Video: Behind the scenes of a life-saving gene therapy stem cell treatment

“We were so desperate. When we heard about this treatment were willing to do anything to come here.”

In the above quote from Zahraa El Kerdi, “here” refers to UCLA, a world away from her hometown in Lebanon. In September 2015, Zahree gave birth to a son, Hussein, who appeared perfectly healthy. But by six months, he was barely clinging to life due to an inherited blood disorder, ADA-SCID, also called Bubble Baby disease. The disorder left Hussein without a functioning immune system so even a common cold could prove deadly. In fact, SCID babies rarely survive past one year of age. Up until now, no treatment options existed for the disease.

But Zahraa and her husband Ali heard about a CIRM-funded clinical trial, led by Donald Kohn, M.D. at UCLA, that could modify Hussein’s blood stem cells to fix the gene problem that’s causing his disease. The El Kerdi’s 7500-mile journey to save Hussein’s life is captured in a wonderful, five-minute video produced by UCLA’s Broad Stem Cell Research Center.

With before and after scenes of Hussein’s treatment as well as animation describing how the therapy works, the short documentary is equal parts heart wrenching, uplifting and educational. Basically, what I’m trying to say is, it’s a must-see and available to view above.

The story behind the book about the Stem Cell Agency

DonReed_BookSigning2018-35

Don Reed at his book launch: Photo by Todd Dubnicoff

WHY I WROTE “CALIFORNIA CURES”  By Don C. Reed

It was Wednesday, June 13th, 2018, the launch day for my new book, “CALIFORNIA CURES: How the California Stem Cell Research Program is Fighting Your Incurable Disease!”

As I stood in front of the audience of scientists, CIRM staff members, patient advocates, I thought to myself, “these are the kind of people who built the California stem cell program.” Wheelchair warriors Karen Miner and Susan Rotchy, sitting in the front row, typified the determination and resolve typical of those who fought to get the program off the ground. Now I was about to ask them to do it one more time.

My first book about CIRM was “STEM CELL BATTLES: Proposition 71 and Beyond. It told the story of  how we got started: the initial struggles—and a hopeful look into the future.

Imagine being in a boat on the open sea and there was a patch of green on the horizon. You could be reasonably certain those were the tops of coconut trees, and that there was an island attached—but all you could see was a patch of green.

Today we can see the island. We are not on shore yet, but it is real.

“CALIFORNIA CURES” shows what is real and achieved: the progress the scientists have made– and why we absolutely must continue.

For instance, in the third row were three little girls, their parents and grandparents.

One of them was Evangelina “Evie” Vaccaro, age 5. She was alive today because of CIRM, who had funded the research and the doctor who saved her.

Don Reed and Evie and Alysia

Don Reed, Alysia Vaccaro and daughter Evie: Photo by Yimy Villa

Evie was born with Severe Combined Immunodeficiency (SCID) commonly called the “bubble baby” disease. It meant she could never go outside because her immune system could not protect her.  Her mom and dad had to wear hospital masks to get near her, even just to give her a hug.

But Dr. Donald Kohn of UCLA operated on the tiny girl, taking out some of her bone marrow, repairing the genetic defect that caused SCID, then putting the bone marrow back.

Today, “Evie” glowed with health, and was cheerfully oblivious to the fuss she raised.

I was actually a little intimidated by her, this tiny girl who so embodied the hopes and dreams of millions. What a delight to hear her mother Alysia speak, explaining  how she helped Evie understand her situation:  she had “unicorn blood” which could help other little children feel better too.

This was CIRM in action, fighting to save lives and ease suffering.

If people really knew what is happening at CIRM, they would absolutely have to support it. That’s why I write, to get the message out in bite-size chunks.

You might know the federal statistics—133 million children, women and men with one or more chronic diseases—at a cost of $2.9 trillion dollars last year.

But not enough people know California’s battle to defeat those diseases.

DonReed_BookSigning2018-22

Adrienne Shapiro at the book launch: Photo by Todd Dubnicoff

Champion patient advocate Adrienne Shapiro was with us, sharing a little of the stress a parent feels if her child has sickle cell anemia, and the science which gives us hope:  the CIRM-funded doctor who cured Evie is working on sickle cell now.

