Cautionary Response Issued for Clinical Trials With Embryonic Stem Cells

Three biotech companies are currently preparing for their upcoming clinical trials that will test the therapeutic value of their proprietary embryonic stem cell products. In the midst of such preparation, the U.S. FDA (Food and Drug Administration) convened a panel of experts yesterday to examine the safety concerns associated with such proposed therapies, not the least of which is the risk of cancer.

It is a well-established fact that embryonic stem cells cause the formation of a specific type of cancerous tumor known as a teratoma; indeed, such a feature of embryonic stem cells constitutes their defining trait. An embryonic stem cell is a cell which, by definition, forms a teratoma, and this remains the universal laboratory test by which embryonic stem cells are identified throughout the world. This test is the global scientific standard of measurement: if a cell forms a teratoma, then it is recognized as being an embryonic stem cell; if a cell does not form a teratoma, then it is recognized as being just an ordinary adult stem cell or some other type of cell. Adult stem cells, by stark contrast to embryonic stem cells, carry no such risk for the formation of teratomas. These facts are well known and well understood throughout the scientific community, and always have been, although they are not often reported to the general public by the media.

The three companies under current scrutinization, namely, Geron, Advanced Cell Technology, and Novocell, are in the process of planning their imminent clinical trials to test embryonic stem cells in the treatment of, respectively, acute spinal cord injury, visual impairment, and diabetes. Following the announcement by the FDA, yesterday’s discussion among a panel of experts focused on the many unanswered questions that are associated with the as yet unproven safety and efficacy of embryonic stem cells.

Ever since 1999, when an 18-year-old patient named Jesse Gelsinger died four days after receiving experimental gene therapy in a clinical trial, FDA regulators have been particularly sensitive to potential risks that may be associated with clinical trials, and justifiably so. Any further undesirable medical conditions that may result from clinical trials would not only constitute personal tragedies for the individuals involved, but such consequences would also constitute severe policy setbacks for the entire FDA approval process as a whole. Currently, with human embryonic stem cells, the dangers are already well documented and no successes to date have ever been reported or published. Thus far, human embryonic stem cells have never been used to treat any human disease or injury, precisely because human embryonic stem cells have proven to be so highly problematic in the laboratory. By dramatic contrast, however, adult stem cells are already being used in numerous clinics around the world to treat a wide variety of diseases and injuries, efficaciously and in most cases without any side effects.

According to the authors of this review, “Scientists know that undifferentiated stem cells can form a benign mass known as a teratoma when injected into animals, and they fear that a safety incident in the first round of clinical trials could devastate the already-troubled field. The cell therapies under development use differentiated cells, but the possibility remains that some undifferentiated cells may be left in the mix.” While teratomas are technically classified as “benign”, in the sense that they do not metastasize, they do have a malignant counterpart known as a teratocarcinoma, which may also form from embryonic stem cells. It should also be noted that a person can die from either of these tumorous forms, including the so-called “benign” teratoma.

The committee convened by the FDA plans to release a formal guidance statement, formulated at yesterday’s meeting. Meanwhile, however, the 3 companies under consideration remain undaunted, with Geron in particular insisting that they will proceed with plans for clinical trials with embryonic stem cells that will commence in the summer of this year.

An Adult Stem Cell Bill Advances in the Colorado State Legislature

Currently in the state of Colorado, there are only three hospitals in which the systematic collection of umbilical cord blood is routinely performed after the delivery of babies. In all the rest of the hospitals throughout the state, as in most other states, this precious source of pluripotent stem cells is discarded as waste. Democratic House Representative Dianne Primavera sees this as “an opportunity to turn medical waste into a medical miracle.” Indeed, patients such as Sheila Gannon agree. Diagnosed with advanced leukemia over two years ago, Sheila received an adult stem cell transplant from donated umbilical cord blood. As she stated in her testimony before the State House Health and Human Services Committee, “We are extremely grateful for this technology and for the medical community that administers it. I often think about the moms who graciously donate their umbilical cord blood. There is no doubt that without this I would not be here today.”

Many others enthusiastic advocates joined Representative Primavera and Ms. Gannon in supporting what is known as House Bill 1372, which, if ratified, would create the Adult Stem Cell Cure Fund: a voluntary income tax checkoff that would appear on future state income tax forms, revenue from which would promote the proper collection and storage of umbilical cord blood throughout the state of Colorado.

