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Service dog receives cutting-edge stem cell therapy

A service dog that has come from the brink of death and back was in Terry on Wednesday to receive cutting-edge stem cell therapy.

Davis Hawn said his dog, Booster, saved his life and now he's working to return the favor.

"With Booster by my side, I greet each day knowing we can change the world for the better," Hawn said.

Together, Hawn and Booster helped foster international relations by appearing on TV in Cuba. They reassured Thai orphans infected with the HIV virus that life will be OK and they are loved. The list of accomplishments continued to grow until Booster developed hip dysplasia.

"When Booster couldn't get off the floor, I couldn't get out of bed," said Hawn, who suffers from depression. "Just as assuredly as God put Booster into my life, He again answered the call when I read about the modern day marvel of stem-cell implantation."

Medivet America, a global leader in veterinary science with more than 1,000 clinics in 28 countries, learned of Booster's plight and jumped in to help.

"They arranged to perform a procedure in which they injected Booster's own stem cells into his hips and got him back up and running again," Hawn said. "When I went to pay the bill, they refused to accept payment. I like to say that God paid the bill."

In January 2013, Booster again faced a health battle. He was diagnosed with squamous cell carcinoma and given three weeks to live. An aggressive tumor had eaten through Booster's skull cap and left him writhing in pain. In an effort to save Booster's life, Hawn moved to Florida where the University of Florida operated on Booster and a referral clinic performed radiation therapy.

The University of Minnesota took a piece of the tumor that was removed from Booster and used it to developed the first vaccine for squamous cell carcinoma in dogs.

Booster is now a cancer survivor.

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Service dog receives cutting-edge stem cell therapy

Top 10 Stem Cell Treatment Facts | Closer Look

Many clinics that are offering stem cell treatments make claims about what stem cells can and cannot do that are not supported by our understanding of science. The information on this page corrects some of the misinformation that is being widely circulated.

There are many different types of stem cells that come from different placesin the body or are formed at different times in our lives. These include embryonic stem cells that exist only at the earliest stages of development and various types of tissue-specific or adult stem cells that appear during fetal development and remain in our bodies throughout life.

Our bodies use different types of tissue-specific stem cells to fit a particular purpose. Tissue-specific stem cells are limited in their potential and largely make the cell types found in the tissue from which they are derived. For example, the blood-forming stem cells (or hematopoietic stem cells) in the bone marrow regenerate the blood, while neural stem cells in the brain make brain cells. A neural stem cell wont spontaneously make a blood cell and likewise a hematopoietic stem cell wont spontaneously make a brain cell. Thus, it is unlikely that a single cell type could be used to treat a multitude of unrelated diseases that involve different tissues or organs. Be wary of clinics that offer treatments with stem cells thatoriginate from a part of the body that is different from the part being treated.

Read more about differentTypes of Stem Cells

As described above, each type of stem cell fulfills a specific function in the body and cannot be expected to make cell types from other tissues. Thus, it is unlikely that a single type of stem cell treatment can treat multiple unrelated conditions, such as diabetes and Parkinsons disease. The underlying causes are very different and different cell types would need to be replaced to treat each condition. It is critical that the cell type used as a treatment be appropriate to the specific disease or condition.

Embryonic stem cells may one day be used to generate treatments for a range of human diseases. However, embryonic stem cells themselves cannot directly be used for therapies as they would likely cause tumors and are unlikely to become the cells needed to regenerate a tissue on their own. They would first need to be coaxed to develop into specialized cell types before transplantation. A major warning sign that a clinic may not be credible is when treatments are offered for a wide variety of conditions but rely on a single cell type.

The range of diseases where stem cell treatments have been shown to be beneficial in responsibly conducted clinical trials is still extremely restricted. The best defined and most extensively used is blood stem cell transplantation to treat diseases and conditions of the blood and immune system, or to restore the blood system after treatments for specific cancers. Some bone, skin and corneal diseases or injuries can be treated with grafting of tissue that depends upon stem cells from these organs. These therapies are also generally accepted as safe and effective by the medical community.

