BIO PRO STEM TECHNOLOGY COMPANY
Biopro Stem Technology was established in 2009. The company’s aim was to provide Ukraine with a modern, biotechnological stem cell center, that is both compliant with international standards of treatment and meets the demands of the market.
The first achieved step was the opening of the top-of-the-line laboratory, compliant with all international standards of biotechnological work.
Biopro Stem Technology established cooperation with the leading scientific and medical institutions of Ukraine. Because of the close cooperation with the National Academy of Medical Sciences (and the State Institute of Genetic and Regenerative Medicine of the NAMS in particular), Biopro Stem Technology was able to successfully develop and practically implement a unique approach to the isolation and cultivation of autologous human stem cells.
The third step was a pilot practical implementation of the newly developed approach. Partnering with the Ministry of Defence of Ukraine, the company conducted Ukraine’s first clinical trial on the practical application of stem cells in treatment. The trial was conducted at the National Military Medical Clinical Center “Main Military Clinical Hospital” to great success, showing not only that stem cell therapy is safe but also significant results in the treatment of conditions like:
- endarteritis obliterans
- critical limb ischemia
- diabetic foot
- diabetes types 1 and 2
- autoimmune diseases
- and others.
The next goals are to establish cooperation with state and commercial medical institutions.
In 2015, Biopro Stem Technology was awarded the International Star for Quality (in the Gold Category) by the Business Initiative Directions in recognition of our innovations and quality of service.
DIAGNOSIS: THROMBOANGIITIS OBLITERANS (BUERGER’S DISEASE)
Man, 44 years old
Diagnosis: Thromboangiitis obliterans of the lower limbs (Buerger’s disease), arterial occlusion of the shin, critical limb ischemia of the left shin and foot, multiple ulcers of the toes and the rear of the left foot, diagnosed in spring 2011.
Prior to that, the patient was ill for more than a year, the deterioration occurred at the end of 2010. He was treated in a military hospital in Khmelnitsky, then he was transferred to the Kyiv Military Hospital.
He agreed to undergo a new, experimental treatment with stem cells.
Under local anesthesia, some adipose tissue was taken from the abdomen. The first injection was performed after 4 weeks intravenously, then two more injections were performed a month apart intravenously and intramuscularly near the leg ulcers.
Visible improvements appeared a week after the first dose was introduced into the patient’s body. Pain was reduced, ulcers started to heal and the skin on the leg acquired a natural pink hue.
Prognosis before the start of stem cell treatment – left leg amputation. Three months after the start of the stem cell treatment, patient was able to walk without a cane. As a result of the cell therapy, the patient was able to remain fit for work.
DIAGNOSIS: HEPATITIS C, COMPLICATED BY CIRRHOSIS
Man, 42 years old
Went to Efferent Therapy Clinic in December of 2012. Complaints of generalized fatigue and weakness, reduced productivity, bleeding gums and nose bleeds. Upon examination, multiple spider angiomas along with an abdominal distention were noted.
After examination and tests was diagnosed with Hepatitis C with an estimated duration of 10 years. Did not receive antiviral therapy. Five years ago, patient underwent heart surgery, which is why antiviral therapy was contraindicated.
Patient hesitated to participate in stem cell treatment due to fear of liposuctions and any manipulations in the stomach area. The decision was made after he realized the unacceptability of other treatment methods and the unfavorable prognosis for further life (life expectancy at the time of the decision – 4 months).
Stem cells were injected once every 3 months, in the absence of any other treatment. As a result, there was a noted improvement in the state of the liver and lab results.
Stem cells were injected 1 time in 3 months, in the absence of any other treatment.
MAN, 54 YEARS OLD
Since 2002, he has been under doctor observation for type II diabetes.
He was prescribed Glibenclamide for diabetes management.
In 2011 he was admitted to the hospital with the following diagnosis: advanced arteriosclerosis obliterans, chronic limb ischemia, diabetic foot ulcers, gangrene of the left toe.
Endarterectomy was carried out in the common and deep femoral artery of the left leg, followed by profundoplasty and alloplasty. The fourth finger of the left foot was amputated.
To restore the tissues and vessels of the left leg, the patient agreed to undergo stem cell therapy. Adipose tissue was removed with liposuction from the lower abdomen.
The autologous stem cells obtained in the laboratory were injected intramuscularly within 3 sessions for 2 and a half months.