Because of CIRM, newly paralyzed people now have a realistic chance to recover function: a stem cell therapy begun long ago (pride compels me to mention it was started by the Roman Reed Spinal Cord Injury Research Act, named after my son), is using stem cells to re-insulate damaged nerves in the spine.  Six people were recently given the stem cell treatment pioneered by Hans Keirstead, (currently running for Congress!)  and all six experienced some level of recovery, in a few cases regaining some use of their arms hands.

Are you old enough to remember the late Annette Funicello and Richard Pryor?  These great entertainers were stricken by multiple sclerosis, a slow paralysis.  A cure did not come in time for them. But the international cooperation between California’s Craig Wallace and Australia’s Claude Bernard may help others: by  re-insulating MS-damaged nerves like what was done with spinal cord injury.

My brother David shattered his leg in a motorcycle accident. He endured multiple operations, had steel rods and plates inserted into his leg. Tomorrow’s accident recovery may be easier.  At Cedars-Sinai, Drs. Dan Gazit and Hyun Bae are working to use stem cells to regrow the needed bone.

My wife suffers arthritis in her knees. Her pain is so great she tries to make only one trip a day down and up the stairs of our home.  The cushion of cartilage in her knees is worn out, so it is bone on bone—but what if that living cushion could be restored? Dr. Denis Evseenko of UCLA is attempting just that.

As I spoke, on the wall behind me was a picture of a beautiful woman, Rosie Barrero, who had been left blind by retinitis pigmentosa. Rosie lost her sight when her twin children were born—and regained it when they were teenagers—seeing them for the first time, thanks to Dr. Henry Klassen, another scientist funded by CIRM.

What about cancer? That miserable condition has killed several of my family, and I was recently diagnosed with prostate cancer myself. I had everything available– surgery, radiation, hormone shots which felt like harpoons—hopefully I am fine, but who knows for sure?

Irv Weissman, the friendly bear genius of Stanford, may have the answer to cancer.  He recognized there were cancer stem cells involved. Nobody believed him for a while, but it is now increasingly accepted that these cancer stem cells have a coating of protein which makes them invisible to the body’s defenses. The Weissman procedure may peel off that “cloak of invisibility” so the immune system can find and kill them all—and thereby cure their owner.

What will happen when CIRM’s funding runs out next year?

If we do nothing, the greatest source of stem cell research funding will be gone. We need to renew CIRM. Patients all around the world are depending on us.

The California stem cell program was begun and led by Robert N. “Bob” Klein. He not only led the campaign, was its chief writer and number one donor, but he was also the first Chair of the Board, serving without pay for the first six years. It was an incredible burden; he worked beyond exhaustion routinely.

Would he be willing to try it again, this time to renew the funding of a successful program? When I asked him, he said:

“If California polls support the continuing efforts of CIRM—then I am fully committed to a 2020 initiative to renew the California Institute for Regenerative Medicine (CIRM).”

Shakespeare said it best in his famous “to be or not to be” speech, asking if it is “nobler …to endure the slings and arrows of outrageous fortune, or to take arms against a sea of troubles—and by opposing, end them”.

Should we passively endure chronic disease and disability—or fight for cures?

California’s answer was the stem cell program CIRM—and continuing CIRM is the reason I wrote this book.

Don C. Reed is the author of “CALIFORNIA CURES: How the California Stem Cell Program is Fighting Your Incurable Disease!”, from World Scientific Publishing, Inc., publisher of the late Professor Stephen Hawking.

For more information, visit the author’s website: www.stemcellbattles.com

 

World Sickle Cell Day: Managing the disease today for tomorrow’s stem cell cures

Today is World Sickle Cell Day, a day to promote awareness about sickle cell disease (SCD), an inherited, chronic blood disorder which can cause severe pain, stroke, organ failure, and other complications, including death. Sadly, it’s estimated that this year 300,000 babies around the world will be born with SCD.

To recognize World Sickle Cell Day, we’re sharing a one-minute clip from a video interview we filmed last week with Adrienne Shapiro, a tireless advocate for sickle cell patients and the development of stem cell-based cures.

Shapiro, the fifth generation of mothers in her family to have a child born with SCD, is co-founder of Axis Advocacy, a Southern California organization whose mission is to improve the lives of patients and caregivers who are dealing with this chronic illness.

In the video, Shapiro says that just the promise of stem cell-based therapies for SCD, “relieves that pain and suffering and guilt of having passed this (inherited disorder) along as well as knowing that I can really be the last mother, the last generation to fight for my child’s life.”

