The January ICOC Board Meeting begins this morning in San Francisco, CA.
The complete agenda and dial-in instructions can be found here.
Stay tuned for updates after the meeting!
The January ICOC Board Meeting begins this morning in San Francisco, CA.
The complete agenda and dial-in instructions can be found here.
Stay tuned for updates after the meeting!
Jackie Ward is a graduate student at the University of California, San Diego (UCSD), and received a training grant from CIRM while studying for her PhD. At UCSD Jackie uses stem cells as a model to study rare neurodegenerative diseases in the lab of Albert La Spada. Her work as a PhD student focuses on a rare form of inherited neurodegeneration called spinocerebellar ataxia. From time to time Jackie shares her experiences with us. Here’s her latest.
One of the many questions I get over my annual trek home during the holidays is “What…exactly…do you do?” This is usually couched somewhere between “have you learned to surf yet?” and “how’s the weather?” In the past, I preferred to talk about my surfing skills (very minimal) and the sunshine (always amazing, thanks San Diego), more than what I do every day. It’s amazing how this seemingly innocuous question can be the most difficult to answer. Because we’re used to presenting our work in lecture formats or lengthy scientific papers, summing it up in three sentences of non-jargon can be difficult. A similar thought was outlined recently at UCSD, by the actor and science advocate Alan Alda. The title of his presentation, “Getting the Public Past a Blind Date with Science,” highlighted the uncomfortable feelings many people have towards science. Like any relationship, sustained communication and trust is necessary for success. Unfortunately, on many scientific issues, that relationship has suffered. As a PhD student, I am constantly surrounded by my peers—other scientists who know exactly what I mean when I use terms like “reprogramming” or “retinal photoreceptor.” While these scientist-to-scientist conversations are vital to our work, we often forget that it is equally, or perhaps more, important to have conversations with people who have no idea what we do. As any CIRM- or NIH-funded lab is well aware, a significant portion of our funding comes from taxpayer dollars. It’s these “investors” to whom we ultimately report back. This conversation is challenging. Not only do we have to change our language, we have to remember what it was like to not know everything we do now. The best practice I’ve gotten in this regard is talking to kids. Seventh graders seem to be less afraid to ask you questions or call you out on something that doesn’t make sense to them. (Now that I think about it, it might be beneficial to include some 13-year-olds on our grant review panels.) My graduate program allows students to fulfill their teaching requirement by doing science outreach activities. I chose to do this with the Salk Institute’s mobile science lab, where real scientists are connected to local middle schools to discuss their jobs and lead hands-on science labs. I didn’t realize how valuable this experience was until it started to become easier for me to answer the “what do you do” question. I changed the words I use. I replaced the word “reprogram” with “rewind” and “retinal photoreceptor” with “eye cell.” Unexpectedly, I think this practice helped me become a better communicator when I talk to other scientists now too. I try not to assume a certain level of knowledge with anybody. While I still love talking about pretending to surf and gloating about the weather, I’ve become more fond of the “what do you do” question. I hope to only improve with time. It’ll be my small contribution for getting science to that second date.
It’s a time-honored tradition for the President of the United States to begin his State of the Union speech by saying “The state of our union is strong.” Well, Ed Lanphier, the incoming Chairman of the Alliance for Regenerative Medicine (ARM) – the industry trade group – took a leaf out of that book in kicking off the annual “State of the Industry Briefing” in San Francisco yesterday. He said the state of the industry is not just strong, but getting stronger all the time.
He pointed to the growing number of partnerships and alliances between big pharmaceutical businesses and smaller biotech and cell therapy companies as a sign that deep pocket investors recognize the potential in the field, saying “Big Pharma sees the value of these outcomes and the maturation of these pipelines.”
Lanphier also highlighted the more than 375 clinical trials that were underway last year, and the fact that more than 60 regenerative medicine products have been approved.
But he also pointed out that the field as a whole faces some big challenges in the coming years. One of the most pressing could be pricing. He cited criticisms that exploded over medicines like Gilead’s hepatitis C treatment Sovaldi because of its $1,000-a-day price tag. Lanphier warned that regenerative medicine could face similar criticisms when some of its therapies are finally approved, because they are likely to be very expensive (at least to start with). He said we need to start thinking now how to talk to patients and the public in general about this, so they understand why these treatments are so expensive, but may be cheaper in the long run if they cure rather than just treat disease.
As if to reinforce that message the first panel discussion in the briefing focused on the gene therapy and genome-editing field. Panel members talked about the high expectations for this field in the 1990’s but that it took decades of work before we finally started to see those early hopes turn into reality.
