ISSCR Annual Meeting

Can regenerative medicine turn back the clock on aging?

/ Kevin McCormack / Leave a comment

One of my favorite phrases is “standing room only”. I got a chance to use it last week when we held a panel discussion on whether regenerative medicine could turn back the clock on aging. The event was at the annual conference of the International Society for Stem Cell Research (ISSCR) and more than 150 people packed into a conference room to hear the debate (so far more than 800 also watched a live stream of the event.)

It’s not surprising the place was jammed. The speakers included:

  • Dr. Deepak Srivastava, the President of the Gladstone Institutes, an expert on heart disease and the former President of ISSCR.
  • Dr. Stanley “Tom” Carmichael, Chair of the Department of Neurology at UCLA and an expert on strokes and other forms of brain injury.
  • Adrienne Shapiro, the mother of a daughter with sickle cell disease, a tireless patient advocate and supporter of regenerative medicine research, and the co-founder of Axis Advocacy, a family support organization for people with sickle cell.
  • Jonathan Tomas, PhD, JD, the Chair of the CIRM Board.

And the topic is a timely one. It is estimated that as many as 90 percent of the people who die every day, die from diseases of aging such as heart disease, stroke, and cancer. So, what can be done to change that, to not just slow down or stop these diseases, but to turn back the clock, to repair the damage already done and replace cells and tissues already destroyed.

The conversation was enlightening, hopeful and encouraging, but also cautionary.

You can watch the whole event on our Youtube channel.

I think you are going to enjoy it.

Join us to hear how stem cell and gene therapy are taking on diseases of aging

/ Kevin McCormack / Leave a comment

It is estimated that as many as 90 percent of people in industrialized countries who die every day, die from diseases of aging such as heart disease, stroke, and cancer. Of those still alive the numbers aren’t much more reassuring. More than 80 percent of people over the age of 65 have a chronic medical condition, while 68 percent have two or more.

Current medications can help keep some of those conditions, such as high blood pressure, under control but regenerative medicine wants to do a lot more than that. We want to turn back the clock and restore function to damaged organs and tissues and limbs. That research is already underway and we are inviting you to a public event to hear all about that work and the promise it holds.

On June 16th from 3p – 4.30p PST we are holding a panel discussion exploring the impact of regenerative medicine on aging. We’ll hear from experts on heart disease and stroke; we will look at other ground breaking research into aging; and we’ll discuss the vital role patients and patient advocates play in helping advance this work.

The discussion is taking place in San Francisco at the annual conference of the International Society for Stem Cell Research. But you can watch it from the comfort of your own home. That’s because we are going to live stream the event.

Here’s where you can see the livestream: https://www.youtube.com/watch?v=CaUgsc5alDI

And if you have any questions you would like the panel to answer feel free to send them to us at info@cirm.ca.gov

The stem cell conference where even the smartest people learn something

/ Kevin McCormack / Leave a comment
A packed house for the opening keynote address at ISSCR 2019

At first glance, a scientific conference is not the place you would think about going to learn about how to run a political or any other kind of campaign. But then the ISSCR Annual Meeting is not your average conference. And that’s why CIRM is there and has been going to these events for as long as we have been around.

For those who don’t know, ISSCR is the International Society for Stem Cell Research. It’s the global industry representative for the field of stem cell research. It’s where all the leading figures in the field get together every year to chart the progress in research.

But it’s more than just the science that gets discussed. One of the panels kicking off this year’s conference was on ‘Why is it Important to Communicate with Policy Makers, the Media and the Public?” It was a wide-ranging discussion on the importance of learning the best ways for the scientific community to explain what it is they do, why they do it, and why people should care.

Sean Morrison

Sean Morrison, a former President of ISSCR, talked about his experience trying to pass a bill in Michigan that would enable scientists to do embryonic stem cell research. At the time CIRM was spending millions of dollars funding scientists in California to create new lines of embryonic stem cells; in Michigan anyone doing the same could be sent to prison for a year. He said the opposition ran a fear-based campaign, lying about the impact the bill would have, that it would enable scientists to create half man-half cow creatures (no, really) or human clones. Learning to counter those without descending to their level was challenging, but ultimately Morrison was successful in overcoming opposition and getting the bill passed.

Sally Temple

Sally Temple, of the Neural Stem Cell Institute, talked about testifying to a Congressional committee about the importance of fetal tissue research and faced a barrage of hostile questions that misrepresented the science and distorted her views. In contrast Republicans on the committee had invited a group that opposed all fetal tissue research and fed them a bunch of softball questions; the answers the group gave not only had no scientific validity, they were just plain wrong. Fortunately, Temple says she had done a lot of preparation (including watching two hours Congressional hearings on C-SPAN to understand how these hearings worked) and had her answers ready. Even so she said one of the big lessons she stressed is the need to listen to what others are saying and respond in ways that address their fears and don’t just dismiss them.

Other presenters talked about their struggles with different issues and different audiences but similar experiences; how do you communicate clearly and effectively. The answer is actually pretty simple. You talk to people in a way they understand with language they understand. Not with dense scientific jargon. Not with reams of data. Just by telling simple stories that illustrate what you did and who it helped or might help.

