# My Experience with Forever Labs

## Banking my stem cells by removing bone marrow

Our understanding of aging biology is rapidly growing, and as such longevity startups are gaining much more traction. The longevity space is getting large enough that it can be pictured as being divided into different verticals or niches. These range from taking high-resolution data snapshots of mice to figure out how to make them live longer, to developing drugs that target senescent cells hereby leaving the physically younger ones behind, to focusing on specific symptoms of aging like hearing and balance loss, to using simple model organisms to screen for promising new compounds, to many others that you’d prefer me to skip over for now because you want to hear about the stem cell banking from the title.

Anyway…

The aging vertical that I focused on most recently was the stem cell niche replenishment vertical. While much of the public discussion around stem cells has been focused on embryonic stem cells, fully-grown organisms do have stem cells in their bodies. While most of these are not totipotent or pluripotent like the cells in embryos, their differentiating capacity is often enough to sustain the tissues they reside in.

These progenitor cells are one of the factors behind maintaining and repairing the tissues and organs in our bodies. It’s not perfect, however. Without the epigenetic reprogramming that happens during embryogenesis, our stem cells do age. They will slowly lose their differentiating capacity and undergo cell cycle arrest. The clusters (or “niches”) of these stem cells throughout the body also decrease in number as time goes on. This concept of depleting stem cell niches was made famous by Dr. López-Otín, et al.’s “The hallmarks of aging.” in 2013 (as well as works more specific to bone marrow stem cell niches since then).

### What is Forever Labs?

Forever labs is a company focused on the aspect of stem-cell based therapies. Not a specific therapy, but rather making stem cells available for any potential therapies. Cell banking is nothing new, obviously. Since the 1990s umbilical cord blood been relatively cheap. What distinguishes, Forever Labs is that it’s the first company to offer collection and storage of adult stem cells. The company was started 4 years ago by Dr. Mark Katakowski, Dr. Ben Buller, Dr. Laith Farjo, and Steven Clausnitzer. After going through Y Combinator back in 2017, the company now does stem-cell-harvesting from bone marrow in eight states.

I met the founders of Forever Labs at an Indiebio event last year. After putting off setting up the appointment for several months, I finally got around to scheduling it. I figured that I’d be glad if I froze my 26-year-old stem cells instead of 27-year-old stem cells.

### The Setup

Stem cell banking with Forever labs is surprisingly cheap. The procedure costs either $\$5,000 upfront, or $\$500 for the first year, and $\$250 for consecutive years. I know that theoretically means that the latter option would be much higher, though truth be told if it turns out I pay more because Forever Labs successfully stored my cells for 18 years, I can’t really see myself getting mad about something like that.

The sign-up process is straightforward. I was able to sign up using an online form to fill out my information. There were also options for making available to researchers some of the stem cells of mine that are used for quality control (see a similar rationalle for experimental life extension technology in Tim Urban’s post on justifying Alcor’s cryonic freezing by supporting research). Given that the alternative fate for the quality-control cells is disposal, it seemed like a pretty easy “yes”.

Forever Labs representative Kelly Borg then helped connect me with a doctor in San Francisco who would do the procedure.

a number of questions about the procedure. Here is a full summary of her responses to the questions I asked before and af

1. Which stem cell types will we be able to access from the bone marrow?

We collect and preserve all of the nucleated cells - Mesenchymal stem cells (MSCs) can rebuild bone, cartilage, muscle, tendons and ligaments.. And hematopoetic stem cells that can rebuild blood and immune systems.

2. How much bone marrow is removed? How does this compare to, say, bone marrow donation or a bone marrow biopsy?

60cc’s is removed and stored in multiple aliquots for future therapeutic use. This is a minimal amount, especially compared to a bone marrow donation. The process only takes about 15 minutes to collect and only a local anesthetic is needed. A bone marrow draw is much more invasive, time consuming, and typically requires a general anesthetic to complete.

3. How long can the stem cells remain viable as long as they’re frozen. Does this viability change over time? What kinds of quality testing are done on the stem cells when they are harvested?

