CIRM invests $1.3 million to study stem cells in metabolic liver disease

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Dr. Tracy Grikscheit. Image courtesy of Children’s Hospital LA.

Metabolic liver disease, is an emerging public health concern in Western countries, but has largely been overshadowed by health issues such as cancer and diabetes. Chronic liver disease (of which metabolic liver disease is a significant contributor) however, is a significant public health concern, evidenced by its contribution to nearly 2 million deaths per year worldwide.

The primary treatment option for metabolic liver disease is a liver transplant. In fact, of the liver transplants performed every year, 14% are due to damage associated with metabolic disorders. With any organ transplant, however, such a procedure comes with drawbacks, the most frustrating of which is the need for patients to wait for an organ donor.

As transplants are not a reasonable or feasible option for many people, alternative treatment options are necessary.  Enter Dr. Tracy Grikscheit, a doctor-scientist at the Children’s Hospital Los Angeles, who hopes to make liver transplant a thing of the past for the millions of people who live with metabolic liver disease.

Dr. Grikscheit was awarded a $1.3 million grant to study how stem cells can be used to treat liver disease caused by metabolic disorders. In a press release, Dr. Grikscheit details the importance and practicality of using stem cells to treat liver disease:

“Liver-based metabolic diseases are the perfect starting point to apply cellular therapy to liver disorders. The only current therapy — a liver transplant — is costly and in short supply. Plus, it requires suppressing the patient’s immune system, which has long-term consequences.”

The project, termed UPLiFT for Universal Pluripotent Stem Cell Therapy, aims to use pluripotent stem cells (cells that can turn into any cell in the body) to correct liver associated disorders like Crigler-Najjar Syndrome. A genetic mutation in liver cells of these patients makes them unable to covert bilirubin (a byproduct of red blood cell degradation) to its non-toxic form. Dr. Grikscheit hopes to bypass the need for a liver transplant by giving these patients pluripotent stem cells that can become liver cells without the genetic mutation, and are able to convert bilirubin to its non-toxic form. The use of pluripotent stem cells would also potentially eliminate the need for lifelong immunosuppressive therapy

Dr. Grikscheit will use the CIRM grant to test safety and efficacy of the stem cell treatment in pre-clinical trials to determine the optimal cell dosage that will be both safe and relieve disease symptoms, as well as assessing any off-target effects of the treatment. She has previously received a grant from CIRM to study stem cell therapy options for digestive neuromuscular condition, which you can read about here.

 

Stories that caught our eye: Is a Texas law opening up access to stem cell treatments working? Another CIRM-funded company gets good news from the FDA.

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Texas Capitol. (Shutterstock)

In 2017 Texas passed a sweeping new law, HB 810, which allowed medical clinics to provide “investigational stem cell treatments to patients with certain severe chronic diseases or terminal illnesses.” Those in favor of the law argued that patients battling life-threatening or life-changing diseases should have the right to try stem cell therapies that were involved in a clinical trial.

Now a new study, published in the journal Stem Cells and Development, looks at the impact of the law. The report says that despite some recent amendments t there are still some concerns about the law including:

  • It allows treatment only if the patient has a “severe, chronic” illness but doesn’t define what that means
  • It doesn’t have clearly defined procedures on tracking and reporting procedures so it’s hard to know how many patients might be treated and what the outcomes are
  • There is no Food and Drug Administration (FDA) oversight of the patients being treated
  • Because the treatments are unproven there are fears this will “open up the state to unsavory and predatory practices by individuals preying on vulnerable patients”

The researchers conclude:

“While HB 810 opens up access to patients, it also increases significant risks for their safety and financial cost for something that might have no positive impact on their disease. Truly understanding the impact of stem cell based interventions (SCBI) requires scientific rigor, and accurate outcome data reporting must be pursued to ensure the safety and efficacy behind such procedures. This information must be readily available so that patients can make informed decisions before electing to pursue such treatments. The creation of the SCBI registry could allow for some level of scientific rigor, provide a centralized data source, and offer the potential for better informed patient choices, and might be the best option for the state to help protect patients.”

Another CIRM-funded company gets RMAT designation

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When Congress approved the 21st Century Cures Act a few years ago one of the new programs it created was the Regenerative Medicine Advanced Therapy (RMAT) designation. This was given to therapies that are designed to treat a serious or life-threatening condition, where early clinical stage trials show the approach is safe and appears to be effective.

