Institute for Microcirculation Berlin/Bernau (near Berlin), 04.15.2013
⦁ About me and my Institute
I was born in 1943, and after studying first physics and then medicine, I spent 12 years working firstly as an assistant and then as a senior assistant and university lecturer in physics and biophysics at Berlin University. I then worked as a senior physician until 1992, and then as head of the Clinical Pathophysiology/Microcirculation department at the Berlin University medical school. My area of responsibility included specialist research and teaching as a university lecturer in pathophysiology.
In 1980, I lead the foundation of the Microcirculation department of the Berlin University hospital, which resulted in the formation of the Institute for Microcirculation within the medical school the following year. In 1992, the university Institute for Microcirculation developed into the independent Institute for Microcirculation, which I have headed up ever since.
One of the tasks of my institute is the practice-oriented specialist research into the diagnosis and treatment of microcirculation disorders.
A few examples of this are:
⦁ Investigations into the side effects of X-ray contrast agents on microcirculation
⦁ investigations into the effects of stable prostacyclin derivatives on microcirculation
⦁ research into the optimization of compression therapy in chronic venous insufficiency
⦁ investigations into impaired wound healing and scar formation
⦁ the effects of ACE inhibitors on microcirculation
⦁ research into the influence of different ß-receptors on microcirculation
⦁ Research findings for the new BEMER system, some of which were completed as recently as the end of last year, have now been submitted to prestigious journals for publication; the first publications are expected over the coming months.
My institute is and always has been run independently from financial aid. In order to carry out our work, we have a regular independent income that we use primarily to finance our research projects. We also receive material research support from different private enterprises without being dependent upon them.
⦁ Why have we focused on the BEMER system and been involved with research and development?
Microcirculation is the functionally most important part of human blood circulation. It comprises all transport processes required for the exchange of substances in the area of the smallest blood vessels (capillaries) and their regulation processes in the area of the smallest arterial and venous blood vessels (arterioles and venules).
The efficiency of these transport processes during the exchange of substances determines the functionality of the affected tissue or organ.
It is commonly accepted in medicine today that a wide range of illnesses are either caused by microcirculation disorders or at least accompanied by disorders of this type. There is a range of different medications designed to treat circulatory regulation and organ blood flow disorders. Of these medications, the medications that influence the arteriole regulation processes (arteriole diameter variations, also known as vasomotion) are extremely significant.
An example of these types of medications are β-receptor blockers.
These types of medications have side effects that can bring about serious problems, particularly in older patients who are being treated with multiple medications due to their multi-morbidity.
However, this is not the only disadvantage of these medications.
Another disadvantage of these medication therapy options is the fact that this type of medication may only have an effect on a limited arteriole section, which impairs the therapeutic success in a large number of cases (see point 3).
There is therefore a great need in clinical medicine, and geriatric medicine in particular, to develop treatments that work alongside conventional medication therapy options (chemical energy transfer) and that have a targeted physical influence on these important regulation mechanisms.
A variety of general physical treatments do already exist (ultrasound massage, various heat treatments etc.), but to date no treatment has been developed that has a direct physical effect on impaired blood circulatory regulation. This was made possible for the very first time by the new BEMER system.
Does the new BEMER system replace tried-and-tested medication therapies? No! It is not designed to replace tried-and-tested therapies, but to complement them in order to optimize therapeutic success. Complementary use of the new BEMER system achieves promising results in prophylactic use, and in all cases where restitution or healing processes are impaired by deficient organ blood flow.
⦁ prophylactic use in chronic stress, injury, or inflammation
⦁ in order to reduce or prevent functional restrictions of the organs or even organ damage
⦁ in deferred rehabilitation
⦁ to reduce the effects of age-related afflictions and in different chronic illnesses for which no causal therapy has yet been developed etc.
⦁ What were the focal points of the research? Which new findings acted as a basis for the research?
The adaptation mechanisms (regulatory mechanisms) of organ blood flow and the organ’s changing metabolic requirements in different functional states within the normal range and in the event of an illness acted as starting points for the research.
How are substances exchanged between the blood and the tissue cells, and how is this regulated?
The exchange of substances is carried out almost exclusively between the blood flowing into the capillary networks of the organ tissues and the surrounding cells.
Figure 1 shows a diagram of a capillary supplied with red blood cells and plasma, and the adjacent cells.
As a result of different concentration gradients, the red blood cells provide the body’s cells (a) with oxygen (O2) at the start of the capillaries by means of diffusion, and almost simultaneously pick up metabolic waste product CO2 (b), which is removed.
At the start of the capillaries, the hydrostatic blood pressure exceeds the colloid-osmotic pressure, resulting in an outflow of plasma fluid into the space between the cells (c), and at the end of the capillaries, the hydrostatic pressure falls below the colloid- osmotic blood pressure, causing an inflow of fluid into the capillaries (e).
