NOVEL & NEW: Amusing and Creative Stem Cell Applications

I read with much amusement today, 2 articles -which were on stem cells- but not the stem cells that we usually think about or cover here in this blog. But because of its novelty value I thought I'd dwell on it in this entry.

The first amusing article was about a spa in New York's Upper Manhattan which launched a USD 250 (RM 900) facial treatment named "Frozen in Time" that claimed to use stem cells derived from aborted cow embryos to restore damaged skin.

Note: If you're not a regular spa client, you can get a great regular facial using plant extracts or aromatherapy essences for about USD 50 (RM 130-180) in Kuala Lumpur.

The owner (sounds like an enterprising chinese lady) is capitalizing on the rejuvenating properties of stem cells to attract well-heeled clientele who have tried everything else to, launch her new day spa. A cheeky note in the article said that La Prairie (a Swiss anti-ageing spa) at the Ritz Carlton in New York was not to be outdone and offered caviar facials for USD 270 (also available in KL!).

I've been to La Prairie's spa opening here in KL, the caviar creams come in beautiful bottles were very tempting but the caviar should probably have been eaten for its nutritional value which might have at least had some systemic effect! I'm not sure about what other's think but aborted cow fetuses sounds a little gory to me...

The second article revolves around the launch of a new stem cell bank which explores and pushes the limit of the source of stem cells. A company called BioEden has decided that there is a potential market of parents who wish to bank their children's teeth stem cells. Based on the founding of these stem cells (contribution by his 6 year old daughter) by Dr. Song tao Shi* (who heads the Dental Biology Unit at NIH) in 2003, it appears that they have managed to spin this off as a new business idea.

The cells obtained are purely for autologous use and the company's website indicates that a special kit is required to ensure that the tooth is collected in special solutions (milk based) before it falls out on its own. The bank charges USD 595 per tooth for the initial processing (stem cells are harvested from the tooth pulp and grown to a certain bankable number) and USD 89 for its annual cryogenic fee. The site also reminds you that each child will have 12 teeth... that's 12 chances to bank the stem cells for future use!


IS IT WORTH IT?

Frankly, I think it's a bit of a stretch- parents already feel the pinch parting with cash for baby's cord blood stem cells which is a proven source, so tooth stem cells might be targetting a niche market for now. Until the time that these stem cells can prove that it can grow another set of teeth, there'll be skeptics... and orthodontics!

As for 6 year old teeth, if you decide to do it, at least you can tell your kid that the tooth fairy kept one of them for the same price as a unit of cord blood stem cells in Malaysia.



*Read how tooth stem cells were first found in this article published in the New Scientist in 2003.

Cancer transplants: Bone Marrow and PBSC Q and A's

Bone marrow transplants are often performed for cancer (esp. blood cancers) and usually offered only at major oncology centers. Here in Malaysia, bone marrow transplants are performed for cancer patients and also for other blood disorders like thalassemia major and other severe anemias.

I was reading the National Cancer Institute's website which I thought had a rather informative Q and A section explaining the different types of transplants with stem cells from sources obtained from bone marrow and peripheral blood stem cells (PBSC).

It also mentions donation of cord blood being free of charge, but it does not mention how much it will cost to acquire the stem cells from any of the sources, merely that aspects of it may be covered by insurance.

Do have a read if you'd like to know more about bone marrow transplantation and understand the different types of transplants that a cancer patient may undergo.

Cord Blood Stem cells for Multiple Sclerosis? Another report of successful treatment

I had an enquiry about using cord blood stem cells for multiple sclerosis (MS) this week and it appears that cases of multiple sclerosis in Malaysia are not insignificant in number. I referred the enquirer to my previous 2 blog entries ([1],[2]) for information on who performed the therapy and its reported outcome and whilst browsing found another article which also describes the procedure and its outcome.

My belief is that the clinic which conducted the treatment may be the very same one in Rotterdam mentioned previously and the price for the therapy quoted is largely similar (GBP 13,500). A lady suffering from MS, Julia Sandeman (33 years old) was previously confined to a wheelchair and apparently had no sensation in her limbs. After the stem cell infusion, she was able to balance upright in a pool and regained some sensation in her limbs. The article mentions that before her condition started, she was a dancer and had a daughter 5 years ago. Her hope is that she would be able to walk alongside her daughter on a beach. Her condition deteriorated fairly rapidly and her vision was affected, as was sensation in her limbs.