Getting an RMAT designation is a big deal. It means the company or researchers are able to apply for an expedited review by the FDA and could get approval for wider use.

This week Poseida Therapeutics was granted RMAT designation by the Food and drug Administration (FDA) for P-BCMA-101, its CAR-T therapy for relapsed/refractory multiple myeloma. This is currently in a Phase 1 clinical trial that CIRM is funding

In this trial Poseida’s technology takes an immunotherapy approach that uses the patient’s own engineered immune system T cells to seek and destroy cancerous myeloma cells.

In a news release Eric Ostertag, Poseida’s CEO, welcomed the news:

“Initial Phase 1 data presented at the CAR-TCR Summit earlier this year included encouraging response rates and safety data, including meaningful responses in a heavily pretreated population. We expect to have an additional data update by the end of the year and look forward to working closely with the FDA to expedite development of P-BCMA-101.”

This means that five CIRM-funded companies have now been granted RMAT designations:

Using blood stem cells as delivery vehicles to weed out hidden cancer cells

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Most stem cell research is focused on finding ways to make stem cells become particular cell types to treat different diseases. Scientists at the UCLA Samueli School of Engineering, however, have found an atypical use for blood stem cells: delivery vehicles.

Zhen Gu’s group wanted to test a new way to treat acute myeloid leukemia (AML). AML, one of the most common types of leukemia in adults, is tricky to treat because cancerous cells can remain in the bone marrow hidden from chemotherapy drugs. This reserve population can reactivate and cause cancer that is much more difficult to control than the initial manifestation.

To solve this problem, the scientists hooked up the cancer treatment molecule (a protein that turns immune cells on to fight cancer cells) to blood stem cells and platelets. Because blood stem cells are naturally able to enter the bone marrow (this is where blood stem cells become the many different types of cells of the immune system), the investigators reasoned that this system would deliver the cancer drug to the quiescent cancer cells. Platelets were utilized in the system to aid delivery to the correct cells.

Indeed, when they tested this system in AML mice, 87.5% of them survived for over two months, whereas the mice that were given the cancer drug without the complete delivery system survived less than half of that time. In addition, the drug delivery complex made the mice more resistant to becoming sick when they were artificially injected with leukemia cells. The complete results of their study were published in the journal Nature Biomedical Engineering.

This approach is particularly exciting because although bioengineered cells have been used in drug delivery, this is the first time that two different cell types have been using in conjunction to achieve this goal.

There are certainly many steps before this type of treatment can be used in patients, but Gu is optimistic that this treatment will be successfully expanded to humans. In an article, he also states his hope that this strategy can be incorporated into existing treatment options:

 “We can package medicines or immune system boosters on the cell surface of platelets, and have them activated to unload once at the target site inside the body.”

The Sad Lane: How I navigated one of the happiest times of my life while my mom was losing hers to Alzheimer’s

In 1983 President Ronald Reagan named November as Alzheimer’s Awareness month, to raise awareness about the growing impact the disease was having on Americans. At the time there were less than two million people with the disease. Today that number has grown to more than five million and is expected to reach 16 million by the year 2050. There is no cure and no effective treatments.

To mark Alzheimer’s Awareness month we are reprinting an article that CIRM Board member and Patient Advocate for Alzheimer’s, Lauren Miller, wrote for Lenny magazine, charting her own personal journey with the disease.

The Sad Lane

Stories that caught our eye: SanBio’s Traumatic Brain Injury trial hits its target; A new approach to endometriosis; and a SCID kid celebrates Halloween in style

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Traumatic brain injury: graphic courtesy Brainline.org

Hopeful signs for treating brain injuries

There are more than 200,000 cases of traumatic brain injury (TBI) in the US every year. The injuries can be devastating, resulting in everything from difficult sleeping to memory loss, depression and severe disability. There is no cure. But this week the SanBio Group had some encouraging news from its Phase 2 STEMTRA clinical trial.

In the trial patients with TBI were given stem cells, derived from the bone marrow of healthy adult donors. When transplanted into the area of injury in the brain, these cells appear to promote recovery by stimulating the brain’s own regenerative ability.

In this trial the cells demonstrated what the company describes as “a statistically significant improvement in their motor function compared to the control group.”

