ESI Abandoning Embryonic Stem Cell Research and the Start of a San Franciso based Embryo Stem Cell Bank

This entry relates to 2 separate news articles.

I read with some regret last month (sorry, only had time to write it up tonight) that the company known as Embryonic Stem Cell International (ESI) folded up its embryonic stem cell research program after a 5-year attempt to get the research off the ground.

The company announced that it had to abandon the work on therapies due to the lack of success and soaring costs. The aim by the original investors- namely the Singapore Government and the Australian Stem Cell Centre (a private investment group)- raised an impressive SGD 24 million (approx RM 50 million) and recruited Dolly creator Alan Colman as its CEO to lead the research effort.


DECISIONS AND REASONS

Professor Alan Colman was extremely honest in providing the reason for the company's decision, mainly that investors had lost interest due to:

a) any commercialization of its research in the short term was "vanishingly small"

b) the attempt to make well functioning insulin cells and cardiac muscle cells from embryos "proved really difficult" as each therapy would require a minumum of 1 billion cells for each dose

c) and that producing such a dose would be prohibitively expensive.


Other scientists comment that other problems with embryonic stem cells include scaling up the required number of cells and problem with immune rejection and the risk of tumour formation.


ESI MOVING ON TO OTHER NON STEM CELL ACTIVITIES?

ESI has not closed down however, according to this article Professor Alan Colman has tendered his resignation as the CEO, the company has since been taken over by its board of directors and its direction is now towards more revenue generating activities such as "drug screening and drug discovery" (which could mean that its services are rented out to the pharma companies).

Prof. Colman has moved onto a position in the Government which is responsible for stem cell research. He is now named as the Executive Director of the Singapore Stem Cell Consortium and the principal investogator at the Institute of Medical Biology. His focus now will be back to laboratory work (presumably he had to do more marketing and administrative work in the previous entity) and dealing with "all sorts of stem cells, not just human embryonic" he was quoted as saying.

I don't usually write about embryonic stem cells in this blog, but have decided that this piece provides some important perspectives on the topic of stem cell research. While the goals of embryonic stem cell research and commercialization are noble and the prospect attractive at first glance, the existing chasm in both its applications (still none confimed to-date) and its hype to the public has been far greater than any in adult stem cells. Investors will base their expectations on when they see the return of their investment, and these days even a 5 year business plan -with the best and most experienced names on board- can seem difficult to forecast.

Ultimately, investors look at revene generation and the company's bottom line to decide whether they wish to stick with it or cut their losses and find somewhere else to put their money. I admit that it is very difficult to assess what to look for in a biotech investment, most are research oriented and revenue will often seem like betting on a horse you know very little about.

And even if you do know a lot about biotechnology and science, understanding the business strategies and direction of the board and its management team is also critical to whether the company will be able to deliver on its corporate objectives. One may have the most wonderful idea in the world, demonstrated its usefulness in advancing the human race and yet have it sidelined due to factors concerning costs and the lack of adoption by the masses.


ANOTHER RISKY EMBRYONIC STEM CELL INVESTMENT?

This brings me to the next interesting snippet of news that I came across. It appears that since my partners and I started the company close to 6 years ago, there have been some others around the world who have decided that they like our company's name enough to either use it in its entirety or an approximation of it.

The headline of the news article screamed "PRIVATE STEM-CELL BANK IS A POOR INVESTMENT". The "stem cell bank" that the article was referring to was an embryonic stem cell company called StemLifeLine which offered couples undergoing IVF to transfer their unused frozen embryos to a company in San Francisco Bay.

The company will make a "personal stem cell line"*, providing clients with a way to "protect their future and the future of their children". A very, very bold statement indeed (surprising that the US Ministry of Health / Federal Agencies isn't restricting the use of these words?)

The journalist correctly points out in the article that although the cell lines are personalized, they would be personalized to the unborn embryo, not to any of its parents or siblings. Furthermore, they state that a minimum of 10-12 embryos would be required to yield a viable line (okay ladies, that's 10-12 eggs, which is what you ovulate in a year). The article states that on average each IVF cycle yields about 10 embryos which are used in an attempt for successful implantation. I've also heard that the success rate of a couple that chooses to undergo IVF is less than 30% in some cases, so most couples would use all the viable embryos to give the procedure the best chance... hence would the stem cell bank be saving the least viable embryos to create the stem cell lines?

The company plans to market its services through leading IVF centres and generate its revenue (although it doesn't state how much the charges are) by isolating, growing and storing frozen embryonic stem cells. Given that ESI has just announced its plans to switch out of this area, this company's investors and doctors seem not to have read about all the issues surrounding the reason why embryonic stem cells have failed to live up to expectations thus far.

For those who think that cord blood stem cell collection and storage is not a valuable investment despite its proven list of applications and future potential applications, this embryonic stem cell service sounds to be of an even riskier bet.

I'm not saying that the public shouldn't have a choice, its just that from a business perspective I wouldn't even know where to start on that embryonic risk vs. benefit chart for ethical counselling.


*The idea of creating personalized stem cell lines for patients has been mooted before, and collapsed. If you're interested, read this 2005 article, a subsquent article and this one.

Singapore's Successful Double Cord Blood Stem Cell Transplant

Just when you've heard from other news sources that:
a) cord blood stem cells are useless;
b) that you'll never ever need it;
c) that cord blood units contain too little to be used in a transplant or;
d) that it is only used in cases of small children

Bravo to Singapore's marrow transplant doctors for their successful case of 19 year-old Nanyang Polytechnic student Candy Yeow. She had Philadelphia positive acute lymphoblastic leukemia which had very poor prognosis of survival. However, she was very lucky because the medical team was able to find 2 HLA matching (or near matching) units of cord blood stem cells from an overseas cord blood bank. Her transplant went well and at her one-year transplant anniversary, she's in complete remission and off all immuno-suppressants.

Her doctor at the Singapore General Hospital Dr. Mickey Koh was quoted as saying that a single unit of cord blood didn't have enough stem cells for the transplant and hence they went for two combined units in order to achieve the requisite number of stem cells for the patient.

Hence, if you're wondering whether cord blood stem cells can be used for an adult, it depends on how many stem cells were collected in the first instance and if it isn't, at least you're halfway there with one unit. The odds of finding one matching unit is challenging enough, but two matching units like what Candy has here is almost a miracle*.


