Advanced stem cell research and therapy development for more than 75 diseases.
Funded 76 clinical trials with 3,200+ patients enrolled.
Helped cure over 40 children of fatal immunological disorders with gene-modified cell therapies.
One of these patients is Ronnie, who just days after being born was diagnosed with severe combined immunodeficiency (SCID), a rare immune disorder that is often fatal within two years.
Fortunately, doctors told his parents about a CIRM-funded clinical trial conducted by UC San Francisco and St. Jude Children’s Hospital. Doctors took some of Ronnie’s own blood stem cells and, in the lab, corrected the genetic mutation that caused the condition. They then gave him a mild dose of chemotherapy to clear space in his bone marrow for the corrected cells to be placed and to grow. Over the next few months, the blood stem cells created a new blood supply and repaired Ronnie’s immune system. He is now a happy, healthy four-year-old boy who loves going to school with other children.
Another patient, Evie Junior, is pioneering the search for a cure for sickle cell disease: a painful, life-threatening condition.
In July of 2020, Evie took part in a CIRM-funded clinical trial where his own blood stem cells were genetically modified to overcome the disease-causing mutation. Those cells were returned to him, and the hope is they’ll create a sickle cell-free blood supply. Evie hasn’t had any crippling bouts of pain or had to go to the hospital since his treatment.
To demonstrate treatment efficacy, study investigators will continue to monitor the recovery of Evie, Ronnie, and others who participate in clinical trials.
CIRM’s new strategic plan seeks to help real life patients like Ronnie and Evie by optimizing its clinical trial funding partnership model to advance more therapies to FDA for approval.
In addition, CIRM will develop ways to overcome manufacturing hurdles for the delivery of regenerative medicine therapies and create Community Care Centers of Excellence that support diverse patient participation in the rapidly maturing regenerative medicine landscape. Stay tuned as we cover these goals here on The Stem Cellar.
Oncternal Therapeutics, Inc. is celebrating an encouraging milestone at the start of the new year following a successful End-of-Phase 2 meeting with the FDA.
Specifically, the FDA agreed on key elements of the company’s potentially pivotal Phase 3 clinical trial of zilovertamab, which offers potential treatment advantages to patients suffering from relapsed or refractory mantle cell lymphoma (MCL). Zilovertamab (previously called cirmtuzumab because it was developed with CIRM funding) is the company’s investigational anti-ROR1 monoclonal antibody.
Mantle cell lymphoma is an aggressive form of blood cancer that develops when white blood cells, which are a key component of our immune system and help fight infections, grow out of control.
The California Institute for Regenerative Medicine (CIRM) funded an earlier-stage trial conducted by Oncternal Therapeutics in collaboration with UC San Diego.
The Phase 3 clinical trial will be led by Dr. Michael Wang, of the Department of Lymphoma & Myeloma at MD Anderson Cancer Center. The trial will randomize patients with relapsed or refractory MCL who have experienced stable disease or a partial response after receiving four months of oral ibrutinib therapy to receive either blinded zilovertamab or placebo. All patients will continue receiving oral ibrutinib.
The study (ZILO-301) will be conducted internationally in at least 50 centers experienced in treating MCL, and is expected to begin in the second quarter of 2022.
The researchers hope the treatment will lead to progression-free survival for patients getting zilovertamab and that this will lead to FDA approval of the therapy.
The company is also planning to conduct study ZILO-302, an open-label companion study of zilovertamab plus ibrutinib for patients who have progressive disease during the initial four months of ibrutinib monotherapy from Study ZILO-301.
Read the full release of the study here and be sure to follow the Stem Cellar blog for more updates on the clinical trial.
If you want to know if a new drug or therapy is going to work in the people it affects the most you need to test the drug or therapy in the people most affected by the disease. That would seem blindingly obvious, wouldn’t it? Apparently not.
Case in point. A new asthma medication, one that seemingly shows real promise in reducing attacks in children, was tested on an almost entirely white patient population, even though Black and Puerto Rican children are far more likely to suffer from asthma.
