THE NEW WORLD OF CELLULAR HEALING WORDS By J.P. Faber PHOTOGRAPHY Tommy Chung

Has the day of adult stem cells arrived? Harvesting them from a patients fat, doctors are using them for everlthingfrom providing

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natural faceliftg-to healing damaged heart tissue. And its only just begun.

Imagine if you could go into a hospital where doctors could remove some of your fat-naturally, from some place you really didn't want it any way-then process that fat to produce special

healing cells that could repair damaged organs in your body, such as your heart or your lungs. And imagine that within a matter of weeks you eQuId start to function again, like you did before your organs went bad.

Does that sound futuristic? Maybe so, but it's happening right now, in special clinics around the world, and in experimental trials here in the U.S. And those special cells? Stem cells. Not the embryonic stem cells that were taboo because they came from unborn fetuses, but something called 'adult' stem cells, which are found abundantly in our own fat.

Of all the tools in the growing medicine chest of anti-aging doctors, nothing matches the exciting potential of adult stem cells. The possibilities seem limitless. Already more than 30 different cures are being tested, from repairing damaged knees to fixing neurological disorders like multiple sclerosis.,

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But j st what are these magic bullets called stem cells? When

the ~uman egg is fertilized, it starts multiplying universal cells stem cells-that have the potential to become any cell in the b dy. As the fetus develops, these 'toti-potent' cells (which means they can turn into any type of cell) get their instructions from ou DNA to start taking on their special roles.

"The OriginJ stem cell was the ovum [the female egg cell], and the first'[~inical) use of stem cells was in 1978, with the first test-tube baby," says Craig Saunders, M.D., a cosmetic surgeon in Dallas, Texas. "I start with that explanation, because patients understand it."

These embryonic stem cells are not what are turning to day's medical world upside down, however. The new kids on the block are stems from fat, the so-called 'adult' or adipose­derived stem cells, adipose being the fancy name for fat.

These fat stem cells are not the same as the embryonic stem cells. Among other things, they are, not 'toti-potent: meaning they can't turn into any other kind of cell. They are already somewhat evolved, so they can only become other fat cells, or muscle, blood, bone or cartilage cells. But that seems to be enough-and actually good news, because they can't become cancer cells either. And that array provides a host of applications, from giving you a more youthful face to repairing your heart muscles after a heart attack.

"Their whole mission is to become another type of tissue, like bone, or muscle, or blood," says Dr. Saunders, who has a background in sports medicine. "They provide you a choice, an alternative medicine, that may delay and possibly re-grow your cartilage, for example .. . 1 make no claims, but 1 am using them for joints, wrists, and knees, for cartilage re-growth."

Until recently, these fat-derived stem cells were used only for aesthetic purposes. For several decades, cosmetic physicians have been using patient's fat to plump out faces, buttocks and breasts, with sometimes mixed results. Why? Because fat is a delicate substance when it's transferred and doesn't always 'take' - as much as half of it gets reabsorbed, so cosmetic surgeons have been hesitant to embrace a procedure they couldn't control with certainty.

"Doctors have tried [fat transfer) for years, but it wasn't a predictable therapy:' says Sharon McQuillan, M.D., a South Florida cosmetic physician and director of the Aesthetic Fellowship of the American Academy of Anti-Aging Medicine. "Otherwise, the facial filler market might not exist. Because, who wouldn't want to take fat from where they don't want it and put it where they do want it? It's a very seductive concept." Then came Sydney Coleman, M.D., a New York plastic surgeon who in the 1990s tried to standardize the technique.

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What Coleman found was that if you inject fat in small amounts, it tends to 'take: because the fat gets enough blood supply. Big lumps tend to clump up and die off. But then Dr. Coleman noticed something unexpected: the skin where the fat was injected started to get healthier and less wrinkled.

Nor was Dr. Coleman the only physician to notice the phenomenon. "I have been doing fat grafting for 10 years," says Harold Bafitis, D.O., a double board-certified plastic surgeon in Palm Beach, Fla. "Every time 1 inject fat [into the face), eight months later the quality of the skin is better, the quality of the tissue is better. .. 1 see an increase in the radiance and glow."

The mystery was finally revealed in the late 1990s by researchers at the University of Pittsburgh: They discovered stem cells in fat, and lots of them. Again, not embryonic stem cells that can become any organ in the body, but adult stem cells with the power to become muscle, bone, fat and blood. Naturally, it wasn't long before researchers wondered if these fat-derived stem cells could repair things like bum knees or damaged lungs. Suddenly it was a whole new ball game.

"The Bush administration convinced everyone that you had to kill embryos to get stem cells," says Dr. Bafitis. "But your own fat contains huge numbers of stem cells, way more than bone marrow or anyplace else ... The science of this is just beginning to emerge in America."