As Representative Primavera described, she sees an analogy between the umbilical cord as a “lifeline for a baby” and a lifeline for someone with a disease such as cancer or multiple sclerosis. As Sheila Gannon added, “I cannot think of a better way to pay it forward than to give all women the opportunity to donate the baby’s umbilical cord blood.” Doctors testifying before the Committee stated that there are roughly 80,000 births each year in Colorado, less than 1% of which currently result in a cord blood donation. If House Bill 1372 is passed, it is hoped that the money raised by the income tax checkoff could be used both for promoting education on the topic as well as for the actual cryogenic storage of donated cord blood, possibly for as long as 20 years for each donation. According to Dr. Chris Carey, who runs the OB-Gyn department at the Denver Health Medical Center, “It is my belief that this bill offers a tremendous opportunity to improve the health of Coloradans for a relatively small expense.”

Thus far, the new measure has passed the Committee unanimously. Next, it advances to the House Appropriations Committee.

Alzheimer’s Slowed by Stem Cells From Umbilical Cord Blood

More than 5 million people in the U.S. alone are currently afflicted with Alzheimer’s disease, and the global number is increasing dramatically each year. Now, researchers at the University of South Florida, in collaboration with Saneron CCEL Therapeutics, Inc., an affiliate of Cryo-Cell International, have demonstrated the ability of cord blood stem cells to slow the progression of this debilitating disease.

In this study, mice with symptoms mimicking those of Alzheimer’s were treated with a series of infusions containing stem cells derived from umbilical cord blood. The scientists then tested the mice for the two main markers of Alzheimer’s, and found that the myloid-beta proteins had been reduced by 62%, and cerebral amyloid angiopathy had been reduced by 86%. Currently, Alzheimer’s disease is considered to be irreversible since an effective conventional medical therapy does not exist. This study, however, demonstrates that Alzheimer’s disease can in fact be reversed with the potency of certain types of adult stem cells such as those derived from umbilical cord blood.

Although conservative groups often promote the use of adult stem cells over embryonic stem cells for ethical reasons, scientists are increasingly turning to adult stem cells over embryonic stem cells purely for scientific reasons. Increasingly, studies such as this indicate significant success with adult stem cells while embryonic stem cells still remain plagued with numerous unsolved scientific problems. According to Mercedes Walton, Chairman and CEO of Cryo-Cell International, an organization of cord blood banks which funded the study, “The scientific community has only skimmed the surface in uncovering the many potential therapeutic uses for cord blood stem cells, and this new research in Alzheimer’s disease may pave the way for discoveries around the use of these cells for a host of neurodegenerative and other chronic conditions.”

According to Dr. Jennifer Roback Morse, a senior fellow in economics at the Acton Institute for the Study of Religion and Liberty, “The use of umbilical cord blood is more humane than the use of embryos for two reasons. First, no human life has to be destroyed to produce the umbilical cord blood. Second, the use of umbilical cord blood will undoubtedly be less costly than the use of embryonic stem cells. The supply of umbilical cords is pretty much umlimited.”

Ever since 2004 when a South Korean woman who had been paralyzed for 20 years was able to walk again following cord blood stem cell therapy which repaired the damaged tissue in her spine, this particular source of adult stem cells has been a topic of of intense interest by numerous researchers and clinicians around the world. According to Cryo-Cell, cord blood offers one of the most viable sources of stem cells, as cord blood has already been used in over 7,000 transplantations since 1988, and stem cells derived from cord blood have been clinically administered to human patients for the treatment of more than 70 life-threatening illnesses, which include cardiac injury, neurological injury, type I diabetes, type II diabetes, leukemia, multiple sclerosis, and numerous other types of diseases and injuries.

Next, Alzheimer’s disease may also be added to the list.

Multiple Sclerosis Patient Improves With Autologous Adult Stem Cell Transplant

Leah Telder of Surrey, British Columbia, had enjoyed ballet dancing until struck with multiple sclerosis in her teens. The demyelinating, auto-immune disorder eventually robbed her of her vision and confined her to a wheelchair. Now 24 years old, Leah is the youngest of seventeen MS patients who have been treated in Canada with their own (autologous) adult stem cells.

Conducted in October of 2007 in Ottawa, the procedure was led by the neurologist Dr. Mark Freedman and the bone marrow transplant specialist Dr. Harold Atkins. In this procedure, stem cells are harvested from the peripheral blood of each patient and are then expanded in a laboratory and readministered after the patient has received a heavy dose of chemotherapy, which is administered with the specific intent of destroying the immune system. Although 16 of the 17 patients are improving as a result of the stem cells, one patient in the study died as a result of the chemotherapy. In fact, at these high doses, each patient has a 5% (or a one in 20) chance of dying from the chemotherapy. Whether or not the chemotherapy even needs to be administered at all is increasingly a topic of debate, and there is strong scientific evidence to support the claim that chemotherapy is unnecessary in this type of stem cell treatment.

