UK-Singapore Stem Cell Symposium I

Just to remind the world that the UK isn't behind in science (vis-a-vis the US), the British High Commission probably decided that this exhibition panel was important to remind everyone of the UK's key scientific achievements.

So, if you didn't already know or can't read the words in the picture, here's three that you might have confused as a US invention...

UK GREATS
1953: Discovery of structure of DNA
1978: Birth of first test-tube baby
1985: Discovery of hole in Ozone layer
1990: Invention of World Wide Web (bet you all thought this was from the US!)

Anyway, I mentioned in my last post that I'd tell you a bit about what I learned in the symposium. My apologies for the delayed write up.

The first lecture after lunch was by Professor Tariq Enver, Professor of Stem Cell Biology at Oxford and Director of Stem Cell Research at the MRC's Molecular Haematology Unit in the Weatherall Institute for Molecular Medicine.

Prof. Enver's talk was of interest to me for 2 reasons - inspiring content AND all the key ingredients of a good presentation:

1. Clinical relevance (patient's photos to inspire the right emotional context)
2. Clear introductory statistics for the uninitiated
3. Direct genetic implications of the research
4. A happy conclusion (very important)


WHAT IT WAS ABOUT

The story begins with the introduction of stem cells and their existence in babies' blood. The first question he posed to the audience was whether anyone knew what a "Guthrie card" was (when a baby is born, a small heel prick is performed to obtain the baby's blood, which is stained on a filter paper- known as a Guthrie card- and used to test for inborn metabolic diseases). Prof. Enver suggests that Guthrie cards can be kept for extended periods of time so that if a child is later found to develop certain types of leukemia, it would be possible to identify whether the indications of leukemia were there at birth.


WHY IS THIS IMPORTANT?

The reason why it is useful to know whether the leukemic cells are present at birth, is because if the cells are present at birth, doctors may choose to treat the patient with different medications as leukemic cells (which behave like stem cells) have different chemo-sensitivities in children. Leukemic cells from birth may require more specific and less intensive drugs than adult patients.


At this point, I feel that it is important to point out the difference between "stem cells" and what is popularly termed "cancer stem cells".

Stem cells are cells which exist in the body and are responsible for continuous maintenance of the body and a controlled replacement of our cells and tissues. The stem cells are known to be "relatively immortal" (ie they live a far longer lifespan than our normal cells, which may die after 7-90days) and are key to our existence and survival of our blood and immune systems etc.

Cancer stem cells however, are like other cancers -cells gone wrong- except that the cell that has gone wrong is the stem cell. Hence, the cancer stem cell does not make other tissues and does not replace cells like it should. It merely makes more of itself, which isn't useful under the normal circumstances.

So, a pertinent question to ask is how do you know a stem cell from a cancer stem cell? Well, Prof Enver believes that there is a lot of talk about "markers" for stem cells, but there is no doubt that these markers have a long way to go in being defined and that the best way to know is to conduct functional studies (ie, to see how the cells really work in real life).


REAL LIFE SCENARIO

A pair of very beautiful twin girls from Bromley a city in Kent, were the subjects of the study. According to the news story, which was reported in January this year, Olivia Murphy developed acute lymphoblastic leukemia (ALL) when she was 2 years old, while her twin sister Isabella remained healthy. I'm not exactly sure how the case came to Prof. Enver's attention at the MRC (I wanted to ask him but didn't get a chance) but he and his group ended up researching why one of the twins developed the disease while the other remained healthy. Prof. Enver's team elucidated that both twins carried a gene that pre-disposes them to developing the ALL, but while Isabella only had one hit to her gene, Olivia had two hits which resulted in cancer development (cancer usually results from several mutations to certain genes which allow the cells to grow uncontrollably).

They proved to be the perfect research subjects to understand if genetics had a pivotal role in the stem cells, which could already be susceptible to chance changes after birth. The aim of the research, was to discover where the point of change was that resulted in the cancer, and whether it would be possible to design a method to protect the susceptible genes (prevention) or necessary drugs which would target the cancer cells.

There was a more detailed write up which describes how the twin's parents brought Olivia in for fever which the doctors had then thought was tonisilitis. The parents insisted on a blood test and were given the ALL diagnosis. Fortunately, Olivia's cancer responded well to the chemotherapy and was a success, but not without side effects.

The chemotherapy was so strong that her immune system was damaged and she suffered six attacks of shingles (chicken pox relative) which infected her eye and blinded it. In the course of research, Prof. Enver's team took regular samples of both the girls' blood and the doctors will screen Isabella regularly to monitor any signs of the 'second hit'.


OPTIMISM FOR TARGETING PRE-CANCER CELLS

According to Prof. Enver, as the total cancer relies on less than one per cent of the cancer generating cells to maintain the disease, this offers a unique opportunity to develop better drugs to kill off this one per cent of cells. He was quoted saying that there could be a day where the prevention of leukemia would be possible as the pre-leukemia cells could be eliminated at the source, potentially curing 90% of the cases detected.

However, no medical procedure is risk free and the strong chemotherapy may result in the death of 1-2% of cases treated. And for those couples with identical twins, you might like to know that nine out of ten children who have an identical twin with leukemia do not develop the disease.

That means that Isabella's chances of staying cancer free remains pretty high. :)

StemLife Berhad Pakar Sel Stem Darah Tali Pusat dalam Program NONA TV3

Sel Stem Darah Tali Pusat, Sel Stem Sum-Sum Tulang, Sel Stem Embrio, Transplantasi Sel Stem, Transplantasi Sum-Sum Tulang, Leukemia, Talasemia, Limfoma, Simpanan Krio, Bank Sel Stem Darah Tali Pusat – Apakah maknanya semua ini?, Apakah kepentingnya? Apakah perbezaan diantara kesemuanya?

Assalamualaikum WBK,

Salam Sejahtera kepada rakan-rakan saya sekelian, ibu-bapa, bakal ibu-bapa, pengunjung/pembaca blog ini.

Pelbagai atikel, rencana, dan pendapat telah dan sentiasa diterbitkan dalam akhbar-akhbar serta majalah-majalah tempatan, antarabangsa serta laman web-laman web seluruh dunia. Jumlahnya memang tidak terkira. Ramai pembaca akan mengalami perasaan buta huruf dan kadang-kadang tersesat dalam kegelapan kerana terlalu banyak pencapaian yang dihebohkan, pendapat yang berbeza, serta kontroversi yang tidak dijelaskan. Banyak atikel-atikel ini juga agak teknikal dan saintifik tanpa mengesyorkan bagaimana teknologi ini dapat memberi manfaat kepada kami di Malaysia buat masa ini mahupun masa hadapan.

Saya akan cuba untuk memberi pendapat saya dari seorang pengamal sains dan akan cuba menterjemahkan atikel-atikel serta isu-isu yang tidak begitu rumit tetapi sentiasa lebih rumit dari yang sebenarnya.

