This year the most widely read blog was actually one we wrote back in 2018. It’s the transcript of a Facebook Live: “Ask the Stem Cell Team” event about strokes and stroke recovery. Because stroke is the third leading cause of death and disability in the US it’s probably no surprise this blog has lasting power. So many people are hoping that stem cells will help them recover from a stroke.
But of the blogs that we wrote and posted this year there’s a really interesting mix of topics.
The most read 2019 blog was about a potential breakthrough in the search for a treatment for type 1 diabetes (T1D). Two researchers at UC San Francisco, Dr. Matthias Hebrok and Dr. Gopika Nair developed a new method of replacing the insulin-producing cells in the pancreas that are destroyed by type 1 diabetes.
Dr. Hebrok described it as a big advance saying: “We can now generate insulin-producing cells that look and act a lot like the pancreatic beta cells you and I have in our bodies. This is a critical step towards our goal of creating cells that could be transplanted into patients with diabetes.”
It’s not too surprising a blog about type 1 diabetes was at the top. This condition affects around 1.25 million Americans, a huge audience for any potential breakthrough. However, the blog that was the second most read is the exact opposite. It is about a rare disease called cystinosis. How rare? Well, there are only around 500 children and young adults in the US, and just 2,000 worldwide diagnosed with this condition.
It might be rare but its impact is devastating. A genetic mutation means children with this condition lack the ability to clear an amino acid – cysteine – from their body. The buildup of cysteine leads to damage to the kidneys, eyes, liver, muscles, pancreas and brain.
UC San Diego researcher Dr. Stephanie Cherqui and her team are taking the patient’s own blood stem cells and, in the lab, genetically re-engineering them to correct the mutation, then returning the cells to the patient. It’s hoped this will create a new, healthy blood system free of the disease.
Dr. Cherqui says if it works, this could help not just people with cystinosis but a wide array of other disorders: “We were thrilled that the stem cells and gene therapy worked so well to prevent tissue degeneration in the mouse model of cystinosis. This discovery opened new perspectives in regenerative medicine and in the application to other genetic disorders. Our findings may deliver a completely new paradigm for the treatment of a wide assortment of diseases including kidney and other genetic disorders.”
The third most read blog was about another rare disease, but one that has been getting a lot of media attention this past year. Sickle cell disease affects around 100,000 Americans, mostly African Americans. In November the Food and Drug Administration (FDA) approved Oxbryta, a new therapy that reduces the likelihood of blood cells becoming sickle shaped and clumping together – causing blockages in blood vessels.
But our blog focused on a stem cell approach that aims to cure the disease altogether. In many ways the researchers in this story are using a very similar approach to the one Dr. Cherqui is using for cystinosis. Genetically correcting the mutation that causes the problem, creating a new, healthy blood system free of the sickle shaped blood cells.
Two other blogs deserve honorable mentions here as well. The first is the story of James O’Brien who lost the sight in his right eye when he was 18 years old and now, 25 years later, has had it restored thanks to stem cells.
The fifth most popular blog of the year was another one about type 1 diabetes. This piece focused on the news that the CIRM Board had awarded more than $11 million to Dr. Peter Stock at UC San Francisco for a clinical trial for T1D. His approach is transplanting donor pancreatic islets and parathyroid glands into patients, hoping this will restore the person’s ability to create their own insulin and control the disease.
2019 was certainly a busy year for CIRM. We are hoping that 2020 will prove equally busy and give us many new advances to write about. You will find them all here, on The Stem Cellar.
There are a growing number of predatory clinics in California and around the US, offering unproven stem cell therapies. For patients seeking a legitimate therapy it can often be hard finding a reliable clinic, one offering treatments based on the rigorous science required in a clinical trial sanctioned by the US Food and Drug Administration (FDA). That’s one of the reasons why the California Institute for Regenerative Medicine (CIRM) created the CIRM Alpha Stem Cell Clinic Network and we are delighted the clinics have now been chosen as a Core program of the American Society of Hematology (ASH) Sickle Cell Disease (SCD) Collaborative Trials Network.
The Alpha Clinics are a network of top California medical centers that specialize in delivering stem cell clinical trials to patients. It consists of five leading medical centers throughout California: City of Hope, University of California (UC) San Diego, UC Irvine & UC Los Angeles, UC Davis and UC San Francisco.
