Giving Thanks by Looking Forward


The CIRM Team gather to give Thanks

Thanksgiving is traditionally a time of reflection, a time to look back and express gratitude for all the good things that have happened in the past year. At CIRM we have a lot to be thankful for but this Thanksgiving we are looking forward, not backward. We’re unveiling our new Strategic Plan, our blueprint for the future, and we would love to hear what you think about it.

Randy Mills, our President and CEO, calls the Strategic Plan “a bold, new vision” for what we hope to achieve over the next five years. After reading it we hope you’ll agree.

Taking it on the road

We actually began this process several months ago with a talking tour of California. Randy Mills went around the state talking to researchers, academics, company officials, patients and patient advocates – anyone who has a stake in what we do. He posed a few simple questions such as: “what’s impeding progress?” and “how do you think we could do better?” and asked them what they thought we should focus on in the next five years.

As you can imagine we got a wide range of answers, but there was also surprising agreement on some key issues – such as the need to push for regulatory reform to help remove some of the obstacles slowing down the ability of researchers to move their therapies into clinical trials.

Bold ideas

The plan is an ambitious one, but then as Sherry Lansing, the cancer Patient Advocate member of our Board, says in a news release, why aim low:

“As we enter what could be CIRM’s last phase, we want to show the people of California that we are doing everything we can to fulfill the hopes of all those who voted to create the agency when they supported Proposition 71 in 2004.  That’s what this Strategic Plan demonstrates. It’s an ambitious plan, but you never achieve anything worthwhile by playing it safe. Too many lives are at stake for us to do anything less than work as hard as we can, as long as we can, to achieve as much as we can.”

Over the course of the next five years we hope to:

  • Launch 50 new clinical trials covering at least 20 unique diseases or conditions, and including at least 10 rare and 5 pediatric indications
  • Increase the number of projects advancing to the next stage of development by 50%
  • Work with patient advocates, the FDA and researchers to develop a new, more efficient regulatory process for cell therapies
  • Reduce the time it takes a stem cell therapy to move from discovery into a clinical trial by 50%

But wait, there’s more

And that’s just a taste of what we are planning. For the full picture you need to check out the Strategic Plan. But as Randy Mills says, we don’t want you to just read it. This process began with us asking you for your thoughts. Now we want to end it the same way.

“Your input was invaluable in helping us chart an ambitious course and giving us the inspiration to be bold and think outside of the box. Now, as we get ready to put this new vision for the agency into action, we want to share it with the public, with patients and patient advocates, scientists and researchers, and give them a chance to let us know what they think.”

Here’s where you can find the Strategic Plan.

What do you think?

If you have any thoughts or comments send them to me by 5pm, Thursday, December 3rd at

The Strategic Plan is due to go before the CIRM Science Subcommittee on Monday, November 30th and the full Board for its approval on Thursday, December 17th.


CIRM’s clinical trial portfolio: Two teams tackle blindness, macular degeneration and retinitis pigmentosa

RPE precursor cells

Researchers seek to restore health to the retina in the back of the eye using cells such as these precursors of an area called the RPE.

More than seven million people in the US struggle to see. While most are not completely blind they have difficulty with, or simply can’t do, daily tasks most of us take for granted. CIRM has committed more than $100 million to 17 projects trying to solve this unmet medical need. Two of those projects have begun clinical trials testing cell therapies in patients. (Both were featured in the “Stem Cells in Your Face” video we released yesterday.)

The two diseases targeted by those therapies bookend the spectrum of patients impacted and their symptoms. Retinitis pigmentosa (RP) strikes young people, wiping out peripheral version first and only later attacking the central vision. Age related macular degeneration (AMD), the leading cause of blindness in the elderly, slowly erodes the central vision.

The RP team

Researcher Henry Klassen at the University of California, Irvine, was told as a kid he might have RP. He didn’t. Instead he has spent more than 25 years searching for cures for blindness, including RP. When asked about the dogged determination it has required to get to the point of the CIRM-funded clinical trial, he naturally fell into visual metaphors.

“It really has been difficult with many opportunities to lose the path, but I think I just had a singular vision of what was possible and when you see the possibility and you know it’s there, you feel this deep responsibility for acting even if other people aren’t seeing what you’re seeing.”

Klassen’s team has treated eight patients in the first part of the clinical trial, all with severe vision loss. If the monitoring of those patients shows the therapy to be safe the team should be given permission to treat a second group of patients, this time people with less progressed vision loss.


Rosie Barrero

The therapy involves injecting nerve stem cells into the fluid of the eye. There the cells release various proteins and factors that promote the health of the photo-receptors that become non-functional in RP.