Atikel-atikel yang telah diterbitkan di akhbar-akhbar tempatan serta seluruh dunia akan diteliti. Saya juga akan cuba menterjemahkan mesej-mesej dalam laman web-laman web antarabangsa seperti parentsguide.com dan banyak lagi.

Sebagai permulaan blog ini, saya ingin menjemput anda untuk menonton program NONA dari TV3 pada 23hb Mac 2008:



Nona TV3



Saya harap program ini dapat memberi anda sedikit latarbelakang tentang topik ini dan akan membolehkan Saya meneliti topik-topik yang lebih teknikal pada masa yang akan datang.



Sekian buat masa ini.. Wslm.

Blogging Live from Singapore at the UK-Singapore Stem Cell Symposium

Its been a long time since I sat in a room full of developmental biologists discussing the intricate biochemical pathways -some discovered and debated heatedly- and listened to the fundamental scientific research performed in the UK.

Organized by A*STAR’s Singapore Stem Cell Consortium and the British High Commission at Singapore’s Biopolis, it was another event which made evident Singapore’s financial commitment to establishing a scientific research base through educating its PhD students and motivating local researchers to aspire to international knowledge standards. Since I did spend a few years in a research position in Singapore, it is only right that I promote their efforts in scientific education.

15 scientists (of which 7 were Professors and researchers from their respective departments) from the Universities of Cardiff, Cambridge, UCL, Sheffield and Edinburgh presented a thirty-five minute summary of their work involving stem cell pathways derived from embryonic cell lines and cancer cells.

All the presentations were very technical (as they should be) and involved the investigation of signaling pathways in the cell.

For those who are less scientifically inclined, signaling pathway research, in plain language is finding out how a cell talks to another cell, and how each of the cells respond in body language according to what is said. Imagine that a cell is itself made up of many components (kind of like organs within your body) and these components need to synchronize in order to regulate and make the cell what it is, or what it is to become. In this case, the researchers were trying to find out which factors affect the embryonic stem cells and make them change or “differentiate” into a specialized cell type.

As always in basic scientific research, as long as governments don’t run dry on funding, scientists will always have work to do because we are still a long way off understanding how our cells talk to each other, and most importantly how to control unnecessary conversations which may spark off a chain of unwanted reactions.

You can find the list of speakers and topics here, and for the sake of brevity and also without having to go into too much basic cell biology, I’m going to give you an outline of a few of the talks which I find easier to explain and are relevant to the faithful readers of this blog. I've chosen 4 presentations (Prof. Tariq Enver, Dr. Phil Jones, Dr. James Hui and Prof. Pete Coffey) to share with you and you'll find them in the ensuing entries.

Viacell chose SEPAX

Well, it wouldn't be fair that other automated systems aren't discussed on this blog.

A burning question you must all have is:

What systems are all the other cord blood stem cell companies using?

Well, last year, Viacell announced in a short brief that they were integrating automation into its existing closed processing system using the SEPAX system, designed and manufactured by BioSafe, a Swiss rival of Thermogenesis.

The announcement stated that:

"SEPAX is the only FDA cleared cord blood processing system. Biosafe received FDA clearance in January 2007 and European CE mark approval in 2001."


THE SEPAX MACHINE: WHAT IS IT?

The SEPAX automated processing system is an all-in-one machine which is achieves a similar outcome of stem cell separation through an in-built centrifugal technology. It is approximately 14 Kg in weight (2 year old baby) and reminds me somewhat of a large square automated rice cooker (the newer Sanyo versions, that is).

The separation of stem cells from other blood components is achieved in a central core which spins the blood at high speed and through an optical reader, squeezes the separated components into the various compartments until the process is complete (watch the Quicktime animated demo). SEPAX kits are single use (just like AXP) and come with an option of storage bags, although it is rumoured that the kits will soon only come with a single compartment bag as Thermogenesis is revoking permission for the dual compartment design use (business as usual for public banks but potential consumer's angst in private banks).


THE PROS AND THE CONS

Let's start with the Pros.

1) The machine does away entirely with a centrifuge (no Beckmann or Sorvall)
2) One unit processed at a time
3) Portable
4) Closed system
5) Single disposable kit
6) No requirement for clean room
7) Used and endorsed by major european cord blood banks affiliated with Netcord*

The Cons.

1) Each unit takes approx 40 mins to process
2) One machine processes one unit at one time
(i.e. if you have 1 machines and 10 units, it will take you approx 5+ hours to complete the lot, more machines = more costs)
3) Possible breakdown of light detector (replacement downtime?)
4) Limitation of single compartmented storage systems
5) Technical oversight to ensure that the initial connections are placed correctly
6) Price (the euro has been incredibly expensive since last year)
7) Service when things go wrong (specialized engineer required from Switzerland)

CONSIDERATIONS FROM THE USER'S PERSPECTIVE

Both the AXP and the SEPAX have their pros and cons, and as a potential user, I'm interested in knowing the breakdown rates and other problems banks have in using the system. These are usually not disclosed and the user takes on the risk to find out. Unlike public banks which can afford to discard units which don't turn out right, private stem cell facilities have zero tolerance for error as every single one hurts both the client and the company's balance sheet. Additionally, if the system does not work out for the company for whatever reason, the expensive asset has to be written off (may cost millions) which would be an extremely painful decision to make.However, unlike the AXP system, the SEPAX system has been in use for a while and has not released any public recalls of their product. Hence, the only reason that I can think of for its slow uptake in the rest of the world is that unlike Europe, which promotes public banking largely for blood cancer use, America and the rest of the world is promoting cord blood stem cells for regenerative use- hence the need for a multi-compartmented bag- which is a different concept entirely.


PROFIT & LOSS

Certainly all companies selling the automated systems would stand to profit greatly from entering the cord blood stem cell market. Cord blood stem cell banks can still use generic products on the market, making it relatively affordable to bank as long as the team is technically competent. Now, automated systems will increase general standards of quality for those with less well trained staff (its a matter of practice and the total experience) but it also pushes prices up for the consumer or makes it less profitable for smaller operators. Public banks will also need to campaign for more funds in order to buy new systems and costs of processing will need to be revised from previous proposals.

For now, the small number of options in automated systems commands a forced loyalty as each system only accepts their own product. Many of the stem cell banking services that face the consumer directly will await the day that there is a generic design of standard quality which can be used with any machine, which will be more open to price transparency. Of course, that day may still be far away until either governments have budget surpluses to devote to a huge volume of public banking (when it takes precedence in funding over other healthcare priorities) or legislate to provide a conducive environment for the public to exercise their choice to bank privately should they wish to.

KNOW WHAT YOU'RE PAYING FOR

There is no doubt in my mind that automation is inevitable at some point but let's not forget that this is still version 1 with potential to move to version 2. In the meantime, I'd like to see who and how the AXP system and SEPAX system is used in private hands, and whether it is used according to manufacturer's recommendation** to achieve the desired result.


*Prof. Eliane Gluckman's - the first cord blood stem cell transplanter- facility Eurocord uses the SEPAX system, in direct rivalry with AXP whose public endorser is the New York Cord Blood Bank led by Dr. Pablo Rubenstein who developed cord blood storage procedures in the US.

