Stem cell study holds out promise for kidney disease

Kidney failure

Image via youtube.com

Kidney failure is the Rodney Dangerfield of diseases, it really doesn’t get the respect it deserves. An estimated 660,000 Americans suffer from kidney failure and around 47,000 people die from it every year. That’s more than die from breast or prostate cancer. But now a new study has identified a promising stem cell candidate that could help in finding a way to help repair damaged kidneys.

Kidneys are the body’s waste disposal system, filtering our blood and cleaning out all the waste products. Our kidneys have a limited ability to help repair themselves but if someone suffers from chronic kidney disease then their kidneys are slowly overwhelmed and that leads to end stage renal disease. At that point the patient’s options are limited to dialysis or an organ transplant.

Survivors hold out hope

Italian researchers had identified some cells in the kidneys that showed a regenerative ability. These cells, which were characterized by the expression of a molecule called CD133, were able to survive injury and create different types of kidney cells.

Researchers at the University of Torino in Italy decided to take these findings further and explore precisely how CD133 worked and if they could take advantage of that and use it to help repair damaged kidneys.

In their findings, published in the journal Stem Cells Translational Medicine, the researchers began by working with a chemotherapy drug called cisplatin, which is used against a broad range of cancers but is also known to cause damage to kidneys in around one third of all patients. The team found that CD133 was an important factor in helping those damaged kidneys recover. They also found that CD133 prevents aging of kidney progenitor cells, the kind of cell needed to help create new cells to repair the kidneys in future.

Hope for further research

The finding opens up a number of possible lines of research, including exploring whether infusions of CD133 could help patients whose kidneys are no longer able to produce enough of the molecule to help repair damage.

In an interview in DD News, Dr. Anthony Atala, Director of the Wake Forest Institute for Regenerative Medicine – praised the research:

“This is an interesting and novel finding. Because the work identifies mechanisms potentially involved in the repair of tissue after injury, it suggests the possibility of new therapies for tissue repair and regeneration.”

CIRM is funding several projects targeting kidney disease including four clinical trials for kidney failure. These are all late-stage kidney failure problems so if the CD133 research lives up to its promise it might be able to help people at an earlier stage of disease.

It’s World Kidney Day: Highlighting CIRM’s Investments in Treating Kidney Failure

WKD-Logo-HiToday is World Kidney Day. Hundreds of events across the globe are taking place “to raise awareness of the importance of our kidneys to our overall health and to reduce the frequency and impact of kidney disease and its associated health problems worldwide.” (Side note: in recognition that today is also International Women’s Day, World Kidney Day’s theme this year is “Kidney’s & Women: Include, Value, Empower.)

To honor this day, we’re highlighting how CIRM is playing its part in that mission. The infographic below provides big picture summaries of the four CIRM-funded clinical trials that are currently testing stem cell-based therapies for kidney failure, a condition that affects well over 600,000 Americans.

When a person’s kidneys fail, their body can no longer filter out waste products and extra fluid from the blood which leads to life-threatening complications. About 30% of those affected in the U.S. have organ transplants. Due to the limited availability of donor organs, the other 70% need dialysis, a blood filtration therapy, that requires several trips a week to a special clinic.

Both treatment options have serious limitations. Organ recipients have to take drugs that prevent organ rejections for the rest of their lives. Over time, these drugs are toxic and can increase a patient’s risk of infection, heart disease, cancer and diabetes. In the case of dialysis treatment, the current procedure uses a plastic tube called a shunt to connect to a patient’s vein. These shunts are far from ideal and can lead to infection, blood clots and can be rejected by the patient’s immune system. These complications probably play a role in the average life expectancy of 5-10 years for dialysis patients.

Four CIRM-funded clinical trials aim to circumvent these drawbacks. Humacyte has received over $24 million from the Agency to support two clinical trials that are testing an alternative to the plastic shunt used in dialysis treatment. The company has developed a bioengineered vessel that is implanted in the patient’s arm and over time is populated with the patient’s own stem cells which develop into a natural blood vessel. The trials will determine if the bioengineered vessel is superior to the shunt in remaining open for longer periods of time and with lower incidence of interventions due to blood clots and infections.

The other two CIRM-funded trials, one headed by Stanford University and the other by Medeor Therapeutics, aims to eliminate the need for long-life, anti-rejection medicine after kidney transplant. Both trials use a similar strategy: blood stem cells and immune cells from the organ donor are infused into the patient receiving the organ. If all goes as planned, those donor cells will engraft into and mix with the recipient’s immune system, making organ rejection less likely and ending the need for immune-system suppressing drugs.

