CIRM invests in stem cell clinical trial targeting lung cancer and promising research into osteoporosis and incontinence

Lung cancer

Lung cancer: Photo courtesy Verywell

The five-year survival rate for people diagnosed with the most advanced stage of non-small cell lung cancer (NSCLC) is pretty grim, only between one and 10 percent. To address this devastating condition, the Board of the California Institute for Regenerative Medicine (CIRM) today voted to invest almost $12 million in a team from UCLA that is pioneering a combination therapy for NSCLC.

The team is using the patient’s own immune system where their dendritic cells – key cells in our immune system – are genetically modified to boost their ability to stimulate their native T cells – a type of white blood cell – to destroy cancer cells.  The investigators will combine this cell therapy with the FDA-approved therapy pembrolizumab (better known as Keytruda) a therapeutic that renders cancer cells more susceptible to clearance by the immune system.

“Lung cancer is a leading cause of cancer death for men and women, leading to 150,000 deaths each year and there is clearly a need for new and more effective treatments,” says Maria T. Millan, M.D., the President and CEO of CIRM. “We are pleased to support this program that is exploring a combination immunotherapy with gene modified cell and antibody for one of the most extreme forms of lung cancer.”

Translation Awards

The CIRM Board also approved investing $14.15 million in four projects under its Translation Research Program. The goal of these awards is to support promising stem cell research and help it move out of the laboratory and into clinical trials in people.

Researchers at Stanford were awarded almost $6 million to help develop a treatment for urinary incontinence (UI). Despite being one of the most common indications for surgery in women, one third of elderly women continue to suffer from debilitating urinary incontinence because they are not candidates for surgery or because surgery fails to address their condition.

The Stanford team is developing an approach using the patient’s own cells to create smooth muscle cells that can replace those lost in UI. If this approach is successful, it provides a proof of concept for replacement of smooth muscle cells that could potentially address other conditions in the urinary tract and in the digestive tract.

Max BioPharma Inc. was awarded almost $1.7 million to test a therapy that targets stem cells in the skeleton, creating new bone forming cells and blocking the destruction of bone cells caused by osteoporosis.

In its application the company stressed the benefit this could have for California’s diverse population stating: “Our program has the potential to have a significant positive impact on the lives of patients with osteoporosis, especially in California where its unique demographics make it particularly vulnerable. Latinos are 31% more likely to have osteoporosis than Caucasians, and California has the largest Latino population in the US, accounting for 39% of its population.”

Application Title Institution CIRM funding
TRAN1-10958 Autologous iPSC-derived smooth muscle cell therapy for treatment of urinary incontinence

 

 

Stanford University

 

$5,977,155

 

TRAN2-10990 Development of a noninvasive prenatal test for beta-hemoglobinopathies for earlier stem cell therapeutic interventions

 

 

Children’s Hospital Oakland Research Institute

 

$1,721,606

 

TRAN1-10937 Therapeutic development of an oxysterol with bone anabolic and anti-resorptive properties for intervention in osteoporosis  

MAX BioPharma Inc.

 

$1,689,855

 

TRAN1-10995 Morphological and functional integration of stem cell derived retina organoid sheets into degenerating retina models

 

 

UC Irvine

 

$4,769,039

 

Stem Cell Roundup: Backup cells to repair damaged lungs; your unique bowels; and California Cures, 71 ways CIRM is changing the face of medicine

It’s good to have a backup plan

3D illustration of Lungs, medical concept.

Our lungs are amazing things. They take in the air we breathe and move it into our blood so that oxygen can be carried to every part of our body. They’re also surprisingly large. If you were to spread out a lung – and I have no idea why you would want to do that – it would be almost as large as a tennis court.

But lungs are also quite vulnerable organs, relying on a thin layer of epithelial cells to protect them from harmful materials in the air. If those materials damage the lungs our body calls in local stem cells to repair the injury.

Now researchers at the University of Iowa have identified a new group of stem cells, called glandular myoepithelial cells (MECs), that also appear to play an important role in repairing injuries in the lungs.

These MECs seem to be a kind of “reserve” stem cell, waiting around until they are needed and then able to spring into action and develop into new replacement cells in the lungs.

In a news release study author Preston Anderson, said these cells could help develop new approaches to lung regeneration:

“We demonstrated that MECs can self-renew and differentiate into seven distinct cell types in the airway. No other cell type in the lung has been identified with this much stem cell plasticity.”

The study is published in Cell Stem Cell.

Your bowels are unique

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Not to worry, that’s a plastic model of  a bowel

If you are eating as you read this, you should either put your food down or skip this item for now. A new study on bowel cancer says that every tumor is unique and every cell within that tumor is also genetically unique.

Researchers in the UK and Netherlands took samples of normal bowel tissue and cancerous bowel tissue from three people with colorectal cancer. They then grew these in the labs and turned them into mini 3D organoids, so they could study them in greater detail.

