Using stem cells to fix bad behavior in the brain

 

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Gladstone Institutes Steven Finkbeiner and Gaia Skibinski: Photo courtesy Chris Goodfellow, Gladstone Institutes

Diseases of the brain have many different names, from Alzheimer’s and Parkinson’s to ALS and Huntington’s, but they often have similar causes. Researchers at the Gladstone Institutes in San Francisco are using that knowledge to try and find an approach that might be effective against all of these diseases. In a new CIRM-funded study, they have identified one protein that could help do just that.

Many neurodegenerative diseases are caused by faulty proteins, which start to pile up and cause damage to neurons, the brain cells that are responsible for processing and transmitting information. Ultimately, the misbehaving proteins cause those cells to die.

The researchers at the Gladstone found a way to counter this destructive process by using a protein called Nrf2. They used neurons from humans (made from induced pluripotent stem cells – iPSCs – hence the stem cell connection here) and rats. They then tested these cells in neurons that were engineered to have two different kinds of mutations found in  Parkinson’s disease (PD) plus the Nrf2 protein.

Using a unique microscope they designed especially for this study, they were able to track those transplanted neurons and monitor what happened to them over the course of a week.

The neurons that expressed Nrf2 were able to render one of those PD-causing proteins harmless, and remove the other two mutant proteins from the brain cells.

In a news release to accompany the study in The Proceedings of the National Academy of Sciences, first author Gaia Skibinski, said Nrf2 acts like a house-cleaner brought in to tidy up a mess:

“Nrf2 coordinates a whole program of gene expression, but we didn’t know how important it was for regulating protein levels until now. Over-expressing Nrf2 in cellular models of Parkinson’s disease resulted in a huge effect. In fact, it protects cells against the disease better than anything else we’ve found.”

Steven Finkbeiner, the senior author on the study and a Gladstone professor, said this model doesn’t just hold out hope for treating Parkinson’s disease but for treating a number of other neurodegenerative problems:

“I am very enthusiastic about this strategy for treating neurodegenerative diseases. We’ve tested Nrf2 in models of Huntington’s disease, Parkinson’s disease, and ALS, and it is the most protective thing we’ve ever found. Based on the magnitude and the breadth of the effect, we really want to understand Nrf2 and its role in protein regulation better.”

The next step is to use this deeper understanding to identify other proteins that interact with Nrf2, and potentially find ways to harness that knowledge for new therapies for neurodegenerative disorders.

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

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

Stock Image

Stock Image

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

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

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

Dr. Roger Barker

Dr. Roger Barker

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

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

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

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

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

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

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

But not without responsibility. And a dose of realism.


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

What’s the big idea? Or in this case, what’s the 19 big ideas?

supermarket magazineHave you ever stood in line in a supermarket checkout line and browsed through the magazines stacked conveniently at eye level? (of course you have, we all have). They are always filled with attention-grabbing headlines like “5 Ways to a Slimmer You by Christmas” or “Ten Tips for Rock Hard Abs” (that one doesn’t work by the way).

So with those headlines in mind I was tempted to headline our latest Board meeting as: “19 Big Stem Cell Ideas That Could Change Your Life!”. And in truth, some of them might.

The Board voted to invest more than $4 million in funding for 19 big ideas as part of CIRM’s Discovery Inception program. The goal of Inception is to provide seed funding for great, early-stage ideas that may impact the field of human stem cell research but need a little support to test if they work. If they do work out, the money will also enable the researchers to gather the data they’ll need to apply for larger funding opportunities, from CIRM and other institutions, in the future

The applicants were told they didn’t have to have any data to support their belief that the idea would work, but they did have to have a strong scientific rational for why it might

As our President and CEO Randy Mills said in a news release, this is a program that encourages innovative ideas.

Randy Mills, Stem Cell Agency President & CEO

Randy Mills, CIRM President & CEO

“This is a program supporting early stage ideas that have the potential to be ground breaking. We asked scientists to pitch us their best new ideas, things they want to test but that are hard to get funding for. We know not all of these will pan out, but those that do succeed have the potential to advance our understanding of stem cells and hopefully lead to treatments in the future.”

So what are some of these “big” ideas? (Here’s where you can find the full list of those approved for funding and descriptions of what they involve). But here are some highlights.