Once the cells have been properly preserved, they are rendered biologically inert. This means they are essentially frozen in time and will not change. The time spent in the cryoprotectant is inconsequential - What is most important is how well the cells are preserved upfront, as well as how they are thawed. To ensure each sample is preserved properly, we set aside a mini aliquot from each sample for Quality Assurance. We take this tiny sample through the entire freeze/thaw process to ensure they were preserved correctly and test to make sure there are viable MSCs present.

4. At what temperatures are the stem cells kept kept?

The cells are stored at a clinical grade biorepository in Liquid Nitrogen, which sits around -200C (77 kelvin, to be more precise). At this temperature, no biological reactions take place. The only thing that can degrade biomaterials in liquid nitrogen is radiation from space, and the facility is protected from radiation, so even this is not an issue.

5. Where are the stem cells physically located now that they’ve been banked?

We are partnered with Brooks Life Sciences. They are a phenomenal FDA compliant facility, specializing in cell storage and retrieval for over 20 years. You can read about them HERE.

6. What precautions are there against events like power failures for the freezing? How does Forever Labs guarantee that the cells are shipped appropriately when needed? It would be a shame if the cells were successfully stored for decades only to become non-viable during the shipping.

Brooks Life Sciences has done an amazing job of not only mitigating any potential risk, but has back-ups to their back-ups in place to protect the samples:

• Back up generators that store 7 days of fuel on site - Tested every week for full capacity
• Tested every minute, and recorded every 10 for safety (Records are available)
• They keep extra, empty freezers at temp in case they’d have to move samples
• Share a power grid with the airport, so first to be responded to if power outage
• Barcoded tubes for identification. Tri-coded for triple identification, which is permanent and laser etched so it’s traceable throughout the sample lifetime.
• They boast a proprietary way to have access to one sample at a time, without compromising the entire tank when retrieval is requested.
• Partnered as TSA Pre-screening so samples can be expedited, and not held up in airport / customs. When requested, documentation is included, shipped on dry ice and shipped commercial next flight out. A temperature monitor can be added to ensure quality control.
7. Let’s say there’s a stem cell therapy that I’m in need of and I want to retrieve my stem cells? How would I do that? What is the cost to me the customer for retrieving and shipping the stem cells if needed?

We have a very simple request system in place - Clients can literally click a button (found in your membership login) and request the cells. The current cost is $\$300 for anywhere in the US. The cost to ship internationally is determined based on the destination. (ie a sample shipped to Chile recently was $\$800). Samples are shipped on 25 pounds of dry ice, still in their preserved state, in a double thermal pack with a temperature-regulation gauge.

8. How frequently do customers currently use their banked stem cells? How common have retrievals been in the present?

Our clients are banking their stem cells, now, for future therapies once they are approved by the FDA. The FDA shared a press release earlier this year (in January) where they stated that by 2025 they anticipate opening anywhere between 10-20 stem cell therapies every year as they move through the pipeline of clinical trials currently registered. You can read the press release HERE. You can look at clinical trials HERE.

9. I’m aware forever labs offers the stem cell harvesting service for adipose cells from liposuction. What are the main reasons for not harvesting stem cells from blood?

The collection from bone marrow or adipose tissue is easy to obtain, aligns with the clinical trials that are using specific cell types, and is well tolerated for the patient.

Before the procedure, I had an informational video chat with the doctor so he could give the full details. He told me that he had done the procedure many times, and that this was more similar to a bone marrow biopsy than a bone marrow donation in terms of how much is removed. He went over the instructions for the pain medication I would be receiving in the mail to take 30 minutes beforehand, as well as the instructions for after the procedure. Other than the bandage, the only inconvenience would be that I had to avoid submerging myself in water immediately after. No baths, swimming pools, dunk tanks, mud wrestling, bodysurfing, water parks, spartan races, snorkelling, or sitting in sensory deprivation tanks for at least a few days after (showers could still remain part of my plans for that weekend).

