Sports Medicine

A Christmas miracle or untested therapy? Why even feel-good stem cell stories need to be checked for accuracy

/ Kevin McCormack / Leave a comment

We’ve written several pieces over the last couple of years about the trend for professional athletes to turn to untested and/or unproven stem cell therapies to help them bounce back from injuries. This week, however, came news of something a little more worrying. Ice hockey legend Gordie Howe was given stem cells to help him recover from a series of debilitating strokes. As is often the case with these stories it’s not just the nature of the treatment that raises questions, it’s also the way the media has covered it.

Gordie Howe - photo courtesy Sean Hagen from Maple Ridge, Canada

Gordie Howe – photo courtesy Sean Hagen from Maple Ridge, Canada

The facts are pretty straightforward. Howe’s strokes left him “essentially bedridden with little ability to eat or communicate on his own”, according to a statement issued by his family. Two companies – Stemedica and Novastem – then “volunteered” their services, delivering a stem cell therapy to Howe. According to the family “The response was truly miraculous.”

And that was often the extent of the digging that dozens of media outlets that reported the news did. They reported the facts of the stroke, and then just reprinted the statement from the family without questioning what kinds of cells, how they might work, etc etc. They didn’t bother to interview other stem cell scientists about this kind of approach to see if it was something that might benefit other stroke patients. They didn’t even take a closer look at the two companies involved to see what their track record on this kind of research is.

In short, it’s clearly a feel-good story about a sports legend and no one wanted to be the one to say, “hey, wait a minute here, how do we know this is real.”

No one, except Dr. Paul Knoepfler. Paul, as regular readers of this blog know, is a CIRM-funded stem cell researcher at the University of California, Davis and an avid blogger. In a post on his blog he took a much closer look at the story, posed some thoughtful questions and raised some doubts about it. He also reached out to Stemedica who, to their credit, responded promptly to his questions. You can read what they had to say here.

Paul, like the rest of us, would love to be able to say that this kind of approach worked for Gordie Howe and could work for millions of others left disabled by strokes. But Paul, unlike many news outlets that reported the story, isn’t willing to just accept it on face value.

There’s an old adage in journalism: “If your mother tells you she loves you, check to see if it’s true.” It basically means don’t accept anything on face value; dig a little deeper to see if it’s really true. Paul is doing that, and doing it very well. Other journalists might do well to follow his lead.

Stem cells and professional sports: a call for more science and less speculation

/ Kevin McCormack / 1 Comment

In the world of professional sports, teams invest tens of millions of dollars in players. Those players are under intense pressure to show a return on that investment for the team, and that means playing as hard as possible for as long as possible. So it’s no surprise that players facing serious injuries will often turn to any treatment that might get them back in the game.

image courtesy Scientific American

image courtesy Scientific American

A new study published last week in 2014 World Stem Cell Report (we blogged about it here) highlighted how far some players will go to keep playing, saying at least 12 NFL players have undergone unproven stem cell treatments in the last five years. A session at the recent World Stem Cell Summit in San Antonio, Texas showed that football is not unique, that this is a trend in all professional sports.

Dr. Shane Shapiro, an orthopedic surgeon at the Mayo Clinic, says it was an article in the New York Times in 2009 about two of the NFL players named in the World Stem Cell Report that led him to becoming interested in stem cells. The article focused on two members of the Pittsburgh Steelers team who were able to overcome injuries and play in the Super Bowl after undergoing stem cell treatment, although there was no direct evidence the stem cells caused the improvement.

“The next day, the day after the article appeared, I had multiple patients in my office with copies of the New York Times asking if I could perform the same procedure on them.”

Dr. Shapiro had experienced what has since become one of the driving factors behind many people seeking stem cell therapies, even ones that are unproven; the media reports high profile athletes getting a treatment that seems to work leading many non-athletes to want the same.

“This is not just about high profile athletes it’s also about older patients, weekend warriors and all those with degenerative joint disease, which affects around 50 million Americans. Currently for a lot of these degenerative conditions we don’t have many good non- surgical options, basically physical therapy, gentle pain relievers or steroid injections. That’s it. We have to get somewhere where we have options to slow down this trend, to slow down the progression of these injuries and problems.”

Shapiro says one of the most popular stem cell-based approaches in sports medicine today is the use of plasma rich platelets or PRP. The idea behind it makes sense, at least in theory. Blood contains platelets that contain growth factors that have been shown to help tissue heal. So injecting a patient’s platelets into the injury site might speed recovery and, because it’s the patient’s own platelets, the treatment probably won’t cause any immune response or prove to be harmful.