There are three main reasons why a person might feel better that are unrelated to the actual stem cell treatment: the placebo effect, accompanying treatments, and natural fluctuations of the disease or condition. The intense desire or belief that a treatment will work can cause a person to feel like it has and to even experience positive physical changes, such as improved movement or less pain. This phenomenon is called the placebo effect. Even having a positive conversation with a doctor can cause a person to feel improvement. Likewise, other techniques offered along with stem cell treatmentsuch as changes to diet, relaxation, physical therapy, medication, etc.may make a person feel better in a way that is unrelated to the stem cells. Also, the severity of symptoms of many conditions can change over time, resulting in either temporary improvement or decline, which can complicate the interpretation of the effectiveness of treatments. These factors are so widespread that without testing in a controlled clinical study, where a group that receives a treatment is carefully compared against a group that does not receive this treatment, it is very difficult to determine the real effect of any therapy. Be wary of clinics that measure or advertise their results primarily through patient testimonials.

Science, in general, is a long and involved process. Understanding what goes wrong in disease or injury and how to fix it takes time. New ideas have to be tested first in a research laboratory, and many times the new ideas dont work. Even once the basic science has been established, translating it into an effective medical treatment is a long and difficult process. Something that looks promising in cultured cells may fail as a therapy in an animal model and something that works in an animal model may fail when it is tried on humans. Once therapies are tested in humans, ensuring patient safety becomes a critical issue and this means starting with very few people until the safety and side effects are better understood.

If a treatment has not been carefully designed, well studied and gone through the necessary preclinical and clinical testing, it is unlikely to have the desired effect. Even more concerning is that it may prove to make the condition worse or have dangerous side effects. SeeHow Science Becomes Medicine

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Top 10 Stem Cell Treatment Facts | Closer Look

Pushing the boundaries of stem cells

PUBLIC RELEASE DATE:

7-May-2014

Contact: Lucia Lee NewsMedia@mssm.edu 212-241-9200 The Mount Sinai Hospital / Mount Sinai School of Medicine

(NEW YORK May 7) Adults suffering from diseases such as leukemia, lymphoma, and other blood-related disorders may benefit from life-saving treatment commonly used in pediatric patients. Researchers at the Icahn School of Medicine at Mount Sinai have identified a new technique that causes cord blood (CB) stems cells to generate in greater numbers making them more useful in adult transplantation.

The study, published in the May issue of The Journal of Clinical Investigation, looked at ways to expand the number of hematopoietic stem cells (HSC) in the laboratory required to replenish and renew blood cells. Cord blood stem cells have the ability to rapidly divide in the presence of combinations of growth factors but they often lose their marrow-repopulating potential following cell division. Researchers looked at ways to overcome this limitation by inducing a genetic program by which a stem cell retains its full functional properties after dividing in the laboratory.

"Cord blood stem cells have always posed limitations for adult patients because of the small number of stem cells present in a single collection," said Pratima Chaurasia, PhD, Assistant Professor of Medicine at the Tisch Cancer Institute at Mount Sinai. "These limitations have resulted in a high rate of graft failure and delayed engraftment in adult patients."

Researchers used a technique called epigenetic reprogramming which reshaped cell DNA by treating cells with a combination of histone deacetylase inhibitors (HDACI) and valproic acid. The VPA-treated cells produced a greater number of repopulating cells, and established multilineage hematopoiesis in primary, secondary and tertiary immune-deficient mice.

"We're excited by these results. The findings have important implications for patients battling blood cancers and the difference between success and failure of life saving stem cell transplants." added Ronald Hoffman, MD, Albert A. and Vera G. List Professor of Medicine, Director of Myeloproliferative Disorders Research Program at the Tisch Cancer Institute at Mount Sinai.

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This study was supported by a New York Stem Cell Science grant from the Empire State Stem Cell Board, whose mission is to foster a strong stem cell research community in New York State and to accelerate the growth of scientific knowledge about stem cell biology and the development of therapies and diagnostic methods under the highest ethical, scientific, and medical standards for the purpose of alleviating disease and improving human health.

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Pushing the boundaries of stem cells

One step closer to cell reprogramming

20 hours ago Cells with activated Wnt can no longer be reprogrammed (in green) are located on the periphery; cells that can be reprogrammed are aggregated anad can be seen in the center of the image (in red) Credit: CRG

In 2012, John B. Gurdon and Shinya Yamakana were awarded the Nobel Prize in medicine for discovering that adult cells can be reprogrammed into pluripotent ones (iPS); the cells obtained are capable of behaving in a similar way to embryonic stem cells, and hence have enormous potential for regenerative medicine.