Apparently, the cord blood stem cells were injected into the acupuncture points in her body in February this year. Her father vouches for her improvement and has observed her move her foot and steadying her hand enough to send a text message. Additionally, her father is willing to liquidate some of his assets in order to fund further treatment for her in the hope that she will improve much more.

I am not sure why stem cells injected specifically into acupuncture points would help to re-myelinate nerve tissue or perhaps play a role in immuno-modulation to stop the immune attack, but these observations are interesting and in science and medicine, many of the body's functions remain nature's secret and have not been able to be explained by current analysis (even acupuncture is not well explained in western medicine despite its clearly effective use for thousands of years!).

Clearly though, its taken 5 months to see this change and it will be interesting to see whether she'll improve after another 5. The Dutch clinic seems to attract quite a number of people in the UK. I'm wondering how many MS patients they have treated already and whether the results are consistent. Given that this area has received a lot of media attention and hailed successes, I'm sure it won't be long before its revealed to us- let's pray that this isn't a fraud and is indeed an experimental therapy worth trying.

First Collective Interview of Adult Stem Cell Patients with Successful Outcomes

I read with great interest an announcement that a few successful adult stem cell therapy patients would be gathering in Washington to share their experiences and show how they have improved.

Many patients are tremendously shy when discussing their condition and I think its marvellous that they are willing to come forward. No doubt there may be a political slant to organizing this event (given that Senator Sam Brownback from Kansas and Dr. David Weldon who is from the House of Representatives will be giving keynote speeches), but if it is to promote awareness and funding for stem cell clinical trials and to further understanding of applications, I'm all for it.

There were 5 featured speakers:

Jacki Rabon- Stem cells used for treatment in her spinal cord (see previous entry)

Cathy Pell- Daughter Abby received cord blood treatment for cerebral palsy and used her own cord blood stem cells

Dr. David Foege- Heart failure patient who underwent Theravitae's stem cell therapy developed by Dr. Amit Patel in Pittsburgh

Mary Schneider- Son Ryan treated with his own cord blood when he was 2 for cerebral palsy at Duke University (same as Abby)

Stephen Sprague- Was diagnosed with CML 10 years ago and used cord blood stem cells for a transplant source and is well today

Apparently they shared phenomenal stories of success in their treatments and encourage more adult stem cell work to be done.

"To date, embryonic stem-cell research has failed to produce one successful treatment," said Paul Chaim Schenck, director of the national pro-life action center. "Conversely, adult and cord-blood stem-cell research has yielded over 65 successful treatments, including curing diabetes in some patients."

Interestingly, the session was organized rather innovatively as a wine-tasting session sponsored by a company called BOGO wines. Its owner, Bill Schneeberger is a Catholic from Ohio who donates $2 (USD) from every bottle sold to adult stem cell research. Check out the follow-up article here, it's got some interesting insights to the event but not much on the patients themselves.

I would have loved to be there to listen and ask them questions. If anyone reading this blog attended the session, I'd really appreciate if you'd share the information with me.

Mobilized Peripheral Stem Cells for Retina Repair?

A welcome announcement from the researchers at University of Florida earlier in the month on the possibility of using patient's own mobilized bone marrow stem cells in peripheral blood to restore lost retinal pigment epithelium (RPE).

RPE is important as it forms the nourishing outer barrier of the retina and supports the cells that receive light for transmission through our optic nerve to our brain. Essentially, damaged RPE results in macular degeneration (important for fine work and reading) which often happens with age.

Interestingly, scientists were able to establish that RPE cells could replenish naturally in animals that received bone marrow cells. What they did was to use bone marrow stem cells from normal male mice and put them into albino females with acute RPE injuries. The scientists were able to track the male pigment producing cells in the female albino recipients, proof that the stem cells were the reason for regenerating the RPEs.