That’s the theory. The problem is few well-designed clinical trials have been done to see if that’s actually the case. Shapiro talked about one relatively small, non-randomized study that used PRP and in a 14-month follow-up found that 83% of patients reported feeling satisfied with their pain relief. However, 84% of this group did not have any visible improved appearance on ultrasound.

He is now in the process of carrying out a clinical trial, approved by the Food and Drug Administration (FDA), using bone marrow aspirate concentrate (BMAC) cells harvested from the patient’s own bone marrow. Because those cells secrete growth factors such as cytokines and chemokines they hope they may have anti-inflammatory and regenerative properties. The cells will be injected into 25 patients, all of whom have arthritic knees. They hope to have results next year.

Dr. Paul Saenz is a sports medicine specialist and the team physician for the San Antonio Spurs, the current National Basketball Association champions. He says that sports teams are frequently criticized for allowing players to undergo unproven stem cell treatments but he says it’s unrealistic to expect teams to do clinical studies to see if these therapies work, that’s not their area of expertise. But he also says team physicians are very careful in what they are willing to try.

“As fervent as we are to help bring an athlete back to form, we are equally fervent in our desire not to harm a $10 million athlete. Sports physicians are very conservative and for them stem cells are never the first thing they try, they are options when other approaches have failed.”

Saenz said while there are not enough double blind, randomized controlled clinical trials he has seen many individual cases, anecdotal evidence, where the use of stem cells has made a big difference. He talked about one basketball player, a 13-year NBA veteran, who was experiencing pain and mobility problems with his knee. He put the player on a biologic regimen and performed a PRP procedure on the knee.

“What we saw over the next few years was decreased pain, and a dramatic decrease in his reliance on non-steroidal anti inflammatory drugs. We saw improved MRI findings, improved athletic performance with more time on court, more baskets and more rebounds.”

But Saenz acknowledges that for the field to advance anecdotal stories like this are not enough, well-designed clinical trials are needed. He says right now there is too much guesswork in treatments, that there is not even any agreement on best practices or standardized treatment protocols.

Dr. Shapiro says for too long the use of stem cells in sports medicine has been the realm of individual physicians or medical groups. That has to change:

“If we are ever to move forward on this it has to be opened up to the scientific community, we have to do the work, do the studies, complete the analysis, open it up to our peers, report it in a reputable journal. If we want to treat the 50 million Americans who need this kind of therapy we need to go through the FDA approval process. We can’t just continue to treat the one patient a month who can afford to pay for all this themselves. “

Putting the promise to the test: a new move to see if stem cell therapies can help injured athletes

/ Kevin McCormack / Leave a comment

One of the toughest questions we get asked, and we get asked this a lot, is a variation on the theme of “I have xxxx disease and want to know where I can get a stem cell therapy for it?” All too often, in fact pretty much all the time, we have to explain that there aren’t any therapies available, at least not yet, and that it might be a couple of years before any of the really promising projects we are funding are enrolling patients in a clinical trial.

Injured knee

But still the questions come in, fueled in part by all the clinics and centers out there claiming they can treat everything from rheumatoid arthritis to type 2 diabetes and Crohn’s disease. The biggest problem of course is that very few, if any, of these centers and physicians back up their claims with any evidence or studies to show that their treatments work. They have patient testimonials plastered all over their websites. They have lots of very reassuring sounding information, but no evidence or proof that anything they are doing will work.

Fortunately there are a growing number of researchers and reporters holding these clinics up to the light to see if what they are claiming could be true. In most cases the answer is a resounding “heck no.”

Just a week ago we told you about a couple of recent reports that looked at all the claims about using stem cells to treat sports injuries and whether there is anything to support claims by some cosmetic practitioners that they can use stem cell-based therapies to reverse the aging process (spoiler alert – there isn’t, otherwise I’d be first in line to try them out).

Cover of article about stem cells in Muscle and Medicine

Cover of article about stem cells in Muscle and Medicine

But now some mainstream media reporters are taking a closer look at claims these therapies are effective, particularly those associated with top-flight athletes. A recent issue of Muscle and Medicine – an online website that is part of the Sports Illustrated stable of publications – carried a really in-depth and thoughtful look at the use of stem cells to treat superstar athletes.

Writer Jenny Vrentas sets the tone in the opening paragraph saying:

“It may be the next big breakthrough in the treatment of sports ailments, but for now the use of such therapy is strictly limited in the U.S. – and questions about effectiveness outweigh the answers.”

