It’s all about the patients

Ronnie, born with a fatal immune disorder now leading a normal life thanks to a CIRM-funded stem cell/gene therapy: Photo courtesy of his mum Upasana

Whenever you are designing something new you always have to keep in mind who the end user is. You can make something that works perfectly fine for you, but if it doesn’t work for the end user, the people who are going to work with it day in and day out, you have been wasting your time. And their time too.

At CIRM our end users are the patients. Everything we do is about them. Starting with our mission statement: to accelerate stem cell treatments to patients with unmet medical needs. Everything we do, every decision we make, has to keep the needs of the patient in mind.

So, when we were planning our recent 2020 Grantee Meeting (with our great friends and co-hosts UC Irvine and UC San Diego) one of the things we wanted to make sure didn’t get lost in the mix was the face and the voice of the patients. Often big conferences like this are heavy on science with presentations from some of the leading researchers in the field. And we obviously wanted to make sure we had that element at the Grantee meeting. But we also wanted to make sure that the patient experience was front and center.

And we did just that. But more on that in a minute. First, let’s talk about why the voice of the patient is important.

Some years ago, Dr. David Higgins, a CIRM Board member and patient advocate for Parkinson’s Disease (PD), said that when researchers are talking about finding treatments for PD they often focus on the dyskinesia, the trembling and shaking and muscle problems. However, he said if you actually asked people with PD you’d find they were more concerned with other aspects of the disease, the insomnia, anxiety and depression among other things. The key is you have to ask.

Frances Saldana, a patient advocate for research into Huntington’s disease

So, we asked some of our patient advocates if they would be willing to be part of the Grantee Meeting. All of them, without hesitation, said yes. They included Frances Saldana, a mother who lost three of her children to Huntington’s disease; Kristin MacDonald, who lost her sight to a rare disorder but regained some vision thanks to a stem cell therapy and is hoping the same therapy will help restore some more; Pawash Priyank, whose son Ronnie was born with a fatal immune disorder but who, thanks to a stem cell/gene therapy treatment, is now healthy and leading a normal life.

Because of the pandemic everything was virtual, but it was no less compelling for that. We interviewed each of the patients or patient advocates beforehand and those videos kicked off each session. Hearing, and seeing, the patients and patient advocates tell their stories set the scene for what followed. It meant that the research the scientists talked about took on added significance. We now had faces and names to highlight the importance of the work the scientists were doing. We had human stories. And that gave a sense of urgency to the work the researchers were doing.

But that wasn’t all. After all the video presentations each session ended with a “live” panel discussion. And again, the patients and patient advocates were a key part of that. Because when scientists talk about taking their work into a clinical trial they need to know if the way they are setting up the trial is going to work for the patients they’re hoping to recruit. You can have the best scientists, the most promising therapy, but if you don’t design a clinical trial in a way that makes it easy for patients to be part of it you won’t be able to recruit or retain the people you need to test the therapy.

Patient voices count. Patient stories count.

But more than anything, hearing and seeing the people we are trying to help reminds us why we do this work. It’s so easy to get caught up in the day to day business of our jobs, struggling to get an experiment to work, racing to get a grant application in before the deadline. Sometimes we get so caught up in the minutiae of work we lose sight of why we are doing it. Or who we are doing it for.

At CIRM we have a saying; come to work every day as if lives depend on you, because lives depend on you. Listening to the voices of patients, seeing their faces, hearing their stories, reminds us not to waste a moment. Because lives depend on all of us.

Here’s one of the interviews that was featured at the event. I do apologize in advance for the interviewer, he’s rubbish at his job.

Meet the people who are changing the future

Kristin MacDonald

Every so often you hear a story and your first reaction is “oh, I have to share this with someone, anyone, everyone.” That’s what happened to me the other day.