Rosie Barrero lives with RP’s limitation every day. Although in hindsight she believes the progressive disease started as a young child, she was not diagnosed until the age of 26. Now, with three children of her own to help raise, she can only see shadows and shapes to maneuver, but can not recognize the faces of family and friends—something that can make some new acquaintances think she is a bit of a snob when she unknowingly ignores them.

“A cure for RP would mean independence for me. It would mean I would play a bigger role as a parent; I would do more things, I would help out more.”

Rosie and her husband German explained more about living with the disease in our “Spotlight” series. And at the same event, Klassen gave a more detailed description of the project.

Second team aims for AMD

A multi-center team lead by Mark Humayun and David Hinton at the University of Southern California and Dennis Clegg at the University of California, Santa Barbara, are the force behind the second CIRM-funded clinical trial . They developed an approach to treating dry AMD with stem cells fairly different from other teams around the world that are also in the midst of clinical trials. While the other groups generally inject cells from various sources directly into the eye, the California team combines cells with a synthetic scaffold to hold them in place in the eye.


Artist Virginia Doyle had to change her style of painting to adjust to the reduced vision of AMD. See her tell her story and hear more about the research in this short video.

Most of the clinical work in AMD seeks to replace a monolayer of cells under the retina that support that critical part of our eye where the photoreceptors reside. That layer of cells, called the Retinal Pigmented Epithelium (RPE) degenerates in AMD for unknown reasons and without its support structure the photoreceptors start to give out. Rather than hoping injected cells will find their way to where they need to be, the CIRM-funded team grows them on a thin synthetic scaffold. They then implant that three-by-five millimeter piece of plastic under the retina where it is needed.


Dennis Clegg

“We’ve designed the scaffold material—the little piece of plastic that we’re putting the cells on—to be very, very thin such that anything can move through it that needs to move through,” said UC Santa Barbara’s Dennis Clegg. “And there are a number of nutrients that are delivered to the RPE cells from the corriocapillaris, which is the system of blood vessels underneath.”

USC’s Humayan presented more detail about the science behind the project at one of our “Spotlight” presentations very early in the project in 2009, and his clinical collaborator at USC, David Hinton provided clinical perspective at the same session.

Others working on the goal

A collaborating team led by Pete Coffey in London has begun a clinical trial for the more aggressive wet form of AMD.  Coffey splits his time between University College London and UC Santa Barbara.

The clinical trial teams have formed companies or collaborated with corporate partners to manage the clinical trials and further development of the technology—something CIRM considers critical to moving therapies forward for patients. jCyte manages the RP work and Regenerative Patch Technologies manages the AMD project. Pfizer is involved with the London project.

Somewhere close to a dozen teams around the world are trying various forms of stem cell-based therapies to fill the huge patient need created by AMD. Clegg suggests this is not redundant but rather a great thing for patients:

“Sometimes I like to compare it to the beginning of the space program. There are a lot of ways you can build a rocket ship. We don’t know which one is going to get to the moon, but it’s worth trying all of these to see what works best for patients.”

Eyeing Stem Cell Therapies for Vision Loss

Back by popular demand (well, at least a handful of you demanded it!) we’re pleased to present the third installment of our Stem Cells in Your Face video series. Episodes one and two set out to explain – in a light-hearted, engaging and clear way – the latest progress in CIRM-funded stem cell research related to Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis, or ALS) and sickle cell disease.

With episode three, Eyeing Stem Cell Therapies for Vision Loss, we turn our focus (pun intended) to two CIRM-funded clinical trials that are testing stem cell-based therapies for two diseases that cause severe visual impairment, retinitis pigmentosa (RP) and age-related macular degeneration (AMD).

Two Clinical Trials in Five Minutes
Explaining both the RP and AMD trials in a five-minute video was challenging. But we had an ace up our sleeve in the form of descriptive eye anatomy animations graciously produced and donated by Ben Paylor and his award-winning team at InfoShots. Inserting these motion graphics in with our scientist and patient interviews, along with the fabulous on-camera narration by my colleague Kevin McCormack, helped us cover a lot of ground in a short time. For more details about CIRM’s vision loss clinical trial portfolio, visit this blog tomorrow for an essay by my colleague Don Gibbons.

Vision Loss: A Well-Suited Target for Stem Cell Therapies
Of the wide range of unmet medical needs that CIRM is tackling, the development of stem cell-based treatments for vision loss is one of the furthest along. There are a few good reasons for that.

The eye is considered to be immune privileged, meaning the immune system is less accessible to this organ. As a result, there is less concern about immune rejection when transplanting stem cell-based therapies that did not originally come from the patient’s own cells.