The mission of the ASH Research Collaborative SCD Clinical Trials Network is to improve outcomes for individuals with Sickle Cell Disease by promoting innovation in therapy development and clinical trial research.
“The key to finding a cure for this crippling disease, and finding it quickly, is to work together”, says Maria T. Millan, MD, President & CEO of CIRM. “That’s why we are delighted to be chosen as a core program for the ASH Sickle Cell Disease Clinical Trials Network. This partnership means we can share data and information about best practices to help us improve the quality of the research being done and the clinical care we can offer patients. We already have 23 clinical stage therapies in cell and gene therapy, including two clinical trials targeting SCD, so we feel we have a lot to bring to the partnership in terms of experience and expertise.”
Sickle Cell disease is a life-threatening blood disorder that affects 100,000 people, mostly African Americans, in the US. It is caused by a single genetic mutation that results in the production of “sickle” shaped red blood cells that can block blood vessels causing intense pain, recurrent hospitalization, multi-organ damage and strokes.
“We hear a lot about the moonshot for curing cancer, but a moonshot for curing sickle cell disease should also be possible. Sickle cell disease was the first genetic disease that was discovered, and wouldn’t it be great if it is also one of the first ones we can cure in everyone?”
It is hoped that creating this network of clinical trial sites across the US will better serve an historically under-served population.
Establishing links and educational materials across these sites can increase patient engagement and recruitment
Standardizing resources across the network can ensure efficiency and coordination
Improving the training of clinical research staff can promote patient safety and trust and increase research quality
The CIRM Alpha Clinics Network has a proven track record of creating a faster, more streamlined approach in running clinical trials. It has developed the tools and systems to simultaneously launch clinical trials at multiple sites; created model non-disclosure agreements to make it easier for clinical trial sponsors to sign up; created a system to enable one Institutional Review Board (IRB) to approve a trial to be carried out at multiple sites rather than requiring each site to have its own IRB approval; developed best practices to quickly share experience and expertise across the network; and set up a database of over 20 million Californians to improve patient recruitment.
An Executive Summary prepared for the Western States Sickle Cell Disease Clinical Trials Network said: “the ASCC provides a formidable clinical trial unit uniquely qualified to deliver the next generation of cell and gene therapy products for SCD.”
There’s a lot of
fiction, a lot of misinformation surrounding stem cells and stem cell research.
There are claims that are not based on solid science and clinics that are
offering so-called “treatments” that are unproven, even dangerous for patients.
Now you have a chance to talk to the experts in the field and get solid answers
from them about what’s working, what’s not, and how you can find a therapy that
might be appropriate for you.
Do you have
questions about the latest in research using stem cells to help people
recovering from a stroke? We’ll have someone who can answer them.
Want to know if stem
cells can help people battling cancer? Or what’s happening in finding a stem
cell treatment for diabetes or sickle cell disease, even autism, Alzheimer’s or
Parkinson’s disease? We’ll have experts to answers those.
This is all
happening in a special Facebook Live “Ask the Stem Cell Team” event on Thursday,
December 12th from 10.30am to 11.30amPDT. To take part
all you have to do is tune in on the day and post a question or you can send us
one ahead of time at email@example.com
We will do our best
to answer as many of them as we can during the Facebook Live event, and those
we don’t have time to get to we’ll answer in a blog at a later date.
A powerful opening statement by Angela Ramirez Holmes, Founder & President of the California Action Link for Rare Diseases (CAL RARE).
Tuesday of last week, patient advocates, patient advocacy organizations, and members of the public filled a room at the California Capitol for an informational hearing on research related to rare diseases. One of the organizations present was CAL RARE, a non-profit organization that is dedicated to improving the lives of California patients with rare diseases. Angela’s opening statement reflects CAL RARE’s core mission of bringing awareness of rare diseases to the general public and decision makers in order to improve access to physicians, treatments, and social services.
One of the first presenters was Dr. Martin Cadeiras from the Department of Cardiovascular Medicine at UC Davis. His presentation focused on a rare disease named amyloidosis, which occurs when a protein called amyloid builds up in the body’s organs and tissues. This can lead to problems in the heart, skin, kidneys, liver, and digestive tract. There are several different types of amyloidosis, one of which is hereditary and another form that can occur after chronic infection. Dr. Cadeiras spoke in detail about the scientific complexities behind amyloidosis and shared images of patients affected with the disease as well as the complications associated with their condition.