**Manufacturers recommend certain minimum volumes and maximum volumes to be used with their system. Any deviation of this will not result in the promised outcomes, hence clients who are paying more for the promise of this system but don't meet the criteria will still ultimately be getting manual processing (which works well in a competent facility but not in one where the practice is limited).

The point of these systems is also to provide a "functionally closed" system of processing and there certainly wouldn't be any point in using the automated system if you had to transfer the cells from the final bag into a different storage method (e.g. vials) at the end, which would break it into a "functionally open" one instead.

US Recall News: AXP AutoXpress Cord Blood and Sick Cow Meat

In this week alone, I've received two articles from friends and colleagues informing me on the latest in a string of bad news from the US.

The first article was about Thermogenesis recalling 7,000 of its latest disposable bags custom designed to be used with the automated AXP device, used to process cord blood for stem cell separation.


WHAT'S THE PROBLEM?

Thermogenesis apparently failed to perform a quality control procedure on every shipment of the Auto-Xpress units from the time that the product first went on the market in 2006 up until now. The CEO, Willaim Osgood, who joined after the product went on the market, launched the recall after an internal audit found the flaw which was against the federal laws.

The flaw was the failure to perform quality control test for pyrogens (substances which cause fever, including bacterial toxins), which was omitted from the company's operating procedures.

This is one of my concerns in using any new products, as mentioned in my previous blog entry. It's always a real worry when products have problems and the service provider has to explain it to the clients. This is one of the reasons why we're evaluating if moving from a time trusted method to technology 1.0 is something that our clients would accept. Admittedly, cord blood stem cell clients need to be made aware of these concerns too.


WHAT'S BEING DONE ABOUT IT?

The CEO has admitted that "it was a mistake" on Thermogenesis's part and is now working with customers to retroactively test the Auto-XPress units, while the US FDA recommends that any cord blood units already stored be labeled as such so that they will be able to trace any problems if the unit is required for transplant.


According to the article:
There is currently no way to test whether a frozen cord blood sample is contaminated, according to the FDA recall notice. ThermoGenesis is in the process of validating a way to test for contaminants after a sample has been thawed.


While the AutoXpress sales accounts for 25% of Thermogenesis's USD 5.5 million revenue (making it the fastest growing product in the 22 year old company's history), its not the first problem with the bags due to the false-negative results in the first round which delayed shipments. This has depressed the company's share price (NASDAQ:KOOL) down by 6% to USD 1.53.

The AutoXpress bags are manufactured at an outsourced facility in Pennsylvania and the bags are tested at another outsourced facility.

GE Healthcare's Amersham division in Sweden signed an exclusive 15-year distribution deal with Thermogenesis to supply the AutoXpress system worldwide last October.

THE THERMOGENESIS REVENUE STREAM

The bulk of Thermogenesis's AutoXpress sales is currently from Cord Blood Registry (CBR) which collects and processes the majority of cord blood units in the US, though financial arrangements between them and Thermogenesis are not disclosed. The New York Cord Blood Bank also utilizes Thermogenesis's AutoXpress and I wonder how many units were used in public collections since June last year.

Thermogenesis predicts that first year revenue should be about USD 4 million with USD 50 million in total. Based on this number, between CBR, NYCBB and a smattering of other users around the world, approximately 35,000 to 40,000 AutoXpress units would have already been used for cord blood stem cell storage.


WHAT PROMPTED THE 143 MILLION KG BEEF RECALL?

The second news article was the US Beef recall that was sent to me via email... if you havent' already seen the nasty video and would like to see what prompted the recall, you can watch it here.

Bioengineering like the movies: Stem Cell Capturing Gadget

I'd hate to sound as if I was brought up on an entertainment diet of Hollywood movies, but back in the 1970's to 80's there was a real revolution in cinematic production and audience interest that led to a cult following of the science fiction genre.

Film directors often take what's probable in science and stretch them to the limits of our imagination, engaging us to just reflect on not only how far we've come but also how much further we can aspire. This next entry is a tribute to the 1987 movie "Inner Space"*.




In a recent announcement, MIT's bioengineers have designed an implantable device that is capable of capturing pure samples of stem cells from the circulating blood. The device is described as "a length of plastic tubing coated with proteins" which has been experimentally implanted into the bloodstream of rats.

The more accurate medical description of this plastic tubing is known as a "shunt" and the method of implantation would most likely involve the severance and reconnection of a small but high through-flow blood vessel. The proteins -known as selectins- attract and trap specific cells with the right signals on the surface (imagine a sticky mat). The cell capture devices are developed by chemical engineers led by Associate Professor Michael King from the Biomedical Engineering department at the University of Rochester. The technical details will be described in the March edition of the British Journal of Hematology.

(personal note: Mr. B.C. this is for you.)


WHY IS THIS DEVICE IMPORTANT?


The medical impact of this device could weigh in for cancer patients who may need to use autologous (one's own) stem cells for their treatment. These cancer patients are treated with chemotherapy to reduce and eliminate as many of the malignant circulating cancer cells as possible from the bloodstream and bone marrow. The treating doctor will collect the patient's own stem cells during this period of remission when the cancer load is at its lowest.

The patient's own stem cells are stimulated using GCSF (read about it here) and the stem cells are harvested and stored in anticipation of the possibility that the cancer cells will multiply again, requiring another round of chemotherapy which may damage the existing healthy marrow further. The collected stem cells will be infused back to the patient to ensure that the patient has sufficient stem cells to repopulate and replenish the marrow, thereby restoring normal cell levels to the bloodstream.

To address the concern that perhaps cancer cells from the patient might also be collected in the same fraction as the healthy stem cells (impossible to distinguish during harvesting) this device could lend a hand to filter out the cancer cells inside or out of the patient's body, i.e. the cancer cells would travel around the bloodstream until they reach the shunt, where they would then be immobilized.

Note though, that the inventors have conceded that this device will not be able to collect enough stem cells for a transplant, therefore the customary stem cell collection procedures will still need to be performed.


SOME INTERESTING STATISTICS


According the A/Prof. King, the shunt placed in an non-GCSF induced rat in a 2 hour period enabled the capture of 3-4 times the number of usual stem cells obtained in normal circulating bloodstream (approx 1%). Hence the device is thought to attract and specifically retain a significantly higher number of stem cells.

This stem cell number could be significantly higher in patients who have been mobilized.


WHAT ELSE CAN IT DO?


Well, it is a concept device which will be as good as its selectin coating. A/Prof. King has already forecasted the use of the device in trapping specific cancer cells in the body to prevent metastatic spread and layering in proteins which could help steer cell development processes by differentiating them while passing through the shunt. (analogy: think sticky mats for dust, sticky mats for cockroaches, sticky mats for cat fur...all requiring different levels of stickiness for its target)



WHEN CAN I BUY IT?