The power of ISSCR is that it can bring together a roomful of brilliant scientists from all over the world who want to learn about these things, who want to be better communicators. They know that much of the money for scientific research comes from governments or state agencies, that this is public money, and that if the public is going to continue to support this research it needs to know how that money is being spent.

That’s a message CIRM has been promoting for years. We know that communicating with the public is not an option, it’s a responsibility. That’s why, at a time when the very notion of science sometimes seems to be under attack, and the idea of public funding for that science is certainly under threat, having meetings like this that brings researchers together and gives them access to new tools is vital. The tools they can “get” at ISSCR are ones they might never learn in the lab, but they are tools that might just mean they get the money needed to do the work they want to.

Taking the message to the people: fighting for the future of stem cell research in California

/ Kevin McCormack / Leave a comment

Stem cells have been in the news a lot this week, and not necessarily for the right reason.

First, the US Food and Drug Administration (FDA) won a big legal decision in its fight to crack down on clinics offering bogus, unproven and unapproved stem cell therapies.

William Shatner: Photograph by Jerry Avenaim.wikimedia.org/w/index.php?curid=3413082

But then came news that another big name celebrity, in this case Star Trek star William Shatner, was going to one of these clinics for an infusion of what he called “restorative cells”.

It’s a reminder that for every step forward we take in trying to educate the public about the dangers of clinics offering unproven therapies, we often take another step back when a celebrity essentially endorses the idea.

So that’s why we are taking our message directly to the people, as often as we can and wherever we can.

In June we are going to be holding a free, public event in Los Angeles to coincide with the opening of the International Society for Stem Cell Research’s Annual Conference, the biggest event on the global stem cell calendar. There’s still time to register for that by the way. The event is from 6-7pm on Tuesday, June 25th in Petree Hall C., at the Los Angeles Convention Center at 1201 South Figueroa Street, LA 90015.

The event is open to everyone and it’s FREE. We have created an Eventbrite page where you can get all the details and RSVP if you are coming.

It’s going to be an opportunity to learn about the real progress being made in stem cell research, thanks in no small part to CIRM’s funding. We’re honored to be joined by UCLA’s Dr. Don Kohn, who has helped cure dozens of children born with a fatal immune system disorder called severe combined immunodeficiency, also known as “bubble baby disease”. And we’ll hear from the family of one of those children whose life he helped save.

And because CIRM is due to run out of money to fund new projects by the end of this year you’ll also learn about the very real concerns we have about the future of stem cell research in California and what can be done to address those concerns. It promises to be a fascinating evening.

But that’s not all. Our partners at USC will be holding another public event on stem cell research, on Wednesday June 26th from 6.30p to 8pm. This one is focused on treatments for age-related blindness. This features some of the top stem cell scientists in the field who are making encouraging progress in not just slowing down vision loss, but in some cases even reversing it.

You can find out more about that event here.

We know that we face some serious challenges in trying to educate people about the risks of going to a clinic offering unproven therapies. But we also know we have a great story to tell, one that shows how we are already changing lives and saving lives, and that with the support of the people of California we’ll do even more in the years to come.

Your Guide to Awesome Stem Cell Conferences in 2017

/ Karen Ring / Leave a comment

Welcome to 2017, a year that will likely be full of change and new surprises. I’m hoping that some of these surprises will be in regenerative medicine with new stem cell therapies showing promise or effectiveness in clinical trials.

A great way to stay on top of new advances in stem cell research is to attend scientific conferences and meetings. Some of them are well known and highly attended like the International Society for Stem Cell Research (ISSCR) conference, which this year will be in Boston in June. There are also a few smaller, more intimate conferences focusing on specific topics from discovery research to clinical therapies.

There are loads of stem cell meetings this year, but a few that I would like to highlight. Here’s my abbreviated stem cell research conference and meeting guide for 2017. Some are heavy duty research-focused events and probably not suitable for someone without a science background; they’re also expensive to sign up for. I’ve marked those with an * asterix.

January 8-12th, Keystone Symposium (Fee to register)*

Keystone will be hosting two concurrent stem cell meetings in Tahoe next week, which are geared for researchers in the field. One will be on neurogenesis during development and in the adult brain and the other will be on transcriptional and epigenetic control in stem cells. CIRM is one of the co-funders of this meeting and will be hosting a panel focused on translating basic research into clinical trials. Keystone symposiums are small, intimate meetings rich with scientific content and great for networking. Be on the look out for blog coverage about this meeting in the coming weeks.

February 3rd, Stanford Center for Definitive and Curative Medicine Symposium (Free to the public)

This free symposium at Stanford University in Palo Alto, CA will present first-in-human cell and gene therapies for a number of disorders including bone marrow, skin, cardiac, neural, uterine, pancreatic and neoplastic disorders. Speakers include scientists, translational biologists and clinicians. Irv Weissman, a Stanford professor and CIRM grantee focused on translational cancer research, will be the keynote speaker. Space is limited so sign up ASAP!

