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Using the courts to protect patients from unapproved stem cell therapies

Mon, 02/26/2018 - 12:22

A recent article in Nature looked at using lawsuits to help rein in the activities of clinics offering “unapproved” therapies. CIRM’s Geoff Lomax explains.

When public health officials wanted to raise awareness about the dangers of smoking they filed lawsuits against the tobacco companies. They accused Big Tobacco of deceptive marketing and hiding the negative health effects of smoking. Ultimately, they won. Now a new study says a similar tactic could prove effective in combating clinics that offer unproven stem cell therapies.

CIRM works tirelessly to accelerate the delivery of stem cell treatments to patients with unmet medical needs. But, that doesn’t mean we support any treatment that claims to help people. CIRM only partners with projects that have been given the go-ahead by the US Food and Drug Administration (FDA) to be tested in people in a clinical trial.  That’s because FDA approval means the clinical trial will be monitored and evaluated under high scientific and ethical standards.

In contrast, there are numerous examples where “stem-cell treatments” not sanctioned by the FDA are being marketed directly to patients. For years the FDA, CIRM and others have been warning consumers about the risks involved with these untested treatments. For example, just last  November the FDA issued a warning and advice for people considering stem cell treatments.

Legal steps

Last year CIRM also helped author a new California law designed to protect consumers. The law requires health care providers to disclose to patients when using a treatment that is not FDA approved or part of an FDA-sanctioned clinical trial.

At CIRM, we frequently direct patients seeking treatments to our Alpha Stem Cell Clinics Network. The Alpha Clinics only perform clinical trials that have been given the green light by the FDA, and they provide expert consultation and informed consent to patients to help ensure they make the best choice for themselves. Further, the Alpha Clinics follow up with patients after their treatments to evaluate safety and the effectiveness of the treatments.

These are steps that clinics offering unproven and unapproved therapies typically don’t follow. So, the question is how do you let people know about the risks involved in going to one of these clinics and how do you stop clinics offering “therapies” that might endanger the health of patients?

Using the law to hit clinics where it hurts

In a recently published perspective in the journal Nature an international team of policy experts considered whether civil lawsuits may play a role in stemming the tide of unproven treatments. In the article the authors say:

“The threat of financial liability for wrongdoing is the primary means by which civil law governs behavior in the private sector. Despite calls for stepping up enforcement efforts, the US Food and Drug Administration (FDA) is currently restricted in its ability to identify and target clinics operating in apparent violation of regulations. The fear of tort liability {lawsuits} may provide sufficient incentive for compliance and minimize the occurrence of unethical practices.”

The authors identified nine individual and class action lawsuits involving clinics offering what they called “unproven stem cell interventions.” A few of those were dismissed or decided in favor of the clinics, with judges saying the claims lacked merit. Most, however, were settled by the clinics with no ruling on the merits of the issue raised. Even without definitive judgements against the clinics the authors of the article conclude:

“Stem cell lawsuits could intensify publicity and raise awareness of the harms of unproven treatments, set legal precedent, reshape the media narrative from one focused on the right to try or practice to one highlighting the need for adequate safety and efficacy standards, and encourage authorities to turn their attention to policy reform and enforcement.”

The authors suggest the courts may provide a forum where medical experts can inform patients, the legal community and the public about good versus harmful clinical practices. In short, the authors believe the legal process can be an effective forum for to provide education and outreach to those with disease and the public at large.

The better option of course would be for the clinics themselves to reform their practices and engage with the FDA to test their therapies in a clinical trial. Until that happens the courts may offer an alternative approach to curbing the marketing of these unproven and unapproved therapies.

 

 

Stem Cell Roundup: Improving muscle function in muscular dystrophy; Building a better brain; Boosting efficiency in making iPSC’s

Fri, 02/23/2018 - 12:31

Here are the stem cell stories that caught our eye this week.

Photos of the week

TGIF! We’re so excited that the weekend is here that we are sharing not one but TWO amazing stem cell photos of the week.

Image caption: Cells of a human intestinal lining, after being placed in an Intestine-Chip, form intestinal folds as they do in the human body. (Photo credit: Cedars-Sinai Board of Governors Regenerative Medicine Institute)

Photo #1 is borrowed from a blog we wrote earlier this week about a new stem cell-based path to personalized medicine. Scientists at Cedars-Sinai are collaborating with a company called Emulate to create intestines-on-a-chip using human stem cells. Their goal is to create 3D-organoids that represent the human gut, grow them on chips, and use these gut-chips to screen for precision medicines that could help patients with intestinal diseases. You can read more about this gut-tastic research here.

Image caption: UCLA scientists used four different fluorescent-colored proteins to determine the origin of cardiomyocytes in mice. (Image credit: UCLA Broad Stem Cell Research Center/Nature Communications)

Photo #2 is another beautiful fluorescent image, this time of a cross-section of a mouse heart. CIRM-funded scientists from UCLA Broad Stem Cell Research Center are tracking the fate of stem cells in the developing mouse heart in hopes of finding new insights that could lead to stem cell-based therapies for heart attack victims. Their research was published this week in the journal Nature Communications and you can read more about it in a UCLA news release.

Stem cell injection improves muscle function in muscular dystrophy mice

Another study by CIRM-funded Cedars-Sinai scientists came out this week in Stem Cell Reports. They discovered that they could improve muscle function in mice with muscular dystrophy by injecting cardiac progenitor cells into their hearts. The injected cells not only improved heart function in these mice, but also improved muscle function throughout their bodies. The effects were due to the release of microscopic vesicles called exosomes by the injected cells. These cells are currently being used in a CIRM-funded clinical trial by Capricor therapeutics for patients with Duchenne muscular dystrophy.

How to build a better brain (blob)

For years stem cell researchers have been looking for ways to create “mini brains”, to better understand how our own brains work and develop new ways to repair damage. So far, the best they have done is to create blobs, clusters of cells that resemble some parts of the brain. But now researchers at the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research at UCLA have come up with a new method they think can advance the field.

Their approach is explained in a fascinating article in the journal Science News, where lead researcher Bennet Novitch says finding the right method is like being a chef:

“It’s like making a cake: You have many different ways in which you can do it. There are all sorts of little tricks that people have come up with to overcome some of the common challenges.”

Brain cake. Yum.

A more efficient way to make iPS cells

Shinya Yamanaka. (Image source: Ko Sasaki, New York Times)

In 2006 Shinya Yamanaka discovered a way to take ordinary adult cells and reprogram them into embryonic-like stem cells that have the ability to turn into any other cell in the body. He called these cells induced pluripotent stem cells or iPSC’s. Since then researchers have been using these iPSC’s to try and develop new treatments for deadly diseases.

There’s been a big problem, however. Making these cells is really tricky and current methods are really inefficient. Out of a batch of, say, 1,000 cells sometimes only one or two are turned into iPSCs. Obviously, this slows down the pace of research.

Now researchers in Colorado have found a way they say dramatically improves on that. The team says it has to do with controlling the precise levels of reprogramming factors and microRNA and…. Well, you can read how they did it in a news release on Eurekalert.

 

 

 

Stem Cell Agency invests in stem cell therapies targeting sickle cell disease and solid cancers

Thu, 02/22/2018 - 12:45

Today CIRM’s governing Board invested almost $10 million in stem cell research for sickle cell disease and patients with solid cancer tumors.

Clinical trial for sickle cell disease

City of Hope was awarded $5.74 million to launch a Phase 1 clinical trial testing a stem cell-based therapy for adult patients with severe sickle cell disease (SCD). SCD refers to a group of inherited blood disorders that cause red blood cells to take on an abnormal, sickle shape. Sickle cells clog blood vessels and block the normal flow of oxygen-carrying blood to the body’s tissues. Patients with SCD have a reduced life expectancy and experience various complications including anemia, stroke, organ damage, and bouts of excruciating pain.

A mutation in the globlin gene leads to sickled red blood cells that clog up blood vessels

CIRM’s President and CEO, Maria T. Millan, explained in the Agency’s news release:

Maria T. Millan

“The current standard of treatment for SCD is a bone marrow stem cell transplant from a genetically matched donor, usually a close family member. This treatment is typically reserved for children and requires high doses of toxic chemotherapy drugs to remove the patient’s diseased bone marrow. Unfortunately, most patients do not have a genetically matched donor and are unable to benefit from this treatment. The City of Hope trial aims to address this unmet medical need for adults with severe SCD.”