The entrepreneurial A/Prof. King has already started a company by the name of CellTraffix and the anti-metastasis implants are set for animal trials later this year in collaboration with bioengineers Professor Jeffrey Karp and Robert Langer at Harvard and MIT who will develop stable selectin coatings that will last over months than days. Meanwhile, the CEO of CellTraffix, Tom Fitzgerald has already announced that the company's first product for researchers to capture stem cells or cancer cells for lab experimentation will be marketed by early 2009, with clinical testing of the anti-cancer coatings in 2010.


Read how a chance encounter between a bioengineer and a haematology clinician gave rise to this work and watch the cells being captured here (note that you will need a high speed broadband connection as the video files are rather large).


*Why does this remind me of the movie Inner Space I hear you ask... well the term cell capturing device often conjurs up the image of a little machine (like the exploration submersible the protaganist uses) to grab and hold onto cells in circulation :)

Your OWN or your FAMILY's are always the BEST!

Use your OWN or a SIBLING’S cord blood stem cells and achieve CURE or REMISSION!

Data from a retrospective review of blood disorder patients treated with stem cells from their own cord blood (autologous transplant) or from the cord blood of a sibling (allogeneic-related transplant), presented at the American Society for Blood and Marrow Treatment (ASBMT) annual meeting showed that the majority of the patients were cured or achieved remission from their disease. Moreover, low risk of transplant-related complications with genetically-Related cord blood stem cells was seen.

Dr. Jennifer Willert, senior attending transplant physician and clinical professor at Rady Children's Hospital, University of California - San Diego, and lead author of this study said that “we now have important insights into the ability of transplant physicians to achieve successful outcomes using an individual's own cord blood to treat an environmentally-triggered blood disease or cord blood from a family member to treat certain genetic blood disorders and inherited bone marrow failure syndromes (IBMFs). Furthermore, the use of genetically-related cord blood may reduce the rate of mortality as well as the risk of treatment-related complications".

The analysis examined transplant recipient data from 16 cases of nonmalignant blood disorders. Four of the patients were infused with their own cord blood stem cells to treat aplastic anemia, an acquired condition. Twelve patients were transplanted with cord blood stem cells of a sibling for a range of inherited conditions including, thalassemia, sickle cell anemia, Fanconi anemia and Hurler syndrome. The review showed that two-thirds of the patients (10) are either cured or in remission, including half of the patients treated with their own cord blood. Three patients died of complications unrelated to their cord blood transplant; one patient experienced a relapse; and the outcomes status of two patients is not known. All 16 cord blood collections were processed and cryo-preserved at Cord Blood Registry and were viable for transplant when requested. The average storage time prior to use was about 27 months; however, one child's collection was stored for nine and half years and used to successfully cure that child's aplastic anemia (autologous use)!

Advantages of Genetically-Related Cord Blood Use in Transplantation

According to previously published data, transplantation of genetically-related umbilical cord blood has demonstrated clinical advantages over bone marrow, peripheral blood and unrelated umbilical cord blood. Since cord blood stem cells are immunologically younger than other "adult" stem cell sources, they demonstrate more versatility and flexibility when used in transplantation. Stem cell transplants from genetically-related sources (those from an immediate family member) result in better treatment outcomes than transplants from an unrelated donor and are associated with less frequent and less severe graft-vs.-host disease, a complication that occurs when the donor cells attack different parts of the body. Cord blood is rapidly becoming a preferred stem cell source in transplant therapy (a standard treatment in children's BMT already), with more than 10,000 cord blood transplants performed worldwide to-date.

Dr Willert said: "This study is relevant to any expectant parent considering whether or not to privately bank cord blood stem cells, Individuals who have access to their own cord blood stem cells, as well as a sibling's, have the best chance of treating a blood disorder that develops."

It is really not much to talk about here; the study really speaks for itself! The final comments of one of the authors say it all. Little miracles are hidden in our OWN veins!

Juvenile Diabetes Research Foundation (JDRF)

The Juvenile Diabetes Research Foundation (JDRF) gets into the game of stem cells, ADULT Stem Cells, together with Plureon Corporation, a biotechnology company based in Winston-Salem, N.C. that focuses on developing therapeutic applications of stem cells. The project plans to use Plureon’s technology platform to isolate adult stem cells from a type 1 diabetes patient and re-program them to generate fully functional pancreatic beta-cells. The objective is to return the re-programmed insulin-producing cells back into the patient in an autologous manner, i.e., without the need for immunosuppressive agents normally required for organ transplantation – in this manner, the patient’s own transplanted cells will be capable of glucose-dependent insulin secretion and the restoration of normal blood sugar levels.

Those of you that come here regularly you may remember a previous post about "A unique human blood-derived cell population displaying high potential for producing insulin", meaning that Plureon will be looking closer on to those cells, isolating them and eventually giving them back to the same patient (autologous) to cure the dreaded disease. If JDRF puts half a million dollars over 2 years on this then something is in the making. In the meanwhile, keeping and storing your own PBSC at a young age is probably the way to go in order to fully exploit this new technique when it comes! As an Endocrinologist and a Diabetes specialist I feel that exciting times are about to unfold in front of us. The future is here!

Brain Stem Cells killed by Space Radiation

A lot of the concepts surrounding that of anti-aging first involves protecting and conserving what the body has left to the best of your ability and secondly attempting to regenerate and increase the number of functionally productive living cells in the desired tissues and organs.

In a previous blog entry, I described a face cream by Dior (Capture) which promises to protect and nourish the remaining stem cells one has left in wrinkled skin. If you are a frequent long-haul air traveller (Richard Quest please take note), you might wish to give a small thought to this rather esoteric but possibly significant research study -which was conducted by the researchers at Cold Spring Harbor, Brookhaven National Laboratory, the Kennedy Space Center and the University of Florida- published the the Journal of Experimental Neurology.

For those of us who spend enough time in the airplane and feel that we could have reached Mars and back, we might wish to consider plausible types of protection for the stem cells in our brain responsible for learning and memory.

In the preparative research for the proposed next NASA project to put a man on Mars, scientists conducted an experiment with mice where a single dose of radiation was administered considered to be equivalent to the amount an astronaut might be exposed to during a 3 year space voyage to Mars and back. What they found was that the radiation particularly affected the stem cells in the region of the hippocampus.


"We are going to have to rethink our understanding of stem cell susceptibility to radiation, including cosmic radiation encountered during space travel, as well as radiation doses that accompany different medical procedures," said Professor Dennis Steindler of the University of Florida, co-investigator of the study.


WHAT IS COSMIC RADIATION AND IS IT SOMETHING TO WORRY ABOUT?

Well, this really depends on how much long haul, high altitude flying you get to do as part of your job. Air crew and presumably flight military will be subjected to the highest amounts of exposure. Background cosmic radiation at ground level have been established at 2-3 mSv (microSievert) which is considered natural exposure. In the plane, higher altitudes reduces the protective layers in the atmosphere which shield most of the cosmic radiation and thus cosmic radiation exposure is increased. If you'd like to have an indication of cosmic radiation levels during flight, have a look at this table on the WHO site. (Note: if you're flying the A380 long distance at 43,000 feet, you'll need to double the figures up by 2)

As a result of this, aircrew are now monitored and their time tables adjusted accordingly to ensure that they do not exceed the recommended dose. The WHO and the UK Department for Transport also does not recommend pregnant air stewardesses to work on flights due to the exposure to the unborn child.

