CIRM Sponsored Clinical Trial Program Notable for Near Lack of hESCs

The California Institute of Regenerative Medicine (CIRM) is nearing the end of its ten year term.  Debate in California is ongoing as to whether CIRM will actually close, or whether it will continue in a different form with different funding sources.

The Alpha Stem Cell Clinics Network program may very likely be one of the last major initiatives CIRM takes before its current term is over sometime this year.  As such, it is emblematic of the funding course CIRM has travelled over the years.

The Network’s goal, according to CIRM, “is to accelerate the development and delivery of stem cell treatments to patients.”  To do this, CIRM authorized the creation of up to 5 alpha clinics.  These clinics are to be set up at academic institutions across California in order to serve as a “hub for stem cell clinical trials.” So far, three such clinics have been established, housed at City of Hope, University of California/San Diego, and UCLA/UC Irvine.

Earlier this year, at City of Hope, the Network held its second annual symposium, where patients and doctors met to discuss ongoing research and review progress in clinical trials underway.

At the time the symposium was held, there were 36 CIRM-funded Alpha Stem Cell Network clinical trials underway, spread across the three already established alpha clinics.

This blog has called attention to the way that CIRM – founded to give priority funding to human embryonic stem cell research – has over the years been providing the lion’s share of its grants to adult and other non-embryonic stem cell research.

A look at the Alpha Stem Cell Network clinical trials shows the same pattern of funding that has come to characterize so many of CIRM’s grants: away from research using human embryonic stem cells (hESCs) in favor of research using adult and other non-embryonic stem cell alternatives.

Only two of the trials listed on CIRM’s website utilize hESCs. However, they are really the same trial, with two different phases, so out of the 36 ongoing alpha network trials, only one is using hESCs.  Moreover, although utilizing such cells, they are not even the main focus of the trial.[1]

The trial is being conducted by a company called ViaCyte.  ViaCyte is testing a device it is developing that is intended to be placed under a patient’s skin, in order to deliver pancreatic progenitor cells derived from hESCs.  So the focus of the study is the performance of the device, not the efficacy of the stem cells it delivers for treating diabetes.

But should the device prove to be successful, it could deliver non-embryonic derived stem cells useful for treating diabetes as well.

For example, Harvard researcher Doug Melton has produced identical sets of mature, insulin producing beta cells from both hESCs and non-embryonic, induced pluripotent stem cells.  So if a device such as Viacyte’s should prove successful in delivering cells, it could just as well deliver ethically non-contentious, non-embryonic derived cells capable of treating diabetes.[2]

In fact, Melton is himself working on his own version of such a device.  Moreover, Melton has expressed concern that because the cells being used by ViaCyte to test its device are embryonic-derived progenitor cells, not yet fully differentiated to produce insulin, the cells may take months to mature into true insulin producing cells.  He has also expressed concern that not all the progenitor cells will necessarily develop into insulin producing ones, but rather could develop into other types of pancreatic cells.  Thus, while the device itself may prove efficacious, the embryonic stem cell derived progenitor cells it is intended to deliver may be far less so. 

So as CIRM nears the completion of its original term, the grants it has made to the Alpha Clinic Stem Cell Network are again confirming that adult and other non-embryonic stem cells would appear to be showing the most promise for helping patients.

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[1] Eight of the trials used adult stem cells and three iPSCs.  Three used cells derived from fetal tissue, which are considered adult stem cells, but which raise their own ethical issues. The remaining trials are a mix consisting of the use of the patient’s own cells and gene therapy.

[2] In 1999, then-President Clinton’s National Bioethics Advisory Commission became the first such body to investigate the ethical issues surrounding human embryonic stem cell research.  NBAC made pursuit of the research conditional: harvesting “left-over” IVF embryos for stem cells “is justifiable only if no less morally problematic alternatives are available for advancing the research (at pg. 53).”  In this instance, it would seem there are indeed ethical alternatives to ViaCyte’s embryonic stem cell-derived progenitors. 

Supporting hESCR for Parkinson's: At the Fox Foundation, Not So Much

The German drug discovery and development company Evotec recently issued a press release announcing a grant to develop drugs to treat Parkinson’s.

Nothing unusual about that – medical research and development companies routinely issue press releases upon receiving a major grant. 

But what made this press release stand out was that the grant was awarded by the Michael J. Fox Foundation (MJFF), for research using non-embryonic stem cells.

Evotec’s Chief Scientific Officer Dr. Cord Dohrmann says the grant is part of a larger “initiative to address neurodegenerative diseases through highly innovative approaches involving patient-derived stem cells and genetically validated mechanisms.”