March 23rd, CIRM Alpha Stem Cell Clinics Symposium (Free to the public)

This free one-day meeting will bring together scientists, clinicians, patient advocates, and other partners to describe how the CIRM Alpha Stem Cell Clinics Network is making stem cell therapies a reality for patients. The City of Hope Alpha Clinic is part of a statewide effort funded by CIRM to develop a network of “Alpha Clinics” that has one unifying goal: to accelerate the development and delivery of stem cell treatments to patients.

City of Hope Medical Center and Alpha Stem Cell Clinic

City of Hope Medical Center and Alpha Stem Cell Clinic

June 14-17th, International Society for Stem Cell Research (Fee to register)*

The Annual ISSCR stem cell research conference will be hosted in Boston this year. This is an international conference focusing on new developments in stem cell science and technology. CIRM was one of the funders of the conference last year when ISSCR was in San Francisco. It’s one of my favorite research events to attend full of interesting scientific presentations and great for meeting future collaborators.

For a more comprehensive 2017 stem cell conference and meeting guide, check out Paul Knoepfler’s Niche blog.

A patient perspective on how stem cells could give a second vision to the blind

/ Karen Ring / 1 Comment

October is Blindness Awareness month. In honor of the patients who suffer from diseases of blindness and of the scientists and doctors who work tirelessly to develop treatments and cures for these diseases, we are featuring an interview with Kristin Macdonald, a woman who is challenged by Retinitis Pigmentosa (RP).

RP is a genetically inherited disease that affects the photoreceptors at the back of the eye in an area called the retina. It’s a hard disease to diagnose because the first signs are subtle. Patients slowly lose their peripheral vision and ability to see well at night. As the disease progresses, the window of sight narrows and patients experience “tunnel vision”. Eventually, they become totally blind. Currently, there is no treatment for RP, but stem cell research might offer a glimmer of hope.

Kristin MacDonald

Kristin MacDonald

Kristin Macdonald was the first patient treated in a CIRM-funded stem cell trial for RP run by Dr. Henry Klassen at UC Irvine. She is a patient advocate and inspirational speaker for the blind and visually impaired, and is also a patient ambassador for Americans for Cures. Kristin is an amazing woman who hasn’t let RP prevent her from living her life. It was my pleasure to interview her to learn more about her life’s vision, her experience in CIRM’s RP trial, and her thoughts on patient advocacy and the importance of stem cell research.

Q: Tell us about your experience with being diagnosed with RP?

I was officially diagnosed with RP at 31. RP is a very difficult thing to diagnose, and I had to go through a series of doctors before we figured it out. The signs were there in my mid-to-late twenties, but unfortunately I didn’t really know what they were.

Being diagnosed with RP was really surprising to me. I grew up riding horses and doing everything. I had 20/20 vision and didn’t need any reading glasses. I started getting these night vision symptoms in my mid-to-late 20s in New York when I was in Manhattan. It was then that I started tripping, falling and getting clumsy. But I didn’t know what was happening and I was having such a great time with my life that I just denied it. I didn’t want to acknowledge that anything was wrong.

So I moved out to Los Angeles to pursue an acting and television career, and I just kept ignoring that thing in the brain that says “something’s wrong”. By the time I broke my arm for the second time, I had to go to see a doctor. And that’s when they diagnosed me.

Q: How did you boost yourself back up after being diagnosed with RP?

RP doesn’t come with an instruction booklet. It’s a very gradual adjustment emotionally, physically and spiritually. The first thing I did was to get out of denial, which was a really scary place to be because you can break your leg that way. You have to acknowledge what’s happening in life otherwise you’ll never get anywhere or past anything. That was my first stage of getting over denial. As I slowly started to accept things, I learned to live in the moment, which in a way is a big thing in life because we should all be living for today.

I think the fear of someone telling you that you’re going to go into the dark when you’ve always lived your life in the light can be overwhelming at times. I used to go to the mall and sometimes a door to a store would be gone or an elevator that I used to see is gone. What I did to deal with these fears and changes was to become as proactive as possible. I enlisted all of the best people around me in the business. I started doing charitable work for the Center for the Partially Sighted and for the Foundation for Fighting Blindness. I sat on the board of AIRSLA.org, an internet radio service for the blind and visually impaired, where I still do my radio show. Through that, I met other people who were going through the same type of thing and would come into my home to teach me independent living skills.

I remember the first day when an independent living counselor from the Center for the Partially Sighted came to my house and said we have to check in and see what your adjustment to blindness is like. Those words cut through me. “Adjustment to blindness”. It felt like I was going to prison, that’s how it felt like to me back then. But I am so glad I reached out to the Center for the Partially Sighted because they gave me invaluable instructions on how to function as a blind person. They helped me realize I could really live a good life and be whole, and that blindness would never define me.

I also worked a lot on my spiritual side. I read a lot of positive thinking books and found comfort in my faith in god and the support from my family, friends and my boyfriend. I can’t even enumerate how good they’ve been to me.

Q: How has being blind impacted your ability to do the things you love?

I’m a very social person, so giving up my car and suddenly being confined at night was crushing to me. And we didn’t have Uber back then! During that time, I had to learn how to lead a full life socially. I still love to do salsa dancing but it’s tricky. If I stand on the sidelines, some of the dancers will pass you by because they don’t know you’re blind. I also learned how to horseback ride and swim in the ocean – just a different way. I go in the water on a surf leash. Or I ride around the ring with my best friend guiding me.