Jeffrey Walsh, the COO of bluebird bio talked about: “The excitement about gene therapy in the early days… and then having to survive the 15-20 years after that in the very challenging days for gene therapy.”
Katrine Bosley, the CEO of Editas Medicine, says those challenges have not gone away and that the field will have to address some big issues in the future. Among those are working with regulatory agencies such as the Food and Drug Administration (FDA) to win approval for completely new ways of treating disease. Another is anticipating the kinds of ethical issues they will have to address in using these techniques to alter genes.
Questions about the regulatory process also popped up in the second panel, which focused more on advanced therapy and drug development. Paul Laikind of ViaCyte (whose clinical trial in type 1 diabetes we are funding) highlighted those challenges saying: “Making the cells the way you want is not rocket science; but doing it in a way that meets regulatory requirements is rocket science.”
Paul Wotton, the President and CEO of Ocata Therapeutics (formerly called ACT) echoed those sentiments:
“We are pioneering things here and it’s the pioneers who often end up with arrows in their back, so you really have to spend a lot of time working with the FDA and other regulatory bodies to make sure you are having all the right conversations ahead of time.”
But while everyone freely acknowledged there are challenging times ahead, the mood was still very positive, perhaps best summed up by C. Randal Mills, the President of CEO of CIRM and moderator of the panel, when he said:
“I find it remarkable where we are in this space today – with this number of cutting edge companies in clinical trials. Stem cell therapy is becoming a reality, it’s no longer a place where only a foolish few dare to go in; it’s a reality. There is a change in the practice of medicine that is coming and we are all fortunate to be a part of it.”
2014 marked an extraordinary year for regenerative medicine and for CIRM. We welcomed a new president, several of our research programs have moved into clinical trials—and our goal of accelerating treatments for patients in need is within our grasp.
As we look back we’d like to revisit The Stem Cellar’s ten most popular stories of 2014. We hope you enjoyed reading them as much as we did reporting them. And from all of us here at the Stem Cell Agency we wish you a Happy Holidays and New Year.
The December ICOC Board Meeting begins this morning in Berkeley, CA.
The complete agenda can be found here. Dude to inclement weather our Spotlight on Disease has been canceled.
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In the world of professional sports, teams invest tens of millions of dollars in players. Those players are under intense pressure to show a return on that investment for the team, and that means playing as hard as possible for as long as possible. So it’s no surprise that players facing serious injuries will often turn to any treatment that might get them back in the game.
A new study published last week in 2014 World Stem Cell Report (we blogged about it here) highlighted how far some players will go to keep playing, saying at least 12 NFL players have undergone unproven stem cell treatments in the last five years. A session at the recent World Stem Cell Summit in San Antonio, Texas showed that football is not unique, that this is a trend in all professional sports.
Dr. Shane Shapiro, an orthopedic surgeon at the Mayo Clinic, says it was an article in the New York Times in 2009 about two of the NFL players named in the World Stem Cell Report that led him to becoming interested in stem cells. The article focused on two members of the Pittsburgh Steelers team who were able to overcome injuries and play in the Super Bowl after undergoing stem cell treatment, although there was no direct evidence the stem cells caused the improvement.
“The next day, the day after the article appeared, I had multiple patients in my office with copies of the New York Times asking if I could perform the same procedure on them.”
Dr. Shapiro had experienced what has since become one of the driving factors behind many people seeking stem cell therapies, even ones that are unproven; the media reports high profile athletes getting a treatment that seems to work leading many non-athletes to want the same.
“This is not just about high profile athletes it’s also about older patients, weekend warriors and all those with degenerative joint disease, which affects around 50 million Americans. Currently for a lot of these degenerative conditions we don’t have many good non- surgical options, basically physical therapy, gentle pain relievers or steroid injections. That’s it. We have to get somewhere where we have options to slow down this trend, to slow down the progression of these injuries and problems.”
Shapiro says one of the most popular stem cell-based approaches in sports medicine today is the use of plasma rich platelets or PRP. The idea behind it makes sense, at least in theory. Blood contains platelets that contain growth factors that have been shown to help tissue heal. So injecting a patient’s platelets into the injury site might speed recovery and, because it’s the patient’s own platelets, the treatment probably won’t cause any immune response or prove to be harmful.
That’s the theory. The problem is few well-designed clinical trials have been done to see if that’s actually the case. Shapiro talked about one relatively small, non-randomized study that used PRP and in a 14-month follow-up found that 83% of patients reported feeling satisfied with their pain relief. However, 84% of this group did not have any visible improved appearance on ultrasound.
