Stem Cell Therapy Crosses a Threshold
June 3, 2016 11:27 PM Subscribe
It's certainly exciting, in particular as there is a reasonably firm timetable for the prospect of getting some more significant data in blinded studies.
It feels, generally, like we may be on the verge of a significant shift in the state of biomedical science. It makes me feel both optimistic about our potential future and also very conscious of the exceptionally difficult political work that will be needed to minimise the expansion of health inequality between rich and poor.
posted by howfar at 1:47 AM on June 4, 2016 [19 favorites]
It feels, generally, like we may be on the verge of a significant shift in the state of biomedical science. It makes me feel both optimistic about our potential future and also very conscious of the exceptionally difficult political work that will be needed to minimise the expansion of health inequality between rich and poor.
posted by howfar at 1:47 AM on June 4, 2016 [19 favorites]
Whoa. That is fascinating.
*forwards the URL to a specific loved one*
posted by Too-Ticky at 4:02 AM on June 4, 2016
*forwards the URL to a specific loved one*
posted by Too-Ticky at 4:02 AM on June 4, 2016
The detail is interesting too, since they suspect the injected cells (from other people) do not turn into brain cells. They're guessing that the stem cells worked by reactivating/coordinating basic healing processes in the host—that could even go as far to mean that stem cells aren't strictly necessary. Future research needed.
posted by polymodus at 4:12 AM on June 4, 2016 [2 favorites]
posted by polymodus at 4:12 AM on June 4, 2016 [2 favorites]
I have some trepanation about this finding.
posted by srboisvert at 5:00 AM on June 4, 2016 [102 favorites]
posted by srboisvert at 5:00 AM on June 4, 2016 [102 favorites]
That would have worked if you hadn't stopped me.
posted by Strange Interlude at 5:48 AM on June 4, 2016 [15 favorites]
posted by Strange Interlude at 5:48 AM on June 4, 2016 [15 favorites]
This kind of discovery is like the equivalent of finding penicillin or something. Amazing to see it in our lifetime.
posted by gt2 at 5:51 AM on June 4, 2016 [5 favorites]
posted by gt2 at 5:51 AM on June 4, 2016 [5 favorites]
Ok, I know very little about this kind of stuff, so I have some questions that may be stupid -
1. It says that the stem cells came from the bone marrow of adult donors. So does that mean that in the future they could use a patient's own stem cells from their own bone marrow to do this? Anyone have any ideas why they didn't do it this time?
"A theory is that they turn the adult brain into the neonatal brain that recovers well," he explained.
2. So the follow up to my first question is, does this mean that at some point they may be able to harvest our own stem cells from our own bone marrow, inject them into our brains, and potentially cure all manner of brain injuries? What about repairing some of the damage of normal brain aging? Things like memory loss, cognitive skills, etc.?
3. If the answer to #2 is yes, then where do I sign up?
posted by MexicanYenta at 6:32 AM on June 4, 2016 [9 favorites]
1. It says that the stem cells came from the bone marrow of adult donors. So does that mean that in the future they could use a patient's own stem cells from their own bone marrow to do this? Anyone have any ideas why they didn't do it this time?
"A theory is that they turn the adult brain into the neonatal brain that recovers well," he explained.
2. So the follow up to my first question is, does this mean that at some point they may be able to harvest our own stem cells from our own bone marrow, inject them into our brains, and potentially cure all manner of brain injuries? What about repairing some of the damage of normal brain aging? Things like memory loss, cognitive skills, etc.?
3. If the answer to #2 is yes, then where do I sign up?
posted by MexicanYenta at 6:32 AM on June 4, 2016 [9 favorites]
I think it's so early in the process that nobody can answer 2 yet. They saw moderate improvements in 7 of 18 patients; they're now enrolling patients in a larger double blind study (156 patients) and then I think they'll have a better idea of the mechanism for this and other brain injuries and damage that it may work for.