Two weeks after the first injection, diabetic ulcers started to heal.
No new gangrenous tissue or diabetic ulcers have been observed so far. Patient noted a disappearance of pain during walking as well as an overall improvement in well-being.
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An alternative for bone marrow transplant?
Nobody wants to hear an ominous phrase: “you need a bone marrow transplant”. Not only patients and their loved ones are unaware as to what that procedure entails and its potential consequences. Not to mention the difficulties in finding a matching donor.
TREATMENTS THAT INVOLVE BONE MARROW TRANSPLANTS
Without delving into the details, we all have a certain amount of tissue that’s called bone marrow. This tissue is extremely important for our blood production. This tissue can be irreversibly affected by certain disorders or treatments (for instance, chemotherapy for cancers).
In these cases, such irreversible changes will inevitably lead to fatal outcomes, if left untreated. These are the reasons that may cause your doctor to suggest a bone marrow transplant.
WHAT HAPPENS DURING THIS PROCEDURE?
Bone marrow is extracted from the donor and transplanted into the patient’s (recipient’s) body as a stem cell suspension culture. The entire reason for this procedure is to transfer healthy bone marrow cells to facilitate regrowth of bone marrow and renewal of blood cell production.
WHY ARE STEM CELLS USED?
Mesenchymal stem cells (MSCs) are capable of differentiating into various types of human tissue, which makes them an excellent instrument of regenerative medicine. Basically, as soon as stem cells enter the patient’s bloodstream, they immediately start to initiate regenerative processes within the recipient organism.
Is there a more modern approach?
Thankfully, there is. Right now, adipose tissue is considered a good and modern replacement for bone marrow tissue as a source of mesenchymal stem cells. Studies have shown that adipose-derived mesenchymal stem cells (AdMSCs) and bone marrow-derived mesenchymal stem cells, given identical in vitro growth conditions, are similar in their morphologic, immunophenotypic, and colony-forming properties.
However, a comparative study of stem cells that were derived from donors of similar age and health, has shown that a lesser dose of AdMSCs is required to achieve the same effect, compared to bone marrow-derived stem cells.
It was also established that adipose-derived mesenchymal stem cells have greater immunomodulatory properties compared to bone marrow-derived mesenchymal stem cells, which is especially important for the treatment of autoimmune disorders.
BONE MARROW DERIVED MESENCHYMAL STEM CELLS
Bone marrow is one of the principal organs involved in the formation of blood (hematopoiesis). It is mostly located in the middle of long bones, called the diaphysis. These types of bones are mostly found in the pelvis, ribs, and sternum. Mesenchymal stem cells comprise no more than 0.005-0.01% of an average adult’s bone marrow.
Before a bone marrow transplant, a thorough medical examination is undertaken to ensure that both provider and recipient of the transplant will be able to withstand this procedure. This may take several weeks.
The procedure for obtaining bone marrow is standard for all types of transplantation (autologous and allogeneic). It is extracted from the ilium or sternum under general or local anesthesia. A maximum of 30 to 50 ml of bone marrow is possible to extract in a single aspiration without any damage to the patient’s health.
ADIPOSE-DERIVED MESENCHYMAL STEM CELLS
Compared with bone marrow, stem cells in adipose tissue comprise up to 5% of the total volume, with the abdominal area being the richest in stem cell concentration.
The extraction of adipose tissue is also much simpler and less invasive, compared with bone marrow extraction. Mini liposuction is used to extract anything from 10 to 100 ml of fat under local anesthesia. The procedure leaves no scars, with a small puncture healing in a few days.
Compared with bone marrow-derived stem cells, treatment with AdMSCs is also cheaper – around 5 to 10 thousand dollars.
Extracted mesenchymal stem cells are administered to the patient intravenously. If the extracted stem cells are derived from bone marrow, it is possible to administer only the same quantity of the cells that were originally obtained. If the extracted stem cells are adipose-derived, it possible to cultivate them. Thus the dose patient will receive may vary, making repeated administration of autologous AsMSCs possible.
The typical course of treatment with AdMSCs involves three injections, which is more effective than a one-time injection of bone marrow stem cells.
Cartilage injuries are difficult to treat. Current methods are mainly based on transplantation of healthy cartilage portion into the damaged area. Such a procedure affects healthy cartilage. Moreover, the cartilage gradually degrades with age.