*Apart from just finding the right matching cord blood stem cell units, the medical care provided to ensure successful recovery is equally important and not to be taken for granted.


WHY CANDY HAD TO HAVE A STEM CELL TRANSPLANT FOR HER CONDITION

From Blood Journal:

Philadelphia chromosome (Ph1)-positive acute lymphoblastic leukemia (ALL) has a poor prognosis when treated with conventional chemotherapy. We analyzed the outcome of 67 HLA-identical sibling bone marrow transplants (BMTs) for Ph1-positive ALL reported to the International Bone Marrow Transplant Registry (IBMTR). Twenty-one of 67 (31%) transplant recipients survived in continuous complete remission more than 2 years after transplant. Two-year actuarial probabilities (95% confidence interval) of leukemia-free survival were 38% (23% to 55%) for 33 patients transplanted in first remission, 41% (23% to 61%) for 22 patients transplanted after relapse, and 25% (9% to 53%) for 12 patients failing to achieve remission with conventional chemotherapy. These data indicate that transplants are effective treatment for Ph1- positive ALL.


Also for the record, there is little indication that propensity for ALL is passed on from parents to children.

Stem Cell Cure Claims for Cerebral Palsy and Down's Syndrome? Definitely NOT StemLife

There were a few statements made by the Malaysian Minister of Health reported in Malaysia's local newspaper "the Star" today. I'm writing this entry for StemLife clients, staff, shareholders and supporters who may be wondering if it relates to our work.

The Health Minister was quoted saying that there are those who claim that stem cells can cure diseases such as cerebral palsy and Down's syndrome, and a doctor who charged RM 25,000 for a stem cell treatment for these two conditions*.

Firstly, I'd like to put on record that StemLife has never claimed that stem cells can cure either of these conditions and that the doctor who administered the "treatment" worth RM25,000 is NOT in any way associated with StemLife.

Secondly, I'd like to address a few points that the article failed to mention (perfectly understandable as the journalist was reporting statements, not providing any analysis). The assumption that people only invest in something when there is a guarantee is largely incorrect, especially when it comes to one's health. One thing that can be certain is that in the medical profession, there is never a guarantee for a cure for any disease, whether the procedure concerns stem cells or not.

Further, the article and statements address the false hopes about what stem cells can do but fails to mention anything about the areas where stem cells have been used successfully in medical applications in Malaysia. This does not provide the Malaysian public with a pragmatic assessment of what facilities and procedures are available or possible in the appropriate medical context.

Thirdly, cord blood stem cell banking has been available in Malaysia over the last five and a half years -both privately and publicly- and the cost of storing stem cells has been declining, while the number of applications has increased significantly since it was first used in 1987. Therefore if one can afford the storage costs, then it is an option that can be considered.

Finally, in all fairness, no one should think of stem cells as a miracle cure for anything and everything. In all of human history, there has yet to be such a thing.

In case this topic is new to you, I'm including a few links below that I hope you will find useful. More stories can be found on this blog- try using the search box on the top left of this page or let me know if you have a particular question (we will refer to the medical specialists). We can't guarantee that we'll have an answer, but we'll be happy to share any information that we have on stem cells or its current applications.


Cord Blood Transplants from the National Marrow Donor Program, USA

Cord Blood Transplant Case as reported on CNN

Cord Blood Stem Cells as a Source for Adult Cancer Patients from the American Cancer Society

Cord Blood Registry (CBR)- one of USA's Largest and Oldest Cord Blood Stem Cell Banks Application Publication (click on the thumbnail on the right)

Cord Blood Stem Cell Transplant for Immune Diseases (from the British Medical Journal)

Statistics of Autologous Cord Blood Storage and Use by Dr. Frances Verter and Dr. Nietfeld (note that this is a .ppt file)


* I found this article published which might be one of the organizations that the Minister might be referring to.

First Ever Beijing Stem Cell Donor for Taiwanese Recipient

Despite any political maneuvering between China and Taiwan, it is articles like these (1, 2) that bring our minds back to the basics- which is that geopolitics aside, our genetic heritage links us and binds us eventually to a common fate.

Additionally, stem cell resources will always reside with the size and diversity of the population, hence China with more than 1.3 billion is a stem cell treasure trove for chinese people all over the world if we are able to thoroughly profile and screen the stem cells.


The article which I noted a while ago (sorry, it's a late comment, but I thought it worthwhile) reports the first time that stem cells were matched from a patients in Taiwan to donors in Beijing*. The two profiled donors were Ms. Hang from Jiangsu province and Ms. Xiaoyan from Hunan province. (click here if you'd like to know where the provinces are in relation to Beijing)

They were brought to Beijing and their stem cells were mobilized from their bone marrow to the bloodstream (you can read more on mobilization and collection here) and their stem cells collected via apheresis. Their stem cells were subsequently transported to Taiwan for the transplantation.

The second article provides a little more detail on the donors and their perceptions of stem cell harvesting and donation.

Ms. Hang who is a youthful 36 year-old is a registered blood donor who has donated blood several times in her life. Apparently, a marrow bank was established in her home province in 2003 but few people registered as donors. Ms. Hang signed up as a donor in the registry not only because her employer, Amway urged all employees to do so, but also because she saw it as "an opportunity to help others... why not do it?"

Amway's staff registration yielded 1,500 new potential donors and they report that 4 of them have already been called on as donors.

Ms. Hang's father is a doctor and said that the process of mobilizing and collecting stem cells was harmless and supported her decision to donate. The recipient was a 16 year-old girl and I hope that they collected as many stem cells as they could and that the patient has recovered.



*Taiwan has exported stem cells obtained from donor's cord blood, bone marrow and peripheral blood to patients all over the world. Cord blood stem cells obtained from a private company that facilitates the storage facility for databasing and sale, Stemcyte incur a charge of between RM 100,000 to RM 150,000 per unit (they have released in excess of 250 cord blood stem cell units). Some patients have also withdrawn 2 cord blood stem cell units to use in a double transplant when one unit is insufficient.

Malaysian patients have accessed this facility many times and have been able to find successful matches which has allowed life-changing stem cell transplantation to proceed.

Credit also goes to the Tzu Chi Taiwan Marrow Donor Registry, the third largest of its kind in the world, which has made over a hundred matches for mainland patients and patients in South East Asia.

