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Welcome to part two of why all regenerative medicine therapies are not alike. I’m Dr. Mark Sanna. Thanks so much for joining us. I hope you enjoyed part one. If you hadn’t had the chance to see that, go back and watch it and you’re gonna find out the differences between regenerative therapies and single-spin and double-spin PRP, and that’s where we’re gonna pick up right now.
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We’re gonna cover some information about stem cells. Hot topic. We’re gonna learn about alpha-2 macroglobulin. You might not have heard about that one. Hey, listen, I wanna do a special shout-out to our friends at ChiroSecure. Thank you so much for helping to make this program possible. And let’s go to the slide I mentioned Wharton’s jelly before.
That’s the, uh, uh, human cellular tissue product, uh, that comes from a donated umbilical cord. These are undifferentiated cells. They’re mesenchymal cells. They do have a factor of, uh, differentiation, unlike platelets, which don’t Uh, Wharton’s Jelly is filled with amazing amounts of, uh, signaling and healing types of, uh, substances as well.
And, uh, it’s super important that you know where these are sourced from because I’ve seen, uh, Wharton’s Jelly or these types of, uh, stems when they’re assayed, uh, the cell- cells are all dead because they weren’t handled. These are live cells. They weren’t handled properly. So typically, you’re gonna receive these from an assayed lab that is a certified lab that is producing them.
However, not only is it important how they are produced in the lab and how they’re handled in the lab, but how they’re transported as well. So these are typically sent by FedEx in a dry ice, and they’re stored in your facility in a cryo, uh, tank, a nitrogen tank, at a temperature that you simply cannot achieve in a typical refrigerator or freezer, uh, that you might have even in a medical grade, uh, freezer or refrigerator.
These things are kept at a very, very cold temperature because we want them to be live and viable when we put them in the joint, not just when they leave the lab. So how we handle them is super, super- So the advantages, Wharton’s jelly, it’s in abundant supply. It’s non-invasive. In fact, we’re not poking you for your adipose or poking into your hip to get your, uh, uh, bone marrow.
Uh, these are young cells, as young, as vibrant as you could possibly get. They peripherally– pro-proliferate readily, and there’s a almost no chance of rejection. Super, super, super low. Uh, so for providers, understand origin, where they come from matters. Your source has to be reputable. It has to have the consent, important consent, where these were harvested from.
Uh, you must make sure that you’re following any regulatory rules that, uh, comply with, uh, the FDA that, uh, requires, uh, minimal manipulation of these, uh, types of products. And, uh, you wanna be sure that we have the, uh, mesenchymal cell, uh, marker and viability checks that take place along the, uh, supply chain.
Super, super important. I mentioned cryopreservation. We want to know that not only do we store them properly, that we thaw them properly. Uh, I mentioned that it’s super important to have this nitrogen tank. Goodness sakes, if you happen to lose a, a supply oof electricity in your practice, and I’ve seen docs have to have a, uh, stem cell party, and they’re injecting stem cells in their patients and their, uh, staff members, whoever wants them, because they’re gonna be not viable shortly.
And that’s not a happy day for the practice, not something that you want either. Um, and so we wanna make sure that we’re in control of how we store them and how we thaw them, primarily to maintain that cell viability. Patient selection is super important as well. As I mentioned, this is a customized treatment.
This is not one-size-fits-all. Age impacts the viability of platelets. If we’re doing PRP, there’s lots of research that, uh, shows that the older that we are, the less viable our platelets are. Now, that doesn’t mean there’s a hard and fast age at, uh, 60, 65 years old that you are, are no longer a candidate for PRP.
They can function and do function. It’s that they just don’t function as well, uh, as in a younger patient. And if you have somebody who has any type of comorbid-comorbidities, uh, diabetes, obesity, cigarette smoke, or liver toxic- drugs, taking NSAIDs for a long period of time, which many of these patients have, they may not be a candidate for platelets, and then we have to use the outside source, and that’s where we go to the word’s jelly for stem.
Uh, we have to know what those contraindications are and screen patients out properly if their health Like I said before, if their platelets are pooped out, if they’re pooped out, their platelets are gonna be pooped out. So follow-up is also super important for Wharton’s and STEM. Uh, we wanna monitor the patient for the long term.