To elaborate more on the patient perspective of this disease, patient advocate Len Strickland shared his journey living with amyloidosis. In addition to living with the disease, Len also has the sickle cell trait, meaning he has one copy of the sickle cell disease gene but one normal copy.
In his early life, Len was a typical young adult with no health problems. Unfortunately for him that changed in 2006, when he started having problems with shortness of breath and heart palpitations almost overnight. He visited many doctors, all of which were perplexed by his condition and were unable to diagnose him.
“My normal life was gone, and I was very concerned.” said Strickland.
One year later, after multiple tests and specialists, he was finally diagnosed with the hereditary version of amyloidosis. As a result of his condition, he was in dire need of a heart transplant. On March 4, 2008 he was placed on the transplant list. Because he was relatively lower on the priority list, he was told to keep hope to a minimum. Fortunately, on June 10, 2008 a matching donor heart was found and by the next day, Len had successfully received the heart transplant.
Len wrote a thank you letter to the mother of the deceased donor and regularly keeps in touch with her. She hopes to one day meet Len in person so that she can hug Len and hear her son’s heartbeat.
Although the amyloid deposits have spread to Len’s hand and feet, he is still able to live his life.
Len ended his speech by telling the crowd,
“Make the best of the time you have, if I can do it, so can you.”
The challenges Len faced with getting a proper diagnosis brought up the need for technology that can better screen rare diseases. The next presenter, Dr. Lauge Farnaes of Rady Children’s Institute for Genomic Medicine, discussed a project that focused on just that. Under a two million dollar Medi-Cal program titled Project Baby Bear, Dr. Farnaes and his team have used genome sequencing as a diagnostic test for critically ill newborns. The ultimate goal is to get this screening as a Medi-Cal covered benefit.
Comprehensive early testing enables physicians to make early decisions about and minimize the damage accumulated before diagnosis. “We have a chance to go in early on and make a difference in the life of patients.” said Farnaes.
Dr. Farnaes told stories of some of the children enrolled in the screening program. One was a young girl that had problems related to the heart. She was enrolled February 6th and diagnosed two days later with Timothy Syndrome, making her one of the youngest patients ever diagnosed. She was implanted with a defibrillator to help with her heart problems. Dr. Farnaes had stated that without the screening, she would have likely just been prescribed beta blockers, which would only have worsened her condition.
Another child enrolled in the program had difficulty breathing as a result of bone fractures. Because of the bone fractures, it was thought that the child had undergone abuse at the hands of the parents. However, thanks to the screening technology, it was found to be the result of a genetic condition. Dr. Farnaes talked about how this technology vindicated the parents, who were already going through the difficult process of having a sick child without throwing other problems into the mix.
To date, 116 children have been diagnosed with genetic conditions early on using this technology and the number is expected to eventually approach 150.
Last, but not least, Assemblymember Mike Gipson shared an update on the work that the rare disease caucus has made with relation to sickle cell disease. He mentioned how the legislative black caucus had successfully advocated for allocating $15 million for sickle cell disease. This money will be used to open seven new sickle cell centers across California.
The meeting in the California Capitol highlighted the impact that patient stories have on policy, as well as the ongoing need of funding and new technologies to address the disparities in rare disease.
At CIRM we are privileged to work with many remarkable people who combine brilliance, compassion and commitment to their search for new therapies to help people in need. One of those who certainly fits that description is UC Davis’ Jan Nolta.
This week the UC Davis Newsroom posted a great interview with Jan. Rather than try and summarize what she says I thought it would be better to let her talk for herself.
Talking research, unscrupulous clinics, and sustaining the momentum
In 2007, Jan Nolta
returned to Northern California from St. Louis to lead what was at the
time UC Davis’ brand-new stem cell program. As director of the UC Davis Stem Cell Program
and the Institute for Regenerative Cures, she has overseen the opening
of the institute, more than $140 million in research grants, and dozens
upon dozens of research studies. She recently sat down to answer some
questions about regenerative medicine and all the work taking place at UC Davis Health.
Q: Turning stem cells into cures has been your mission and mantra since you founded the program. Can you give us some examples of the most promising research?
I am so excited about our research. We have about 20 different disease-focused teams.
That includes physicians, nurses, health care staff, researchers and
faculty members, all working to go from the laboratory bench to
patient’s bedside with therapies.