In the study, published in the journal Nature, the researchers say they found that tumor cells, not surprisingly, had many more mutations than normal cells, and that not only was each bowel cancer genetically different from each other, but that each cell they studied within that cancer was also different.

In a news release, Prof Sir Mike Stratton, joint corresponding author on the paper from the Wellcome Sanger Institute, said:

“This study gives us fundamental knowledge on the way cancers arise. By studying the patterns of mutations from individual healthy and tumour cells, we can learn what mutational processes have occurred, and then look to see what has caused them. Extending our knowledge on the origin of these processes could help us discover new risk factors to reduce the incidence of cancer and could also put us in a better position to create drugs to target cancer-specific mutational processes directly.”

California Cures: a great title for a great book about CIRM

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CIRM Board Chair Jonathan Thomas (L) and Don Reed

One of the first people I met when I started working at CIRM was Don Reed. He impressed me then with his indefatigable enthusiasm, energy and positive outlook on life. Six years later he is still impressing me.

Don has just completed his second book on stem cell research charting the work of CIRM. It’s called “California Cures: How the California Stem Cell Research Program is Fighting Your Incurable Disease”. It’s a terrific read combining stories about stem cell research with true tales about Al Jolson, Enrico Caruso and how a dolphin named Ernestine burst Don’s ear drum.

On his website, Stem Cell Battles, Don describes CIRM as a “scrappy little stage agency” – I love that – and says:

“No one can predict the pace of science, nor say when cures will come; but California is bringing the fight. Above all, “California Cures” is a call for action. Washington may argue about the expense of health care (and who will get it), but California works to bring down the mountain of medical debt: stem cell therapies to ease suffering and save lives. We have the momentum. We dare not stop short. Chronic disease threatens everyone — we are fighting for your family, and mine!”

 

East Coast Company to Sell Research Products Derived from CIRM’s Stem Cell Bank

With patient-derived induced pluripotent stem cells (iPSCs) in hand, any lab scientist can follow recipes that convert these embryonic-like stem cells into specific cell types for studying human disease in a petri dish. iPSCs derived from a small skin sample from a Alzheimer’s patient, for instance, can be specialized into neurons – the kind of cell affected by the disease – to examine what goes wrong in an Alzheimer’s patient’s brain or screen drugs that may alleviate the problems.

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Neurons created from Alzheimer’s disease patient-derived iPSCs.
Image courtesy Elixirgen Scientific

But not every researcher has easy access to a bank of patient-derived iPSCs and it’s not trivial to coax iPSCs to become a particular cell type. The process is also a time sink and many scientists would rather spend that time doing what they’re good at: uncovering new insights into their disease of interest.

Since the discovery of iPSC technology over a decade ago, countless labs have worked out increasingly efficient variations on the original method. In fact, companies that deliver iPSC-derived products have emerged as an attractive option for the time-strapped stem cell researcher.

One of those companies is Elixirgen Scientific of Baltimore, Maryland. Pardon the pun but Elixirgen has turned the process of making various cell types from iPSCs into a science. Here’s how CEO Bumpei Noda described the company’s value to me:

Bumpei-Noda-200

Bumpei Noda

“Our technology directly changes stem cells into the cells that make up most of your body, such as muscle cells or neural cells, in about one week. Considering that existing technology takes multiple weeks or even months to do the same thing, imagine how much more research can get done than before.”

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With Elixirgen’s technology, different “cocktails” of ingredients can quickly and efficiently turn iPSCs into many different human cell types. Image courtesy Elixirgen Scientific

Their technology is set to become an even greater resource for researchers based on their announcement yesterday that they’ve signed a licensing agreement to sell human disease cells that were generated from CIRM’s iPSC Repository.

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Stephen Lin

“The CIRM Repository holds the largest publicly accessible collection of human iPSCs in the world and is the result of years of coordinated efforts of many groups to create a leading resource for disease modeling and drug discovery using stem cells,” said Stephen Lin, a CIRM Senior Science Officer who oversees the cell bank.

 

The repository currently contains a collection of 1,600 cell lines derived from patients with diseases that are a source of active research, including autism, epilepsy, cerebral palsy, Alzheimer’s disease, heart disease, lung disease, hepatitis C, fatty liver disease, and more (visit our iPSC Repository web page for the complete list).

While this wide variety of patient cells lines certainly played a major role in Elixirgen’s efforts to sign the agreement, Noda also noted that the CIRM Repository “has rich clinical and demographic data and age-matched control cell lines” which is key information to have when interpreting the results of experiments and drug screening.

Lin also points out another advantage to the CIRM cells:

“It’s one of the few collections with a streamlined route to commercialization (i.e. pre-negotiated licenses) that make activities like Elixirgen’s possible. iPSC technology is still under patent and technically cannot be used for drug discovery without those legal safeguards. That’s important because if you do discover a drug using iPSCs without taking care of these licensing agreements, your discovery could be owned by that original intellectual property holder.”

