stem cells

First test with Human Embryonic Stem Cells

U.S. doctors announced Monday, October 11 have begun to treat a patient partially paralyzed with cells derived from human embryonic cell lines. The attempt raised great hopes among people who suffer damage to the spinal cord but also the important ethical questions. This is the first time ever a test of this type is attempted.

For now, he is evaluating the safety and tolerance of Human Embryonic Stem Cells research that were injected on a voluntary patient. Before checking in a second time, this treatment can regenerate damaged nerve cells and eventually allow the patient to regain mobility and sensitivity. The firm Geron, which works on this test since 1999, is known for its high-profile ads that drive up its stock market quotations. The firm has fought for years against the administration of George Bush who refused to authorize such work. She finally received the green light by U.S. authorities following the election of Barack Obama. Geron claims to have conducted a series of attempts in animals before launching today in humans.

The biggest unknown for such a graft remains the risk of cancer. Embryonic stem cells have indeed the capacity to differentiate into any cell in the human body, but also to multiply without limit. “This trial seems premature because the risk of tumor formation is real because of the genetic instability of these cells,” said Professor Alain Privat, research director at Inserm and specialist in spinal cord. For him “it is being tested on humans treatment whose safety is not assured.”

The use of Human Embryonic Stem Cells raises ethical questions because it involves destroying an embryo. Other labs are working on alternative techniques, including using adult stem cells Ips, that is to say reprogrammed to become nerve cells. But they are also currently a high risk of tumor formation. “We will succeed in overcoming this risk but it will take time,” said Professor Privat. Other gene therapy trials focus to promote regrowth of nerve cells. Privat’s lab has tested this method successfully on mice and rats and is about to implement it on pork.

The expectation of patients, often young and severely disabled, is enormous. “We need to exercise extreme caution on a topic of great hope for our patients are ready for anything, including becoming guinea pigs in dangerous experiments,” said the doctor who saw in China, practitioners grafted nerve cells “to the unknown origin.” In France, the use of human embryonic stem cells will soon be debated in Parliament within the framework of the revision of the bioethics laws.

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The National Institute for Research in Reproductive Health (NIIRH) announced it has developed four Embryonic Stem Cell Lines. The peculiarity of these lines is that they use human feeder cells.

These fibroblasts were recovered from an embryo after an abortion. This breakthrough is a response to one of the main shortcomings of the current technology of stem cells. In fact, it usually develops human stem cells on mouse feeder cells, which can cause contamination phenomena in human cells.

Lines of NIIRH were developed by Dr Deepa Bhartiya, Dr Sadhana Desai and Dr Vijay Mangole, who were funded for this by Department of Biotechnology (DBT) and Indian Council of Medical Research (ICMR). They should yield cells cleared of virtually all foreign elements, and therefore more able to pass the clinical tests. These cells have spent 12 stages (expansion in culture) and some of these should be cryopreserved for future use. Dr. Indira Hinduja, the father of the first test tube baby India, had already said last October have developed three embryonic stem cell lines using human feeder cells (cells of the skin removed during circumcision).

The Director of NIIRH Dr Chander Puri, also drew from his vows to create a reserve of embryonic stem cell lines, which would be made available to scientists across the country for their research projects.

There are two embryonic stem cell clinical trials in humans, one of which began in mid-October, were allowed in the United States. In France, a first trial should soon see the day. Objective: To demonstrate the safety of these treatments.

Therapies based on human embryonic stem cells *, ES say, are likely to revolutionize medicine in the twenty-first century. Properly grown and oriented laboratories, these cells can be transformed at will into specialized cells (neurons, liver cells, heart, etc.). In animals, injection of embryonic cells specialized animal has already helped cure some genetic diseases. ES cells are not specialized genetic information incorrect guinea pig. Defective in colonizing the body, they allow it to work again normally. These cells can also be used to repair tissues that do not regenerate naturally (brain, spinal cord). In humans, the first controlled clinical trials are beginning to emerge. They are currently testing designed to prove the safety of treatments, a preliminary step before their effectiveness can be studied in turn. And unsurprisingly, the United States has already one step ahead in this area.

A second clinical trial is in effect this week to get the precious U.S. health authorities (Federal Drug Association, FDA). The company Advanced Cell Technology has been authorized to test the injection into the eye of retinal cells derived from embryonic stem cells in ten volunteer patients, suffering from the same incurable genetic eye disease. This procedure, applied initially to the elderly, seeks to prove the safety of treatment. Eventually, it should help care for children who lose their sight because of this inherited disease called Stargardt macular dystrophy.