Kristin loves to ride horses.

Kristin doesn’t let being mostly blind stop her from riding horses.

Q: What treatments have you had for RP?

I investigated just about everything that was out there. [Laughs] After I was diagnosed, I became very proactive to find treatments. But after a while, I became discouraged because these treatments either didn’t work or still needed time for the FDA to give approval.

I did participate in a study nine years ago and had genetically modified cells put into my eye. I had two surgeries: one to put the cells in and one to take them out because the treatment hadn’t done anything. I didn’t get any improvement, and that was crushing to me because I had hoped and waited so long.

I just kept praying, waiting, reading and hoping. And then boom, all the sudden I got a phone call from UC Irvine saying they wanted me to participate in their stem cell trial for RP. They said I’d be the third person in the world to have it done and the first in their clinical trial. They told me I was to be the first North American patient to have progenitor cells put in my eye, which is pretty amazing.

Q: Was it easy to decide to participate in the UC Irvine CIRM-funded trial?

Yes. But don’t get me wrong, I’m human. I was a little scared. It’s a new thing and you have to sign papers saying that you understand that we don’t exactly know what the results will be. Essentially, you are agreeing to be a pathfinder.

Luckily, I have not had any adverse effects since the trial. But I’ve always had a great deal of faith in stem cells. For years, I’ve been hearing about it and I’ve always put my hopes in stem cells thinking that that’s going to be the answer for blindness.

Q: Have you seen any improvements in your sight since participating in this trial?

I was treated a year ago in June. The stem cell transplant was in my left eye, my worse eye that has never gotten better. It’s been about 15 months now, and I started to see improvement after about two months following the treatment. When I would go into my bathroom, I noticed that it was a lot brighter. I didn’t know if I was imagining things, but I called a friend and said, “I don’t know if I’m imagining things but I’m getting more light perception in this eye.”

Sure enough, over a period of about eight months, I had gradual improvement in light perception. Then I leveled off, but now there is no question that I’m photo sensitive. When I go out, I use my sunglasses, and I see a whole lot more light.

Because I was one of the first patients in the trial, they had to give me a small dose of cells to test for safety. So it was amazing that a smaller dose of cells was still able to help me gain back some sight! One of the improvements that I’ve had is that I can actually see the image of my finger waving back and forth on my left side, which I couldn’t before when I put mascara on. I say this because I have put lip pencil all over my mouth by accident. That must have been a real sight! For a woman, putting on makeup is really important.

Q: What was your experience like participating in the UC Irvine trial?

Dr. Klassen who runs the UC Irvine stem cell trial for RP is an amazing person. He was in the room with me during the transplant procedure. I have such a high regard and respect for Dr. Klassen because he’s been working on the cure for RP as long as I’ve had it. He’s someone who’s dedicated his life to trying to find an answer to a disease that I’ve been dealing with on a day-to-day basis.

Dr. Klassen had the opportunity to become a retinal surgeon and make much more money in a different area. But because it was too crushing to talk to patients and give them such a sad diagnosis, he decided he was going to do something about it. When I heard that, I just never forgot it. He’s a wonderful man and he’s really dedicated to this cause.

Q: How have you been an advocate for RP and blindness?

I’ve been an advocate for the visually impaired in many different aspects. I have raised money for different research foundations and donated my time as a host and an MC to various charities through radio shows. I’ve had a voice in the visually impaired community in one way or another on and off for 15 years.

I also started getting involved in Americans for Cures only a few months ago. I am helping them raise awareness about Proposition 71, which created CIRM, and the importance of funding stem cell research in the future.

I may in this lifetime get actual vision again, a real second vision. But in the meantime, I’ve been working on my higher self, which is good because a friend of mine who is totally blind reminded me today, “Kristin, just remember, don’t live for tomorrow just getting that eye sight back”. My friend was born blind. I told him he is absolutely right. I know I can lead a joyful life either way. But trust me, having a cure for RP would be the icing on the cake for me.

Q: Why is it important to be a patient advocate?

I think it’s so important from a number of different aspects, and I really felt this at the International Society for Stem Cell Research (ISSCR) conference in San Francisco this summer when certain people came to talk to me afterwards, especially researchers and scientists. They don’t get to see the perspective of the patient because they are on the other side of the fence.

I think it’s very important to be a patient advocate because when you have a personal story, it resonates with people much more than just reading about something or hearing about something on a ballot.  It’s really vital for the future. Everybody has somebody or knows somebody who had macular degeneration or became visually impaired. If they don’t, they need to be educated about it.

Q: Tell us about your Radio Show.

My radio show “Second Vision” is about personal development and reinventing yourself and your life’s vision when the first one fails. It was the first internet radio show to support the blind and visually impaired, so that’s why I’m passionate about it. I’ve had scores of authors on there over the years who’ve written amazing books about how to better yourself and personal stories from people who have overcome adversity from all different types of challenges in terms of emotional health, physical health or problems in their lives. You can find anything on the Second Vision website from interviews on Reiki and meditation to Erik Weihenmayer, the blind man who climbed the seven summits (the highest mountains of each of the seven continents).

Q: Why is stem cell research important?