At CIRM, we’re laser-focused on accelerating stem cell treatments to patients with unmet medical needs. That’s why we’re excited that Elixirgen Scientific has licensed access to the our iPSC repository. We’re confident their service will help researchers work more efficiently and, in turn, accelerate the pace of new discoveries.

Bioengineers make breathtaking step toward building a lung

Tissue engineers have made amazing progress when it comes to using stem cells to build tissues such as blood vessels, which have relatively simple tubular shape. In fact, a late stage CIRM-funded clinical trial run by Humacyte is testing an engineered vein to improve dialysis treatment for people with kidney disease. Building a lung that works properly, on the other hand, has proven elusive due in no small part to its extremely intricate structure. But in a Science Advances report published yesterday, Columbia University bioengineers describe a potentially breakthrough method for building a functional lung in the lab.

Building a better lung that removes and repopulates lung cells without hurting blood vessels. Figure courtesy of N. Valerio Dorrello and Gordana Vunjak-Novakovic, Columbia University.

Lung disease tends to not get as much attention as other deadly diseases like cancer and heart failure. Yet it’s the world’s third leading cause of death with 400,000 deaths per year in just the United States. The only true treatment is a very drastic one: a lung transplant. This option is not very attractive even to those with severe disease because it’s a very expensive procedure that only has a 10-20% survival rate after 10 years. On top of that, donor lungs are in very short supply. So, clinicians and their patients are in desperate need for other approaches.

Tissue engineering approaches to building a lung face many challenges due to the organ’s complex structure. How complex, you ask? Science writer and scientist, Shelly Fan, uses a great analogy to describe it in her Singularity Hub article about this study:

“The lung is a real jungle: at the microscopic level, the tree-like airways contain alveoli, tiny bubble-like structures where the lungs exchange gas with our blood. Both arteries and veins enwrap the alveoli like two sets of mesh pockets.”

Now, one approach to building an organ is to start from scratch by manufacturing a synthetic scaffold resembling the shape of the organ and then seeding it with stem cells or other precursor cells. But because of this complicated microscopic jungle, bioengineers have steered clear of this path. Instead, the Columbia team has generated a natural scaffold by removing the cells from rat lungs using detergents. What’s left behind is a lung “skeleton” of proteins and molecules called the extracellular matrix that’s devoid of cells.

Building a better lung that removes and repopulates lung cells without hurting blood vessels. Figure courtesy of N. Valerio Dorrello and Gordana Vunjak-Novakovic, Columbia University.

In previous experiments using rat lungs, the team stripped out the lung cells, called epithelial cells, which are the type typically damaged in lung disease. Their method also removed the blood vessel cells, called endothelial cells, which make up the vascular system that is key to taking up the oxygen inhaled into the lungs. While repopulating the functional epithelial cells has been achieved, restoring the blood vessels is another story as mentioned in a university press release:

“An intact vascular network—missing in these scaffolds—is critical not only for maintaining the blood-gas barrier and allowing for proper graft function, but also for supporting the cells introduced to regenerate the lung. This has proved to be a daunting challenge.”

So, the current study attempted to only clear out the lung epithelial cells without disturbing the blood vessels to see if they would have better results. This approach makes sense on another level when envisioning future clinical applications: the therapy would be less complex if you only had to remove the diseased cells, which typically are the lung epithelial cells.

The researchers devised a cell removal method that was specific to the airways so that only epithelial cells would be cleared away. A battery of tests showed that, that although the lungs lost much of their ability to inflate and expand, the blood system remained intact after the procedure. The team then introduced either human epithelial cells or human induced pluripotent stem cell-derived epithelial cells into the scaffold. Within a day, they watched as the cells began to repopulate the lung in the correct areas. Follow-up experiments showed that the addition of new epithelial cells restored a good portion of the lungs expansion abilities.

Lead author, Dr. N. Valerio Dorrello, gave a big picture perspective on how this proof-of-concept study could one day help those who suffer from lung disease:

Nicolino Valerio Dorrello, MD

“Every day, I see children in intensive care with severe lung disease who depend on mechanical ventilation support. The approach we established could lead to entirely new treatment modalities for these patients, designed to regenerate lungs by treating their injured epithelium.”

Stem cell stories that caught our eye: new baldness treatments?, novel lung stem cells, and giraffe stem cells

Novel immune system/stem cell interaction may lead to better treatments for baldness. When one thinks of the immune system it’s usually in terms of the body’s ability to fight off a bad cold or flu virus. But a team of UCSF researchers this week report in Cell that a particular cell of the immune system is key to instructing stem cells to maintain hair growth. Their results suggest that the loss of these immune cells, called regulatory T cells (Tregs for short), may be the cause of baldness seen in alopecia areata, a common autoimmune disorder and may even play a role in male pattern baldness.