The proposed treatment involves transplanting blood-forming stem cells from a donor into a patient who has received a milder, less toxic chemotherapy treatment that removes some but not all of the patient’s diseased bone marrow stem cells. The donor stem cells are depleted of immune cells called T cells prior to transplantation. This approach allows the donor stem cells to engraft and create a healthy supply of non-diseased blood cells without causing an immune reaction in the patient.

Joseph Rosenthal, the Director of Pediatric Hematology and Oncology at the City of Hope and lead investigator on the trial, mentioned that CIRM funding made it possible for them to test this potential treatment in a clinical trial.

“The City of Hope transplant program in SCD is one of the largest in the nation. CIRM funding will allow us to conduct a Phase 1 trial in six adult patients with severe SCD. We believe this treatment will improve the quality of life of patients while also reducing the risk of graft-versus-host disease and transplant-related complications. Our hope is that this treatment can be eventually offered to SCD patients as a curative therapy.”

This is the second clinical trial for SCD that CIRM has funded – the first being a Phase 1 trial at UCLA treating SCD patients with their own genetically modified blood stem cells. CIRM is also currently funding research at Children’s Hospital of Oakland Research Institute and Stanford University involving the use of CRISPR gene editing technologies to develop novel stem cell therapies for SCD patients.

Advancing a cancer immunotherapy for solid tumors

The CIRM Board also awarded San Diego-based company Fate Therapeutics $4 million to further develop a stem cell-based therapy for patients with advanced solid tumors.

Fate is developing FT516, a Natural Killer (NK) cell cancer immunotherapy derived from an engineered human induced pluripotent stem cell (iPSC) line. NK cells are part of the immune system’s first-line response to infection and diseases like cancer. Fate is engineering human iPSCs to express a novel form of a protein receptor, called CD16, and is using these cells as a renewable source for generating NK cells. The company will use the engineered NK cells in combination with an anti-breast cancer drug called trastuzumab to augment the drug’s ability to kill breast cancer cells.

“CIRM sees the potential in Fate’s unique approach to developing cancer immunotherapies. Different cancers require different approaches that often involve a combination of treatments. Fate’s NK cell product is distinct from the T cell immunotherapies that CIRM also funds and will allow us to broaden the arsenal of immunotherapies for incurable and devastating cancers,” said Maria Millan.

Fate’s NK cell product will be manufactured in large batches made from a master human iPSC line. This strategy will allow them to treat a large patient population with a well characterized, uniform cell product.

The award Fate received is part of CIRM’s late stage preclinical funding program, which aims to fund the final stages of research required to file an Investigational New Drug (IND) application with the US Food and Drug Administration. If the company is granted an IND, it will be able to launch a clinical trial.

Scott Wolchko, President and CEO of Fate Therapeutics, shared his company’s goals for launching a clinical trial next year with the help of CIRM funding:

“Fate has more than a decade of experience in developing human iPSC-derived cell products. CIRM funding will enable us to complete our IND-enabling studies and the manufacturing of our clinical product. Our goal is to launch a clinical trial in 2019 using the City of Hope CIRM Alpha Stem Cell Clinic.”

Stem cell-based gut-on-a-chip: a new path to personalized medicine

Wed, 02/21/2018 - 12:39

“Personalized medicine” is a trendy phrase these days, frequently used in TV ads for hospitals, newspaper articles about medicine’s future and even here in the Stem Cellar. The basic gist is that by analyzing a patient’s unique biology, a physician can use disease treatments that are most likely to work in that individual.

Emulate’s Organ-on-a-Chip device.
Image: Emulate, Inc.

This concept is pretty straight-forward but it’s not always clear to me how it would play out as a routine clinical service for patients. A recent publication in Cellular and Molecular Gastroenterology and Hepatology by scientists at Cedars-Sinai and Emulate, Inc. paints a clearer picture. The report describes a device, Emulate’s Intestine-Chip, that aims to personalize drug treatments for people suffering from gastrointestinal diseases like inflammatory bowel disease and Chrohn’s disease.

Intestine-Chip combines the cutting-edge technologies of induced pluripotent stem cells (iPSCs) and microfluidic engineering. For the iPSC part of the equation, skin or blood samples are collected from a patient and reprogrammed into stem cells that can mature into almost any cell type in the body. Grown under the right conditions in a lab dish, the iPSCs self-organize into 3D intestinal organoids, structures made up of a few thousand cells with many of the hallmarks of a bona fide intestine.

Miniature versions of a human intestinal lining, known as organoids, derived from induced pluripotent stem cells (iPSCs).
Image: Cedars-Sinai Board of Governors Regenerative Medicine Institute

These iPSC-derived organoids have been described in previous studies and represent a breakthrough for studying human intestinal diseases. Yet, they vary a lot in shape and size, making it difficult to capture consistent results. And because the intestinal organoids form into hollow tubes, it’s a challenge to get drugs inside the organoid, a necessary step to systematically test the effects of various drugs on the intestine.

The Intestine-Chip remedies these drawbacks. About the size of a double A battery, the Chip is made up of specialized plastic engineered with tiny tunnels, or micro-channels. The research team placed the iPSC-derived intestinal organoid cells into the micro-channels and showed that passing fluids with a defined set of ingredients through the device can prod the cells to mimic the human intestine.

Cells of a human intestinal lining, after being placed in an Intestine-Chip, form intestinal folds as they do in the human body. Image: Cedars-Sinai Board of Governors Regenerative Medicine Institute

The Intestine-Chip not only looks like a human intestine but acts like one too. A protein known to be at high levels in inflammatory bowel disease was passed through the microchannel and the impact on the intestinal cells matched what is seen in patients. Clive Svendsen, Ph.D., a co-author on the study and director of the Cedars-Sinai Board of Governors Regenerative Medicine Institute, explained the exciting applications that the Intestine-Chip opens up for patients:

Clive Svendsen

“This pairing of biology and engineering allows us to re-create an intestinal lining that matches that of a patient with a specific intestinal disease—without performing invasive surgery to obtain a tissue sample,” he said in a press release. “We can produce an unlimited number of copies of this tissue and use them to evaluate potential therapies. This is an important advance in personalized medicine.”

Emulate’s sights are not just set on the human intestine but for the many other organs affected by disease. And because disease rarely impacts only one organ, a series of Organs-on-Chips for a particular patient could be examined together. Geraldine A. Hamilton, Ph.D., president and chief scientific officer of Emulate, Inc. summed up this point in a companion press release:

Geraldine Hamilton

“By creating a personalized Patient-on-a-Chip, we can really begin to understand how diseases, medicines, chemicals and foods affect an individual’s health.”

 

 

A Noble pursuit; finding the best science to help the most people

Tue, 02/20/2018 - 12:31

Mark Noble: Photo by Todd Dubnicoff

Mark Noble, Ph.D., is a pioneer in stem cell research and the Director of the University of Rochester Stem Cell and Regenerative Medicine Institute in New York. He is also a member of CIRM’s Grants Working Group (GWG), the panel of independent scientific experts we use to review research applications for funding and decide which are the most promising.

Mark has been a part of the GWG since 2011. When asked how he came to join the GWG he joked: “I saw an ad on Craigslist and thought it sounded fun.”  But he is not joking when he says it is a labor of love.

“My view is that CIRM is one of the greatest experiments in how to develop a new branch of science and medicine. If you look at ventures, like the establishment of the National Institutes of Health, what you see is that when there is a concentrated effort to achieve an enormous goal, amazing things can happen. And if your goal is to create a new field of medicine you have to take a truly expansive view.”

Mark has been on many other review panels but says they don’t compare to CIRM’s.

“These are the most exciting review panels in which I take part. I don’t know of any comparable panels that bring together experts working across such a wide range of disciplines and diseases.   It’s particularly interesting to be involved in reviews at this stage because we get to look at the fruits of CIRM’s long investment, and at projects that are now in, or well on the way towards, clinical trials.

It’s a wonderful scientific education because you come to these meetings and someone is submitting an application on diabetes and someone else has submitted an application on repairing the damage to the heart or spinal cord injury or they have a device that will allow you to transplant cells better. There are people in the room that are able to talk knowledgeably about each of these areas and understand how the proposed project might work in terms of actual financial development, and how it might work in the corporate sphere and how it fits in to unmet medical needs.  I don’t know of any comparable review panels like this that have such a broad remit and bring together such a breadth of expertise. Every review panel you come to you are getting a scientific education on all these different areas, which is great.”