I do think that stem cells will help people with blindness. I don’t know whether it will be a 100% treatment. Scientists may have to do something else along the way to perfect stem cell treatments whether it’s gene therapy or changing the number of cells or types of cells they inject into the eye. I really do have a huge amount of faith in stem cells. If they can regenerate other parts of the body, I think the eye will be no different.

To read more about Kristin Macdonald and her quest for a Second Vision, please visit her website.

Related Links:

Another way to dial back stem cell hype (but not hope): Put a dollar figure on it

/ Lisa Willemse / 2 Comments

In an effort to reign in the hype surrounding stem cell research that has led to a proliferation of unapproved and potentially dangerous stem cell therapies, the International Society for Stem Cell Research (ISSCR) recently released updated guidelines outlining conduct for stem cell researchers that,  for the first time, included communications activities.  At only 1.5 pages in the 37-page document, the statements around communications asked researchers, communications professionals, institutions and the media to be more proactive in combatting stem cell hype by ensuring accuracy and balance in communications activities.

Stock Image

Stock Image

It’s too early to know what the full impact of the guidelines will be, however, the communications recommendations did generate a good deal of interest and some media, at least, have taken steps to address the issue.

Whether directly influenced by the guidelines or not, in the final plenary session of the ISSCR annual meeting last week, Professor Roger Barker, a research-clinician at the University of Cambridge, provided a candid portrayal of some of the challenges of preclinical and early clinical research.

Though he may have poked a small hole in some of the optimism that characterized the four-day conference, in providing a rare glimpse of the real costs of research, Dr. Barker might also have given us a new way to frame research to downplay hype.

Dr. Roger Barker

Dr. Roger Barker

Dr. Barker is one of many researchers across the globe working on a potential cell-based treatment for Parkinson’s Disease. Parkinson’s is a rather straightforward disease to tackle in this way, because its cause is known: the death of cells that produce the chemical dopamine. Even so, the challenges in developing a treatment are many. Apart from the design of a clinical study (which includes, for example, careful selection of the Parkinson’s patients to include; as Barker pointed out, there are two main types of Parkinson progression and one type may respond to a treatment while the other may not. This is a real concern for Barker, who commented that “a lack of rigour in selecting patients has dogged the field for the past 25 years.”), there are several other factors that need to be addressed in the pre-clinical work, such as identifying the best type of cells to use, how to scale them up and make them both GMP-compliant and standardized for reproducibility.

Such work, Barker estimated, costs between £2 and £3 million (or roughly $3-5 million, valued at pre-Brexit currency rates, one would assume). And, having invested so much to this point, you don’t even have something that can be published yet.

Running the actual clinical phase 1 study, with roughly 20 patients, will cost millions more. If it doesn’t work, you’re back to lab and in search of more pre-clinical funding.

But, assuming the study nets the desired results, it’s still only looking at safety, not efficacy. Getting it to phases 2 and 3 costs several orders of magnitude more. Put in this light, the $3 billion USD given to the California Institute for Regenerative Medicine seems like not nearly enough. The Ontario Institute for Regenerative Medicine’s $25 million CAD is nothing at all. Not that we aren’t grateful — we do what we can to maximize impact and make even a small investment worthwhile. Every step counts.

Another point to consider is whether the final therapy will be more cost-effective than existing, approved medical interventions. If it’s not, there is little incentive in pursuing it. This is the notion of headroom that I’ve heard discussed more directly at commercialization-based conferences (and is very well explained here) but is one that will become increasingly relevant to research as more basic and translational work finds its way into the clinic.

Talking about money with regard to health can be seen as tedious and even crass. The three short talks given by patient advocates at the ISSCR meeting served to emphasize this – each outlined personal tragedy connected to illness or disease: congestive heart failure at 11 years of age, four generations of a family with sickle cell disease, retinitis pigmentosa that derailed a young woman’s budding career. You simply can’t put a price on a person’s life, happiness and well-being. Each of these patients, and millions more, have hope that research will find an answer. It’s a lofty goal, one that is sometimes hard to remember in the lab trenches when a grant doesn’t materialize or a negative result sends the work back to ground zero.

And therein lies some of the tension that can easily lead to hype. We do want to fly high. We do want to deliver cures and therapies. We need to be reminded, by interactions with the patient community, of what’s at stake and what we can gain for humanity. The field should and will continue to strive to achieve these goals.

But not without responsibility. And a dose of realism.

This post appears simultaneously on OIRM Expression and appears here with permission by the author Lisa Willemse.

Presentations at ISSCR that caught our eye: Stem cell clinical trials expand as work to improve our understanding of just how they work goes on in parallel

/ Don Gibbons / Leave a comment

In a special edition of our weekly roundup, here are some highlights from just the first two days of the four-day annual meeting of the International Society for Stem Cell Research

 Seeing stem cells from both sides now. As the biggest gathering of stem cell researchers each year, the annual meeting of the International Society for Stem Cell Research offers a chance to catch up on progress across the complete spectrum of research, from fundamental exploration in the lab to clinical trials. This year’s meeting in San Francisco offers more advances toward the clinic than ever before, but it also shows a cadre of basic researchers struggling to understand what is really going on at the genetic and molecular level with some of the biggest breakthroughs of the past few years. It is a bit like the opening verse of Joni Mitchell’s song “Both Sides Now” in which she laments that even after seeing clouds as beautiful patterns and as blocks to the sun she does not really know clouds at all.