For more details visit our Clinical Trial Dashboard.

MonthofCIRM_Kidney3b

Stem Cells Profiles in Courage: Frank’s final gift

frank-st-clair

Not every story has a happy ending. But they do all have something to teach us. In the case of Frank St. Clair the lesson was simple: live life fully and freely, love those around you, and never give up.

We were fortunate enough to get to know Frank as one of the people we profiled in our 2016 Annual Report. Frank was a patient in a clinical trial we are funding to test a new kind of bioengineered vein needed by people undergoing hemodialysis, the most common form of dialysis.

It was an all too brief friendship. Frank passed away on December 17th due to complications from heart disease. But in that time he touched us with his warmth, his kindness, his sense of humor and his generosity. Frank never gave up. He kept fighting to the end. His courage, and compassion for others is a reminder to us that we need to work as hard as we can, to bring treatments to those who need them most.

This is Frank’s story, in his own words:

“I have kidney disease. Had it about four years. When I first started dialysis I had a shunt in my chest.  I had to be careful with the shunt, especially at night, in case I pulled it out. It kept clogging up on me and I’d have to go in and get it reopened and that was a terrible thing.

One time when they were opening up the shunt in my chest I ran into the doctor and I got talking to him. He knew how miserable I was and he asked if I wanted to take part in this clinical trial. I said I did and they arranged for me to get this, the device. I just lucked out and was in the right place at the right time. Best move I ever made. Didn’t know anything about stem cells then, sure didn’t, I just knew I was miserable and if there was any way to make life better I just wanted to do it or try it.

And then I did this and it was like day and night.

Since I’ve done this my life has improved 100%. I can do a lot now that I couldn’t do before. My wife and I are so grateful that we can have this. Now we can go out to dinner and do anything we want. We could go out before but we had to always be careful because of the thing in my chest. But now I don’t even think about it. It’s like getting my life back.

I don’t notice it all. I don’t feel it at all. I hate to say it, but I can’t believe I’m on dialysis. I would like to have a kidney but I’ll be honest with you this is the next best thing.

When I go to the clinic there’s a lot of old people there and I just try to make them laugh, tell them jokes, I just can’t believe how good I feel and I want to make others feel good too.

I take the time to talk to them, and give them gum and that cheers them up. My wife has to keep me supplied with gum.

I’ve been married 45 years. We met in high school chorus. I didn’t care too much about singing but I went to chorus because I wanted to meet girls. That’s where I met Paula. Best move I ever made.

I sure don’t feel old. My wife and I are two people that love each other very dearly, that’s my blessing, with her help I couldn’t get old.

I’m a workaholic but until I got the Humacyte device I couldn’t work. I had to sell my business.

I used to be a private detective. It had its moments. My wife used to get mad because I got up at 2 or 3 in the morning to get someone who was in hiding. I had one guy, he was about 6’ 7”, big guy. I knocked at the door and said the name of the guy I was looking for, and asked if he was there. He asked why, so I told him why I was there and he said “It’s me,” and ran right over me and knocked me on the ground and ran away. But I managed to talk him into coming back.

We served a lot of papers on foreclosures and I hated that, and I would always try and help those people if I could.

One time I ran into an old lady, she was a nice woman, and her husband handled all the bills but he died and they had stock in Bernie Madoff’s company and when he went under it left her broke.  They had $1.7 million in a company that went bankrupt. She lost it all. She didn’t know what to do. When I went to serve her papers she hadn’t eaten in two days,  so I went and bought her and brought some groceries and made sure the electric bill got paid and then called her son and made sure she was taken care of.

My wife said we were going broke helping so many people, but I felt that if you help people it comes back to you and it has.

I volunteer at the VA, help out there when I can. Just trying to give back. Always have. I think if you can help someone you need to do it.

I feel damn lucky, really lucky, more ways than one. You have to understand I have lived 50 years longer than I should have; I could have died in Vietnam, so I would just say do not give up. Don’t give up. My wife wouldn’t let me give up, and things happen. If they are meant to be, of course. Something will happen and I’m telling you. The key is making people around you feel like they want to be around you.”