Another aspect of CIRM’s work that Mark admires is its ability to look past the financial aspects of research, to focus on the bigger goal:

“I like that CIRM recognizes the larger problem, that a therapy that is curative but costs a million dollars a patient is not going to be implemented worldwide. Well, CIRM is not here to make money. CIRM is here to find cures for unmet medical needs, which means that if someone comes in with a great application on a drug that is going to cure some awful disease and it’s not going to be worth a fortune, that is not the main concern. The main concern is that you might be able to cure this disease and yeah, we’ll put up money to help you so that you might be able to get into clinical trials, to get enough information to find out if it works. And to have the vision to go all the way from, ‘ok, you guys, we want you to enter this field, we want you to be interested in therapeutic development, we are going to help you structure the clinical trials, we are going to provide all the Alpha Stem Cell Clinics that can talk to each other to make the clinical trials happen.

The goal of CIRM is to change medicine and these are the approaches that have worked really well in doing this. The CIRM view clearly is:

‘There are 100 horses in this race and every single one that crosses the finish line is a success story.’ That’s what is necessary, because there are so many diseases and injuries for which new approaches are needed.”

Mark says working with CIRM has helped him spread the word back home in New York state:

“I have been very involved in working with the New York state legislature over the years to promote funding for stem cell biology and spinal cord injury research so having the CIRM experience has really helped me to understand what it is that another place can try and accomplish. A lot of the ideas that have been worked out at CIRM have been extremely helpful for statewide scientific enterprises in New York, where we have had people involved in different areas of the state effort talk to people at CIRM to find out what best practice is.”

Mark says he feels as if he has a front row seat to history.

“Seeing the stem cell field grow to its present stage and enhancing the opportunity to address multiple unmet medical needs, is a thrilling adventure. Working with CIRM to help create a better future is a privilege.”

 

 

 

 

Stem Cell Roundup: Lab-grown meat, stem cell vaccines for cancer and a free kidney atlas for all

Fri, 02/16/2018 - 13:40

Here are the stem cell stories that caught our eye this week.

Cool Stem Cell Photo: Kidneys in the spotlight

At an early stage, a nephron forming in the human kidney generates an S-shaped structure. Green cells will generate the kidneys’ filtering device, and blue and red cells are responsible for distinct nephron activities. (Image/Stacy Moroz and Tracy Tran, Andrew McMahon Lab, USC Stem Cell)

I had to take a second look at this picture when I first saw it. I honestly thought it was someone’s scientific interpretation of Vincent van Gogh’s Starry Night. What this picture actually represents is a nephron. Your kidney has over a million nephrons packed inside it. These tiny structures filter our blood and remove waste products by producing urine.

Scientists at USC Stem Cell are studying kidney development in animals and humans in hopes of gaining new insights that could lead to improved stem cell-based technologies that more accurately model human kidneys (by coincidence, we blogged about another human kidney study on Tuesday). Yesterday, these scientists published a series of articles in the Journal of American Society of Nephrology that outlines a new, open-source kidney atlas they created. The atlas contains a catalog of high resolution images of different structures representing the developing human kidney.

CIRM-funded researcher Andrew McMahon summed it up nicely in a USC news release:

“Our research bridges a critical gap between animal models and human applications. The data we collected and analyzed creates a knowledge-base that will accelerate stem cell-based technologies to produce mini-kidneys that accurately represent human kidneys for biomedical screening and replacement therapies.”

And here’s a cool video of a developing kidney kindly provided by the authors of this study.

Video Caption: Kidney development begins with a population of “progenitor cells” (green), which are similar to stem cells. Some progenitor cells (red) stream out and aggregate into a ball, the renal vesicle (gold). As each renal vesicle grows, it radically morphs into a series of shapes — can you spot the two S-shaped bodies (green-orange-pink structures)? – and finally forms a nephron. Each human kidney contains one million mature nephrons, which form an expansive tubular network (white) that filters the blood, ensuring a constant environment for all of our body’s functions. (Video courtesy of Nils Lindstorm, Andy McMahon, Seth Ruffins and the Microscopy Core Facility at the Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research at the Keck School of Medicine of USC)

Lab-grown hamburgers coming to a McDonald’s near you…

“Lab-grown meat is coming, whether you like it or not” sure makes a splashy headline! This week, Wired magazine featured two Bay Area startup companies, Just For All and Finless Foods, dedicated to making meat-in-a-dish in hopes of one day reducing our dependence on livestock. The methods behind their products aren’t exactly known. Just For All is engineering “clean meat” from cells. On the menu currently are cultured chorizo, nuggets, and foie gras. I bet you already guessed what Finless Foods specialty is. The company is isolating stem-like muscle progenitor cells from fish meat in hopes of identifying a cell that will robustly create the cell types found in fish meat.

Just’s tacos made with lab-grown chorizo. (Wired)

I find the Wired article particularly interesting because of the questions and issues Wired author Matt Simon raises. Are clean meat companies really more environmentally sustainable than raising livestock? Currently, there isn’t enough data to prove this is the case, he argues. And what about the feasibility of convincing populations that depend on raising livestock for a living to go “clean”? And what about flavor and texture? Will people be willing to eat a hamburger that doesn’t taste and ooze in just the right way?

As clean meat technologies continue to advance and become more affordable, I’ll be interested to see what impact they will have on our eating habits in the future.

Induced pluripotent stem cells could be the next cancer vaccine

Our last story is about a new Cell Stem Cell study that suggests induced pluripotent stem cells (iPSCs) could be developed into a vaccine against cancer. CIRM-funded scientist Joseph Wu and his team at Stanford University School of Medicine found that injecting iPSCs into mice that were transplanted with breast cancer cells reduced the formation of tumors.

The team dug deeper and discovered that iPSCs shared similarities with cancer cells with respect to the panel of genes they express and the types of proteins they carry on their cell surface. This wasn’t surprising to them as both cells represent an immature development stage. Because of these similarities, injecting iPSCs primed the mouse’s immune system to recognize and reject similar cells like cancer cells.

The team will next test their approach on human cancer cells in the lab. Joseph Wu commented on the potential future of iPSC-based vaccines for cancer in a Stanford news release:

“Although much research remains to be done, the concept itself is pretty simple. We would take your blood, make iPS cells and then inject the cells to prevent future cancers. I’m very excited about the future possibilities.”

iPSCs (Kathrin Plath, University of California, Los Angeles)

 

Seeing is believing. Proof a CIRM-funded therapy is making a difference

Thu, 02/15/2018 - 11:39

Thelma, participant in the Camellia clinical trial

You have almost certainly never heard of Thelma, or met her, or know anything about her. She’s a lady living in England who, if it wasn’t for a CIRM-funded therapy, might not be living at all. She’s proof that what we do, is helping people.

Thelma is featured in a video about a treatment for acute myeloid leukemia, one of the most severe forms of blood cancer. Thelma took part in a clinical trial, called Camellia, at Oxford Cancer Centre in Oxford, UK. The clinical trial uses a therapy that blocks a protein called CD47 that is found on the surface of cancer cells, including cancer stem cells which can evade traditional therapies. The video was shot to thank the charity Bloodwise for raising the funds to pay for the trial.

Prof. Paresh Vyas of Oxford University, who was part of the clinical trial team that treated Thelma, says patients with this condition face long odds.

“Patients with acute myeloid leukemia have the most aggressive blood cancer. We really haven’t had good treatments for this condition for the last 40 years.”

While this video was shot in England, featuring English nurses and doctors and patients, the therapy itself was developed here in California, first at Stanford University under the guidance of Irv Weissman and, more recently, at Forty Seven Inc. That company is now about to test their approach in a CIRM-funded clinical trial here in the US.

This is an example of how CIRM doesn’t just fund research, we invest in it. We help support it at every stage, from the earliest research through to clinical trials. Without our early support this work may not have made it this far.

The Forty Seven Inc. therapy uses the patient’s own immune system to help fight back against cancer stem cells. It’s looking very promising. But you don’t have to take our word for it. Take Thelma’s.

A Tribute to Stem Cells on Valentine’s Day

Wed, 02/14/2018 - 11:15

In case you forgot, today is Valentine’s Day. Whether you love, hate, or could care less about this day, you do have one thing in common with our other readers – you’re a fan of stem cells. (If you’re not, then why are you reading this blog??)

As a tribute to how awesome and important stem cell research is, I offer you a special Valentine’s Day-themed interview with the authors of the CIRM Stem Cellar blog.

What’s your favorite type of stem cell and why? 