“Patient-derived stem cells” – in other words, non-embryonic stem cells.  That MJFF is funding such research is noteworthy, because Michael J. Fox himself has been a leading public proponent of human embryonic stem cell research (hESCR) since 1998.  While many Hollywood celebrities advocated for such research, Fox was perhaps second only to the late Christopher Reeve in promoting hESCR.  He testified before Congress on several occasions that hESCR would be the key to finding a cure for Parkinson’s.

Yet non-embryonic stem cell alternatives now account for the majority of research grants awarded by MJFF for stem cell research. 

According to its website, since it launched in 2000, the MJFF has awarded a total of 1,345 research grants.  However, of that total, a mere 66 grants were for stem cell research[1]

Of those 66, 48 directly involved the use of stems cells, either human embryonic stem cells (hESCs) or adult and other non-embryonic stem cells, such as induced pluripotent stem cells (iPSCs).[2]

Thirty of the 48 grants, or 62.5%, were for adult, induced pluripotent, or other non-embryonic stem cell research.  Eighteen grants or 37.5% were for embryonic stem cell research. 

Notwithstanding his past congressional testimony enthusiastically endorsing hESC research, Michael J. Fox admitted that “other avenues of research have grown and multiplied and have become as much or more promising…an answer may come from [human embryonic] stem cell research but it’s more likely to come from another area.”

As the majority of grants awarded by the Michel J. Fox Foundation shows, those “other avenues” of research may not even involve stem cells, whether adult or non-embryonic. 

But the grants that the MJFF has awarded to stem cell research show a clear preference for non-embryonic stem cell projects – an indication of their greater potential for addressing Parkinson’s than the once highly touted hESCs. 

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[1] The result using the search engine on the Funded Grants page to search the term “stem cell.”

[2] Fourteen of the grants did not actually use human stem cells, either embryonic or non-embryonic, or were for research using animal models, which virtually all agree is ethically non-contentious.   The remaining four grants utilized cells derived from fetal tissue which makes them adult, not embryonic stem cells. But because such tissue is harvested from aborted fetuses, research utilizing it carries the same ethical baggage as hESC research which, of course, requires the destruction of human embryos.

Predictably Unpredictable

Predictions about science can be, well, unpredictable.

A recent posting on the science/technology website Gizmodo nicely makes the point.

The author reviews a year-end issue of Scientific American from 10 years ago, December 2005, identifying the top 50 scientific trends of the year and where those trends might lead. The author was interested to see how accurate the magazine’s predictions turned out to be 10 years later.

On any number of the predictions, the actual outcomes either fell far short or have not been fulfilled at all.  Science can be predictably unpredictable.

But for purposes of this blog, one prediction stands out. Topping the list of 50 leading scientific trends for 2005 was: “Patient-specific stem cells that pave the way for stem cell therapy.”

Such a prediction was typical at that time, fueled by the dramatic announcement in March 2004 that South Korean researcher Woo Suk Hwang had succeeded in using somatic cell nuclear transfer (SCNT) to create cloned human embryos. The goal was to use these embryos to harvest stem cells genetically matched to the original donor of the somatic cell used in the SCNT cloning process. Hwang published a second paper in 2005, confirming his initial success while claiming improved efficiency in the cloning process.

Hwang’s claim to be the first to create human embryos by cloning garnered international attention and vaulted him into the top tier of scientific researchers.

This was because cloning was seen as the essential step to realizing the promise of embryonic stem cells. Since 1998, when University of Wisconsin researcher James Thomson first isolated human embryonic stem cells (hESCs) from so-called “leftover” IVF embryos, they were hyped as the potential cure for all manner of diseases and conditions. The drawback was that these stem cells would be subject to tissue rejection if injected into a patient. Cloning appeared to offer a solution to this problem, since the patient’s body would not reject its own cells. So cloning, in turn, was hyped as the key to the future of regenerative medicine.

For example, at a February 2002 hearing before the Senate Judiciary Committee, participants, both Senators and witnesses from the scientific community hailed human cloning as key to the future advance of medicine. As Sen. Dianne Feinstein said in her opening remarks: “Many doctors and scientists have argued that we must protect our ability to use cloning techniques to try to save and improve the lives of those ravaged by disease and other ailments. In fact, nuclear transplantation offers enormous potential for pro-viding cures to diseases such as cancer, diabetes, cystic fibrosis, and heart disease, as well as conditions such as spinal cord injuries, liver damage, arthritis, and burns… and many other potential cures and treatments for a variety of diseases and ailments.”