We are forever grateful to Frank for being willing to be part of a clinical trial that will, hopefully, improve the quality of life for many others. That is his legacy. Our thoughts and wishes go out to his wife Paula

Bioengineered veins give hope to kidney disease patients on dialysis

As blood travels around your body, it helps your body get around. Blood is essential for delivering oxygen and nutrients to all the cells in your body and for removing waste products made by these cells. Your body contains approximately 1.5 gallons of blood, which translates to around 7% of your body weight. In order for all this blood to do its job, it needs to be constantly cleaned of waste and extra fluids.

Your kidneys are your blood’s best friend. They act as natural filters that remove those cellular waste products and extra fluid from the blood and pass them off to the bladder, where they are disposed of through urine. Kidneys have the important job of maintaining the proper balance of fluids, electrolytes and chemicals in the blood. They are also involved in other essential biological processes such as regulating blood pressure, making new blood cells, and maintaining healthy bones. It’s a big problem when your kidneys stop working. Without this built-in filtration system, toxic byproducts build up in your blood and cause a multitude of not fun symptoms.

Hemodialysis acts as an artificial kidney to filter the blood of kidney disease patients. (wikipedia)

Hemodialysis acts as an artificial kidney to filter the blood of kidney disease patients. (wikipedia)

More than half a million Americans suffering from kidney dysfunction or failure are being treated by hemodialysis. This process involves connecting a patient to a machine that acts as an artificial kidney. “Old blood” is pumped into the machine from a plastic tube, also known as a shunt, that’s inserted into the patient’s vein. The blood is then passed through a dialyzer which filters out the waste products and extra fluid and allows clean blood to pass through and be put back into the patient (see image).

While hemodialysis is successful at extending the lifespan of kidney disease patients, serious complications can arise from this treatment including uncontrolled changes in blood pressure, bone disease, and anemia. Another common problem occurs with the shunt that’s inserted into a patient’s vein. Shunts can cause infection, blood clots, and can also be rejected by a patient’s immune system. As a result, patients have to get new shunts implanted every year. This is not always feasible for older patients whose veins cannot hold up to this invasive procedure.

A tubular alternative for better hemodialysis

A North Carolina company called Humacyte is trying to improve current hemodialysis technology by engineering human acellular vessels (HAVs) (meaning that the vessels don’t have any cells) that can be transplanted into patients and develop into a human version of a shunt. Sounds complicated, but it’s not really!

First, scientists take muscle cells from human organ donors and coax these cells to grow into tube-like structures. During this process, the cells secrete a compound called cellulose – a component of the extracellular matrix – which forms a biological scaffold that maintains the structure of the cells.

Next, the scientists chemically wash away the muscle cells, leaving an intact scaffold with a hole the diameter of your pinky finger. These scaffolds are then placed under the skin of patients on dialysis. Once transplanted, a patient’s own stem cells migrate to the empty scaffold, set up shop and create a new vein with a wide enough hole that can be used for hemodialysis.

Humacyte’s Chief Medical Officer, Jeff Lawson, explained it an interview with KQED Science:

Jeff Lawson, Humacyte

Jeff Lawson, Humacyte

“This scaffold, once implanted, uniquely becomes repopulated with their own stem cells. That then turns back into something that looks like a vascular cell. And it now transitions over the period of a few months into something that’s indistinguishable from your own tissue. One of the holy grails in vascular surgery is to come up with a prosthetic artificial graft that has the same properties as the patient’s own blood vessels.”

The great news about this promising technology is that Humacyte is testing it in a Phase III clinical trial – the final stage before a drug or treatment is approved by the US Food and Drug Administration (FDA). In a Phase III trial, the treatment has already proven to be safe and shown some effectiveness (in a Phase II trial) and is now being tested in a larger group of patients to hopefully confirm these findings.

In July, CIRM invested $10 million in Humacyte’s Phase III trial in hopes that this technology will improve the lives and health of dialysis patients. Randy Mills, the President and CEO of CIRM, views kidney failure as an unmet medical need that could benefit from a stem cell related treatment:

“This approach has the potential to significantly improve our ability to care for people with kidney disease. Being able to reduce infections and clotting problems, and increase the consistency of care hemodialysis patients get, would meaningfully impact the quality of their lives.”

A patient’s story and CIRM’s efforts to fund clinical trials

Raymund Ramirez

Raymond Ramirez (KQED Science)

Yesterday, David Gorn from KQED Science published a nice piece about Humacyte’s stem cell derived technology and featured the story of a kidney failure patient, Raymond Ramirez. Raymond’s story is very emotional. He is a Vietnam war veteran that has experienced a gauntlet of maladies including bladder cancer and blindness in his right eye. On top of that, his kidneys aren’t functioning well and he is unable to continue his dialysis treatments because his veins aren’t holding up.