The interesting part is that the stem cells were able to travel to the site of injury from the blood stream and repair the damaged RPEs which were thought incapable of regeneration in adults.

"The dogma has been that we're born with a fixed amount of RPE, but there is growing evidence retinal progenitor cells exist in the adult," said Lawrence Rizzolo, Ph.D., a Yale University associate professor of anatomy and experimental surgery and of ophthalmology and visual science.

"To derive cells of neuronal lineage from cells of bone-marrow lineage is significant, if the finding stands up to the test of time. Compared to RPE transplantation, there are a lot of advantages if someone's own bone marrow could supply the cells, because it's a ready source and the cells would not be rejected by the patient. Further, if bone-marrow progenitors circulating in the blood could be attracted to sites of disease, surgery could be avoided."

Sight is such an important sense, probably more than smell and likely on par with hearing and touch. If a stem cell infusion could restore RPEs and at least help stop the progress of macular degeneration, this would really be a treatment categorized under anti-aging. Apart from mice, I'm wondering when they'll start enrolling humans into the trial.

Cord Blood Banking in the UK: Status and Directions of the RCOG

Its been a hectic week at StemLife and I apologise for not having updated the blog for a while. A few friends and family members kindly updated me with emails about the recent announcement by the Royal College of Obstetricians and Gynaecologists (RCOG) on cord blood banking.

Firstly, I'd like to clarify the role and function of the RCOG. Most relevant is that the RCOG sets the exams that all aspiring gynaecologists have to pass in order to practice. If you check out their website, its tagline is "Setting standards to improve women's health". Clearly, the focus of the College is on women and one of their roles is also to "reduce maternal and neonatal mortality and morbidity", i.e. to assess the risks involved in any gynaecological or obstetric procedures for both the mother and the doctor involved.

It was in this capacity that the College issued a recent statement reflecting the same sentiment that they had back in 2001- that they supported cord blood banking if for altruistic reasons- that is for donation and public use. From the statement made by the head of Department of Women's Health at King's College London and Chair of the RCOG expert group, Professor Peter Braude said that they "had a huge amount of commercial companies offering cord blood storage to parents and medical practitioners wanted guidance on the validity of some of the advertising claims".

I checked out the number of companies offering this service in the UK and found that there are now 7 (acknowledgements to Dr. Frances Verter's wonderful site) which is a significant number for 595,000 or so births per year. I can imagine that the clinics must get very crowded with brochures all claiming to be the better bank. There has also probably been some confusion amongst the doctors, nurses and hospital staff when parents come in requesting a collection from cord blood bank a,b or c.

However, the biggest problem that I forsee is not so much that parents might come in with different kits, but rather for the three following reasons:

1) Most deliveries requesting cord blood are at NHS (government) hospitals where doctors are on rotation duty (leading to point 2)

2) The doctors delivering the babies are not necessarily the same as those seeing the patient in the clinic (which doctor gives consent to collect?)

3) Most doctors are not trained to collect cord blood for this purpose and may not always be successful (whom does the client/patient hold responsible?)

Clearly, these pertinent issues warrant the intervention of the RCOG due to the potential risk taken by the doctor in collecting the cord blood when the doctor may not know what to do and that he/she has to do it. It is the slight confusion that happens which can result in really bad taste for both patient, hospital and doctor. Therefore, to protect the reputation of the doctors and lessen the paper procedures (which are already a big hassle for the hospital staff), the RCOG has taken the stand that cord blood should be donated to the NHS, and that if NHS hospitals choose to permit cord blood collection, they have to draw up their own guidelines on what charges there should be and who bears the liability. I think that a fair payment made to the hospital and doctor for successful procedures would be acceptable to the requesting client (full refund if unsuccessful for the avoidance of doubt on anyone's part).


A MIS-INTERPRETATION

Unlike what has been proclaimed on the headlines of news articles(BBC, Times), the RCOG is not against cord blood banking but rather prefers that in its NHS hospitals, cord blood is donated for the public's immediate use- instead of banking it for a possible future use.

One of the messages that the RCOG then helps to advertise is that the NHS provides banking of donated cord blood at the following hospitals, where staff are available to assist and ensure that its done right.