Yamanaka at ISSCR 2016

Nobelist Shinya Yamanaka at the annual ISSCR meeting

Nothing captured that spirit better than the opening talk on the second day by Nobel Prize winner Shinya Yamanaka who maintains labs at Kyoto University in Japan and at the Gladstone institutes here in San Francisco, about a mile from the site of the meeting. This year marks the 10th anniversary of his Nobel-winning discovery that you can use genetic factors to reprogram adult cells into embryonic-like stem cells called iPS cells. Even as his institute is supplying the cells for the first ever clinical trial using iPS, in this case in the blinding disease called macular degeneration, he spent much of his talk discussing his ongoing basic research trying to understand what really goes on in that reprogramming process, and why so many cells are refractory to reprogramming with only a few percent in most experiments becoming stem cells.

Before launching into his ongoing basic research—some of it from a research thread he began to unravel as a postdoc at the Gladstone—he told an enlightening tale of how he had been reprogrammed as a scientist.  He said that he went from a a basic researcher just working in his lab to someone who spent much of their time talking to government officials, bankers and donors. But he noted that like our cells, part of him was refractory to reprogramming and he still liked getting into the lab to do the basic research needed to understand the creation of iPS cells and make it it faster and more efficient, which is critical to any future role for the cells at the other end of the research pipeline—treating patients in need.

 

It takes a neighborhood. As usual much of the basic science revolved around the lab recipes needed to keep stem cells in the stem cell state in the lab, or how to efficiently direct them to become a specific type of adult tissue. On the latter there was also considerable work presented on how to get around the fact that too often the adult cells created from stem cells are not fully mature and function more like those tissues would in the fetus than they should in an adult patient.

Fiona Watt of Kings College London presented her work on studying the one “organ” that is easier to study in humans than mice: the skin hair follicle. In the furry critters the hair follicles are too close together to easily isolate individual ones. With our sparser covering it is easy to study single hair follicles, which serve as the niche that houses skin stem cells until they are needed to replenish or repair our outer barrier. In recent years, when trying to understand how stem cells stay stem cells or decide to mature into specific tissue, researchers have increasingly turned their attention to the niches all over the body that stem cells call home. They are finding that there are many facets to these homes—physical, chemical and genetic—that like any neighborhood, impact how a stem cell grows up.

Watt opened by paying tribute to a pioneer in the field who died this past year, Harvard Med School’s Howard Green, who was always a treat to interview when I was there, and who pioneered single cell analysis in skin four decades ago. Watt’s work tries to break down the various components of the skin stem cell niche in the lab to see how each contributes to cell fate. She looked at the extracellular matrix, the scaffold that holds cells in place, and found a link between the size of the hole in the scaffold and cells remaining stem cells. She also found difference between soft and hard scaffolds. She noted other factors such as the type of cell that lives next door and the oxygen level all impact the cell decisions.

She suggested that these determinants of cell fate are likely consistent across stem cell niches throughout the body and will be critical to more efficiently producing replacement tissues to help patients.

 

Jumping from A to C, skipping B.  Two researchers followed Watt who are trying to develop ways to skip the step of turning adult cells in to iPS-type stem cells and instead convert them directly into the desired tissue needed for repair. Stanford’s Marius Wernig, who cited funding from CIRM and the New York Stem Cell Foundation, reported on his work trying to improve his breakthrough from a few years ago in which he converted skin into nerve with just one genetic factor. He is investigating the underlying structures of our DNA to try to understand why only 20 percent of cells make the desired conversion. He is finding some answers but has more to ferret out.

 

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Malin Parmar

Then Malin Parmar of Sweden’s Lund University went into more detail on the fetal cell and stem cell transplant trials she is working with in Parkinson’s disease that she described at our public symposium earlier in the week. But she closed with work that she thinks could be the ultimate best solution to the disease.  Finding genetic factors that can convert other nerve cells directly into the dopamine-producing nerve cells lost in patients with the disease. She started with Wernig’s recipe and added a genetic factor known to drive cells to become dopamine nerves. She succeeded in turning brain cells called glial cells into dopamine nerves inside the brains of mice and showed they made the needed connections to other brain cells. But the work is still some years from getting to patients.

 

The complexities of the heart.  Yesterday afternoon five researchers presented different ways to figure out how to use stem cells to repair or replace a very complex organ, the heart. Shen Ding from Gladstone, who has pioneered the concept of using chemical instead of genetic factors to reprogram cells, presented his latest work in which he used that technique to grow partially mature heart cells in the lab, transplanted them into mice and saw them mature into tissue that improved heart function in a model of heart attack. He said his next experiments will involve finding a way to deliver the chemicals directly into the damaged heart to try to get the reprogramming done in the living animal.

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Stephanie Protze, of the McEwen Centre for Regenerative Medicine in Toronto, presented work on another component of the heart, the pace maker cells that ensure any new muscle cell beats at the right speed.  She described a recipe to drive stem cells to become pace maker cells, but there was a glitch. They beat at 150 beats per minute, which is the fetal rate not the adult rate. So, once again the field ran into the block of creating only partially mature tissue.