My boyfriend's dad is almost two years post-stroke, and watching that plateau is incredibly upsetting, especially as they stop doing occupational and physical therapy because it "doesn't improve things." It certainly keeps things from getting worse. I hope this therapy helps people who have otherwise been relegated to nursing homes because insurance companies don't want to devote resources to keeping them in rehabilitation centers or maintaining therapies that aren't showing significant improvements.
posted by ChuraChura at 6:43 AM on June 4, 2016 [9 favorites]
My boyfriend's dad is almost two years post-stroke, and watching that plateau is incredibly upsetting, especially as they stop doing occupational and physical therapy because it "doesn't improve things." It certainly keeps things from getting worse. I hope this therapy helps people who have otherwise been relegated to nursing homes because insurance companies don't want to devote resources to keeping them in rehabilitation centers or maintaining therapies that aren't showing significant improvements.
posted by ChuraChura at 6:43 AM on June 4, 2016 [9 favorites]
MexicanYenta,
One of the commenters on the HN thread founded a company to freeze your stem cells for that use (and similarly revolutionary therapeutic applications) as their therapeutic potential apparently decreases as you age. The commenters seemed pretty convinced that these treatments would be available in the near future.
posted by polyhedron at 7:35 AM on June 4, 2016 [2 favorites]
One of the commenters on the HN thread founded a company to freeze your stem cells for that use (and similarly revolutionary therapeutic applications) as their therapeutic potential apparently decreases as you age. The commenters seemed pretty convinced that these treatments would be available in the near future.
posted by polyhedron at 7:35 AM on June 4, 2016 [2 favorites]
As the owner of two optic nerves badly damaged by micro-strokes at the retinal interface, this is extremely relevant to my interests. Now, if they can regrow the lost retinal cells as well and the visual cortex is capable of working with new signals, then I will subscribe to that newsletter straight away.
Any neuroscientists looking for a test subject in the above areas, do MeMail me. I wash regularly, have a good sense of humour, and am comfortable with highly technical invasive procedures.
posted by Devonian at 8:17 AM on June 4, 2016 [20 favorites]
Any neuroscientists looking for a test subject in the above areas, do MeMail me. I wash regularly, have a good sense of humour, and am comfortable with highly technical invasive procedures.
posted by Devonian at 8:17 AM on June 4, 2016 [20 favorites]
I wonder if this could also be applicable to people who have had traumatic brain injury. Anyone savvy in medical/neuroscience able to indulge in informed speculation?
posted by Fantods at 10:25 AM on June 4, 2016
posted by Fantods at 10:25 AM on June 4, 2016
surgeons drilling a hole into the study participants' skulls and injecting stem cells in several locations ... The patients were conscious the whole time
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
For anyone squicked out by this, the way they do this is pretty typical for any stereotactic surgical procedure. The incision is very small and local anesthetic is used; the patient is also sedated for the painful parts of the procedure, sometimes approaching general anesthetic levels of sedation. The brain itself has no sensory receptors, so the main part of the procedure is painless. Having the patient awake during critical parts of the procedure can be helpful in ensuring that the surgeon is getting to the abnormal part of the brain (such as that producing tremors or seizures) while leaving healthy brain tissue (such as the speech center) intact.
Definitely interesting and shows a lot of promise, but the breathless tone of the article was a bit much for me. As ChuraChura mentioned, only 7 out of 18 patients showed improvement. Was it due to the stem cells, or was the fact that they were getting more medical attention an influence on their recovery? I was able to access the original article via work, and it does note that the patients received no rehabilitation during the study, but I still wonder if they were more highly motivated than other patients. And although the subjective descriptions in the article sound impressive, the original paper is a little more subdued:
Furthermore, a total of 7 patients experienced a ≥10-point change from baseline of the F-M motor function total score. For patients in the study, this represented a clinical improve- ment in the power of upper and lower limbs, ranging from an improvement in the ability to stand to the disappearance of tremor.
I hope this pans out, and it could certainly be tried in brain injury patients as well, but it may not be as dramatic as the article in the FPP indicates; of course, as dose and timing are optimized, it could turn out to be even better than expected, and given the poor recovery for these patients after the first few months, even small steps in the right direction are to be applauded.
posted by TedW at 10:56 AM on June 4, 2016 [6 favorites]
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
For anyone squicked out by this, the way they do this is pretty typical for any stereotactic surgical procedure. The incision is very small and local anesthetic is used; the patient is also sedated for the painful parts of the procedure, sometimes approaching general anesthetic levels of sedation. The brain itself has no sensory receptors, so the main part of the procedure is painless. Having the patient awake during critical parts of the procedure can be helpful in ensuring that the surgeon is getting to the abnormal part of the brain (such as that producing tremors or seizures) while leaving healthy brain tissue (such as the speech center) intact.