Vrentas carries that questioning attitude throughout, highlighting some of the athletes who talk openly about procedures (we can’t really call them “treatments” because we don’t know if they actually treat anything) but also profiling orthopedic surgeon, James Andrews, who is a proponent of stem cells and is trying to do the kind of study necessary to see if these therapies work or not:

Andrews speaks carefully about the potential of stem-cell treatments. He’s hyper-aware of the danger of sensationalizing among his clientele of elite athletes, particularly since many questions remain—not the least of which is how well the treatments actually work. But the early returns have motivated him, as has seeing his top patients go abroad for therapy: “They don’t really know what they are getting,” he says. “Are they getting illegal stuff? We don’t have any control over it, so it’s something we needed to bring back and do in a controlled environment here.”

It’s an excellent example of the kind of reporting that can really help people, weekend warriors or anyone else, who are wondering whether stem cells might help them. It highlights the promise, but also underlines the fact that we need proof to back up that promise before it’s ready for prime time.

kevin mccormack 

Stem cell stories that caught our eye: better cell reprogramming, heart failure and false claims for stem cells

/ Don Gibbons / Leave a comment

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.

Improving the efficiency of creating stem cell lines. Ever since researchers first learned to reprogram adult cells to behave like embryonic stem cells in 2007 teams have tried to do it better. The earliest reprogramming resulted in less than one percent of cells converting to the stem cell state. Many years and many reprogramming recipes later some teams have got that up to a few percent, but usually still in the single digits. CIRM-funded researchers at the University of California, San Francisco, have uncovered a path that could yield dramatic increases in efficiency in creating these stem cells. They stepped back to look at what genetic factors were acting as brakes on the reprogramming and have now mapped out multiple brake points that could be inhibited to improve the production of stem cells. HealthCanal ran the university’s press release based on the journal publication in Cell.

Does source of adult cells matter for iPS-type stem cells. When researchers turn adult tissue into embryonic-like iPS cells, they know that the reprogrammed stem cells retain some memory of the type of adult tissue they were, whether it was skin, brain or heart. So, a CIRM-funded team at Stanford set out to do a series of experiments to see if that mattered. They created iPS cells from heart tissue and from skin cells. And initially, there was a difference. The stem cells made from heart more readily matured into heart muscle than those from skin, but over time, as the cells grew in the lab the difference abated. Both types of cells began to function like normal heart muscle. Stanford’s Scope blog wrote about this and a companion paper that were published this week in the Journal of the American College of Cardiology.

Heart progenitor cells, the middlemen between stem cells and adult heart muscle, shown here in green and infected with coxsackie vurus.

Heart progenitor cells, the middlemen between stem cells and adult heart muscle, shown here in green and infected with coxsackie vurus.


Viral heart failure link may be via stem cells. Our hearts are one of our poorest performing organs when it comes to repairing themselves. The liver does it well. The lining of our guts does it well—the heart not so much. Scientists generally attribute this to the very small number of stem cells we retain in our hearts. If you lose those few, you are in deep trouble. While there are many reasons for heart failure, we have known that a high percent of those who develop this weakening of the heart’s ability to pump blood have signs of having been infected with the coxsackie virus. Researchers at San Diego State University have found out a possible reason why. The virus appears to selectively seek out and destroy the heart stem cells and middlemen progenitor cells. HealthCanal ran the university’s press release based on work published this week in PLOS Pathogens.

Review talks about reality of stem cells in sports. Over the past year, there has been a parade of headlines about athletes getting their sports injuries treated with stem cells. The EuroStemCell collaborative has published online a great review of the reasons why stem cells might work for some of those conditions, and might not. The piece dutifully starts by noting that none of these treatments have been approved for general use because none have had sufficient testing. Taking muscle, cartilage, tendon and bone repair individually the authors discuss what research has been done and what it shows. In general, the results have not been great, in large part because we haven’t yet figured out what is the best type of cell for each injury and the best way to deliver it.

False claims in stem cell for plastic surgery. CIRM-grantee Michael Longaker at Stanford has called out his fellow plastic surgeons to lead the charge in evaluating the uses of stem cells in cosmetic procedures. In an article in the journal Plastic and Reconstructive Surgery he describes research he did into 50 clinics that showed up in a google search offering stem cell face lifts. While they were claiming to inject age-reversing stem cells, he suggests they were doing no more than the established practice of injecting fat to smooth out wrinkles. While fat does have a few stem cells in it, he could find no evidence that the clinics had the necessary equipment to isolate those cells, and even if they did, there is scant research into whether those stem cells could have any impact. Popular Science and ScienceNewsline both ran stories about the journal article this week.

Don Gibbons