This enables nutrients (substrates) to reach the body’s cells together with the fluid flow, and the metabolic waste products are removed (e). The fluid flow in the space between the cells (d) concerns the trans-capillary fluid flow.
It is immediately clear that the efficiency of these transport processes determines whether and to what extent the functionality of an organ is guaranteed. Microcirculation disorders are therefore always transportation disorders.
Figure 2 provides a more precise view of blood flow in microcirculation. In blood circulation, the large arteries (macrocirculation) expand ever further into the different organs – right down to the smallest arteriole vessels, known as arterioles.
These arterioles have a large-caliber section (A) and expand into small- caliber sections (B) and finally flow into the capillary networks (C).
Organs can be in rest state or working state. As a result, all available capillaries are not always supplied with blood cells and plasma to the same extent. The number of capillaries in a network that are supplied predominantly with blood cells is different depending on the activity state of the organ.
In rest state, several capillary pathways are predominantly perfused with plasma (figure 2). In working state, fewer capillaries are predominantly perfused with plasma and more with red blood cells.
There is therefore a blood flow distribution problem in the capillary networks. In this sense, impaired microcirculation manifests itself as a distribution disorder in the capillary network.
These changes to the blood’s distribution state in the capillary networks are based on different physical separation phenomena between blood cells and blood plasma.
How does the blood’s distribution state in the capillary networks now adapt to the respective functional state of the organ and so to the changing metabolic requirements?
The distribution state of the plasma-blood-cell mixture in the capillary networks is guaranteed by the execution of the separation processes between the blood cells and blood plasma of the circulating blood. These separation processes are significantly influenced by the arteriole vessel wall movements (vasomotions), bringing about rhythmic changes to the arteriole diameters.
Figure 3 shows another view of the ramifications of the vascular bed for blood flow in microcirculation from the large- caliber arterioles (A) to the small-caliber arterioles (B) and to the capillary networks (C).
The rhythmical vessel wall movements in the large-caliber section of the arterioles (A) are different to the vessel wall movements in the downstream small-caliber section of the arterioles (B) in that they have a different biorhythm.
Figure 3 shows these processes as oscillation processes (d = diameter of the vessel sections, t = time).
How can this be explained?
The large-caliber section of the arteriole wall contains receptors via which nerval and hormonal influences are imparted.
There are none of these receptors in the small- caliber section of the arteriole wall.
The vasomotions in the small-caliber section of the arterioles take place autorhythmically, and are adapted to the specific metabolic requirements of the tissue to be supplied exclusively by means of local influences.
It is therefore only possible for pharmaceutical treatment to have an effect on deficient vasomotion in the large-caliber section of the arterioles, not the small-caliber section.
In the large-caliber section of the arterioles, vascular dilation or constriction is caused by the nervous system or by adrenal substances, such as hormones.
These changes must correspond to the respective changes in autorhythmic vasomotion in the downstream small-caliber section of the arterioles. Otherwise, blood circulation and distribution disorders could occur (one example here is the chronic stress patient).
One to five vasomotion oscillations per minute usually take place (autorhythmically) in the small-caliber section of the arterioles.
In the event of a disorder or illness (e.g. in decompensated and elderly diabetic patients) the amplitude and frequency of these vasomotion oscillations is significantly reduced. Inadequate changes to the autorhythmic vasomotion also often occur in chronic stress patients, for example, which can lead to malfunctions in the organ to be supplied, or even organ damage.
This makes it clear that we must search for a way of influencing the vasomotion in the small-caliber section of the arterioles in a non- medicinal manner in order to increase therapeutic success.
How is it possible to physically influence this process in this way?
Figure 4 shows a comparison of the vessel wall structure in the large- caliber arterioles (A), the small-caliber arterioles (B) and the capillaries (C).
All blood vessels are internally coated with an endothelial layer (a). Large-caliber arterioles are sheathed with several layers of smooth muscle cells (b), while small-caliber arterioles have only one or two layers of smooth muscle cells in the vessel wall.
Vasomotions are carried out by means of rhythmic contraction changes to these smooth muscle cells. Capillaries do not have any muscle cell layers; they are comprised solely of one endothelial layer and are therefore not able to carry out vasomotions.
Is it possible to stimulate deficient autorhythmic vasomotion using physical means?
In what way can physical energy be transferred, and how much energy is required?
What is a suitable stimulation signal?
According to knowledge of medical research, comparably low amounts of energy are required. Stimulation energy can be transferred by means of an electromagnetic field or elastomechanical vibrations (ultrasound). It is currently also understood that it is less the amount of energy and much more the biorhythmics of a physical stimulation signal that is of greater importance.
How can that be explained?
Unlike other cells (e.g. skeletal and cardiac muscles), smooth muscle cells, which are some of the phylogenetically oldest cells in our body, still have the property of changing their contraction state in response to a comparably very low physical stimulus.