Speaking of stem cell therapies, CIRM is currently funding two clinical trials related to SCD. A UCLA team is testing a stem cell and gene therapy product from the patient’s own blood to correct the mutation that causes the production of abnormal, sickle-like shaped red blood cells. And City of Hope scientists are testing a novel blood stem cell transplant procedure that uses a milder, less toxic chemotherapy treatment that allows donor stem cells to engraft and create a healthy supply of non-diseased blood cells without causing an immune reaction in the patient.

While Shapiro’s Axis Advocacy and CIRM provide critical support here in California, other organizations like the American Society of Hematology and the Sickle Cell Disease Coalition have their efforts set on the developing world, particularly in sub-Saharan Africa, where an estimated 50–90 percent of infants born with SCD will die before their fifth birthday.

To do something about this heartbreaking statistic, these organization are debuting a public service announcement and short documentary – watch the video playlist below – to help improve newborn screening and early care for children in Africa living with sickle cell disease.

As Shapiro explained to us during her interview, it’s important to provide the support and education needed to manage the disease so that when the cure comes, the patients will be alive to receive it.

SCID kid scores big on TV

Evie at book signing

One of the stories I never tire of telling is about Evie Vaccaro. She’s the little girl who was born with a fatal immune condition called severe combined immunodeficiency or SCID. Children with this condition have no immune system, no protection against infections, and often die in the first two years of life. But thanks to a stem cell therapy Evie was cured.

Evie is now five years old. A happy, healthy and, as we discovered last week, a very energetic kid. That’s because Evie and her family came to CIRM to celebrate the launch of Don Reed’s new book, “California Cures! How the California Stem Cell Program is Fighting Your Incurable Disease”.

Don Reed and Evie and Alysia

Don Reed with Alysia and Evie Vaccaro – Photo courtesy Yimy Villa

Don’s book is terrific – well, it’s about CIRM so I might be biased – but Evie stole the show, and the hearts of everyone there.

KTVU, the local Fox News TV station, did a couple of stories about Evie. Here’s one of them.

We will have more on Don Reed’s book later this week.

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

 

TELL ME WHAT I NEED TO KNOW: A Patient Advocate’s guide to being a Patient Advocate

A few weeks ago I was at the CIRM Alpha Stem Cell Clinic Network Symposium at UCLA and was fortunate enough to hear Gianna McMillan speak about patient advocacy. It was a powerful, moving, funny, and truly engaging talk. I quickly realized I wanted to blog about her talk and so for the first few minutes I was busy taking notes as fast as I could.  And then I realized that a simple blog could never do justice to what Gianna was saying, that what we needed was to run the whole presentation. So here it is.

Gianna McMillan

Gianna McMillan at the CIRM Alpha Stem Cell Clinic Symposium: Photo courtesy UCLA

TELL ME WHAT I NEED TO KNOW

Gianna McMillan, MA – Patient/Subject Advocate, Bioethics Institute at Loyola Marymount University

Stem cell research and regenerative medicine are appealing topics because patients, families and society are weary of inelegant medical interventions that inflict, in some cases, as much harm as benefit. We are tired of putting poison in our loved ones to kill their cancer or feeling helpless as other diseases attack our own bodily functions. California, full of dreamers and go-getters, has enthusiastically embraced this new technology—but it is important to remember that all biomedical research— even in a new field as exciting and inspiring as stem cell therapeutics – must adhere to basic premises. It must be valid science and it must be based on an ethical partnership with patients and research subjects.

In the world of research ethics, I wear a lot of hats. I have been a subject, a care-giver, an Institutional Review Board (IRB) member (someone who actually reviews and approves research studies before they are allowed to proceed), and I have worked with the government on regulatory committees. These days I am finishing my doctoral studies in Bioethics, and while I love the interplay of philosophy and ethical principles, I most truly identify as an in-the-trenches Patient/Subject Advocate. I am compelled to champion patients who struggle with new and devastating diagnoses, hoping desperately for a cure, and who might be faced with decisions about participating in research for their own benefit and for the greater good of science.