He is now in the process of carrying out a clinical trial, approved by the Food and Drug Administration (FDA), using bone marrow aspirate concentrate (BMAC) cells harvested from the patient’s own bone marrow. Because those cells secrete growth factors such as cytokines and chemokines they hope they may have anti-inflammatory and regenerative properties. The cells will be injected into 25 patients, all of whom have arthritic knees. They hope to have results next year.
Dr. Paul Saenz is a sports medicine specialist and the team physician for the San Antonio Spurs, the current National Basketball Association champions. He says that sports teams are frequently criticized for allowing players to undergo unproven stem cell treatments but he says it’s unrealistic to expect teams to do clinical studies to see if these therapies work, that’s not their area of expertise. But he also says team physicians are very careful in what they are willing to try.
“As fervent as we are to help bring an athlete back to form, we are equally fervent in our desire not to harm a $10 million athlete. Sports physicians are very conservative and for them stem cells are never the first thing they try, they are options when other approaches have failed.”
Saenz said while there are not enough double blind, randomized controlled clinical trials he has seen many individual cases, anecdotal evidence, where the use of stem cells has made a big difference. He talked about one basketball player, a 13-year NBA veteran, who was experiencing pain and mobility problems with his knee. He put the player on a biologic regimen and performed a PRP procedure on the knee.
“What we saw over the next few years was decreased pain, and a dramatic decrease in his reliance on non-steroidal anti inflammatory drugs. We saw improved MRI findings, improved athletic performance with more time on court, more baskets and more rebounds.”
But Saenz acknowledges that for the field to advance anecdotal stories like this are not enough, well-designed clinical trials are needed. He says right now there is too much guesswork in treatments, that there is not even any agreement on best practices or standardized treatment protocols.
Dr. Shapiro says for too long the use of stem cells in sports medicine has been the realm of individual physicians or medical groups. That has to change:
“If we are ever to move forward on this it has to be opened up to the scientific community, we have to do the work, do the studies, complete the analysis, open it up to our peers, report it in a reputable journal. If we want to treat the 50 million Americans who need this kind of therapy we need to go through the FDA approval process. We can’t just continue to treat the one patient a month who can afford to pay for all this themselves. “
On Friday’s closing day of the 2014 World Stem Cell Summit a panel of three researchers working on neurodegenerative diseases drove home the importance of paying attention to the environment that surrounds stem cells after transplant.
CIRM grantee Evan Snyder from the Sanford-Burnham Institute noted that most of the neurologic diseases people are looking at are conditions associated with aging and the cellular makeup of the brain changes as we get older, adding that most of the diseases result from chronic states that have existed over many years. He contrasted this against mouse models of the disease, which usually involve artificially recreating the disease and treating shortly after the injury happens.
“In stem cell therapies there is a dialogue between the transplanted cells and the recipient. The host influences the fate of the stem cells.”
He noted that the patients we will be treating have generally had long-term degeneration and asked if we might be able to develop drugs that effect the environment where the stem cells will be placed so that it mimics more closely the environment found in the animal model in the acute phase, that is right after injury.
One aspect of the environment in the brain in most patients with neurodegeneration is chronic inflammation. Another CIRM grantee on the panel, Jeanne Loring of the Scripps Research Institute, discussed a project her team hopes will take advantage of the inflammation that occurs in Alzheimer’s disease. They are loading nerve stem cells with an enzyme that can degrade the plaque that accumulates in nerves in the disease. Because stem cells home to inflammation, they hypothesize that the stem cells will be drawn to deliver their cargo to the nerves with the worst plaque.
The third panelist, Erzi Kokovay of the University of Texas Health Science Center in San Antonio, described the changes in the brain as we age in a bit more detail. She described infiltration of cells called microglia that researchers will need to take into account when they plan to transplant stem cells in the brain.
While on the surface this all may sound like another road block to getting to the stem cell cures we all want, the presentation actually made me optimistic that we are starting to learn enough about the field that we are more likely to get it right when we start to treat some of these devastating brain diseases.
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.
Success at the World Stem Cell Summit. This week some of the biggest names in regenerative medicine descended upon San Antonio, Texas for the annual summit. Along with researchers from the world’s top universities, institutions and companies were members of CIRM, including CIRM President and CEO C. Randall Mills.
We’ve been publishing top highlights from the Summit all week here on the Stem Cellar. There’s also been detailed coverage in the local San Antonio press, including the local ABC station. And if you’d like to find out more about this year’s conference, be sure to visit @WSCSummit and #WSC14 on Twitter.