An orderly biorhythm of autorhythmic vasomotion is achieved when individual muscle cells in the cluster of smooth muscle cells in the small- caliber arteriole wall function as quasi pacemaker cells whose “pulses” are adopted by other cells in the cell cluster. During this process, a physical influence in our body naturally functions as a “manipulated variable” for the respective vasomotion.
This influence relates to the rhythmic diameter regulation derived from the endothelium to the smooth muscle cells. This diameter regulation is dependent upon the shear stress of the circulating blood. It is clear that very low levels of energy are sufficient to trigger or stimulate this regulatory process.
Why does nature require such a small amount of energy for this process?
A simple example. If we were to repeat a molecular-biological process in a test tube, a comparably very large amount of energy would be required in order for a reaction to take place. This is not the case in a natural context. Nature uses so-called biocatalysts (known as enzymes), which have the task of significantly reduce the amount of activation energy required to carry out natural processes. The shear-stress-dependent vasomotion regulation mentioned above is influenced by an entire chain of different enzymes, meaning that only very small physical influences are required.
All biological processes, including all regulatory processes, are ultimately subject to molecular- biological processes, but it is not permitted to transfer test results obtained in a test tube or on membranes or cell structures directly and exclusively to complex regulatory processes in diversely networked organ tissue.
How was the stimulation signal used in the new BEMER system developed?
Using the following research paths:
- Measurement of the vasomotion oscillations and depiction as displacement-time diagrams. Mathematical-physical analysis of the (autorhythmical) vasomotion oscillation as a composite oscillation with healthy subjects and with different disease states. FOURIER analysis, determination of basic oscillation and partial oscillations. Depiction of amplitude- frequency spectrums.
- Based on this knowledge, development of a stimulation signal that corresponds to the vasomotoric oscillation behavior of healthy subjects.
- Use of this stimulation signal in deficient vasomotion in elderly rehabilitation patients (testing in clinical practice).
- In order to develop a suitable stimulation signal, experimental tests were carried out in parallel to points 1 to 3 in accordance with the “trial and error” principle.
The tests for points 1 to 3 and the tests for point 4 achieved the same result.
As a result of this research, a biorhythmically defined stimulation signal was developed, which is used in the current BEMER system.
A weak electromagnetic field is used to transfer energy. Preliminary tests have shown that a biorhythmically defined ultrasound signal is also
effective in stimulating deficient (autorhythmic) vasomotion. Solely cost factors were decisive when selecting the electromagnetic field.
The current BEMER system can therefore not be viewed as magnetic field therapy or electromagnetic field therapy. A number of comparative studies have shown me that treatment devices offered on the international market with the names of “magnetic field therapy” or “electromagnetic field therapy” are not, and cannot be, therapeutically effective.
In clearer terms: The new BEMER system is not a “magnetic field therapy device” and must be clearly differentiated from these devices.
The BEMER system reproduces a natural process.
The research into the new BEMER system has to date been focused on the development of a suitable biorhythmically defined stimulation signal to stimulate deficient vasomotion and on clinically proving therapeutically relevant effects.
The research results were firstly put to medical conferences for discussion, and will be published in prestigious journals this year. Future research will focus on further detailed explanations of the mechanisms of action.
⦁ What therapeutic relevance does the new BEMER system have?
The BEMER system must not be compared with a highly effective prescribed medication. Its effects are not sufficient to establish a causal therapy, but it is sufficiently relevant for prophylactic and complementary therapeutic use. It acts as a complementary, additional treatment method to increase the therapeutic success of tried-and-tested conventional treatments. Its complementary- therapeutic use achieves promising results with all states of deficient vasomotion (organ blood flow regulatory disorders). There are no clinical contraindications.
Points to take into consideration: The stimulation of deficient blood flow regulation and the subsequent prevention or alleviation of a blood distribution disorder in microcirculation is not only important in cell metabolism, but also for the unhindered progression of immunological reactions. The transport of plasmatic factors (antibodies) and cellular factors (white blood cells) is of great importance for the body’s defense mechanisms. Prevention or alleviation of distribution disorders in microcirculation can reduce susceptibility to infection, which is of great importance in elderly patients in particular.
As far as I am aware, the BEMER system complies with and has been tested in accordance with all legal regulations for safe operation. In terms of side effects, there is no relevant risk to users.
⦁ To what extent has the new BEMER system been distributed in the medical profession to date?
I personally know a large number of practitioners in Germany who are using the BEMER system in their practices. The BEMER system is also being used in several clinical institutions, including two university hospitals (complementary therapy studies).
I am also personally aware of this also being the case in Hungary.
I have received reports from practitioners from various other countries too (e.g. Switzerland).
Effective physical treatment methods with more or less undifferentiated effects on the whole organism are widely distributed in medical practice (general heat treatments, various massage treatments etc.). However, there has to date been a lack of therapeutically relevant physical treatment methods for the targeted influencing of important regulatory processes. The new BEMER system carries out this complementary- therapeutic role.