Perhaps the most promising and
exciting research right now comes from combining blood-forming
stem cells with gene therapy. We’re working in about
eight areas right now, and the first cure, something that we definitely
can call a stem cell “cure,” is coming from this combined approach.
doctors will be able to prescribe this type of stem cell therapy.
Patients will use their own bone marrow or umbilical cord stem cells.
Teams such as ours, working in good manufacturing practice
facilities, will make vectors, essentially “biological delivery
vehicles,” carrying a good copy of the broken gene. They will be
reinserted into a patient’s cells and then infused back into the
patient, much like a bone marrow transplant.
“Perhaps the most promising and exciting research right now comes from combining blood-forming stem cells with gene therapy.”
Along with treating the famous bubble baby disease,
where I had started my career, this approach looks very promising for
sickle cell anemia. We’re hoping to use it to treat several different
inherited metabolic diseases. These are conditions characterized by an
abnormal build-up of toxic materials in the body’s cells. They interfere
with organ and brain function. It’s caused by just a single enzyme.
Using the combined stem cell gene therapy, we can effectively put a good
copy of the gene for that enzyme back into a patient’s bone marrow stem
cells. Then we do a bone marrow transplantation and bring back a
person’s normal functioning cells.
The beauty of this therapy is
that it can work for the lifetime of a patient. All of the blood cells
circulating in a person’s system would be repaired. It’s the number one
stem cell cure happening right now. Plus, it’s a therapy that won’t be
rejected. These are a patient’s own stem cells. It is just one type of
stem cell, and the first that’s being commercialized to change cells
throughout the body.
Q: Let’s step back for a moment. In 2004, voters approved Proposition 71.
It has funded a majority of the stem cell research here at UC Davis and
throughout California. What’s been the impact of that ballot measure
and how is it benefiting patients?
We have learned so
much about different types of stem cells, and which stem cell will be
most appropriate to treat each type of disease. That’s huge. We had to
first do that before being able to start actual stem cell therapies. CIRM [California Institute for Regenerative Medicine] has funded Alpha Stem Cell Clinics.
We have one of them here at UC Davis and there are only five in the
entire state. These are clinics where the patients can go for
high-quality clinical stem cell trials approved by the FDA
[U.S. Food and Drug Administration]. They don’t need to go to
“unapproved clinics” and spend a lot of money. And they actually
“By the end of this year, we’ll have 50 clinical trials.”
By the end of this year, we’ll have 50 clinical trials [here at UC Davis Health]. There are that many in the works.
Our Alpha Clinic
is right next to the hospital. It’s where we’ll be delivering a lot of
the immunotherapies, gene therapies and other treatments. In fact, I
might even get to personally deliver stem cells to the operating room
for a patient. It will be for a clinical trial involving people who have
broken their hip. It’s exciting because it feels full circle, from
working in the laboratory to bringing stem cells right to the patient’s
We have ongoing clinical trials
for critical limb ischemia, leukemia and, as I mentioned, sickle cell
disease. Our disease teams are conducting stem cell clinical trials
targeting sarcoma, cellular carcinoma, and treatments for dysphasia [a
swallowing disorder], retinopathy [eye condition], Duchenne muscular
dystrophy and HIV. It’s all in the works here at UC Davis Health.
also great potential for therapies to help with renal disease and
kidney transplants. The latter is really exciting because it’s like a
mini bone marrow transplant. A kidney recipient would also get some
blood-forming stem cells from the kidney donor so that they can better
accept the organ and not reject it. It’s a type of stem cell therapy
that could help address the burden of being on a lifelong regime of
immunosuppressant drugs after transplantation.
Q: You and
your colleagues get calls from family members and patients all the
time. They frequently ask about stem cell “miracle” cures. What should
people know about unproven treatments and unregulated stem cell clinics?
That’s a great question.The number one rule is that if
you’re asked to pay money for a stem cell treatment, don’t do it. It’s a
big red flag.