I asked about options other than bone marrow for the stem cell harvesting, as this is doable with bone marrow, blood, and even fat cells (I college I was trained in how to harvest mesenchymal stem cells from the inguinal fat pads of rats). The doctor’s response was that the methods for extracting multipotent stem cells from blood are still very inefficient. He also said that while Forever Labs does offer stem cell extraction from fat cells harvested from liposuction, I was too skinny for that.

Once I was informed of the process, the risks, and the recovery time, I scheduled the bone marrow removal itself.

### The Procedure and Aftermath

I went into the doctor’s office. This was a regular doctor’s office in San Francisco at 450 Sutter St. (I was actually amazed to find out the building the doctor was in had a wikipedia page, but I digress). I took some of the vicodin they gave me about 30 minutes before the procedure, filled out the necessary paperwork acknowledging the difference between Forever Labs and the doctor doing the harvesting procedure, and was welcomed in. It was refreshing to see that this procedure had been done many times before. In fact, aside from the storage methods this was functionally indistinguishable from a bone marrow biopsy.

I went in. The doctor had a wonderful habit of explaining out loud everything he was doing to his assistants. I suspect in addition to being instructional, this was also meant as a verbal checklist as a safety measure. As I lay on my stomach with my pants partially down, the doctor used an ultrasound to find the spot on my pelvis where the 6 mm needle was going to be inserted, and then marked the spot with a surgical marker. The next few minutes involved sanitizing the area and injecting local anesthesia. The anesthesia affects the pain receptors, but not the pressure receptors, so while I did not feel pain from the needle being inserted, I could still feel the sensation.

Next came the actual removal of the bone marrow. This was when a wide syringe was inserted into the hole in my bone and the plunger was pulled back. At this point, the conversation between me and the doctor went something like this:

Doctor: “Now, we’re going to start removing the bone marrow. This might feel a little weird”

Me: “Weird? What do you mean weiiiiieeeeoooOOOOOOOOHHHHHWWWEEEEEE!!!”

Well, he wasn’t wrong. Curiously enough this was one area that the pain medication and local anesthetic did not seem to affect. I’m not quite sure how to describe the sensation, only that it felt almost like a reverse pressure pain. When the doctor asked what the pain was on a scale of 1 to 10, I answered about a 6. This was apparently normal, as the range apparently fell between 5 and 8 for most of the patients he had seen. It was actually less painful than the injection of the local anesthetic. Luckily it was over very quickly. Plus, I had definitely experienced far worse pain at the hands of a medical procedure than anything this involved.

After everything was closed up, and my lower back was covered in copious amounts of waterproof medical tape, the doctors made sure I took my time when it came to rolling off of my stomach, sitting up, and then bringing myself to a stand. It seemed unnecessary at the time, but I know it’s the unexpected cases which are why they do this.

Recovery was surprisingly quick. After I thanked the doctor and left the office, I was able to walk around the city and make it back home. The pain started to settle in a little bit later, but it wasn’t so much that some Ibuprofen couldn’t take care of it. Toward the end, the doctor said that while there was a bit more bleeding, getting through the bone didn’t take too much effort. With overweight or obese patients, their bone densities can sometimes result in an actual hammer being needed to get the needle in (this doctor in particular was adamant about NOT using hammers for this, though).

After about 24 hours after the procedure, I finally got this email message from Forever Labs:

Dear Matthew,

Congratulations, your stem cells have been successfully processed for cryostorage. You now have access to a pool of your own stem cells that no longer biologically age. Here’s a photograph of them! Along with this photographic confirmation:

So with that confirmation, all I need to do is wait 4-6 weeks for the bone marrow that was taken out of me to regenerate.

Thus far my experience with Forever Labs has been nothing but positive. There are over 900+ clinical trials being conducted on Mesenchymal stem cell procedures around the world. While this is certainly not a guarantee that all of them will work for their intended uses, storing bone marrow stem cells in the event one gets past Phase 3 seemed like a good way of hedging the risk. If I go through any other elective procedures for healthspan extension, I will use the experience with Forever Labs as a baseline for comparison.

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