Alopecia, a common autoimmune disorder that causes baldness. Image: Shutterstock

While most cells of the immune system recognize and kill foreign or dysfunctional cells in our bodies, Tregs act to subdue those cells to avoid collateral damage to perfectly healthy cells. If Tregs become impaired, it can lead to autoimmune disorders in which the body attacks itself.

The UCSF team had previously shown that Tregs allow microorganisms that are beneficial to skin health in mice to avoid the grasp of the immune system. In follow up studies they intended to examine what happens to skin health when Treg cells were inhibited in the skin of the mice. The procedure required shaving away small patches of hair to allow observation of the skin. Over the course of the experiment, the scientists notice something very curious. Team lead Dr. Michael Rosenblum recalled what they saw in a UCSF press release:

“We quickly noticed that the shaved patches of hair never grew back, and we thought, ‘Hmm, now that’s interesting. We realized we had to delve into this further.”

That delving showed that Tregs are located next to hair follicle stem cells. And during the hair growth, the Tregs grow in number and surround the stem cells. Further examination, found that Tregs trigger the stem cells through direct cell to cell interactions. These mechanisms are different than those used for their immune system-inhibiting function.

With these new insights, Dr. Rosenblum hopes this new-found role for Tregs in hair growth may lead to better treatments for Alopecia, one of the most common forms of autoimmune disease.

Novel lung stem cells bring new insights into poorly understood chronic lung disease. Pulmonary fibrosis is a chronic lung disease that’s characterized by scarring and changes in the structure of tiny blood vessels, or microvessels, within lungs. This so-called “remodeling” of lung tissue hampers the transfer of oxygen from the lung to the blood leading to dangerous symptoms like shortness of breath. Unfortunately, the cause of most cases of pulmonary fibrosis is not understood.

This week, Vanderbilt University Medical Center researchers report in the Journal of Clinical Investigation the identification of a new type of lung stem cell that may play a role in lung remodeling.

Susan Majka and Christa Gaskill, and colleagues are studying certain lung stem cells that likely contribute to the pathobiology of chronic lung diseases.  Photo by: Susan Urmy

Up until now, the cells that make up the microvessels were thought to contribute to the detrimental changes to lung tissue in pulmonary fibrosis or other chronic lung diseases. But the Vanderbilt team wasn’t convinced since these microvessel cells were already fully matured and wouldn’t have the ability to carry out the lung remodeling functions.

They had previously isolated stem cells from both mouse and human lung tissue located near microvessels. In this study, they tracked these mesenchymal progenitor cells (MPCs) in normal and disease inducing scenarios. The team’s leader, Dr. Susan Majka, summarized the results of this part of the study in a press release:

“When these cells are abnormal, animals develop vasculopathy — a loss of structure in the microvessels and subsequently the lung. They lose the surfaces for gas exchange.”

The team went on to find differences in gene activity in MPCs from healthy versus diseased lungs. They hope to exploit these differences to identify molecules that would provide early warnings of the disease. Dr. Majka explains the importance of these “biomarkers”:

“With pulmonary vascular diseases, by the time a patient has symptoms, there’s already major damage to the microvasculature. Using new biomarkers to detect the disease before symptoms arise would allow for earlier treatment, which could be effective at decreasing progression or even reversing the disease process.”

The happy stem cell story of Mahali the giraffe. We leave you this week with a feel-good story about Mahali, a 14-year old giraffe at the Cheyenne Mountain Zoo in Colorado. Mahali had suffered from chronic arthritis in his front left leg. As a result, he could not move well and was kept isolated from his herd.

Giraffes at Cheyenne Mountain Zoo. Photo: Denver Post

The zoo’s head veterinarian, Dr. Liza Dadone, decided to try a stem cell therapy procedure to bring Mahali some relief and a better quality of life. It’s the first time such a treatment would be performed on a giraffe. With the help of doctors at Colorado State University’s James L. Voss Veterinary Teaching Hospital, 100 million stem cells grown from Mahali’s blood were injected into his arthritic leg.

Before treatment, thermograph shows inflammation (red/yellow) in Mahali’s left front foot (seen at far right of each image); after treatment inflammation resolved (blue/green). Photos: Cheyenne Mountain Zoo

In a written statement to the Colorado Gazette, Dr. Dadone summarized the positive outcome:

“Prior to the procedure, he was favoring his left front leg and would lift that foot off the ground almost once per minute. Since then, Mahali is no longer constantly lifting his left front leg off the ground and has resumed cooperating for hoof care. A few weeks ago, he returned to life with his herd, including yard access. On the thermogram, the marked inflammation up the leg has mostly resolved.”

Now, Dr. Dadone made sure to state that other treatments and medicine were given to Mahali in addition to the stem cell therapy. So, it’s not totally clear to what extent the stem cells contributed to Mahali’s recovery. Maybe future patients will receive stem cells alone to be sure. But for now, we’re just happy for Mahali’s new lease on life.