Alysson Muotri at UC San Diego has identified some anti-retroviral drugs – already approved by the Food and Drug Administration (FDA) – that could help stop inflammation in the brain. This kind of inflammation is an important component in several diseases such as Alzheimer’s, autism, Parkinson’s, Lupus and Multiple Sclerosis. Alysson wants to find out why and how these drugs helps reduce inflammation and how it works. If he is successful it is possible that patients suffering from brain inflammation could immediately benefit from some already available anti-retroviral drugs.

Stanley Carmichael at UC Los Angeles wants to use induced pluripotent stem (iPS) cells – these are adult cells that have been genetically re-programmed so they are capable of becoming any cell in the body – to see if they can help repair the damage caused by a stroke. With stroke the leading cause of adult disability in the US, there is clearly a big need for this kind of big idea.

Holger Willenbring at UC San Francisco wants to use stem cells to create a kind of mini liver, one that can help patients whose own liver is being destroyed by disease. The mini livers could, theoretically, help stabilize a person’s own liver function until a transplant donor becomes available or even help them avoid the need for liver transplantation in the first place. Considering that every year, one in five patients on the US transplant waiting list will die or become too sick for transplantation, this kind of research could have enormous life-saving implications.

We know not all of these ideas will work out. But all of them will help deepen our understanding of how stem cells work and what they can, and can’t, do. Even the best ideas start out small. Our funding gives them a chance to become something truly big.


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Approach that inspires DREADD could create new way to treat Parkinson’s disease

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Dopamine producing brain nerve cells, made from embryonic stem cells

Imagine having a treatment for Parkinson’s that acts like a light switch, enabling you to turn it on or off depending on your needs. Well, that’s what researchers at the University of Wisconsin-Madison have come up with. And if it works, it might help change the way we treat many other diseases.

For years researchers have been trying to come up with a way of replacing the dopamine-producing brain nerve cells, or neurons, that are attacked and destroyed by Parkinson’s. Those cells regulate movement and as they are destroyed they diminish a person’s ability to control their body, their movement and even their emotions.

Attempts to transplant dopamine-producing cells into the brains of people with Parkinson’s disease have met with mixed results. In some cases the transplanted cells have worked. In many cases the cells don’t make enough dopamine to control movement. In about 10 percent of cases the cells make too much dopamine, causing uncontrolled movements called graft-induced dyskinesia.

But now the researchers at UW Madison have found a new approach that might change that. Using the gene-editing tool CRISPR (you can read about that here) they reprogrammed embryonic stem cells to become two different types of neurons containing a kind of genetic switch called a DREADD, which stands for designer receptor exclusively activated by designer drug. When they gave mice the designer drug they created to activate DREADD, one group of cells boosted production of dopamine, the other group shut down its dopamine production.

In a news release about the study, which is published in the journal Cell Stem Cell, lead author Su-Chun Zhang says this kind of control is essential in developing safe, effective therapies:

“If we are going to use cell therapy, we need to know what the transplanted cell will do. If its activity is not right, we may want to activate it, or we may need to slow or stop it.”

Zhang says the cells developed using this approach have another big advantage:

“We can turn them on or off, up or down, using a designer drug that can only act on cells that express the designer receptor. The drug does not affect any host cell because they don’t have that specialized receptor. It’s a very clean system.”

Tests in mice showed that the cells, and the designer drug, worked as the researchers hoped they would with some cells producing more dopamine, and others halting production.

It’s an encouraging start but a lot more work needs to be done to make sure the the genetically engineered stem cells, and the designer drug, are safe and that they can get the cells to go to the part of the brain that needs increased dopamine production.

As Zhang says, having a method of remotely controlling the action of transplanted cells, one that is reversible, could create a whole new way of treating diseases.

“This is the first proof of principle, using Parkinson’s disease as the model, but it may apply to many other diseases, and not just neurological diseases.”

Two National Parkinson’s Disease Organizations Join Forces

David Higgins, Parkinson's advocate and CIRM Board member

David Higgins, Parkinson’s advocate and CIRM Board member

Guest blogger David R. Higgins, PhD, is a Parkinson’s Patient Advocate and a CIRM ICOC board member.

Two national Parkinson’s organizations have decided to join forces: The Parkinson’s Action Network (PAN) will be integrated into The Michael J. Fox Foundation (MJFF). Both have served the Parkinson’s community in separate and important ways, but as MJFF CEO Todd Sherer said in a joint press release, “Working as a single entity, MJFF and PAN will bring the passion and commitment of our joint community to bear on articulating and advancing key public policy priorities affecting millions of PD patients and families.”