CIRM did not fund this research but we are partnering with SanBio on another clinical trial targeting stroke.

 

Using a woman’s own cells to heal endometriosis

Endometriosis is an often painful condition that is caused when the cells that normally line the inside of the uterus grow outside of it, causing scarring and damaging other tissues. Over time it can result in severe pain, infertility and increase a woman’s risk for ovarian cancer.

There is no effective long-term treatment but now researchers at Northwestern Medicine have developed an approach, using the woman’s own cells, that could help treat the problem.

The researchers took cells from women, turned them into iPS pluripotent stem cells and then converted those into healthy uterine cells. In laboratory tests these cells responded to the progesterone, the hormone that plays a critical role in the uterus.

In a news release, Dr. Serdar Bulun, a senior author of the study, says this opens the way to testing these cells in women:

“This is huge. We’ve opened the door to treating endometriosis. These women with endometriosis start suffering from the disease at a very early age, so we end up seeing young high school girls getting addicted to opioids, which totally destroys their academic potential and social lives.”

The study is published in the journal Stem Cell Reports.

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Happy Halloween from a scary SCID kid

A lot of the research we write about on the Stem Cellar focuses on potential treatments or new approaches that show promise. So every once in a while, it’s good to remind ourselves that there are already stem cell treatments that are not just showing promise, they are saving lives.

That is the case with Ja’Ceon Golden. Regular readers of our blog know that Ja’Ceon was diagnosed with Severe Combined Immunodeficiency (SCID) also known as “bubble baby disease” when he was just a few months old. Children born with SCID often die in the first few years of life because they don’t have a functioning immune system and so even a simple infection can prove life-threatening.

Fortunately Ja’Ceon was enrolled in a CIRM-funded clinical trial at UC San Francisco where his own blood stem cells were genetically modified to correct the problem.

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Today he is a healthy, happy, thriving young boy. These pictures, taken by his great aunt Dannie Hawkins, including one of him in his Halloween costume, show how quickly he is growing. And all thanks to some amazing researchers, an aunt who wouldn’t give up on him, and the support of CIRM.

Living with sickle cell disease: one person’s story of pain and prejudice and their hopes for a stem cell therapy

Whenever we hold an in-person Board meeting at CIRM we like to bring along a patient or patient advocate to address the Board. Hearing from the people they are trying to help, who are benefiting or may benefit from a therapy CIRM is funding, reminds them of the real-world implications of the decisions they make and the impact they have on people’s lives.

At our most recent meeting Marissa Coors told her story.

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Marissa Coors addressing the CIRM Board

My name is Marissa Coors, I have sickle cell disease. I was diagnosed with sickle cell disease at six months of age. I am now 40. Sickle cell has been a part of my life every day of my life.

The treatments you are supporting and funding here at CIRM are very important. They offer a potential cure to a disease that desperately needs one. I want to tell you just how urgently people with sickle cell need a cure.

I have been hospitalized so many times that my medical record is now more than 8 gigabytes. I have almost 900 pages in my medical record from my personal doctor alone.

I live with pain every day of my life but because you can’t see pain most people have no idea how bad it can be. The pain comes in two forms:

Chronic pain – this comes from the damage that sickle cell disease does to the body over many years. My right knee, my left clavicle, my lower back are all damaged because of the disease. I get chronic headaches. All these are the result of a lifetime of crisis.

Acute pain – this is the actual crisis that can’t be controlled, where the pain is so intense and the risk of damage to my organs so great that it requires hospitalization. That hospitalization can result in yet more pain, not physical but emotional and psychological pain.

But those are just the simple facts. So, let me tell you what it’s really like to live with sickle cell disease.

Marissa at ICOC front, smiling

It means being in a constant state of limbo and a constant state of unknown because you have no idea when the next crisis is going to come and take over and you have to stop your life. You have absolutely no idea how bad the pain will be or how long it will last.

It is a constant state of frustration and upset and even a constant state of guilt because it is your responsibility to put in place all the safety nets and plans order to keep life moving as normally as possible, not just for you but for everyone else around you. And you know that when a crisis comes, and those plans get ripped up that it’s not just your own life that gets put on hold while you try to deal with the pain, it’s the lives of those you love.