Kevin: Embryonic stem cells. Without that one cell none of this work, none of us when you come to think of it, would be possible. Whenever I give talks to the public one of the first things I talk about when explaining what stem cells are and how they work is the cartoon from Piraro, the one featuring the snowmen who look up at snowflakes and say “oh look, stem cells”. For me that captures the power and beauty of these cells. Without them the snowmen/women would not exist. With them all is possible.

Karen: Neural stem cells (NSCs) for the win! First off, they created my brain, so I am truly in their debt. Second, NSCs and I have an intimate relationship. I spent eight years of my life (PhD and postdoc) researching these stem cells in the lab on an epic quest to understand what causes Alzheimer’s and Huntington’s disease. As you can see from the subject matter of my latest blogs (here, here, here), I am pretty stoked to write about NSCs any chance I get.

Microscopic image of a mini brain organoid, showing layered neural tissue and different groups of neural stem cells (in blue, red and magenta) giving rise to neurons (green). Image: Novitch laboratory/UCLA

Todd: Induced pluripotent stem cells (iPSCs) rule! They’re my favorite because they allow researchers to study poorly understood human diseases in a way that just wasn’t possible before iPSCs came on the scene in the late 2000’s. For instance, it’s neither practical nor ethical to study autism by taking cell samples out of the brains of affected children. But with iPSC technology, you can recover cells from an autistic child’s baby teeth after they fall out and grow them into nerve cells in the lab to more directly study the cellular causes of the disorder. I also like the fact that iPSCs are the ultimate in personalized medicine in that you could make a stem cell-based therapy from a person’s own cells.

What do you love most about your job at CIRM?

Kevin: That’s hard to say, it’s like asking which is your favorite child? I love getting to work with the team here at CIRM. It’s such an incredible group of individuals who are fiercely committed to this work, but who are also ridiculously smart and funny. It makes for a great work place and one I enjoy coming into every day.

I also love working with patient advocates. Their courage, compassion and commitment to the work that we do at CIRM is inspirational. If ever I think I am having a bad day I simply have to think about what these extraordinary people go through every day and it puts my day in perspective. They are the reason we do this work. They are the reason this work has value and purpose.

Karen: You know how some people have a hard time choosing what flavor of ice cream to get? I have the same issue with science. I enjoyed my time doing stem cell experiments in the lab but at the same time, I was frustrated that my research and communications was so narrowly focused. I joined CIRM because I love educating patients and the public about all types of stem cell research. I also am a self-professed multitasker and love that my job is to find new ways to connect with different audiences through social media, blogging, and whatever I can think of!

I guess if I really had to choose a favorite, it would be managing the SPARK high school educational program. Each year, I get to work with 60 high school students who spend their summers doing stem cell research in labs across California. They are extremely motivated and it’s easy to see by watching their journeys on instagram how these students will be the next generation of talented stem cell scientists.

Todd: My interests have always zig-zagged between the worlds of science and art. I love that my job allows me to embrace both equally. I could be writing a blog about stem cell-derived mini-intestines one moment, then in the next moment I’m editing video footage from an interview with a patient.

Speaking of patients, they’re the other reason I love my job. As a graduate student I worked in a fruit fly lab so it probably doesn’t surprise you that I had virtually no interactions with patients. But as a member of the science communications team at CIRM, I’ve been fortunate to hear firsthand from the patients and their caregivers who show so much courage in the face of their disease. It makes the work we do here all the more motivating.

CIRM communications team: Todd Dubnicoff, Kevin McCormack, Maria Bonneville, Karen Ring

Please share a poem inspired by your love for stem cell research

 Kevin: I’m from Ireland so obviously I wrote a limerick.

There was a young scientist at CIRM

Whose research made some people squirm

He took lots of cells

Fed them proteins and gels

Until they were grown to full-term

 Karen: I wrote a haiku because that was the only type of poem I received a good grade for in elementary school.

Pluripotency

One stem cell to rule them all

Many paths to choose

Todd: Limerick-shimerick, Kevin. Only true poets haiku!

Shape-shifting stem cell

Hero for those who suffer

Repairing lost hope

One year ago…

In a stem cell first, functioning human kidney structures grown in living animals

Tue, 02/13/2018 - 12:24

One of the ultimate quests in the stem cell field – growing organs to repair diseased or damaged ones – took a significant step forward this week. In a first, researchers at the University of Manchester, in the U.K., showed that human embryonic stem cell-derived kidney tissue forms into functional kidney structures, capable of filtering blood and producing urine, when implanted under the skin of mice.

Cross-section of human stem cell-derived kidney tissue grown in mouse. When injected in blood, dextran (green) was taken up by the kidney structure, proving it’s functional. (Credit University of Manchester/ Stem Cell Reports)

When a person has end-stage kidney disease, their body can no longer filter out waste products and extra fluid from the blood which leads to serious health complications, even death. Blood filtration therapy, called dialysis, can substitute for a kidney but the average life expectancy is only about 10 years for patients receiving dialysis. Kidney transplants are another answer for treating kidney disease, but organ availability is in limited supply. About 2.2 million people die worldwide from a lack of access to these treatment options. So other therapeutic approaches to help end-stage kidney disease sufferers are sorely needed.

The current study, published in Stem Cell Reports, used human embryonic stem cells to grow kidney tissue in the lab. While the lab-grown tissues showed hallmarks of kidney structures, they were unable to fully develop into mature kidney structures in a culture dish. So the scientists tried implanting the human kidney tissue under the skin of mice and left it there for 12 weeks. The team showed that kidney structures, called glomeruli, which play a key role in filtering the blood, formed over that time and had become vascularized, or connected with the animal’s blood supply. The team further showed those structures were functional by injecting a fluorescently tagged substance called dextran. Tracing the fate of the dextran in the blood showed that it had been filtered and taken up by tubular structures in the kidney tissue which indicates urine production had begun.

Professor Sue Kimber, one of the leaders of the study, summed up the significance and current limitations of these results in a press release:

Sue Kimber

“We have proved beyond any doubt these structures function as kidney cells by filtering blood and producing urine – though we can’t yet say what percentage of function exists. What is particularly exciting is that the structures are made of human cells which developed an excellent capillary blood supply, becoming linked to the vasculature of the mouse.

Though this structure was formed from several hundred glomeruli, and humans have about a million in their kidneys – this is clearly a major advance. It constitutes a proof of principle- but much work is yet to be done.”

To be sure, curing a person suffering from end-stage kidney disease with a stem cell-grown kidney is some ways off. But, on the nearer horizon, this advance will provide a means to study the human kidney in a living animal, a powerful tool for uncovering insights into kidney disease and new therapeutic approaches.

California gets first royalty check from Stem Cell Agency investments

Mon, 02/12/2018 - 14:22

CIRM recently shared in a little piece of history. The first royalty check, based on CIRM’s investment in stem cell research, was sent to the California State Treasurer’s office from City of Hope. It’s the first of what we hope will be many such checks, helping repay, not just the investment the state made in the field, but also the trust the voters of California showed when they created CIRM.

The check, for $190,345.87, was for a grant we gave City of Hope back in 2012 to develop a therapy for glioblastoma, one of the deadliest forms of brain cancer. That has led to two clinical trials and a number of offshoot inventions that were subsequently licensed to a company called Mustang Bio.

Christine Brown, who is now the principal investigator on the project, is quoted in a front page article in the San Francisco Chronicle, on the significance of the check for California:

“This is an initial payment for the recognition of the potential of this therapy. If it’s ultimately approved by the FDA as a commercial product, this could be a continued revenue source.”

In the same article, John Zaia, Director of the City of Hope Alpha Stem Cell Clinic, says this also reflects the unique nature of CIRM:

“I think this illustrates that a state agency can actually fund research in the private community and get a return on its investment. It’s something that’s not done in general by other funding agencies such as the National Institutes of Health, and this is a proof of concept that it can work.”

Maria Millan, CIRM’s President & CEO, says the amount of the payment is not the most significant part of this milestone – after all CIRM has invested more than $2.5 billion in stem cell research since 2004. She says the fact that we are starting to see a return on the investment is important and reflects some of the many benefits CIRM brings to the state.

“It’s a part of the entire picture of the return to California. In terms of what it means to the health of Californians, and access to these transformative treatments, as well as the fact that we are growing an industry.”

 

Stem Cell Roundup: New infertility tools, helping the 3 blind mice hear and cow ESCs

Fri, 02/09/2018 - 13:36

Cool Stem Cell Image of the Week

Human egg grown from immature cells in ovarian tissue. (credit: David Albertini)

This week’s Cool Stem Cell Image of the Week comes to us from the lab of reproductive biologist Evelyn Telfer at the University of Edinburgh. Telfer and her team successfully grew human eggs cells from immature ovarian tissue.