A Lifetime of Ailments and Probable Strokes removed by Stem Cell Transplantation

More often than not, when we think of people who suffer from strokes, older people- someone's uncle, father or grandmother- comes to mind. Did you know that some 2 year-olds have strokes too?

This article reports the work of doctors at a Children's medical center who performed a stem cell transplant in 2005 on 2 year-old Shylynn Turner, whose previous two strokes had already hobbled her right leg and limited the ability of her right hand.


YOUNGER SISTER'S STEM CELLS

Now a bright looking 4 year old (her photo is in the article), Shylynn received her younger sister's stem cells for the treatment of her condition- sickle cell anemia*. Her transplant was performed last year and after clearing the one-year anniversary of her transplant, her pediatric hematologist and oncologist Dr. Mukund Dole pronounced her "cured of her sickle cell disease".

The credit for this work is attributed to the supervising doctor and his transplant team at Dayton Children's hoapital.

"She is cured of her sickle cell disease," said Dr. Mukund Dole, a pediatric hematologist and oncologist at Dayton Children's.


NOT EVERY TRANSPLANT IS A SUCCESS

Shylynn's doctor can say that with confidence now that Shylynn has passed the one-year anniversary of the transplant, Children's first success at the rare, complicated and potentially fatal procedure. A previous attempt at the same hospital for another patient to transplant a patient for the same condition failed.


WHAT IS SICKLE CELL ANEMIA?

Shylynn's doctor defines this condition* as follows:

Sickle cells are abnormally shaped red blood cells that can get stuck in blood vessels and block blood flow, which can cause pain, strokes, organ damage and infections. The only way to rid the body of the cells is through a stem cell transplant.

The idea is that normal blood cells (red cells, white cells and platelets) and immune cells (lymphocytes) will arise from the donated stem cells, which can come from bone marrow, peripheral blood and umbilical cord blood.

But the chance of a donor sibling who is a perfect tissue match is only about 25 percent, Dole said, which is why the procedure is so rare.

It's also risky because the patient first must undergo intensive chemotherapy to wipe out the abnormal blood cells and bone marrow, which devastates the patient's immune system.

Worldwide several hundred patients have undergone the procedure with a success rate of 85 percent.


A NEW LIFE?

"I am happy, I feel very blessed and Shylynn's very happy since they took her off her restrictions," Amber Turner said. "She gets to go out and play with other kids now. She's really been enjoying it."


**Sickle cell anemia is not prevalent in Malaysia but a parallel genetic condition of the blood that is prevalent is Thalassemia major. However, unlike the possible evolutionary advantages that sickled cells confer, I am not sure about Thalassemia. If anyone has any ideas or clues, please feel free to post your comment.

THE SICKLE CELL'S POSSIBLE EVOLUTIONARY ADVANTAGE

In 1949, British geneticist Anthony Allison found that the frequency of sickle cell carriers in tropical Africa was higher in regions where malaria raged all year long. Blood tests from children hospitalized with malaria found that nearly all were homozygous for the wild type of sickle cell allele. The few sickle cell carriers among them had the mildest cases of malaria. Was the presence of malaria somehow selecting for the sickle cell allele by felling people who did not inherit it? The fact that sickle cell disease is far less common in the United States, where malaria is rare, supports the idea that sickle cell heterozygosity provides a protective effect.

Going Deaf? Hello Stem Cells?

"GRANDDAD, DO YOU WANT SOME TEA?"

The reason why I enjoy reading about stem cells is because everytime an article is published on a novel application, I can think of someone who might benefit from it. In this case, its my grandfather who is presently a healthy 96 year-old (or young depending on his mood).

He is still energetic and full of enthusiasm but one of the first senses to deteriorate was his sense of hearing. He started off with just one hearing aid about ten years ago but now has one in each ear. It has become quite difficult to communicate with him now unless you can get his attention visually or by gently nudging him first (and if he turns up his hearing aid, we get the do-doo-do sounds due to the radio requencies when a nearby mobile phone rings).


Hearing Loss

Hearing loss has many causes, including genetics, aging, and infection, and may be complete or partial. Such loss may involve damage to inner ear cells called cochlear fibrocytes, which are fundamental to inner ear function.

Blind as a Bat, Deaf as a ......



Stem Cells Restore Hearing

Anyway, this article tells us of some exciting research published in the American Journal of Pathology (well, exciting to me anyway) conducted in the National Tokyo Medical Center (Japan*) by Dr. Tatsuo Matsunaga. He came up with the idea of finding out if bone marrow derived stem cells could help to restore damaged cochlear fibrocytes and thus speed up the recovery of hearing.

Dr. Matsunaga and team came up with the devastating idea of killing off these cochlear fibrocytes with a drug in mice, thus inducing an acute hearing loss. Partial recovery due to innate stem cells may occur over many weeks but these poor mice almost never regain their high-frequency hearing. Dr. Matsunaga then explored if direct administration of stem cells into the inner ear of these mice might restore the lost cell population and consequently, hearing.

The results were very interesting.

Stem cells injected into the inner ear survived in half of the injured rats, where they migrated away from the site of injection toward the injured region within the inner ear. These stem cells divided in the new environment and expressed several proteins necessary for hearing, suggesting tissue-specific differentiation. Further, transplanted cells that migrated to the damaged area of the inner ear displayed shape similar to that of cochlear fibrocytes.

Importantly, transplanted rats exhibited faster recovery from hearing loss, particularly in the high frequency range, which is difficult to restore by natural regeneration. Stem cell migration into the damaged area of the inner ear improved hearing of high frequency sound (40 kHz) by 23% compared to natural recovery in untreated animals.

So it appears that the stem cells are able to "home in" on damaged areas of the inner ear and initiate regeneration of the lost cells, and that the transplanted cells were able to adapt morphologically and functionally to their new environment.

My questions are how the stem cells are injected** into the inner ear (under X-ray guidance?), how many stem cells we'll need and whether it might work on a 96 year-old. I think this work is very exciting and I'd really like to tell my grandfather about it, but I'll wait to tell him in person, not over the phone :).



*The work was supported by grants, one of which was from the Japan Foundation of Aging and Health. It is interesting to note this as Japan as one of the most serious aging populations in the world today.