I found the list of hospitals from this site and here's an extract:

NHS cord blood banks centres currently collecting donor cord bloods in UK

Although antenatal patients may offer to donate for unrelated transplantation, the option of altruistic cord blood banking for the National Blood Service banks is, for logistic reasons, currently undertaken only at the following hospitals: Northwick Park Hospital in Harrow, Barnet General Hospital, The Luton and Dunstable Hospital, and the Mater Infirmorum Hospital in Belfast.


Is collecting cord blood as dangerous as the RCOG articles proclaim?

StemLife Malaysia has already successfully banked more than 6000 units of cord blood with the assistance of doctors and nurses with the mutual understanding that cord blood collection can only take place if it is safe and does not alter the process of birth by the mother nor affect the baby's aftercare. I'm not sure about the UK, but having worked with private hospitals in Malaysia, care of the mother and the baby is always the doctor's first priority. Cord blood is collected in utero to ensure that the blood is collected without clots and only as much as the umbilical cord is able to yield. Furthermore, doctors also respect the patient's wishes and knows that they may play a part in the welfare of the child subsequently in life (StemLife has a story about this, but I'll tell you about it at a later date).

Additionally, I checked out the College of Paediatrics website too to see what the role of its doctors are supposed to play. I found that one of the roles would involve the education of the public about the potential use of cord blood stem cells in the child's life.

Duties of a paediatrician:

Paediatricians, whatever their specialty interest, should understand their particular responsibilities for the holistic and life-long health of children who come under their care: each contact is an opportunity for health promotion and disease prevention.

Paediatricians should be aware of current medical and political affairs affecting the lives and health of children.

We have supportive paediatricians here and I'm delighted to say that they are increasingly aware that stem cells could play a role in helping siblings and the child itself should it take ill with a condition treatable with stem cells.


You can read the actual message from the RCOG here, but bear in mind that it takes into account the fact that the NHS is already an overburdened government healthcare institution. In the appeal for funding for the NHS cord blood bank, if the potential use of cord blood stem cells is as small and insignificant as they say, why bother putting anymore money into something which might never be used?


The NHS has had structural and economic issues* for a while and we should not find it surprising that if you try to overlay a private service (like cord blood banking) on top of a public-funded healthcare system, there will undoubtedly be tensions as to what services are on offer at public hospitals and, at what cost to the system.

*UK Health Secretary Patrcia Hewitt has announced earlier this month that the NHS's overall deficit is GBP 512 million (approx. RM 3.4 billion).

Cavan General Hospital Gives in on Harvest of Cord Blood Stem Cells

Hurray for Catherina MacCauley's newborn baby!

Caven General Hospital which had previously refused its patient's request to collect umbilical cord blood stem cells has given in to media and industry pressure and agreed to permit its own hospital staff to perform the collection procedure after a confidential waiver was signed. The baby has already had its cord blood stem cells collected and banked.

The reason stated for not permitting the procedure in the first place was that hospital management was worried about liability should the procedure fail.

There are 2 salient points which I'd like to highlight here:

1) The converse liability of not permitting a patient a choice to bank- could the mother sue the hospital if her baby was diagnosed subsequently with a condition which its own cord blood stem cells could be used to treat? (..and possibly died as a result of not having the stem cells for therapy?)

2) I'm surprised that the bank Ms. MacCauley chose did not have a waiver already prepared for the doctor and hospital to sign. (StemLife has this in place for all doctors, hospital staff and everyone involved in the collection. Umbilical cord blood is not collected in the event where the safety of mother or baby is compromised)

That lawyers and risk management specialists had to be consulted on something which is pretty routine (cord blood is currently collected for neo-natal testing for G6PD and TSH), which poses no significant harm to mother or child (proven in probably almost a million babies cord blood stem cells collected and banked worldwide over the last 17 years) and with support from their own staff would take so much to achieve.

Having said that though, its always about education and whether this topic touches a personal and compassionate nerve. Many articles cite the minimal chances of use and some doctors cite these articles to their patients. But while a balanced view must be presented to every patient, so should its corresponding opportunity for patients to bank their babies stem cells.