Michael J. Fox Foundationmjff_vert_rgb_logo_300

Best known for its namesake founder and mission to fund Parkinson’s research, MJFF has awarded more than $450 million to fund Parkinson’s research. MJFF has distinguished itself as a fundraising giant and has kept their eye on their goal of funding high-quality PD research always with the goal of a cure in mind. In addition to funding research, the MJFF is known for its database of Parkinson’s related clinical trials, which it vets and makes available to anyone interested through a system that works a lot like a matchmaking service (i.e. the right trial for the right person based on personal preferences and interests). To learn more about the MJFF follow the link: https://www.michaeljfox.org.

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PAN has been a Washington, DC-based organization created to be a single voice for a united Parkinson’s community, with a proven track record for effective advocacy for federal legislation and policy that considers the needs of the Parkinson’s community. We used to call this “lobbying”, now we call it “advocacy”. To learn more about PAN follow the link: http://parkinsonsaction.org.

One + One = ThreePAN-MJFF-homepage-img

Integration of PAN into MJFF creates a Parkinson’s patient advocacy trifecta that brings together the strengths of each organization: patient care (access, knowledge, education), research support (fundraising to support research, new therapies and ultimately a cure) and political action (legislation and public policy supporting the Parkinson’s community).

The merged organization will have two groups of advisors, the Unified Parkinson’s Advocacy Council, which will maintain a single voice for advocacy, and a Public Policy Council, which will provide guidance and advice on policy strategies that are important to the Parkinson’s community. While MJFF will continue to be based in NYC, for the first time they will also have an office in Washington, DC. You can read more about the merge here.

PAN and CIRM Have Common Roots

As it turns out there is a strong connection between PAN and CIRM. California attorney and Parkinson’s patient Joan Samuelson founded PAN in 1991. Samuelson described her “surge of excitement” in 1990 when she read about a possible breakthrough in Parkinson’s therapies that used tissue transplants, and how that hope was “swept away” when she read about a federal policy banning any federal support for such research.

PAN was Samuelson’s brainchild and reflected her prescient vision that it would take a political effort at the national level to counter this anti-tissue transplant movement. PAN became famous for its national network of grassroots organizers who could muster thousands of calls to Congress with a day’s notice to voice support or opposition to legislation.

It should come as no surprise that Samuelson was a supporter of California’s Proposition 71 that voters approved in 2004, creating CIRM. Samuelson became CIRM’s first Parkinson Patient Advocate and served in that role until 2014. She was a famously outspoken member of the ICOC (CIRM’s governing Board) and supporter of the Parkinson’s community.

I am humbled to be the one to follow her as the Parkinson’s Patient Advocate on the ICOC, but have no illusions that Samuelson didn’t just leave “big” shoes behind to fill, she left behind shoes so big a family of four could live in them! Samuelson lives in retirement in Sonoma County, CA. I met her once, but never knew her other than by reputation. Words I have heard used to describe her include character, integrity, brilliance, tenacity and one who conveys a sense of urgency for making the world a better place for Parkinson’s patients.

Today, there is not yet a cure, but there is plenty of hope.


 

Notes on Parkinson’s disease

Parkinson’s disease (PD) is a progressive disease that affects the nervous system and for which there is no cure. Over a million people in the US are known to have this debilitating disease. PD is a type of movement disorder, characterized by so-called motor symptoms including too little, too much, or inappropriate movements of the body. Motor symptoms are attributed to the death of specialized cells in a part of the brain that controls movement. These cells produce dopamine, a chemical that allows these specialized nerve cells to “talk” to each other and thus direct movement. What causes these cells to die is an active area of research, including CIRM-funded research. Our understanding of PD has gotten more sophisticated and we now understand that in addition to motor symptoms there are so-called non-motor symptoms. Non-motor symptoms include severe fatigue, insomnia, depression, anxiety, mild cognitive impairment and dementia among others. PD patients often report that non-motor symptoms impact the quality of their lives more than motor symptoms.

How do you know what patients want if you never even ask them?

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Our mission at CIRM is to accelerate stem treatments to patients with unmet medical needs. But what if those needs are not just unmet, they’re also unknown? What happens when those developing treatments never even bother to ask those they are trying to help if this is what they really need, or want?