The many established, non-invasive tools that can peer directly into the eye also make it an attractive target for stem cell–based treatment. Being able to continuously monitor the structure and function of the eye post-treatment will be critical for confirming the safety and effectiveness of these pioneering therapies.

Rest assured that we’ll be following these trials carefully. We eagerly await the opportunity to write future blogs and videos about encouraging results that could help the estimated seven million people in the U.S. suffering from disabling vision loss.

Related Links:

Stem Cellar archive: retinitis pigmentosa
Stem Cellar archive: macular degeneration
Video: Spotlight on Retinitis Pigmentosa
Video: Progress and Promise in Macular Degeneration
CIRM Fact Sheet on Vision Loss

Stem cell stories that caught our eye: making vocal cords, understanding our brain and the age of donor cells matters

Here are some stem cell stories that caught our eye this past week. Some are groundbreaking science, others are of personal interest to us, and still others are just fun.

Tissue engineered vocal cords. A report from the University of Wisconsin that researchers there had grown new vocal cords got quite a bit of play in the media including this piece on the NBC News web site. It caught my attention not so much because of what they had created, but rather because of the vivid example it provides of cells having a memory of their role and their ability to communicate with each other to function in that role.

In the rather simple experiment, the team took vocal fold tissue from patients who had their larynxes removed for reasons other than cancer. They then used a solution to separate the tissue into individual cells and seeded those cells onto collagen scaffolding. Within 14 days they had fully formed tissue. One of the researchers stated in a phone briefing that the cells knew what they should be doing:

“They’re effectively talking to each other and producing the structural proteins that make this special tissue capable of vibration,” said Brian Frey.

The team transplanted the tissue into a larynx from a deceased dog and was able to demonstrate that the cells could make sound. In the artificial lab setting it evidently sounded a bit like a Kazoo, but the researchers maintained that if transplanted into a human it could easily sound like a voice.

Never ending quest to understand our brain. We’ve known for some time that the gene NeuroD1 plays a critical role in the early development of the brain. Now work by researchers at the Institute of Molecular Biology in Mainz, Germany report that this one gene seems to be the master switch to creating the brain.

Neurons using NeuroD1

Cells in which NeuroD1 is turned on are reprogrammed to become neurons. Cell nuclei are shown in blue and neurons are shown in red

They used several popular new techniques to track the activity of NeuroD1 in living tissue. They found it turned on a large number of genes that act to maintain cells’ trajectory to become nerves. Another indication of NeuroD1’s Svengali role came when they realized that even after it is turned off, the other genes stay active and keep driving cells to become more brain tissue.

“Our research has shown how a single factor, NeuroD1, has the capacity to change the epigenetic landscape of the cell, resulting in a gene expression program that directs the generation of neurons,” wrote the investigators in the EMBO Journal.

A story in Genetic Engineering News describes the potential impact this finding could have on understanding brain development as well as in figuring out how to repair brain damage.

Age of donor cells matters. Stem cells in older individuals just don’t do their jobs as well as those in younger people. Now a team at the Miller School of Medicine in Miami has provided clear evidence that this difference matters when selecting donor stem cells—at least in the mice in this study.

The study, published in Translational Research, looked at the ability of mesenchymal stem cells (MSCs) to protect lungs from injury. HealthCanal picked up the institution’s press release that quoted one of the researchers.

“Donor stem cells from younger mice were effective in preventing damage when infused into older mice at the same time as a disease-causing agent,” said Marilyn K. Glassberg. “However, donor MSCs from older mice had virtually no effect.”

The issue becomes key when debating the merits of autologous cells (from the patient themselves) versus allogeneic cells (from donors). This study adds weight to the side that says for older patients choose allogeneic—and make sure the donor is young.

Stem cells could offer hope for deadly childhood muscle wasting disease

Duchenne muscular dystrophy (DMD) is a particularly nasty rare and fatal disease. It predominantly affects boys, slowly robbing them of their ability to control their muscles. By 10 years of age, boys with DMD start to lose the ability to walk; by 12, most need a wheelchair to get around. Eventually they become paralyzed, and need round-the-clock care.

There are no effective long-term treatments and the average life expectancy is just 25.

Crucial discovery

Duchenne MD team

DMD Research team: Photo courtesy Ottawa Hospital Research Inst.

But now researchers in Canada have made a discovery that could pave the way to new approaches to treating DMD. In a study published in the journal Nature Medicine, they show that DMD is caused by defective muscle stem cells.

