cell ...when the first human embryonic stem cell

line was established in 1998... “The line was established in 1998... “The discovery was quickly engulfed in the discovery was quickly engulfed in the

turbulent waters of religion and politics.” turbulent waters of religion and politics.” National Geographic July 2005National Geographic July 2005

Injection into coronary Injection into coronary arteries arteries (Germany, bone marrow)(Germany, bone marrow)

“Cardiac function improves significantly”“Cardiac function improves significantly”

Lupus treatments Lupus treatments (U. Mass, bone marrow)(U. Mass, bone marrow)

“75% of patients remain in remission for “75% of patients remain in remission for 2-8 years after treatment”2-8 years after treatment”

Neuronal Stem Cells from Neuronal Stem Cells from Human Fetus Human Fetus (Palo Alto, embryo)(Palo Alto, embryo)

Transplanted into mouse brain. “they Transplanted into mouse brain. “they started working right alongside the started working right alongside the

mouse’s own neurons.”mouse’s own neurons.”

(All before 2005) (All before 2005)

National Geographic July 2005National Geographic July 2005

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Adipose Derived Stem Cells Adipose Derived Stem Cells ...for cell therapy of the corneal ...for cell therapy of the corneal

stroma.stroma.Arnalich-Montiel F et. al.Arnalich-Montiel F et. al.

Stem Cells 2006 Stem Cells 2006

What is a Stem Cell?What is a Stem Cell?

Capacity for asymmetrical division.Capacity for asymmetrical division.

Mitosis results in the generation of a daughter cell that retains Mitosis results in the generation of a daughter cell that retains stem cell plasticity, and another daughter cell that is committed toward a given stem cell plasticity, and another daughter cell that is committed toward a given

differentiation fate.differentiation fate.

Property of “self renewal.”Property of “self renewal.”

Fetal tissue Fetal tissue Adult tissue Adult tissue

BrainBrainBloodBlood

CorneaCorneaRetinaRetinaHeart Heart

Adipose tissueAdipose tissueSkinSkin

Dental pulpDental pulpBone marrowBone marrowBlood vesselsBlood vessels

Skeletal muscleSkeletal muscleIntestinesIntestines

Cord bloodCord blood

Where Do Stem Cells Live?Where Do Stem Cells Live?

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Adult adipose stem cells are much more Adult adipose stem cells are much more “plastic” than anyone imagined. They are “plastic” than anyone imagined. They are autologous cellular “building blocks” that autologous cellular “building blocks” that

are readily available to produce long are readily available to produce long lasting functional and cosmetic lasting functional and cosmetic

improvements.improvements.AdipocytesAdipocytesOsteoblastsOsteoblasts

CardiomyoctyesCardiomyoctyesChondrocytesChondrocytes

Endothelial CellsEndothelial CellsEpithelial DifferentiationEpithelial Differentiation

NeurogenesisNeurogenesisHepatic DifferentiationHepatic Differentiation

Stem cells from fat.Stem cells from fat.One of Time Magazine’s 50 Best “Inventions” of 2011One of Time Magazine’s 50 Best “Inventions” of 2011

60cc of adult fat yields60cc of adult fat yields100-280 million adult mesenchymal stem cells (AMSC) 100-280 million adult mesenchymal stem cells (AMSC)

in a “slurry” of SVF (stromal vascular fraction) in a “slurry” of SVF (stromal vascular fraction) (Cell cultures are unnecessary)(Cell cultures are unnecessary)

This is more than 100x the quantity of stem cells in the This is more than 100x the quantity of stem cells in the same volume of bone marrow. same volume of bone marrow.

Platelet rich plasma (PRP) also contains stem cells. Platelet rich plasma (PRP) also contains stem cells.

1. Liposuction of 20cc adult fat.1. Liposuction of 20cc adult fat.

2. Centrifuge for 8-15 minutes @ 3,500 RPM.2. Centrifuge for 8-15 minutes @ 3,500 RPM.

3. Add 2.5cc of collagenase (12-13 Wunch units)3. Add 2.5cc of collagenase (12-13 Wunch units)

4. Incubate for 30 min. @ 38 C in MaxStem 4. Incubate for 30 min. @ 38 C in MaxStem incubatorincubator

How are stem cells isolated in How are stem cells isolated in the stromal vascular fraction?the stromal vascular fraction?