It means having to put your life on hold so often that it’s hard to have a job, hard to have a career or lead a normal life. Hard to do the things everyone else takes for granted. For example, in my 30’s, while all my friends from home and college were building careers and getting married and having families, I was in a cancer ward trying to stay alive, because that’s where they put you when you have sickle cell disease. The cancer ward.

People talk about new medications now that are more effective at keeping the disease under control. But let me tell you. As a black woman walking into a hospital Emergency Room saying I am having a sickle cell crisis and need pain medications, and then naming the ones I need, too often I don’t get treated as a patient, I get treated as a drug addict, a drug seeker.

Even when the doctors do agree to give me the medications I need they often act in a way that clearly shows they don’t believe me. They ask, “How do we know this is a crisis, why is it taking you so long for the medication to take effect?” These are people who spent a few days in medical school reading from a textbook about sickle cell disease. I have spent a lifetime living with it and apparently that’s still not enough for them to trust that I do know what I am talking about.

That’s when I usually say, “Goodbye and don’t forget to send in your replacement doctor because I can’t work with you.”

I have had doctors take away my medication because they wanted to see how I would react without it.

If I dare to question what a doctor or nurse does, they frequently tell me they have to go and take care of other patients who are really sick, not like me.

Even when I talk in my “nice white lady” voice they still treat me and call me “an angry black girl”. Girl. I’m a 40 year old woman but I get treated like a child.

It’s hard to be in the hospital surrounded by doctors and nurses and yet feel abandoned by the medical staff around you.

This month alone 25 people have died from sickle cell in the US. It’s not because we don’t have treatments that can help. It’s due to negligence, not getting the right care at the right time.

I know the work you do here at CIRM won’t change those attitudes. But maybe the research you support could find a cure for sickle cell, so people like me don’t have to endure the pain, the physical, emotional and spiritual pain, that the disease brings every day.

You can read about the work CIRM is funding targeting sickle cell disease, including two clinical trials, on this page on our website.

Mechanical forces are the key to speedy recovery after blood cancer treatment

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Mesenchymal stem cells grown on a surface with specialized mechanical properties. Image courtesy of Krystyn Van Vliet at MIT.

Blood cancers, such as leukemia and lymphoma, are projected to be responsible for 10% of all new cancer diagnoses this year. These types of cancers are often treated by killing the patient’s bone marrow (the site of blood cell manufacturing), with a treatment called irradiation. While effective for ridding the body of cancerous cells, this treatment also kills healthy blood cells. Therefore, for a time after the treatment, patients are particularly vulnerable to infections, because the cellular components of the immune system are down for the count.

Now scientists at MIT have devised a method to make blood cells regenerate faster and  minimize the window for opportunistic infections.

Using multipotent stem cells (stem cells that are able to become multiple cell types) grown on a new and specialized surface that mimics bone marrow, the investigators changed the stem cells into different types of blood cells. When transplanted into mice that had undergone irradiation, they found that the mice recovered much more quickly compared to mice given stem cells grown on a more traditional plastic surface that does not resemble bone marrow as well.

This finding, published in the journal Stem Cell Research and Therapy, is particularly revolutionary, because it is the first time researchers have observed that mechanical properties can affect how the cells differentiate and behave.

The lead author of the study attributes the decreased recovery time to the type of stem cell that was given to mice compared to what humans are normally given after irradiation. Humans are given a stem cell that is only able to become different types of blood cells. The mice in this study, however, were give a stem cell that can become many different types of cells such as muscle, bone and cartilage, suggesting that these cells somehow changed the bone marrow environment to promote a more efficient recovery. They attributed a large part of this phenomenon to a secreted protein call ostepontin, which has previously been describe in activating the cells of the immune system.

In a press release, Dr. Viola Vogel, a scientist not related to study, puts the significance of these findings in a larger context:

“Illustrating how mechanopriming of mesenchymal stem cells can be exploited to improve on hematopoietic recovery is of huge medical significance. It also sheds light onto how to utilize their approach to perhaps take advantage of other cell subpopulations for therapeutic applications in the future.”

Dr. Krystyn Van Vliet, explains the potential to expand these findings beyond the scope of just blood cancer treatment:

“You could imagine that by changing their culture environment, including their mechanical environment, MSCs could be used for administration to target several other diseases such as Parkinson’s disease, rheumatoid arthritis, and others.”