**Have a look at this interesting cochlear implant (developed by Seoul National University) which gets inserted all the way into the cochlear and connected to a speech processor. Read this page if you want an idea of how cochlear implants are surgically implanted and its risks.




On another note, I found this very interesting language company in Luxembourg. The emphasis of its founder, Dr. Alfred Tomatis, is that you have to be able to hear the language before you can speak it with the right tones. The teaching method involves the assessment of your auditory abilities before you commence the language course. Notice how English speakers are on the higher frequency whilst other european languages tend toward the lower frequencies.

Bristol Cardiac Team Uses Stem Cells for Heart

Articles from or about Bristol always brings with them a sense of nostalgia for me and its been a while since the last opportunity to visit (StemLife keeps me in Asia, mostly).

Anyway, back to the stem cell news. I was very pleased to see that the Bristol cardiac team based at the Bristol Royal Infirmary and at the University will in August start a stem cell program which involves the injection of autologous (patient's own) bone marrow stem cells into the affected heart during routine coronary bypass surgery. The surgeons, led by Dr. Raimondo Ascione, believe that stem cells can assist in the healing process post surgery, reducing scarring and thereby improving the heart's pumping action. Follow-up time of the patients is stated to be six months, which I think is a perfectly reasonable length of time (based on our experience here).

The work is funded by the British Heart Foundation and amounts to GBP 210,000 (approximately 1,455,070 RM).


The article describes why the surgical team acknowledges the usefulness of stem cells:

In a heart attack, blocked blood vessels starve the heart's muscle of oxygen and cells in that part of the heart die, leaving scarring.

The scarred heart is then less able to pump blood around the body and can lead to heart failure.

While the blood supply to the heart can be improved with coronary bypass surgery or angioplasty (mechanical stretching of the heart blood vessels), these techniques do not restore the viability and function of the area already damaged.

And scarring can cause further complications - a fifth of patients develop a dangerous thinning of the walls of the heart within six months of bypass surgery.

The patients who will be selected are those who suffered a heart attack between 10 days to three months ago, and half of them will receive the stem cells, while the other half will receive a dummy injection.


Are there any ethical issues?

Dr. Ascione says that using the patient's own stem cells will not only avoid the risk of rejection and infection, but also get round any ethical issues sometimes associated with embryonic cells or foetal tissue (which is hotly debated). It was also great that Professor Jeremy Pearson, Associate Medical Director of the British Heart Foundation, is also looking forward to stem cells being used routinely in the repair of damaged hearts.


At StemLife, we also offer adult-derived stem cell therapies for patients with ischemic heart disease. Not all patients are eligible for the program however, so please check with us to see if you're a suitable candidate.

1667: First Human Blood Transfusion

Once in a while, an interesting scientific snippet crosses my path and I'll share it with you to increase the number of somewhat weird facts that you may already know (and maybe use it to impress others!).

Did you know that June 15th 1667 was the first time ever that a blood transfusion was given to a human being? (Medical and scientific knowledge of blood was rather primitive back then, people even thought you could stay alive by drinking the blood of others..)

According to this article, the patient was a 15 year-old boy who had been bled so much by the doctor (probably during a procedure) that he required a blood transfusion. The doctor* used sheep's blood and amazingly, the boy managed to recover. Other patients weren't as successful though and the practice was banned. Doctors had no idea back then that interspecies transfusion isn't tolerated by the immune system and that humans have different and sometimes incompatible blood types (humans have 4 types, you inherit your blood types from your parents).



The major blood type groupings were elucidated in 1907, only when a critical piece of the jigsaw puzzle was identified by Viennese physician Karl Landsteiner discovered the presence of agglutinins and iso-agglutinins in the blood. He went on the win a Nobel Prize for his work.


*It seems that the doctor who performed this daring procedure is disputed as either Jean-Baptiste Denys, personal physician to France's King Louis XIV, or Englishman Sir William Lower. While Jean Baptiste is accredited for the transfusion in humans, Sir William Lower was the first to demonstrate blood transfusion from one dog to another in 1665.

You can read about other amusing ancient stories on blood here.


How does this all relate to stem cells?

Well, not much correlation really, except that when we process cord blood and adult peripheral blood, reducing the number of red blood cells is part of the procedure. This is to ensure a smaller volume for infusion and also that the unit can be safely given to a patient with matching stem cell type but a different blood group from the donor.

Surgeons Using Stem Cells for Bone Fractures

I was intrigued when I saw this article, not so much by the actual announcement of the stem cell work performed, but rather exactly where the location of the hospital was and I was surprised that hospitals outside the major cities of England were also conducting stem cell therapeutic trials.

Oswestry, I found out is a small town in the county of Shropshire, off Shrewsbury on route to the Cambrian mountains near Wales. The Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry does look like an excellent hospital and has a website which is very detailed. It is clear from the description of the hospital's history that pioneering new techniques and investing in research is a priority, so stem cell clinical application is certainly on their checklist.

The consultant surgeons there have been conducting clinical trials using stem cells obtained from patient's own bone marrow (autologous) to heal bone fractures which could not be successfully healed with conventional techniques using metal pins and plates. According to the report, the research trial plans to take in forty patients. Fifteen patients have since undergone the treatment and 8 out of the first 10 patients followed up are successfully healed (able to drive and return to work).

The procedure:
Surgeons harvest the stem cells from the patient's pelvic bone and multiply the stem cells for a period of 3 weeks.

Consultant surgeon Professor James Richardson said: "Things have worked out quite well. A few patients have needed other procedures, refixation for instance, but the important thing is they're healing."
Surgeons collect the stem cells in a sample of bone marrow, usually from the patient's pelvis. They are purified and then multiplied in a sterile laboratory. 3 weeks later, the surgeons have to re-expose the fracture and place the stem cells at the site. After a few months, the bone appears to regain the strength of its original structure. One of the patients, Sarah Humphreys was one of the first patients to be treated with stem cells and is now able to walk unaided.

She said: "I'm absolutely fine, the leg doesn't give me any problems at all apart from a bit of residual pain if I've been for a long walk, or been a bit more active than I would have been, but not to the extremes it was. I'm basically doing everything I was prior to the accident."

The surgeons aim to treat 40 patients in the clinical trial and due to the autologous nature of the cells, there are no chances of rejection. They are unsure as to how the stem cells transplants work (nature does in deed work in mysterious ways) but speculate that the cells may turn into bone and seal the gap, or play a role in the secretion of chemicals that kick-start the healing process.