What’s so great about adult adipose stem What’s so great about adult adipose stem cells?cells?

Ask your dog.Ask your dog.

Stromal Vascular Fraction injections of Stromal Vascular Fraction injections of 3-5 million cells per canine joint:3-5 million cells per canine joint:

Anti-inflammatoryAnti-inflammatoryAngiogenicAngiogenicAnti-aptoticAnti-aptotic

Anti-bacterialAnti-bacterialAnti-scarringAnti-scarringPain relievingPain relieving

Cells are “homing pigeons” to inflamed areasCells are “homing pigeons” to inflamed areasMarked radiologic and symptomatic improvement was “the norm.”Marked radiologic and symptomatic improvement was “the norm.”

Robert J. Harman DVM, MPVM, VetStemRobert J. Harman DVM, MPVM, VetStem

““From 2003-2011, VetStem injected 13,000 canine joints with From 2003-2011, VetStem injected 13,000 canine joints with SVF.SVF. 7,000 for osteoarthritis, 4,000 for tendon & ligament 7,000 for osteoarthritis, 4,000 for tendon & ligament

damage. damage. We spend $1.2 billion per year treating canine joint problems, We spend $1.2 billion per year treating canine joint problems,

part of the over $10 billion per year we spend for pet part of the over $10 billion per year we spend for pet healthcare.”healthcare.”

Or ask a celebrity, athlete, or someone treated outside Or ask a celebrity, athlete, or someone treated outside of the United States.of the United States.

Peyton Manning, Rick Perry, Bartolo Colon, Peyton Manning, Rick Perry, Bartolo Colon, Suzanne Sommers, Kobe Bryant, many others.Suzanne Sommers, Kobe Bryant, many others.

In Mexico, Shanghi, Berlin (and elsewhere) clinical trials In Mexico, Shanghi, Berlin (and elsewhere) clinical trials involve IV infusion of h-ASC to treat COPD, Parkinson’s involve IV infusion of h-ASC to treat COPD, Parkinson’s Disease, Multiple Sclerosis, ALS, and renal failure. For Disease, Multiple Sclerosis, ALS, and renal failure. For

CHF, the cells are delivered directly to the heart muscle with CHF, the cells are delivered directly to the heart muscle with a catheter.a catheter.

(Just as they were in the National Geographic article from 2005. (Just as they were in the National Geographic article from 2005. For more information, Google “ClinicalTrials.gov...search stem cells and/or ageless)For more information, Google “ClinicalTrials.gov...search stem cells and/or ageless)

Although the initial study sizes are very small, CHF Although the initial study sizes are very small, CHF patients achieved an average ejection fraction patients achieved an average ejection fraction

improvement of 13%.improvement of 13%.

83% of COPD patients demonstrated marked 83% of COPD patients demonstrated marked improvement in their exercise capacity and statistically improvement in their exercise capacity and statistically

significant improvement in their quality of life. significant improvement in their quality of life. Regenerative Medicine Institute, Florida, www.agelessregen.comRegenerative Medicine Institute, Florida, www.agelessregen.com

Initial reports indicate remarkable improvement in many of the Initial reports indicate remarkable improvement in many of the previously mentioned diseases. previously mentioned diseases.

Many of the traditional laboratory parameters that “indicate or Many of the traditional laboratory parameters that “indicate or measure” aging also improve with SVF given IV.measure” aging also improve with SVF given IV.

Mark Berman, M.D. , AACS Scientific Meeting, January 2012Mark Berman, M.D. , AACS Scientific Meeting, January 2012Personal communication from his clinic in Shanghai Personal communication from his clinic in Shanghai

Cell therapy of corneal stroma or Cell therapy of corneal stroma or intra-ocular damageintra-ocular damage

Visual changes in multiple Visual changes in multiple sclerosissclerosis

Orbital changes in thyroid eye Orbital changes in thyroid eye diseasedisease

Potential Potential Ophthalmologic Uses Ophthalmologic Uses

of Stem Cells:of Stem Cells:

Should liposuction harvesting technique be added to Should liposuction harvesting technique be added to oculoplastic and neuro-ophthalmologic fellowship training?oculoplastic and neuro-ophthalmologic fellowship training?

