Stem Cell Therapy, SVF & Liposome Treatment
An Interview with Dr. Elliot Lander
by Jill Osborne, MA
Editor’s Note – It’s been three years since we last interviewed Dr. Elliot Lander of the California Stem Cell Treatment Center and it’s time for an update on his cutting edge research into the use of stem cells to treat interstitial cystitis. Dr. Lander is one of the few urologists in the world who has a passion and interest for the fairly new field of regenerative medicine, the goal of which is to stimulate organs to heal themselves through the use of living, functional tissues. In this case, the use of adult derived adipose (aka fat) stem cells and natural growth factors. One common misperception of stem cell therapy is that it requires the use of fetal tissue. As Dr. Lander explains in this interview, fat tissue taken from adults is a rich and plentiful source for both stem cells and growth factors which could help trigger the bladder to repair itself. One critical barrier to expanding this line of research is the lack of funding. Because there is no product under development, i.e that this therapy involves harvesting a patients own tissues which are then used only for that patient, there is no profit incentive that could attract big research dollars. As a result, this research is being driven by patients who pay for the service. We call this patient funded research and it’s not inexpensive. We encourage you to visit their website to learn more about their research program.
How do you define interstitial cystitis?
Put twenty urologists in a room and you’ll have twenty different opinions. I believe it begins in the bladder after some type of assault, usually infection or change in hormones. The bladder wall degrades and, in a normal person, this is restored immediately by the secretion of growth factors, such as the heparin binding growth factor (HP-EGF). For whatever reason, patients with IC don’t secrete growth factors properly to restore the barrier allowing urine to damage the urothelium. If you don’t have a barrier, urine is like battery acid. With each contact, it triggers a cascade of neuroinflammation that overstimulates the afferent nerve fibers and affects the entire pelvic floor.
Do you believe that infection plays a role in IC?
No. It’s the fact that the bladder wall barrier does not heal as rapidly as it should.
One of your first priorities in working with IC patients is to restore the bladder wall barrier. Several years ago, you started using pentosan polysulfate (aka Elmiron) in a very different way. Rather than having patients take it by mouth, you’re placing elmiron into small liposomes that are then placed into the bladder. What inspired this novel use?
Liposomes are nano-spheres made of the same material that makes up all of our cell walls. Drugs can be placed into the center of these fatty spheres and the drugs remain protected, making liposomes an extremely efficient drug delivery system. They have the ability to attach to cell walls through very narrow junctions and deliver drugs up to, and in to, cells. The urothelium has “tight junctions” which make drug delivery very difficult but liposomes are incredibly effective at traversing these barriers. The bladder is also what we call a “hostile environment” where lots of small molecules are normally destroyed. The fatty, double lipid layers of the liposome acts to protect the medication so that it can be delivered deeper into the tissue.
What results are you seeing?
I think we’re getting good results. As a barrier therapy, it’s highly effective. Previous research studies have found that placing empty liposomes into an IC bladder provided a therapeutic effect and helped to augment bladder barrier function. We have taken that a step further by also using the time-honored pentosan. By using liposomes we’re able to deliver 400 mg of medication into the bladder and most of it stays there. It’s a much more effective dose than taking Elmiron orally and it does not have the systemic toxicity and side effects. The only downside is that it’s easier to take a pill rather than have an instillation.
What’s your treatment protocol?
Our original treatment protocol called for liposome instillations every two weeks but lately we’re also doing weekly therapy to improve efficacy. Most patients have improvement after two to three months though a couple
required three to four months of treatment. It’s about patching the barrier and giving the bladder a rest period. If you can do that for about ninety days, I think you can achieve some healing and a lot of other researchers are noticing that around the country as well.
What other treatments do you use?
I take a multi-pronged approach to treatment and barrier therapy is just one piece. For patients with painful sex, vaginal atrophy and trigger points, I’m using growth factor therapy.
What are growth factors?