The study enrolled more than 400 children, between the ages of 6 and 11, with moderate to serious uncontrolled asthma and treated them with a medication called Dupixent. The results, published in the New England Journal of Medicine, were impressive. Children given Dupixent had an average drop in severe asthma attacks of 65 percent compared to children given a placebo.
The only problem is 90 percent of the children in the study were white. Why is that a problem? Because, according to the Asthma and Allergy Foundation of America, only 9.5 percent of white children have asthma, compared to 24 percent of Puerto Rican children and 18 percent of Black children. So, the groups most likely to suffer from the disease were disproportionately excluded from a study about a treatment for the disease.
Some people might think, “So what! If the medication works for one kid it will work for another, what does race have to do with it?” Quite a lot actually.
A study in the Journal of Allergy and Clinical Immunology concluded that: “Race/ethnicity modified the association between total IgE (an antibody in the blood that is a marker for asthma) and asthma exacerbations. Elevated IgE level was associated with worse asthma outcomes in Puerto Ricans… Our findings suggest that eligibility for asthma biologic therapies differs across pediatric racial/ethnic populations.”
The article concluded by calling for “more studies in diverse populations for equitable treatment of minority patients with asthma.” Something that clearly didn’t happen in the Dupixent study.
While that’s more than disappointing, it’s not surprising. A recent study of vaccine clinical trials in JAMA Network Open found that:
Overall, white individuals made up almost 80 percent of people enrolled.
Black individuals were represented only 10.6 percent of the time.
Latino participants were represented just 11.6 percent of the time.
Additionally, in pediatric trials, Black participants were represented just over 10 percent of the time and Latino participants were represented 22.5 percent of the time. The study concluded by saying that “diversity enrollment targets are needed for vaccine trials in the US.”
I would expand on that, saying they are needed for all clinical trials. That’s one of the many reasons why we at the California Institute for Regenerative Medicine (CIRM) are making Diversity, Equity and Inclusion an important part of everything we do, such as requiring all applicants to have a written DEI plan if they want funding from us. Dr. Maria Millan, our President and CEO, recently co-authored an article in Nature Cell Biology, driving home the need for greater diversity in basic science and research in general.
DEI has become an important part of the conversation this past year. But the Dupixent trial shows that if we are truly serious about making it part of what we do, we have to stop talking and start acting.
It’s hard to get somewhere if you don’t know where you are going. Without a map you can’t plan a route to your destination. That’s why the CIRM Board approved a new Strategic Plan laying out a roadmap for the Stem Cell Agency for the next five years.
The plan builds on the achievements of Proposition 71, the voter approved ballot initiative that created the Agency in 2004, including:
Supporting 76 clinical trials.
Helping cure more than 40 children born with a rare, fatal immune disorder.
Creating the Alpha Clinics Network that specializes in the delivery of stem cell therapies to patients.
Training over 3000 students and scholars to become the future workforce of regenerative medicine.
Stimulating California’s economy with $10.7 Billion in additional sales revenue and the creation of 56,000 new jobs (between 2004-2018)
The passage of Proposition 14 in 2020 has positioned CIRM to continue to accelerate research from discovery to clinical; to drive innovative, real-world solutions resulting in transformative treatments for patients; and to ensure the affordability and accessibility of those treatments to a diverse community of patients in an equitable manner, including those often overlooked or underrepresented in the past.
“We achieved a lot in the last 15 years and this provides a solid foundation for our strategy to bring us to the new era of CIRM and to deliver the full potential of regenerative medicine, says Dr. Maria T. Millan, the President and CEO of CIRM. “This plan lays out a roadmap for us to overcome the challenges in developing transformative therapies and making them accessible and affordable in an equitable fashion to a diverse California. The plan will guide us in that work through the development of novel scientific endeavors, effective healthcare delivery models, and expanded education and training programs.”
The Strategic Plan is organized into three main themes:
Advance World Class Science – Foster a culture of collaborative science by creating knowledge networks and shared research tools and technologies that encourage and facilitate data and resource sharing.