Researchers from the University of Pennsylvania, USA,
have developed the innovative approach of growing new cartilage from a patient’s own stem cells.
The study was conducted by Jason Burdick, Associate Professor of Bioengineering School of Engineering and Applied Sciences (Department of Bioengineering in the School of Engineering and Applied Science) and Mauke Robert, Associate Professor of the Department of Orthopaedic Surgery School of Medicine Perelman (Department of Orthopaedic Surgery in Penn’s Perelman School of Medicine.
The study is published in «Proceedings of the National Academy of Sciences», the Journal of the National Academy of Sciences of the USA.
“We started our research with focal lesions – such as sports injuries,” – Jason Burdick said. “Our further research is aimed to replace the surface of the cartilage destroyed with age. At the moment, we are trying to find the most suitable conditions for growing cartilage from adult human mesenchymal stem cells. “
“In the process of aging cartilage cell viability decreases, so the cartilage repair is ineffective if using adult chondrocytes,” – Robert Mauke says.
“Mesenchymal stem cells, characterized by potent proliferative potential are perfect for this.”
Burdick and his colleagues studied the mesenchymal stem cells that can “transform” into the cells of bone, cartilage and adipose tissue for a long time. His team was particularly interested in the conditions that allow stem cells to differentiate into chondrocytes.
One of the problems faced by researchers is that, despite the low density of adult chondrocytes in tissue, the actual formation of cartilage begins at a direct interaction of cells located close to each other.
“In the hydrogels used for the cultivation of tissue engineered cartilage cells located at a distance from each other, which leads to loss of interaction signals. That’s when we started thinking about the cadherins, molecules by which cells interact with each other, particularly in the early stages of differentiation into chondrocytes, “- Jason Burdick says.
Researchers added peptide sequence mimicking cadherin connection for simulation of conditions for the growth of cells into the hydrogel.
“At the present time a direct link between cadherins and chondrogenesis is not well understood,” – Robert Mauke says: “We only know that simulating cellular interactions in the early stages of tissue generation leads to more cartilage formation. Blocking of interactions slows down the formation of cartilage.
This gel makes the cell ‘assume’ that it is surrounded by other cells.”To test the effectiveness of the gel with peptides that mimic cadherin, the researchers placed mesenchymal stem cells into different types of gels such as conventional hydrogel, hydrogel with disrupted, non-functional variants of the peptide, a peptide hydrogel, cadherin activity of which was blocked by antibodies.
The maximum amount of genetic markers of chondrogenesis among all cultured samples was identified in the mesenchymal stem cells cultured for a week in a gel containing cadherin-like peptides. In another experiment, cells were grown in a tested gel for four weeks. This is sufficient time for the beginning of formation of the cartilage matrix tested for different stresses such as mechanical stress.
Scientists concluded that the cartilage derived from a gel containing peptides is closest to a”natural” than the one grown in other control hydrogels.
The researchers also performed various tests by staining the gel slices for detecting the chondroitin sulphate and type-II collage which are part of the cartilage matrix. As it was shown before, gels peptide with contained the biggest amount of markers of tissue formation comparing to other hydrogels.
“In the near future it is important to study the behavior of obtained cells for prolonged stay under in vivo conditions”, – Robert Mauke says.
Diabetes is an insidious disease that affects a lot of people around the world. The disease may go unnoticed for years, with only changes in urination and thirst being present. Over time however, if left undiagnosed and untreated, it will severely decrease the quality of living or may even cause death.
Diabetes can also lead to a multitude of complications, that may include heart, blood vessels, liver, nervous system, etc. The primary symptom of diabetes is either increased or decreased blood sugar levels.
While management of diabetes is obviously necessary, drugs used to manage it often have adverse reactions involving the heart.
Stem cell therapy, however, does not have that drawback. It addresses the primary cause of the disease instead of treating its manifestations by repairing the pancreas, thus improving the blood sugar level.
TREATMENT OF DIABETES WITH STEM CELLS
Diabetes can be effectively addressed with multiple rounds of stem cell injections (consisting of 3 injections per round) at certain intervals.
If diabetic foot is present, then an additional injection may also be added to the treatment plan (usually directly into the affected tissue). Cell injection protocols are similar to standard IV drug injection protocols.