Growth factors are cytokines, a type of signaling molecule that the body uses to signal for cell division, cell repair and so forth. They are commonly used in medicine, often to encourage healing of wound tissue. AQ Skin
Solutions, a company located in Southern California, has created several growth factor products that are FDA approved and mostly used in cosmetics. Their Vaginal Rejuvenation System is used to relieve vaginal dryness and soothe irritation. It seems to stimulate a significant thickening of the vaginal lining and improve lubrication. Because the vaginal canal is integrally related to the trigone of the bladder, I think I’m also seeing some improvement in my IC patients. I’m also using it for my lichen sclerosis patients.
Stem cell therapy is the cornerstone of your work and research. How do you use it in the treatment of interstitial cystitis?
Stem cell treatment is not a “drug,” rather it uses a patient’s own cells to help trigger healing and growth. From each patient, we harvest stem cells from their own fat tissue which is obtained using a minor liposuction
procedure. Using technology developed in Japan and Korea, we then create a solution called “Stromal Vascular Fraction” or SVF. This SVF is kind of like a soup containing millions of stem cells and hundreds of natural growth factors. SVF can be injected through veins, arteries, subcutaneously or directly into joints or organs. For IC patients, we inject it into the trigone of the bladder and give it to the patients by IV where it acts to reboot the immune system. We also inject SVF into painful trigger points in the pelvic floor and/or near the urethra.
What results are you seeing?
IC patients have the same response to this treatment that we see in all of the autoimmune conditions that we work with. Patients symptoms first improve and then, after about nine months, start to decline. Repeat treatment is necessary. Researchers are now working to develop new methods of cryopreservation so that we can store SVF and then retreat the patient. Once that is up and running, we’ll be able to redose patients every three months to give them doses of their own cells to reboot their immune system.
What symptoms respond best to SVF treatment?
I had one patient from LA who had stabbing pelvic pain for 22 years. She really did not tell anyone she had IC. She’s very private and discreet. She suffered with this pain and after we deployed it into her trigone, the pain
went away right away but her frequency did not improve at all. I have other patients who have the opposite effect. It’s been sporadic as to which symptoms respond best.
Have you seen any adverse events?
We have seen no profound adverse events. Only minor events like bruising and/or hematomas under the skin at the site of the liposuction. No one has had anything serious happen, such as blood clot development.
How do you decide which treatment a patient should receive?
I like to use a multimodal approach to treatment where we try to deal with whatever is bothering the patient the most. Some patients I’ll throw the book at, giving them barrier therapy (liposomes containing pentosin),
growth factors and SVF based cell therapy over a two to three month period to give a chance for those nerve endings in the bladder to desensitize.
What’s holding stem cell research back? Very few doctors seem to know about it or use it?
Research is frequently funded by pharmaceutical companies who want to create a product to sell. We use your own cells in only your body as a surgical procedure. There is no medication for sale thus there’s no profit available for a large pharmaceutical corporation. Government grants are oriented to drug trials and we do not believe that a person’s own fat-derived cells should be considered a drug. As a result, we have had little in the way of research funding and our studies are still early in their development. Our stem cell studies are patient driven and patient funded at this time.
The good news is that we have licensed our technology to 40 other sites in the USA and several more abroad including Korea, Philippines, and Thailand. These centers are using our intellectual property to develop
fat-derived stem cell techniques and we are sharing the data and results in a very large database.
How much does it cost?
It’s around $7000. Interested patients can go to the www.18.104.22.168/~califstemcell website where they can read more about it and IC. They can check the candidate information and criteria to see if they qualify.
Is it covered by any health insurance companies?
No. We have done over 1000 cases and not one insurance company has paid for it.
Do you have an assistance program available for patients?
We do a fair number of charity cases, particularly where we need to learn something. For example, we recently offered free treatment to a patient with a very rare neurological disease.
Many patients have gone abroad to more affordable “stem cell clinics.” Is this safe?
There are hucksters out there. You have to look at the clinic, their track record, credentials and so forth. Do some research online to see if there are any bad reports. In general, we think its safer to use a clinic operating
in the USA where rigorous safety standards and provider qualifications are reported.
How can I find a physician using this therapy?
There are currently forty clinics using SVF now in the USA. You can learn more about them and find a list of our physician network at: http://stemcellclinicsofamerica.net/physician-network/
How should patients contact you?
They can visit our website www.22.214.171.124/~califstemcell or call 800-231-0407.