Treatment of heart failure: the French track

In January 2009, the U.S. Company Geron had already obtained a permit for a similar test for safety. It was now time to test the use of ES cells to repair severed spinal cord of injured people. This trial began in mid-October with the first patient in which two million of these stem cells (grown to become neurons) were administered. The results are not yet known. If prove the safety of treatment remains the primary objective, the researchers hope to observe the first positive effects on motor function of patients.

In France, the unit cell therapy in cardiovascular pathology of the George Pompidou Hospital who should conduct the first clinical trial of this type. The goal is to treat heart failure by depositing a film on the heart collagen colonized by cardiac cells from ES cells. Philippe Michel and Ménasché Pucéat, who coordinate this work, have received a positive opinion of the Committee to protect people, a necessary step before a possible approval of their protocol by French health authorities (AFSSAPS).

Raise doubts about the risk of cancer induction

These three tests will raise several highly anticipated fears. First, the risk of cancer induction: “Research on animals has shown that when all the injected stem cells had not been transformed into specialized cells previously, tumors were formed,” warns George Uzan, director of an INSERM unit working on therapeutic applications stem cells. As for transplants, the risk of rejection of embryonic cells, since they necessarily come from foreign agencies, will also be studied carefully.

In case of bad results – and many disappointments had been with adult stem cells – iPS cells offer only one more hope. Developed in 2004, these stem cells “made” from the skin include the ability to put aside the ethical issues related to the destruction of human embryos. A major obstacle is in France and the United States, the proper development of the research.

In France or the United States, used stem cells derived from unused frozen human embryos to researchers and sold by their parents who have already succeeded in vitro fertilization. They are usually a few days old and consist only of a handful of cells. No new embryo is created for research.

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U.S. biopharmaceutical, Geron Corporation, had submitted to the FDA issue a new treatment is still experimental Investigational New Drug (IND), a treatment that dream of generations of neurologists: repair a lesion marrow cord. The FDA has blocked the file, while Geron wanted to get his product: GRNOPC1 in a Phase 1 trial in patients suffering from this type of accident.

The U.S. drug agency has just released the record, notifying that Geron may consider the first global clinical trial in humans of a treatment based on human embryonic cells or hESC (human embryonic stem cells), according to the scientific nomenclature. The Phase 1 trial will seek to establish multicenter safety for patients GRNOPC1 medulla in patients affected by the selected level of the A scale established by the American Spinal Injury Association (ASIA).

For Dr. Thomas B. Okarma, Geron’s CEO, the release of the record is GRNOPC1 satisfaction, the goal being to achieve the biopharma to show that repair marrow injured is possible, that is to say, to restore its function, by injecting embryonic stem cells in spinal cord injuries – here through the course of the thoracic marrow cord, That is to say precisely between the vertebrae D3 to D10), treatment starting between 7 and 14 days after formation of the lesion. We must act early, then a scar is formed and if repair is possible, it would be compromised.

For other violations of the CNS also: Meanwhile, Geron studying the feasibility of this cell therapy to other central nervous system like Alzheimer’s disease, multiple sclerosis and leukodystrophies. Tests on animal models of these diseases are already underway with the proceeds of Geron.

The FDA had previously blocked the file based on Geron’s animal experiments conducted (preclinical), which showed the appearance of small cysts at the site of spinal cord injury treated with GRNOPC1. Based on these observations, the biopharma has reworked its product and provided new preclinical results endorsed by the FDA.

Geron said that if this first clinical trial is primarily to confirm the safety of GRNOPC1, it is planned to test secondarily improve neuromuscular function and sensation in the trunk and limbs. If this first test confirms product safety, Geron will seek FDA approval for further testing of patients with more severe disease (grades B and C of the scale ASIA).

GRNOPC1 contains cells progenitor cells (oligodendrocytes) derived from hESCs that have shown properties of remyelination (myelin membrane protective beams of ships) and stimulation of regrowth of nerves, which have been observed in animal models of injuries spinal cord in the acute stage. “We know that demyelination is the heart of the lesional pathology and its reversion by injection cells oligodendrocyte progenitor should revolutionize this field [the care of spinal cord injury], “says Professor Richard Fessler, a surgeon neurologist.

If it proves safe and active, this treatment should provide a reliable treatment option for thousands of patients who endure injuries of marrow cord each year.”

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Where do totipotent stem cells come from?

Where to get stem cells?

There are several possible sources for stem cells:

• Human supernumerary embryos from IVF or recovered after abortion could provide totipotent stem cells can be cultured.