In the old days, doctors made decisions on behalf of their patients— who, meekly grateful for the guidance, did whatever they were told. It is a little different now. Patients are better informed, often do their own homework, and demand to be an integral part of their treatment plan. The world of research has undergone similar changes. Instead of investigators “doing things to research subjects”, best practices involve patients in the design of clinical trials. Patients and experienced subjects help decide what specific questions should be the focus of the research; they identify endpoints in the research that are meaningful to the patient population being studied; and they assist in devising tools for patient-reported outcomes and delivery of study results.

The investigator and the research subject have come to be seen as partners.

While the evolution of this important relationship is healthy and wonderful, it should not be assumed that this is an equal partnership. Why? Because subjects are always at a disadvantage.  I realize that this might be an uncomfortable concept. Physician-investigators in charge of the study might want to qualify this statement it by insisting “but we do our best to accommodate their needs”. Subjects would also rather not admit this—because it is hard to make a decision with confidence while simultaneously acknowledging, “I am really at a disadvantage here.”

However, I have learned the hard way that an honest partnership requires addressing some uncomfortable realities.

A short personal story illustrates what I am talking about. When my oldest son was five years old, he was diagnosed with malignant brain cancer. Before meeting with our son’s treatment team for the first time, my husband and I decided that my husband, articulate and concise, would take the lead. He had a legal pad, with a list of questions… each question and answer would take us down the page until, at last, we would use all the information to make a decision—a life or death decision – on behalf of our young child.

In the meeting, the neurosurgeon pointed at brain scans and explained a few things. And then radiologist drew pictures of machines and treatment angles. The oncologist described risks and benefits and side effects. Then we all looked expectantly at my husband—because it was his turn. This lovely man opened his mouth. And closed his mouth. And then burst into tears, holding that legal pad over his chest like a shield. He could not speak. After a few seconds of horrified silence, I stammered out what few questions I could remember. The doctors answered, of course. Their mouths moved, and I leaned in and nodded while making eye contact – but I have no idea what they said.  All I heard was a loud white noise that filled my skull and my husband’s raspy breathing, and my own voice crying out in my head – “Oh my God! My child! My child!”

The point of this story is to illustrate that good people, educated and prepared, ready to bring their best selves to make the most important decision they would ever make, one that would affect the life of a beloved child— these people could not function. Despite this, in just a few days’ time, we were introduced to a research study, one that might cure our child while limiting the damage to his growing brain.  No matter how well-intentioned the research team was—no matter how desirous they were of a “partnership” with us, we were at such a distinct disadvantage, that the relationship we had with these investigators could not be categorized as one “among equals”.

Even now, more than twenty years later, it is painful for me to reflect on this. But I have learned, working with hundreds of families whose children went into clinical trials, that if we can be honest about the dysfunctional nature of this situation, we might take some action to improve it. Let me be specific about the ways research subjects are at a disadvantage.

  1. They often don’t speak the language of the disease.
  2. They are unfamiliar with the process of research.
  3. They are wrestling with emotions: despair, denial, anger and hope.
  4. Their life has been disrupted – and there are consequences.

Compare this with the research team, who knows the lingo, designed the research plan, is not personally affected by the scenario and well, this is business as usual: enroll a subject, let’s get going! How is the notion of “partnership” affected by such unequal circumstances?

Is a meaningful “partnership” even possible?

I say, yes! And this notion of “partnership” is especially important as new technologies come to invade intimate qualities of “self” and the building blocks of what makes each of us human. However, we need to be realistic about what this partnership looks like. It is not equal.  I am going to take a stand here and say that the partner who has the advantage (in this case, the researcher/scientist) is morally obligated to meaningfully address the disadvantage of the other party. This bears repeating. The partner who has the advantage is morally obligated to meaningfully address the disadvantage of the other party.

Over the years, families and subjects have told me what they want and need from the doctors and researchers they work with. They say:

  1. Tell me what I need to know.
  2. Tell me in a way I can hear it.
  3. Tell me again and again.

Let me expand on these a bit. First, if I am a patient new to a diagnosis, a treatment or research—I probably do not know what I do not know. Help me learn vocabulary, procedures, and systems. Tell me about the elements of informed consent so that I recognize them when I see them in the documents you want me to sign. Explain the difference between “standard of care” and “experimental treatment”. Help me understand the research question in the context of the disease (in general) and my own ailment (in particular). Give me the words to ask the questions that I should be asking.