Growing Spinal Cords in the Lab. Tissue engineering, the process of using stem cells to build new tissues and organs, has been the Holy Grail for regenerative medicine. And while there has been some progress with engineering some organs, others—especially the spinal cord—have proven far more difficult. This is because the biodegradable scaffolding cannot be made correctly to grow complex and intricately connected nerve cells.
But now, a research team in Germany has grown complete spinal cords in the lab, pointing to a new strategy for treating those with irreparable spinal cord injuries.
As reported in The Guardian this week, Andrea Meinhardt of the Dresden University of Technology and her colleagues worked around the problem of scaffolding by employing a new method called self-directed morphogenesis, first developed by the late Yoshiki Sasai. According to The Guardian‘s Mo Costandi:
“Self-directed morphogenesis is a method for growing embryonic stem cells in a three-dimensional suspension. Cells grown in this way can, when fed the right combination of signaling molecules, go through the motions of development and organize themselves to form complex tissues such as eyes, glands and bits of brain.”
While preliminary, this research offers immense promise towards the ultimate goal: reversing the devastating effects of spinal cord injuries.
Stem Cells and the NFL. Despite the best efforts of experts, stem cell tourism continues to proliferate. A new study published this week in 2014 World Stem Cell Report (a special supplement to Stem Cells and Development) describes the latest example of people seeking unproven stem cell treatments: this time in the NFL.
New research from Rice University is suggesting that some NFL players are seeking out unproven stem cell treatments—oftentimes traveling abroad without fully understanding the risks. This poses serious problems not only for players but also for the NFL as a whole. As Co-lead author Kirsten Matthews elaborated in a news release:
“With the rise of new and unproven stem cell treatments, the NFL faces a daunting task of trying to better understand and regulate the use of these therapies in order to protect the health of its players.”
Specifically, 12 NFL players are known to have received unproven treatments at some point during the last five years, including star quarterback Peyton Manning who we’ve blogged about before The authors caution that high-profile players broadcasting that they are receiving these unproven therapies could influence regular patients who are also desperate for cures.
In order to fix this growing problem, the authors recommend the NFL review and investigate these unproven stem cell treatments with the help of an independent committee of medical professionals. Finally, they suggest that the NFL could support stem cell research here in the United States—so that proven, effective stem cell-based treatments could more quickly enter the clinic.
Just a day and a half into this year’s World Stem Cell Summit in San Antonio and there have been numerous highlights. But a pair of sessions on gene editing grabbed the attention of many of the scientists at the meeting. One of the renown leaders in the field, Harvard’s George Church wowed the scientists, but I fear the heavy dose of scientific detail may have overwhelmed many of the patient advocates that make the attendee mix at this meeting special.
In 2013, Church first published results using a new gene-editing tool he helped perfect called CRISPR, and almost immediately it became the most talked-about tool for advancing stem cell research. As powerful as stem cells may be by themselves, in many situations, they become even more powerful—especially if you use them to deliver a gene that corrects an error in a patient’s cells. Before 2013 we had a few ways to edit genes in living cells and all were modestly effective at making the desired change and relatively specific in making only a few unwanted changes, called “off target” edits.
In some uses, particularly when cells are being modified in the lab for specific and small targets, these other editing techniques are probably OK. This is what several CIRM-funded teams (links) are doing with diseases like sickle cell anemia and HIV, where you can target blood-forming stem cells and even giving a small percentage the proper gene edit may be sufficient to cure the disease. But with something like muscular dystrophy where the gene editing would be required throughout the body and have to be done in the patient not in the lab, you need to improve the efficiency and precision.
After that first publication CRISPR was viewed as a home run in efficiency, taking the number of cells with the gene correction from a few percent to 50 percent or more. But it still had off-target effects. Yet only a year after the technology was introduced, a few teams developed so-called “next generation” CRISPR that comes close to perfect precision, causing an unintended edit in just one in a billion cells, by Church’s estimate.
I have never seen the full name of CRISPR spelled out in a scientific presentation, and after a visit to Wikipedia I know why. Here it is: Clustered Regularly Interspersed Short Palindromic Repeats. Basically, Church took advantage of something that occurs naturally in many bacteria. Just as we are susceptible to viruses, bacteria have their version known as phages. When those parasites integrate their DNA into the bacteria’s genes, part of the bacterial DNA forms CRISPRs that can partner with a protein called Cas to cut the phage DNA and keep the phage from hurting the host bacteria.
In a research setting, creating that “nick” in the DNA is the first step in harnessing CRISPR to insert a desired gene. So, that extreme precision in finding spots on our DNA where we want to create an opening for inserting a new gene became this valuable research tool. It can create a nick as precise as a single nucleotide base, the building blocks of our DNA.