The question came up during a panel discussion at a meeting of the CIRM Alpha Stem Cell Clinics Network in San Diego earlier this month. David Higgins, a CIRM Board member and a Patient Advocate for Parkinson’s disease, highlighted the problem saying that if you ask most people what they think is the biggest problem for Parkinson’s sufferers, they would probably say the movement disorders such as tremors and muscle rigidity. But David said that if you ask people who have Parkinson’s what their biggest problems are, then movement disorder probably wouldn’t even come in the top five concerns that they really have.

David listed insomnia, severe fatigue, anxiety, and depression as far more pressing and important:

“Researchers study what they know and they look to solve the things they think they can solve, and it is sometimes very different than the things that patients would like them to solve to ease their concerns.”

That sparked a fascinating discussion about the gap between what researchers and scientists sometimes think they should be doing, the kinds of treatments they should be trying to develop, and what the people who have those conditions really want.

David Parry, who is with GlaxoSmithKline and worked in drug development and discovery for most of his career, said:

“If I told you how many times I sat in meetings with my medical discovery group and talked about what our targets should be then we’d be here all night. We focus on what we know, what we think we can fix and what will work, when maybe we need to be more mindful of what could really make a difference in the life of patients.”

Alpha clinic panelAlpha Stem Cell Clinics Network panel discussion: Left David Higgins, David Parry, Catriona Jamieson, John Zaia, John Adams

Clearly there is a gap between what we think we can fix and what we should try and fix, and the best way to close that gap is to have a conversation.

Patients and Patient Advocates need to speak up and tell researchers what their main concerns and problems are, to help the scientists understand that while they would dearly love something that saves their life, they would also appreciate something that helps improve the quality of their lives.

Researchers too need to take a step back and not just get caught up in the search for an answer to a scientific or medical puzzle, without first asking “is this a puzzle that people want solved?”

At CIRM we work hard to make sure the voices of the patients and Patient Advocates are heard at every level of the work we do; from deciding what to fund to how to design a clinical trial involving our funding. But clearly it’s important that those voices be heard at a much earlier stage, to help shape the direction the research takes long before it comes to us for funding.

Breaking down barriers

For too long there has been a communications barrier between researchers and patients. This is not something that was deliberately constructed, it is something that simply evolved over time. Now it’s time to break down that barrier, and make sure both groups are talking to each other.

When it comes to developing treatments for deadly diseases and disorders, patients and researchers should think of themselves as partners. Researchers put their minds to work developing these treatments. Patients put their bodies on the line testing them.

Without the research there is no hope. Without the patients there is no proof. So, let’s start talking to each other.

If you have any thoughts or suggestions on how we can get this conversation started we would love to hear from you.

Stem cell stories that caught our eye: Parkinson’s trial revived, aspirin kills cancer stem cells and a stem cell role in mother-child obesity

Here are some stem cell stories that caught our eye this past week. Some are groundbreaking science, others are of personal interest to us, and still others are just fun.

Parkinson’s clinical trials back on track.
After nearly 20 years of being stuck on the clinical trial “bookshelf”, an international team from Cambridge, UK revived a cell therapy for Parkinson’s disease.

In an announcement picked up this week by the Genetic Literacy Project, the team reported they had treated their first patient. Specifically, fetal brain cells were injected into the brain of a man in his mid-50’s with the disease.

Neurons derived from human embryonic stem cells

A fluorescent microscopic image of numerous dopaminergic neurons (the type of neurons that are degenerated in Parkinson’s disease patients) generated from human embryonic stem cells. Image courtesy of the Xianmin Zeng lab at the Buck Institute for Age Research.

In Parkinson’s, nerve cells controlling movement die for poorly understood reasons. An accumulation of data through the 60’s and 70’s suggested transplantation of fetal brain cells into the Parkinson’s brain would replace the lost nerve cells and restore movement control. After initial promising results in the 80’s and 90’s, larger clinical trials showed no significant benefit and even led to a worsening of symptoms in some patients.

Due to these outcomes, the research community shelved the approach. Insights gained in the interim pointed to more ideal brain injection sites in order to help avoid side effects. Also, follow up on patients beyond the two-year run of those early trials suggested that positive effects of the cell therapy may not emerge for at least three to five years. So this latest trial will run longer to capture this time window.