Deliver Real World Solutions – Accelerate approval of therapies by optimizing our support models for CIRM-funded clinical trials with attention to including underserved communities; build the California Manufacturing Network to overcome manufacturing hurdles; and expand the Alpha Clinics network and create the Community Care Centers of Excellence to deliver therapies to a diverse patient population often in underserved communities.
Provide Opportunity for All – Build a racially, ethnically and experientially diverse and highly skilled workforce to support the growing regenerative medicine economy in California; deliver a roadmap for access and affordability of regenerative medicine for all California patients.
Reflecting these goals, CIRM’s new mission statement is: Accelerating world class science to deliver transformative regenerative medicine treatments in an equitable manner to a diverse California and world.
“We realize that these are ambitious goals but they are achievable,” says Dr. Millan, “If CIRM is going to continue to be a global leader in the field of regenerative medicine, and to live up to the faith shown in us by the people of California, we believe we have to aim high. We have a terrific team, a clear vision and a determination to fulfill our mission. And that’s what we intend to do.”
One of the huge advantages of a stem cell agency like CIRM (not that there is anything out there quite like us, but anyway) is our ability to support projects as they progress from a great idea to a therapy actually being tested in people.
Exhibit A on that front came via a news release from ViaCyte, a company that is developing a new approach to helping people with severe Type 1 Diabetes (T1D).
Unlike type 2 diabetes, which is largely diet & lifestyle related and develops over time, T1D is an autoimmune condition where the person’s immune system attacks and destroys the insulin-producing cells in the pancreas. Without those cells and insulin the body is not able to regulate blood sugar levels and that can lead to damage to the heart, kidneys, eyes and nerves. In severe cases it can be fatal.
ViaCyte (which has been supported with more than $72 million from CIRM) has developed a pouch that can be implanted under the skin in the back. This pouch contains stem cells that over a period of a few months turn into insulin-producing pancreatic islet cells, the kind destroyed by T1D. The goal is for these cells to monitor blood flow and when they detect blood sugar or glucose levels are high, can secrete insulin to restore them to a safe level.
They tested this approach in 15 patients in a Phase 1 clinical trial in Canada. Their findings, published in the journals Cell Stem Celland Cell Reports Medicine, show that six months after implantation, the cells had turned into insulin-producing islet cells. They also showed a rise in C-peptide levels after patients ate a meal. C-peptides are a sign your body is producing insulin so the rise in that number was a good indication the implanted cells were boosting insulin production.
As Dr. James Shapiro, the Chair of Canada Research and one of the lead authors of the study says, that’s no small achievement: “The data from these papers represent a significant scientific advance. It is the first reported evidence that differentiated stem cells implanted in patients can generate meal-regulated insulin secretion, offering real hope for the incredible potential of this treatment.”
And that wasn’t all. The researchers say that patients spent 13 percent more time in the target range for blood sugar levels than before the treatment, and some were even able to reduce the amount of insulin they injected.
Now this is only a Phase 1 clinical trial so the goal was to test the safety of the pouch, called PEC-Direct (VC-02), to see if the body would tolerate it being implanted and to see if it is effective. The beauty of this method is that the device is implanted under the skin so it can be removed easily if any problems emerge. So far none have.
Ultimately the hope is that this approach will help patients with T1D better regulate their blood sugar levels, improve their health outcomes, and one day even achieve independence from the burden of daily insulin injections.
A truly modern epidemic, HIV/AIDS has hit every continent on the planet and affects nearly 40 million people worldwide. Today, we celebrate World AIDS Day by commemorating those who have died from AIDS-related illness, showing support for people living with HIV, and fighting for a cure.
World AIDS Day was first observed in 1988 and takes place on December 1st each year. The first ever global health day, the path to acceptance and scientific advancements towards HIV/AIDS hasn’t been easy. Over the past four decades, the epidemic has changed enormously and so, too, has the global agenda. Universal testing is the main key to halting the number of new infections. Scientific advances in HIV treatment have prolonged lives and, in many cases, even made the virus undetectable. But this battle is far from over.