PROTOCOL FOR TREATMENT OF DIABETES WITH STEM CELLS
Step one – a certain amount of patient’s adipose tissue is extracted. The procedure lasts about 30 minutes, performed under local anaesthesia. To ensure prevention of any complications, a patient will remain in the clinic under doctor’s supervision.
Step two – a medical examination of a patient, after which they are discharged. Then, the necessary amount of stem cells is cultivated within 3 to 4 weeks.
Patient is then invited back to the clinic for step three, where they receive an IV injection of autologous stem cells, which were cultivated from the previously collected adipose tissue. The procedure takes somewhere around 10 to 15 minutes. Patient is then discharged again, to return for two weeks for another dose of stem cells.
Every 2 weeks the procedure is repeated twice. These are steps four and five.
Step 6 – If diabetes is severe, then an additional injection may be advised.
Step seven – cultivated cells are then sent to crystorage. Liquid nitrogen can preserve cells for up to 20 years until needed. Cryopreserved cells may be revived and cultivated to necessary amount within two weeks.
Patients are also offered an option to cryogenically store a therapeutic dose, ready for immediate use. Price for said storage will be the same.
CELL MANIPULATIONS IN OUR LABORATORY
Most of the work is done in our laboratory. Our lab is fully equipped and compliant with modern lab standards, which allows us to efficiently test and cultivate cells extracted from our patients.
Contraindications to administration of stem cells
Stem cells are susceptible to bacterial and viral infections. This means, injection of stem cells is contraindicated for people currently experiencing infection.
Stem cells in the treatment of neurological disorders
With improvements in detection protocols, doctor training and equipment, as well as our sedentary lifestyles, has led to a substantial raise in detection of neurological disorders.
Doctors now see more and more younger patients who present symptoms similar to people in their 50s and 60s.
Unfortunately, despite our advances, many people still continue to ignore their problems until it’s too late and their disease is either in persistent, chronic state or terminal. The longer the disease is allowed to progress, less chances there are for full recovery.
SHORT INFO ABOUT NEUROLOGICAL DISORDERS
According to The World Health Organization, around 1 billion people in the world are affected by neurological disorders of various severity: from usual migraines and headaches to epilepsy and dementia.
The WHO report “Neurological Disorders: Public Health Challenges”, published in 2006, cites 24.3 million as the number of people worldwide currently suffering from Alzheimer’s disease and other types of neurodegenerative disorders.
In 2017 the WHO has updated the number and cites it at 29.8 million. It is expected to reach 50 to 55 million by 2026. Experts suggest that the majority of new cases will be diagnosed in developing countries.
Another major neurological disorder, epilepsy, is currently affecting 40 to 50 million people across the world.
Various neurological disorders also are the second leading cause of mortality. The group, which includes disorders like M.S., stroke, Parkinson’s disease etc.) now claims almost 10 million people every year, according to the 2015 estimates by Global Burden of Disease Study program.
While conventional medical treatments of neurological disorders have improved, they’re still unable to halt the increasing trend of mortality and disability, which is why many medical professionals and researchers (including us) have turned to stem cells and stem cell-based treatments.
Stem cell-based treatments are representatives of a new approach to medical and biotech industries, being often called “personalized medicine” for how they are tailored for every situation.
Given that neurology studies all disorders and violations, related to the human nervous system, the list of such diseases is extremely long.
AUTOLOGOUS STEM CELL-BASED THERAPY SHOULD BE CONSIDERED FOR THE FOLLOWING DISORDERS:
- Autoimmune myopathy
- Systemic lupus erythematosus (SLE)
- Rheumatoid arthritis (RA),
- Polyarteritis nodosa
- Focal myositis
- Multiple sclerosis
- Amyotrophic lateral sclerosis and ABC syndrome
- Guillain-Barre syndrome in a recovery stage
- Encephalopathy (discirculatory, metabolic, toxic…)
- Recuperation after a stroke
- Recovery period after acute infectious diseases of the brain and/or spinal cord
- Osteochondrosis complicated by spinal disc herniation, spinal disc herniation with painful, dystrophic syndromes (cervicalgia, cervicobrachialgia, thoracalgia, lumbodynia, lumbodynia, coccygodynia…)
- Compression neuropathies (carpal tunnel syndrome, ulnar nerve neuropathy, radial nerve neuropathy, femoral nerve neuropathy, peroneal nerve neuropathy)
- Non-compression neuropathies (cranial neuropathy, ocular neuropathy
- Neuralgias (trigeminal, occipital, etc.)