One remaining snag for this therapeutic strategy is the limited number of available cells for each transplant. So in the meantime, scientists including some of our grantees are working hard at getting embryonic stem cell- or iPS cell-based therapies to the clinic. Since stem cells divide indefinitely, this approach could provide an off-the-shelf, limitless supply of the nerve cells. Stay tuned.

Targeting cancer stem cells with the Wonder Drug.
Aspirin: it’s the wonder drug that may turn out to be even more wonderful.

Ball and stick model of aspirin, the wonder drug: relieves pain and prevents cancer

Ball and stick model of aspirin, the wonder drug: relieves pain and prevents cancer

Famous for relieving pain and preventing heart attacks, aspirin may add breast cancer-killer to its resume. This week a cancer research team at the Kansas City (Mo.) Veteran Affairs Medical Center published experiments picked up by Eureka Alert showing a daily dose of aspirin could put the brakes on breast cancer.

The analysis attributed this anti-cancer effect to aspirin’s capacity to reduce the growth of cancer stem cells. These cells make up a tiny portion of a tumor but if chemotherapy or radiation treatment leaves any behind, it’s thought the cells’ stem cell-like ability for unlimited growth drives cancer relapse and spread (metastasis).

In the study, mice with tumors given a daily low dose of aspirin for 15 days had, on average, tumors nearly 50% smaller than the aspirin-free mice. In another set of experiments, the team showed aspirin could prevent tumors as well. Mice were given aspirin for 10 days before exposing them to cancer cells. After another 15 days, the aspirin treated animals had significantly less tumor growth compared to an untreated group.

Senior author Sushanta Banerjee stands behind these findings: he’s been taking an aspirin a day for three years but stresses that you should consult with your doctor before trying it yourself.

A stem cell link to the passing on of obesity from mom to child?
It’s been observed that children of obese moms have a high risk for obesity and diabetes. You might conclude that genetics are the culprit as well as lifestyle habits passed down from parent to child. But research published this week by researchers at the University of Colorado School of Medicine suggests another mechanism: they conclude the mere presence of the growing embryo in the uterus of an obese mother may instruct the child’s cells to take on more fat.

The team’s reasoning is based on an analysis of umbilical cord blood stem cells collected from babies born to 12 obese mothers and 12 normal weight mothers. In the lab, the stem cells were specialized into fat and muscle cells. The cells from babies of obese mothers showed increased fat accumulation and a lower production of proteins important for uptake of blood sugar (a state that could eventually tip the scales towards diabetes).

Certainly it’s a leap to link the property of cells in a dish to the eventual health of a child. But the results are intriguing enough that the researchers intend to follow the children as they get older to look for more connections between the state of the kids’ stem cells and their health profile.

Desperate patients and false hope: a troubling trend for stem cell-based therapies

A gambler’s odds are usually stacked against them but the possibility, however slim, of hitting the jackpot keeps bringing them back to the table. Now imagine, unbeknownst to them, the system is rigged so there’s a zero percent chance of any winnings. They’d essentially be giving their money away based on a false hope. Sadly, many desperate people looking for stem cell cures do exactly that.

Earlier this week, Cristin Severance, a Team10 TV news reporter in San Diego, investigated local stem cell clinics promising treatments for a number of chronic incurable diseases. Severance cites Stemgenex of La Jolla, which offers people with Parkinson’s disease the chance of improving their symptoms through a therapy using stem cells from their own fat. This opportunity comes at a cost – $15,000. According to stem cell expert Jeanne Loring of The Scripps Research Institute, there’s no prospect the treatment will work.

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Cristin Severance, a Team10 San Diego TV news reporter, investigated local stem cells clinics offering questionable therapies at a steep price.

First, some background: Parkinson’s disease is an incurable neurodegenerative disorder that affects nearly a million people in the United States. The symptoms include tremors, slow movement, muscle rigidity and less facial expression. Parkinson’s occurs when nerve cells, or neurons, in the region of the brain that controls movement, die for reasons that remain unclear. Which leads us to the snag with Stemgenex’s treatment strategy. Dr. Loring, who is a CIRM-funded researcher, explains in the TV news segment:

“The cells they are giving these patients cannot help them. My stem cells [in my laboratory] make neurons of a certain type. The stem cells they are getting out of people’s fat can’t do that. They could never do it. They aren’t capable of it.”