40 years ago, in the spring of 1981, a mystery illness began exploding across the gay communities of New York, Los Angeles and San Francisco. Men were inexplicably coming down with cancer and other mysterious illnesses. Many of them would be dead within weeks. As more cases were confirmed across the Atlantic, it become known as the ‘gay plague’. It wasn’t until 1982 that this mysterious plague earned a name: Acquired Immune Deficiency Syndrome or AIDS. The following year, scientists uncovered the culprit behind AIDS. It was a virus, which they eventually called HIV: the human immunodeficiency virus.
And the disease wasn’t just targeting homosexuals. Anyone could be infected through blood, sexual intercourse, pregnancy, and breastfeeding. However, word was to slow get out and ignorance about HIV remained rampant. By 1984, as the death toll climbs, the top priority become preventing the spread of AIDS.
As the science progressed, activism intensified. AIDS patients and their loved ones began uniting all over the world to demand greater access to experimental drugs and plead their governments for more funding. In 1990, Congress passed the largest federally funded program in the US for people living with HIV/AIDS through the Ryan White CARE Act. In 1993, President Clinton set up the White House Office of National AIDS Policy and the National Institute of Health (NIH) expanded its AIDS research.
With great funding came great scientific breakthroughs for the treatment and prevention of HIV. FDA’s approval of Atripla in 2006 marked a watershed in HIV treatment. By combining three different antiviral medications- efavirenz, emtricitabine and tenofovir- into a single fixed-dose combination pill, HIV treatment became a once-daily single tablet regimen. Between 2005 and 2018, there was a 45% decline in AIDS related deaths worldwide.
Despite tremendous biomedical and scientific progress, there’s still no cure for AIDS. As people with HIV live longer, AIDS is a topic that has drifted from the headlines. When World AIDS Day was first established in 1988, the world looked very different to how it is today. As we celebrate the progress of the past four decades on this historic day, we mustn’t lose sight of the ultimate goal that lays ahead of us. CIRM has committed nearly $80 million to HIV/AIDS research including funding four separate clinical trials.
Taking even the most promising therapy and moving it out of the lab and into people is an incredibly complex process and usually requires a great team. Now, two great teams have paired up to do just that with a therapy for type 1 diabetes (T1D). ViaCyte and CRISPR Therapeutics have put their heads together and developed an approach that has just been given clearance by Health Canada to start a clinical trial.
Regular readers of this blog know that CIRM has been a big supporter of ViaCyte for many years, investing more than $72 million in nine different awards. They have developed an implantable device containing embryonic stem cells that develop into pancreatic progenitor cells, which are precursors to the islet cells destroyed by T1D. The hope is that when this device is transplanted under a patient’s skin, the progenitor cells will develop into mature insulin-secreting cells that can properly regulate the glucose levels in a patient’s blood.
One of the challenges in earlier testing was developing a cell-based therapy that could evade the immune system, so that people didn’t need to have their immune system suppressed to prevent it attacking and destroying the cells. This particular implantable version sprang out of an early stage award we made to ViaCyte (DISC2-10591). ViaCyte and CRISPR Therapeutics helped with the design of the therapeutic called VCTX210.
In a news release, Michael Yang, the President and CEO of ViaCyte, said getting approval for the trial was a major milestone: “Being first into the clinic with a gene-edited, immune-evasive cell therapy to treat patients with type 1 diabetes is breaking new ground as it sets a path to potentially broadening the treatable population by eliminating the need for immunosuppression with implanted cell therapies. This approach builds on previous accomplishments by both companies and represents a major step forward for the field as we strive to provide a functional cure for this devastating disease.”
The clinical trial, which will be carried out in Canada, is to test the safety of the therapy, whether it creates any kind of reaction after being implanted in the body, and how well it does in evading the patient’s immune system. In October our podcast – Talking ‘Bout (re)Generation – highlighted work in T1D and included an interview with Dr. Manasi Jaiman, ViaCyte’s Vice President for Clinical Development. Here’s an excerpt from that podcast.