The chances may be slim for cancer (last published estimates several years ago are 1:20,000, but I seem to have many friends whose family members have had cancer so I think this statistic is out of date) but think about the other uses which may come online for the healing and repair of damaged tissue (accidents? sports injuries? infection related injuries?) or for degenerative conditions such as heart, liver, joints or eyes. In these cases, drugs or surgery can help reduce the pain and prolong life, but once the damage is done, most patients are never able to return quite to the lifestyle they had before the onset of the symptoms. It is this return to active life that stem cells aims to achieve in conjunction with current modes of therapy.

Most of us are likely and lucky to be born healthy, but it is down to our own pre-emptive action to stay healthy which is what keeps us productive and alive.

Kuala Lumpur Stem Cell Resource Center for Malaysians and International Patients

StemLife Malaysia held a press conference with Gleneagles Hospital and HSC Medical Center yesterday to announce the launch of a stem cell resource center for members of the public or medical community to be able to obtain information on stem cells, its applications and therapies available in Malaysia. It was an overall well attended event with the film crew from TV3 and editors from The Edge, New Straits Times, Sin Chew Jit Poh and Nanyang Siau Pau. We also had guests from Hong Kong, Mr & Mrs Albert Wong and Dr. Kostas from Thai StemLife and 2 of his colleagues.


For Immediate Release
6 June 2006


MoU SIGNING CEREMONY BETWEEN GLENEAGLES HOSPITAL (KL) SDN. BHD., STEMLIFE BHD. & HSC TELE-MEDIC BHD.-
THE ESTABLISHMENT OF KL STEM CELL RESOURCES & THERAPY CENTRE



Kuala Lumpur, 6 June 2006 - Gleneagles Hospital (KL) Sdn. Bhd., StemLife Bhd. and HSC Tele-Medic Sdn. Bhd. announced the signing of a tri-partite MoU for the exclusive formation of a stem cell therapy and resources centre and stem cell therapeutic treatment centre today (also to be known as KL Stem Cell Resources & Therapy Centre).

The KL Stem Cell Resources & Therapy Centre which will be located in Gleneagles Intan Medical Centre, will allow patients interested in stem cell banking and stem cell therapy to obtain information on stem cell services and treatments available in Gleneagles Intan and HSC Medical Centre. The services offered at Gleneagles and HSC will be provided by medical professionals at the respective medical centers in a collaborative effort with StemLife, Malaysia’s first stem cells bank and regenerative medicine company.

This new facility is the first of its kind in South East Asia. In addition, the respective private medical centers are also the first in Malaysia to provide stem cell therapeutic services for heart and diabetic foot ulcer patients. Furthermore, this facility- the first collaboration in innovative medical treatments involving one of Kuala Lumpur’s leading hospitals and diagnostic centers as well as one of the country’s most reputable stem cell companies- represents a commitment by the partners to invest in the advancement of stem cell therapies and regenerative medicine for the benefit of patients suffering from chronic degenerative diseases.

Commenting on the signing of this momentous MOU, Mr. Stuart J.V. Pack, Chief Executive Officer of Gleneagles Intan Medical Centre said: “This is good news for the healthcare and medical service industry in the country and an excellent step forward for GIMC in our continuous effort to be one of the best health service providers in the region. GIMC is committed in offering innovative therapies and high quality medical services to serve local and international patients. We are proud to be associated with established partners with proven track records and expertise.”

HSC Medical Centre’s Executive Director, Dr. Lim Yin Chow, said: “HSC Medical Centre is an early adopter of stem cell therapy for the treatment of heart diseases. We believe that stem cell innovation is the way of developing future medical therapies. We look forward to the next phase of development in creating public awareness in stem cell research and therapy through this team effort and dedication. Furthermore, we hope that our combined expertise and accumulated knowledge will place us in good stead to treat heart diseases by utilizing stem cell therapy, within the next few years.