Stem cell stories that caught our eye: spinal cord injury trial update, blood stem cells in lungs, and using parsley for stem cell therapies

More good news on a CIRM-funded trial for spinal cord injury. The results are now in for Asterias Biotherapeutics’ Phase 1/2a clinical trial testing a stem cell-based therapy for patients with spinal cord injury. They reported earlier this week that six out of six patients treated with 10 million AST-OPC1 cells, which are a type of brain cell called oligodendrocyte progenitor cells, showed improvements in their motor function. Previously, they had announced that five of the six patients had shown improvement with the jury still out on the sixth because that patient was treated later in the trial.

 In a news release, Dr. Edward Wirth, the Chief Medical officer at Asterias, highlighted these new and exciting results:

 “We are excited to see the sixth and final patient in the AIS-A 10 million cell cohort show upper extremity motor function improvement at 3 months and further improvement at 6 months, especially because this particular patient’s hand and arm function had actually been deteriorating prior to receiving treatment with AST-OPC1. We are very encouraged by the meaningful improvements in the use of arms and hands seen in the SciStar study to date since such gains can increase a patient’s ability to function independently following complete cervical spinal cord injuries.”

Overall, the trial suggests that AST-OPC1 treatment has the potential to improve motor function in patients with severe spinal cord injury. So far, the therapy has proven to be safe and likely effective in improving some motor function in patients although control studies will be needed to confirm that the cells are responsible for this improvement. Asterias plans to test a higher dose of 20 million cells in AIS-A patients later this year and test the 10 million cell dose in AIS-B patients that a less severe form of spinal cord injury.

 Steve Cartt, CEO of Asterias commented on their future plans:

 “These results are quite encouraging, and suggest that there are meaningful improvements in the recovery of functional ability in patients treated with the 10 million cell dose of AST-OPC1 versus spontaneous recovery rates observed in a closely matched untreated patient population. We look forward to reporting additional efficacy and safety data for this cohort, as well as for the currently-enrolling AIS-A 20 million cell and AIS-B 10 million cell cohorts, later this year.”

Lungs aren’t just for respiration. Biology textbooks may be in need of some serious rewrites based on a UCSF study published this week in Nature. The research suggests that the lungs are a major source of blood stem cells and platelet production. The long prevailing view has been that the bone marrow was primarily responsible for those functions.

The new discovery was made possible by using special microscopy that allowed the scientists to view the activity of individual cells within the blood vessels of a living mouse lung (watch the fascinating UCSF video below). The mice used in the experiments were genetically engineered so that their platelet-producing cells glowed green under the microscope. Platelets – cell fragments that clump up and stop bleeding – were known to be produced to some extent by the lungs but the UCSF team was shocked by their observations: the lungs accounted for half of all platelet production in these mice.

Follow up experiments examined the movement of blood cells between the lung and bone marrow. In one experiment, the researchers transplanted healthy lungs from the green-glowing mice into a mouse strain that lacked adequate blood stem cell production in the bone marrow. After the transplant, microscopy showed that the green fluorescent cells from the donor lung traveled to the host’s bone marrow and gave rise to platelets and several other cells of the immune system. Senior author Mark Looney talked about the novelty of these results in a university press release:

Mark Looney, MD

“To our knowledge this is the first description of blood progenitors resident in the lung, and it raises a lot of questions with clinical relevance for the millions of people who suffer from thrombocytopenia [low platelet count].”

If this newfound role of the lung is shown to exist in humans, it may provide new therapeutic approaches to restoring platelet and blood stem cell production seen in various diseases. And it will give lung transplants surgeons pause to consider what effects immune cells inside the donor lung might have on organ rejection.

Add a little vanilla to this stem cell therapy. Typically, the only connection between plants and stem cell clinical trials are the flowers that are given to the patient by friends and family. But research published this week in the Advanced Healthcare Materials journal aims to use plant husks as part of the cell therapy itself.

Though we tend to focus on the poking and prodding of stem cells when discussing the development of new therapies, an equally important consideration is the use of three-dimensional scaffolds. Stem cells tend to grow better and stay healthier when grown on these structures compared to the flat two-dimensional surface of a petri dish. Various methods of building scaffolds are under development such as 3D printing and designing molds using materials that aren’t harmful to human tissue.

Human fibroblast cells growing on decellularized parsley.
Image: Gianluca Fontana/UW-Madison

But in the current study, scientists at the University of Wisconsin-Madison took a creative approach to building scaffolds: they used the husks of parsley, vanilla and orchid plants. The researchers figured that millions of years of evolution almost always leads to form and function that is much more stable and efficient than anything humans can create. Lead author Gianluca Fontana explained in a university press release how the characteristics of plants lend themselves well to this type of bioengineering:

Gianluca Fontana, PhD

“Nature provides us with a tremendous reservoir of structures in plants. You can pick the structure you want.”

The technique relies on removing all the cells of the plant, leaving behind its outer layer which is mostly made of cellulose, long chains of sugars that make up plant cell walls. The resulting hollow, tubular husks have similar shapes to those found in human intestines, lungs and the bladder.