Definitely interesting and shows a lot of promise, but the breathless tone of the article was a bit much for me. As ChuraChura mentioned, only 7 out of 18 patients showed improvement. Was it due to the stem cells, or was the fact that they were getting more medical attention an influence on their recovery? I was able to access the original article via work, and it does note that the patients received no rehabilitation during the study, but I still wonder if they were more highly motivated than other patients. And although the subjective descriptions in the article sound impressive, the original paper is a little more subdued:
Furthermore, a total of 7 patients experienced a ≥10-point change from baseline of the F-M motor function total score. For patients in the study, this represented a clinical improve- ment in the power of upper and lower limbs, ranging from an improvement in the ability to stand to the disappearance of tremor.
I hope this pans out, and it could certainly be tried in brain injury patients as well, but it may not be as dramatic as the article in the FPP indicates; of course, as dose and timing are optimized, it could turn out to be even better than expected, and given the poor recovery for these patients after the first few months, even small steps in the right direction are to be applauded.
posted by TedW at 10:56 AM on June 4, 2016 [6 favorites]
There was no blinding nor placebo arm in the study, correct?
posted by benzenedream at 11:10 AM on June 4, 2016
posted by benzenedream at 11:10 AM on June 4, 2016
No, this was mainly phase 1 for safety. I'm not sure how you could do a placebo or double blinded study of this, for both practical and ethical reasons. It would be hard to get IRB approval for sham brain surgery.
posted by TedW at 11:16 AM on June 4, 2016 [2 favorites]
posted by TedW at 11:16 AM on June 4, 2016 [2 favorites]
I note the article indicates that they are embarking on double blinded trials. I wonder if the sham "surgery" need be particularly invasive. Presumably the hole being drilled are very small. If they were small enough, would it be possible to create shallow depressions that don't pierce the skull but give the impression of potentially having done so?
posted by howfar at 11:25 AM on June 4, 2016 [1 favorite]
posted by howfar at 11:25 AM on June 4, 2016 [1 favorite]
you could definitely make a superficial wound that would mimic the external surgical changes, but given that the patients are awake for at least part of the procedure, there would have to be more to it than that to ensure that the patients don't know which arm they are in. It will be interesting to see how they do this.
posted by TedW at 11:35 AM on June 4, 2016 [1 favorite]
posted by TedW at 11:35 AM on June 4, 2016 [1 favorite]
"willholloway" in that HN thread is an excellent representative of the technology.
posted by rhizome at 11:56 AM on June 4, 2016
posted by rhizome at 11:56 AM on June 4, 2016
TedW: given the poor recovery for these patients after the first few months, even small steps in the right direction are to be applauded.
I have to agree. Seemingly small differences in motor skills may have a lot of impact on people's quality of life; I say that as the partner of someone who had a stroke at a relatively young age (< 60) and while his recovery is certainly relatively good, if only he had just a bit more control over his right foot, it's very likely that he could drive a car again. As it is, he doesn't consider it to be safe.
posted by Too-Ticky at 11:59 AM on June 4, 2016
I have to agree. Seemingly small differences in motor skills may have a lot of impact on people's quality of life; I say that as the partner of someone who had a stroke at a relatively young age (< 60) and while his recovery is certainly relatively good, if only he had just a bit more control over his right foot, it's very likely that he could drive a car again. As it is, he doesn't consider it to be safe.
posted by Too-Ticky at 11:59 AM on June 4, 2016
You have to wonder how effective this could be if it was done while coupled with therapy, and closer in time to the stroke. If they can get significant quality of life improvements years (in some cases) after the stroke, and without supporting therapy, maybe getting in there during that early window, and combining with full therapy, they could get some really impressive outcomes.
posted by YAMWAK at 12:16 PM on June 4, 2016 [1 favorite]
posted by YAMWAK at 12:16 PM on June 4, 2016 [1 favorite]
TedW: there would have to be more to it than that to ensure that the patients don't know which arm they are in.