THE MAGIC OF FAT There is still a lot of disagreement about the best way to harvest, process and apply stem cells from fat. Scores of doctors and companies now tout one method over the next each step of the way. About the only thing that everyone agrees on is that they work.

Most of the procedures involving stem cells today are done by cosmetic and plastic surgeons-a.k.a. beauty docs-who use liposuction to sculpt the female form. When liposuction became the rage in the 1980s and 1990s, a number of pioneering doctors perfected the art of re-injecting that fat into areas of the body that needed it. As Las Vegas-based laser lipo expert Edward Zimmerman, M.D., says, "We started calling fat liquid gold. It was just too valuable to discard." Some went into faces and hands, replacing the fat that time takes away; for others it was to add size, shape and form to the buttocks or breasts.

One of the first physicians to advocate the use of stem cell-rich fat for facelifts was Mark Berman, M.D., a cosmetic surgeon in Beverly Hills who had previously used synthetic fillers to plump out tired faces. Dr. Berman, last year's president of the American Academy of Cosmetic Surgery, was interested in

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Regrowth of damaged heart tissue is one area showing great promise in FDA-sanctioned stem cell research.

the cosmetic use of fat, and so he used the same technique as Dr. Coleman­take the patient's liposuctioned fat, spin it in a centrifuge, then inject the concentrated layer that had the most stem cells.

Flash forward half a decade. Dr. Berman has not only perfected his process of preparing fat for cosmetic procedures, he is also co-founder of the California Stem Cell Center, working with various specialists to see if these same stem cells can't help cure other illnesses, especially damaged cartilage. So far his results are dramatically encouraging. Under the supervision of orthopedic surgeons, Dr. Berman has injected stem cells into the knees of dozens of patients.

One patient, 47 -year-old Laurie Hanna, reports that following years of suffering from a ski accident at age 30 that damaged her left knee, several injections of stem cells have led to "an amazing recovery" and that she is skiing at the same level she had been 15 years earlier. This, after a physical therapist told her surgery would be required.

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Another patient, 75-year-old real estate manager Joyce Syme, had been seeing Dr. Berman for facial fat transfers. After he injected stem cells in her knees, she reported that after decades of pain that left her limping, her knees are now pain-free and fully functional. "My family and friends can't believe it," she says. "I never anticipated that there would be no pain."

Under the supervision of interventional cardiac doctors, interventional radiologists, urologists and neurologists, the California Stem Cell Center has also used volunteer patients to try stem cells for heart damage, lung damage and other degenerative conditions. So far, the Center has reported success with everything from asthma to chronic back pain. Even neurological disorders have been treated with positive outcomes.

Not far from Dr. Berman, cosmetic physician Nathan Newman, M.D., has also been using stem cells to enrich the fat he injects for facelifts. Because of what he has seen in terms of skin regeneration, he also uses stem cells to heal scar tissue, another of the big effects observed by Dr. Coleman. Similar to Dr. Berman, he has been injecting stem cells into the joints of patients who suffer stiffness and pain. "I have patients who, with one injection, have become pain-free with increased function," he says.

Likewise in Orlando, Fla., Dr. Carlos Mercado is a cosmetic physician who specializes in non-surgical aesthetic procedures. He also came from a 'bioplasty' background, using fat as a form of natural filler for facial rejuvenation; he even uses a stem cell delivery 'pistol' that allows him to put small amounts of fat with stem cells in specific places in the face.

Then an 84-year-old patient who was in great pain with a broken shoulder that would not heal asked him to try stem cells. "I told him, 'I don't know if this is going to work for you since it's so advanced,'" says Dr. Mercado. "He said he'd been everywhere, to orthopedic surgeons, etc., but that the pain was so great it was affecting his quality of life ... " After injecting the patient with his own stem cells, says Dr. Mercado, the patient regained functional use of his arm. "I watched him use his arm to eat a Subway sandwich. I literally started to cry. I couldn't believe it."

With such anecdotal reports coming in from doctors across the county, the scientific research community-with little stem cell funding during the Bush Administration-is now catching up. Today there are more than 2,400 studies in the U.S. looking at the power of stem cells. Like the doctors who use stem cells, researchers do not claim that they can do anything. All they can say is that the

results look promising. The FDA, likewise, prohibits doctors in the field from making any medical claims about stem cells-not until their efficacy is proven.

This is not the case with cosmetic applications. The FDA, in general, does not govern the practice of medicine, and fat transfer is a bit like the medical practice of blood transfusion. The doctor is merely extracting your own fat tissue, separating the stem cells, then either replacing the stem cells alone or mixing them back into the fat before re-injecting them. The only reason for the FDA to become involved is when the tissue has been significantly changed, turning it into a drug.