- Plexopathies (brachial, lumbosacral)
- Parkinson’s disease
- Spinal cord injury
- Craniocerebral injury
- Restless leg syndrome
- Chronic fatigue syndrome
- Neurological disorders in somatic diseases and poisonings
Treatment of acute necrotizing pancreatitis with stem cells
In 2012 Ukrainian Ministry of Health has approved usage of stem cells as a viable treatment of acute necrotizing pancreatitis.
Necrotizing pancreatitis is an extreme complication of acute pancreatitis. It may occur when pancreatitis is left untreated for a prolonged period of time and pancreas becomes extremely inflamed.
Inflammation leads to closure of ducts, therefore digestive enzymes can’t pass and “spill over” to the rest of the pancreas. In a way, pancreas then eats itself by destroying the pancreatic tissue, leading to necrosis. Untreated necrotizing pancreatitis then may lead to pancreatic abscess, sepsis and death.
There’s a popular perception that pancreatitis is exclusively a “drinker’s disease”, which is one of the leading causes of pancreatitis. However, there are many other processes who may lead to development of the disease, ranging from genetic component to infections to gallstones. Typical symptoms of pancreatitis include pain in the abdomen area, nausea and vomiting.
Treatment of acute necrotizing pancreatitis is two-fold: acute pancreatitis attack must be contained and already dead tissue must also be removed. Dead tissue may be removed with an endoscopic procedure to minimize risks, however, if the damage to the pancreas is significant, an open surgery may also be performed.
Surgeons of the P.L. Shupyk National Medical Academy of Postgraduate Education together with Institute of Cell Therapy and Center for Coordination of Transplantation of Organs, Tissue and Cells have developed an effective approach to treatment of necrotizing pancreatitis by utilizing cord blood and tissue transplants.
The essence of the approach is to transplant a specially prepared, cryopreserved sample of cord tissue which will facilitate reopening of inflamed pancreatic ducts, following the surgical removal of necrotic tissue. This also prevents formation of pancreatic cysts.
On the second day after the operation, the transplant is removed using a drainage system. The treatment regimen is then followed by daily administration of small doses of cord blood to stimulate regeneration processes and decrease inpatient care time.
This approach was then tested in a small-scale test, where 20 people with the diagnosis of necrotizing pancreatitis were treated with cord blood and tissue transplant, following surgical intervention. All showed favourable outcomes, with zero patients showing signs of pancreatic cysts following a six-months follow-up.
One patient who was not a part of the group during the test (but was diagnosed with necrotizing pancreatitis) has developed a respiratory distress with oxygen saturation dropping to 50%. Patient then was administered a quintuple dose of cord blood within 24 hours, which then followed by stabilization and improvement of SAT and V/Q stats.
The breath function and respiratory circulation recovered. Patient left the hospital without any complications 10 days after the first administration of cord blood stem cells.
Treatment of psoriasis with stem cells
WHAT IS PSORIASIS?
Psoriasis is a chronic, long-lasting autoimmune disease of the skin. According to the current estimates, from 2 to 4% of the global population are affected. While there are different types of psoriasis, 90% of the cases usually manifest as plaques (inflamed white scales) on the skin.
Psoriasis may cause not only physical but also mental discomfort, often leading to depression and problems in social adaptation.
Besides previously mentioned plaque psoriasis, which constitutes 90% of all psoriasis cases, other types of psoriasis are: pustular, inverse, napkin psoriasis (which is reported as a type affecting infants up to 2 years of age), guttate psoriasis and seborrheic-like psoriasis.
There’s also psoriatic arthritis, which involves a long-lasting chronic inflammation of the joints along with the psoriasis and there’s also nail psoriasis, which some researchers qualify as a separate form of psoriasis.
CAUSES OF PSORIASIS
Psoriasis is an autoimmune disease, which means that the body attacks its own cells, perceiving them as foreign. The exact cause of psoriasis is not known, however, there are a number of theories.
Majority of the researchers currently consider psoriasis as a disease with a very strong genetic component. However, correlation with obesity, smoking and excessive alcohol consumption, along with certain infections and medication has also been observed.