My (lay) understanding of a double blind trial suggests that the surgeons shouldn't know which arm they are in either. So there would need to be a lot more to it than that.
posted by merlynkline at 12:39 PM on June 4, 2016
My (lay) understanding of a double blind trial suggests that the surgeons shouldn't know which arm they are in either. So there would need to be a lot more to it than that.
posted by merlynkline at 12:39 PM on June 4, 2016
These patients could easily have been selected to have better responses than your average stroke patient (wealthy, no comorbidities, excellent post stroke care and follow-up). I'd wait for a reasonably randomized and blinded trial before deciding the stem cells were responsible.
posted by benzenedream at 12:47 PM on June 4, 2016 [2 favorites]
posted by benzenedream at 12:47 PM on June 4, 2016 [2 favorites]
My (lay) understanding of a double blind trial suggests that the surgeons shouldn't know which arm they are in either. So there would need to be a lot more to it than that.
Lay speculation: if the surgeon doesn't have any contact with the patient afterwards, s/he wouldn't be able to affect the study by their expectations, so you'd just need to blind the other people around the subject. Which would be a bit tricky but not impossible.
posted by BungaDunga at 12:51 PM on June 4, 2016 [2 favorites]
Lay speculation: if the surgeon doesn't have any contact with the patient afterwards, s/he wouldn't be able to affect the study by their expectations, so you'd just need to blind the other people around the subject. Which would be a bit tricky but not impossible.
posted by BungaDunga at 12:51 PM on June 4, 2016 [2 favorites]
I agree with benzenedream that it is too early to say something. 10% patients with the same grade of stroke as their patients do recover even after the 6 month without a stem cell therapy. n=18 is too small.
I am more concerned by trying to cure brain function with non-neurogenic stem cells that are supposed to make blood, bone, etc. The news article also fails to disclose that the research was funded by the company produces those cells (the original Stroke article did disclose).
posted by Ultrabithorax at 8:35 PM on June 4, 2016 [1 favorite]
I am more concerned by trying to cure brain function with non-neurogenic stem cells that are supposed to make blood, bone, etc. The news article also fails to disclose that the research was funded by the company produces those cells (the original Stroke article did disclose).
posted by Ultrabithorax at 8:35 PM on June 4, 2016 [1 favorite]
Double-blind would mean the same surgery and the surgeon doesn't know which they're injecting.
posted by lastobelus at 9:12 PM on June 4, 2016
posted by lastobelus at 9:12 PM on June 4, 2016
I have had stem cell injections frim stem cells harvested from my body. Amazing results for me. Pain from neck back injury that ruptured two discs gone in a month. Movement amd strength back to normal in two months after years of other treatment. Amazing was that 6 months later the hole in my heart decreased by 70%. My cardiologist has never seen this before. Coincidence? I don't think so. Bring on the reaearch.
posted by OhSusannah at 3:01 AM on June 5, 2016 [10 favorites]
posted by OhSusannah at 3:01 AM on June 5, 2016 [10 favorites]
I would think that the requirements of a double-blind study would indicate that the surgeons might know which procedure they are administering, but the researchers do not know the subjects' treatment group until after final data collection and comparative analysis.
posted by entropone at 1:50 PM on June 5, 2016
posted by entropone at 1:50 PM on June 5, 2016
Follow-up: Risky stem cell treatment reverses MS in 70% of patients in small study
posted by StrikeTheViol at 6:08 PM on June 10, 2016
posted by StrikeTheViol at 6:08 PM on June 10, 2016
Ablating the immune system and replacing it is dangerous enough it is very rarely done. It is known to be a "cure" for many autoimmune diseases (and some leukemias), but has a significant chance of killing you in the process, which is why doctors are very hesitant to recommend it for non-fatal conditions. Stem cells are not magic and I would not recommend anyone get stem cell treatments unless the treatment is FDA approved and there is 5+ years of data on the outcomes post treatment.
posted by benzenedream at 3:37 PM on June 11, 2016
posted by benzenedream at 3:37 PM on June 11, 2016
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AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
posted by adept256 at 1:22 AM on June 4, 2016 [23 favorites]