Secondly, there are many different ways of sharing this information: print, video, websites, peer mentors, nurse-educators, and research team members. Hit the topic from all sides and in multiple formats. Thirdly, please realize that there is a learning curve for me— and it is closely tied to my emotional journey with my predicament. I may not be able to absorb certain facts at the very beginning, but a few weeks later I might be mentally and cognitively in a different place. And obviously, I might be an inexperienced research subject when I sign the consent form— but a few months later I will be vastly more sophisticated and at that time, I need the opportunity to ask my more considered and context-savvy questions.

I want to point out that researchers have access to a deep well of wisdom – a resource that can advise and support ethical actions that will help their disadvantaged partners: researchers can ask their experienced subjects for advice.

Remember those hundreds of families I worked with, whose children ultimately enrolled in clinical trials? These experienced parents say:

  • Let me tell you what I needed to know.
  • Let me tell you how I needed to hear it.

Getting input from these experienced subjects and caregivers does two things.

First, the research team is leveraging the investment they have already made in the participants of their studies; and secondly — very importantly — they are empowering the previously disadvantaged partner. Experienced subjects can to share what they have learned or give suggestions to the research team. Physicians and researchers might even build a stable of peer mentors who might be willing to help newbies learn about the process.

Everything I have said applies to all avenues of clinical research, but these are especially important considerations in the face of new and exciting science. It took a long time for more traditional research practices to evolve into an investigator/subject partnership model. Stem cell research and regenerative medicine has the opportunity to do this from the very start—and benefit from previous lessons learned.

When I was preparing my remarks for today, someone casually mentioned that I might talk about the “importance of balancing truth-telling in the informed consent process with respect for the hope of the family.” I would like to unequivocally state that the very nature of an “informed consent process” requires 100% truth, as does respect for the family—and that this does not undermine our capacity for hope. We place our hope in this exciting new science and the doctors and researchers who are pioneers. We understand that there are many unknowns in this new field. Please be honest with us so that we might sort out our thoughts and our hopes for ourselves, in our own contexts.

What message would I wish the scientists here, today, to take away with them?      Well, I am putting on my Patient/Subject Advocate hat, and in my Patient/Subject Advocate voice, I am saying: “Tell me what I need to know!”

 

 

Stem Cell Agency’s supporting role in advancing research for rare diseases

Orchard

The recent agreement transferring GSK’s rare disease gene therapies to Orchard Therapeutics was good news for both companies and for the patients who are hoping this research could lead to new treatments, even cures, for some rare diseases. It was also good news for CIRM, which played a key role in helping Orchard grow to the point where this deal was possible.

In a news releaseMaria Millan, CIRM’s President & CEO, said:

“At CIRM, our value proposition is centered around our ability to advance the field of regenerative medicine in many different ways. Our funding and partnership has enabled the smooth transfer of Dr. Kohn’s technology from the academic to the industry setting while conducting this important pivotal clinical trial. With our help, Orchard was able to attract more outside investment and now it is able to grow its pipeline utilizing this platform gene therapy approach.”

Under the deal, GSK not only transfers its rare disease gene therapy portfolio to Orchard, it also becomes a shareholder in the company with a 19.9 percent equity stake. GSK is also eligible to receive royalties and commercial milestone payments. This agreement is both a recognition of Orchard’s expertise in this area, and the financial potential of developing treatments for rare conditions.

Dr. Millan says it’s further proof that the agency’s impact on the field of regenerative medicine extends far beyond the funding it offers companies like Orchard.

“Accelerating stem cell therapies to patients with unmet medical needs involves a lot more than just funding research; it involves supporting the research at every stage and creating partnerships to help it fulfill its potential. We invest when others are not ready to take a chance on a promising but early stage project. That early support not only helps the scientists get the data they need to show their work has potential, but it also takes some of the risk out of investments by venture capitalists or larger pharmaceutical companies.”

CIRM’s early support helped UCLA’s Don Kohn, MD, develop a stem cell therapy for severe combined immunodeficiency (SCID). This therapy is now Orchard’s lead program in ADA-SCID, OTL-101.

Sohel Talib, CIRM’s Associate Director Therapeutics and Industry Alliance, says this approach has transformed the lives of dozens of children born with this usually fatal immune disorder.