Or we can live near the equator where cosmic radiation is reduced by half.



HOW CAN WE PROTECT OUR STEM CELLS FROM COSMIC RADIATION?

Come to think of it, maybe those Imperial Stormtroopers might have been wearing reasonable looking outfits for the fight and flights through space to protect their cells. Ridiculous as it may have been (note that Luke and Leia never wore any type of helmet or protective outfit) astronauts going out on a space walk have to put up with much more cumbersome outfits due to the numerous protective layers.

A CHALLENGE FOR SPACE BIOENGINEERS AND PHYSICISTS

NASA engineering scientists are working on new materials and polymers which confer more protection and estimate that a new spacesuit which will be worn by the super-fit astronauts on Mars will be as light as 21 Kg and comprise of 12 different layers.

Better shielding on spacecrafts are also on the way (using water as an absorbent material) and hopefully, some of this technology will also filter down for use in commercial flights so that we can reduce our cancer risk (bad enough already) and retain as many hippocampal stem cells as possible.

As for the rest of us who are already losing our memory and learning capabilities due to cosmic radiation, we'll have to see about how to potentially replace and regenerate new stem cells along the way without resorting to NASA designed storm trooper outfits when we board the A380 from Singapore to London or New York.

Program on Stem Cell Therapy for Joint and Bone Diseases

It's now 8:34 pm and I'm wishing that I could catch the program on Channel News Asia right now, except that I can't get it here in KL. The program is named the "Medical Touch" and features some interesting degenerative joint conditions and how stem cell therapy can help. If you're able to catch it, I'd appreciate your feedback on the program.


The Medical Touch
Episode 11
The Medical Touch drills down on degenerative bone diseases to uncover the bare bones about joint pains, myths shrouding an emerging silent killer and the promise of stem cell therapy. Osteoporosis starts decades before onset. So do the opportunities to prevent and reverse it. Bone up on how to keep yours strong and wise up on why you should not take your skeleton for granted.

Update on Ryan Schnieder- Cord Blood Stem Cells for Cerebral Palsy

Anyone remember Ryan Schneider and his active mum Mary? I mentioned them in a very early blog entry and recently found an update on Ryan's condition in an interview with his mother, posted on their website promoting new treatments for children with neurobiological conditions. I also learned from the article that Mary is working to pass a bill promoting cord blood banking and advocating stem cell research.

The pictures of the family are very nice and Ryan does look like a happy and healthy child. I took an excerpt from the interview which I thought would be of interest to those parents who are considering storing their babies' cord blood stem cells. Mary explains why storing and using your own child's cord blood stem cells is the best option.


Question to Mary Schneider:
What do you say to other special-needs parents who want to know how they can try this same procedure for their children?

Answer:
At this point only children with cerebral palsy or similar brain injury, and who have their own cord blood banked at birth are candidates for this treatment.

In order to receive donated umbilical cord blood stem cells, a patient currently has to go through chemotherapy like that endured by cancer patients. Chemotherapy is likely to do significant harm to children, and so is not an option for children with stable neurological conditions like Ryan’s. So it has to be the patient’s own cord blood banked at birth, and not a sibling or other donated stem cells.

To date, seven more children have seen Dr. Kurtzberg. Their issues are all different (as a parent might imagine) and their results vary based upon their previous level of impairment and the viability of the stem cells used.

The common thread is that each child has seen some kind of improvement. Ryan’s results are more than I had hoped for, yet for all the other children there has been a quality of life change on some level. Some of the major improvements parents have reported are in the areas of strength and mobility in both upper and lower body; feeding and gastrointestinal issues; reduction or elimination of seizure activity; body temperature regulation; speech; tactile defensive issues and visual tracking abilities.





WHAT ARE THE CAUSES?

Often rather difficult to define depending on which part of the brain is damaged, but here are a few that I found online.

Causes before birth:
Infections of the mother while she is pregnant. These include German measles and shingles (herpes zoster).
Differences between the blood of mother and child (Rh incompatibility).
Problems of the mother, such as diabetes or toxemia of pregnancy.
Inherited. This is rare, but there is a 'familial spastic paraplegia'.
No cause can be found in about 30% of the children.

Causes around the time of birth:
Lack of oxygen (air) at birth. The baby does not breathe soon enough and becomes blue and limp. In some areas, misuse of hormones (oxytocics) to speed up birth narrows the blood vessels in the womb so much that the baby does not get enough oxygen. The baby is born blue and limp-with brain damage.
Birth injuries from difficult births. These are mostly large babies of mothers who are small or very young. The baby's head may be pushed out of shape, blood vessels torn, and the brain damaged.
Prematurity. Babies born before 9 months and who weigh under 2 kilos (5 pounds) are much more likely to have cerebral palsy. In rich countries, over half the cases of cerebral palsy happen in babies that are born early.

Causes after birth:
Very high fever due to infection or dehydration (water loss from diarrhea). It is more common in bottle-fed babies.
Brain infections (meningitis, encephalitis). There are many causes, including malaria and tuberculosis.
Head injuries.
Lack of oxygen from drowning, gas poisoning, or other causes.
Poisoning from lead glazes on pottery, pesticides sprayed on crops, and other poisons.
Bleeding or blood clots in the brain, often from unknown cause.
Brain tumors. These cause progressive brain damage in which the signs are similar to cerebral palsy but steadily get worse.



Well done Mary for tirelessly bringing stem cell application to the front of everyone's minds and reminding them that the patient should always be first and never to fear a logical next step even though it may be new.

"I want to look like Sharon Stone..."

... I suppose this must be what all the American 35+ year olds must be thinking as they rush out to buy Christian Dior's latest product on Macy's shelves on the weekend (Sharon Stone is the advertising model for "Capture" chosen by LVMH).


COSMETICS MOVE ASIDE

The product -which sounds like a piece of sexy photographic equipment or imaging software- is called Capture 60/80 XP and claims to have "lassoed the power of adult stem cells to help repair wrinkles". (For the interested Asian clients, Christian Dior plans to launch it internationally at the start of 2008)

The product was researched and developed by researchers at the Dior innovation center and the researchers at LVMH in collaboration with Professor of dermatology Carlo Pincelli, who heads the research unit at the laboratory of cutaneous biology in the University of Modena and Reggio Emilia in Italy. It contains a collection of treatment creams and serums for the face and eyes which target women in the 35+ age group who are trying to escape the clutches of skin aging by protecting their adult stem cells in the skin, making them more active and thus reduce the formation or deepening of wrinkles.

The article states that the company's patented "Stemsome" technology and TP-Vityl ingredient is included in the Capture cream's formula and works on a time release system to protect basal cells and the skin's bionectin scaffold which keeps the collagen in place.