Other participants spoke of SCNT’s “very real promise” and “considerable potential for developing new medical therapies for life-threatening diseases,” and of how “essential” human cloning research was to the future of medicine. 

In The Scientific Conquest of Death (Libros en Red, 2004), leading cloning proponent Dr. Michael West, claimed that cloning offered healing powers of literally biblical proportions.  In his essay “Therapeutic Cloning,” West wrote: “We have been given two talents of gold. The first, the root of immortal human life, is the human embryonic stem cell. The second is nuclear transfer technology. Shall we, like the good steward of the Bible, take these gifts to mankind and courageously use them to the best of our abilities to alleviate the suffering of our fellow human beings, or will we fail most miserably and bury these gifts in the earth?”

On August 1, 2001, West had testified to a Senate subcommittee to similar effect: “On the scientific front, I think it's useful to point out that mankind occasionally is given gifts, things that can greatly advance the human condition. I think we've been given two in just recent history. The first, as we've talked about at some length already this morning, is the human embryonic stem cell. … A second gift we've been given is this miracle we call cloning, or nuclear transfer.”

Yet contrary to predictions by Scientific American as well as Pelosi, West and others, Hwang’s research and SCNT did not pave the way to stem cell therapies. 

Why? As the Gizmodo blog points, the prediction was based on a “breakthrough that turned out to be one of the biggest cases of scientific fraud ever.”

Towards the end of 2005, the credibility of Hwang’s research findings came under intense scrutiny. His claim to be the first to successfully clone human embryos and derive stem cells from them was revealed to be completely fraudulent.  By January 2006, Science had retracted both of Hwang’s papers. It seemed the hype in favor of cloning was so great that it encouraged him to exaggerate and even fabricate results. Yet the Scientific American prediction that “patient specific stem cells” would pave the way for stem cell therapies was not entirely wrong. In fact, that prediction is coming true -- but not the way proponents of cloning predicted.

The prediction is becoming reality because of ethically non-controversial research that does not rely on human cloning or the destruction of human embryos.

In 2007, Japanese scientist Shinya Yamanaka developed a method to take an ordinary somatic cell – the same type of cell used for human cloning -- and coax (i.e., induce) that cell to a fully pluripotent state, so that it has many of the properties of an embryonic strem cell. He was able to do this without destroying embryos or obtaining eggs for use in cloning. Such cells are an exact genetic match to the person the body cell was obtained from.   

Since Yamanaka’s original breakthrough discovery, scientists have refined and improved the technique for producing these “induced pluripotent stem cells” (iPSCs). Dr. Yamanaka himself has won the Nobel Prize for this scientific and medical advance. And iPSCs are helping to realize the “vast potential” of stem cells for therapeutic benefits – a potential once wrongly claimed for human cloning.

 

More Embryonic Stem Cell Hype, Less Reality and Ethics

Dr. Prentice is Senior Fellow for Life Sciences at the Family Research Council (FRC) and a founding member of Do No Harm: The Coalition of Americans for Research Ethics.  This blog was originally posted by Dr. Prentice at the FRC website and is reposted here with his permission

More Embryonic Stem Cell Hype, Less Reality and Ethics

Excitement over a newly-released paper on stem cells making insulin is a tribute to the Harvard stem cell Press Office.

The actual report is quite a bit less earth-shaking than you might be led to believe by the Harvard press office.  The science itself, in a paper from the lab of Dr. Doug Melton published in the journal Cell, provides an incremental improvement in the derivation of functional (insulin-secreting) beta cells.  Melton’s lab developed an improved method to generate millions of insulin-secreting cells from human embryonic stem cells (hESC, which require the destruction of a young human being) and from human induced pluripotent stem cells (hiPSC, the stem cells created from normal skin cells, without using embryos.)  The multistep protocol, which took 4-5 weeks and treatment with eleven different factors, produced insulin-secreting cells which the paper termed “SC-β” cells, that secreted about half the amount of insulin as normal adult beta cells from the pancreas.  Previous attempts resulted in insulin-secreting cells that were immature and more like fetal than adult cells.  In this new report, the authors note that global gene expression analysis showed “SC-β cells made ex vivo are most similar, but not completely identical, to cadaveric beta cells.”  The SC-β cells secreted insulin in response to different glucose levels in the lab dish and when injected into immunocompromised mice.  When the new SC-β cells were tested in a diabetic mouse model, 5 out of 6 mice survived up to 4 months, compared to 1 out of 6 control mice.

Embryonic Stem Cells Unnecessary

The paper itself makes the case that embryonic stem cells are not needed for even this incremental advance or any subsequent work.  The authors tested batches of SC-β cells made from hESC as well as from hiPSC.  The results were equivalent no matter the starting cell type.  So for any future production of SC-β cells, the authors have shown that no embryonic stem cells are necessary.