As of now, psoriasis can’t be cured but managed. Current approach to the management of psoriasis may involve topical treatments, light therapy and oral/injected medication. Topical treatments unfortunately will only alleviate symptoms without actually addressing the core of the problem, while medication (usually prescribed in severe cases) has severe side effects, which limit their use.
CAN PSORIASIS BE EFFECTIVELY MANAGED WITH STEM CELLS TREATMENT?
The study of healthy skin donors have demonstrated that proliferative signal from T-cells of patients with psoriasis is not able to stimulate the non-psoriatic keratinocyte stem cells.
It means that if psoriatic keratinocyte stem cells from patient’s skin are replaced by new ones, it will cause the non-sensitivity of these cells to proliferative signal. Finally, the psoriatic lesions and inflammation will disappear.
In this way, stem cells derived from adipose tissue act as immune system modulators but NOT suppressors. Moreover, stem cells do not cause any allergic reactions or side effects because they originate from patient’s organism.
Cirrhosis is a serious and often a life-threatening condition. It’s characterized by replacement of liver tissue with scar tissue due to persistent necrotic and inflammatory damage to the liver and its’ attempts to repair itself.
The longer cirrhosis goes undiagnosed and untreated, the more extensive is the damage. The final stage of the condition requires a liver transplant, in itself a very expensive procedure with a lot of potential complications.
ALTERNATIVES TO CONVENTIONAL MANAGEMENT OF CIRRHOSIS
There’s now an extensive history of research and practical application and introduction of donor hepatocytes (functional liver cells) into the liver parenchyma of patients to successfully halt progression of cirrhosis. However, this shouldn’t be attempted if the liver damage is too great.
Unfortunately, there are still a number of issues with liver cell transplants, such as:
- A lack of donors.
- Rejection of transplants (however, when detected early, it is easily treatable).
- Relatively low rate of survival for cell transplants (around 30%)
- Often, also an inability to maintain and increase hepatocyte count
We believe that the solution to these problems is in mesenchymal stem cells (MSCs).
ADVANTAGES OF MSCS:
- They are easy to extract and grow.
- They’re less expensive than hepatocyte transplants
- No risk of cancer compared to embryonic stem cells
- Repeated injections boost the response and improve the outcome
- Zero possibility of rejection due to usage of patient’s own stem cells.
MSCs have certain features that allow them to be used as treatment and/or therapy of various disorders and conditions, including disorders of the liver. They are able to differentiate themselves into various types of cells, including hepatocytes.
Results of experiments have shown that, when injected intravenously, mesenchymal stem cells embed themselves into the liver, differentiating into fully functional liver cells, thus restoring the damage that might’ve caused by deleterious processes.
Furthermore, MSCs produce cytokines and growth factors which suppress inflammation, thus reducing the rate of incidence of liver fibrosis, which is the underlying mechanism behind occurrence of cirrhosis.
MSCs are able to migrate to precise locations of inflammation after they are re-introduced into the patient’s body. This is due to special receptors similar to those present in leukocytes, that prompt the cells to move to the locations with accumulation of chemokines.
MSCs are also able to inhibit proliferation of hepatic stellate cells, as they usually serve as markers of underlying inflammatory processes in the liver, fibrosis in particular.
Mesenchymal stem cell therapy is an effective and safe way to manage liver conditions.
It has no contraindications and, coupled with conventional treatment, is extremely effective at halting or even reversing damage caused by cirrhosis.
BIOTECHNOLOGICAL COMPANY BIOPRO STEM TECHNOLOGY
Bone marrow transplantation
Cartilage formed with stem cells
Acute necrotizing pancreatitis
The clinic is equipped with an internal reception and a separate entrance to ensure the anonymity of patients. It is guarded around the clock.
The coordinating doctor stays in touch with the patient 24/7 by phone and instant messengers. An interpreter accompanies the patient during their stay in the clinic. We keep in touch even after the patient returns home to receive feedback and continue treatment remotely.
Hospital wards are spacious and comfortable, they resemble rooms in a prestigious hotel. The clinic has a restaurant with a special diet menu. For the period of stay in the country, the patient and accompanying person are provided with a room in the central metropolitan hotel. All transfers to the clinic, to the hotel and to the airport are organized by the clinic at its own expense.
You do not need to search for information, compare prices, book tickets and accommodation, coordinate travel dates with a doctor, hire an interpreter … We take care of all the arrangements for your trip.