by admin | Nov 7, 2020 | Osteoarthritis, Mesenchymal Stem Cells, Stem Cell Research, Stem Cell Therapy
Osteoarthritis is the most common form of arthritis. In osteoarthritis, the cartilage of the joints breaks down, bone spurs form, the synovial linings become inflamed, and the ligaments around the joint calcify. All of these pathological changes combine to cause joint pain, swelling, and stiffness. The breakdown of the joint also means that it does not function properly. The arthritic joint may “lock up,” “give out,” or simply not be able to move through its normal range of motion. Early in the disease, the pain of osteoarthritis may be brought on by movement. Later, the pain is more or less constant with severe pain flares.
Initially, the treatment for osteoarthritis is pain medications, exercise, braces, and physical therapy. Joint injections may be helpful for 4 to 6 weeks, but recent research suggests that repeated steroid injections may break down cartilage and speed up joint destruction. Unlike treatments for rheumatoid arthritis, there are no disease-modifying treatments for osteoarthritis. The disease tends to get worse over time until surgery is required. Joint replacement surgery is usually the treatment of last resort.
Since osteoarthritis is a degenerative joint disease, a reasonable approach to therapy is to try to rebuild or regenerate the joint tissues. This would not only stop the disease progression of osteoarthritis but perhaps even heal the damaged joint. For this reason, regenerative medicine, also known as stem cell therapy, is drawing the attention of many scientists who are looking for alternative therapeutic treatments for osteoarthritis.
Researchers tested the ability of mesenchymal stem cells to relieve pain and treat the damage of osteoarthritis. More specifically, they used the exosomes that the mesenchymal stem cells produce. Exosomes are tiny packets of substances like RNA and peptides that support tissue growth and repair. Exosomes contain most of the molecules that make mesenchymal stem cells helpful.
The scientists found that giving exosomes from mesenchymal stem cells to animal subjects with experimental osteoarthritis had some remarkable effects. Not only did the stem cell-derived treatment substantially reduce pain in the rats with osteoarthritis, but microscopic and molecular evidence also showed that the exosomes were able to repair cartilage in the affected joints. This is truly impressive when you consider that other treatments for osteoarthritis only reduce symptoms—they do not repair cartilage or stop the progression of the disease.
While this work will need to be replicated in human clinical studies (and that work has already begun), this is an exciting finding for the millions of Americans who struggle with osteoarthritis.
Reference: He, L., He, T., Xing, J. et al. Bone marrow mesenchymal stem cell-derived exosomes protect cartilage damage and relieve knee osteoarthritis pain in a rat model of osteoarthritis. Stem Cell Res Ther 11, 276 (2020). https://doi.org/10.1186/s13287-020-01781-w
by admin | Oct 30, 2020 | COPD, Stem Cell Research, Stem Cell Therapy
Chronic obstructive pulmonary disease (COPD) is a lung condition that makes it hard for patients to breathe. In COPD, small airways in the lungs thicken and lose their elasticity. People with COPD have shortness of breath, especially during physical activity. Patients with severe COPD may experience a more challenging quality of life. COPD patients may experience several exacerbations a year which require a stay in the hospital.
Patients with COPD typically need one or more inhalers a day. These inhalers help to open airways and, in some cases, decrease lung inflammation. Patients who also have bronchiectasis may need to take an oral antibiotic every day. During a COPD exacerbation, patients usually must receive powerful steroid treatments intravenously, routine breathing treatments, and supplemental oxygen.
People with COPD are more prone to lung infections, and so they usually receive IV antibiotics for pneumonia. Those who successfully stop smoking can help to prevent further lung damage, however, the inflammation and lung damage persists for a long time. Today, patients are seeking alternative therapies for COPD. Many are discovering regenerative medicine, also known as stem cell therapy, that may offer an incredibly promising therapy for COPD.
The lungs have a large number of naturally occurring stem cells that can restore function. For example, mice who lose half their lung capacity from experimental COPD survive, and natural stem cells within the lungs can restore their lungs to a natural state within 5 months. Unfortunately, humans with COPD cannot repair their lungs as quickly and as fully as mice can. This is why researchers are studying the use of stem cell treatment to restore lung function in patients with COPD.
Studies have shown that stem cells have the potential to help improve lung function. Stem cell treatment improved oxygen and carbon dioxide exchange, exercise tolerance, and cell injury in early studies.
One review did show that stem cell treatment is “safe and may improve patients’ condition and quality of life; however, larger-scale studies are needed to evaluate efficacy.” More research in humans is needed, but the pre-clinical (aka animal and laboratory) research in this area is quite promising.