I was talking with Kristin MacDonald, an amazing woman, a fierce patient advocate and someone who took part in a CIRM-funded clinical trial to treat retinitis pigmentosa (RP). The disease had destroyed Kristin’s vision and she was hoping the therapy, pioneered by jCyte, would help her. Kristin, being a bit of a pioneer herself, was the first person to test the therapy in the U.S.

Anyway, Kristin was doing a Zoom presentation and wanted to look her best so she asked a friend to come over and do her hair and makeup. The woman she asked, was Rosie Barrero, another patient in that RP clinical trial. Not so very long ago Rosie was legally blind. Now, here she was helping do her friend’s hair and makeup. And doing it beautifully too.

That’s when you know the treatment works. At least for Rosie.

There are many other stories to be heard – from patients and patient advocates, from researchers who develop therapies to the doctors who deliver them. – at our CIRM 2020 Grantee Meeting on next Monday September 14th Tuesday & September 15th.

It’s two full days of presentations and discussions on everything from heart disease and cancer, to COVID-19, Alzheimer’s, Parkinson’s and spina bifida. Here’s a link to the Eventbrite page where you can find out more about the event and also register to be part of it.

Like pretty much everything these days it’s a virtual event so you’ll be able to join in from the comfort of your kitchen, living room, even the backyard.

And it’s free!

You can join us for all two days or just one session on one day. The choice is yours. And feel free to tell your friends or anyone else you think might be interested.

We hope to see you there.

A Tribute to Huntington’s Disease Warriors in the Age of COVID-19

Frances Saldana is one of the most remarkable women I know. She has lost all three of her children to Huntington’s disease (HD) – a nasty, fatal disease that steadily destroys the nerve cells in the brain – but still retains a fighting spirit and a commitment to finding a cure for HD. She is the President Emeritus for HD-Care, an organization dedicated to raising awareness about HD, and finding money for research to cure it. She recently wrote a Mother’s Day blog for HD-Care about the similarities between HD and COVID-19. As May is National Huntington’s Disease Awareness Month we wanted to share her blog with you.

Frances Saldana

COVID-19 has consumed our entire lives, and for many, our livelihoods.  This is a pandemic like we have never experienced in our lifetime, bringing out in many families fear, financial devastation, disabilities, isolation, suffering, and worst of all, loss of life.  But through all this, the pandemic has uncovered emotions in many who rose to the occasion – a fight and stamina beyond human belief.

As a family member who has lost all of my children to Huntington’s disease, it makes me so sad to watch and hear about the suffering that people all over the world are currently experiencing with COVID-19.  This devastation is nothing new to Huntington’s disease families.  Although Huntington’s disease (HD) is not contagious, it is genetic, and much of the uncertainty and fears that families are experiencing are so similar to what HD families experience….in slow motion, with unanswered questions such as:  

  • Who in my family is carrying the mutant HD gene?  (Who in my family is carrying the coronavirus?)
  • Who in my family will inherit the mutant HD gene? (Who will get infected by the COVID-19?)
  • Will my loved on live long enough to benefit from a treatment for HD? (Will there be a vaccination soon if my loved one is infected by COVID-19?) 
  • How long will my HD family member live?  (Will my affected COVID-19 loved one survive after being placed on a ventilator?)
  • Is my HD family member going to die?  (Will my COVID-19 family member die?)

In watching some of the footage of COVID-19 patients on TV and learning about the symptoms, it appears that those with a severe case of the virus go through similar symptoms as HD patients who are in the late and end-of-life stages:  pneumonia, sepsis, pain, and suffering, to name a few, although for HD families, the journey goes on for years or even decades, and then carries on to the next generation, and not one HD patient will survive the disease. Not yet!

Scientists are working furiously all over the world to find a treatment for COVID-19.  The same goes for scientists focused on Huntington’s disease research.  Without their brilliant work we would have no hope.  Without funding there would be no science.  I have been saying for the last 20 years that we will have a treatment for Huntington’s disease in the next couple of years, but with actual facts and successful clinical trials, there is finally a light at the end of the tunnel and we have much to be thankful for.  I feel it in my heart that a treatment will be found for both COVID-19 and Huntington’s disease very soon.    