When the COVID pandemic broke out researchers all over the world scrambled to find new approaches to tackling the virus. Some of these, such as the vaccines, proved remarkably effective. Others, such as the anti-parasite medication ivermectin or the anti-malaria drug chloroquine, were not only not helpful, they were sometimes harmful.
Part of the problem was the understandable desire to find something, anything that would protect people from the virus. But another part of the problem was that even with research that was based on solid science, the reporting of that research in the media sometimes tilted towards hype rather than hard evidence.
A new study in the journal Stem Cell Reports takes a look at the explosion of research targeting COVID. They highlighted the lack of rigor that sometimes accompanied that research, and the lack of regulation that allowed some predatory clinics to offer stem cell “therapies” that had never been tested in people let alone shown to be either safe or effective.
Dr. Leigh Turner, from the University of California Irvine and a co-author of the study, warned against studies that were cutting ethical and scientific corners. “Scientists, regulators, and policymakers must guard against the proliferation of poorly designed, underpowered, and duplicative studies that are launched with undue haste because of the pandemic, but are unlikely to provide convincing, clinically meaningful safety and efficacy data.”
The researchers cited an earlier study (by UC Davis’ Dr. Paul Knoepfler and Dr. Mina Kim) that looked at 70 clinical trials involving cell-based treatments for COVID-19. Drs. Knoepfler and Kim found that most were small, involving around 50 patients, and only 22.8% were randomized, double-blinded, and controlled experiments. They say even if these produced promising results they would have to be tested in much larger numbers to be of real benefit.
Another issue that Turner and his team highlighted was the hype that sometimes accompanied this work, citing news releases that over-hyped findings and failed to mention study limitations to gain more media coverage.
In a news releaseDr. Laertis Ikonomou, of the University at Buffalo and a co-author of the study, said over-hyping treatments is nothing new but that it seemed to become even more common during COVID.
“Therefore, it is even more important to communicate promising developments in COVID-19-related science and clinical management [responsibly]. Key features of good communication are an accurate understanding of new findings, including study limitations and avoidance of sensationalist language.”
“Realistic time frames for clinical translation are equally important as is the realization that promising interventions at preliminary stages may not always translate to proven treatments following rigorous testing.”
They also warned about clinics advertising “stem cell therapies” that were unproven and unlicensed and often involved injecting the patients’ own cells back into them. The researchers say it’s time that the FDA and other authorities cracked down on companies taking advantage of patients in this way.
“If companies and affiliated clinicians are not fined, forced to return to patients whatever profits they have made, confronted with criminal charges, subject to revocation of medical licensure, or otherwise subject to serious legal and financial consequences, it is possible that more businesses will be drawn to this space because of the profits that can be generated from selling unlicensed and unproven cell-based products in the midst of a pandemic.”
At a time when so many were dying or suffering long-term health problems as a result of COVID, it’s unconscionable that others were happy to cash in on the fear and pain to make a quick buck.
When the pandemic broke out the CIRM Board voted to approved $5 million in emergency funding to help develop new therapies to combat the virus. Altogether we funded 17 different projects including three clinical trials.
Adrienne Shapiro and Marissa Cors are a remarkable pair by any definition. The mother and daughter duo share a common bond, and a common goal. And they are determined not to let anyone stop them achieving that goal.
Marissa was born with sickle cell disease (SCD) a life-threatening genetic condition where normally round, smooth red blood cells are instead shaped like sickles. These sickle cells are brittle and can clog up veins and arteries, blocking blood flow, damaging organs, and increasing the risk of strokes. It’s a condition that affects approximately 100,000 Americans, most of them Black.
Adrienne became a patient advocate, founding Axis Advocacy, after watching Marissa get poor treatment in hospital Emergency Rooms. Marissa often talks about the way she is treated like a drug-seeker simply because she knows what medications she needs to help control excruciating pain on her Sickle Cell Experience Live events on Facebook.
Now the two are determined to ensure that no one else has to endure that kind of treatment. They are both fierce patient advocates, vocal both online and in public. And we recently got a chance to sit down with them for our podcast, Talking ‘Bout (re) Generation. These ladies don’t pull any punches.