In a news release Dr. Michael Rudnicki, senior author of the study, says this discovery is completely changing the way they think about the condition:

“For nearly 20 years, we’ve thought that the muscle weakness observed in patients with Duchenne muscular dystrophy is primarily due to problems in their muscle fibers, but our research shows that it is also due to intrinsic defects in the function of their muscle stem cells. This completely changes our understanding of Duchenne muscular dystrophy and could eventually lead to far more effective treatments.”

Loss and confused

DMD is caused by a genetic mutation that results in the loss of a protein called dystrophin. Rudnicki and his team found that without dystrophin muscle stem cells – which are responsible for repairing damage after injury – produce far fewer functional muscle fibers. The cells are also confused about where they are:

“Muscle stem cells that lack dystrophin cannot tell which way is up and which way is down. This is crucial because muscle stem cells need to sense their environment to decide whether to produce more stem cells or to form new muscle fibers. Without this information, muscle stem cells cannot divide properly and cannot properly repair damaged muscle.”

While the work was done in mice the researchers are confident it will also apply to humans, as the missing protein is almost identical in all animals.

Next steps

The researchers are already looking for ways they can use this discovery to develop new treatments for DMD, hopefully one day turning it from a fatal condition, to a chronic one.

Dr. Ronald Worton, the co-discoverer of the DMD gene in 1987, says this discovery has been a long-time coming but is both welcome and exciting:

“When we discovered the gene for Duchenne muscular dystrophy, there was great hope that we would be able to develop a new treatment fairly quickly. This has been much more difficult than we initially thought, but Dr. Rudnicki’s research is a major breakthrough that should renew hope for researchers, patients and families.”

In this video CIRM grantee, Dr. Helen Blau from Stanford University, talks about a new mouse model created by her lab that more accurately mimics the Duchenne symptoms observed in people. This opens up opportunities to better understand the disease and to develop new therapies.






New type of diabetes caused by old age may be treatable

I’m going to tell you a secret: I love sugar. I love it so much that as a little kid my mom used to tell me scary stories about how my teeth would fall out and that I might get diabetes one day if I ate too many sweets. Thankfully, none of these things happened. I have a full set of teeth (and they’re real), my blood sugar level is normal, and I’ve become one with the term “everything in moderation”.

I am not out of the woods, however: a newly discovered type of diabetes could strike in a few decades. A research team has found the cause of a type of diabetes that occurs because of old age, and a potential cure, at least in mice.

Diabetes comes in different flavors

People who suffer from diabetes (which is almost 30 million Americans) lack the ability to regulate the amount of sugar in their blood. The pancreas is the organ that regulates blood sugar by producing a hormone called insulin. If blood has a high sugar level, the pancreas releases insulin, which helps muscle, liver, and fat cells to absorb the excess sugar until the levels in the blood are back to normal.

There are two main forms of diabetes, type 1 and 2, both of which cause hyperglycemia or high blood sugar. Type 1 is an autoimmune disorder where the immune system attacks and kills the insulin-producing cells in the pancreas. As a result, these type 1 diabetics aren’t able to produce insulin and endure a lifetime of daily insulin shots to manage their condition. Type 2 diabetes is the more common form of the disease and occurs when the body’s cells become unresponsive, or resistant, to insulin and stop absorbing sugar from the bloodstream.

The cause of type 1 diabetes is not known although genetic factors are sure to be involved. Type 2 diabetes can be caused by a combination of factors including poor diet, obesity, genetics, stress, and old age. Both forms of the disease can be fatal if not managed properly and raise the risk of other medical complications such as heart disease, blindness, ulcers, and kidney failure.

While type 1 or 2 diabetes make up the vast majority of the cases, there are actually other forms of this disease that we are only just beginning to understand. One of them is type 3, which is linked to Alzheimer’s disease. (To learn more about the link between AD and diabetes, read this blog.)

Old age can cause diabetes

Another form of diabetes, which is in the running for the title of type 4, is caused by old age. Unlike type 2 diabetes which also occurs in adults, type 4 individuals don’t have the typical associated risk factors like weight gain. The exact mechanism behind age-related type 4 diabetes in humans isn’t known, but a CIRM-funded study published today in Nature identified the cause of diabetes in older, non-obese mice.

Scientists from the Salk Institute compared the immune systems of healthy mice to lean mice with age-associated insulin resistance or mice with obesity-associated insulin resistance (the equivalent to type 2 diabetes in humans). When they studied the fat tissue in the three animal models, they noticed a striking difference in the number of immune cells called T regulatory cells (Tregs). These cells are the “keepers of the immune system”, and they keep inflammation and excessive activity of other immune cells to a minimum.

