Latest news regarding stem cell treatments and multiple sclerosis; unfortunate ending for a patient.

Today I read this news and it is very much related to my previous post. Again this news highlights the importance of patients doing their homework and talking to the experts and physicians before considering such risky treatments.

Woman dies of a heart attack as a result of stem cell treatment she received in Russia for her multiple sclerosis.

There is a point to ponder though.

How was it revealed that the heart attack was due to the stem cell treatment?

I will let you know as soon as I figure out more details on this story.

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Are stem cells being used as a treatment option for multiple sclerosis (MS)?

Multiple sclerosis (MS) is a disorder in which the immune system of the body starts to attack the central nervous system (CNS). Each neural cell or neuron, has an extension called an “axon” that transports nervous signals along itself and to new nerve cells. Axons are similar to electric wires, and as wires have a plastic cover that protects and insulates them, our axons have myelin sheaths. Myelin is the primary attack site of the immune system during MS and when myelin gets damaged, the nerve signals that travel among neurons in the brain and spinal cord, become distorted and the different symptoms of MS develop.

Two main strategies exist in cellular treatment of MS: 1) remyelination: to use stem cells to repair or form new myelin, and 2) immunemodulation: to prevent further damage by the immune system cells. Another abvious strategy would be to use stem cells to regenerate new neurons and form new axons, however, due to many complications, this strategy is still being studied and much more research is needed to enter it into a clinical trial.

MS has the highest number of registered clinical trials among the disorders of the CNS and many different types of stem cells are being studied to be used for each of the mentioned strategies. The following website lists all the ongoing and completed trials that study application of stem cells in MS.

Clinical Trials Website.

Clinical Trials---MS copy

Out of the listed 31 clinical studies, most of the initial results on safety and feasibility of use of stem cells in immunemodulation treatments are positive. However, further research is needed to prove effectiveness of the cells in treating the disease. If you are an MS patient or know someone who has MS, please remember that while stem cell treatment might have potential to be used in the future, there are no clinically approved treatments available at the moment. There are many “stem cell clinics” that offer treatments suggesting that it would cure MS. However, these should be considered experimental treatments and at the moment there simply are not enough scientific data to back up their claims. Therefore, I would highly suggest that patients be aware of the marketing strategies that such clinics use and do their research before committing to such expensive and potentially unsafe treatments.

Following are links to documents that provide further information in this regard:

Stem cell treatment handbook by MS society of Australia.

Patient handbook by the International Society of Stem Cell Research (ISSCR).

 

Changing the Path

Over the past month, I have been trying to choose and decide among so many different topics related to stem cells to write about. I emailed a list of friends and was curious to see what they thought when they hear the word “Stem Cell”.

Their answers were kind of eye-opening for a stem cell scientist. Not many cared much about knowing what these cells were, but almost everyone was interested in knowing if these cells really have the potential in treatment of disease. Most importantly, whether stem cells are being used “right now” for such a purpose in humans. If not, how far are we in achieving such a thing.

Therefore, in my next posts I will focus on news and artciles related to the clinical use of stem cells. I will try to describe the different types of cells as I go along. Please feel free to comment and ask questions if you had any.

What are the different types of stem cells?

Scientists devide stem cells into three main categories.
1) The embryonic stem cells
2) Non-embryonic stem cells
3) Induced pluripotent stem cells

The Embryonic stem cells have been described in an earlier post. Here, I focus on the other types of stem cells.

The non-embryonic stem cells are called adult stem cells and reside in almost all tissues and organs of the body. They have been found in brain, spinal cord, bone marrow, blood and blood vessels, skin, teeth, heart, gut, ovarian epithelium, and testis. They are the cells that can regenerate themselves and some or many of the other types of cells of the organ or tissue they belong to. (They are mostly multipotential.)

The induced pluripotent stem cells or iPSCs are adult cells that scientists modify through reprogramming of their genes and turn them into cells with similar abilities as embryonic stem cells. The generation of first mouse iPSCs in 2006 and first human iPSCs in 2007 created huge excitement in the field of stem cell science. The lead scientist of these pioneering projects was Shinya Yamanaka who received a Nobel Prize in 2012 along with John Gurdon for the discovery of reprogramming techniques to convert adult cells into pluripotent stem cells. iPSCs hold great potential since they can replace embryonic stem cells thus bypassing the ethical controversy of their use in treatment of disease. Additionally, patient’s own cells can be reprogrammed into iPSCs and make individualized treatment possible; therefore eliminating the risks of immune system rejection when using allogeneic ie another individual’s cells.