However, although there are many research groups around the world studying this process, it is still not completely understood, it is not totally efficient, and it is not safe enough to be used as the basis for a new cell therapy.

Now, researchers at the Centre for Genomic Regulation (CRG) in Barcelona have taken a very important step towards understanding cell reprogramming and its efficiency: they have discovered the key role of the Wnt signalling pathway in transforming adult cells into iPS cells.

"Generally, transcription factors are used to try to increase or decrease the cell reprogramming process. We have discovered that we can increase the efficiency of the process by inhibiting the Wnt route", explains Francesco Aulicino, a PhD student in the Reprogramming and Regeneration group, led by Maria Pia Cosma and co-author of the study that has just been published in Stem Cell Reports.

The Wnt signaling pathway is a series of biochemical reactions that are produced in cells. In frogs or lizards, for example, these reactions are those that allow their extremities to regenerate if the animal suffers an injury. Although in general, humans and mammals have lost this regenerative capacity, the Wnt pathway is involved in numerous processes during embryonic development and cell fusion.

As it is in reprogramming. The researchers have studied how the Wnt route behaves throughout the entire process of transforming cells into iPS cells, which usually lasts two weeks. It is a very dynamic process that produces oscillations from the pathway, which is not active all the time. "We have seen that there are two phases and that in each one of them, Wnt fulfils a different function. And we have shown that by inhibiting it at the beginning of the process and activating it at the end we can increase the efficiency of reprogramming and obtain a larger number of pluripotent cells", indicates Ilda Theka, also a PhD student in Pia Cosma's group and a co-author of the article.

To artificially control the pathway, the group has employed a chemical molecule, Iwp2, which is a Wnt secretion inhibitor that does not permanently alter the cells, something which other research into reprogramming using different factors has still has not been able to acheive.

They have also seen that the exact moment when the Wnt pathway is activated is crucial. Doing it too early, makes the the cells begin to differentiate, for example into neurones or endodermal cells, and they are not reprogrammed.

"It is a very important and an innovative advance in the field of cell reprogramming, because until now this was a very inefficient process. There are many groups trying to understand the mechanism by which adult cells become pluripotent, and what blocks that process and makes only a small percentage of cells end up being reprogrammed. We are providing information on why it happens", says Theka.

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One step closer to cell reprogramming

Cedars-Sinai researchers identify how heart stem cells orchestrate regeneration

PUBLIC RELEASE DATE:

6-May-2014

Contact: Sally Stewart sally.stewart@cshs.org 310-248-6566 Cedars-Sinai Medical Center

LOS ANGELES (EMBARGOED UNTIL NOON ET ON MAY 6, 2014) Investigators at the Cedars-Sinai Heart Institute whose previous research showed that cardiac stem cell therapy reduces scarring and regenerates healthy tissue after a heart attack in humans have identified components of those stem cells responsible for the beneficial effects.

In a series of laboratory and lab animal studies, Heart Institute researchers found that exosomes, tiny membrane-enclosed "bubbles" involved in cell-to-cell communication, convey messages that reduce cell death, promote growth of new heart muscle cells and encourage the development of healthy blood vessels.

"Exosomes were first described in the mid-1980s, but we only now are beginning to appreciate their potential as therapeutic agents. We have found that exosomes and the cargo they contain are crucial mediators of stem cell-based heart regeneration, and we believe this might lead to an even more refined therapy using the 'active ingredient' instead of the entire stem cell," said Eduardo Marbn, MD, PhD, director of the Cedars-Sinai Heart Institute and a pioneer in developing investigational cardiac stem cell treatments.

"The concept of exosome therapy is interesting because it could potentially shift our strategy from living-cell transplantation to the use of a non-living agent," he added. "Stem cells must be carefully preserved to keep them alive and functioning until the time of transplant, and there are some risks involved in cell transplantation. In contrast, exosome therapy may be safer and simpler and based on a product with a longer shelf life."

In lab experiments, the researchers isolated exosomes from specialized human cardiac stem cells and found that exosomes alone had the same beneficial effects as stem cells. Exosomes also produced the same post-heart attack benefits in mice, decreasing scar size, increasing healthy heart tissue and reducing levels of chemicals that lead to inflammation. Even when exosomes were injected in mice after heart attack scars were well-established, and traditionally viewed as "irreversible," they brought about multiple structural and functional benefits.