• Adult tissues may contain multipotent stem cells. It should select, extract and put them in culture. This promising method is still experimental

• The specialized tissues such as bone marrow contains multipotent stem cells capable of giving, for example, all blood cells

• The cord blood of newborns contains a large number of stem cells producing blood and other stem cells such as muscles, cartilage, heart or liver disease. Some researchers are even looking to keep the cord blood of newborns so that they can use in times of need compatible source of stem cells when the individual is affected by the disease.

• Another approach could be used to obtain stem cells with the same genetic identity of the patient: by taking the nucleus from a somatic cell and injecting it into an enucleated human oocyte, an embryo can be obtained which will serve as a source undifferentiated cells specific for the individual to be treated. However, this technique, derived from cloning is not yet mature and has a ridiculous performance. Furthermore, human oocytes are scarce!

• It would be interesting also able to transform a cell differentiated embryonic cell character. Indeed, any cell contains in its nucleus all the genetic information necessary to build an organization. Experimentally, this alternation of dedifferentiation / redifferentiation is often observed in the gastrointestinal tract and its annexes. This technique, however, is difficult because this type of transformation is precisely that which leads to the formation of cancer cells!

Stem cells are already used widely in medicine

When practicing a bone marrow transplant, it really makes a stem cell blood. These stem cells are recovered in the bone marrow from a donor or can be extracted directly from the blood when using a product before allowing multiplying the number.

The injected cells will settle in the bone marrow of the recipient or they will multiply and give all blood cells. Stem cells are not always a therapy of the future, but are sometimes used in everyday medical practice!

Number of challenges remain

- Injection of cells in an organism is analogous to a graft. If the cells are recognized as foreign supplied to the body, they will be destroyed regardless of their therapeutic value! This shows the interest of the newly discovered stem cells in adults, and that does not trigger rejection.

- Selected cells injected do not have an unlimited life. Cardiac muscle cells, for example, remained viable 7 weeks

- Undifferentiated cells injected in adults can form a single mass of cells varied, similar to a tumor (teratoma). The selection and controlled differentiation of stem cells derived must be effectively controlled.

- Embryonic stem cells must be harvested from human embryos. In many societies and cultures, it creates obstacles to the development of ethical practice.

- The resulting cells remain isolated and unable to associate to form an organ. At best, they penetrate and colonize a body already formed. Building a body is a complex process that involves interactions between different cell types. For now, this process is not reproducible, but it is reasonable to think that stem cells opens the way to the constitution, in the relatively near future, genuine replacement organs needed to rebuild and fight the man effective against many diseases that are fatal.

Stem cells therefore give hope to obtain a reconstruction of artificial organs severely affected, first among which are the heart muscle, blood vessels and brain, organs whose alteration ranks first among causes of death in industrialized countries.

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The search adult stem cells capable, like their counterparts embryonic differentiate into all cell types, continues. Minnesota researchers have identified pluripotent progenitor cells and highly proliferative in the bone marrow of adult humans.

Could it be false stem cells, a kind of cultural artifacts resulting from the fusion of two cells, such as those in March, have been the source of great disappointment? The normal chromosome formula of these cells has ruled out this hypothesis. The researchers then followed their individual destiny in the mouse genome by marking them with a retrovirus. In vitro and in vivo, each of these progenitor cells can give rise, by division and clonal differentiation of many different cell types. Injected into a blastocyst, they are part of the embryo and contribute to most somatic tissues.

A team of researchers led by Professor Mari DEZAWA Tohoku University has managed to isolate and cultivate a new type of pluripotent adult stem cells present in skin and bone marrow of adults. Named MUSE (for Differentiating Stress-Enduring Multilineage Cells), these cells appear to have interesting properties for future therapeutic applications.

A pluripotent stem cell can proliferate and differentiate into various types of cells. Until now, we knew two major types of pluripotent stem cells: embryonic stem cells, whose use is controversial ethical, and induced pluripotent stem cells, discovered in 2007 by Professor Yamanaka of the University Kyoto and from reprogrammed adult somatic cells.

Discovered by mistake

Researchers mistakenly put in contact with human skin cells with an enzyme capable of dissolving them, but they found that some cells survived. By examining them, they realized that surviving cells had markers characteristic of pluripotent stem cells known. When these cells were implanted into mice, they are differentiated by location of the graft in nerve cells, muscle cells, liver cells…

A smaller rate of proliferation

According to the research team, museums are relatively rare (1 in 5000 cells in the bone marrow). Furthermore, compared to two other types of pluripotent stem cells, the MUSE appear to have a proliferation rate lower; unlike embryonic cells, or iPS, which can multiply indefinitely, they stopped dividing after two weeks. However, they appear less risky: rats that were implanted with MUSE in the testicles did not develop tumors after six months of observations; embryonic stem cells implanted in the same place have become cancerous after eight weeks.