But what about the positive video patient testimonials often posted on these clinics’ websites? Watch enough of them and you’ll notice a pattern: the patients are typically recorded shortly after the treatment with no long-term follow up and no published data in peer-reviewed medical journals. Loring points out the likely explanation for these seemingly successful treatments:

“There is something called a placebo effect…If you believe whatever you’re getting is going to help you then there’s a short period of time in which your body is convinced that it has helped you. But that goes away.”

A plausible approach to treating Parkinson’s is to start with so-called pluripotent stem cells, which have the potential to specialize into any cell type. With these cells in hand, scientists can generate the neurons that are lost in Parkinson’s – a feat Loring and others have accomplished. The next step is to inject these neurons into the brains of Parkinson’s patients to restore—hopefully—proper movement control. But first the researchers must gather enough evidence in animal studies to convince the Food and Drug Administration (FDA) that this therapy is safe and effective enough to test in humans.

So what about people who need stem cell cures today, right now? The sobering truth is, there are very few stem-call based products approved by the FDA. Most of those involve blood stem cell transplantation for treating leukemia and some genetic blood disorders as well as the use of stem cells for skin and hair grafts and cartilage repair.

Still, more and more stem cell-based clinical trials are coming online and recruiting people with a wide range of diseases. Everyday at CIRM, we receive emails and phone calls from people looking for advice about these experimental stem cell treatments. Our main recommendation: carefully read an excellent online resource provided by the International Society for Stem Cell Research (ISSCR) called, A Closer Look at Stem Cell Treatments. In particular, the Things to Consider about Clinical Trials section includes a list of questions anyone thinking about participating in a stem cell trial should ask. It would be a good idea to get the answers in writing and discuss them with a physician you trust. That way, you can truly know your odds when forming a decision.

Visit our website for more information about stem cell-related Parkinson’s research as well as the current list of CIRM-funded clinical trials.

Mutation Morphs Mitochondria in Models of Parkinson’s Disease, CIRM-Funded Study Finds

There is no singular cause of Parkinson’s disease, but many—making this disease so difficult to understand and, as a result, treat. But now, researchers at the Buck Institute for Research on Aging have tracked down precisely how a genetic change, or mutation, can lead to a common form of the disease. The results, published last week in the journal Stem Cell Reports, point to new and improved strategies at tackling the underlying processes that lead to Parkinson’s.

Mitochondria from iPSC-derived neurons. On the left is a neuron derived from a healthy individual, while the image on the right shows a neuron derived from someone with the Park2 mutation, the most common mutation in Parkinson's disease (Credit: Akos Gerencser)

Mitochondria from iPSC-derived neurons. On the left is a neuron derived from a healthy individual, while the image on the right shows a neuron derived from someone with the Park2 mutation, the most common mutation in Parkinson’s disease (Credit: Akos Gerencser)

The debilitating symptoms of Parkinson’s—most notably stiffness and tremors that progress over time, making it difficult for patients to walk, write or perform other simple tasks—can in large part be linked to the death of neurons that secrete the hormone dopamine. Studies involving fruit flies in the lab had identified mitochondria, cellular ‘workhorses’ that churn out energy, as a key factor in neuronal death. But this hypothesis had not been tested using human cells.

Now, scientists at the Buck Institute have replicated the process in human cells, with the help of stem cells derived from patients suffering from Parkinson’s, a technique called induced pluripotent stem cell technology, or iPSC technology. These newly developed neurons exactly mimic the disease at the cellular level. This so-called ‘disease in a dish’ is one of the most promising applications of stem cell technology.

“If we can find existing drugs or develop new ones that prevent damage to the mitochondria we would have a potential treatment for PD,” said Dr. Xianmin Zeng, the study’s senior author, in a press release.

And by using this technology, the Buck Institute team confirmed that the same process that occurred in fruit fly cells also occurred in human cells. Specifically, the team found that a particular mutation in these cells, called Park2, altered both the structure and function of mitochondria inside each cell, setting off a chain reaction that leads to the neurons’ inability to produce dopamine and, ultimately, the death of the neuron itself.