 

Stories Caught our Eye: Advances in Brain Radiotherapy, and a New Drug Discovery in Schizophrenia

Avoiding the hippocampus during whole-brain radiotherapy prevents cognitive side effects (Adonica Shaw)

Whole-brain radiotherapy can be delivered more safely to patients with brain metastases by avoiding the hippocampus according to a new phase III trial.

At the beginning of the study, scientists hypothesized that radiation to the hippocampal stem cells played a role in cognitive decline. 500 patients were randomized to whole brain radiotherapy, some with and without hippocampal avoidance. The results of the clinical trial found a 26% relative reduction in risk of cognitive toxicity following whole brain radiation therapy with hippocampal avoidance versus whole brain radiotherapy. The cognitive function benefit of hippocampal avoidance did not differ by age.

“This study demonstrates that we can deliver whole brain radiotherapy with similar cognitive outcomes as radiosurgery,” said lead author and co-principal investigator of the phase III trial Vinai Gondi, MD, director of research at the Northwestern Medicine Chicago Proton Center and co-director of the Brain Tumor Center at Northwestern Medicine Cancer Center Warrenville. “These trial results revolutionize our understanding of the cognitive effects of brain irradiation in a manner that has far-reaching implications in terms of the safer radiotherapy treatment of primary or metastatic brain tumors.”

Brain metastases, cancer cells that have spread to the brain from primary tumors in other organs, is one of the most common cancer conditions managed by radiation oncologists. Due to concerns about cognitive decline, whole brain radiotherapy is currently often the last resort, even though it is one of the most effective treatments for brain metastases.

By establishing that the hippocampal region is sensitive to radiation, treatment plans for brain metastases or other brain tumors can employ advanced techniques such as intensity-modulated radiation therapy (IMRT) or proton therapy to reduce dose to the hippocampus and offer brain therapy with less toxicity.

Better model to help speed up new drugs for schizophrenia (Kevin McCormack)

One of the problems in developing new treatments for diseases is finding a model that accurately reflects how a new treatment might work in people. Typically, we’ll test some new approach on a mouse model of a disease, to see if it is safe and works. But often what works in a mouse doesn’t work in people. Now a new study in the journal Nature Communications may have found a better model to test drugs for people with schizophrenia.

Right now, all antipsychotic drugs approved by the Food and Drug Administration (FDA) for schizophrenia target one specific dopamine receptor in the brain. Dopamine is a chemical that acts as a messenger in the brain and it’s thought that imbalances in this receptor are a leading cause of schizophrenia. However, around two-thirds of people with the condition don’t respond to the medications that target this receptor.

So, researchers at the Icahn School of Medicine at Mount Sinai, Eli Lilly and Company, and Sema4 thought that maybe a better way to test potential new medications would be on cells that came from people who actually have schizophrenia, rather than a mouse.

They took cells from 12 people with schizophrenia and 12 healthy people, and turned those cells into neural progenitor cells, the kind of brain cell affected by the disease. They then tested those cells against 135 different medications and found that the patient-derived cells provided lots more information about how those cells would affect someone with schizophrenia than traditional testing methods.

In a news release Adam Margolin, from the Icahn Institute, said these findings could have wider implications:

“This study nicely illustrates the importance of using an integrative genomics approach for improving drug discovery and, ultimately, patient care. The results should be immediately applicable not only to drug discovery for schizophrenia but also more broadly to a wide range of diseases for which more biologically relevant screening models are long overdue.

How stem cells may help children battling birth injuries

From time to time we invite patients or patient advocates to post a guest blog on the Stem Cellar. Today we are featuring Brigitta Burguess, a mother and writer from Michigan, who focuses on pregnancy, parenting, and children with disabilities. Brigitta writes for the HIE Help Center, a website that offers information and supportive resources for families of children with disabilities.

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Because stem cells are the building blocks of the immune system, they possess the ability to develop into other types of cells. You can use stem cells to help repair tissues, organs, and blood vessels, and even treat a host of different diseases. This is done through stem cell harvesting and stem cell therapy. In stem cell therapy, stem cells are injected into injured tissues in the hopes of replacing damaged tissue and preserving existing tissues.