This technology could revolutionize the way doctors approach infertility. For instance, when girls and young women undergo chemotherapy for cancer, their eggs are often damaged. By preserving a small piece of ovarian tissue before the cancer treatments, this method could be used to generate eggs later in life for in vitro fertilization. Much more work is necessary to figure out if these eggs are healthy and safe to use to help infertile women.

The study was recently published in Molecular Human Reproduction and was picked up this Science writer Kelly Servick.

Forget 3 blind mice, iPS cells could help 3 deaf mice hear again (Kevin McCormack)
For years scientists have been trying to use stem cells to restore hearing to people who are deaf or hearing impaired. Now a group of researchers in Japan may have found a way.

The team used human iPS cells to create inner ear cells, the kind damaged in one of the most common forms of hereditary deafness. They then transplanted them into the inner ears of mice developing in the womb that are suffering from a congenital form of hearing loss. The cells appeared to engraft and produce a protein, Connexin 30, known to be critical in hearing development.

The research, published in the journal Scientific Reports, could be an important step towards developing a therapy for congenital hearing loss in people.

UC Davis team isolates cow embryonic stem cells for the first time

An early stage cow embryo. Inner cell mass (red) is source of embryonic stem cells. (Credit: Pablo Ross/UC Davis) 

Although human embryonic stem cells (ESCs) were isolated way back in ’98, researchers haven’t had similar luck with embryonic stem cells from cows. Until this week, that is.  A UC Davis team just published a report in PNAS showing that they not only can isolate cow ESCs but their method works almost 100% of the time.

 

Genetic engineering of these cow stem cells could have huge implications for the cattle industry. Senior author Pablo Ross mentioned in a press release how this breakthrough could help speed up the process of generating superior cows that produce more milk, release less methane and are more resistant to disease:

“In two and a half years, you could have a cow that would have taken you about 25 years to achieve. It will be like the cow of the future. It’s why we’re so excited about this.”

These cow ESCs may also lead to better models of human disease. Because of their small size, rat and mouse models are not always a good representation of how potential therapies or drugs will affect humans. Creating stem cell models from larger animals may provide a better representation.

Stanford Scientist Sergiu Pasca Receives Prestigious Vilcek Prize for Stem Cell Research on Neuropsychiatric Disorders

Thu, 02/08/2018 - 11:38

Sergiu Pasca, Stanford University

Last month, we blogged about Stanford neuroscientist Sergiu Pasca and his interesting research using stem cells to model the human brain in 3D. This month we bring you an exciting update about Dr. Pasca and his work.

On February 1st, Pasca was awarded one of the 2018 Vilcek Prizes for Creative Promise in Biomedical Science. The Vilcek Foundation is a non-profit organization dedicated to raising awareness of the important contributions made by immigrants to American arts and sciences.

Pasca was born in Romania and got his medical degree there before moving to the US to pursue research at Stanford University in 2009. He is now an assistant professor of psychiatry and behavioral sciences at Stanford and has dedicated his lab’s research to understanding human brain development and neuropsychiatric disorders using 3D brain organoid cultures derived from pluripotent stem cells.

The Vilcek Foundation produced a fascinating video (below) featuring Pasca’s life journey and his current CIRM-funded research on Timothy Syndrome – a rare form of autism. In the video, Pasca describes how his lab’s insights into this rare psychiatric disorder will hopefully shed light on other neurological diseases. He shares his hope that his research will yield something that translates to the clinic.

The Vilcek Prize for Creative Promise in Biomedical Science comes with a $50,000 cash award. Pasca along with the other prize winners will be honored at a gala event in New York City in April 2018.

You can read more about Pasca’s prize winning research on the Vilcek website and in past CIRM blogs below.

Related Links:

Novel approach to slowing deadly brain cancer stem cells may lead to new treatments

Wed, 02/07/2018 - 13:32

Glioblastoma, a form of brain cancer, is one of the most dreaded cancer diagnoses. Standard radiation and chemotherapy treatments for glioblastoma almost always prove ineffective because of the cancer’s ability to grow back. With their unlimited potential to self-renew, cancer stem cells within the brain tumor are thought to be responsible for its aggressive reoccurrence. Not surprisingly, researchers looking to develop more effective therapies are focused on trying to better understand the biology of these cancer stem cells in order to exploit their vulnerabilities.

MRI image of high grade glioma brain tumor (white mass on left). Image: Wikipedia

This week, the Dartmouth-Hitchcock Medical Center reports that a research team led by Damian A. Almiron Bonnin has identified a cell signal that the brain cancer stem cells rely on to resist standard treatments and to regrow. They also showed that drugs which interrupt this signal reduced tumor growth in animal studies.

Because if its aggressive growth, the cells within the glioblastoma eventually become starved for oxygen or, in scientific lingo, they become hypoxic. The presence of hypoxia in brain tumors is actually predictive of a poor prognosis in affected patients. A protein called hypoxia-inducible factor (HIF) becomes activated in these low oxygen conditions and helps the cancer stem cells to survive and continue to grow. The research team found that HIF carries out this function by triggering a cascade of cell activity that leads to the secretion of a protein called VEGF out into the microenvironment of the tumor. As secreted VEGF spreads through the tumor, it stimulates new blood vessel growth which is key to the tumor’s survival by nourishing the tumor with oxygen and nutrients.

Adding drugs that block a cell’s ability to release proteins, led to a reduction in glioblastoma tumor growth both in petri dishes and in animal studies. With these results, published in Oncogene, Dr. Almiron Bonnin’s team is performing the necessary preclinical studies that could lead to testing this novel strategy in patients. He summed this effort in a press release:

Damian Almiron Bonnin

“Being able to target the cancer stem cells within these tumors, like we did here, could potentially improve response to current chemotherapies and prevent recurrences, which would translate into an increase in patient survival rates.”

 

Creating a platform to help transplanted stem cells survive after a heart attack

Tue, 02/06/2018 - 14:18

Developing new tools to repair damaged hearts

Repairing, even reversing, the damage caused by a heart attack is the Holy Grail of stem cell researchers. For years the Grail seemed out of reach because the cells that researchers transplanted into heart attack patients didn’t stick around long enough to do much good. Now researchers at Stanford may have found a way around that problem.

In a heart attack, a blockage cuts off the oxygen supply to muscle cells. Like any part of our body starved off oxygen the muscle cells start to die, and as they do the body responds by creating a layer of scars, effectively walling off the dead tissue from the surviving healthy tissue.  But that scar tissue makes it harder for the heart to effectively and efficiently pump blood around the body. That reduced blood flow has a big impact on a person’s ability to return to a normal life.

In the past, efforts to transplant stem cells into the heart had limited success. Researchers tried pairing the cells with factors called peptides to help boost their odds of surviving. That worked a little better but most of the peptides were also short-lived and weren’t able to make a big difference in the ability of transplanted cells to stick around long enough to help the heart heal.

Slow and steady approach

Now, in a CIRM-funded study published in the journal Nature Biomedical Engineering, a team at Stanford – led by Dr. Joseph Wu – believe they have managed to create a new way of delivering these cells, one that combines them with a slow-release delivery mechanism to increase their chances of success.

The team began by working with a subset of bone marrow cells that had been shown in previous studies to have what are called “pro-survival factors.” Then, working in mice, they identified three peptides that lived longer than other peptides. That was step one.

Step two involved creating a matrix, a kind of supporting scaffold, that would enable the researchers to link the three peptides and combine them with a delivery system they hoped would produce a slow release of pro-survival factors.

Step three was seeing if it worked. Using fluorescent markers, they were able to show, in laboratory tests, that unlinked peptides were rapidly released over two or three days. However, the linked peptides had a much slower release, lasting more than 15 days.

Out of the lab and into animals

While these petri dish experiments looked promising the big question was could this approach work in an animal model and, ultimately, in people. So, the team focused on cardiac progenitor cells (CPCs) which have shown potential to help repair damaged hearts, but which also have a low survival rate when transplanted into hearts that have experienced a heart attack.

The team delivered CPCs to the hearts of mice and found the cells without the pro-survival matrix didn’t last long – 80 percent of the cells were gone four days after they were injected, 90 percent were gone by day ten. In contrast the cells on the peptide-infused matrix were found in large numbers up to eight weeks after injection. And the cells didn’t just survive, they also engrafted and activated the heart’s own survival pathways.