Unanswered Questions—Transplant Rejection and Safety

The paper and its results do not address some significant questions related to these new SC-β cells—immune rejection and safety (tumor formation).  The cells were tested in immunocompromised mice, so they were free from immune attack.  This will be an issue in any potential treatment if the SC-β cells are derived from hESC.  Use of hiPSC made from a diabetic patient might provide a way around immune attack on the SC-β.

Safety, especially from aberrant cell growth including tumor formation, is always an issue with pluripotent stem cells, especially hESC.  In the mouse experiment, the authors note that large masses of tumors were not seen, but also point out: “A much larger number of transplants and more extensive histological examination will be needed to assess the possibility of undesired cell growth in the grafts.” 

While the Harvard press release discusses testing of an implantation device to protect SC-β cells implanted into mice, this simply makes the point that the issues of immune rejection, as well as keeping the implanted cells from running free in the patient, have not been tackled.  In the end, this combination device is simply a potential cell-based insulin pump, not a cure for diabetes.

Embryonic Stem Cells Questionable

In the past, the obsession with ESC has led to some questionable claims about their abilities to treat diabetes.  Their ability to make authentic insulin, in quantities that would be useful, were first trumpeted and then shown to be incorrect and even artifactual (see, e.g., here and here).  In fact, teratoma formation was often the result or even the inducer of insulin secretion from ESC.

In fact, the high-efficiency production of insulin-secreting cells from hESC and hiPSC has been done before today’s announcement—similar results were published in September 2014 by Rezania et al.  That report also failed to address the questions that the current paper did not address, such as transplant rejection.

Other Ways to Make Insulin-Secreting Cells—No Embryonic Stem Cells Needed

The obsession with ESC continues to make headlines, but not help patients.  Even Melton’s lab has shown various other ways to make insulin-secreting cells, including: stimulating growth of pancreatic beta cells (which improves glucose tolerance) by expression of betatrophin growth factor; direct reprogramming to turn other pancreatic cells into new insulin-secreting cells within the body; and regeneration of insulin-secreting beta cells by the normal pancreas, achieved by stopping the autoimmune attack typical of Type 1 diabetes.

This latter result is important, because it addresses the underlying cause of Type 1 diabetes:  the autoimmune attack on the insulin-secreting cells.  Stopping the autoimmune destruction of beta cells allows the body to regenerate normal, insulin-secreting cells from the body’s own adult stem cells and progenitors.

Other scientists have shown the real promise of this approach. 

Faustman et al. used a simple treatment with BCG to achieve a transient improvement in patients, providing proof of principle for the concept.

Zhao et al. used cord blood-derived adult stem cells to “re-educate” the immune cells of diabetic patients, providing lasting improvement in metabolic control.

The best results thus far for Type 1 diabetic patients has resulted from the collaboration of Voltarelli and Burt, using immunosuppression to remove rogue immune cells followed by transplantation of the patient’s own adult stem cells.  Their success was reported in 2007 and in 2009 in JAMA.  This was able to induce complete remission (insulin independence) in most patients with early onset type 1 diabetes mellitus.  As they noted after publication of their second paper in 2009: “It's the first therapy for patients that leaves them treatment-free — no insulin, no immune suppression for almost five years.”  Sadly, Dr. Voltarelli died in 2012, but his team continues to work on effective patient treatments.

Adult stem cells remain the gold standard for real patient treatments.

Non-Embryonic Stem Cell “Alternatives” Again Taking the Lead

The New York Times has long been – and continues to be – a vocal advocate for human embryonic stem cell research (e.g., here).  From the time hESCs were first isolated in 1998, the Times has published numerous editorials endorsing the research and calling for federal funding of it.

So a recent Times story providing a look at where stem cell research stands today was – no doubt unintentionally – revealing.

In marked contrast to the delirious enthusiasm with which advocates promoted hESCR,  promising it would lead to cures for virtually all diseases and conditions (one prominent politician at the time said human embryonic stem cells could become a “veritable fountain of youth”), the tone of the article is far more cautious and restrained in assessing what advances have actually been made to date in the field of  stem cell research.

The article’s title sets the newly sober tone: “The Trials of Stem Cell Therapy;” “trial” here can mean “to test,” as in a clinical trial, but also “difficult” as in the difficulties researchers face in bringing stem cells to therapy.  The article calls the process “halting” and notes that “progress has been slow.” 

But while progress may be “slow” and “halting” the article does note some promising developments.

And they are all being accomplished with adult and other non-embryonic sources of stem cells.

