What is Ankylosing Spondylitis? 

• It’s a rare type of arthritis also known as Bechterew disease. 
• Usually starts in lower back, may affect neck too. 
• Ankylosis = fused bones/tissue 
• Spondylitis = inflammation in spine 
• Hallmark feature is the involvement of the sacroiliac (SI) joints during the progression of the disease. 
• Unfortunately – can affect other areas of the body such as shoulders, hips, knees, heels, hands – eyes, lungs, heart too! 

Diagnosing AS 

• Pain starts before the age of about 35 – 45. 
• It starts and gets worse gradually. 
• It lasts for at least 3 months. 
• The pain is linked with morning stiffness that usually lasts for more than 1 hour. 
• The pain improves with exercise. 
• Family member affected? 
• The clearest sign of the disease is a change in the sacroiliac joints at the base of the low back. 
• X-rays – bony erosions/fusion/calcification 
• Blood Tests 
• CRP/Sed Rate 
• RF negative – which is why it’s called seronegative spndylarthropathy 
• HLA B27 – 5% 

Conventional Treatment Options for AS 

• First-line therapy  
• NSAIDS 
• Exercise, PT 
• Together, these treatments can lead to substantial clinical improvement in 70-80% of patients. 
• Local steroid injection and DMARDs (sulfasalazine and methotrexate) can also help with peripheral manifestations.  
• Second-line therapy includes TNF-alpha blockers (etanercept, infliximab, adalimumab, certolizumab, golimumab) and IL17 inhibitors (secukinumab) and/or narcotics. 

Stem Cell Therapy for AS –  How Do Stem Cell Biologics Work? 

• Paracrine Signaling 
• Recruitment of cells, neovascularization, reduced neuron death. 
• Neovascularization 
• Immunomodulation 
• Direct mechanisms 

Mesenchymal stem cells (MSCs) with considerable immunomodulatory and regenerative properties could be able to attenuate the inflammatory responses and help tissue repair by cell-to-cell contact and secretion of soluble factors. 

Study #1 in the video: 

MSC infusion in AS patients is a safe and beneficial choice with no severe side effects, and is effective in decreasing the related clinical symptoms and severity of the disease 

• 5 month study
• four IV infusions of MSCs on days 0, 7, 14, and 21.  
• 1 million stem cells/kg 
• 31 patients 
• Patient symptoms dramatically improved 
• CRP and ESR decreased 
• Reduction of inflammation by MRI. 
• Theories – migration of MSC to inflammation. Reduction of inflammation by cell-cell contact. 

Study #2 – Bone Marrow Stem Cells May be a Problem 

grafts of normal autologous or allogeneic BM-MCS might become one of the best solutions to treat various inflammatory rheumatisms, a small subset of subchondral BM-MSCs could on the opposite be an underrated issue.  Abnormal behaviour of BM-MSCs and/or their progeny has been found in RA, SpA, and AS NOT seen in UC MSCs. 

Conclusion 

Many small studies, early clinical trials and our own experience show that stem cell therapy for AS is not only safe, but typically very effective. 

Key Point: 

• Appears that high stem cell numbers are necessary. 
• Combo is what we’ve seen to work best: IV and Injxn 
• UC-MSCs give great results, just like autologous. 
• Embryonic stem cell therapy and IPSC therapy are NOT ready for prime time use by a long shot. 
• Run away if anyone suggests those types of stem cell treatment.
• Stem Cell Therapy with MSC’s and HSC’s are the way to go. 
•  R3 Stem Cell International Treatment Program 
•  Performed in Tijuana, Mexico or Mexicali. 20 minutes from SD Airport. 
•  Process starts with a free phone consultation – licensed, experienced stem cell doctor. 
•  Patient concierge rep assists with all travel logistics including travel from airport to clinic and back. 

R3 Stem Cell International Treatment Program 

The cells 

• GenCell is the lab in Mexico City. Pristine safety record. 
• QA more stringent than FDA. 
• Umbilical cord stem cells are cx, no preservative needed. 
• 95% viability. 
• Pure, potent cells below 5th generation.