The MUSE therefore represent a promising new avenue for the development of regenerative medicine.

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The team of Professor Hiroaki MATSUBARA Prefecture University of Medicine Kyoto has successfully treated a patient with heart trouble by using his own adult stem cells. This is a first in Japan.

The adult human body has a number of types of stem cells able to renew and to differentiate into various cell types. Among the best known include hematopoietic stem cells capable of differentiating into all blood cell types and located in the bone marrow. The heart also contains stem cells that can become cardiomyocytes (heart muscle cells) or blood vessel cells.

The patient, a 60 year old man was suffering from an acute heart failure and had had a heart attack last February. In April, doctors have taken him about 15 milligrams of coronal tissue (tissue constituting the arteries that cover the surface of the heart and nourish the latter). They then isolated the stem cells in the sample were collected and cultured, multiplying their numbers by 40,000 a month.

In June, the team performed a bypass surgery on the patient. On this occasion, they injected stem cells in the wall of the left ventricle of the heart, which was now become necrotic due to lack of blood supply. To stimulate growth and multiplication of cells, they also placed a plaque on the wall of gelatin than 5 cm square containing proteins. Before the operation the patient very weak, could not leave his bed. Two weeks after the operation, his heart had found a rhythm. After a month he was released from the hospital and get on with their daily lives. He does not suffer for the moment no side effects.

Following this initial success, the team must perform a similar operation in August and intends to make four more. Once the safety of the method is confirmed, it is anticipated that the project takes on the scale: from fiscal year 2012 four other universities, including those of Tokyo and Kyushu, will collaborate with University of Medicine Kyoto Prefectural to conduct tests to prove the effectiveness of the method on forty patients with heart disease.

According to Professor MATSUBARA, the method will be used initially as a temporary treatment for patients awaiting a heart transplant. Eventually, however, one can imagine that it replaces and prosthetic heart transplants.

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Embryonic Stem Cell Therapy Side Effects

The coming years will be decisive for the future of embryonic stem cells therapy. The next step is indeed to finally test it on humans the regenerating power of these cells, which may potentially be used for repairing all tissues, and compare it to that of adult cells, which are inherently more limited. So far, no one was sufficiently advanced in this work for daring to run.

However, in recent months, the pace is accelerating. For the great fear of side effects associated with the implantation of these cells seems to be fading. Particularly feared the appearance of teratomas (tumors uncontrolled containing all human tissues) would be avoided if we are to believe the animal tests, provided that the cells are grown in remaining under the control of factors growth well chosen.

The rumor in laboratories around the world said several teams are preparing to test their work on a handful of patients. One of the most advanced one is that of U.S. researchers who isolated the first human embryonic stem cells, James Thomson (University of Wisconsin), associated with Geron, a biotechnology company known for her private part in sequencing the human genome.

According to Geron, the health safety agency (FDA) could give the go-ahead in 2007 for conducting trials in paraplegic patients: their spinal cord receive implants of neural cells derived from embryonic stem cells therapy.

But it is unfortunately impossible to know so much financial and ethical issues exacerbate the cult of secrecy in such companies as Geron and its great rival, ACT (Advanced Cell Technology), which also announced loud and clear its intention to enter the race.

A HEART LIKE NEW!

The Stem Cell Institute in Evry, created in partnership with Inserm and Genethon, houses the work of Michel Pucéat, an eminent specialist in cardiac cells. In association with Michel Ménasché, one of the pioneers of cellular grafts in the heart, he knows already obtained from human embryonic cell lines still undifferentiated, but engaged in a biological pathway that will lead them to turn into cells cardiac muscle as they become established.

A feat as these state “transitional” cells (they are here longer quite strains, but not specialized) is extremely unstable. So much so that very few teams in the world manage to properly maintain in culture. Yet there are good reasons to persist: “When a stroke occurs, hundreds of millions of cells are destroyed in the heart, and our goal is to resurrect the whole heart muscle disappeared,” says the researcher.

However, it is impossible to cultivate such a quantity of cells in vitro. Hence the idea of implanting cells undergoing differentiation into cardiac muscle, “they expose theoretically not at risk of teratoma, while maintaining a high capacity to multiply.”

And it works! In rodents, 100% of cardiac lesions were repaired.

And the advantage compared to tests conducted with adult stem cells is enormous, because this is a complete regeneration of cardiac muscle and not an upgrade of a diseased tissue. The Heart is like new!

Name proved less spectacular tests on sheep. Meanwhile those use in monkeys the last step before moving on to humans. But already, the results achieved were so impressive that a formal record of authorization for a first clinical trial is in preparation.

