Frequently asked questions We tried to sum up the most frequently asked questions about the therapy used in the Clinic and to clearly describe in details the peculiarities of stem cell therapy.

1. When the first works that laid the basis for a new method appeared?

The first impulse was given ten-fifteen years ago by the studies of Russian and foreign scientists in the field of cell transplantation. Among foreign colleagues we would specially note Professor Olaf Bakstrem (Sweden), Professor Evan Snyder (USA) and others. The fact that scientific thought took the same direction both abroad and in Russia proves the objective necessity to develop a new branch of medicine. However we have a right to be proud because the priority here belongs Russian scientists. The new method was “nursed” by the RAMS academicians: Tatyana B. Dmitriyeva, Valeriy I. Shumakov, Gennadiy T. Sukhikh, Vladimir P. Chekhonin and other Russian researchers.

2. What are the characteristic features and peculiarities of a new method?

A new direction was born at the junction of conservative and transplantation therapy, that is joining conventional treatment and transplantation of organs and tissues. The idea is that we do not treat but replace old damaged cell structures that for various reasons (infections, traumas etc) are unable to perform their functions. However we mean here not an organ transplantation but intratissuenal reconstruction, i.e. restoration of intratissuenal structure of the damaged organ. We provide a new biological resource that is used by the patient’s organism acoording to standard rules of sanogenesis

3. How the method is implemented?

Modern diagnostics permit to detect that certain areas, for example in the brain, are deprived of normal blood supply and/or the propagation of neural impulses is damaged due to the injury or autoimmune process. It means that although formally the cell structure is preserved really it is dead. These dead neural cells are to be replaced and new innervation is to be set up to restore the lost functions of the organs and tissues. In reality it looks very simple: we just surgically obtain autologous stem cells from bone marrow of the patient or separate the stem cells from peripheral blood after stimulation by the stimulating factors. Then we standardize the cells, culture to get necessary number, then cryopreserve them and they can be stored in specialized blood and stem cells banks for an unlimited period of time. Further we use thawed stem cells for direct transplantations into brain, CSF space etc.

4. How the stem cells can be transplanted?

First the method of direct stem cell transplantation, known as the method of cell transplantation comes to mind. Lately we started to widely implement conservative approaches and transplant the suspension of cultures stem cells into blood or cerebrospinal fluid. The region of the dead cells in the brain/spinal cord is similar to the burned field, and the doctors’ practice can be compared with the actions of a seeder. It is possible to implant the stem cells into the site of injury calculating its location accurate to the thousandth part of micron as our Western colleagues do. We also have these researches. However budget limitation combined with the need for urgent assistance to the patients forced us to search the other way. We simply infuse healthy cell structures into CSF space and the cell rush to the site of injury. It appears that live cells are able to migrate through the brain/spinal cord in “correct” direction. The stem cells received from outside make the oasis of young regenerating tissue. As a result brain/spinal cord that due to autoimmune, viral, degenerative diseases, hemorrhages or traumas functions poorly acquires the second wind. After the outside impulse the inner mechanism of self curing is triggered. Then the patients require the support and assistance of rehabilitologists and other doctors to make new cells function and to maximally use new resource.

5. Is the surgical intervention necessary to ”repair” the damaged brain/spinal cord structure? How exactly the neural cells are transplanted into sick brain?

Our method of stem cells administration can hardly be called a surgical intervention. In a classical surgical intervention you know exact time when the narcosis is given, the surgeon takes a scalpel etc. It is possible to calculate all the time necessary for the surgery. In our case cytotransfusion into brain is performed in stages and may last for two or two and a half weeks. As for the scalpel we do not need it in this case. We have developed low-invasive technologies. To accomplish the intervention in success it is necessary to perform X-ray-surgery, bioassembling, restoration of vegetative innervation, main and circular blood supply.