The article states: These are experimental treatments for now. But surgeons say the results so far are so promising that stem cells are likely to be widely used on the NHS in a matter of years.


Editor's Note:
I am particularly enthused by these results as StemLife has also been obtaining positive results from patients who have had stem cells in combination with their orthopaedic procedure. We have also been working with a niche and focussed orthopaedic hospital- the Kuala Lumpur Sports Medicine Center. If you have a cartilage injury that you'd like to discuss and explore stem cells may help in its healing, please give us a call.

Expert Hematologists Say Stem Cell Harvesting is SAFE

If you've been following this blog for a while, this probably isn't news to you, but I thought that this article only lends further credence to those patients concerned about whether stem cells are safe to collect.

Baby umbilical cord blood stem cells certainly are safe to collect, and very apparently so are adult stem cells. The article is so clear in its message that I thought it would be good to excerpt it here for you to read just in case they take it off line.



Experts At Hematologists' Congress In Vienna Say The Procedure For Donating Stem Cells Is Safe EHA Congress 2007
14 Jun 2007

Donating stem cells is almost free of risk for donors and is often the only chance of survival for many patients with certain severe blood or bone marrow diseases. This was the conclusion arrived at in an observation study conducted by the Medical University of Hanover and just presented at the Congress of the European Hematology Association in Vienna.

Stem cell donors can save lives. The only way to fully cure most types of blood cancer (leukemia) is through the transplantation of what are called hematopoetic stem cells, i.e. by transferring healthy blood-building cells from an appropriate donor. Physicians cannot call on cell donors in good conscience unless this procedure is free of danger. There have been isolated cases of donors reported in the past who themselves came down with leukemia several years after making their life-saving gift. Researchers undertook a number of different studies to determine if there was any connection here.

The Congress of the European Hematology Association (EHA), the leading association of experts on blood and bone-marrow diseases in Europe, is currently being held in Vienna. One of the speakers, Dr. Michael Stadler, senior physician in the Department of Hematology, Hemostaseology and Oncology at the Medical University of Hanover (D), presented the results of a recent study on this subject: "Since March 1994, we have examined nearly 600 donors of bone marrow or peripheral stem cells and determined that the donation of stem cells is a very safe procedure. We have not detected a single case of leukemia to date among our donors and unpleasant side effects occurred for a total of only one percent of these individuals."

The study involved 596 donors aged one to 71 (60% males, 40% females). Both common methods of hematopoetic stem cell transplantation were represented, namely classic bone-marrow transplantation and the modern method of peripheral blood stem cell transplantation.
"Bone marrow can only be extracted under general anesthesia and requires a one to two-day hospital stay," explained Dr. Stadler. "During this procedure, a half to one liter of a mixture of blood and bone marrow is suctioned from around the donor's iliac crest, not from the spinal cord, as is often falsely reported. This mixture is filtered and then transfused into the recipient by way of intravenous infusion. The intervention itself takes about one hour. The bone-marrow cells that are removed are replenished in the donor within about two weeks by subsequent cell growth."

Peripheral blood stem cell transplantation is an even simpler and more comfortable procedure for donors. The reason for the designation is that the stem cells are taken not from bone marrow but from the blood stream at the periphery of the body, e.g. from a vein in the arm. This procedure does require biochemical preparation, however. Dr. Stadler: "For a period of five days beforehand, the donor receives a substance called G-CSF, which stands for Granulocyte-Colony Stimulating Factor. G-CSF is a hormone the body produces itself and is released in the case of inflammations to stimulate the reproduction of white blood corpuscles. If administered as a drug in high doses, it accelerates the overall formation of blood and causes blood stem cells that are not yet fully matured to be detached from their environment in bone marrow, for lack of space you might say. These stem cells make their way to the peripheral blood stream where they can be fished out for the patient using a special separation method called stem cell aphaeresis."

G-CSF stimulation in particular was long suspected of being a possible trigger for leukemia in donors over the long term. In their long-time study, however, Dr. Stadler and his colleagues did not observe a single case of leukemia or a single case of death over a period of more than 12 years.


The risk of anything happening to you in harvesting your own stem cells is really minimal, so please don't be afraid to donate or bank your stem cells for yourself and your family members.

Stem Cell Transplants for Peri-anal Fistulas

I'd like to nominate this article for one of the top ten most interesting stem cell applications to date.


The background

Crohn's disease is an inflammatory bowel disease which can cause swelling anywhere along the digestive tract but mostly affects the small intestine. The most common symptom leading to its diagnosis is diarrhea. The most common complication leading to its diagnosis is the blockage of the intestines. Due to the thickening of the intestinal wall, the passage narrows and may also cause sores or ulcers involving surrounding tissues and organs such as the bladder, vagina, and the anus and rectum.


Anal Fistulas

The anal glands which drain into the anal canal can become blocked and infected, resulting in an abscess formed in an abnormal tunnel called a fistula. The fistula can cross the anal sphincter, and if infected, may present the patient with a painful and problematic condition.

Crohn's disease is typically diagnosed in people (males and females) between the ages of 15-35, but can strike at any point in their life.


Phase II Clinical Trials

The article described a clinical study conducted in Madrid, where patients with Crohn's disease (or a similar glandular condition) and symptomatic anal fistulas were treated with and without stem cells complementing the existing therapeutic strategy.

Previously, patients with perianal fistulas were provided with the option of surgery. However, while this cures the fistula, it leaves behind a scar which can cause incontinence problems. What they were performing in Madrid, were fibrin glue injections which involves the injection of a biodegradable glue into the fistula to close the tunnel and prevent any bacteria from entering to form an abscess. This procedure provides minimal risk of incontinence (no surgery to damage muscle tissue) and also much less stress for the patient.

Disappointingly, fibrin glue treatment only cures 16% of conditions and this prompted the doctors to explore a more definitive method of curing the fistula internally and externally (closing the fistula completely).


Plus Stem Cells

In this phase II clinical trial led by Prof. Damian Garcia-Olmo of La Paz Hospital, patients were treated with fibrin glue and stem cells derived by liposuction from their own fatty tissue. The cells were grown in the lab to an order of 20 million and re-injected into the internal opening of the fistula 3 months later. Control patients only got the fibrin glue.