This is not necessarily one and done. Osteoarthritis is a chronic disease, and, uh, probably some of the lifestyle factors that originally brought the patient in with osteoarthritis or caused that osteoarthritis to develop are, are still gonna be there. So it’s important to let patients know that we’re gonna check them at six months and a year.
Probably the outside, uh, functionality of these types of joint injections procedures are about two years, right? By then, the patient should know and be prepared that they’re going to have a, a second round of it. Uh, we wanna be checking in on safety and the long-term safety along the way and the e-efficacy over the long term for the patient.
So the differences in PRP to re- uh, review one more time, single spin and double spin, very distinct platelet concentrations, very distinct effectiveness levels as well. Uh, the concentration in single spin is gonna be lower. Double spin, it’s gonna be higher. In fact, single spin is, uh, lower, uh, than double spin, but double spin is gonna be 1.5 to three times higher in concentration.
So it gives us a very significant, uh, increase above the baseline by doing that second spin. It really doesn’t take a whole heck of a lot more time to spin that down a second time as well. It’s totally worth it. So single spin, it’s a little bit faster, a little bit cheaper overall. It’s good for moderate concentration needs like soft tissue.
Double spin, higher concentration of signaling growth factors. It’s gonna be more effective where that’s needed, potentially better patient outcomes, and you get a second separation of pure PRP that is produced. What’s a PRP kit? You may have heard about that. That’s one of the tools that you need to make a PRP.
It’s a specialized device used in PRP preparation. It has therapeutic uses. It actually prepares the platelet-rich plasma. It’s, uh, has several components, uh, blood tubes, an anticoagulant, and, uh, tubes that actually fit into a specific centrifuge. Standardized kits, these aren’t made for s-re-injection of blood.
They’re okay for a blood draw but not putting the blood back in you. Um- Those kits that you can buy, they’re about $8, something like that. You’ll see those out on the market. Those are not to be used for PRP. We wanna be aware of something called pyrogens and silica. These are cytotoxic. Now remember, in an osteoarthritic joint, we have a catabolic situation going on.
We need to switch that, turn the switch to make it anabolic, have it be growing instead of breaking down. And if we’re injecting cytotoxic materials in there, it’s gonna be hard to shift that to anabolism. So they hurt the anabolic potential overall, pyrogens and silica. Um, y- you can use some of the kits that have pyrogens and silica for things like, uh, the vampire facial aesthetic, mild needs like that, but you do not wanna be putting those into a joint.
Uh, the double pin spin PRP kits, uh, have a high-yield system, uh, seven to 11 times the platelet concentration when done properly. That’s 9 to 10 billion platelets per use. That’s very, very significant So altogether, we wanna use bio scaffolding that’s gonna help give us the maximum effort, keep that product in the joint as long as possible for a slower release over time and less chance of having to do repeat procedures where it doesn’t work, and it doesn’t work, and it doesn’t work at all.
So really good PRP is without irritants, more platelets, kits that, uh, filter out irritants, pyrogen and silica-free. Uh, they also filter out white blood cells. You don’t wanna be injecting white blood cells into a joint if we’re, again, we’re trying to create, uh, anabolism there. Uh, it’s also causes some pain.
You put a little white blood cell in there, you put a little– get a little red blood cell in there by accident instead of just filtering out the platelets, the patient is gonna have not only contamination of the good product that you’re preparing, but it’s gonna hurt, and you don’t wanna hurt the patient.
I mentioned A2M before, and A2M is a plasma protein. Right now, sitting where you are, it is absolutely circulating around your bloodstream. It’s circulating around my bloodstream at this point in time, and, uh, it is a blood protein, macroglobulin, meaning big macro, globulin blood protein. It’s the largest circulating protein in your blood.
Its job is to do cleanup. And, uh, so it has a protease inhibitor. So how the body cleans up inflammation, cellular damage that at the cellular level, tissue damage at the cellular level, is through proteolytic action. Proteases get in there, and they do the cleanup. And that’s all well and good unless they’re stuck inside an osteoarthritic joint capsule that’s scarred over, and the A2M can’t get in, and the proteases, guess what?
They’re going to town on your cartilage or what you have left there. So A2M, produced in the liver, it’s a protease inhibitor and has great therapeutic use. Uh, as I mentioned, A2M is an anti-protease. It inhibits fibrinolysis and coagulation. It neutralizes plasmin. Uh, it is a binder to growth factors and cytokines.