The article opens anecdotally, with the story of a heart disease patient who lost one-third of his heart’s functioning ability.  The patient volunteered for a medical trial in which researchers injected adult stem cells, derived from the patient’s own bone-marrow, directly into his heart.  While the article notes that “It’s impossible to know for sure whether the bone marrow cells’ descendants became heart muscle cells or if repairs were spurred some other way,” doctors nonetheless were able to tell the patient that his heart “is one-third of the way back to normal.”  The patient himself is quoted saying, “My quality of life is like night and day to before the treatment.”

The article further notes there are “as many as 4,500 clinical trials involving stem cells” currently underway in the U.S. for a whole host of diseases and conditions, but it does not clarify that virtually all of these trials are using non-embryonic stem cells.  That’s because only three trials using embryonic stem cells have been approved here: two are testing hESCs in two types of macular degeneration; they are ongoing and valid results have not yet been reported.  The third approved trial was for spinal cord injury; however, it was halted in 2011, a little over a year after it began. The California-based Asterias Biotherapeutics Inc. recently announced that it would resume the trial.

Another sign of progress mentioned in the article is that the California Institute of Regenerative Medicine (CIRM) has awarded over $2 billion since 2006 to stem cell researchers, and that it is enrolling patients for 10 clinical trials.

Unmentioned again, is the fact that the clear majority of these trials all involve non-embryonic stem cells.

A look at CIRM’s website shows a list of eight clinical trials “directly funded by grants from CIRM.”  Of these eight, just one employed embryonic stem cells, and it was the one mentioned above for spinal cord injury that was eventually shut down.

As for CIRM’s $2 billion in research grants awarded, this blog has noted several times that, over the years, more and more of the money awarded by CIRM has gone to fund adult and other non-embryonic stem cell research projects (here, here, and here).

The article also references the work being done using non-embryonic, induced pluripotent stem cells (iPSCs) for disease modeling and drug testing.  Dr.  Kevin Eggan of Harvard, the article notes, has used the iPSC process to create patient-specific stem cells from two patients with ALS (i.e., Lou Gehrig’s disease) and then coaxed those cells into becoming neurons.  Dr. Eggan noticed a signaling defect between those neurons that appeared to cause the neural degeneration typical of ALS. After extensive testing on the iPSC-derived neurons, Dr. Eggan has singled out a drug currently used to treat epilepsy that may correct the defect in the ALS neurons, which he expects to test on patients by the end of this year.

Commenting on the use of iPSCs for such disease modeling and drug testing, Dr. Eggan said that “the whole process is something that’s never been remotely possible before.”

Other researchers agree.  Earlier this year, in July, scientists used this same method to study Down syndrome, allowing them to discover a possible cause of the condition and a possible drug to treat it. “The advent of induced pluripotent stem cell technology has created exciting new approaches to model neurodevelopmental and neurodegenerative diseases for the study of pathogenesis and for drug screening,” said David Pleasure, a coauthor of the study.

The more sober approach to reporting on the therapeutic progress of stem cell research, as reflected in this New York Times article is, no doubt, a welcome development.

But however “halting” such progress may be, it is important to note, as the examples cited by the Times article – however unwittingly – show, that virtually all of it is being made on the non-embryonic stem cell front.

Adult Taking Charge

The California Institute for Regenerative Medicine’s (CIRM) choice for its new head would have been unthinkable when the institute was first established almost 10 years ago.   Yet today, it seems fitting, given the direction stem cell research has taken over the same decade.

C. Randal Mills recently took over as CIRM’s new president.  Before taking his new post, Mills had been president and CEO of Osiris Therapeutics.  Osiris pursues therapies based on stem cell research, so in that regard, Mill’s appointment to head up CIRM would seem highly appropriate.

However, Osiris pursues non-embryonic, adult stem cell research, particularly with mesenchymal stem cells.  That why his appointment would have been so unthinkable at CIRM’s founding.

Apart from the federal government, CIRM is the nation’s largest funder of stem cell research.  As noted before in this blogspot, CIRM was established for the express purpose of giving priority funding for embryonic stem cell research and SCNT (i.e., cloning) over all other avenues of stem cell research.  And in its early years, CIRM did just that.  But over the years, more and more of CIRM’s grants have gone to support adult and other avenues of non-embryonic stem cell research such as induced pluripotent stem cell (iPSC) research.  So in this regard, Mill’s appointment to head CIRM today makes perfect sense.

Mills succeeds Alan Trounson as president of CIRM.  Trounson was an enthusiastic supporter of human embryonic stem cell research (hESCR), being one of the first Australian researchers to have isolated hESCs.  