This study, which was funded in part by a grant from CIRM, could be critical in the search for a cure for a disease that, as of yet, has none. Current treatment regimens aimed at slowing or reducing symptoms have had some success, but most begin to fail overtime—or come with significant negative side effects. The hope, says Zeng, is that iPSC technology can be the key to fast-tracking promising drugs that can actually target the disease’s underlying causes, and not just their overt symptoms. Hear more from Dr. Xianmin Zeng as she answers your questions about Parkinson’s disease and stem cell research:

Bringing out the Big Guns: Scientists Weigh in on How Best to Combat Deadly Diseases of the Brain

Despite our best efforts, diseases of the brain are on the rise. Neurodegenerative conditions such as Alzheimer’s and Parkinson’s diseases threaten not only to devastate our aging population, but also cripple our economy. Meanwhile, the causes of conditions such as autism remain largely unknown. And brain and spinal cord injuries continue to increase—leaving their victims with precious few options for improving their condition.

This special review issue of addresses some of the key challenges for translational neuroscience and the path from bench to beside. [Credit: Cell Press]

This special review issue of Neuron addresses some of the key challenges for translational neuroscience and the path from bench to beside. [Credit: Cell Press]

We need to do better.

The scientific community agrees. And in a special issue of the journal Neuron, the field’s leading researchers lay out how to accelerate much-needed therapies to the many millions who will be affected by brain disease or injury in the coming years.

The journal’s leadership argues that now is the time to renew efforts in this field. Especially worrying, say experts, is the difficulty in translating research breakthroughs into therapies.

But Neuron Editor Katja Brose is optimistic that the answers are out there—we just need to bring them to light:

“There is resounding agreement that we need new approaches and strategies, and there are active efforts, discussion and experimentation aimed at making the process of therapeutic development more efficient and effective.”

Below are three papers highlighted in the special journal, each giving an honest assessment of how far we’ve come, and what we need to do to take the next step.

Fast-tracking Drug Development. In this perspective, authors from the Institute of Medicine (IOM) and the Salk Institute—including CIRM grantee Fred Gage—discuss the main takeaways from an IOM-sponsored workshop aimed at finding new avenues for accelerating treatments for brain diseases to the clinic.

The main conclusion, according to the review’s lead author Steve Hyman, is a crucial cultural shift—various stakeholders in academia, government and industry must stop thinking of themselves as competitors, but instead as allies. Only then will the field be able to successfully shepherd a breakthrough from the lab bench and to the patient’s bedside.

Downsized Divisions’ Dangerous Effects. Next, an international team of neuroscientists focuses their perspective on the recent trend of pharmaceutical companies to cut back on funding for neuroscience research. The reasoning: neurological diseases are far more difficult than other conditions, and proving to be too costly and too time-consuming to be worth continued effort.

The solution, says author Dennis Choi of State University of New York Stonybrook, is a fundamental policy change in the way that market returns of neurological disease drug development are regulated. But Choi argues that such a shift cannot be achieved without a concerted effort by patient advocates and nonprofits to lead the charge. As he explains:

“The broader neuroscience community and patient stakeholders should advocate for the crafting and implementation of these policy changes. Scientific and patient group activism has been successful in keeping the development of therapies in other areas—such as HIV and cancer—appropriately on track, but this type of sector-wide activism would be a novel step for the neuroscience community.”

Indeed, here at CIRM we have long helped support the patient community—a wonderful collection of individuals and organizations advocating for advances in stem cell research. We are humbled and honored that so many patients and patient advocates have stepped forward as stem cell champions as we move towards the clinic.

The Road to Preclinical Diagnosis. Finally, we hear from Harvard University neuroscientists highlighting how far the research has come—even in the face of such extraordinary difficulty.

Specifically focused on Alzheimer’s disease, the authors touch on the discoveries of protein markers, such as amyloid-beta and tau, that serve as an indicator of neurodegeneration. They make the important point that because Alzheimer’s is almost certainly is present before the onset of physical symptoms, the ultimate goal of researchers should be to find a way to diagnose the disease before it has progressed too far.

“[Here we] highlight the remarkable advances in our ability to detect evidence of Alzheimer’s disease in the brain, prior to clinical symptoms of the disease, and to predict those at greatest risk for cognitive decline,” explained lead author Reisa Sperling.

The common thread between these perspectives, say Neuron editors in an accompanying editorial, is that “by leveraging shared resources, tools and knowledge and approaching these difficult problems collaboratively, we can achieve more together.”

A sentiment that we at CIRM fully support—and one that we will continue to foster as we push forward with our mission to accelerate stem cell-based therapies to patients in need.