The researchers showed that human stem cells not only attach and grow onto the plant scaffolds but also organize themselves in alignment with the structures’ patterns. The function of human tissues rely on an organized arrangement of cells so it’s possible these plant scaffolds could be part of a tissue replacement cell product. Senior author William Murphy also points out that the scaffolds are easily altered:

William Murphy, PhD

“They are quite pliable. They can be easily cut, fashioned, rolled or stacked to form a range of different sizes and shapes.”

And the fact these scaffolds are natural products that are cheap to manufacture makes this a project well worth watching.

Raising awareness about Rare Disease Day

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One of the goals we set ourselves at CIRM in our 2016 Strategic Plan was to fund 50 new clinical trials over the next five years, including ten rare or orphan diseases. Since then we have funded 13 new clinical trials including four targeting rare diseases (retinitis pigmentosa, severe combined immunodeficiency, ALS or Lou Gehrig’s disease, and Duchenne’s Muscular Dystrophy). It’s a good start but clearly, with almost 7,000 rare diseases, this is just the tip of the iceberg. There is still so much work to do.

And all around the world people are doing that work. Today we have asked Emily Walsh, the Community Outreach Director at the Mesothelioma Cancer Alliance,  to write about the efforts underway to raise awareness about rare diseases, and to raise funds for research to develop new treatments for them.

“February 28th marks the annual worldwide event for Rare Disease Day. This is a day dedicated to raising awareness for rare diseases that affect people all over the world. The campaign works to target the general public as well as policy makers in hopes of bringing attention to diseases that receive little attention and funding. For the year 2017 it was decided that the focus would fall on “research,” with the slogan, “With research, possibilities are limitless.”

Getting involved for Rare Disease Day means taking this message and spreading it far and wide. Awareness for rare diseases is extremely important, especially among researchers, universities, students, companies, policy makers, and clinicians. It has long been known that the best advocates for rare diseases are the patients themselves. They use their specific perspectives to raise their voice, share their story, and shed light on the areas where additional funding and research are most necessary.

To see how you can help support the Rare Disease Day efforts this year, click here.

Groups like the Mesothelioma Cancer Alliance and the Mesothelioma Group are adding their voices to the cause to raise awareness about mesothelioma cancer, a rare form of cancer caused by exposure and inhalation of airborne asbestos fibers

Rare diseases affect 300 million people worldwide, but only 5% of them have an FDA approved treatment or cure. Malignant mesothelioma is among the 95 percent that doesn’t have a treatment or cure.

Asbestos has been used throughout history in building materials because of its fire retardant properties. Having a home with asbestos insulation, ceiling tiles, and roof shingles meant that the house was safer. However, it was found that once asbestos crumbled and became powder-like, the tiny fibers could become airborne and be inhaled and lodge themselves in lung tissue causing mesothelioma. The late stage discovery of mesothelioma is often what causes it to have such a high mortality rate. Symptoms can have a very sudden onset, even though the person may have been exposed decades prior.

Right now, treatment for mesothelioma includes the usual combination of chemotherapy, radiation, and surgery, but researchers are looking at other approaches to see if they can be more effective or can help in conjunction with the standard methods. For example one drug, Defactinib, has shown some promise in inhibiting the growth and spread of cancer stem cells – these are stem cells that can evade chemotherapy and cause patients to relapse.”

Some people might ask why spend limited resources on something that affects so few people. But the lessons we learn in developing treatments for a rare disease can often lead us to treatments for diseases that affect many millions of people.

But numbers aside, there is no hierarchy of need, no scale to say the suffering of people with Huntington’s disease is any greater or less than that of people with Alzheimer’s. We are not in the business of making value judgements about who has the greatest need. We are in the business of accelerating treatments to patients with unmet medical needs. And those suffering from rare disease are very clearly  people in need.

 


Related Links:

Cured by Stem Cells

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To get anywhere you need a good map, and you need to check it constantly to make sure you are still on the right path and haven’t strayed off course. A year ago the CIRM Board gave us a map, a Strategic Plan, that laid out our course for the next five years. Our Annual Report for 2016, now online, is our way of checking that we are still on the right path.

I think, without wishing to boast, that it’s safe to say not only are we on target, but we might even be a little bit ahead of schedule.

The Annual Report is chock full of facts and figures but at the heart of it are the stories of the people who are the focus of all that we do, the patients. We profile six patients and one patient advocate, each of whom has an extraordinary story to tell, and each of whom exemplifies the importance of the work we support.

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Brenden Whittaker: Cured

Two stand out for one simple reason, they were both cured of life-threatening conditions. Now, cured is not a word we use lightly. The stem cell field has been rife with hyperbole over the years so we are always very cautious in the way we talk about the impact of treatments. But in these two cases there is no need to hold back: Evangelina Padilla Vaccaro and Brenden Whittaker have been cured.