The patients were monitored for 8 weeks and if the fistula still was not healed, the patients got a second dose of 40 million stem cells + fibrin glue or fibrin glue alone depending on which group they were in (note that the second dose of stem cells was also a double dose).

The stem cell treatment was apparently effective and recorded a significant difference and the patients are now leading a better quality of life with no further fistulas.


I wonder if Prof. Garcia-Olmo will try this procedure with stem cells from other sources which may be able to avoid surgical intervention for extraction of stem cells altogether. I'm not sure what the incidence of Crohn's disease is in Malaysia, but as it seems to be a condition which might be related to urban lifestyle (and possibly poor diet) there might be an undiagnosed population out there who are too embarrassed to seek help unless its very severe. Well, at least now there is way to improve the chances of removing an uncomfortable part of the problem altogether with stem cells.

There is no cure for Crohn's disease at this time and treatment involved medication and/or surgery.

Umbilical Cord Blood Stem Cell Transplant Saves Singapore Baby

It's always nice to have good news, and children who have had successful outcomes with stem cell therapy is always good news to me.

Last night, Singapore's Channel News Asia announced that a 2 year-old baby boy has recovered from a fatal disease (exactly what wasn't named) after fighting against viral and fungal infections, which are often associated with poor immune systems in transplantation.

The transplant was performed by A/Prof. Dr. Tan Ah Moy, head of KK Women's and Children's Paediatric Haematology Unit in May last year.

The little boy's name and nationality has been withheld for now -probably for privacy reasons- but I hope we'll get to hear more about his condition, whether it was genetic or spontaneous and the factors that led to the successful transplant.

We have transplant facilities in Kuala Lumpur at the University Hospital and also at the Kuala Lumpur General Hospital, but I have to admit that Singapore's hospitals do a much better job at marketing themselves online. KK states on its website that the paediatric haematology team has performed 35 transplants to date, and I'm sure that with a fairly homogenous population and the Singapore cord blood bank in its basement, there will be many more babies that can be saved.

If you need a transplantation specialist, here's a short who's who list:

Clin A/Prof Tan Ah Moy
Head & Senior Consultant
Appt. tel: +65 6294 4050

Prof. Chan Lee Lee
Head and Senior Consultant
Appt. tel: +603-79502275

Cord Blood Stem Cells for Broad Range of Medical Conditions

This news is interesting and reveals what cord blood stem cells are being used for on the other side of our planet. Cord Blood Registry (CBR), one of America's top 3 (or perhaps the top) cord blood stem cell storage companies has just announced the release of five units in the first quarter of this year for autologous infusions/ transplantation.


WHAT ARE THE STEM CELLS BEING USED TO TREAT?

3 of the infusions are for autologous use, namely Cerebral Palsy, Type 1 Diabetes, Auto-immune disorder related Autism.

2 of the infusions are for family members to treat Acute Myeloid Leukemia and Diamond Blackfan Anemia.


Statement from CBR's Scientific Director and Transplanter at University of Arizona

"The growing number of requests CBR is receiving for release of samples to the families who stored them is an important indication that the medical community is increasingly using autologous and genetically-related cord blood stem cells to help save lives," said David Harris, Ph.D., CBR scientific director and professor of immunology at the University of Arizona. "It is particularly encouraging to see the benefits of cord blood stem cells extend to patients with diverse unmet medical needs. This includes a number of regenerative medicine therapies which require a patient's own cells."


Interesting? Given the conventional options available, I'm certainly keen on knowing the patient outcomes.

Adult Patient gets Cord Blood Stem Cells for Transplant

I found this video pretty interesting as the interviewee highlights the plight of many patients today who aren't told or advised about the uses of cord blood stem cells. Eric Drew was only told about bone marrow transplantation (but didn't have any full siblings) and wasn't informed of any other options. It was on his own initiative that he found out about cord blood stem cells and followed up with a successful transplant. So, another adult has been successfully cured with cord blood stem cells... don't let anyone tell you that cord blood stem cells aren't useful for adults.

At StemLife, we do advise parents that while their children may not need it within the first few years of their life (touch wood), it is affordable and reasonable to bank the stem cells so that the resource is available for possible later use.

The video is a little bit heavy to download but its worth hearing his optimism and it's good listening to a patient who has been through the procedure.


"Don't take NO for an answer"

Installation of Malaysia's 13th King & Launch of StemLife's New Services

Malaysia's new king from Terengganu, Yang di-Pertuan Agong Tuanku Mizan Zainal Abidin was installed last week on the 26th of April and it was declared a bank holiday. There are beautiful yellow posters all over Kuala Lumpur paying tribute to the new King, with words "Daulat Tuanku", which I think means "Long live the King" in Malay.

The King and the Queen look really resplendent in their royal gold outfits and as my colleagues and I drove by the signs, we were commenting on how complementary they were in terms of their looks and how attractive the Queen is.

A GOOD DAY FOR A LAUNCH

It was also a good day for StemLife as we launched our new services in the presence of our guest of honor -Malaysian jazz singer, mother and StemLife client- Sheila Majid. She rang us to ask about StemLife's newborn umbilical cord blood stem cell banking service for her newest addition to her family and we asked her if she would kindly grace our event as a client and guest-of-honor. She said to us: " I am happy to do it because it's a good thing, doesn't hurt anyone and certainly important that other parents should know about it" (she missed the previous baby's stem cells as she delivered early).

If you're a StemLife client already or a mum-to-be who's considering stem cell banking, I'm really excited to share news on our latest stem cell services with you.


StemGuard

Parent Question: " Can I afford transplantation if it comes to pass?"
StemLife Answer: Yes, you can with StemGuard. A specially designed transplant insurance policy that allows parents to cover the costs of transplantation should it be required in the future. Parents are offered very affordable rates (from 20 cents per day) for transplantation costs in Malaysian hospitals. It covers most major transplantable disorders todate.


StemAssured

Parent Question: " Will my baby's stem cells be alright after years of storage?"
StemLife Answer: "Yes, StemLife is confident that your baby's stem cells are safe with us and we're willing to provide a money back guarantee."