Exosomes transport small pieces of genetic material, called microRNAs, that enable cells to communicate with neighboring cells to change their behavior. The researchers pinpointed one such microRNA one that is especially plentiful in cardiac stem cell exosomes as responsible for some of the benefits. It is likely, they believe, that this and other microRNAs in the exosomes work together to produce the regenerative effects.

"The exosomes appear to contain the signaling information needed to regenerate healthy heart tissue, they are naturally able to permeate cells, and they have a coating that protects their payloads from degradation as they shuttle from cell to cell," said Marbn, senior author of an article in the May 6, 2014 Stem Cell Reports. "Injecting exosomes derived from specialized cardiac stem cells may be an attractive alternative to the transplantation of living cells."

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Cedars-Sinai researchers identify how heart stem cells orchestrate regeneration

OMICS Groups Cell Science & Stem Cell Research Congress to Explore the Recent Developments

Valencia, spain (PRWEB) May 07, 2014

Cell Science International Conference is being organized to broaden the scope of the research in the field of Tumorogenesis, Recombinant DNA technology, Cancer cell development and signaling pathway, Evolution of cancer, Genetic engineering and Gene therapy, Tumor suppressor genes, Tissue Engineering, Stem cell treatment, Bioinformatics and Computational biology, Bio Ethics and Patent Rights.

Eminent speakers including Stewart Sell, University of Albany, USA, Sudhakar Akul Yakkanti, SRI International, USA, and Diana Anderson, University of Bradford, UK will be joining their peers at Cell Science-2014, an International Conference 2014 to share their upcoming researches and experience in the field of Cell Science.

James L Sharely, Director of The Adult Stem Cell Technology Centre, LLC, USA organizes a symposium on Stem Cell DNA Segregation and Genetic Fidelity. Ornella Parolini, President, International Placenta Stem Cell Research (IPLASS) holds another symposium on Fetal-derived Stem cells: Characteristics and Applications during Cell Science-2014.

The GID Group, Inc. that manufactures and distributes versatile tissue processing system, sterile disposable canister like GID 700 and GID SVF-1 exhibits its products and services during the conference.

The Organizing Committee welcomes you to attend Cell Science-2014 which includes Ornella Parolini, IPLASS (International Placenta Stem Cell Society), Italy; Sudhakar A Yakkanti, Stanford Research Institute (SRI) International, USA; Stewart Sell, University of Albany, USA; Valles Marti, University of Valencia, Spain; LilianSoraya, University of Valencia, Spain; James L. Sherley, The Adult Stem Cell Technology Center, LLC, USA; Diana Anderson, University of Bradford, UK; Shiaw-Yih (Phoebus) Lin, Anderson Cancer Center The University of Texas, USA; Behjatolah Monzavi Karbassi, University of Arkansas for Medical Sciences, USA.

Cell Science-2014 official partners include The Adult Stem Cell Technology Center, LLC USA and the International Placenta Stem Cell Research (IPLASS).

The three day conference will be hosting significant sessions like Keynote forum, speaker Sessions, Poster sessions, awards and Exclussive session on Successful Postdoctoral Fellowship training.

In addition to this, Soraya L Valles, University of Valencia, Spain organized a pre-conference workshop on NeuroSceince at Salon de Grados, Faculty of Medicine Valencia, Spain on February 25th, 2014 thus promulgating this pragmatic conference.

OMICS Publishing Group hosts 350 Open Access, Online ScientificJournals and hosts more than 100 Scientific Conferences worldwide. With 30,000 strong editorial board members drawn from academics, research and industries, OMICS Group Journals will publish the best papers presented in Cell Science- 2014.

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OMICS Groups Cell Science & Stem Cell Research Congress to Explore the Recent Developments

Unlicensed stem cell doctor slapped with charges over patient's death

Charges of syndicated estafa, illegal medical practice and murder were filed on Tuesday against Dr. Zoharina Antonia Pedrera Carandang, also known as Dr. Antonia Carandang-Park, for practicing stem cell therapy on 23-year-old cancer patient Katherine Kate Tan. The treatment was alleged to have caused the Tan's death.