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Evangelina: Cured

 

In the coming weeks we’ll feature our conversations with all those profiled in the Annual Report, giving you a better idea of the impact the stem cell treatments have had on their lives and the lives of their family. But today we just wanted to give a broad overview of the Annual Report.

The Strategic Plan was very specific in the goals it laid out for us. As an agency we had six big goals, but each Team within the agency, and each individual within those teams had their own goals. They were our own mini-maps if you like, to help us keep track of where we were individually, knowing that every time an individual met a goal they helped the Team get closer to meeting its goals.

As you read through the report you’ll see we did a pretty good job of meeting our targets. In fact, we missed only one and we’re hoping to make up for that early in 2017.

But good as 2016 was, we know that to truly fulfill our mission of accelerating treatments to patients with unmet medical needs we are going to have do equally well, if not even better, in 2017.

That work starts today.

 

Stem cell heroes: patients who had life-saving, life-changing treatments inspire CIRM Board

 

It’s not an easy thing to bring an entire Board of Directors to tears, but four extraordinary people and their families managed to do just that at the last CIRM Board meeting of 2016.

The four are patients who have undergone life-saving or life-changing stem cell therapies that were funded by our agency. The patients and their families shared their stories with the Board as part of CIRM President & CEO Randy Mill’s preview of our Annual Report, a look back at our achievements over the last year.

The four included:

jake_javier_stories_of_hope

Jake Javier, whose life changed in a heartbeat the day before he graduated high school, when he dove into a swimming pool and suffered a spinal cord injury that left him paralyzed from the chest down. A stem cell transplant is giving him hope he may regain the use of his arms and hands.

 

 

karl

Karl Trede who had just recovered from one life-threatening disease when he was diagnosed with lung cancer, and became the first person ever treated with a new anti-tumor therapy that helped hold the disease at bay.

 

brenden_stories_of_hopeBrenden Whittaker, born with a rare immune disorder that left his body unable to fight off bacterial or fungal infections. Repeated infections cost Brenden part of his lung and liver and almost killed him. A stem cell treatment that gave him a healthy immune system cured him.

 

 

evangelinaEvangelina Padilla Vaccaro was born with severe combined immunodeficiency (SCID), also known as “bubbly baby” disease, which left her unable to fight off infections. Her future looked grim until she got a stem cell transplant that gave her a new blood system and a healthy immune system. Today, she is cured.

 

 

Normally CIRM Board meetings are filled with important, albeit often dry, matters such as approving new intellectual property regulations or a new research concept plan. But it’s one thing to vote to approve a clinical trial, and a very different thing to see the people whose lives you have helped change by funding that trial.

You cannot help but be deeply moved when you hear a mother share her biggest fear that her daughter would never live long enough to go to kindergarten and is now delighted to see her lead a normal life; or hear a young man who wondered if he would make it to his 24th birthday now planning to go to college to be a doctor

When you know you played a role in making these dreams happen, it’s impossible not to be inspired, and doubly determined to do everything possible to ensure many others like them have a similar chance at life.

You can read more about these four patients in our new Stories of Hope: The CIRM Stem Cell Four feature on the CIRM website. Additionally, here is a video of those four extraordinary people and their families telling their stories:

We will have more extraordinary stories to share with you when we publish our Annual Report on January 1st. 2016 was a big year for CIRM. We are determined to make 2017 even bigger.

Stem cell stories that caught our eye: insights into stem cell biology through telomeres, reprogramming and lung disease

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.

Telomeres and stem cell stability: too much of a good thing

Just like those plastic tips at the end of shoelaces (fun fact: they’re called aglets), telomeres form a protective cap on the end of chromosomes. Because of the way DNA replication works, the telomeres shorten each time a cell divides. Trim away enough of the telomere over time and, like a frayed shoelace, the chromosomes become unstable and an easy target for damage which eventually leads to cell death.

telomere_caps

Telomeres (white dots) form a protective cap on chromsomes (gray). (Wikimedia) 

Stem cells are unique in that they contain an enzyme called telomerase that lengthens telomeres. Telomerase activity and telomere lengthening are critical for a stem cell’s ability to maintain virtually limitless cell divisions. So you’d assume the longer the telomere, the more stable the cell. But Salk Institute scientists reported this week that too much telomere can be just as bad, if not worse, than too little.

The CIRM-funded work, which was published in Nature Structural & Molecular Biology, used genetic engineering to artificially vary telomerase activity in human embryonic stem cells. Cells with low telomerase activity had shorter telomeres and died. This result wasn’t a surprise since the short telomeres-cell death observation has been well documented. Based on those results, the team was expecting cells with boosted telomerase activity and, in turn, extended telomeres would be especially stable. But that’s not what happened as senior author Jan Karlseder mentioned in a Salk press release:

“We were surprised to find that forcing cells to generate really long telomeres caused telomeric fragility, which can lead to initiation of cancer. These experiments question the generally accepted notion that artificially increasing telomeres could lengthen life or improve the health of an organism.”

