#442 Regenerative Doctor on How to Fix Joint Pain Without Surgery - Dr David Karli

David Karli (0:00)

When you stop moving your body, everything goes south. So we can fix hormones, and we can eat right, and we can live healthy, but if we don't move, then we still have to continue to move it. Use it or lose it still applies to degenerative tissues, but sometimes we have to be a little bit more cautious and careful and manage that activity so that we don't cause more problems than we solve in doing so.

Siim Land (0:26)

Dr. Karli, welcome to the show.

David Karli (0:28)

Thanks, Siim. Great to be on. Thank you for having me. Always good to talk with someone who's engaged in kind of innovative topics, so happy to be here. Thank you.

Siim Land (0:38)

Yeah, likewise. And you're in a lot of ways actually on the forefront of a lot of these regenerative technologies that we have access to nowadays. So yeah, a lot of people are very interested in hearing about how they work and what's the kind of advances in that field over the last few years. But yeah, maybe we can start with a little bit of your backstory because you've been in the field for many years. So yeah, we can start with a little backstory.

David Karli (1:07)

Yeah, it's a long one. So I'll do the short version because we've been at this for 20 some years. And one of the nice things is having kind of lived the maturation of the cell therapy space, we've seen the good, bad, and the ugly.

I was a traditionally trained MD, and I trained in the Harvard system and practiced traditional interventional pain management coming out. That's what I was certified in and taught to do, and I did it really well. But progressively became disenchanted with that because we were at best creating very temporary solutions. And we also knew that we were risking causing as many problems as we were solving with the traditional interventional pain management techniques at the time, which were primarily steroid driven. And as that frustration kind of grew, it led me, long story short, into Europe and to other parts of the world to explore alternatives, to try to achieve the same outcome, which was to manage chronic musculoskeletal and orthopedic problems without having to go through surgery. Not that we're anti-surgery. Surgery has its role. But wherever possible, we wanted to keep people's own parts and try to prevent the joint replacements and arthroplasties and things like that. But we didn't have the tools and the tool belt coming out of training to be able to do that effectively. It was really just filling a small gap to bridge someone to surgery. And we wanted to kind of get into the game with better therapies that would allow us to work with that person and that disease process for longer to either delay the surgery or in the future, hopefully prevent it entirely. We're not quite there yet today, but in many cases, we can manage problems successfully for quite some time. So that was the genesis of how I got involved in cell therapy research. And then early on, as I did, and this is in the early 2000s, I identified quite a few deficiencies in quality control, for example. Physicians weren't measuring the number of cells in a PRP, you know, in the early days and things like that. And it was really kind of throw the biologic in there, let the magic happen and hope for the best. And we didn't feel with an expensive cellular therapy that that was an acceptable nor a sustainable path. So we started to engage in ways to make cell therapies more pharma-like, more drug-like. This concept of a cellular dose and effect, right? Dose and response mechanisms and effects. Those are the things that we began to study, and that has evolved into its own kind of science over many years, whereby now we're starting to look at, you know, more advanced markers and biomarkers and things like that, all of which are done to try to create a predictive model. So if you came to see me sin for your shoulder, I'd say, okay, so we saw, you know, 567 patients with your problem, and we know based on what's published in our own internal research, that if we do this, there's an 87.9% chance you're going to feel good at five years, right? Those are the types of things we're driving towards to make cellular therapies, stem cell therapies more predictable, consistent. And we think patients can make much more educated and informed decisions if we have that type of counseling available.

Siim Land (4:37)

Yeah, like, you know, dose is very critical to any kind of, you know, supplement or pharmaceutical or any intervention. And yeah, like the individual as well, like what's the right dose for them? And yeah, how long is it? Should I do it? Or, you know, there's a lot of, a lot of things that go into, into that procedure.