The charges were filed by Kate's father Bernard Tan before the Tagaytay Municipal Fiscal's Office. Aside from Carandang, owner and operator of Tagaytay-based Green & Young Health and Wellness Center, also charged were Joy Dimaranan, Estrella Maranan, Bebot Maranan and several other employees of the wellness center.

Tan also filed on Tuesday a separate administrative complaint against Park before Tagaytay's Office of the City Administrator, GMA News TV's Quick Response Team (QRT) reported.

According to the City Administrator's Office, Park had, in the past, applied for a permit to operate a medical clinic but was denied for failing to present the necessary documents, such as a Department of Health (DOH) certification.

Park, was, however, granted a permit to operate a massage clinic in 2012.

A caretaker at the wellness center, who received the copy of the criminal and administrative complaints, said Park had left the clinic Tuesday morning.

The Fiscal's Office also sent a letter to Park requiring her to respond to the complaint within two days, otherwise an investigation based only on the evidence presented by the Tans would be pursued.

The Office of the City Administrator also prohibited the wellness clinic from operating until a reply to the administrative complaint was filed.

Alternative treatment

In a separate complaint filed last month before the National Bureau of Investigation (NBI), Tan alleged that Park was not licensed by the Professional Regulation Commission (PRC) to practice medicine in the Philippines.

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Unlicensed stem cell doctor slapped with charges over patient's death

Stem Cell Basics: Introduction [Stem Cell Information]

Introduction: What are stem cells, and why are they important? What are the unique properties of all stem cells? What are embryonic stem cells? What are adult stem cells? What are the similarities and differences between embryonic and adult stem cells? What are induced pluripotent stem cells? What are the potential uses of human stem cells and the obstacles that must be overcome before these potential uses will be realized? Where can I get more information?

Stem cells have the remarkable potential to develop into many different cell types in the body during early life and growth. In addition, in many tissues they serve as a sort of internal repair system, dividing essentially without limit to replenish other cells as long as the person or animal is still alive. When a stem cell divides, each new cell has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell.

Stem cells are distinguished from other cell types by two important characteristics. First, they are unspecialized cells capable of renewing themselves through cell division, sometimes after long periods of inactivity. Second, under certain physiologic or experimental conditions, they can be induced to become tissue- or organ-specific cells with special functions. In some organs, such as the gut and bone marrow, stem cells regularly divide to repair and replace worn out or damaged tissues. In other organs, however, such as the pancreas and the heart, stem cells only divide under special conditions.

Until recently, scientists primarily worked with two kinds of stem cells from animals and humans: embryonic stem cells and non-embryonic "somatic" or "adult" stem cells. The functions and characteristics of these cells will be explained in this document. Scientists discovered ways to derive embryonic stem cells from early mouse embryos nearly 30 years ago, in 1981. The detailed study of the biology of mouse stem cells led to the discovery, in 1998, of a method to derive stem cells from human embryos and grow the cells in the laboratory. These cells are called human embryonic stem cells. The embryos used in these studies were created for reproductive purposes through in vitro fertilization procedures. When they were no longer needed for that purpose, they were donated for research with the informed consent of the donor. In 2006, researchers made another breakthrough by identifying conditions that would allow some specialized adult cells to be "reprogrammed" genetically to assume a stem cell-like state. This new type of stem cell, called induced pluripotent stem cells (iPSCs), will be discussed in a later section of this document.

Stem cells are important for living organisms for many reasons. In the 3- to 5-day-old embryo, called a blastocyst, the inner cells give rise to the entire body of the organism, including all of the many specialized cell types and organs such as the heart, lung, skin, sperm, eggs and other tissues. In some adult tissues, such as bone marrow, muscle, and brain, discrete populations of adult stem cells generate replacements for cells that are lost through normal wear and tear, injury, or disease.

Given their unique regenerative abilities, stem cells offer new potentials for treating diseases such as diabetes, and heart disease. However, much work remains to be done in the laboratory and the clinic to understand how to use these cells for cell-based therapies to treat disease, which is also referred to as regenerative or reparative medicine.

Laboratory studies of stem cells enable scientists to learn about the cells essential properties and what makes them different from specialized cell types. Scientists are already using stem cells in the laboratory to screen new drugs and to develop model systems to study normal growth and identify the causes of birth defects.