In contrast, Mills has said he is “agnostic” when it comes to stem cell research, explaining that “for me, it is all about getting stem cell solutions to patients.”  In other words, Mills will not show any favoritism towards funding hESCR projects over non-embryonic stem cell research projects simply because they use embryonic stem cells; instead, funding will go to projects that have the greatest chance of “bringing treatments to patients, fast.”

In the context of CIRM’s founding mission to prioritize funding for hESCR, Mills’ apparent refusal to do so is remarkable.

It is, however an accurate reflection of how CIRM’s funding has been shifting over the years towards funding non-embryonic stem cell research projects.  In fact, it is an accurate reflection of how the whole field of regenerative medicine has shifted over the years.  Human embryonic stem cell research has completely failed to live up to the hype it generated after embryonic stem cells were first isolated in 1998. 

And no longer can proponents of hESCR fairly claim that it is the front-runner in the race to develop therapies for patients.  

Obsolete from the Start

The Washington Post gave a ringing endorsement to the recent news that scientists had  succeeded once again in creating cloned human embryos and then destroying them for their stem cells (about one year ago, another team of researchers became the world’s first to successfully create cloned embryos for their stem cells, but the original somatic cells used to create those cloned embryos came from newborns and aborted fetus; this time, the somatic cells came from a 35-year old and a 75-year old).

While noting that “some ethical worries are reasonable,” the Post nonetheless concludes such worries are “not enough reason to hold back this research.”

But in endorsing human cloning to obtain stem cells, the Post conveniently – and disingenuously – ignored certain facts about the cloning process of somatic cell nuclear transfer (SCNT).  This process does not create stem cells as the Post editorial misleadingly suggests; it creates a human embryo that is then destroyed to obtain its stem cells (the Post is hardly alone in this – numerous media outlets routinely use this journalistic sleight of hand when reporting on this subject to mislead readers into believing that SCNT directly produces stem cells).

Interestingly, the Post was not always so evasive. In an editorial from 10/2/94, the Post acknowledged cloning creates a human embryo and then opposed doing this for any reason, including research and despite any theoretical therapeutic benefits. “Do we want official support of human-cloning research in this country? Do we want it anywhere?” the Post’s editors asked, and they then answered “Potential medical benefits make this a close call, but on balance the answer must be no.

The Post even used a “slippery slope” argument to oppose cloning to create human embryos for research:

“Though therapeutic cloning for parts is not the same as nurturing a human clone to birth, research that perfected the techniques needed for the first purpose would bring the second closer. It is frequently said that, whatever governments do, a human being sooner or later will be cloned. That does not relieve governments of their obligation to do what they can to block that creepy outcome.”

Moreover, on 4/10/00, the Post's editors reaffirmed this stance, and specifically opposed cloning to create human embryos for stem cell research, saying it was “flat wrong,” “unconscionable,” “alarming,” “a step too far” and that “the government has no business funding it.”  The editorial also, like the earlier one, acknowledged cloning’s “slippery-slope potential.”

In addition to the ethical problems with human cloning that the Post once so clearly acknowledged, there are practical problems with it as well. 

Cloning remains notably inefficient, requiring a large number of eggs to produce very few stem cell lines, and the process of obtaining the eggs is not without risks, some serious, to women.

The South Korean team that in April became the second to successfully clone human embryos used 77 eggs to produce 2 stem cell lines from the cloned embryos they created and destroyed.  That’s a 3 percent success rate. 

Following this development, a New York team showed a slight increase in efficiency, using 71 eggs to produce 4 stem cell lines from the embryos they created and destroyed.  That’s a 5.6% success rate.

According to the National Academy of Sciences (NAS), the potential U.S. patient populations for stem cell-based therapies are as follows:

Condition                                Number of patients

Cardiovascular disease            58 million

Autoimmune diseases             30 million

Diabetes                                  16 million

Osteoporosis                           10 million

Cancers                                   8.2 million

Alzheimer’s disease                5.5 million

Parkinson’s disease                 5.5 million

Burns (severe)                         0.3 million

Spinal-cord injuries                 0.25 million

Birth defects                           0.15 million/year

These numbers give a total patient population of 133.9 million. But as the NAS notes, these conditions “occur in many forms and thus not every person with these diseases could potentially benefit from stem cell therapies.”  Conservatively, let us say that perhaps 10% of the total will be eligible for such therapies, or 13.4 million.

At a success rate of 3%, treating this patient population with stem cells derived from cloned embryos would require an astounding 446.6 million eggs.  This in turn would require 29.7 million women to donate the average of 15 eggs per donor.