Stem21

Parent Question: "What will happen to my baby's stem cells if we're not around?"
StemLife Answer: "Not to worry, we'll still take care of them for you. Some of StemLife's parents have asked us what will happen to their babies' stem cell unit should they no longer be around and the minor be unable to pay . StemLife takes a compassionate stance and offers to bank the unit at no further costs to the child until they are 21."


The news was reported in several papers, Business Times carried an article, as did the Star newspaper.

If you're already a StemLife Parent, you'll be receiving a mailer pretty soon explaining how the programs work. Please bear with us, but we're working on making our services better.

As for everyone else, look out for StemLife's new service logos and let me know if you think they're nice :).

Type 1 Diabetics benefit from Stem Cell Transplantation

If you or one of your family members has diabetes, I'm pretty sure that the recent news on stem cell transplantation providing a cure for Type 1 Diabetes (Type 1 DM) has you sitting upright and your full attention. I've had a lot of positive feedback on this news which has appeared in our newspapers here, from clients asking if this would be a cure resulting in an insulin independent life.


REASON FOR OPTIMISM

I think that the news is very positive and certainly its a start to demonstrating that it may be possible to modulate diseases originating from a malfunctioned immune system through a patient's autologous (own) stem cell transplant. This concept has been tested before, systemic lupus erythmatoses for example is a case which has resulted in patients remaining SLE free after stem cell transplantation. In the case of Type 1 DM, experimental stem cell transplantation conducted previously on mice yielded results which indicated the prevention of the disease.


STEM CELL TRANSPLANTATION

It was based on these results* that the doctors Julio Voltarelli and colleagues from the Regional Blood Center, at the University of Sao Paulo in Brazil decided to initiate the study on how stem cell transplantation might assist in halting the deterioration of pancreatic beta cell function in newly diagnosed patients (patients who have had the disease for a long time may not have any pancreatic beta cells left as the immune system would have destroyed them all).


SOURCE: PATIENT'S OWN ADULT STEM CELLS

The stem cells were the patient's own stem cells, mobilized from their bone marrow to the blood stream where they were collected. Then, they were prepared for transplantation by suppressing their immune system (a form of chemotherapy) and wiping out their existing circulating immune cells. The stem cells were then administered back into their bloodstream. The patients stayed in isolation for 2 weeks, which is a typical length of time for the immune system to kick start (using stem cells from others would have taken more than 2 months to have the same result, barring no rejection issues).


SELECTION IS KEY

I have to tell you that patient selection is key in every trial, as not any one procedure will benefit everyone. Disease, timing and response varies from patient to patient and the trick is trying to find patients with similar symptoms and baseline measurements, but yet with no other organ complications. 15 patients were selected out of 100 initally screened, and took place over almost 3 years between November 2003 and July 2006, with observation up til February this year at the Bone marrow transplantation unit of the School of Medicine at Ribeirao Preto(otherwise known as Brazil's California... nice!).

The patients were monitored and gradually reduced their need for injectable insulin. The interesting and exciting results were that 14 out of 15 patients were insulin-independent for lengths from 1 to 36 months, where the insulin free period was nearly 19 months.

The doctors are wondering whether the effect was due to a reprieve of the immune system on the pancreas (hence allowing the remaining beta cells to regenerate) or whether it was truly due to the immune system modulation, which allowed the pancreas cells to work, but eventually give up (organ under stress).


WHAT IF YOU HAD TO HAVE INJECTIONS EVERY DAY?

Whilst there have been those who have pointed out the lack of a control group, it is clear that at least for a short while, these type 1 DM patients experienced a time when insulin injections weren't a mealtime affair**.



*"Autologous Nonmyeloablative Hematopoietic Stem Cell Transplantation in Newly Diagnosed Type 1 Diabetes Mellitus."
Júlio C. Voltarelli, Carlos E. B. Couri, Ana B. P. L. Stracieri, Maria C. Oliveira, Daniela A. Moraes, Fabiano Pieroni, Marina Coutinho,Kelen C. R. Malmegrim, Maria C. Foss-Freitas, Belinda P. Simões, Milton C. Foss, Elizabeth Squiers, Richard K. Burt. JAMA. 2007;297:1568-1576. Vol. 297 No. 14, April 11, 2007.

** Quite a lot of us can't bear injections once a year, so compare that to several injections per day. Transplant specialists, get ready for the phonecalls.


ps. I do apologise that I haven't posted for a while... yes it has been really busy here at StemLife (in a good way) :)

StemLife's New Website and Good News For Women who have stored their Stem Cells

First and foremostly, I'd like to share with everyone that StemLife has recently launched a new website. Our web team has opted to refresh and update both pictures and information to enable company news and services to be accessed more easily. I'm sure that they'll be changing the photos and features from time to time, so please share it with all your friends and family.

StemLife- Malaysia's First Stem Cell Bank and Therapeutics Company for Babies and Adults


Access the site at www.StemLife.com




What about the WOMEN and their Stem Cells?

Well, I thought you might be interested in this article that I read in the Herald today. Apparently, scientists from the University of Pittsburgh have been studying the regenerative potential of stem cells obtained from females versus that from males. While they were investigating muscular dystrophy models in mice, the scientists noticed that the implantation of female stem cells led to significantly better recovery in the muscles than the male stem cells.

The scientist who made the finding, Dr. Bridget Deasy, postulates that the difference may be due to the different ways male and female cells respond to oxidative stress during the process of transplantation. Female cells may just survive the process better. This has a particular relevance to Duchenne's Muscular Dystrophy because this genetic condition mainly affects boys and 1 in 3500 are born with the lifelong degenerative disease.

Further, this study might also provide some insights into the differences between men and women with regards to how either sex responds to ageing or disease. If female stem cells are more tolerant in transplant conditions, any stem cell company trying to grow them for mass use had better obtain female donors. And if a patient has a choice to obtain stem cells from a brother or a sister... well, it might be another good reason for Asian families to have girls too. Stronger stem cells :)

I'm wondering if anyone has done a study on all human transplants to date and found any correlation that might corroborate this finding in mice.

Adult Blood Stem Cells for Muscular Dystrophy

I've had some enquiries before about the use of stem cells to help patients with muscular dystrophy, but never as able to tell them very much. Now I've read that italian scientists from the Stem Cell Research Institute in Rome, have taken human adult stem cells from the bloodstream (much like what StemLife does presumably) and injected the stem cells into mice with muscular dystrophy.