When the voters of California approved Proposition 14 last November (thanks folks) they gave us $5.5 billion to continue the work we started way back in 2014. It’s a great honor, and a great responsibility.
It’s also a great opportunity to look at what we do and how we do it and try to come up with even better ways of funding groundbreaking research and helping create a new generation of researchers.
In addition to improving on what we already do, Prop 14 introduced some new elements, some new goals for us to add to the mix, and we are in the process of fleshing out how we can best do that.
Because of all these changes we decided it would be a good idea to hold a “Town Hall” meeting and let everyone know what these changes are and how they may impact applications for funding.
The Town Hall, on Tuesday June 29, was a great success with almost 200 participants. But we know that not everyone who wanted to attend could, so here’s the video of the event, and below that are the questions that were posed by people during the meeting, and the answers to those questions.
Having seen the video we would be eternally grateful if you could respond to a short online survey, to help us get a better idea of your research and education needs and to be better able to serve you and identify potential areas of opportunity for CIRM. Here’s a link to that survey: https://www.surveymonkey.com/r/VQMYPDL
We know that there may be issues or questions that are not answered here, so feel free to send those to us at firstname.lastname@example.org and we will make sure you get an answer.
Are there any DISC funding opportunities specific to early-stage investigators?
DISC funding opportunities are open to all investigators. There aren’t any that are specific to junior investigators.
Are DISC funding opportunities available for early-mid career researchers based out of USA such as Australia?
Sorry, you have to be in California for us to fund your work.
Does tumor immunology/ cancer immunotherapy fall within the scope of the CIRM discovery grants?
CIRM funding supports non-profit academic grantees as well as companies of all sizes.
I am studying stem cells using mouse. Is my research eligible for the CIRM grants?
Yes it is.
Your programs more specifically into stem cell research would be willing to take patients that are not from California?
Yes, we have treated patients who are not in California. Some have come to California for treatment and others have been treated in other states in the US by companies that are based here in California.
Can you elaborate how the preview of the proposals works? Who reviews them and what are the criteria for full review?
The same GWG panel both previews and conducts the full review. The panel first looks through all the applications to identify what each reviewer believes represents the most likely to be impactful and meet the goals of the CIRM Discovery program. Those that are selected by any reviewer moves forward to the next full review step.
If you meet your milestones-How likely is it that a DISC recipient gets a TRAN award?
The milestones are geared toward preparation of the TRAN stage. However, this is a different application and review that is not guaranteed to result in funding.
Regarding Manufacturing Public Private partnerships – What specific activities is CIRM thinking about enabling these partnerships? For example, are out of state for profit commercial entities able to conduct manufacturing at CA based manufacturing centers even though the clinical program may be primarily based out of CA? If so, what percent of the total program budget must be expended in CA? How will CIRM enable GMP manufacturing centers interact with commercial entities?
We are in the early stages of developing this concept with continued input from various stakeholders. The preliminary vision is to build a network of academic GMP manufacturing centers and industry partners to support the manufacturing needs of CIRM-funded projects in California.
We are in the process of widely distributing a summary of the manufacturing workshop. Here’s a link to it:
If a center is interested in being a sharing lab or competency hub with CIRM, how would they go about it?
CIRM will be soliciting applications for Shared Labs/Competency hubs in potential future RFAs. The survey asks several questions asking for feedback on these concepts so it would really help us if you could complete the survey.
Would preclinical development of stem cell secretome-derived protein therapies for rare neuromuscular diseases and ultimately, age-related muscle wasting be eligible for CIRM TRAN1 funding? The goal is to complete IND-enabling studies for a protein-based therapy that enhances tissue regeneration to treat a rare degenerative disease. the screening to identify the stem-cell secreted proteins to develop as therapeutics is done by in vitro screening with aged/diseased primary human progenitor cells to identify candidates that enhance their differentiation . In vivo the protein therapeutic signals to several cell types , including precursor cells to improve tissue homeostasis.
I would suggest reaching out to our Translation team to discuss the details as it will depend on several factors. You can email the team at email@example.com