“This gene correction approach for severe combined immunodeficiency (SCID) has already transformed the lives of dozens of children treated in early trials and CIRM is pleased to be a partner on the confirmatory trial for this transformative treatment for patients born with this fatal immune disorder.”

Dr. Donald B. Kohn UCLA MIMG BSCRC Faculty 180118Dr. Kohn, now a member of Orchard’s scientific advisory board, said:

“CIRM funding has been essential to the overall success of my work, supporting me in navigating the complex regulatory steps of drug development, including interactions with FDA and toxicology studies that enhanced and helped drive the ADA-SCID clinical trial.”

CIRM funding has allowed Orchard Therapeutics to expand its technical operations footprint in California, which now includes facilities in Foster City and Menlo Park, bringing new jobs and generating taxes for the state and local community.

Mark Rothera, Orchard’s President and CEO, commented:

“The partnership with CIRM has been an important catalyst in the continued growth of Orchard Therapeutics as a leading company transforming the lives of patients with rare diseases through innovative gene therapies. The funding and advice from CIRM allowed Orchard to accelerate the development of OTL-101 and to build a manufacturing platform to support our development pipeline which includes 5 clinical and additional preclinical programs for potentially transformative gene therapies”.

Since CIRM was created by the voters of California the Agency has been able to use its support for research to leverage an additional $1.9 billion in funds for California. That money comes in the form of co-funding from companies to support their own projects, partnerships between outside investors or industry groups with CIRM-funded companies to help advance research, and additional funding that companies are able to attract to a project because of CIRM funding.

Patients at the heart of Alpha Stem Cell Clinics Symposium

I have been to a lot of stem cell conferences over the years and there’s one recent trend I really like: the growing importance and frequency of the role played by patient advocates.

There was a time, not so long ago, when having a patient advocate speak at a scientific conference was almost considered a novelty. But more and more it’s being seen for what it is, an essential item on the agenda. After all, they are the reason everyone at that conference is working. It’s all about the patients.

That message was front and center at the 3rd Annual CIRM Alpha Stem Cell Clinics Network Symposium at UCLA last week. The theme of the symposium was the Delivery of Stem Cell Therapeutics to Patients. There were several fascinating scientific presentations, highlighting the progress being made in stem cell research, but it was the voices of the patient advocates that were loudest and most powerful.

First a little background. The CIRM Alpha Stem Cell Clinics Network consists of six major medical centers – UCLA/UC Irvine (joint hosts of this conference), UC San Diego, City of Hope, UC San Francisco and UC Davis. The Network was established with the goal of accelerating the development and delivery of high-quality stem cell clinical trials to patients. This meeting brought together clinical investigators, scientists, patients, patient advocates, and the public in a thoughtful discussion on how novel stem cell therapies are now a reality.

It was definitely thoughtful. Gianna McMillan, the Co-Founder and Executive Director of “We Can, Pediatric Brain Tumor Network” set the tone with her talk titled, “Tell Me What I Need to Know”. At age 5 her son was diagnosed with a brain tumor, sending her life into a tailspin. The lessons she learned from that experience – happily her son is now a healthy young man – drive her determination to help others cope with similar situations.

Calling herself an “in the trenches patient advocate champion” she says:

“In the old days doctors made decisions on behalf of the patients who meekly and gratefully did what they were told. It’s very different today. Patients are better informed and want to be partners in the treatment they get. But yet this is not an equal partnership, because subjects (patients) are always at a disadvantage.”

She said patients often don’t speak the language of the disease or understand the scientific jargon doctors use when they talk about it. At the same time patients are wrestling with overwhelming emotions such as fear and anxiety because their lives have been completely overturned.

Yet she says a meaningful partnership is possible as long as doctors keep three basic questions in mind when dealing with people who are getting a new diagnosis of a life-threatening or life-changing condition:

  • Tell me what I need to know
  • Tell me in language I can understand
  • Tell me again and again

It’s a simple formula, but one that is so important that it needs to be stated over and over again. “Tell me again. And again. And again.”

David Mitchell, the President and Founder of Patients for Affordable Drugs, tackled another aspect of the patient experience: the price of therapies. He posed the question “What good is a therapy if no one can afford it?”

David’s organization focuses on changing policy at the state and federal level to lower the price of prescription drugs. He pointed out that many other countries charge lower prices for drugs than the US, in part because those countries’ governments negotiate directly with drug companies on pricing.