The month of May happens to be National Huntington’s Disease Awareness Month.  Mother’s Day also falls in the month of May.  Huntington’s disease “Warrior Moms” are exemplary women, and I have been blessed to have known a few.  Driven by love for their children, they’ve worn many hats as caregivers, volunteers, and HD community leaders in organizations such as HD-CARE, HDSA, WeHaveAFace, Help4HD, HD Support &Care Network, and many others. 

The mothers have often also been forced to take on the role of breadwinners when the father of the family has unexpectedly become debilitated from HD.   In spite of carrying a heavy cross, HD Warrior Moms persevere, and they do it with endless love, often taking care of HD family members from one generation to the next.  They are the front-line workers in the HD community, tirelessly protecting their families and at the same time doing all they can to provide a meaningful quality of life. 

Many HD Warrior moms have lost their children in spite of their fierce fight to save them, but they keep their memory alive, never losing hope for a treatment that will end the pain, suffering, and loss of life. Many HD Warrior Moms have lost the fight themselves, not from HD, but from a broken heart. These are the HD Warrior Moms.

We salute them all. We love them all.

CIRM is funding several projects targeting HD. You can read about them here.

Rare Disease Gets Big Boost from California’s Stem Cell Agency

UC Irvine’s Dr. Leslie Thompson and patient advocate Frances Saldana after the CIRM Board vote to approve funding for Huntington’s disease

If you were looking for a poster child for an unmet medical need Huntington’s disease (HD) would be high on the list. It’s a devastating disease that attacks the brain, steadily destroying the ability to control body movement and speech. It impairs thinking and often leads to dementia. It’s always fatal and there are no treatments that can stop or reverse the course of the disease. Today the Board of the California Institute for Regenerative Medicine (CIRM) voted to support a project that shows promise in changing that.

The Board voted to approve $6 million to enable Dr. Leslie Thompson and her team at the University of California, Irvine to do the late stage testing needed to apply to the US Food and Drug Administration for permission to start a clinical trial in people. The therapy involves transplanting stem cells that have been turned into neural stem cells which secrete a molecule called brain-derived neurotrophic factor (BDNF), which has been shown to promote the growth and improve the function of brain cells. The goal is to slow down the progression of this debilitating disease.

“Huntington’s disease affects around 30,000 people in the US and children born to parents with HD have a 50/50 chance of getting the disease themselves,” says Dr. Maria T. Millan, the President and CEO of CIRM. “We have supported Dr. Thompson’s work for a number of years, reflecting our commitment to helping the best science advance, and are hopeful today’s vote will take it a crucial step closer to a clinical trial.”

Another project supported by CIRM at an earlier stage of research was also given funding for a clinical trial.

The Board approved almost $12 million to support a clinical trial to help people undergoing a kidney transplant. Right now, there are around 100,000 people in the US waiting to get a kidney transplant. Even those fortunate enough to get one face a lifetime on immunosuppressive drugs to stop the body rejecting the new organ, drugs that increase the risk for infection, heart disease and diabetes.  

Dr. Everett Meyer, and his team at Stanford University, will use a combination of healthy donor stem cells and the patient’s own regulatory T cells (Tregs), to train the patient’s immune system to accept the transplanted kidney and eliminate the need for immunosuppressive drugs.

The initial group targeted in this clinical trial are people with what are called HLA-mismatched kidneys. This is where the donor and recipient do not share the same human leukocyte antigens (HLAs), proteins located on the surface of immune cells and other cells in the body. Around 50 percent of patients with HLA-mismatched transplants experience rejection of the organ.

In his application Dr. Meyer said they have a simple goal: “The goal is “one kidney for life” off drugs with safety for all patients. The overall health status of patients off immunosuppressive drugs will improve due to reduction in side effects associated with these drugs, and due to reduced graft loss afforded by tolerance induction that will prevent chronic rejection.”