Reference: Kokturk N, Yıldırım F, Gülhan PY, Oh YM. Stem cell therapy in chronic obstructive pulmonary disease. How far is it to the clinic?. Am J Stem Cells. 2018;7(3):56-71. Published 2018 Aug 1.
by admin | Oct 16, 2020 | Alzheimer’s Disease, Stem Cell Research, Stem Cell Therapy
Alzheimer’s disease is the most common form of dementia. Among other symptoms, Alzheimer’s disease causes memory loss as nerve cells in the brain become dysfunctional and die. While the disease is known to be related to the accumulation of β-amyloid plaques and neurofibrillary tangles, how and why those things happen is still a mystery. Nonetheless, researchers have created and tested drugs to change the way the brain process β-amyloid and hyperphosphorylated tau (the substance in neurofibrillary tangles) but nothing, so far, has worked in humans. Instead, we are left with anticholinergic drugs, and memantine used to slow the progression of the disease.
These failures of drug development have forced scientists to reconsider how to treat Alzheimer’s disease. Instead of a focus on neuropathology that we cannot understand or control, why not focus on supporting nerve cells that remain or even restore the nerve cells that are lost? This is the hope of stem cell research in Alzheimer’s disease, and the focus of an extensive review article on the subject.
The review article describes the clinical possibilities of different types of stem cells:
- Neural stem cells (NSCs)
- Mesenchymal stem cells (MSCs)
- Induced pluripotent stem cells (iPSCs)
Neural stem cells (NSCs)
NSCs have the magnificent ability to become any type of brain cell, be they neurons or various types of glia. NSCs would be the ideal stem cell treatment for Alzheimer’s disease except for one major problem: There are very, very few NSCs in the human brain. It is nearly impossible to harvest them in high enough numbers and, right now, we don’t have ideal ways to make them multiply and grow in a laboratory. So, while research in NSCs for the treatment of Alzheimer’s disease is well underway, they won’t be widely available any time soon.
Mesenchymal stem cells (MSCs)
Mesenchymal stem cells can become many different types of cells and can be harvested from many places including bone marrow, umbilical cord, and adipose (fat). MSCs are very versatile, and we are improving at safely using them in various diseases, including Alzheimer’s disease. MSCs are one of the more exciting avenues of research in Alzheimer’s disease and other neurodegenerative diseases.
Induced pluripotent stem cells (iPSCs)
iPSCs are a remarkably interesting type of stem cell. They are stem cells that are created by reprogramming cells found in the skin (fibroblasts) to become other cells of interest. Researchers take fibroblasts and genetically alter them to behave like other types of stem cells or fully differentiated cells. Recent work has shown that scientists can repurpose iPSCs to become neural precursor colonies, which are a lot like NSCs described above. If one could take iPSCs from the skin and convert them into NSCs, this could truly be a treatment for Alzheimer’s disease.
Stem cell treatments provide the promising potential to help those with Alzheimer’s disease and other neurodegenerative diseases. While research is ongoing, the breakthroughs that have been recently discovered provide hope to those seeking an alternative option.
Reference: Lee, J. H., Oh, I. H., & Lim, H. K. (2016). Stem Cell Therapy: A Prospective Treatment for Alzheimer’s Disease. Psychiatry Investigation, 13(6), 583–589. https://doi.org/10.4306/pi.2016.13.6.583
by admin | Oct 6, 2020 | ALS, Stem Cell Research, Stem Cell Therapy
ALS, which stands for amyotrophic lateral sclerosis, is a neurodegenerative disease that has no cure and no substantially effective treatment. Today, there are two drugs available that can slow the progression of ALS— riluzole and edaravone—but these agents may only be modestly effective. Sadly, patients with ALS get progressively worse, sometimes even with treatment. They lose to ability to move, to swallow, and to breathe. It is a devastating disease.
As with other neurodegenerative diseases, researchers are trying to treat ALS with stem cells. Stem cells have the capacity to become other types of cells such as neurons or glia. The notion is that stem cells could be used to rescue and replenish the nerve cells that are dysfunctional or destroyed in ALS. Studies are emerging that suggest that these approaches may bear fruit.
One such stem cell trial comes out of India, published by Dr. Prabhakar and colleagues. The research scientists infused autologous bone marrow-derived stem cells (autologous means the cells were retrieved from the patient and then readministered to the same patient). The scientists conducted the clinical study in ten patients with ALS who had a mean revised ALS Functional Rating Scale score of 30.2 ± 10.58. In other words, patients with this score have about a 60 to 70% chance of being alive for 9 more months.
Impressively, patients treated with autologous bone marrow-derived stem cells did not have a significant reduction in ALS Functional Rating Scale score after one year, which means their disease stayed relatively stable over this time instead of deteriorating. It took about 16.7 months for the score on this scale to drop by 4 points, which is considered a significant drop. The median survival after the procedure was 18.0 months, which is substantially more than would have been expected at the start of the study.
Taken together, these results suggest that patients with moderately severe ALS enjoyed a stabilization of their ALS symptoms for over 16 months on average. While there was no placebo control group, the stem cell-treated patients survived about twice as long as was estimated at the start of the trial.
These positive results must be confirmed in a larger, placebo-controlled trial. However, they strongly argue for further research of stem cells for the treatment of amyotrophic lateral sclerosis.