Tamer Mohamed, also of the Gladstone, presented work using chemicals to convert heart scar tissue to functional heart muscle. His work tweaked an earlier recipe that resulted in fewer than one percent of cells converting to a procedure that resulted in 30 percent. In the mouse model he saw improved heart function and reduced scarring.

University of Pittsburgh’s Lei Yang presented work on a very big, long-term goal for the field: producing a complete replacement heart. Like several other teams, his group started with a mouse donor heart and used detergents to wash away the cells so that all that was left was the scaffold of that extracellular matrix mentioned above.  He then seeded the scaffold with heart cells derived from iPS cells and let them mature.  The work resulted in what he called “beating heart constructs.”  Some of the cells beat with needed synchronicity and some did not.

All in all, the meeting exudes measured confidence. The field is clearly making rapid strides toward understanding stem cells well enough to create meaningful therapies.  However, it is ripe for what is called “reverse translation,” which is taking the findings of early clinical trials  that don’t perform quite as well as desired, and going back to  the lab to figure out how to make them better.

Circular RNAs: the Mind-Boggling Dark Matter of the Human Genome

/ Todd Dubnicoff / Leave a comment

We were just a few hours into the 2016 annual meeting of the International Society for Stem Cell Research (ISSCR) yesterday afternoon and my mind was already blown away. Pier Paolo Pandolfi of the Beth Israel Deaconess Medical Center at Harvard, spoke during the first plenary session about circular RNAs, which he dubbed, “the mind-boggling dark matter of the human genome” because their existence wasn’t confirmed until just four years ago.

To introduce the topic, Pandolfi compared human DNA to that of bacteria. Both species contain stretches of DNA sequence called genes that contain the instructions for making proteins which collectively form our bodies. Each gene is first transcribed into messenger RNA (mRNA) which in turn is translated into a protein.

Iceberg

Our DNA contains 20,000 genes. But that genetic material is just the tip of the iceberg.

But with the ability to sequence all the mRNA transcripts of an organism, or its transcriptome, came a startling fact about how differently our genetic structure is organized compared to bacteria. It turns out that 88% of DNA sequence in bacteria make up genes that code for proteins but only 2% of human DNA sequence directly codes for proteins. So what’s going with the other 98%? Scientist typically call this 98% chunk of the genome “regulatory DNA” because it contains sequences that act as control switches for turning genes on or off. But Pandolfi explained that more recent studies suggest that a whopping 70% of our genome (maybe even 95%) is transcribed into RNA but those RNA molecules just don’t get translated into protein.

 

One type of this “non-coding” RNA which we’ve blogged about plenty of times is called microRNA (miRNA). So far, about 5,000 human miRNAs have been identified compared to the 20,000 messenger RNAs that code for proteins. But by far the most abundant non-coding RNA in our transcriptome is the mysterious circular RNA (circRNA) with at least 100,000 different transcripts. circRNA was first observed as cellular structures in the 1980’s via electronic microscope images. Then in the 1990’s a scientist published DNA sequencing data suggesting the existence of circRNA. But the science community at that time panned the results, discrediting it as merely background noise of the experiments.

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Pier Paolo Pandolfi
Image: Beth Israel Deaconess Medical Center

But four years ago, the circRNAs were directly sequenced and their existence confirmed. The circRNAs are formed when messenger RNA goes through a well-described trimming process of its sequence. Some of the excised pieces of RNA form into the circular RNAs. It would seem that these circRNAs are just throw away debris but Pandolfi’s lab has found evidence that they directly play a role in cellular functions and even cancer.

His team studies a gene called Pokemon which, when genetically “knocked out” or removed from a mouse’s genome, leads to cancer. Now, it turns out this knockout not only removes the Pokemon protein but also a Pokemon circRNA (circPok). When the lab added back just the Pokemon gene, as you might expect, it acted to suppress cancer in the mice. But when just the circPok was added back, stunningly, it increased the formation of cancer in the mice. Given that genetic knockouts are one of the most pervasive techniques in biomedical science, a closer look at circRNAs that may have been overlooked in all of those results is clearly warranted.

Though this finding is somewhat scary in the fact that it’s a whole aspect of our genome that we’ve been unaware of, one fortunate aspect of circRNA is that they all carry a particular sequence which could be used as a target for a new class of drugs.

This data may extend to stem cells as well. We know that microRNAs have critical roles in regulating the maturation of stem cells into specialized cell types. Since circRNAs are thought to act by competing microRNA, it may not be long before we learn about circRNA’s role in stem cell function.

The other speakers at the first plenary session of the ISSCR annual meeting all gave high caliber talks. Luckily, Paul Knoepfler live blogged on two of those presentations. Here are the links:

 

Multi-Talented Stem Cells: The Many Ways to Use Them in the Clinic

/ Karen Ring / Leave a comment

CIRM kicked off the 2016 International Society for Stem Cell Research (ISSCR) Conference in San Francisco with a public stem cell event yesterday that brought scientists, patients, patient advocates and members of the general public together to discuss the many ways stem cells are being used in the clinic to develop treatments for patients with unmet medical needs.