6. The efficient therapy of what diseases has been confirmed by practice?

We do not emphasize when we say that we help to many of the incurable and bring back hope to the desperate. These are the patients with brain and spinal cord traumas, patients after strokes. Quite recently these patients heard that medicine is helpless in their cases, they are to learn how to live with the disease and to put up with it. Now we think that if the disease is over it is possible to start administering stem cells therapy. To date we have proved that the efficacy of autologous stem cell therapy in minor spinal cord injury ranges from 45 to 70%. Here everything depends on the size of lesion, the level of injury and the years post injury. The best results were obtained in the patients with thoracic level of injury; 2-5 years post injury and incompleteness of SCI. We registered high percentage of motor restoration (61.1%), considerable bowel and bladder control restoration (54%). Sensation disorders are more difficult to correct by this method of treatment. We also try to help to the patients with multiple sclerosis, although the rate of curability here is much lower – only 20-25%. But in these patients it is obligatory to perform first complete transplantation of bone marrow with high-dose chemotherapy and only then to study the opportunity of stem cells transfusions. Also the laboratory experiments performed abroad permit to claim that stem cell transplantation is also promising as the method of treatment for Alzheimer’s disease, Parkinson’s disease and other “tremor” syndromes. We have received very good results in 4 patients with Parkinsonism, however in two patients the therapy was inefficient and even caused deterioration. All these cases require deep study and thorough analysis. Besides this method will be efficient in case of residual-organic and hypoxic injuries, that manifest in oligophrenia, infantile cerebral paralysis and other severe disorders. Now the society has turned away from these patients and autologous stem cells therapy gives them hope to live a normal life.

7. Can a new method be a ray of hope for epileptic patients?

So far we did not study this group of patients although laboratory experiments give very promising results. Neural cells transplantation appeared to be especially efficient for epilepsy of traumatic origin.

8. Can you help in the case of spinal cord injury?

Yes. Currently these cases are mainly treated in our Clinic. We work a lot with SCI patients and know that SCI is not a sentence. To date we are able to greatly improve the life quality of these patients. In some of these cases a reconstructive surgical intervention into spine and spinal cord is necessary. These surgeries are extremely time-consuming and complicated; they last for 10-12 hours. Frequently these patients receive autotransplantation, i.e. we use their own cells and tissues, transplanting them into the injury site. But our basic method of SCI therapy is conservative, administration of autologous stem cells and specialized rehabilitation program

9. Where from do you get the stem cells to transplant into injured brain/spinal cord? Who is the donor of the cells in this case?

Initially we used the cells of the dead people and of the aborted human embryos. As you understand it caused lots of problems as the transplanted cells have to match the organism of a host, otherwise they would be rejected. In 2002 we fully refused from using donor, fetal or embryonic cells. We work only with autologous material, that is the patients own stem cells. In this issue a great support is given to us by the special cell culture bank in the Serbsky’s Institute and bone marrow bank on the Russian Cancer Research Centre. Cell culturing permits to obtain cells in practically unlimited quantity. Before administration of the cell the special cell tests are done to check the viability of the transplanted cells.

10. How much does this therapy cost?

So far a new direction of medicine receives no financial support from the state. Meanwhile in all the world the procedures of harvest, standardization, cryopreservation and storage of stem cells are rather expensive costing 200-250 thousand dollars. Our technique of stem cells’ harvest, processing and administration largely repeats the main stages of the protocol of bone marrow transplantation and is 4-5 times cheaper than abroad. These prices are approximate; they can vary depending on the client’s demands to the conditions of stay and treatment. The cost of neurosurgical interventions for spinal cord reconstruction is calculated individually for each case.

11. What are the perspectives of the method developed by you for the future?

Our team has been developing this method for 20 years. We were the first in the world who translated the method of stem cells’ transplantation for neural disease into clinical practice and received all necessary official approvals. We worked in this field when only few knew what the stem cells were. But we were convinced that the time would come and every housewife would know everything about the stem cells. This time has come. So now we think that future belongs to these methods and range of their use will be expanded. Now these techniques are applied for arthroses treatment when about 15 million of people in this country suffer from various diseases of joints. Now we are on the edge of era of full reconstruction of human brain/spinal cord, tissue bioengineering, bioengineering plasty of the joints.

12. Is it possible to apply the method to treat malignant tumors?

We learnt to restore the damaged blood supply of tissues, but the opposite process is also possible. Depriving the tumor of blood supply and nutrients, it will inevitably shrink and reduce in size. Together with the State Research Centre of Social and Forensic Psychiatry we created a new immuno-liposomal vehicle system to transport various therapeutical agents to tumors. The vehicle will be guided by the stem cells that always home to tumors but are unable to cope with pathological cells. To sum up modern science has developed revolutionary technology. It is new ideology in medicine, absolutely unconventional approach to many challenges. Cell transplantation permits to answer fully or at least partially those questions that were considered dead ends quite recently.