HOW MUCH FOR OVER THE COUNTER REGENERATIVE COSMETICS?

The Capture R 60/80 XP collection includes 30- and 50-ml. bottles of serum, which retail for 80.90 euros and 106 euros, or $119.40 and $156.45 at current exchange, respectively. There are also 30- and 50-ml. jars of cream in a light texture and similarly sized jars of cream in a rich texture for 57.80 euros and 86.30 euros, or $85.30 and $127.40, respectively. The 15-ml. eye cream sells for 53 euros, or $78.23. Prices are for France.

In comparison, StemLife stores cord blood stem cells for the equivalent of 5 jars of cream.

While Dior executives would not discuss numbers, industry sources estimated that Capture R 60/80 XP will generate $37 million in wholesale business during its first 12 months worldwide.

SUPPORT FOR STEM CELL INDUSTRY

Interestingly, the article states that some of the proceeds from the sale of Capture will go to Standford University's adult stem cell research funds, which might be a contribution to the Institute of Stem Cell Biology and Regenerative Medicine


It's been known for years that by merely applying cosmetics, women can make themselves more attractive and appear youthful, but can we really nourish our stem cells and prevent them from dying using a cream kept in our cosmetic case? I'll have to ask someone who's going to use the creams. Well, I guess if there's any bit of skin on our body that is most exposed to UV rays and all other environmental insults, it would be our faces. Maybe I'll buy it for a friend as a present and see if those wrinkles do indeed disappear...

Viacell Acquired by Perkin Elmer

Now that PerkinElmer (PE) has purchased Viacell, the company best known to me for its PCR machines* now owns the distribution arm of Viacell's cord blood stem cell storage unit- Viacord. The announcement of Viacell's takeover, valued at USD 300 million (approx 960 million MYR) was certainly a whole lot more than what Celgene paid for LifebankUSA which was closer to USD 60 million a few years ago.

Viacell had several subsidiaries; one focusing on R&D for cord blood expansion and differentiation; one focusing on therapeutics; another focusing on freezing and storing women's eggs (Viacyte) and its most well known backbone cord blood stem cell banking service Viacord.

PE's intention is essentially to sell off Viacell's stem cell therapeutic business, the Viacyte service, probably wind down the R&D aspects of the business and to ride on Viacord's cord blood banking strengths.


WHY ACQUIRE A CORD BLOOD COLLECTION SERVICE?

PE acquired two companies last year namely Macri Technologies and NTD Laboratories, the former developed a genetic screening kit called Ultrascreen and the latter company offers the screening test at their facilities. In the latest addition to its stable, PE's acquisition of Viacord is to develop an end-to-end package for prospective parents who are shopping for cord blood storage and will also be provided the option of having their babies screened for freeBeta hCG (a peptide hormone indicative of first trimester down syndrome prenatal risk assessment). The chairman and CEO of PE indicated that the acquisitions represent the next steps in their initiative to build a comprehensive screening and diagnostics capability in maternal healthcare.

PE also intends to expand their genetic screening tools that test the cord blood collected for any conditions which are potentially treatable with stem cells. PE also plans to take advantage of Viacell's established distribution consumer network which is doesn't have- allowing it direct access to patients and clients instead of having to rely on doctors and hospitals to sell their product.


GROWTH IN THE MARKET

According to the Boston Globe, Viacord expects to generate less than USD 70 million in sales but Perkin Elmer believes that the cord blood banking market could reach more than USD 1 billion within the next five years. Additionally, PE's CEO also said that the genetics screening business is expected to account for more than 10% of PE's annual sales which totals USD 1.7 billion, and is growing faster than PE's business as a whole.


DRUG GIANTS ARE IN

PE plans to sell Viacyte (egg freezing and storage technology) to EMD Serono which is part of Merck Serono and Viacell's therapeutic business to another drug giant- possibly Amgen.


The CEO of PE Gregory Summe said that Viacord would continue to run independently of PE but that PE may provide additional funding and resources to accelerate Viacord's growth. With PE's generous offer of USD 7.25 per share, I wonder if the management team have decided to retire and let PE's management takeover the day to day operations of the company. Will PE succeed in this latest corporate move? It remains to be seen how the acquisition of Viacord's network can integrate with the screening services. In direct comparison, Celgene's acquisition of LifebankUSA hasn't enabled it to boost its position to No. 1 in the US yet.


*PerkinElmer's PCR machines were the most loved of the lot in the research lab where I used to work. There were long queues for the machine as it was known to give beautiful amplification sequences at high yield. Despite its bulky shape, the best labs still insist on having at least one version of the machine.

AutoXpress System: Not Yet A Winner for Thermogenesis Corp

When Thermogenesis announced that they had pioneered an automated system (AXP) for the processing* of cord blood stem cells, we were all quite excited that the industry was indeed moving in this direction. StemLife has been banking babies' cord blood stem cells in the FDA approved Thermogenesis cryo-storage bags since we started the service in Malaysia in 2001, hence the adoption of this system would seem a natural progression for us.

WHEN BEING FIRST IN TECHNOLOGY ISN'T NECESSARILY BEST

However, just like any system update (in IT terms), the question remains as to whether one wants to take a chance on being an alpha user or to wait for the beta version. StemLife's position is that we usually like to wait for all the bugs and kinks to be sorted out before we put our babies' stem cells on the line. There are 2 automated systems available on the market to stem cell processing laboratories namely Biosafe's Sepax System (Sepax) and Thermogenesis's AutoXpress (AXP).

Both systems have been in the Malaysian market for about a year and we've been evaluating them in terms of uptake internationally, performance and consistency of service. Despite the US largest cord blood stem cell provider- Cord Blood Registry- releasing results of 97% and above recovery rates using the system, many stem cell companies in the US (Thermogenesis's home market) and abroad have yet to fully convert their existing processing systems to the AXP system or Sepax system.


I should point out at this stage that the main advantage of using the AXP system (apart from its automatic sensor which makes recovery rates more consistent) is that it is pretty neat because it automatically puts all the stem cells into the thermogenesis cryo-storage bag in one closed loop (if you wanted to store it in any other container, you would have to syringe out the cells, defeating the functionally closed system that the sterile processing set is supposed to provide).


Upon following the most recent news released by Thermogenesis, it appears that thus far the uptake has been lackluster despite big announcements to market the product through General Electric Healthcare. This lackluster sales performance (due to problems with production and slow sales) for the year of 2007 has resulted in a doubling of the net loss at Thermogenesis Corp in the fiscal quarter ending in September.


GREAT, SO WHY AREN'T ALL CORD BLOOD STEM CELL BANKS USING IT?