In terms of both cosmetic and therapeutic applications, however, the big question is still how the fat should be removed, how it should be processed and how it should be re-injected to make the most of the stem cells. "We know that different doctors have different results," says Jeffry Schafer, M.D., a San Diego-based cosmetic surgeon who recently co-hosted a stem cell conference for about 70 doctors in Southern California. "What I've found is that everybody is a cowboy, with different techniques of fat harvesting, processing and transfer."

That lack of standardization is sparking a new wave of companies and products, all trying to figure out how best to 'awaken' the tiny stem cells that are mixed in with the larger fat cells in fat tissue, with solutions ranging from a $100,000 machine made by Cytori, to a simple, affordable centrifuge kit made by Palomar. Other companies, such as IntelliCell BioSciences, are promoting a 'manual' method, where the fat tissue is broken up by ultra sound.

Even with doctors across the country trying to figure out the best way to use stem cells, the big missing ingredient is still scientific verification. Anecdotes are one thing, but clinical evidence is the proof in the pudding.

NOW FOR THE SCIENCE In a state-of-the-art hospital in Tijuana,

Mexico, Dr. McQuillan, and her partner Kristin Comella collaborate with The Regenerative Medicine Institute of Mexico conducting clinical trials of disorders such as congestive heart failure, myocardial ischemia, diabetes, multiple sclerosis, autoimmune disorders, COPD, and more. The Regenerative Medicine Institute at the Angeles Hospital uses a staff of board­certified physicians working within their specialties to treat patients and compile data on stem cells for different conditions.

These trials are conducted under government, university and hospital approval; the ultimate goal is to conduct similar trials in the U.S. to gain approval for the treatment of specific conditions.

"Your own fat contains huge

numbers of stem cells, way more than

bone marrow or anyplace else .. .

The science of this is just beginning to

emerge in America. "

-Dr. Harold Bafitis

Like other cosmetic surgeons, back home in South Florida Dr. McQuillan uses stem cell-rich fat for facial rejuvenation. She also works with orthopedic surgeons to repair damaged knees. But for anything else, she works in Tijuana, where patients come to seek cures for conditions where traditional medicine has failed, or because they are looking for a natural alternative. She and partner/scientist Comella are particularly excited about results they are getting with both cardiac and COPD patients. "We are getting results that would make you cry," says Dr. McQuillan "People who were on oxygen therapy and could hardly walk,

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have improved to a point where they no longer need oxygen and are able to walk, bike ride, and even dance .... "

For traditional researchers, however, anecdotal reports of near-miraculous cures-including the much-ballyhooed use of stem cells to cure the lower back pain of Texas Gov. Rick Perry-means little. They caution that the stem cell craze might be just that, a craze where people so believe it to be true that they will themselves to get better.

MAKING IT REAL For three years now, Dr. Joshua Hare has been working on clinical trials at the University of Miami with NIH (the National Institute of Health) funding and FDA approval. As head of the UM Miller School of Medicine's Interdisciplinary Stem Cell Institute, he has tested close to 100 patients with heart damage. He uses the same type of stem cells found in fat, but from bone marrow.

Dr. Hare injects 2 million stem cells into patients who had previous heart attacks. These patients typically have enlarged hearts and dead heart tissue. The early results show 15 percent shrinkage of the swollen heart and regeneration of previously dead heart tissue, both remarkable results.

Dr. Hare is also treating other patients with a placebo, an injection with no stem cells. Typically, some people get a little better from these as well.

'The placebo effect is very powerful in medicine," he says, and the current wave of belief in stem cells as a cure-all is so strong it may be impacting the results doctors are getting. "There are a lot of things we think will work, but we have to prove it."

While the consensus is that stem cells work, the latest observation is that it may not be the stem cells at all which are actually doing the work. Scientists, researchers and doctors in the field now believe that stem cells are just one of a

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A WORLD OF POSSIBILITIES: STEM CELL APPLICATIONS UNDER INVESTIGATION

Calvarial Bone Defect - -

Corneal Repair - - - -Periodontal Disease -

Facial Reconstruction

Tracheal Repair -

Radiation Injury -

Breast Reconstruction and Augmentation

Liver Insufficiency - -

Tendon Injury -

Wound Healing -

Skeletal Muscle Injury - -

Peripheral Vascular Disease - -

Parkinson's Disease

Stroke

Facial Rejuvenation

- Vocal Fold / Cord Repair

_ Chronic Heart Disease

_ Acute Heart Attack

- Pulomonary Disease

- Kidney Disease

- Diabetes

- Spinal Cord Injury

Burn

Lipodystrophy

- Urinary Incontinence

- Arthritis

Doctors Who Practice Cellular Medicine

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Harold Bajit is, DO, is a board-certified plastic and reconstructive surgeon who practices in Jupiter, Fla. He is a fellow of the American Academy of Cosmetic Surgery and the American College of Osteopathic Surgeons. Dr. Bafitis is past chairman of the American Ostoepathic Board of Surgery.