At the more efficient rate of 5.6 percent, 239.3 million eggs would be required to treat the potential patients for stem cell therapies. 

But now let’s assume scientist refine their skill at cloning to achieve a 20 percent efficiency rate; some 67 million eggs would still be required.

Let’s go even further:  assume scientists achieve an astounding 90 percent efficiency rate; some 15 million eggs would still be required.

Now let’s say scientists became so skilled, they could produce genetically matched stem cells from donors without using any eggs at all!

Oh wait….they’ve already done that.

In 2007, Shinya Yamanaka became the first scientist to reprogram a donor’s somatic cell (such as a skin cell) to generate fully pluripotent, embryonic-like, genetically matched stem cells – no eggs or embryos involved.  “I’ve never used either,” Yamanaka said.  Yamanaka dubbed these stem cells “induced pluripotent stem cells” (iPSCs) because they are generated by inducing somatic cells into a pluripotent state.  So important was Yamanaka’s work to the field of regenerative medicine that within just 5 years of his discovery he was awarded a Nobel Prize.

  

Numerous scientists have hailed these cloning developments for the technical prowess involved in achieving them.  “I think part of the significance is technical and part of the significance is historical,” said John Gearhart, one of the first scientists to isolate, in 1998, human embryonic stem cells.

But they also noted that the therapeutic value for cloning is probably not much.  According to Gearhart,”the more we learn about reprogramming, the more I think IPS will be the one of choice."  Similarly, commenting on the work of the Oregon team that first succeeded in creating cloned human embryos in 2013, MIT professor Rudolf Jaenish, a vocal proponent of cloning for research, called that development “an outstanding issue of whether it would work in humans has been resolved,” but one, he added, that “has no clinical relevance.”

Non-embryonic stem cells are already achieving many of the therapeutic benefits the Post now posits as merely potential for stem cells derived from cloning. For example, scientists are producing whole organs from patients’ own adult stem cells, such as tracheas that have already saved people’s lives.

One wonders what has changed in the scientific and ethical calculus to make the Post now embrace what it once abhorred – especially since the argument for a need to go down this path is weaker than ever. 

Follow the Money...

As this blog has previously reported (here, here, and here), the California Institute for Regenerative Medicine (CIRM) has over the years been steadily moving away from its founding mission of giving funding priority to human embryonic stem cell research (hESCR).  Instead, since 2009 it updated its strategic plan to give priority to funding projects most likely to result in clinical trials; accordingly CIRM  has been providing ever larger amounts of funding to adult stem cell and other ethically non-contentious research alternatives to hESCR.

CIRM’s most recent round of research grants, the Early Translational IV Research Awards, again confirms this trend.  According to CIRM, “the Early Translational Research Initiative aims to fund and advance potentially transformative stem cell therapies towards IND [Investigational New Drug]-enabling preclinical and clinical development.” 

In the fourth round of grants under this Initiative, announced in late August, only two of the thirteen grants awarded were for projects using hESCs, while 10 grants were for research using adult, induced pluripoternt stem cells (iPSCs) and other non-embryonic stem cell approaches.[1]  Of the total $40.6 million in grants awarded, projects using ethically non-contentious alternatives to hESR received $34.1 million; research using human embryonic stem cells received $6.4 million. 

A look at previous grants under the Early Translational Research Awards category clearly confirms CIRM’s developing preference for non-embryonic stem cell research as the best path leading to actual clinical trials.

The first round of such grants came in 2009.  Fifteen grants were awarded; nine for hESCR (three of which also included iPSCs) with the remaining six going to research using adult and/or induced pluripotent stem cells.

With the second round of Early Translational grants in 2010 a clear preference for funding non-hESCR emerges.  The number of funded projects using adult or induced pluripotent stem cells doubled from the previous year to 12, while only five projects were funded using hESCs.

In 2012, a third round of Early Translational grants was awarded.  Fifteen, or just over 70% of the 21 total grants awarded went to adult and induced pluripotent stem cell research; the remaining 6 grants went to hESCR projects. 

In the 2013 round of grants, the percentage of those going to non-hESCR increased to 77%.  The number of grants given to hESCR in 2013 fell to just 15% of the total, the lowest percentage since the first round of Translational grants in 2009, when hESCR received 60% of total grants awarded.

The old Watergate-era adage advises that one should “follow the money” to really get to the truth of the matter.   

In the case of CIRM’s research grants over the past several years, the truth is that when you follow the money, you find yet more evidence that the future of regenerative medicine is with iPSCs, adult stem cells and other ethically non-contentious alternatives to human embryonic stem cell research.