Cord Blood

Every part of the human body contains stem cells. However, many areas of the body do not contain enough stem cells to make harvesting them worthwhile. Cord blood, the leftover blood collected from a baby’s umbilical cord or a mother’s placenta after birth, is especially beneficial because:

  • It provides a rich source of stem cells that can be changed into other types of cells and help to maintain and repair tissues
  • Its stem cells are immature and have not developed the ability to attack foreign cells, which makes them perfect for transplant
  • Its stem cells differ from embryonic stem cells in that they are considered adult stem cells and do not require the destruction of an embryo to harvest
  • It can be used to treat blood disorders, immune deficiencies, and certain cancers
  • Storing cord blood can help family and community members receive gene therapy treatment for the aforementioned conditions and diseases

The Applications of Stem Cell Therapy for Kids

Today, over 2,000 total cord blood stem cell transplants are performed annually, with the total number of cord blood banks worldwide reaching over 150. The innovations in stem cell therapy have made waves over the past four decades. Today, more than 80 difference diseases are being treated with cord blood stem cells.

In 2012, many clinical trials revealed that cord blood transplants were an effective treatment for cerebral palsy. Researchers also believe that cord blood stem cells have great potential in treating the neonatal brain injuries such as hypoxic-ischemic encephalopathy (HIE). As of right now, there is no indication that stem cell therapy can cure these conditions, but there is some evidence that it can lessen the severity of symptoms.

It is important to note that there is thus far no cure for hypoxic-ischemic encephalopathy (HIE) and resulting motor, cognitive, and/or intellectual disorders. Stem cell therapy seeks to limit the damage caused by HIE and reduce the severity of disabilities caused by HIE, but it is not a cure.

Because stem cell therapy is still in clinical trials, parents should think twice before going down this untested path, as no formal guidelines about administration protocol, dosages, safety, or treatment timeline have yet been established. Clinical trials are important for ensuring that treatments are safe and effective – unregulated treatments bear significant risk.

To learn more about stem cell therapy trials for hypoxic-ischemic encephalopathy, please visit the National Institute of Health’s (NIH) Clinical Trial Recruitment Center.

 

Research Transforming Mature Neurons into Dopamine Factories could Help Fight Brain Diseases

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Researchers accidentally converted mature neurons into dopaminergic cells (in green) without first reverting them to a stem-cell state. (Lei-Lei Wang/UT Southwestern)

A team of researchers at the University of Texas Southwestern Medical Center made a startling discovery that could improve patient outcomes for neurological diseases.

And they did it completely by accident.

Scientists have long believed that turning one type of mature cell into another is impossible without first reverting the original cell back into a stem cell. So, the group set out to make dopamine-producing neurons (the kind of cell destroyed in Parkinson’s disease) out of glial cells (support cells in the brain and spinal cord) in live mouse brains. But according to results published in the journal Stem Cell Reports, they instead turned the mature neurons into dopaminergic neuron-like cells. They believe their inadvertent discovery could be used to treat diseases of the brain and spinal cord.

Dopaminergic neurons in the brain produce dopamine, which is important for controlling voluntary movement and the motivation-reward system that drives behavior. The loss of these cells has been linked to disorders like Parkinson’s disease, and scientists are on the hunt for new methods of replenishing these vital neurons.

Glial cells, which surround neurons and provide protective support, can regenerate and multiply easily, thus making them better candidates as potential neuron replacement therapies. That’s why Zhang and his team targeted them in the first place.

They injected a mixture of cell reprogramming promoters into a part of a mouse’s brain called the striatum.

To the team’s dismay, the glia remained unchanged; instead, so-called GABAergic medium spiny neurons that are plentiful within the striatum—and key in controlling movements—had transformed into cells that behaved like dopaminergic neurons. These new cells displayed rhythmic activity and formed network connections, much like dopaminergic cells do. Most importantly, the team found that the new cells came into being without passing through a stem cell-like transition phase.

“To our knowledge, changing the phenotype of resident, already-mature neurons has never been accomplished before,” said Zhang in a statement. “This could mean that no cell type is fixed even for a functional, mature neuron.”

Zhang believes UT Southwestern’s new discovery should be further investigated for the treatment of Parkinson’s and related disorders. “Such knowledge may one day be applied to devise therapeutic strategies for treating neurological diseases through reprogramming the phenotype of local neurons,” the team wrote in the study.