Raymond was the first patient to be treated in Humacyte’s Phase III trial. You can read more about his story here.

Gorn also highlighted CIRM’s recent efforts to fund promising stem cell projects that are further along in development and ready for clinical trials in patients. He ended with a quote from UC San Diego’s director of stem cell research, Larry Goldstein, on how important it is for our agency to continue funding stem cell clinical trials.

Larry Goldstein

Larry Goldstein

“Ten years ago I don’t think there were that many [stem cell] projects that were really ready for clinical trials. The field itself has developed projects that are at clinical stage. If the agency [CIRM] keeps pumping out these types of clinical results, California voters may soon see another ballot measure to keep it going.”

CIRM Board targets diabetes and kidney disease with big stem cell research awards

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A recent study  estimated there may be more than 500 million people worldwide who have diabetes. That’s an astounding figure and makes diabetes one of the largest chronic disease epidemics in human history.

One of the most serious consequences of untreated or uncontrolled diabetes is kidney damage. That can lead to fatigue, weakness, confusion, kidney failure and even death. So two decisions taken by the CIRM Board today were good news for anyone already suffering from either diabetes or kidney disease. Or both.

The Board awarded almost $10 million to Humacyte to run a Phase 3 clinical trial of an artificial vein needed by people undergoing hemodialysis – that’s the most common form of dialysis for people with kidney damage. Hemodialysis helps clean out impurities and toxins from the blood. Without it waste will build up in the kidneys with devastating consequences.

The artificial vein is a kind of bioengineered blood vessel. It is implanted in the individual’s arm and, during dialysis, is connected to a machine to move the blood out of the body, through a filter, and then back into the body. The current synthetic version of the vein is effective but is prone to clotting and infections, and has to be removed regularly. All this puts the patient at risk.

Humacyte’s version – called a human acellular vessel or HAV – uses human cells from donated aortas that are then seeded onto a biodegradable scaffold and grown in the lab to form the artificial vein. When fully developed the structure is then “washed” to remove all the cellular tissue, leaving just a collagen tube. That is then implanted in the patient, and their own stem cells grow onto it, essentially turning it into their own tissue.

In earlier studies Humacyte’s HAV was shown to be safer and last longer than current versions. As our President and CEO, Randy Mills, said in a news release, that’s clearly good news for patients:

“This approach has the potential to dramatically improve our ability to care for people with kidney disease. Being able to reduce infections and clotting, and increase the quality of care the hemodialysis patients get could have a significant impact on not just the quality of their life but also the length of it.”

There are currently almost half a million Americans with kidney disease who are on dialysis. Having something that makes life easier, and hopefully safer, for them is a big plus.

The Humacyte trial is looking to enroll around 350 patients at three sites in California; Sacramento, Long Beach and Irvine.

While not all people with diabetes are on dialysis, they all need help maintaining healthy blood sugar levels, particularly people with type 1 diabetes. That’s where the $3.9 million awarded to ViaCyte comes in.

We’re already funding a clinical trial with ViaCyte  using an implantable delivery system containing stem cell-derived cells that is designed to measure blood flow, detect when blood sugar is low, then secrete insulin to restore it to a healthy level.

This new program uses a similar device, called a PEC-Direct. Unlike the current clinical trial version, the PEC-Direct allows the patient’s blood vessels to directly connect, or vasularize, with the cells inside it. ViaCyte believes this will allow for a more robust engraftment of the stem cell-derived cells inside it and that those cells will be better able to produce the insulin the body needs.

Because it allows direct vascularization it means that people who get the delivery system  will also need to get chronic immune suppression to stop their body’s immune system attacking it. For that reason it will be used to treat patients with type 1 diabetes that are at high risk for acute complications such as severe hypoglycemic (low blood sugar) events associated with hypoglycemia unawareness syndrome.

In a news release Paul Laikind, Ph.D., President and CEO of ViaCyte, said this approach could help patients most at risk.

“This high-risk patient population is the same population that would be eligible for cadaver islet transplants, a procedure that can be highly effective but suffers from a severe lack of donor material. We believe PEC-Direct could overcome the limitations of islet transplant by providing an unlimited supply of cells, manufactured under cGMP conditions, and a safer, more optimal route of administration.”

The Board also approved more than $13.6 million in awards under our Discovery program. You can see the winners here.