Sharon Low, Managing Director of StemLife, said:” I am delighted that Gleneagles Intan and HSC Medical Center have chosen StemLife as their partner in the formation of the first resource and therapy center of its kind in the region. We look forward to working with our medical colleagues and the hospital team in developing this highly stimulating and innovative cutting edge science and its clinical applications. We greatly appreciate the invitation and opportunity to be a part of the KL Stem Cell Resources & Therapy Centre.”



Institutions involved:

Gleneagles Intan Medical Center
HSC Medical Center
StemLife

Pre-clinical Evaluation of Magnetically Enabled Injection Catheter for the Heart

Yesterday, I wrote an entry on stem cells for the heart and lightly touched on the subject of related stem cell delivery equipment. Today, I happened to find a press release from May 17, describing the catheter and how it works. It sounds completely robotic, with the doctor controlling the entire procedure from a control room. Given the high technology that is going into this product, I'm not sure how much they would consider pricing it at and how much the consumables would cost.

A friendly cardiac surgeon who works with robotics told me that each "part" of the robotic machine may cost as much as USD 1,000, each with a shelf-life of 1 operation. As much as I'd like to see it mainstream, it sounds like this might take quite a while to adopt and may remain a training equipment show piece for the time being. But let's not be too pessimistic, this state-of-the art development may have spun off other useful technologies- magnetic catheters may be used for other specific site injections as well...

Heart Surgery with Stem Cells from Patient's Own Thigh Muscles

Its been a busy week for me but a slow week on stem cell news. One piece of news that I thought interesting to mention was about the use of muscle stem cells obtained from a patient's thigh and implanted into his failing heart in the US. A company called Bioheart has been promoting the use of patient's own cultured muscle cells for re-implantation via angioplasty since its inception in 1999. They have been conducting clinical trials for their process- results expected in 2008- and have also developed related instruments for delivery (much like Cordis, which I blogged about in another entry).

The news piece related the story of a patient, Richard Howell, who had heart failure and underwent experimental heart surgery at The Cleveland Clinic (listed as one of Bioheart's clinical trial centers). The treating doctor, Dr. Stephen Ellis did not describe the procedure in any great detail but revealed that the patient received 18 separate injections of a total of 200 million cells. The article mentions a "surgery" that was performed and it is unclear to me as to whether the cells were delivered by angioplasty or by direct cardiac injection.

It does however, say that he underwent the surgery 6 weeks ago and is feeling much better than he has in six years, enough to be out on the beach when he could not leave his living room before.

Previous trials with stem cells obtained from thigh muscles had poor outcomes, enough to stall these trials in a number of countries including Singapore. The stem cells were cultured to form "myoblasts" which are muscle cells and injected into the heart. But little known to the scientists and doctors at the time, although the cells looked genuinely like cardiac muscle cells, they lacked one important and necessary factor- the timing of the heartbeat known as "twitch". Skeletal muscle (normal muscle) fibers exhibit "slow twitch" but cardiac muscle fibers have to have "fast twitch" in order to maintain the contractile action of the heart to pump blood around the body.

There were a few publications that came out strongly against this technique of using cultured thigh muscle cells- although the cells in culture did show the twitch rhythm of the heart- the results upon injection showed that the thigh muscle cells never really engrafted or express cardiac markers, and in fact the cells died after some time. The consequence of this poor clinical outcome was serious enough to warrant patients requiring a pacemaker and to take other measures for their worsening condition.

Ever since those publications in 2002-2003, support for this area of work has waned clinically but I'm sure scientifically, it has spurred the need for greater understanding of the expression markers necessary to show that at the minimum, these cells do no harm to the patient.

As for StemLife's work on the heart, we have taken a more conservative approach of using a mixed population of cells obtained from mobilized peripheral blood. Cell culture is neither cheap nor easy to prove that it works better than a mixed population of cells. For now, we'll be preparing the cells with our own in-house developed protocol, which has helped patients feel better and certainly done them no harm.

If you know anyone with heart failure who would like to seek advice or participate in StemLife's cardiac cell therapy program, feel free to drop by or give us a call.

StemLife Malaysia: +603 2163 8800 (ask for me)
StemLife Thailand: +662 613 1515-8 (ask for Kostas)

We'd be delighted to set up a no obligations appointment for an honest and friendly consultation.