Impact on heart

The team then tested to see if the treatment was helping improve heart function. They did echocardiograms and magnetic resonance imaging up to 8 weeks after the transplant surgery and found that the mice treated with the matrix combination had a statistically improved left ventricular function compared to the other mice.

Jayakumar Rajadas, one of the authors on the paper told CIRM that, because the matrix was made out of collagen, a substance the FDA has already approved for use in people, this research is a major step forward:

“This paper is the first comprehensive report to demonstrate an FDA-compliant biomaterial to improve stem cell engraftment in the ischemic heart. Importantly, the biomaterial is collagen-based and can be readily tested in humans once regulatory approval is obtained.”

 

New Insights into Adult Neurogenesis

Mon, 02/05/2018 - 13:22

To be a successful scientist, you have to expect the unexpected. No biological process or disease mechanism is ever that simple when you peel off its outer layers. Overtime, results that prove a long-believed theory can be overturned by new results that suggest an alternate theory.

UCSF scientist Arturo Alvarez-Buylla is well versed with the concept of unexpected results. His lab’s research is focused on understanding adult neurogenesis – the process of creating new nerve cells (called neurons) from neural stem cells (NSCs).

For a long time, the field of adult neurogenesis has settled on the theory that brain stem cells divide asymmetrically to create two different types of cells: neurons and neural stem cells. In this way, brain stem cells populate the brain with new neurons and they also self-renew to maintain a constant stem cell supply throughout the adult animal’s life.

New Insights into Adult Neurogenesis

Last week, Alvarez-Buylla and his colleagues published new insights on adult neurogenesis in mice in the journal Cell Stem Cell. The study overturns the original theory of asymmetrical neural stem cell division and suggests that neural stem cells divide in a symmetrical fashion that could eventually deplete their stem cell population over the lifetime of the animal.

Arturo Alvarez-Buylla explained the study’s findings in an email interview with the Stem Cellar:

Arturo Alvarez-Bulla

“Our results are not what we expected. Our work shows that postnatal NSCs are not being constantly renewed by splitting them asymmetrically, with one cell remaining as a stem cell and the other as a differentiated cell. Instead, self-renewal and differentiation are decoupled and achieved by symmetric divisions.”

In brief, the study found that neural stem cells (called B1 cells) divide symmetrically in an area of the adult mouse brain called the ventricular-subventricular zone (V-SVZ). Between 70%-80% of those symmetric divisions produced neurons while only 20%-30% created new B1 stem cells. Alvarez-Buylla said that this process would result in the gradual depletion of B1 stem cells over time and seems to be carefully choreographed for the length of the lifespan of a mouse.

What does this mean?

I asked Alvarez-Buylla how his findings in mice will impact the field and whether he expects human adult neurogenesis to follow a similar process. He explained,

“The implications are quite wide, as it changes the way we think about neural stem cell retention and aging. The cells do not seem open ended with unlimited potential to be renewed, which results in a progressive decrease in NSC number and neurogenesis with time.  Understanding the mechanisms regulating proliferation of NSCs and their self-renewal also provides new insights into how the whole process of neurogenesis is choreographed over long periods by suggesting that differentiation (generation of neurons) is regulated separately from renewal.”

He further explained that mice generate new neurons in the V-SVZ brain region throughout their lifetime while humans only appear to generate new neurons during infancy in the equivalent region of the human brain called the SVZ. In humans, he said, it remains unclear where and how many neural stem cells are retained after birth.

I also asked him how these findings will impact the development of neural stem cell-based therapies for neurological or neurodegenerative diseases. Alvarez-Buylla shared interesting insights:

“Our data also indicate that upon a self-renewing division, sibling NSCs may not be equal to each other. While one NSC might stay quiescent [non-dividing] for an extended period of time, its sister cell might become activated earlier on and either undergo another round of self-renewal or differentiate. Thus, for cell-replacement therapies it will be important to understand which kind of neuron the NSC of interest can produce, and when. The use of NSCs for brain repair requires a detailed understanding of which NSC subset will be utilized for treatment and how to induce them to produce progeny. The study also suggests that factors that control NSC renewal may be separate from those that control generation of neurons.”

Scientists developing adult NSC-based therapies will definitely need to take note of Alvarez-Buylla’s findings as some NSC populations might be more successful therapeutically than others.

Neural Stem Cells in the Wild

I’ll conclude with a beautiful image that the study’s first author, Kirsten Obernier, shared with me. It’s shows the V-SVZ of the mouse brain and a neural stem cell in red making contact with a blood vessel in green and neurons in blue.

Image of the mouse brain with a neural stem cell in red. (Credit: Kirsten Obernier, UCSF)

Kirsten described the complex morphology of B1 NSCs in the mouse brain and their dynamic behavior, which Kirsten observed by taking a time lapsed video of NSCs dividing in the mouse V-SVZ. Obernier and Alvarez-Buylla hypothesize that these NSCs could be receiving signals from their surrounding environment that tell them whether to make neurons or to self-renew.

Clearly, further research is necessary to peel back the complex layers of adult neurogenesis. If NSC differentiation is regulated separately from self-renewal, their insights could shed new light on how conditions of unregulated self-renewal like brain tumors develop.

Stem Cell Roundup: New understanding of Huntington’s; how stem cells can double your DNA; and using “the Gary Oldman of cell types” to reverse aging

Fri, 02/02/2018 - 13:07

This week’s roundup highlights how we are constantly finding out new and exciting ways that stem cells could help change the way we treat disease.

Our Cool Stem Cell Image of the Week comes from our first story, about unlocking some of the secrets of Huntington’s disease. It comes from the Laboratory of Stem Cell Biology and Molecular Embryology at The Rockefeller University

A new approach to studying and developing therapies for Huntington’s disease

Researchers at Rockefeller University report new findings that may upend the way scientists study and ultimately develop therapies for Huntington’s disease, a devastating, inherited neurodegenerative disorder that has no cure. Though mouse models of the disease are well-established, the team wanted to focus on human biology since our brains are more complex than those of mice. So, they used CRISPR gene editing technology in human embryonic stem cells to introduce the genetic mutations that cause HD.

Though symptoms typically do not appear until adulthood, the researchers were surprised to find that in their human cell-based model of HD, abnormalities in nerve cells occur at the earliest steps in brain development. These results suggest that HD therapies should focus on treatments much earlier in life.

The researchers observed another unexpected twist: cells that lack Huntingtin, the gene responsible for HD, are very similar to cells found in HD. This suggests that too little Huntingtin may be causing the disease. Up until now, the prevailing idea has been that Huntington’s symptoms are caused by the toxicity of too much mutant Huntingtin activity.

We’ll certainly be keeping an eye on how further studies using this new model affect our understanding of and therapy development for HD.

This study was published in Development and was picked by Science Daily.

How you can double your DNA

As you can imagine we get lots of questions about stem cell research here at CIRM. Last week we got an email asking if a stem cell transplant could alter your DNA? The answer is, under certain circumstances, yes it could.

A fascinating article in the Herald Review explains how this can happen. In a bone marrow transplant bad blood stem cells are killed and replaced with healthy ones from a donor. As those cells multiply, creating a new blood supply, they also carry the DNA for the donor.

But that’s not the only way that people may end up with dual DNA. And the really fascinating part of the article is how this can cause all sorts of legal and criminal problems.

One researcher’s efforts to reverse aging

Gary Oldman: Photo courtesy Variety

“Stem cells are the Gary Oldman of cell types.” As a fan of Gary Oldman (terrific as Winston Churchill in the movie “Darkest Hour”) that one line made me want to read on in a profile of Stanford University researcher Vittorio Sebastiano.

Sebastiano’s goal is, to say the least, rather ambitious. He wants to reverse aging in people. He believes that if you can induce a person’s stem cells to revert to a younger state, without changing their function, you can effectively turn back the clock.

Sebastiano says if you want to achieve big things you have to think big:

“Yes, the ambition is huge, the potential applications could be dramatic, but that doesn’t mean that we are going to become immortal in some problematic way. After all, one way or the other, we have to die. We will just understand aging in a better way, and develop better drugs, and keep people happier and healthier for a few more years.”

The profile is in the journal Nautilus.

 

 

 

 

 

Just a Mom: The Journey of a Sickle Cell Disease Patient Advocate [video]

Thu, 02/01/2018 - 12:11

Adrienne Shapiro will tell you that she’s just a mom.