Research on stem cells continues to advance knowledge about how an organism develops from a single cell and how healthy cells replace damaged cells in adult organisms. Stem cell research is one of the most fascinating areas of contemporary biology, but, as with many expanding fields of scientific inquiry, research on stem cells raises scientific questions as rapidly as it generates new discoveries.

I.Introduction|Next

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Stem Cell Basics: Introduction [Stem Cell Information]

Doctors perform living donor stem cell transplants in eye …

by Jim Ritter

Debra Astrug, who once feared she was going blind, can see fine now, thanks to a stem cell transplant she received from her daughter, Jessica.

The stem cells came from two pieces of tissue that Dr. Charles Bouchard of Loyola University Medical Center removed from the cornea of Jessica's left eye. When Bouchard proposed the innovative procedure, she immediately agreed.

"It's my mom," Jessica said. "If she needs part of my eye, she's got it."

Before the transplant, Debra Astrug's vision was extremely blurred like looking through a glass smeared with Vaseline. She could not read or drive. And when Jessica took her to buy groceries, Debra had to bring a magnifying glass to read labels.

"It was horrible," she said.

But since receiving the stem cell transplant, and wearing special contact lenses, Debra Astrug's vision has improved to 20/25.

Loyola is among a handful of centers that perform living-related corneal stem cell transplants on patients who have too few corneal stem cells. Ophthalmologists traditionally have treated such deficiencies by transplanting stem cells from deceased donors. In these cases, in order to prevent the patient's immune system from rejecting the donated stem cells, patients take immune-suppressing drugs for several years or longer. But such drugs can have toxic side effects and also increase the risk of infections, said Bouchard, who is chair of Loyola's Department of Ophthalmology.

Bouchard is performing corneal/limbal stem cell transplants from living donors who are first-degree relatives of patients. Because the donor and recipient are closely related, most patients can avoid taking systemic immune-suppressing drugs.

Stem cell transplants are the treatment of choice for patients who have severe cases of limbal stem cell deficiency, or LSCD. (Limbal refers to the border of the cornea and sclera. The cornea is the transparent front part of the eye, and the sclera is the white part of the eye.)

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Doctors perform living donor stem cell transplants in eye ...

Beverly Hills Orthopedic Institute Now Offering Stem Cell Procedures for Hip Arthritis to Help Patients Avoid Surgery

Beverly Hills, California (PRWEB) May 05, 2014

The top stem cell orthopedic doctor in Beverly Hills at Beverly Hills Orthopedic Institute is now offering stem cell procedures for hip arthritis to help patients avoid the need for joint replacement. The procedures are administered by a highly respected, Double Board Certified Beverly Hills orthopedic doctor, Dr. Raj. Call (310) 438-5343 for more information and scheduling.

Millions of Americans suffer from debilitating hip arthritis and hundreds of thousands annually undergo hip replacement procedures. While hip replacement typically provides exceptional pain relief, it is a major procedure with potential complications in the short or long term. Therefore, it is recommended to only have the procedure as a last resort.

Stem cell procedures for hip arthritis offer the potential for not only relieving pain, but also regenerating damaged tissue. Dr. Raj offers multiple types of stem cell procedures.

The first type of procedure involves bone marrow from the patient. The marrow is harvested with a short outpatient procedure, with the marrow being immediately processed to concentrate the stem cells and growth factors. At the same setting, the concentrate is then injected into the painful hip. Both can be treated at the same time.

The second type of procedure involves amniotic derived stem cells, which are harvested from consenting donors after a scheduled c-section. No fetal tissue is involved, alleviating any ethical concerns. The fluid is processed at an FDA regulated lab and is extremely rich with stem cells, growth factors, anti-inflammatory material and more.

Results in small studies looking at regenerative medicine injections with stem cells have shown excellent pain relief for joint arthritis, tendonitis and ligament injury. Patients are often able to avoid the need for surgery and get back to participating in desired recreational activities.

Dr. Raj has been named one of the top orthopedic doctors in Los Angeles on several occasions, and is also a medical correspondent for ABC News. He is an expert in the nonoperative and operative treatment of hip arthritis.

For those desiring top notch regenerative medicine treatment options for hip arthritis in Los Angeles and Beverly Hills, call (310) 438-5343.

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Beverly Hills Orthopedic Institute Now Offering Stem Cell Procedures for Hip Arthritis to Help Patients Avoid Surgery