Meanwhile, as a result of being treated with this particular chemotherapy procedure, and as a result of being successfully rescued by her own adult stem cells immediately following the chemotherapy procedure, Leah is once again able to walk by herself, and most of her blurred vision has been restored to normal.

Members of Congress are Briefed on the Successes of Adult Stem Cell Therapy

In a bipartisan briefing in Washington, D.C., members of Congress were updated both on the increasing number of successful cases of adult stem cell therapy, and on the increasing number of failures of embryonic stem cells, which have never advanced beyond the laboratory stage.

House Representatives Randy Forbes, a Republican from Virgina, and Daniel Lipinski, a Democrat from Illinois, co-hosted the event in conjunction with the Family Research Council (FRC). Among the researchers testifying before the Congressmen was Dr. Richard Burt of the Feinberg School of Medicine at Northwestern University, whose publication in the Journal of the American Medical Association in February of 2008 garnered widespread attention for its analysis of hundreds of adult stem cell studies that had been conducted between 1997 and 2007, and from which Dr. Burt gathered together an entire decade’s worth of quantitative proof that adult stem cells derived from blood and bone marrow have already been safely and effectively used to treat a number of cardiac and autoimmune disorders.

Congressmen Forbes and Lipinski are promoting the “Patients First Act”, which would legislate and prioritize the funding of stem cell research by stem cell type. According to a representative of the FRC, “Embryonic stem cells have yet to treat a single human patient and this is unlikely to change in the future. Adult stem cells are already providing therapeutic benefit to human patients for 73 diseases and condition.” Also appearing before the Congressmen were several patients who have been successfully treated with adult stem cell therapy, which included Barry Goudy who had been treated for multiple sclerosis, Amy Daniels who had been treated for systemic sclerosis, and Jill Rosen who had been treated for lupus. Each of these individuals spoke about their personal experiences with adult stem cell therapy.

Stem Cell Therapy Could Eliminate the Need for Surgical Joint Replacement

At the annual meeting of the American Academy of Orthopedic Surgeons held in San Francisco this week, researchers and physicians alike have agreed that regenerative medicine will be their most powerful tool throughout the future. Rather than surgically replacing joints, as has been the standard medical approach in the past, therapies of the future will focus on the use of stem cells and gene therapy in the new scientific field of tissue re-engineering.

Dr. Thomas Einhorn, chairman of the Department of Orthopedic Surgery and professor of orthopedic surgery, biochemistry and biomedical engineering at Boston University, performed his first hip “replacement” last year with a new technique that utilizes the patient’s own stem cells. As he stated, “It’s the future of our specialty.”

A handfull of companies, such as Stryker and Medtronic, already sell bone morphogenic proteins (BMPs) which are comprised of certain cytokines and growth factors that induce the formation of bone and cartilage. According to Dr. Scott Rodeo, who is co-chief of Sports Medicine and Shoulder Service at the Hospital for Special Surgery in New York and an associate team physician for the Super Bowl champion team, the New York Giants, BMPs in combination with stem cells have already been used in the successful repair of torn rotator cuffs in animal models, thereby offering a promising new type of therapy, which does not involve surgery, for one of the most common shoulder injuries to occur in sports and which normally has only been treatable in the past with surgery.

Previously, the tools of an orthopedic surgeon have typically resembled those of a car mechanic. The heavy metal and even the newer synthetic and composite materials from which artificial hip and knee joints are still fashioned may soon be replaced by BMPs in combination with adult stem cells that are easily and safely derivable from such sources as bone marrow, fat, and umbilical cord blood.

Athletes with sports injuries, and non-athletes with more ordinary conditions such as osteoarthritis and other degenerative diseases of the bones and joints, are expected to benefit greatly by these new techniques in which adult stem cell therapy is already making surgical joint replacement obsolete.

Mesenchymal Stem Cells Applied to Wound Healing

Mesenchymal stem cells (MSCs) are of great therapeutic interest because they are already known to be not only regenerative but also immune privileged and immune modulatory, unlike most stem cells. Such characteristics eliminate any need for matching MSCs immunologically to the recipient, and because of these "immune privileged" properties, the biotech company Osiris Therapeutics holds a number of patents on MSCs for a variety of allogeneic uses of MSCs such as the intravenous delivery of these stem cells in the treatment of patients with heart failure. Now the extraordinary properties of MSCs have been applied to yet another medical application, namely, to expediting the process of wound healing.