Reference: Prabhakar S, Marwaha N, Lal V, Sharma RR, Rajan R, Khandelwal N. Autologous bone marrow-derived stem cells in amyotrophic lateral sclerosis: A pilot study. Neurol India 2012;60:465-9
by admin | Jun 25, 2020 | Neurodegenerative Diseases, Mesenchymal Stem Cells, Stem Cell Research
As the name suggests, neurodegenerative diseases are a disease of the nervous system in which nerve cells (i.e. neurons) become dysfunctional and die. As more nerve cells die, certain brain functions slow, change or stop. Alzheimer’s disease, Parkinson’s disease, Huntington’s disease and Amyotrophic lateral sclerosis (ALS) are examples of debilitating and even fatal neurodegenerative diseases. There are no cures for these diseases, but symptom management is the primary focus for patients seeking treatment options.
Neurodegenerative diseases are an attractive target for regenerative medicine. The approach makes sense intuitively; if brain cells are inflamed, dysfunctional, and dying, can mesenchymal stem cells be applied as a targeted approach so that they may differentiate into new brain cells and release all the helpful substances stem cells are known to release. Many researchers share this optimism and believe in the promise of stem cells as a treatment for neurodegenerative diseases. Indeed, Drs. Joyce and coauthors discuss what steps have already been taken to develop stem cells into a potential treatment for neurodegenerative diseases.
The authors describe scientific studies that show how mesenchymal stem cells “promote endogenous neuronal growth, decrease apoptosis and regulate inflammation.” In other words, stem cell transplantation supports nerve cell growth, decreases cell death, and reduces the damaging inflammation that is seen in some neurodegenerative diseases like multiple sclerosis.
According to the scientists, stem cells “can mediate modification of the damaged tissue microenvironment to enhance endogenous neural regeneration and protection.” This means that stem cells can make the area around the diseased brain more favorable to nerve cell growth and development. Stem cells create a protective environment for nerve cells to live and operate.
Clinical trials that study the effects of stem cells in neurodegenerative diseases are progressing. Some studies show that stem cells might be able to slow the rate at which muscle strength declines and are considered safe for those with ALS. Likewise, patients with Huntington’s disease showed motor and cognitive improvements two years after receiving a stem cell transplant into the damaged region of their brains. Moreover, stem cells transplanted into patients with Parkinson’s disease were found to be alive and well 10 years after transplantation. Perhaps more importantly for patients, stem cells provided relief of Parkinson’s disease symptoms.
As of now, stem cell treatments for neurodegenerative diseases can be directed to the targeted tissues with administration techniques such as intranasal or intrathecal injections to bypass the blood-brain barrier. While these injections have been shown time and again to be safe, patients and their providers must consider the process and their safety. Continued research is ongoing and those seeking an alternative option should do their research and discover how regenerative medicine may potentially help them manage their symptoms.
Reference: Joyce, N., et al. (2010). Mesenchymal stem cells for the treatment of neurodegenerative disease. Regenerative Medicine. 2010. Nov; 5(6): 933-946.
by admin | Jun 24, 2020 | ALS, Stem Cell Research
ALS, also known as amyotrophic lateral sclerosis or Lou Gehrig’s disease, is a progressive neurologic condition. There is no current cure for this condition and the only treatments, riluzole and edaravone, are only modestly effective at slowing the disease.
This lack of a cure or effective treatment for ALS is not for a lack of trying. There have been countless clinical trials to test treatments for ALS—almost all have ended in failure in Phase 1 or Phase 2 clinical trials. Indeed, few potential ALS treatments make it to Phase 3 trials—the final stage of clinical testing before a drug is approved by the FDA for treatment.
It is this history of failure that has sparked so much enthusiasm in a new stem cell treatment for ALS. The potential stem cell treatment for ALS is currently known by its development name, NSI-566. NSI-566 is made up of neural stem cells—cells that can become new motor neurons. NSI-566 is injected into the spinal column of patients with ALS so that the stem cells can hopefully restore motor function and improve ALS symptoms.
The Phase 1 study showed a spinal injection of NSI-566 was safe in ALS patients, a finding that was confirmed in the Phase 2 trial. Perhaps more importantly, results from the Phase 2 trial showed that patients who received stem cell treatment did substantially better 24 months later than those who received a placebo. These results were so encouraging, that NSI-566 now heads to Phase 3 clinical testing.
While it will take some time to conduct the Phase 3 clinical trial, reaching this milestone is an achievement in itself. Any Phase 3 trial design will require a relatively large number of patients, so those who are interested should occasionally check clinicaltrials.gov or speak to your neurologist about enrolling as a volunteer.
Reference: Goutman, S., et al. (2018). Long-term Phase 1/2 intraspinal stem cell transplantation outcomes in ALS. Annals of Clinical and TranslationalNeurology 2018; 5(6): 730–740
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