Lean mice with age-related diabetes, had a substantially larger number of Tregs in their fat tissue compared to obesity-related diabetic and normal mice. Instead of being their usual helpful selves, the overabundance of Tregs in the age-related diabetic mice caused insulin resistance.

Salk researchers show that diabetes in elderly, lean animals is caused by an overabundance of immune cells in fat. In this graphic, fat tissue is shown with representations of the immune cells called Tregs (orange). In aged mice with diabetes (represented on the right), Tregs are overexpressed in fat tissue and trigger insulin resistance. When Tregs are blocked, the fat cells in mice become insulin sensitive again. (Image courtesy of Salk Institute)

Diabetes in elderly, lean animals is caused by an overabundance of immune cells called Tregs (orange)  in fat tissue (brown cells). In aged mice with diabetes (right), Tregs are overexpressed in fat tissue and trigger insulin resistance. When Tregs are blocked, the fat cells in mice become insulin sensitive again. (Image courtesy of Salk Institute)

In a Salk Institute press release, lead author Sagar Bapat explained:

Normally, Tregs help calm inflammation. Because fat tissue is constantly broken down and built back up as it stores and releases energy, it requires low levels of inflammation to constantly remodel itself. But as someone ages, the new research suggests, Tregs gradually accumulate within fat. And if the cells reach a tipping point where they completely block inflammation in fat tissue, they can cause fat deposits to build up inside unseen areas of the body, including the liver, leading to insulin resistance.

A cure for type 4 diabetes, but in mice…

After they identified the cause, the authors next searched for a solution. They blocked the build up of Tregs in the fat tissue of age-related diabetic mice using an antibody drug that inhibits the production of Tregs. The drug successfully cured the age-related diabetic mice of their insulin resistance, but didn’t do the same for the obesity-related diabetic mice. The authors concluded that the two forms of diabetes have different causes and type 4 can be cured by removing excessive Tregs from fat tissue.

This study is only the beginning for understanding age-related diabetes. The authors next want to find out why Tregs accumulate in the fat tissue of older mice, and if they also build up in other tissues and organs. They are also curious to know if the same phenomenon happens in elderly humans who become diabetic but don’t have type 2 diabetes.

Understanding the cause of age-related diabetes in humans is of upmost importance to Ronald Evans who is the director of the Gene Expression Lab at the Salk Institute, and senior author on the study.

Ron Evans

Ron Evans

A lot of diabetes in the elderly goes undiagnosed because they don’t have the classical risk factors for type 2 diabetes, such as obesity. We hope our discovery not only leads to therapeutics, but to an increased recognition of type 4 diabetes as a distinct disease.

For more on this exciting study, check out a video interview of Dr. Evans from the Salk Institute:

Related links:

A Fishy Tale: A gene that blocks regeneration in fish blocks cancer in humans

Evolution is a fascinating thing. Over time, the human race has evolved from cavemen to a bustling civilization fueled by technology, science, and economics. While we’ve gained many abilities that separate us from other mammals and our closest ancestors, the apes, we’ve also lost a number of skills along the way.

One of them is the ability to regenerate. Some animals such as lizards, fish, and frogs, have a robust capacity to regenerate entire limbs and organs while humans can only partially regenerate some tissues and organs on a much smaller scale. Why did we lose this advantageous trait?

A human gene that stops cancer also blocks regeneration

Image courtesy of Flickr.

Zebrafish. (Image courtesy of Flickr)

Scientists from UCSF have found a new piece to this evolutionary puzzle in a paper published today in eLife. They found that a gene responsible for preventing cells from growing uncontrollably into deadly cancers in humans is also able to block tissue regeneration in zebrafish.

Detailed in a UCSF news release, professor and senior author on the study, Jason Pomerantz, was always intrigued by why humans can’t regenerate limbs like salamanders. To answer these questions, he turned to model organisms like fish and amphibians:

Jason Pomerantz, UCSF

Jason Pomerantz, UCSF

In the last 10 to 15 years, as regenerative organisms like zebrafish have become genetically tractable to study in the lab, I became convinced that these animals might be able to teach us what is possible for human regeneration. Why can these vertebrates regenerate highly complex structures, while we can’t?


Like other scientists, Pomerantz was curious to know if humans “grew out of” their regenerative abilities in order to acquire systems that block cancer growth. Humans and other mammals have genes called tumor-suppressors that are important for regulating tissue differentiation during development and for preventing excessive cell growth and tumor formation after birth and beyond. Many of these tumor suppressor genes are conserved across a wide range of species, but Pomerantz knew of one that wasn’t shared between humans and regenerative animals, a gene called ARF.