And it’s true. She is just a mom. Just a mom who is the fourth generation of mothers in her family to have children born with sickle cell disease. Just a mom who was an early advocate of innovative stem cell and gene therapy research by UCLA scientist Dr. Don Kohn which has led to an on-going, CIRM-funded clinical trial for sickle cell disease. Just a mom who is the patient advocate representative on a Clinical Advisory Panel (CAP) that CIRM is creating to help guide this clinical trial.

She’s just a mom who has become a vocal stem cell activist, speaking to various groups about the importance of CIRM’s investments in both early stage research and clinical trials. She’s just a mom who was awarded a Stem Cell and Regenerative Medicine Action Award at last month’s World Stem Cell Summit. She’s just a mom who, in her own words, “sees a new world not just for her children but for so many other children”, through the promise of stem cell therapies.

Yep, she’s just a mom. And it’s the tireless advocacy of moms like Adrienne that will play a critical role in accelerating stem cell therapies to patients with unmet medical needs. We can use all the moms we can get.

Adrienne Shapiro speaks to the CIRM governing Board about her journey as a patient advocate

Listen up! Stem cell scientists craft new ears using children’s own cells

Wed, 01/31/2018 - 12:15

Imagine growing up without an ear, or with one that was stunted and deformed. It would likely have an impact on almost every part of your life, not just your hearing. But now scientists in China say they have found a way to help give children born with this condition a new ear, one that is grown using their own cells.

Microtia is a rare condition where children are born with a deformed or underdeveloped outer ear. This is what it can look like.

In an interview in New Scientist, Dr. Tessa Hadlock, at Massachusetts Eye and Ear Infirmary in Boston, said:

“Children with the condition often feel self-conscious and are picked on, and are unable to wear glasses.”

In the past repairing it required several cosmetic surgeries that had to be repeated as the child grew. But now Chinese scientists say they have helped five children born with microtia grown their own ears.

In the study, published in the journal EBioMedicine, the researchers explained how they used a CT scan of the child’s normal ear to create a 3D mold, using biodegradable material. They took cartilage cells from the child’s ear, grew them in the lab, and then used them to fill in tiny holes in the ear mold. Over the course of 12 weeks the cells continued to multiply and grow and slowly replaced the biodegradable material in the mold.

While the new “ear” was being prepared in the lab, the scientists used a mechanical device to slowly expand the skin on the child’s affected ear. After 12 weeks there was enough expanded skin for the scientists to take the engineered ear, surgically implant it on the child’s head, and cover it with skin.

Over the course of the next two and a half years the engineered ear took on a more and more “natural” appearance. The children did undergo minor surgeries, to remove scar tissue, but other than that the engineered ear shows no signs of complications or of being rejected.

Here is a photo montage showing the pre and post-surgical pictures of a six-year old girl, the first person treated in the study.

Other scientists, in the US and UK, are already working on using stem cells taken from the patient’s fat tissue, that are then re-engineered to become ear cells.

Surgeons, like Dr. Hadlock, say this study proves the concept is sound and can make a dramatic difference in the lives of children.

“It’s a very exciting approach. They’ve shown that it is possible to get close to restoring the ear structure.”

 

 

 

The Journey of a Homegrown Stem Cell Research All-Star

Tue, 01/30/2018 - 12:53

Nothing makes a professional sports team prouder than its homegrown talent. Training and mentoring a promising, hard-working athlete who eventually helps carry the team to a championship can lift the spirits of an entire city.

Brian Fury

Here at CIRM, we hold a similar sense of pride in Brian Fury, one of our own homegrown all-stars. Nearly a decade ago, Brian was accepted into the inaugural class of CIRM’s Bridges program which provides paid stem cell research internships to students at California universities and colleges that don’t have major stem cell research programs. The aim of the program, which has trained over 1200 students to date, is to build the stem cell work force here in California to accelerate stem cell treatments to patients with unmet medical needs.

A CIRM full circle
Today, Brian is doing just that as manager of manufacturing at the UC Davis Institute for Regenerative Cures (IRC) where he leads the preparation of stem cell therapy products for clinical trials in patients. It was at UC Davis that he did his CIRM Bridges internship as a Sacramento State masters student back in 2009. So, he’s really come full circle, especially considering he currently works in a CIRM-funded facility and manufactures stem cell therapy products for CIRM-funded clinical trials.

Gerhard Bauer

“Many of the technicians we have in the [cell manufacturing] facility are actually from the Bridges program CIRM has funded, and were educated by us,” Gerhard Bauer, Brian’s boss and director of the facility, explained to me. “Brian, in particular, has made me incredibly proud. To witness that the skills and knowledge I imparted onto my student would make him such an integral part of our program and would lead to so many novel products to be administered to people, helping with so many devastating diseases is a very special experience. I treasure it every day.”

“It sustains me”
Brian’s career path wasn’t always headed toward stem cell science. In a previous life, he was an undergrad in computer management information systems. It was a required biology class at the time that first sparked his interest in the subject. He was fascinated by the course and was inspired by his professor, Cathy Bradshaw. He still recalls a conversation he had with her to better understand her enthusiasm for biology:

“I asked her, ‘what is it about biology that really made you decide this is what you wanted to do?’ And she just said, ‘It sustains me. It is air in my lungs.’ It was what she lived and breathed. That really stuck with me early on.“

Still, Brian went on to earn his computer degree and worked as a computer professional for several years after college. But when the dot com boom went bust in the early 2000’s, Brian saw it as a sign to re-invent himself. Remembering that course with Professor Bradshaw, he went back to school to pursue a biology degree at Sacramento State University.

On a path before there was a path
Not content with just his textbooks and lectures at Sac State, Brian offered to volunteer in any lab he could find, looking for opportunities to get hands-on experience:

Brian at work during his Sacramento State days.

“I was really hungry to get involved and I really wanted to not just be in class and learning about all these amazing things in biology but I also wanted to start putting them to work. And so, I looked for any opportunity that I could to become actively involved in actually seeing how biology really works and not just the theory.”

This drive to learn led to several volunteer stints in labs on campus as well as a lab manager job. But it was an opportunity he pursued as he was finishing up his degree that really set in motion his current career path. Gerhard Bauer happened to be giving a guest lecture at Sac State about UC Davis’ efforts to develop a stem cell-based treatment for HIV. Hearing that talk was an epiphany for Brian. “That’s really what hooked me in and helped determine that this is definitely the field that I want to enter into. It was my stepping off point.”

Brian Fury (center) flanked by mentors Gerhard Bauer (left) and Jan Nolta (right)

Inspired, Brian secured a volunteering gig on that project at UC Davis – along with all his other commitments at Sac State – working under Bauer and Dr. Jan Nolta, the director of the UC Davis Stem Cell Program.

That was 2008 and this little path Brian was creating by himself was just about to get some serious pavement. The next year, Sacramento State was one of sixteen California schools that was awarded the CIRM Bridges to Stem Cell Research grant. Their five-year, $3 million award (the total CIRM investment for all the schools was over $55 million) helped support a full-blown, stem cell research-focused master’s program which included 12-month, CIRM-funded internships. One of the host researchers for the internships was, you guessed it, Jan Nolta at UC Davis.

Good Manufacturing Practice (GMP) was a good move
Applying to this new program was a no brainer for Brian and, sure enough, he was one of ten students selected for the first-year class. His volunteer HIV project in the Nolta lab seamlessly dovetailed into his Bridges internship project. He was placed under the mentorship of Dr. Joseph Anderson, a researcher in the Nolta lab at the time, and gained many important skills in stem cell research. Brian’s project focused on a stem cell and gene therapy approach to making HIV-resistant immune cells with the long-term goal of eradicating the virus in patients. In fact, follow on studies by the Anderson lab have helped lead to a CIRM-funded clinical trial, now underway at UC Davis, that’s testing a stem cell-based treatment for HIV/AIDs patients.

After his Bridges internship came to a close, Brian worked on a few short-term research projects at UC Davis but then found himself in a similar spot: needing to strike out on a career path that wasn’t necessarily clearly paved. He reached out to Nolta and Bauer and basically cut to the chase in an email asking, “do you know anybody?”. Bauer reply immediately, “yeah, me!”. It was late 2011 and UC Davis had built a Good Manufacturing Practice (GMP) facility with the help of a CIRM Major Facility grant. Bauer only had one technician at the time and work was starting to pick up.

The Good Manufacturing Practice (GMP) facility in UC Davis’ Institute for Regenerative Cures.