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[1] The remaining grant was for research on cancer stem cell lines.

Watch What I Do...

With its most recent round of grants – the first for 2013 – the California Institute for Regenerative Medicine (CIRM) continues its transformation from being one of the world’s leading funders of human embryonic stem cell research (hESCR) to one that increasingly supports non-embryonic research alternatives.

In March, CIRM awarded $32 million under three categories of awards.  No funding went to hESCR.  Instead, all of the funding was awarded to programs to promote research using induced pluripotent stem cells (iPSCs).

A grant of $16 million was given to a program to produce 9,000 iPSC lines for use in research on various diseases.  This is in vivid contrast to a previous round of grants, in 2008, also to generate stem cell lines for research.  Then, 16 projects were selected for funding: eight projects were for generating hESCs (5 of these projects also involved iPSCs) while the other eight were for projects involving iPSCs alone.   Now, with this current round of grants, it appears CIRM no longer sees any value in the creation of new hESC lines.

Something similar occurs with another of the March grants, a $10 million award to create a bank to store, grow and make available iPSC lines to researchers. That CIRM has not done the same to establish a bank to house hESC lines would seem, again, to indicate that CIRM finds little value in doing so.  Indeed, as noted in a previous blog, one of the nation’s leading embryonic stem cell banks, the University of Massachusetts Stem Cell Bank, closed its doors in 2012, just four years after its creation was approved.  According to news reports, it had become “obsolete.” 

The remaining grant money was dispersed among 7 projects to produce disease specific iPSC lines.  This is an area where iPSCs have clearly proved their utility in helping to develop therapies, while regular adult stem cells are far ahead in terms of direct clinical use in patients.  Producing iPSCs from cells donated from a patient (a patient with diabetes, Parkinson’s or heart disease, for example) allows scientists to observe the origin and growth of that particular disease and to test drugs to treat it.

There is the old saying “Watch What I Do, Not What I Say.”

Proponents of hESCR can still talk a good game on the supposed ongoing “need” for hESCR.

But when it comes to actually doing the research that has the goal of producing cures and therapies, more and more researchers and institutions, such as CIRM, are turning to induced pluripotent and adult stem cell research and other non-embryonic alternatives.

 After all, talk is cheap, but research costs money and its supporters want results.

Continuing to Ignore Their Own Advice -- Despite Continued Advances

A study in the current issue of  Stem Cells Translational Medicine reports the use of  neural stem cells derived from induced pluripotent stem cells (iPScs) to treat amyotrophic lateral sclerosis (ALS, also known as “Lou Gehrig’s Disease”) in rats.  The study shows that the iPSc-derived neural cells were able to engraft, survive and develop into mature neural cells in the spinal cords of the ALS rats.

Dr. Roland Pochet of the Universite Libre de Bruxelles in Belgium, who headed up the research teams, said the results “demonstrate proof-of-principle of survival and differentiation of human iPSc-derived neural progenitors in in vivo ALS environment, offering perspectives for the use of iPSc-based therapy in ALS."

Dr. Anthony Atala, editor of the journal in which the study appeared, called the results “encouraging,” adding that beyond ALS they “suggest the potential of cell therapy for the field of neurobiology and disease treatment."

The announcement of the study’s results also noted that neural cells had previously been derived from neural stem cells (NSCs) and embryonic stem cells (ESCs) as well.

But this development again demonstrates that along with adult stem cells, iPScs are proving to be viable, ethically non-contentious alternatives to the use of human embryonic stem cells; in this instance the adult and iPSc-derived neural cells did everything the hESCs did, but without having to destroy an embryo in the process.   Indeed this and other studies show the continued pursuit of hESCR is ethically unjustified even by standards first set by its proponents.

In 1999, Presidents Clinton’s National Bioethics commission (NBAC) first recommended federal funding for hESCR.  The supposed potential of the research deserved federal support, NBAC argued -- but on condition.  Given the inherent ethical problems, NBAC judged it was “justifiable only if no less morally problematic alternatives are available for advancing the research (at pg. 53).”  In others words, if viable, ethically non-contentious means existed for advancing such research and pursuing cures, then hESCR should not be pursued at all.

Induced pluripotent stem cells are already replacing the use of hESCs in several areas of research in the filed of regenerative medicine, such as in disease modeling and drug testing.   As noted in a previous blog, the California Institute of Regenerative Medicine, established to give priority funding to hESCR, has over the years been shifting more and more resources into adult stem cell and iPSC research.

Given these developments and others like it, one wonders: why do proponents of hESCR continue to ignore the very standards they set down in the 1999 NBAC report for pursuing it?