Pomerantz and his team decided to see what happened when they added the human Arf gene into the genome of a highly regenerative animal, the zebrafish. While the addition of ARF did not affect zebrafish development, it did almost fully block their ability to regrow their tail fins after the tips were removed.

Normal zebrafish can regrow their tail fins after they are clipped, but fish that have the ARF gene cannot. (eLife)

Normal zebrafish can regrow their tail fins after they are clipped (top) , but fish that have the human ARF gene cannot (bottom). (Image from eLife)

Pomerantz explained ARF’s anti-regenerative role in the fish:

“It’s like the gene is mistaking the regenerating fin cells for aspiring cancer cells. And so it [ARF] springs into action to block it.”

Is Wolverine our future?

Wolverine. (Courtesy of

Marvel’s Wolverine has regenerative powers. (Courtesy of

Knowing that ARF suppresses tissue regeneration in fish, the obvious question that arises from this study is whether blocking the Arf gene in humans would promote tissue regeneration. Would doing this mean we could all be regenerative super heroes like Wolverine one day?

Pomerantz explained further in the UCSF new release that boosting regeneration in humans that need new organs or limbs could be possible but would require a careful balance to avoid setting off rampant tumor growth:

Future efforts to promote regeneration in humans will likely require carefully balanced suppression of this anti-tumor system. The same pathway in humans theoretically could be blocked to enhance researchers’ ability to grow model organs from stem cells in a laboratory dish, to enhance patients’ recovery from injury. Since tumor suppressors are thought to play a role in aging by limiting the rejuvenating potential of stem cells, blocking this pathway could even be a part of future anti-aging therapies.

Scientists will likely have to weigh the risks and benefits for human tissue regeneration on a case by case basis. Pomerantz concluded with this admission:

The ratio of risk and benefit has to be appropriate. For instance, there are certain congenital diseases that cause craniofacial deformities so severe that the risks of such a treatment might be clinically reasonable.


A scientific conference we can all enjoy

Scientific conferences are fascinating events. You get a chance to mingle with some of the leading researchers and thinkers in the field, and to learn about the latest advances. But, to be honest, for those of us who don’t have a scientific background, they can also be a little bit intimidating.

This is sometimes how I feel at them.

Courtesy The New Yorker

Courtesy The New Yorker

That’s where the World Stem Cell Summit comes in. It’s an annual event that brings together researchers, companies, scientists and patient advocates to talk about the progress being made in stem cell research and to explore ways to advance the field even further, and faster by working together.

Changing the tone

The patient advocate role is a critical one here. It makes the voice of the patient a key element in every discussion and changes the tone of the event from talking about what is being done to or for patients, to what is being done with patients. It’s a small but tremendously important difference.

Dr. Evan Snyder, Director of the Stem Cells and Regenerative Medicine program at Sanford – Burnham Medical Research Institute captures that feel when he says:

“We’re looking forward to the valuable information-sharing opportunities and discussions that only occur when stem cell researchers, patient advocates, and representatives of many other stakeholder groups converge at the World Stem Cell Summit. Occasions like these help us advance our research on the basic biology of stem cells and spur the development of new, and more personalized, medical applications for this science.”

Because more than ten percent of those attending are patient advocates the talks are given at a level that someone without a science background can generally understand. The presentations are no less fascinating; they are just a lot more accessible.

Stephen Rose, the Chief Research Officer with the Foundation Fighting Blindness says it brings different groups together in a way other conferences usually don’t:

“Policy experts learned about researchers’ needs. Advocates learn about policy and legislation. It also brought ethical issues to the table, which is critical if we’re going to resolve them and keep the research moving forward.”

Researchers have a lot of opportunities throughout the year to meet with other scientists but patient advocates don’t, so the World Stem Cell Summit is a great chance for them to meet with their colleagues and counterparts from all over the US. It gives them a chance to share ideas, offer support and explore ways they can collaborate.

More than just a meeting

For many advocates who are focused on diseases that affect relatively small numbers of people these events are a great way to recharge their batteries and to remind themselves they are not alone in this fight.

If you are thinking about going to one conference this year, this is a great one to chose. This year the World Stem Cell Summit is being held December 10 – 12 in Atlanta, Georgia.

We’ll be there and we’d love to see you there too.

Stem cell stories that caught our eye: three teams refine cell reprogramming, also stem cell tourism

Here are some stem cell stories that caught our eye this past week. Some are groundbreaking science, others are of personal interest to us, and still others are just fun.