When it comes to advertised therapies: “The number one rule is that if you’re asked to pay money for a stem cell treatment, don’t do it. It’s a big red flag.”
there are unscrupulous people out there in “unapproved clinics” who
prey on desperate people. What they are delivering are probably not even
stem cells. They might inject you with your own fat cells, which
contain very few stem cells. Or they might use treatments that are not
matched to the patient and will be immediately rejected. That’s
dangerous. The FDA is shutting these unregulated clinics down one at a
time. But it’s like “whack-a-mole”: shut one down and another one pops
On the other hand, the Alpha Clinic is part of our
mission is to help the public get to the right therapy, treatment or
clinical trial. The big difference between those who make patients pay
huge sums of money for unregulated and unproven treatments and UC Davis
is that we’re actually using stem cells. We produce them in rigorously
regulated cleanroom facilities. They are certified to contain at least 99% stem cells.
and family members can always call us here. We can refer them to a
genuine and approved clinical trial. If you don’t get stem cells at the
beginning [of the clinical trial] because you’re part of the placebo
group, you can get them later. So it’s not risky. The placebo is just
saline. I know people are very, very desperate. But there are no miracle
cures…yet. Clinical trials, approved by the FDA, are the only way we’re
going to develop effective treatments and cures.
Scientific breakthroughs take a lot of patience and time. How do you and
your colleagues measure progress and stay motivated?
Motivation? “It’s all for the patients.”
all for the patients. There are not good therapies yet for many
disorders. But we’re developing them. Every day brings a triumph.
Measuring progress means treating a patient in a clinical trial, or
developing something in the laboratory, or getting FDA approval. The big
one will be getting biological license approval from the FDA, which
means a doctor can prescribe a stem cell or gene therapy treatment. Then
it can be covered by a patient’s health insurance.
I’m a cancer
survivor myself, and I’m also a heart patient. Our amazing team here at
UC Davis has kept me alive and in great health. So I understand it from
both sides. I understand the desperation of “Where do I go?” and “What
do I do right now?” questions. I also understand the science side of
things. Progress can feel very, very slow. But everything we do here at
the Institute for Regenerative Cures is done with patients in mind, and
We know that each day is so important when you’re watching
a loved one suffer. We attend patient events and are part of things
like Facebook groups, where people really pour their hearts out. We say
to ourselves, “Okay, we must work harder and faster.” That’s our
motivation: It’s all the patients and families that we’re going to help
who keep us working hard.
It’s never easy to tell someone that they are too late, that they missed the deadline. It’s particularly hard when you know that the person you are telling that to has spent years working on a project and now needs money to take it to the next level. But in science, as in life, it’s always better to tell people what they need to know rather than what they would like to hear.
And so, we have posted
a notice on our website for researchers thinking about applying for funding
that, except in a very few cases, they are too late, that there is no money
available for new projects, whether it’s Discovery, Translational or Clinical.
Here’s that notice:
that the budget allocation of funds for new awards under the CIRM clinical
program (CLIN1, CLIN2 and CLIN3) may be depleted within the next two to three
months. CIRM will accept applications for the monthly deadline on June 28, 2019
but will suspend application submissions after that date until further notice.
All applicants should note that the review of submitted applications may be
halted at any point in the process if funds are depleted prior to completion of
the 3-month review cycle. CIRM will notify applicants of such an occurrence.
Therefore, submission and acceptance of an application to CIRM does not
guarantee the availability of funds or completion of a review cycle.
of applications for the CIRM/NHLBI Cure Sickle Cell Initiative (CLIN1 SCD,
CLIN2 SCD) are unaffected and application submissions for this program will
We do, of course, have enough money set aside to continue
funding all the projects our Board has already approved, but we don’t have
money for new projects (except for some sickle cell disease projects).
In truth our funding has lasted a lot longer than anyone
anticipated. When Proposition 71 was approved the plan was to give CIRM $300
million a year for ten years. That was back in 2004. So what happened?
Well, in the early years stem cell science was still very
much in its infancy with most of the work being done at a basic or Discovery
level. Those typically don’t require very large sums so we were able to fund
many projects without hitting our $300m target. As the field progressed,
however, more and more projects were at the clinical trial stage and those need
multiple millions of dollars to be completed. So, the money went out faster.
To date we have funded 55 clinical trials and our
early support has helped more than a dozen other projects get into clinical
trials. This includes everything from cancer and stroke, to vision loss and
diabetes. It’s a good start, but we feel there is so much more to do.
Followers of news about CIRM know there is talk about a possible ballot initiative next year that would provide another $5.5 billion in funding for us to help complete the mission we have started.
Over the years we have built a pipeline of promising
projects and without continued support many of those projects face a difficult
future. Funding at the federal level is under threat and without CIRM there
will be a limited number of funding alternatives for them to turn to.
Telling researchers we don’t have any money to support their
work is hard. Telling patients we don’t have any money to support work that
could lead to new treatments for them, that’s hardest of all.