M ark Berman, M D, is a board-certified cosmetic surgeon in Beverly Hills, Calif. He is past president of the American Academy of Cosmetic Surgery and the California Academy of Cosmetic Surgery. Dr. Berman was named in the "Super Doctors List" by Los Angeles Magazine in 2009 and 2010.

Sydney Coleman, M D, is a board-certified New York-based surgeon and member of the American Society of Plastic and Reconstructive Surgery and the American Society of Aesthetic Plastic Surgeons. Dr. Coleman is internationally known for his research in cellular-assisted fat transfer.

Sharon McQuillan, M D, is a board-certified Aventura, Fla.-based physician who specializes in both aesthetic and anti-aging medicine. Dr. McQuillan is a leading instructor for the American Academy of Anti-Aging Medicine, and a leading developer of protocols for stem cell therapies.

Carlos M ercado, MD, is a board-certi­fied cosmetic and anti-aging physician who practices outside of Orlando, Fla. Dr. Mer­cado is board-certified by the American Board of Geriatric Medicine and certified in Age Management Medicine by the Cenegenics Medical Institute in Las Vegas, Nev.

Nathan Newm an, MD, is a board-certified dermatologist and cosmetic surgeon in Beverly Hills, Calif., who uses stem cell­enriched fat for facelifts, body augmentation, scar treatments and treatment of orthopedic symptoms. Dr. Newman is a member of the American Academy of Cosmetic Surgery.

R. Craig Saunders, MD, is a Dallas-based cosmetic surgeon board-certified by the Ameri­can Academy of Orthopedic Surgery. He is a member of the American Academy of Cosmetic Surgery, the American Academy of Anti-Aging Medicine, and the International Federation of Adipose Therapeutics.

Jeffry Schafer, M D, is a San Diego-based plastic and reconstructive surgeon who specializes in cellular assisted fat transfer. Dr. Schafer was a former staff physician with Scripps Clinic and Research Institute in La Jolla and a clinical instructor at The University of California in San Diego.

With their potential to repare our bodies, stem cells are

poised to become the basisfor an anti-aging revolution.

group of cells that travel together in what's called the stromal vascular fraction, or SVF. Along with the 'mesenchymal' stem cells (which can become bone, muscle or cartilage) there are growth factors (proteins that instruct cells to repair themselves), lymphocytes (white blood cells), preadipocytes (which can become fat cells), endothelial progenitor cells (which can become blood cells), etc., all of which might have something to do with the healing that occurs when you inject stem cells.

"There is controversy now as to whether the stem cells alone are efficacious or that they require other cells in the SVF," says Dr. Ron Shane, a research scholar in neuroendocrinology at UC San Diego. "In five years we may not even be talking about stem cells." .

Some doctors even question whether adult stem cells actually become the tissue into which they are injected. Instead, the stem cells may just be giving special instructions to repair the tissue. "I try to use the word 'repair' cell, rather than stem celi," says Dr. Coleman. "We are starting to realize that fat is part of the repair system of the body. They [the fat-derived stem cells] are not making new organs, they are repairing tissue."

Understanding that stem cells may only be one of the players in the mix, another company-Stemprofill-is marketing a process whereby a patient's blood is drawn and centrifuged to extract both the free floating stem cells (produced by bone marrow) and the PRP, or platelet rich plasma, which contain growth factors. These are combined with standard facial fillers and the mix is used to cosmetically plump up a patient's face; the growth factors (and stem cells) tell the collagen to heal, reproduce and grow. The patient also avoids the time and expense of liposuction. "At the end of the day it's a combination of things," says Benito Novas, president of Stemprofill. One idea is that the cellular mix-including the adult stem cells-are secreting signals that tell damaged cells what to do.

Whatever the reason they work, stem cells are poised to become the basis for a revolution in anti-aging medicine, one in which the patient uses his or her own natural healing mechanisms to regenerate new tissue and repair the old. Pharmaceutical companies are busy trying to make drugs out of stem cells, finding special ones for the heart, lungs and cartilage that they can mass-produce. But in the end, the idea of the family doctor taking your fat, processing it and putting it back in your own body could become as common as taking two aspirins and calling the next day. G

Successful clinical use of stem cells to repair damaged cartilage-especially knees-is now being widely reported.