Why stem cells in the lab don’t grow up right. A classic cartoon among stem cell fans shows a stem cell telling a daughter cell it can grow up to become anything, and in a living creature that is pretty much true. But in the lab those daughter cells often don’t behave and mature properly. This seems particularly true for stem cells made by reprogramming adult cells through the iPS cell technology.

Tissues, such as heart muscle grown in the lab from stem cells too often look and behave like heart tissue found in a growing embryo rather than like a mature adult. A team at Johns Hopkins decided the best way to solve this problem was to understand the differences between those heart tissues maturing in a lab and those grown naturally and to understand those differences at the molecular level. They looked at which molecular and genetic signaling pathways were turned on in each during development.

After studying 17,000 genes in 200 heart cell samples they found that the pathways in the lab-grown cells were like a map in which the roads don’t line up. Pathways that were supposed to be turned on were not and ones that were supposed to be blocked were open. In a university press release picked up by they explain that they now intend to look for ways to correct some of those misguided cellular pathways, in part by making the lab conditions better mimic normal growing conditions.

The result should be tissues grown for research that result in a more accurate model of disease and, potentially, better tissue for transplantation and repair.

Getting the cells needed faster. Pretty much everyone’s cell therapy wish list contains cells that genetically match the patient—to reduce the chance of immune system rejection—and often with the added feature of genetic modification to correct an in-born error. We have the technology to do this. You can use the iPS cell system to reprogram a patient’s adult cells into stem cells and use any number of gene modifying tools to correct the error. But the combined processes can take three months or more; time patients often don’t have.

Researchers at the University of Wisconsin’s Morgridge Institute and the Murdoch Children’s Research Institute in Australia have sped up that process to just two weeks. They found a way to do the stem cell conversion and the genetic correction at the same time and used the trendy new gene-editing tool, CRISPR, which is faster and simpler than other methods. Wisconsin’s stem cell pioneer James Thompson commented on the work led by Sara Howden:

James Thompson

James Thompson

“If you want to conduct therapies using patient-specific iPS cells, the timeline makes it hard to accomplish. If you add correcting a genetic defect, it really looks like a non-starter. You have to make the cell line, characterize it, correct it, then differentiate it to the cells of interest. In this new approach, Dr. Howden succeeded in combining the reprogramming and the gene correction steps together using the new Cas9/CRISPR technology, greatly reducing the time required.”

Howden discussed the work with Australian Broadcasting Corp and her institute issued a press release. In the release she noted than when iPS-based therapies become a reality, the faster method will be critical for certain patients such as children with severe immune deficiency or people with rapidly deteriorating vision.

Skipping the stem cell step. A team at Guangzhou Medical University created unusually pure heart muscle cells directly from skin samples without first turning them into iPS type stem cells. This so-called “direct reprogramming” has been accomplished for a few years, but mostly in nerve tissue and with much less efficiency. This team got 80 percent pure heart muscle.

Heart muscle cells created with traditional iPS cell reprogramming

Heart muscle cells created with traditional iPS cell reprogramming

They also avoided one of the potential problems with iPS technology. Most often, the reprogramming happens using viruses to carry genetic factors into adult cells. The Chinese team used proteins to do the reprogramming, which are much less likely to leave lasting, and potentially cancer-causing, changes in the cells.

“While additional research is needed to fully understand the properties of these cells, the results suggest a potentially safer method to generate cardiac progenitor cells for use as a regenerative therapy after a heart attack,” said Anthony Atala, Editor-in-Chief of STEM CELLS Translational Medicine, which published the work and released a press release picked up by BioSpace.

The research team noted one bit of needed work that reflected back to the first item in this post. They need to see if the new heart cells function like mature native cells and can interact properly with native cells if transplanted.

Stemming stem cell tourism. A pair of medical ethicists, one from Rice University in Houston and one from Wake Forest University in North Carolina, published a call for reforms in how stem cell clinical trials are designed and regulated. They say our system should encourage people to get therapy in the U.S. at regulated clinics rather than go overseas or to seek out unproven therapies here.

“The current landscape of stem cell tourism should prompt a re-evaluation of current approaches to study cell-based interventions with respect to the design, initiation and conduct of U.S. clinical trials,” the authors wrote. “Stakeholders, including scientists, clinicians, regulators and patient advocates, need to work together to find a compromise to keep patients in the U.S. and within the clinical-trial process.”

The web portal MNT wrote an article on the paper based on a Rice press release. The piece notes that many of the same patients who came forward to secure state funding for stem cells like the voter initiative that created CIRM are now tired of waiting for therapies and are seeking out unproven therapies. The authors noted that the problems this causes, in addition to the risks for patients, include the lack of any systematic way to collect data on whether those therapies are really working.