CIRM Board approves first program eligible for co-funding under the agreement
disease (SCD) is a painful, life-threatening blood disorder that affects around
100,000 people, mostly African Americans, in the US. Even with optimal medical care, SCD shortens expected
lifespan by decades. It is caused by a
single genetic mutation that results in the production of “sickle” shaped red
blood cells. Under a variety of
environmental conditions, stress or viral illness, these abnormal red
blood cells cause severe anemia and blockage of blood vessels leading to
painful crisis episodes, recurrent hospitalization, multi-organ damage and
On April 29th the governing Board of the
California Institute for Regenerative Medicine (CIRM) approved $4.49 million to
Dr. Mark Walters at UCSF Benioff Children’s Hospital in Oakland to pursue a
gene therapy cure for this
devastating disease. The gene therapy approach uses CRISPR-Cas9
technology to correct the genetic mutation that leads to sickle cell disease. This program will be eligible for
co-funding under the landmark agreement between CIRM and the National Heart,
Lung and Blood Institute (NHLBI) of the NIH.
This CIRM-NHLBI agreement
was finalized this month to co-fund cell and gene therapy programs under the
NIH “Cure Sickle Cell” initiative. The
goal is to markedly accelerate the development of cell and gene therapies for
SCD. It will deploy CIRM’s resources and expertise that has led to a portfolio of over 50 clinical
trials in stem cell and
“CIRM currently has 23 clinical stage programs in cell and
gene therapy. Given the advancements in
these approaches for a variety of unmet medical needs, we are excited about the
prospect of leveraging this to NIH-NHLBI’s Cure Sickle Cell Initiative,” says
Maria T. Millan, M.D., the President and CEO of CIRM. “We are pleased the NHLBI
sees value in CIRM’s acceleration and funding program and look forward to the
partnership to accelerate cures for sickle cell disease.”
“There is a real
need for a new approach to treating SCD and making life easier for people with
SCD and their families,” says Adrienne Shapiro, the mother of a daughter with
SCD and the co-founder of Axis Advocacy, a sickle cell advocacy and
education organization. “Finding a cure for Sickle Cell would mean that people
like my daughter would no longer have to live their life in short spurts,
constantly having their hopes and dreams derailed by ER visits and hospital
stays. It would mean they get a chance
to live a long life, a healthy life, a normal life.”
CIRM is currently funding two other clinical trials for SCD using different approaches. One of these trials is being conducted at City of Hope and the other trial is being conducted at UCLA.
For years we have talked about the “promise” and the “potential” of stem cells to cure patients. But more and more we are seeing firsthand how stem cells can change a patient’s life, even saving it in some cases. That’s the theme of the 4th Annual CIRM Alpha Stem Cell Clinics Network Symposium.
It’s not your usual
symposium because this brings together all
the key players in the field – the scientists who do the research, the nurses
and doctors who deliver the therapies, and the patients who get or need those
therapies. And, of course, we’ll be there; because without CIRM’s funding to
support that research and therapies none of this happens.
We are going to look
at some of the exciting progress being made, and what is on the horizon. But
along the way we’ll also tackle many of the questions that people pose to us
every day. Questions such as:
How can you distinguish between a good
clinical trial offering legitimate treatments vs a stem cell clinic offering sham
What about the Right to Try, can’t I just
demand I get access to stem cell therapies?
How do I sign up for a clinical trial, and how
much will it cost me?
What is the experience of patients that have
participated in a stem cell clinical trial?
researchers will also talk about the real possibility of curing diseases like
sickle cell disease on a national scale, which affect around 100,000 Americans,
mostly African Americans and Hispanics. They’ll discuss the use of gene editing
to battle hereditary diseases like Huntington’s. And they’ll highlight how they
can engineer a patient’s own immune system cells to battle deadly cancers.
So, join us for what
promises to be a fascinating day. It’s the cutting edge of science. And it’s
There has been a lot of conversation surrounding CRISPR-Cas9 in these recent months as well as many sensational news stories. Some of these stories highlight the promise this technology holds, while others emphasize a word of caution. But what exactly does this technology do and how does it work? Here is a breakdown that will help you better understand.