Cytokines are what causes pain. And so unlike PRP, where you inject platelets into a joint, uh, patient doesn’t typically feel anything the next day, you’ll inject A2M into a joint, and you’ll hear very often when you phone the patient the next day, “Gosh, I feel fantastic, doc. I’ve never felt better.” This is a really important thing for you to understand A2M stops the chemical reaction of osteoarthritic ins- uh, arthritis.
So it’s a step you don’t wanna s- skip, and yet many providers don’t even know about A2M. So A2M, like imagine if you have a garden and you have an infestation of beetles, and the beetles are eating away at your flowers and your plants, and you just try to fertilize your way, uh, to get out ahead of the beetles.
Guess what? The beetles are eventually gonna win, so you’ve gotta take care of the beetles first, get the beetles out of there. In the joint, the beetles are the, the proteolytic enzymes, right? A2M goes in, binds with the proteolytic enzymes, binds with the cytokines, stops that chemical reaction of, uh, osteoarthritis.
We let the patient have about six weeks in between having their A2M procedure. We wait six weeks, and then we’re either going to apply a PRP double spin or the plate… if the patient is simply not a candidate for that, then we’re gonna go ahead and use the Wharton’s Jelly stem cells. So important not to skip, completely improves the outcome that you’re going to achieve with your patients, and it is a really a two-punch, uh, approach to getting rid of osteoarthritis.
It shields the cartilage overall. It’s highly anti-inflammatory as well. Uh, it’s spun. If you looked at the procedure being performed, kinda looks like somebody’s drawing blood for, uh, PRP and spinning it down inside a centrifuge. You gotta draw a little bit more blood than you would for PRP. Uh, there’s less A2M circulating in the blood than there is platelets.
And so we draw the blood, spin it down. Again, you wouldn’t be able to tell. It’s just a different kit, a different tube that’s filtering out A2M rather than platelets, and it’s directly injected right into the joint, again, about six weeks before we’re gonna do our secondary follow-up procedure Patient gets rapid relief.
I call it the fake out, right? So you have to tell them, “You’re gonna feel good.” Patient, “Oh, I don’t need the second, uh, procedure ’cause I feel great.” Well, all we did was put out the fly- the fire. We got the beetles. We’ve reduced the inflammation, maybe slowing, uh, joint degeneration, but we haven’t yet introduced a regenerative, uh, tissue that, like a s- uh, stem, that is going to, again, differentiate into, uh, new healthy cartilage tissue.
A2M’s ultimate protector stops the cartilage loss from protecting us from these destructive proteolytic enzymes. We do the same thing with scaffolding. We’re gonna heat a little bit of that, uh, two, three cc’s of our, uh, product, mix it in, uh, with the A2M prior to injecting it again, holds that in the joint About four months’ time.
So regen protocols, they are the future of healthcare. They are where we’re going. We’re gonna talk about, in some of our presentations as we go on, some really cool things that you can do in addition to these core procedures. Uh, we’re gonna talk about ozone. I’m big on pro ozone, ozone therapy, and how that magnifies the impact.
Another ninja secret of how it magnifies the impact of this, uh, uh, of, of these procedures. We’re gonna talk about how they can be supported by peptides as well. In my next presentation, we’re gonna talk about synergistic services. So we want long-term healing. We wanna know this is the new standard of care.
In the past, having an injection of cortisone into a joint that shreds the joint, done two, three times, just prolongs the time in between when you have, uh, the symptoms and when you need a knee replacement. And our goal with these regenerative therapies are to help you keep from having those at all. So I hope you’ve enjoyed this presentation, why all regenerative m- uh, therapies are not alike.
This is Dr. Mark Santim, CEO of Breakthrough Coaching. Hey, check out our website, mybreakthrough.com. Pick up the phone and call us at 1-807, the word advice, A-D-V-I-C-E. And, uh, I’ll be happy to be in touch with you and give you some personal one-on-one, uh, so that you can actually implement these procedures in your practice, uh, and do it effectively, cost-effectively, in a way that is stepwise.
I like to say that is evolutionary, not revolutionary. You’re not gonna blow up your practice. You can simply add these in, uh, in, in a great way. And a final shout-out to the folks at ChiroSecure. Thank you so much. You guys write the multidisciplinary, uh, malpractice insurance for our clients for many, many years.
We appreciate all you do and all you do for our profession. Thanks so much for being with us, and I hope you see us on our next episode.
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