Bruce Conklin, Gladstone Institutes & UCSF

Bruce Conklin, Gladstone Institutes & UCSF

Bruce Conklin, an Investigator at the Gladstone Institutes and UCSF Professor, moderated the panel of four scientists and three patient advocates. He immediately captured the audience’s attention by showing a stunning video of human heart cells, beating in synchrony in a petri dish. Conklin explained that scientists now have the skills and technology to generate human stem cell models of cardiomyopathy (heart disease) and many other diseases in a dish.

Conklin went on to highlight four main ways that stem cells are contributing to human therapy. First is using stem cells to model diseases whose causes are still largely unknown (like with Parkinson’s disease). Second, genome editing of stem cells is a new technology that has the potential to offer cures to patients with genetic disorders like sickle cell anemia. Third, stem cells are known to secrete healing factors, and transplanting them into humans could be beneficial. Lastly, stem cells can be engineered to attack cancer cells and overcome cancer’s normal way of evading the immune system.

Before introducing the other panelists, Conklin made the final point that stem cell models are powerful because scientists can use them to screen and develop new drugs for diseases that have no treatments or cures. His lab is already working on identifying new drugs for heart disease using human induced pluripotent stem cells derived from patients with cardiomyopathy.

Scientists and Patient Advocates Speak Out

Malin Parmar, Lund University

Malin Parmar, Lund University

The first scientist to speak was Malin Parmar, a Professor at Lund University. She discussed the history of stem cell development for clinical trials in Parkinson’s disease (PD). Her team is launching the first in-human trial for Parkinson’s using cells derived from human pluripotent stem cells in 2016. After Parmar’s talk, John Lipp, a PD patient advocate. He explained that while he might look normal standing in front of the crowd, his PD symptoms vary wildly throughout the day and make it hard for him to live a normal life. He believes in the work that scientists like Parmar are doing and confidently said, “In my lifetime, we will find a stem cell cure for Parkinson’s disease.”

Adrienne Shapiro, Patient Advocate

Adrienne Shapiro, Patient Advocate

The next scientist to speak was UCLA Professor Donald Kohn. He discussed his lab’s latest efforts to develop stem cell treatments for different blood disorder diseases. His team is using gene therapy to modify blood stem cells in bone marrow to treat and cure babies with SCID, also known as “bubble-boy disease”. Kohn also mentioned their work in sickle cell disease (SCD) and in chronic granulomatous disease, both of which are now in CIRM-funded clinical trials. He was followed by Adrienne Shapiro, a patient advocate and mother of a child with SCD. Adrienne gave a passionate and moving speech about her family history of SCD and her battle to help find a cure for her daughter. She said “nobody plans to be a patient advocate. It is a calling born of necessity and pain. I just wanted my daughter to outlive me.”

Henry Klassen (UC Irvine)

Henry Klassen, UC Irvine

Henry Klassen, a professor at UC Irvine, next spoke about blinding eye diseases, specifically retinitis pigmentosa (RP). This disease damages the photo receptors in the back of the eye and eventually causes blindness. There is no cure for RP, but Klassen and his team are testing the safety of transplanting human retinal progenitor cells in to the eyes of RP patients in a CIRM-funded Phase 1/2 clinical trial.

Kristen MacDonald, RP patient

Kristen MacDonald, RP patient

RP patient, Kristen MacDonald, was the trial’s first patient to be treated. She bravely spoke about her experience with losing her vision. She didn’t realize she was going blind until she had a series of accidents that left her with two broken arms. She had to reinvent herself both physically and emotionally, but now has hope that she might see again after participating in this clinical trial. She said that after the transplant she can now finally see light in her bad eye and her hope is that in her lifetime she can say, “One day, people used to go blind.”

Lastly, Catriona Jamieson, a professor and Alpha Stem Cell Clinic director at UCSD, discussed how she is trying to develop new treatments for blood cancers by eradicating cancer stem cells. Her team is conducting a Phase 1 CIRM-funded clinical trial that’s testing the safety of an antibody drug called Cirmtuzumab in patients with chronic lymphocytic leukemia (CLL).

Scientists and Patients need to work together

Don Kohn, Catriona Jamieson, Malin Parmar

Don Kohn, Catriona Jamieson, Malin Parmar

At the end of the night, the scientists and patient advocates took the stage to answer questions from the audience. A patient advocate in the audience asked, “How can we help scientists develop treatments for patients more quickly?”

The scientists responded that stem cell research needs more funding and that agencies like CIRM are making this possible. However, we need to keep the momentum going and to do that both the physicians, scientists and patient advocates need to work together to advocate for more support. The patient advocates in the panel couldn’t have agreed more and voiced their enthusiasm for working together with scientists and clinicians to make their hopes for cures a reality.

The CIRM public event was a huge success and brought in more than 150 people, many of whom stayed after the event to ask the panelists more questions. It was a great kick off for the ISSCR conference, which starts today. For coverage, you can follow the Stem Cellar Blog for updates on interesting stem cell stories that catch our eye.

CIRM Public Stem Cell Event

CIRM Public Stem Cell Event