The researchers also examined induced pluripotent stem (iPS) cells in the study and found that the cells contain “footprints” of telomere trimming. So the team is in a position to study how a cell’s telomere history relates to how well it can be reprogrammed into iPS cells. First author Teresa Rivera pointed out the big picture significance of this finding:

“Stem cell reprogramming is a major scientific breakthrough, but the methods are still being perfected. Understanding how telomere length is regulated is an important step toward realizing the promise of stem cell therapies and regenerative medicine.”

jan-karlseder_teresa-rivera-garcia0x8c7144w

Jan Karlseder and Teresa Rivera

Lego set of gene activators takes trial and error out of cellular reprogramming

To convert one cell type into another, stem cell researchers rely on educated guesses and a lot of trial and error. In fact, that’s how Shinya Yamanaka identified the four Yamanaka Factors which, when inserted into a skin cell, reprogram it into the embryonic stem cell-like state of an iPS cell. That ground-breaking discovery ten years ago has opened the way for researchers worldwide to specialize iPS cells into all sorts of cell types from nerve cells to liver cells. While some cell types are easy to generate this way, others are much more difficult.

Reporting this week in PNAS, a University of Wisconsin–Madison research team has developed a nifty systematic, high-throughput method for identifying the factors necessary to convert a cell from one type to another. Their strategy promises to free researchers from the costly and time consuming trial and error approach still in use today.

The centerpiece of their method is artificial transcription factors (ATFs). Now, natural transcription factors – Yamanaka’s Factors are examples – are proteins that bind DNA and activate or silence genes. Their impact on gene activity, in turn, can have a cascading effects on other genes and proteins ultimately causing, say a stem cell, to start making muscle proteins and turn into a muscle cell.

Transcription factors are very modular proteins – one part is responsible for binding DNA, another part for affecting gene activity and other parts that bind to other proteins. The ATFs generated in this study are like lego versions of natural transcription factors – each are constructed from combinations of different transcription factor parts. The team made nearly 3 million different ATFs.

As a proof of principle, the researchers tried reproducing Yamanaka’s original, groundbreaking iPS cell experiment. They inserted the ATFs into skin cells that already had 3 of the 4 Yamanaka factors, they left out Oct4. They successfully generated iPS with this approach and then went back and studied the makeup of the ATFs that had caused cells to reprogram into iPS cells. Senior author Aseem Ansari gave a great analogy in a university press release:

“Imagine you have millions of keys and only a unique key or combination of keys can turn a motor on. We test all those keys in parallel and when we see the motor fire up, we go back to see exactly which key switched it on.”

atf_ips_cells

Micrograph of induced pluripotent stem cells generated from artificial transcription factors. The cells express green fluorescent protein after a key gene known as Oct4 is activated. (ASUKA EGUCHI/UW-MADISON)

The analysis showed that these ATFs had stimulated gene activity cascades which didn’t directly involve Oct4 but yet ultimately activated it. This finding is important because it suggests that future cell conversion experiments could uncover some not so obvious cell fate pathways. Ansari explains this point further:

“It’s a way to induce cell fate conversions without having to know what genes might be important because we are able to test so many by using an unbiased library of molecules that can search nearly every corner of the genome.”

This sort of brute force method to accelerate research discoveries is music to our ears at CIRM because it ultimately could lead to therapies faster.

Search for clues to treat deadly lung disease

When researchers don’t understand what causes a particular disease, a typical strategy is to compare gene activity in diseased vs healthy cells and identify important differences. Those differences may lead to potential paths to developing a therapy. That’s the approach a collaborative team from Cincinnati Children’s Hospital and Cedars-Sinai Medical took to tackle idiopathic pulmonary fibrosis (IPF).

IPF is a chronic lung disease which causes scarring, or fibrosis, in the air sacs of the lung. This is the spot where oxygen is taken up by tiny blood vessels that surround the air sacs. With fibrosis, the air sacs stiffen and thicken and as a result less oxygen gets diffused into the blood and starves the body of oxygen.  IPF can lead to death within 2 to 5 years after diagnosis. Unfortunately, no cures exist and the cause is unknown, or idiopathic.

(Wikimedia)

(Wikimedia)

The transfer of oxygen from air sacs to blood vessels is an intricate one with many cell types involved. So pinpointing what goes wrong in IPF at a cellular and molecular level has proved difficult. In the current study, the scientists, for the first time, collected gene sequencing data from single cells from healthy and diseased lungs. This way, a precise cell by cell analysis of gene activity was possible.

One set of gene activity patterns found in healthy sample were connected to proper formation of a particular type of air sac cell called the aveolar type 2 lung cell. Other gene patterns were linked to abnormal IPF cell types. With this data in hand, the researchers can further investigate the role of these genes in IPF which may open up new therapy approaches to this deadly disease.

The study funded in part by CIRM was published this week in Journal of Clinical Investigation Insight and a press release about the study was picked up by PR Newswire.