To start off, CRISPR is a naturally occurring process found in bacteria used as an immune system to defend against viruses. CRISPR simply put, are strands of DNA segments that contain repeating patterns. There are “scissor like” CRISPR proteins that have the ability to cut DNA segments. When a copy of a virus enters the bacteria, these “scissor like” proteins cut a segment of DNA from the virus and insert it into CRISPR. A copy of the viral DNA is made and another “attack” protein known as Cas9 attaches to it. By binding to the viral copy, Cas9 is able to sense that virus. When the same virus tries to enter the bacteria, Cas9 is able to seek and destroy it.
You can view a more detailed video explaining this concept below.
Many scientists analyzed this process in detail and it was eventually discovered that this CRISPR-Cas9 complex could be used to removed unwanted genes and insert a corrected copy, revolutionizing the way that we view the approach towards treating a wide variety of genetic diseases.
In fact, researchers at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and the University of Massachusetts Medical School have developed a strategy using this complex to treat two inherited, lethal blood disorders, sickle cell disease (SCD) and beta thalassemia. Both of these diseases involve a mutation that effects production of red blood cells, which are produced by blood stem cells. In beta-thalassemia, the mutation prevent red blood cells from being able to carry enough oxygen, leading to anemia. In SCD, the mutations cause red blood cells to take on a “sickle” shape which can block blood vessels.
By using CRISPR-Cas9 to insert a corrected copy of the gene into a patient’s own blood stem cells, this team demonstrated that functional red blood cells can then be produced. These results pay the way for other blood disorders as well.
In a press release , Dr. Daniel Bauer, an attending physician with Dana-Farber and a senior author on both of these studies stated that,
“Combining gene editing with an autologous stem-cell transplant could be a therapy for sickle-cell disease, beta-thalassemia and other blood disorders.”
In a separate study, scientists at University of Massachusetts Medical School have developed a strategy that could be used to treat genetic disorders associated with unintentional repeats or copies of small DNA segments. These problematic small segments of DNA are called microduplications and cause as many as 143 different diseases, including limb-girdle muscular dystrophy, Hermansky-Pudlak syndrome, and Tay-Sachs.
Because these are issues caused by repeats or copies of small DNA segments, the CRISPR-Cas9 complex can be used to remove microduplications without having to insert any additional genetic material.
Dr. Scot A. Wolfe, a co-investigator of this study, stated that,
“It’s like hitting the reset button. We don’t have to add any corrective genetic material, instead the cell stitches the DNA back together minus the duplication. It’s a shortcut for gene correction with potential therapeutic appeal.”
Although there has been a lot progress made with this technology, there are still concerns that need to be addressed. An article in Science mentions how two studies have shown that CRISPR can still make unintended changes to DNA, which can be potentially dangerous. In the article, Dr. Jin-Soo Kim, a CRISPR researcher at Seoul National University is quoted as saying,
“It is now important to determine which component is responsible for the collateral mutations and how to reduce or avoid them.”
Overall, CRISPR-Cas9 has revolutionized the approach of precision medicine. A wide variety of diseases are caused by small, unexpected segments of DNA. By applying this approach found in bacteria to humans, we have uncovered a way to correct these segments at the microscopic level. However, there is still much that needs to be learned and perfected before it can be utilized in patients.
How often do you get to ask an expert a question about something that matters deeply to you and get an answer right away? Not very often I’m guessing. That’s why CIRM’s Facebook Live “Ask the Stem Cell Team About Patient Advocacy” gives you a chance to do just that this Thursday, March 14th from noon till 1pm PST.
We have three amazing individuals who will share their experiences, their expertise and advice as Patient Advocates, and answer your questions about how to be an effective advocate for your cause.
The three are:
Gigi McMillan became a Patient Advocate when her 5-year-old son was diagnosed with a brain tumor. That led her to helping develop support systems for families going through the same ordeal, to help researchers develop appropriate consent processes and to campaign for the rights of children and their families in research.
Adrienne Shapiro comes from a family with a long history of Sickle Cell Disease (SCD) and has fought to help people with SCD have access to compassionate care. She is the co-founder of Axis Advocacy, an organization dedicated to raising awareness about SCD and support for those with it. In addition she is now on the FDA’s Patient Engagement Collaborative, a new group helping the FDA ensure the voice of the patient is heard at the highest levels.
David Higgins is a CIRM Board member and a Patient Advocate for Parkinson’s Disease. David has a family history of the disease and in 2011 was diagnosed with Parkinson’s. As a scientist and advocate he has championed research into the disease and worked to raise greater awareness about the needs of people with Parkinson’s.