What's interesting is that the scientists injected the cells intravenously into the dogs (young golden retreivers) and the cells circulated to regenerate the muscles of these dogs. Even more interesting was that the researchers proceeded further to obtain the blood cells of patients with muscular dystrophy, insert the correct gene (thereby sliencing the defective gene) and injected them into the mice. The result was that the cells made their way to the skeletal muscle and were able to partly regenerate the muscles.

This is really very interesting work and raises a few possibilities in my mind.

a) Can a muscular dystrophy patient use a younger patient's healthy stem cells and inject intravenously for the same effect?
b) How many cells might they need and would they need a really large stem cell dose to exhibit regeneration of the muscles?
c) Do the cells need to be autologous for effectivity in humans?
d) Any supplementary treatment to be administered?

The only way to really know -as in all research- is to give it a go because muscular dystrophy patients (depending on the severity) don't have time to wait.

I watched a movie entitled "Rory O'Shea was here" the other night (on satellite quite late) about two boys -one with cerebral palsy and the other with muscular dystrophy- about how they form a symbiotic relationship and eventually friendship. It was a moving and touching portrayal of people with the condition, their limitations, frustrations and will. I really enjoyed it and thought that it was well worth watching. Get your tissues ready.


If you'd like to know more about muscular dystrophy and how to recognize it, have a look at this site.

Sports and Stem Cells

My cousin and I used to love wakeboarding and we did it every weekend off the coast of Singapore for almost a year when I lived there. The thing about wakeboarding which makes it a real impact sport, is the pull of the speedboat cutting through seawater, sliding out away from the wake at a sharp angle and slicing back in to use the wake as a ramp for a jump.

Depending on how you've positioned yourself before and during the jump, your landing could be very elegant and soft, or very, very hard and bruising. The worst is probably what's called a "face-plant" where you slam face first onto the surface of the water, and you would be lucky if all you got was the wind knocked out of you without too much injury.

Many of the wakeboarders (well, not so many 11 years ago...) used to sport some injury or another, and I recall my boat driver and instructor whose knee injury was so bad that he had to wear a brace permanently and stop wakeboarding, which he loved so much.

If I had his number now, I'd certainly convince him to store his own stem cells to treat his injured knee.

I believe that applications of stem cells in sports injuries will take centerstage in the near future, simply because there isn't that much out there which assures patients that they'll really be able to get back their full range of motion after serious damage. Apart from the excruciating pain and lengthy recovery period (my cousin hurt her knee once on the board and was out of action for months), injuries are often severe enough that full form is never quite regained and the sport loses its lustre.


ENOUGH ABOUT WAKEBOARDING WHAT ABOUT THE STEM CELLS?

I read this interesting article in the International Herald Tribune about how doctors and researchers are now promoting the storage of stem cells from the umbilical cord to use in tendon, ligament, muscle and ligament repair in the few years.

Estimated timeline?

"It's not a pie in the sky notion," said Dr. Scott Rodeo, an orthopedist and research scientist at the Hospital for Special Surgery in Manhattan. "Maybe it's not going to happen next year, but a three-to-five year horizon is not unreasonable."

Dr. Rodeo, who is the doctor for the New York Giants football team and former US Olympic team doctor, has apparently been conducting common injury trials which do not mend easily on rats, reconstructing knees, ligament and shoulder cuffs with stem cells.


Another strong endorsement for stem cell banking:

"If you have a child who has exceptional athletic talent at the age of 5 or 6, you might want to get a muscle or fat biopsy to draw and freeze some young stem cells," said Dr. Johnny Huard, director of the Stem Cell Research Center of the Children's Hospital of Pittsburgh and a leading gene therapy researcher. "To have a pool of stem cells already removed would be enormously valuable. The practical use might be years away, but that's the future of sports medicine."


Of course there are detractors to using stem cells as a treatment option, but frankly, if you've every played futsal or even fallen down the stairs and sprained your ankle in a life-limiting way, to me having an option is better then no option at all.

If you're a weekend athlete with an injury and would like to consider stem cell banking and therapy, please give us a call (603-2163 8800) and we'll be happy to make the arrangements for you*.


*No, you do not have to be pregnant to store your stem cells, StemLife offers Adult Stem Cell Banking for individuals who wish to use their own stem cells for their own treatment.

Stem Cells for John Plummer's Heart

More and more companies are moving into the US stem cell therapeutic arena, this is probably a good indicator that StemLife is moving in the right direction.

Here's an article that makes a few interesting points, with doctors making positive and strong statements that will lead the industry forward. The exciting thing about the stem cell industry is that it crosses the boundaries between healthcare and science and really seems to have convinced many physicians that this is really the way to go. Stem cell medicine makes gene therapy and other more technical innovations seem not only expensive, but very far away from reality and practicality.

Doctors at Vanderbilt University have led the way in the US to be the first few medical centers to perform stem cell therapy for stimulating regeneration of the heart muscle after heart attacks. Funded by a company called Amorcyte, the trial runs on for five years where the patients enrolled will be monitored on a yearly basis.

I thought the following points were worth noting:

a) Both Chief of Cardiovascular Medicine, Dr. Douglas Vaughan and Director of the Cardiac Cath Lab Dr. David Zhao were very positive about stem cell medicine.

Dr. Douglas Vaughan, had very positive comments to make about stem cell therapy saying that it had the potential to "transform the way we treat people with cardiac disease".

Dr. David Zhao was quoted as saying,"If we treat a patient rapidly, some may not have any damage at all, but for those who, despite all efforts, suffer damage to the heart muscle, we are studying the effects of this treatment in repairing the heart muscle."

b) the article notes that most stem cell work has been conducted in Europe and only recently commenced in the US

c) the patient, a 63 yr old Professor, is delightfully enthusiastic that he's undergoing the treatment

d) the stem cells harvested are delivered in exactly the same way as StemLife's current method

e) preliminary results seen within 3-6 months

f) lastly but certainly not leastly, full support and funding from government body NIH.


Quote from the patient:

"There are no guarantees," said Plummer. "It was the prospect of improvement - any improvement - that made it worth it. There are certain risks, but the prospect of the study proving to be valuable to others as well, all of those considerations made it seem like something I ought to do."

"I look at it this way. This is an improvement you would give almost anything to make. There is nothing more important than your general health."