However, similar to other advances in the field of stem cells many more investigations are needed which are happening in many different labs at the moment, to prove the use of iPSCs for treatment of disease safe.

The following animation effectivley summarizes the main ideas discussed above;

What are induced pluripotent stem cells? Narrated by Dr. Mick Bhatia from Stem Cell Network on Vimeo.

Additionally the following link discusses the different types of stem cells in more detail.

National Institute of Health website about stem cells.

 

Is it ethical to use embryonic stem cells for research?

In order to grow and culture embryonic stem cells in lab, one needs to isolate them from an early embryo called the blastocyst. The isolation process destroys the rest of the embryo. Thus the main ethical concern here is whether a human life is being destoryed or not.

There are two main views in this regard. Those against embryonic stem cell research argue that even at the early stage of develpment, an embryo should be considered a human “person” and therefore would be entitled to the same human rights to live as a grown human being. As a result, they consider embryonic research against this basic right.

On the other hand, those who support it argue that the embryos that are used in this research field, are the ones that would normally be discarded and they will not count as a person unless they have attached to and are growing inside a uterus. (The embryos used are still in tissue culture plates, and will not survive without being put inside a uterus.) So, if normally these embryos would be discarded, why not use them to find cure for or study the many human diseases in order to alleviate the suffering of patients. These patients already have the status of “person” and decreasing their suffering is a more important ethical task.

There are more details into these arguments and the following links do a great job on exploring the issue.

The ethical dilemma of embryonic stem cell research.

Further reading.

What are Embryonic Stem Cells?

A fertilized egg or zygote divides, goes through embryonic cleavage, and multiplies into a cluster of 2, then 4 and 16 cells. This cluster looks like a small mulberry and is called a Morula. All the cells in a Morula are totipotent.The Morula goes through additional changes and forms a hollow ball of cells known as the blastocyst. The inner cells of a blastocyst are pluripotent stem cells that when isolated and cultured, generate the embryonic stem cells or ESCs.

These cells can generate themselves and in theory all the 220 types of cells that can be found in an adult. However, derivation of all the different types of cells from ESCs has challenges and many research projects are focused on establishing protocols for this purpose.

The following video provides a brief but accurate introduction to these type of cells.

What are embryonic stem cells? Narrated by Dr. Janet Rossant from Stem Cell Network on Vimeo.

I will briefly talk about the controversy surrounding research on embryonic stem cells in the next post.

How Effective is “Cord Blood Banking” for Treatment of Future Disease?

This is a frequent question from expectant parents and those who have already committed to cord blood banking.

Stem cells that are isolated from cord blood are multi potential stem cells and are called hematopoietic stem cells. This means that they can generate different types of blood cells and immune cells of the body.

The main potential of these cells is their ability to be used as treatment sources for blood disorders such as cancer. Since cord blood cells are isolated through a noninvasive procedure, they are far more attractive than the alternative bone marrow cells.

Just recently scientists have started exploring the potential of these cells in treating other types of disease, but this research is at very early stages. Further research is needed to prove the hypothetical potential of these cells for treating other types of disease.

It is important to say that the probability of someone needing to use their own cord blood for disease treatment is really slim. (4 in every 10,000)* Additionally, if the baby develops cancer or a genetic disorder later in life, chances are that the cord blood stem cells already carry that disorder in their genetic makeup. Plus, in many cases more than one cord blood unit needs to be used to provide the required amount of cells.  Thus, while many scientists do not recommend storing cord blood in private cord blood banks,  they do encourage parents to consider donating to public banks.

Public banks hope to gather more diverse set of samples that can be used to match nonnative patients and minorities who usually have a smaller chance of finding a match in the bone marrow banks.

There are some factors for parents to consider before comitting to banking their cord blood which are nicely discussed in the following blog:

ASBM

The American Society for Blood and Marrow Transplant.

KidsHealth

Link from KidsHealth.

To sum up: Cord Blood Banking is promising and stem cells available in cord blood are a better alternative source for cells needed for cellular treatment of genetic disorders and cancer of the blood system, and immune system. However, further research is needed, which is happening now, to explore the potential of these cells in treatment of neurological disease, stroke, etc.

*http://www.asbmt.org/?page=63