Immunological tests seem to show that such implanted cells will not cause or little backlash. A slight anti-rejection therapy may be useful, but are likely transient.

“Initially, we prepare a Phase 1 to verify the safety of the therapy on three patients with chronic heart failure,” says Michel Pucéat, who hopes to see even start next year.

We will then know if 2007 is a year and many of embryonic stem cells therapy.

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Embryonic Stem Cell Therapy for Diabetes

Recent results make little less utopian prospects of therapy of diabetes with transplants of cells. Another track, the activation of regenerative capacity of the pancreas, also takes consistency.

While the epidemic of type 2 diabetes is growing rapidly worldwide (more than two million patients in the European Union) and the Type 1 diabetes affects children younger and younger, sustainable solutions become urgent therapeutic. Diabetes is characterized by excess blood sugar (hyperglycemia), due to insufficient production by the pancreas of a hormone, insulin, or its misuse by the body. Without proper treatment and ongoing to standardize blood glucose levels, this excess is toxic and can cause serious complications: heart and kidney disease, blindness, amputations, impotence.

Among the new therapies being considered, the Registry of insulin cells obtained ex vivo from stem cells (cell therapy) is not the most obvious, especially on a large scale. It would nevertheless the advantage of providing a source of natural insulin, while eliminating the stress of daily injections of insulin or medication. A neighbor and therapeutic approach offers the same benefits are to stimulate in vivo the regenerative capacity of functional cells (regenerative therapy). Both strategies are valid for type 1 diabetes, caused by the destruction of cells in the pancreas, beta cells, but also for type 2 diabetes which it gradually lose their secretory capacity.

Advanced California

Yet the results of a team Novocell enterprise (San Diego, California), published in April 2008 in Nature Biotechnology, revived the hope of achieving efficient embryonic stem cell therapy of diabetes. The researchers transplanted mice a population of cells derived from embryonic stem (ES) cells, which have the ability to transform into many tissues (pluripotency). They observed that these cells were differentiated into beta cells – that is the novelty – that they were functional: they reacted to the presence of glucose by secreting insulin and were thus able to protect mice against hyperglycemia caused.

“This is a major advance, “Judge Scharfmann Raphael, director of the team” Normal and pathological development of endocrine organs “Research Center growth and signaling (INSERM U845), Faculty of Medicine Necker (University Paris Descartes). However, this work does not know what the starting ES cells that differentiate into beta cells, or in what other types of cells differentiate transplanted cells. “Indeed, the problem of cell grafts in vivo is that one “immersed” in a cell filled with chemical signals that we do not control and that push stem cells to differentiate into unwanted cell types, including cancer cells. This dive into the unknown is one of the reasons that hinder further investment in the field of cell therapy.

The selection of progenitors

In Paris, Raphael Scharfmann team chose to use more mature and specialized cells that ES cells, and therefore less likely, in principle, be transformed into cancer cells: the “progenitors” of the pancreas. Their natural function is to renew the cells of the body, and therefore the researchers hope to develop in vitro in transplantable insulin cells by identifying the fundamental processes of differentiation. On this level, knowledge is continually developing. Well known that glucose itself is an important factor in the differentiation of progenitors. However, the isolation and culture of progenitors remains a technically difficult operation that researchers do not yet know the routine make, unlike the case of ES cells.

This method has however the advantage to bite on regenerative therapy. Now the team of Harry Heimberg (Free University of Brussels) and Gerard Gradwohl (Inserm U682, Université Louis Pasteur, Strasbourg), which collaborated with Raphael Scharfmann, in January 2008 showed that there are progenitor cells in the pancreas adult mice and that it is possible to induce them to differentiate into beta cells in a pattern recapitulating the normal processes of development. Therefore, the demonstration of the existence of an equivalent of these progenitors in the human pancreas would seem like a small bomb as regenerative therapy with drugs such stimulators progenitors would find a strong argument. It would then be an alternative to the use of progenitors and ES cells cultured in vitro.

Another avenue of research is to create non-endocrine cell lines for embryonic stem cell therapy, but as equipment for testing high-speed molecules with therapeutic potential. This is the reason for the company founded by Paul Endocells Czernichow, and Raphael Philip Ravassard Scharfmann early 2004. It relies on a technique quiconsiste to “infect” fetal tissue with a lentivirus carrying a transgene. Transgenic progenitors differentiate into endocrine cell lines.

Endocells succeeded in 2007 to obtain lines of human beta cells from human fetal tissue. The company expects to be on track to produce as cell lines of the thyroid. Progress which put the company in a favorable position before a first round of funding planned to move now to the next level and give the company a European stature.

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