A GMP facility is a specialized laboratory where clinical-grade cell products are prepared for use in people. To ensure the cells are not contaminated, the entire lab is sealed off from the outside environment and researchers must don full-body lab suits. We produced the video below about the GMP facility just before it opened.

Bauer knew Brian would be perfect at their GMP facility:

“Brian was a student in the first cohort of CIRM Bridges trainees and took my class Bio225 – stem cell biology and manufacturing practices. He excelled in this class, and I also could observe his lab skills in the GMP training part incorporated in this class. I was very lucky to be able to hire Brian then, since I knew what excellent abilities he had in GMP manufacturing.”

CIRM-supported student now supporting CIRM-funded clinical trials

Brian Fury suited up in GMP facility

Since then, Brian has worked his way up to managing the entire GMP facility and its production of cell therapy products. At last count, he and the five people he supervises are juggling sixteen cell manufacturing projects. One of his current clients is Angiocrine which has a CIRM-funded clinical trial testing a cell therapy aimed to improve the availability and engraftment of blood stem cell transplants. This treatment is geared for cancer patients who have had their cancerous bone marrow removed by chemotherapy.

When a company like Angiocrine approaches Brian at the GMP facility, they already have a well-defined method for generating their cell product. Brian’s challenge is figuring out how to scale up that process to make enough cells for all the patients participating in the clinical trial. And on top of that, he must design the procedures for the clean room environment of the GMP facility, where every element of making the cells must be written down and tracked to demonstrate safety to the Food and Drug Administration (FDA).

The right time, the right place…and a whole bunch of determination and passion
It’s extremely precise and challenging work but that’s what makes it so exciting for Brian. He tells me he’s never bored and always wakes up looking forward to what each day’s challenges will bring and figuring out how he and his team are going get these products into the clinic. It’s a responsibility he takes very seriously because he realizes what it means for his clients:

“I invest as much energy and passion and commitment into these projects as I would my own family. This is extremely important to me and I feel so incredibly fortunate to have the opportunity to work on things like this. The reality is, in the GMP, people are bringing their life’s work to us in the hopes we can help people on the other end. They share all their years of development, knowledge and experience and put it in our hands and hope we can scale this up to make it meaningful for patients in need of these treatments.”

Despite all his impressive accomplishments, Brian is a very modest guy using phrases like “I was just in the right place at the right time,” during our conversation. But I was glad to hear him add “and I was the right candidate”. Because it’s clear to me that his determination and passion are the reasons for his success and is the epitome of the type of researcher CIRM had hoped its investment in the Bridges program and our SPARK high school internship program would produce for the stem cell research field.

That’s why we’ll be brimming over with an extra dose of pride on the day that one of Brian’s CIRM-funded stem cell therapy products reaches the goal line with an FDA approval.

Alpha clinics and a new framework for accelerating stem cell treatments

Mon, 01/29/2018 - 13:42

Last week, at the World Stem Cell Summit in Miami, CIRM took part in a panel discussion about the role and importance of Alpha Clinics in not just delivering stem cell therapies, but in helping create a new, more collaborative approach to medicine. The Alpha Clinic concept is to create  a network of top medical centers that specialize in delivering stem cell clinical trials to patients.

The panel was moderated by Dr. Tony Atala, Director of the Wake Forest Institute for Regenerative Medicine. He said the term Alpha Clinic came from CIRM and the Alpha Stem Cell Clinic Network that we helped create. That network now has five specialist health care centers that deliver stem cell therapies to patients: UC San Diego, UCLA/UC Irvine, City of Hope, UC Davis, and  UCSF/Children’s Hospital Oakland.

This is a snapshot of that conversation.

Alpha Clinics Advancing Stem Cell Trials

Dr. Maria Millan, CIRM’s President & CEO:

“The idea behind the Alpha Stem Cell Clinic Network is that CIRM is in the business of accelerating treatments to patients with unmet medical needs. We fund research from the earliest discovery stage to clinical trials. What was anticipated is that, if the goal is to get these discoveries into the clinics then we’ll need a specific set of expertise and talents to deliver those treatments safely and effectively, to gather data from those trials and move the field forward. So, we set out to create a learning network, a sharing network and a network that is more than the sum of its parts.”

Dr. Joshua Hare,  Interdisciplinary Stem Cell Institute, University of Miami, said that idea of collaboration is critical to advancing the field:

“What we learned is that having the Alpha Stem Cell Clinic concept helps investigators in other areas learn from what earlier researchers have done, helping accelerate their work.

For example, we have had a lot of experience in working with rare diseases and we can use the experience we have in treating one disease area in working in others. This shared experience can help us develop deeper understanding in terms of delivering therapies and dosing.”

Susan Solomon, CEO New York Stem Cell Foundation Research Institute. NYSCF has several clinical trials underway. She says in the beginning it was hard finding reputable clinics that could deliver these potentially ground breaking but still experimental therapies:

 

“My motivation was born out of my own frustration at the poor choices we had in dealing with some devastating diseases, so in order to move things ahead we had to have an alpha clinic that is not just doing clinical trials but is working to overcome obstacles in the field.”

 

 

Greg Simon represented the, Biden Cancer Initiative, whose  mission is to develop and drive implementation of solutions to accelerate progress in cancer prevention, detection, diagnosis, research, and care, and to reduce disparities in cancer outcomes. He says part of the problem is that people think there are systems already in place that promote collaboration and cooperation, but that’s not really the case.  

“In the Cancer Moonshot and the Biden Cancer Initiative we are trying to create the cancer research initiative that people think we already have. People think doctors share knowledge. They don’t. People think they can just sign up for clinical trials. They can’t. People think there are standards for describing a cancer. There aren’t. So, all the things you think you know about the science behind cancer are wrong. We don’t have the system people think is in place. But we want to create that.

If we are going to have a unified system we need common standards through cancer research, shared knowledge, and clinical trial reforms. All my professional career it was considered unethical to refer to a clinical trial as a treatment, it was research. That’s no longer the case. Many people are now told this is your last best hope for treatment and it’s changed the way people think about clinical trials.”

The Process

Maria Millan says we are seeing these kinds of change – more collaboration, more transparency –  taking place across the board:

“We see the research in academic institutions that then moved into small companies that are now being approved by the FDA. Academic centers, in conjunction with industry partners, are helping create networks and connections that advance therapies.

This gives us the opportunity to have clinical programs and dialogues about how we can get better, how we can create a more uniform, standard approach that helps us learn from each trial and develop common standards that investigators know have to be in place.

Within the CIRM Alpha Stem Cell Clinic Network the teams coming in can access what we have pulled together already – a database of 20 million patients, a single IRB approval, so that if a cliinical trial is approved for one Alpha Clinic it can also be offered at another.”

Greg Simon says to see the changes really take hold we need to ensure this idea of collaboration starts at the very beginning of the chain:

“If we don’t have a system of basic research where people share data, where people are rewarded for sharing data, journals that don’t lock up the data behind a paywall. If we don’t have that system, we don’t have the ability to move therapies along as quickly as we could.

“Nobody wants to be the last person to die from a cancer that someone figured out a treatment for a year earlier. It’s not that the science is so hard, or the diseases are so hard, it the way we approach them that’s so hard. How do we create the right system?”

More may not necessarily be better

Susan Solomon:

“There are tremendous number of advances moving to the clinic, but I am concerned about the need for more sharing and the sheer number of clinical trials. We have to be smart about how we do our work. There is some low hanging fruit for some clinical trials in the cancer area, but you have to be really careful.”

Greg Simon

“We have too many bad trials, we don’t need more, we need better quality trials.

We have made a lot of progress in cancer. I’m a CLL survivor and had zero problems with the treatment and everything went well.

We have pediatric cancer therapies that turned survival from 10 % to 80%. But the question is why doesn’t more progress happen. We tend to get stuck in a way of thinking and don’t question why it has to be that way. We think of funding because that’s the way funding cycles work, the NIH issues grants every year, so we think about research on a yearly basis. We need to change the cycle.”

Maria Millan says CIRM takes a two pronged approach to improving things, renovating and creating:

“We renovate when we know there are things already in place that can be improved and made better; and we create if there’s nothing there and it needs to be created. We want to be as efficient as we can and not waste time and resources.”

She ended by saying one of the most exciting things today is that the discussion now has moved to how we are going to cover this for patients. Greg Simon couldn’t agree more.

“The biggest predictor of survivability of cancer is health insurance. We need to do more than just develop treatments. We need to have a system that enables people to get access to these therapies.”

 

 

 

 

 

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