He says if we want to make changes in this country that benefit patients then patient have to become actively involved in lobbying their government, at both the state and local level, for more balanced prices, and in supporting candidates for public office who support real change in drug-pricing policy.

It’s encouraging to see that just as the field of stem cell research is advancing so too is the prominence of the patient’s voice. The CIRM Alpha Stem Cell Clinics Network is pushing the field forward in exciting ways, and the patients are becoming an increasingly important, and vital part of that. And that is as it should be.

Stem Cell Roundup: The brain & obesity; iPSCs & sex chromosomes; modeling mental illness

Stem Cell Image of the Week:
Obesity-in-a-dish reveals mutations and abnormal function in nerve cells

cedars-sinai dayglo

Image shows two types of hypothalamic neurons (in magenta and cyan) that were derived from human induced pluripotent stem cells.
Credit: Cedars-Sinai Board of Governors Regenerative Medicine Institute

Our stem cell image of the week looks like the work of a pre-historic cave dweller who got their hands on some DayGlo paint. But, in fact, it’s a fluorescence microscopy image of stem cell-derived brain cells from the lab of Dhruv Sareen, PhD, at Cedars-Sinai Medical Center. Sareen’s team is investigating the role of the brain in obesity. Since the brain is a not readily accessible organ, the team reprogrammed skin and blood cell samples from severely obese and normal weight individuals into induced pluripotent stem cells (iPSCs). These iPSCs were then matured into nerve cells found in the hypothalamus, an area of the brain that regulates hunger and other functions.

A comparative analysis showed that the nerve cells derived from the obese individuals had several genetic mutations and had an abnormal response to hormones that play a role in telling our brains that we are hungry or full. The Cedars-Sinai team is excited to use this obesity-in-a-dish system to further explore the underlying cellular changes that lead to excessive weight gain. Ultimately, these studies may reveal ways to combat the ever-growing obesity epidemic, as Dr. Sareen states in a press release:

“We are paving the way for personalized medicine, in which drugs could be customized for obese patients with different genetic backgrounds and disease statuses.”

The study was published in Cell Stem Cell

Differences found in stem cells derived from male vs female.

168023_web

Microscope picture of a colony of iPS cells. Credit: Vincent Pasque

Scientists at UCLA and KU Leuven University in Belgium carried out a study to better understand the molecular mechanisms that control the process of reprogramming adult cells back into the embryonic stem cell-like state of induced pluripotent stem cells (iPSCs). Previous studies have shown that female vs male embryonic stem cells have different patterns of gene regulation. So, in the current study, male and female cells were analyzed side-by-side during the reprogramming process.  First author Victor Pasquale explained in a press release that the underlying differences stemmed from the sex chromosomes:

In a normal situation, one of the two X chromosomes in female cells is inactive. But when these cells are reprogrammed into iPS cells, the inactive X becomes active. So, the female iPS cells now have two active X chromosomes, while males have only one. Our results show that studying male and female cells separately is key to a better understanding of how iPS cells are made. And we really need to understand the process if we want to create better disease models and to help the millions of patients waiting for more effective treatments.”

The CIRM-funded study was published in Stem Cell Reports.

Using mini-brains and CRISPR to study genetic linkage of schizophrenia, depression and bipolar disorder.

If you haven’t already picked up on a common thread in this week’s stories, this last entry should make it apparent: iPSC cells are the go-to method to gain insight in the underlying mechanisms of a wide range of biology topics. In this case, researchers at Brigham and Women’s Hospital at Harvard Medical School were interested in understanding how mutations in a gene called DISC1 were linked to several mental illnesses including schizophrenia, bipolar disorder and severe depression. While much has been gleaned from animal models, there’s limited knowledge of how DISC1 affects the development of the human brain.

The team used human iPSCs to grow cerebral organoids, also called mini-brains, which are three-dimensional balls of cells that mimic particular parts of the brain’s anatomy. Using CRISPR-Cas9 gene-editing technology – another very popular research tool – the team introduced DISC1 mutations found in families suffering from these mental disorders.

Compared to cells with normal copies of the DISC1 gene, the mutant organoids showed abnormal structure and excessive cell signaling. When an inhibitor of that cell signaling was added to the growing mutant organoids, the irregular structures did not develop.

These studies using human cells provide an important system for gaining a better understanding of, and potentially treating, mental illnesses that victimize generations of families.