I don't know if all cord blood stem cell service providers feel the same way but our reasons for a methodical evaluation are as follow:

a) COST
- It requires the acquisition of new expensive apparatus and equipment
- Technical fragilities (rate of machine breakdowns etc)

b) COMMITMENT
- All processing sets must be purchased from GE alone (effective monopoly)
- Hardware and Software and proprietary to Thermogenesis (data monopoly)

c) CLIENT
- StemLife already promotes the bag storage system but some other cord blood banks are still marketing a non-bag system. Hence Thermogenesis and GE need to convince those banks to adopt the bag storage system.

d) CONSIDERATIONS
- How committed are Thermogenesis and GE to this technology given on-going losses and opaque trendline?
- Price control (we're outside of the US and would be affected if there are currency fluctuations)
- How committed are Thermogenesis and GE to serving the needs of non-US clients? (which accounts for a smaller market)


FINANCIAL IMPACT

According to the article:

Revenue fell to $3.6 million in the quarter, down from $4.3 million in the same three months of 2006. The quarterly net loss swelled from $1.1 million, or 2 cents per diluted share, in last year's initial quarter to $2.3 million, or 4 cents a share, in the same period of fiscal 2008.

Thermogenesis's CEO William Osgood attributed the decline of the company's revenue to a series of false negative results in quality tests for the bags used in the AXP systems (leading to a delay in shipments) and the sale of only 3 BioArchive blood storage systems by GE healthcare, which he said was "significantly below target".

I wonder what the Thermogenesis target given to GE healthcare was, given that the challenges of the system remain and that most cord blood stem cell banks - both public and private- really have to operate on a tight budget and make the service available given their low margins.



*The processing of cord blood to obtain the important and critical stem cell numbers is lengthy (taking between 4-6 hours in total per unit if performed manually) and there is a level of operator dependent subjectivity (good, when you have many units to work on and experienced and well practiced laboratory scientists). This operator-guided process has been in use since the industry pioneered by the founders of the New York Cord Blood Bank in the 1990's.


**The FDA and American Association of Blood Banks (AABB) recommend the Thermogenesis cryo-bag for storage which most of the cord blood stem cell companies have adopted, but not all stem cell companies internationally or in Malaysia are using thermogenesis bag processing systems, instead they have promoted storage in vials, which implies that the AXP system isn't required.

StemLife remembers the late Dr. Tan Qui Hong

Dr. Tan Qui Hong was one of the first Obstetricians in the country to collect cord blood stem cells for StemLife. She paid a personal visit to StemLife's facility in 2004 (photo above). Dr. Tan passed away yesterday morning 8th November 2007 in Johor Bahru and she will be remembered by us as being a fair, kind and forward thinking doctor who always put her patients' best interest first.

The Best Gamble in Las Vegas: Bet on Your Stem Cells

Neostem, a company formerly known as Phase3Med, based in New York (USA) which collects and stores adult stem cells has been around for quite a while. One of their directors was here in Malaysia 3 years ago at one of the locally organized biotech symposiums and expressed a certain interest and admiration for the work that we have accomplished thus far.


LAS VEGAS MEDICINE

After a short hiatus about two years ago where there was a change in management and ownership, the company has started to make regular press announcements about their expansion of collection services in the US in collaboration with aesthetic doctors. Neostem held a press conference last Friday (Oct 23rd) which was sponsored by the Nevada Development Authority and the University of Nevada and a few local companies. Neostem used the opportunity to present to the Nevada Biotechnology and Bioscience Consortium to educate the region's medical and scientific community.


The collection site is apparently sited near the Nevada Cancer Institute and the Nevada Neurosciences Institute. Its CEO Robin Smith said that its expansion in Las Vegas was quite obvious given the large size of the city's population, its tourist attraction status and that tourists also visit for the health and spa-oriented services offered by the hospitality industry. Neostem's target clients for adult stem cell banking include anyone concerned with their long term health or well-being. They are also targeting people concerned about possible exposure to radiation.



MONEY MATTERS

Neostem listed on the American stock exchange on the same day as the Nevada announcement, is unfortunately already trading down and has a market capitalization of 14 million USD. The rapid expansion over the last three years has been loss-making for Neostem (approx. twenty million US dollars) according to its last audit in March. Most of it was operating expenses (expensive infrastructure and qualified personnel requirements).


However, medical director of the Las Vegas facility, Dr. Ivan Goldsmith expressed his enthusiasm to target both residents and tourists and convince them that storing their own stem cells for their future might be a better bet than the gaming tables.


He said: "The odds are far greater that you will eventually be a winner having your stem cells banked"



StemLife offers adult stem cell collection and banking in Malaysia and Thailand. If you're in the region and interested in this service, give us a call. :)

Hip Replacements- Made Real by Surgery and Stem Cells

When my friend's mum fell and broke her femur about 3 years ago, she had to have almost complete bed rest for six months and physiotherapy and rehabilitation for close to three months after that. With a metal screw pin in her thigh bone and a cast around her leg, it was probably the most uncomfortable and frustrating experience for someone who was living a very active lifestyle (tai chi, walking in parks, overseas travel etc.) prior the incident. She has since recovered from the injury but mentions feeling occasional discomfort and tightness in her thigh.

Most people live their early and active life not expecting any bone surgery (unless it is cosmetic) and most fractures tend to happen in osteoporosing elders over sixty. However, hip fractures are far worse than femur fractures the incidence of hip fractues increase with age, doubling for each decade after fifty. Most people who fracture their hips in old age have a poor quality of life and often get depressed and there are estimates that one in four people who fracture their hips completely heal while 20% of those who fracture their hips do not survive the year of their injury.

Given these considerations, it is therefore not surprising that doctors and bio-engineers are often looking at ways to make prostheses more natural and better accepted by the body. In the reported work that is currently being done at University College London (UCL), the doctors are keen on ensuring that people who require a second hip replacement (about 25% undergo a second surgery) will have a better outcome rather than suffer a crumbling joint with a high probability of trauma (apart from a nasty scar) and protracted recovery period involved.


Professor Gordon Blunn's team at UCL's Institute of Orthopaedics collaborates with Dr. John Skinner's group from the Royal National Orthopaedic Hospital in Stanmore, are conducting a trial with a GBP 130,000 (approx. RM 897, 150) grant from the UK Stem Cell Foundation and the Medical Research Council for a preliminary trial -to boost patient's bone growth by 75%- which will lead to a larger trial of 80 patients next year.

The current method of surgery requires bone chips to be packed into damaged hip joints to rebuild, followed by the insertion of the artificial replacement hip. What the research team will do is to improve the quality of the implants by infusing the bone chips with the patient's own stem cells, which they believe might act as a better cement and cause less inflammation.

The cells would be obtained from each individual patient's bone marrow which is extracted from the patient's hip bone under anaesthesia, isolated and grown in the laboratory and used to seed the bone chips.

The cell culture is estimated to cost approximately GBP 2,000 (approx. RM 14,000) and this probably excludes the cost of the surgery and any ancillary medical care.

The Chief Executive of the Medical Research Council, Sir Leszek Borysiewicz summarized this work most clearly when he said:

"The idea is to use autologous stem cells [taken from the patient themselves] to accelerate healing and outcome."



QUESTIONS AND THOUGHTS

I thought that there were a few interesting points to take from the concept and the trial.