NASA is investigating NASA is investigating infusions of autologous infusions of autologous

stem cells for astronauts stem cells for astronauts in deep space travel, in deep space travel, hoping that they will hoping that they will

improve the compromised improve the compromised immunity caused by long immunity caused by long

periods of weightlessness.periods of weightlessness.

““Adult adipose stem cells were on the Atlantis Shuttle Mission. NASA has Adult adipose stem cells were on the Atlantis Shuttle Mission. NASA has not released the results of their experiments.”not released the results of their experiments.”

Douglas Dedo M.D. @ AACS Annual Scientific Meeting, January 2012Douglas Dedo M.D. @ AACS Annual Scientific Meeting, January 2012

If h-ASC cells are If h-ASC cells are relatively simple to relatively simple to

harvest, are harvest, are autologous, and the autologous, and the

results are so results are so promising... promising...

Why are the Why are the trials/treatments not trials/treatments not available in the US? available in the US?

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FDA approval is not required to relocate cells removed from, then returned to, the same FDA approval is not required to relocate cells removed from, then returned to, the same person in a single procedure.person in a single procedure.

Presently, there are at least two commercial facilities (Dallas & New Jersey) that will Presently, there are at least two commercial facilities (Dallas & New Jersey) that will isolate, cryopreserve, and store patients' adult stem cells.isolate, cryopreserve, and store patients' adult stem cells.

In the past 2 years, mesenchymal stem cell isolation, banking, In the past 2 years, mesenchymal stem cell isolation, banking, and tissue scaffolding/engineering have begunand tissue scaffolding/engineering have begun..

Are autologous (adipose derived) stem cellsAre autologous (adipose derived) stem cells body parts, or drugs? body parts, or drugs?

Does an MRI change stem cell characteristics?Does an MRI change stem cell characteristics?

What constitutes stem cell “alteration.” What constitutes stem cell “alteration.”

FDA regulation 21CFR1271FDA regulation 21CFR1271In 2006, one word was very quietly changed, indicating that the In 2006, one word was very quietly changed, indicating that the

placement into “placement into “anyany” human of harvested human cells that ” human of harvested human cells that were changed, altered, or processed was governed by FDA were changed, altered, or processed was governed by FDA

regulations. (Previous wording was placement into “regulations. (Previous wording was placement into “anotheranother” ” human.human.

I have met two surgeons whose offices were “raided” by federal I have met two surgeons whose offices were “raided” by federal agents, because they promoted “stem cell treatments.” One is a agents, because they promoted “stem cell treatments.” One is a

plastic surgeon, the other an orthopedic surgeon.plastic surgeon, the other an orthopedic surgeon.

Who owns our stem Who owns our stem cells?cells?

Who has jurisdiction Who has jurisdiction regarding the use of our regarding the use of our

stem cells?stem cells?

Are autologous (adipose Are autologous (adipose derived) stem cells body derived) stem cells body parts, or drugs? Does an parts, or drugs? Does an

MRI change stem cell MRI change stem cell characteristics? characteristics?

What constitutes stem cell What constitutes stem cell “alteration.” “alteration.”

Summary of h-ASC UseSummary of h-ASC UseAutologous, safeAutologous, safe

Inexpensive, abundant, and simple to produceInexpensive, abundant, and simple to produceExtensively tested in canine clinics for at least 9 Extensively tested in canine clinics for at least 9

years, with remarkable resultsyears, with remarkable resultsFirst 8 years of human results are remarkableFirst 8 years of human results are remarkableU.S. Navy has commissioned study of aquatic U.S. Navy has commissioned study of aquatic

mammals’ h-ASCmammals’ h-ASCLiposuction of seals, dolphins, and sea lions: Liposuction of seals, dolphins, and sea lions:

NASA studying for astronauts in deep space NASA studying for astronauts in deep space Delivered by injection, catheter, IV, nebulizerDelivered by injection, catheter, IV, nebulizerMay provide hope for diseases for which we May provide hope for diseases for which we

currently have no effective treatmentscurrently have no effective treatmentsMay be much less expensive, much more May be much less expensive, much more

effective treatment (for some conditions) than effective treatment (for some conditions) than presently available medications or surgeriespresently available medications or surgeriesMay have significant anti-aging propertiesMay have significant anti-aging properties

Thank you for Thank you for listening.listening.

For any further information, For any further information, contact me atcontact me at

csehrlich@hotmail.comcsehrlich@hotmail.com..