Dr. Yoshikawa and colleagues at the Nara Medical University in Japan have successfully mimicked an artificial dermis layer by culturing bone marrow-derived MSCs on a collagen sponge from which the layer of dermal cells was then implanted subcutaneously into an immune-compromised mouse and explanted after ten days, at which time histological examination revealed the differentiation of the MSCs into dermal tissue in vivo.

The procedure was then applied to 20 human patients who were suffering from pathological skin conditions that were refractory to conventional medical therapies, and for whom the same type of autologous "grafts" were applied to the wound areas after having been created from each patient’s own bone marrow-derived MSCs and the collagen matrix. From this procedure, 18 of the 20 patients were found to have significantly improved.

The procedure offers a promising new therapy for even some of the most severe types of wounds.

Stem Cells Expedite the Healing of Severe Bone Fractures

A team of scientists at the University of Edinburgh in Scotland have developed a “bioactive scaffolding” comprised of materials designed to interact with adult stem cells in such a way that even the most serious types of skeletal injuries may now be able to heal completely. Some types of injuries to bone and cartilage are too traumatic to heal without medical intervention, although the conventional types of orthopedic surgery have not always been successful in repairing such injuries. Now Dr. Brendon Noble and his colleagues at the MRC (Medical Research Council) Centre for Regenerative Medicine in Edinburgh have developed a composite “scaffold” which consists of a rigid mesh structure that has been impregnated with chemicals that facilitate the natural action of stem cells derived from bone marrow. Such a device would be useful not only for treating people who have suffered acute injury, but also for treating chronic conditions such as osteoarthritis and cancer of the bone. People of all ages who may suffer skeletomuscular trauma, especially the elderly, would benefit greatly from such a therapy.

Dr. Noble and his colleagues are working in collaboration with the Scottish National Blood Transfusion Service in the harvesting and culturing of blood-derived stem cells that are known to differentiate into bone, and which are incorporated into this new therapy.

Multiple Sclerosis Treated With Adult Stem Cells

After being diagnosed with multiple sclerosis in 1995, Barry Goudy experienced the slow deterioration of his central nervous system with symptoms that included failing vision, a loss of muscular control and an absence of sensory perception in his limbs. Then in 2003 he enrolled in a clinical trial in which his own adult stem cells were used to rebuild his immune system. As he now states, “I have no symptoms of MS. I do no treatment for MS, I do no shots.”

Dr. Richard Burt and colleagues at Northwestern University Feinberg School of Medicine conducted the clinical trial on 2,500 patients who underwent the stem cell transplants. The results have indicated not only that many patients with autoimmune diseases are now in remission, but also many patients who had suffered heart attacks were found to have improved significantly after receiving the adult stem cell therapy.

As Dr. Burt says, “It’s a whole new approach to these diseases.” In an interview conducted this year, Mr. Goudy adds, “I’ve had 5 years of a good life. Five years. If I didn’t do the transplant I would probably be in a wheelchair today.” Among other activities, Mr. Goudy’s active lifestyle now includes playing and coaching hockey. Similar clinical trials are currently underway in the U.S. for the use of adult stem cells in the treatment of numerous other diseases which typically have been unresponsive to conventional medical therapies.

Adult Stem Cells Show Positive Results in the Treatment of Autoimmune, Vascular and Cardiac Diseases

Researchers at the Feinberg School of Medicine at Northwestern University in Chicago have conducted a review of the medical literature in which adult stem cells derived from blood and bone marrow were utilized in the treatment of nonmalignant, nonhematologic conditions. In particular, the scientists and doctors reviewed reports that were published between 1997 and 2007 on the use of hematopoietic stem cells (HSCs) in the treatment of autoimmune, cardiac and vascular diseases. From a total of 926 reports, 323 were specifically analyzed for feasibility and toxicity.

The team of researchers, which was led by Dr. Richard Burt, concluded that adult stem cell therapy is effective at treating the diseases and at relieving the symptoms of the diseases, while contraindications and side effects were negligible, at less than 1% in most studies. As the scientists stated in their own words, and as published in their report in JAMA, “Stem cells harvested from blood or marrow, whether administered as purified HSCs or mesenchymal stem cells or as an unmanipulated or unpurified product can, under appropriate conditions in select patients, provide disease-ameliorating effects in some autoimmune diseases and cardiovascular disorders.”

Researchers hope that the conclusions drawn from such a literature review might encourage further progress in the formal recognition by legislators and the medical community of the clinical safety and efficacy of adult stem cells.