The study was published in Translation Psychiatry and picked up by Eureka Alert.

Stem Cell Roundup: watching brain cells in real time, building better heart cells, and the plot thickens on the adult neurogenesis debate

Here are the stem cell stories that caught our eye this week.

Watching brain cells in real time

This illustration depicts a new method that enables scientists to see an astrocyte (green) physically interacting with a neuronal synapse (red) in real time, and producing an optical signal (yellow). (Khakh Lab, UCLA Health)

Our stem cell photo of the week is brought to you by the Khakh lab at UCLA Health. The lab developed a new method that allows scientists to watch brain cells interact in real time. Using a technique called fluorescence resonance energy-transfer (FRET) microscopy, the team can visualize how astrocytes (key support cells in our central nervous system) and brain cells called neurons form connections in the mouse brain and how these connections are affected by diseases like Alzheimer’s and ALS.

Baljit Khakh, the study’s first author, explained the importance of their findings in a news release:

“This new tool makes possible experiments that we have been wanting to perform for many years. For example, we can now observe how brain damage alters the way that astrocytes interact with neurons and develop strategies to address these changes.”

The study was published this week in the journal Neuron.


Turn up the power: How to build a better heart cell (Todd Dubnicoff)

For years now, researchers have had the know-how to reprogram a donor’s skin cells into induced pluripotent stem cells (iPSCs) and then specialize them into heart muscle cells called cardiomyocytes. The intervening years have focused on optimizing this method to accurately model the biology of the adult human heart as a means to test drug toxicity and ultimately develop therapies for heart disease. Reporting this week in Nature, scientists at Columbia University report an important step toward those goals.

The muscle contractions of a beating heart occur through natural electrical impulses generated by pacemaker cells. In the case of lab-grown cardiomyocytes, introducing mechanical and electrical stimulation is required to reliably generate these cells. In the current study, the research team showed that the timing and amount of stimulation is a critical aspect to the procedure.

The iPS-derived cardiomyocytes have formed heart tissue that closely mimics human heart functionality at over four weeks of maturation. Credit: Gordana Vunjak-Novakovic/Columbia University.

The team tested three scenarios on iPSC-derived cardiomyocytes (iPSC-CMs): no electrical stimulation for 3 weeks, constant stimulation for 3 weeks, and finally, two weeks of increasingly higher stimulation followed by a week of constant stimulation. This third setup mimics the changes that occur in a baby’s heart just before and just after birth.

These scenarios were tested in 12 day-old and 28 day-old iPSC-CMs. The results show that only the 12 day-old cells subjected to the increasing amounts of stimulation gave rise to fully mature heart muscle cells. On top of that, it only took four weeks to make those cells. Seila Selimovic, Ph.D., an expert at the National Institutes of Health who was not involved in the study, explained the importance of these findings in a press release:

“The resulting engineered tissue is truly unprecedented in its similarity to functioning human tissue. The ability to develop mature cardiac tissue in such a short time is an important step in moving us closer to having reliable human tissue models for drug testing.”

Read more at: https://phys.org/news/2018-04-early-bioengineered-human-heart-cells.html#jCp


Yes we do, no we don’t. More confusion over growing new brain cells as we grow older (Kevin McCormack)

First we didn’t, then we did, then we didn’t again, now we do again. Or maybe we do again.

The debate over whether we are able to continue making new neurons as we get older took another twist this week. Scientists at Columbia University said their research shows we do make new neurons in our brain, even as we age.

This image shows what scientists say is a new neuron in the brain of an older human. A new study suggests that humans continue to make new neurons throughout their lives. (Columbia University Irving Medical Center)

In the study, published in the journal Cell Stem Cell, the researchers examined the brains of 28 deceased donors aged 14 to 79. They found similar numbers of precursor and immature neurons in all the brains, suggesting we continue to develop new brain cells as we age.

This contrasts with a UCSF study published just last month which came to the opposite conclusion, that there was no evidence we make new brain cells as we age.

In an interview in the LA Times, Dr. Maura Boldrini, the lead author on the new study, says they looked at a whole section of the brain rather than the thin tissues slices the UCSF team used:

“In science, the absence of evidence is not evidence of absence. If you can’t find something it doesn’t mean that it is not there 100%.”

Well, that resolves that debate. At least until the next study.