“Policy should be aimed at bringing patients home and fostering responsible scientific research as well as access for patients,” they wrote. “This will require discussions about alternative approaches to the design and conduct of clinical trials as well as to how interventions are approved by the Food and Drug Administration.”

Have your cake and eat it too: Stem cells without the risk of tumors


An unregulated stem cell treatment in 2001 led to tumor growth in the (A) brain stem and (B) spinal cord of the patient four years later. (Fig 1. PLoS Med. 2009 Feb 17;6(2):e1000029)

A real stem cell tourism story
Back in 2001, an Israeli boy suffering from Ataxia Telangiectasia, a genetic brain disease that affects movement, traveled to Russia for an unregulated stem cell treatment. His brain and spinal cord were injected with fetal stem cells though the exact composition of those cells was not known. Four years later, the boy complained of headaches and his doctors back home found tumors in his brain and spinal cord.

 Stem cells: a double-edged sword
As the BBC  and many other news outlets reported in 2009, a Plos Medicine report eventually confirmed the tumor cells originated from the donor stem cells. And here lies a double-edged sword of stem cell-based therapies. On one side, stem cells hold great promise to repair diseased or damaged tissue because they can morph, or differentiate, into a wide range of cell types.

 But on the other side, they have the capacity to remain unspecialized and continually self-renew.This is great for producing enough cells to treat many people. Researchers try to make sure only more mature cells are transplanted, but if any of these propagating, undifferentiated cells get carried along with a stem cell-based treatment, there’s a risk of introducing uncontrolled cell growth and cancers instead of remedies. Human pluripotent stem cells (hPSCs), which can form almost any cell type found in our body, are believed to be especially susceptible to this dangerous potential side effect.

Reporting this week in the journal, eLife, CIRM-funded researchers at UCSD found a way to dodge the risk of tumor growth by identifying a unique, alternate stem cell type that could be applied to kidney disease. To find this cell type, the research team focused on cells that were a bit further along a differentiation path compared to unspecialized hPSCs.

Repeat after me: endoderm, ectoderm, mesoderm

In the earliest stages of embryo development, three germ layers form. (image: Internet Science Room)

In the earliest stages of embryo development, three germ layers form. (image: Internet Science Room)

To explain, let’s take a brief detour into developmental biology. In the very early stages of specialization, the cells of the embryo form the three germ layers: ectoderm, endoderm and mesoderm. Each layer gives rise to specific set of cells and tissues. Endoderm forms, to just name a few, the lungs, intestines and pancreas; ectoderm develops into skin, the brain and spinal cord; mesoderm forms blood, muscle, bone and kidneys. Within each germ layer lie progenitor stem cells, that maintain the capacity to self-renew and can also differentiate into the adult cells formed by that germ layer.

Finding a mesoderm progenitor
While methods for growing ectoderm and endoderm progenitor stem cells from hPSCs had been previously developed, few, if any, labs had done the same for mesoderm. So the UCSD team systematically tested thousands of combinations of nutrients and chemicals for both growing and differentiating hPSCs into mesoderm. Using this approach, they successfully tracked down a recipe that gave rise to mesoderm progenitor cells with the potential to multiply and grow in population yet lacking the ability to form tumors when transplanted into mice.

Color tagged surface proteins indicate a kidney fate for activated mesodermal progenitors (Fig 7c Kumar et al. eLife 2015;4:e08413)

Color tagged surface proteins indicate a kidney fate for activated mesodermal progenitors (Fig 7c Kumar et al. eLife 2015;4:e08413)

The research team planned to work out the various conditions to specialize the progenitor cells into a wide range of mesoderm tissues. But to their surprise, when triggered to differentiate, the progenitors only gave rise to cells of the kidney. This very limited specialization is actually desired for clinical applications since purity of cell therapies is a requirement for testing in humans.

Our kidneys thank you
Putting it all together, the team has identified a cell source with unlimited self renewal capacity that can differentiate into a very specific cell type and doesn’t carry a risk of tumor formation when transplanted. These qualities make the mesoderm progenitor cell an exciting tool for developing future kidney repair or replacement treatments. And as Dr. Karl Willert, senior author and associate professor at UC San Diego, states in a UCSD press release, there is also reason to be excited about near-term applications:

“Our cells can serve as building blocks to generate kidneys that may one day be suitable for cell replacement and transplantation. I think such a therapeutic application is still a few years in the future, but engineered kidney tissue can serve as a powerful model system to study how the human kidney interacts with and filters drugs. Such an application would be of tremendous value to the pharmaceutical industry.”