APPLICATION IN OTHER BONES

Firstly, that marrow stem cells were being infused into the interior of artificial bone as seeding for normal bone structures to form.
-This is not the first time that stem cells have been used to seed bone growth and to kickstart the healing process. It would be interesting to see this method applied in other bones too.


AGE IS NOT AN ISSUE

Secondly, that the autologous stem cells harvested from the patient (usually 60-80 years of age) would still be clearly functional for this purpose, demonstrating that stem cells obtained from an older individual is still useful.


ENOUGH FROM THE SOURCE?

Thirdly and curiously, I wondered where the stem cells would be harvested from in these patients. One has to bear in mind that marrow stem cells are usually collected by puncturing the hip bone. Hence, if these patients are already having their second hip replacement, there can't be much left after all the inflammation and debris to harvest. This might provide the reason why stem cell isolation and growth in the lab becomes an important factor.

The number of stem cells infused needs to be optimal in order for the healing to accelerate and outpace the degenerating tissue, by signalling the required repair factors. I would be most interested to know what that optimal number might be in these cases.



*An renown South African orthopaedic surgeon that I spoke to recently told me that at a recent medical convention, he asked the audience (all doctors) who would undergo and prefer a prosthesis vis-a-vis a natural joint. The answer? Nobody raised their hands for a prosthesis.

Verdict: 100% of doctors themselves would opt for a natural method of joint salvage than have a prosthesis inserted.


If you'd like to watch a hip replacement procedure, here's one I found which gives you an idea of what happens but is censored so that there is none of the gore...

Peripheral blood insulin-producing cells (PB-IPC)

Wonderful news for diabetics! Researchers from the Section of Endocrinology, Diabetes & Metabolism, Department of Medicine at the University of Illinois have discovered a novel cell population from peripheral blood that looks like it is capable of becoming islet cell and produce insulin if in the right place! This novel cell population demonstrated characteristics of islet beta cell progenitors including the expression of beta cell-specific insulin gene transcription factors and prohormone convertases, production of insulin, formation of insulin granules, and the ability to reduce hyperglycemia and migrate into pancreatic islets after transplantation into the diabetic mice.

These findings just published in the Biochemical and Biophysical Research Communications 360 (2007) 205–211 can explain our and other researchers findings that when diabetic ulcers are treated with the patients own peripheral blood stem cells other effects are evident apart from the complete healing of the ulcers, that is IMPROVEMENT of their diabetes. It is very probable that this cell population migrates to the pancreas and restarts insulin production!

Autologous Stem Cells (Peripheral or Bone Marrow)

In my first contribution to the blog I would like to give you some information I have gathered from new research studies around the world on Autologous Stem Cells collected either from the Bone Marrow via a bone marrow aspiration or from the Peripheral Blood after stimulation with G-CSF and the effects of those cells in treating conditions that in the past were considered UNTREATABLE!

SPINAL CORD INJURY
In a recent article of Prof. Eva Sykova from the Czech Republic entitled "Autologous Bone Marrow Transplantation in Patients With Subacute and Chronic Spinal Cord Injury" in Cell Transplantation, Vol. 15, pp. 1–13, 2006 very interesting results were shown. The research team split the patient group (20 patients) in 2 subgroups according to the duration of the spinal cord injury (7 with subacute: 10-30 days and c13 with hronic: 2-17 months) and compared the results of injecting the patients own bone marrow stem cells either intra-arterially (in the artery supplying the injured area) or intravenously (in the peripheral vein). Improvement in motor (movement) and/or sensory (feeling) functions was observed within 3 months in 5 of 6 patients with intra-arterial application, in 5 of 7 acute, and in 1 of 13 chronic patients. This case study showed that the implantation of autologous bone marrow cells appears to be safe, as there have been no complications following implantation to date (11 patients followed up for more than 2 years). The outcomes following transplantation in acute patients, and in one chronic patient who was in stable condition for several months prior to cell implantation, are indeed promising. Further studies are necessary to confirm those results and to evaluate how to administer the stem cells. It seems that administering the cells closer to the injury site, such as through the catheterization of a. vertebralis, or into the cerebrospinal fluid, or even intraspinally at the lesion border, might be important for a better outcome.

Indeed very promising results and we at THAI StemLife can report the preliminary outcome of one patient in Thailand that in August 2007 received autologous (his own) PBSC that his treating neurosurgeon injected in the spinal canal during open spinal surgery. This patient was involved in an accident 2 years ago, was in a stable condition and could not move or feel anything from neck and below but 2 months after the Stem Cell injection he can move his right arm! Follow up injections are planned by the treating physician and we will be reporting the progress here!

Lou Gehrig's Disease

I don't know anyone personally who has Lou Gehrig's disease (amyotrophic lateral sclerosis) but it does sound like pure suffering as the mind might still be sound but due to the nervous degenerative condition, the muscles in the body gradually waste away (the paralyzed would probably empathize).

The plight of a lady by the name of Pam Penley Schuelke was just so and there was an article that reported her battle with the disease that eventually took her life at the age of 44. You can read more about her life and her deteriorating condition in the article but I thought it might be interesting to pick out a few key points about the treatments that she sought and what her closest kin thought of as results.


Experimental Therapy

The article reports that having raised money through local newspapers highlighting her plight, she and her partner traveled to Tijuana in Mexico for a cord blood stem cell injection which contained 1.5 million stem cells costing USD 20,000. They acknowledge that the procedure is not one that is proven in medical circles, but her partner Chuck Greenwalt believes that the injection might have put his fiancee into a remission and given her a quality of life that she didn't have when she first was diagnosed five and a half years ago.


The body works in mysterious ways

A week before she passed away, according to her fiance, Ms. Penley-Schuelke was able to eat her dinner and was even able to stand up for short periods. Even more incredibly, just hours after her stem cell treatment, she was able to use her hands to grab, which she apparently wasn't able to do for some time. They were even considering opting for another stem cell injection just 3 weeks ago. Her fiance said: "I guess, when I look back, getting the stem cells gave us the opportunity to be active participants in this and not just on the sidelines. We were able to fight this disease that everyone said was so hopeless.."


An important point to note is that there is no cure for this condition, there is a drug undergoing clinical trials now by the name of Rilutek which is said to have "modest" improvements for ALS patients. Additionally, we should also note that Mr. Greenwalt and Ms. Penley-Schuelke knew that there was no cure and looked to stem cells merely as a possible way to improve her quality of life by perhaps stimulating the regeneration of some neurons or slowing the disease process.

I doubt that there will ever be a way to conduct any sort of real randomized controlled trial for conditions such as these, simply because disease progress is fast and providing placebos might just not be fair. Perhaps instead of decrying it as useless treatment, doctors could design some way of measuring quality of life before and after stem cell injections for the patient, these might provide some objectivity which can be presented reasonably at a medical meeting.


*The picture above is interesting as it cites excessive glutamate as a possible cause of ALS, and that Rilutek which acts to slow the bodies' production of glutamate, only keeps patients alive for another 2-3 months.