Church and two additional speakers gave detailed descriptions about how the technology has improved and how it is being used to model disease today and is expected to be used to treat disease in the near future. An exciting future is in store.
Nothing undermines the credibility of science and scientists more than the retraction a high profile paper. Earlier this year there was a prime example of that when researchers at one of Japan’s most prestigious research institutions, the Riken Center for Developmental Biology in Kobe, had to retract a study that had gathered worldwide attention. The study, about a new method for creating embryonic-like stem cells called stimulus triggered acquisition of pluripotency or STAP, was discredited after it was discovered that the lead author had falsified data.
The STAP incident drew international coverage and condemnation and raised the question, how common is this and what can be done to combat it? A panel discussion at the World Stem Cell Summit in San Antonio, Texas entitled “Reproducibility and rigor in research: What have we learned from the STAP debacle” tackled the subject head on.
Ivan Oransky, medical journalist and the co-founder of the website Retraction Watch posed the question “Does stem cell research have a retraction problem?” He says:
“The answer to my question is yes. But so does everyone else. All of science has a retraction problem, not just stem cells.”
Oransky says the number of retractions has doubled from 2001 to 2010. One author has retracted 183 times – the record so far – but to break into the top 5 you need to have at least 50 retractions. These come from all over the world from the US to Germany and Japan and most recently Azerbaijan.
Oransky says part of the problem is the system itself. Getting your research results published is critical to advancing a career in science and those kinds of pressures force people to cut corners, take risks or even just falsify data and manipulate images in order to get a paper into a high profile journal. In most cases, journals charge a fee of several hundred to thousands of dollars to publish studies, so they have no incentive to dig too deeply into findings looking for flaws, as it might undermine their own business model.
“Some authors, more than 100, have been caught reviewing their own papers. When the journal they were submitting their paper to asked for the names of recommended reviewers they would submit the names of people who are legitimate reviewers in the field but instead of giving real email addresses they would give fake email addresses, ones they controlled so they could submit their own reviews under someone else’s name.”
What gave them away is that all the potential “reviewers” didn’t first reply and say “yes, I’ll review”, instead they responded by sending back a full review of the paper, raising suspicions and ultimately to detection.
Graham Parker, a researcher at Wayne State University School of Medicine and the editor of Stem Cell and Development says spotting the problem is not always easy:
“As an editor I regard scientific misconduct as fabrication, falsification or plagiarism of data but there are lots of other areas where it’s not always so clear – there are often shades of gray”
He says researchers may make an honest mistake, or include duplicative images and in those cases should be allowed to fix the problems without any stigma attached. But when serious cases of falsification of data are uncovered they can have a big impact by retarding scientific progress and sapping public confidence in the field as a whole.
Jeanne Loring, a stem cell scientist at The Scripps Research Institute and a recipient of funding from CIRM, says the STAP incident was actually a sign of progress in this area. Ten years ago when a Korean researcher named Hwang Woo-Suk claimed to have cloned human embryos it took more than a year before he was found to have falsified the data. But in the STAP case it took a little over a week for other researchers to start raising red flags:
“One of the real heroes in this story is Paul Knoepfler (a CIRM-funded researcher at UC Davis) who takes on difficult issues in his blog. It took Paul just 8 days to post a request for people to crowdsource this study, asking people who were trying to replicate the findings to report their results – and they did, showing they failed over and over again”
Parker said it’s getting easier for editors and others in the field to double check data in studies. For example new software programs allow him to quickly check submitted manuscripts for plagiarism. And he says there is a growing number of people who enjoy looking for problems.
“Nowadays it’s so easy for people to dig very deeply into papers and check up on every aspect of it, from the content to the methodology to the images they use and whether those images were in any way manipulated to create a false impression. Once they find a problem with one paper they’ll dig back through papers in that scientist’s past to see if they can find other problems dating back years that were never found at the time.”
He says that in most cases researchers caught falsifying data or deliberately misleading journals faced few consequences:
“Often the consequences of misconduct are very mild, the equivalent of a slap on the wrist, which does not discourage others from trying to do the same.”
Each panel member says that tougher penalties are needed. For example, in extreme cases a threat of criminal action could be warranted, if the falsified research could lead to serious consequences for patients.
But the panel ended on an encouraging note. Oransky says, for example, that medical journals are now paying more attention and imposing stricter rules and he says there’s even scientific evidence that “doing the right thing might pay off.”
“One study recently showed that if you made an honest error and corrected it publicly not only does the stigma of retraction not apply to you, you don’t get a decrease in your citations—you actually get an increase. So we’d like to think that doing the right thing is a good thing and might actually be a positive thing.”