Top Healthcare Conversations of 2008

Many of the great healthcare thinkers and bloggers wrapped up 2008 with end-of-year considerations of the important developments in their fields, and some looked ahead with predictions for 2009.

Cord Blood Bank Accounts Suddenly Look A Lot Smarter

The early buzz in the general press focuses on the non-destructive harvesting of amniotic stem cells. But another aspect of the new findings shows how science develops faster than the policies we make to manage it.

Chimeras: Mice with Human Brain Cells

PnasheadAn AP story today reports on a research project at the Salk Institute in San Diego led by Fred Gage. 100,000 human embryonic stem cells were injected into the brains of 14-day-old mouse embryos. The mice were born with one-tenth of one percent of human cells in their head. The findings are key to modeling human neurological diseases in test animals. A paper will be published in the upcoming Proceedings of the National Academy of Sciences.

A second story is how the news was covered. The New York Times carried a relatively careful headline: "Trace of Human Stems Cells Put Into Unborn Human Mice Brains." The Toronto Star focused on the small percentage involved: "Scientists create mice with brains that are 0.1% human" But the Sydney Morning Herald jumped right ahead to: Mice with human brains[!]

Creating chimeras — combining parts from different animals — has been part of medicine for years. Senator Jesse Helms famously had a pig valve installed in his heart. But combining genes and stem cells creates chimeras that grow into their new states blending human and animal characteristics, prompting what ethicists call the "yuck factor." (See the September article Transgenic Pigs’ Milk to Treat Cancer.)  Sen. Sam Brownback, R-Kan., has introduced legislation banning chimerical research.

In Slate: The Korean Stem Cell Advantage

"…the country is not preoccupied with moral questions about the beginning of life."

In an article in Slate this week on South Korea’s science-friendly culture — The Seoul of Clones: Solving a biotech mystery: Why South Korea leads the world in stem cell research — David Plotz describes some critical factors that contribute to the country’s news-making stem cell successes:

  • the lack of significant religious objections,
  • a family focus on bloodlines and genetics,
  • an openness to medical improvement,
  • plus a hardworking, collaborative, high-status scientific community skilled in IVF techniques.

Plotz compares the relative size and investment of  U.S. and Korean stem cell initiatives and their results, and he highlights the influence of Korea’s stem cell leader, Hwang Woo-suk. Dr. Hwang adds another reason for Korean exceptionalism: their lifelong use of metal chopsticks helps Koreans with the  micromanipulation of embryos and eggs.

Transgenic Pigs’ Milk to Treat Cancer

PigIn another demonstration of Korea’s emerging biotech prowess, scientists at Chungnam National University have cloned pigs that have been genetically modified to produce an expensive cancer treatment. Professor Park Chang-sik and his team at the Research Center  for Transgenic Cloned Pigs said that four female piglets are expected to express GM-CSF (granulocyte-macrophage colony stimulating factor) in their milk next year. GM-CSF, marketed by Berlex Pharmaceuticals under the trade name Leukine, builds up white blood cells in patients with leukemia and anemia or those who have low white blood cell counts during cancer treatment. From Berlex, GM-CSF costs more than $100 per daily dose. According to an article in The Korea Times, "Park expected the GM-CSF produced by genetically
engineered pigs would be commercially viable in a decade after going
through a serious of clinical tests."

Nikas’ Five-Day-Old Embryo Photo

Needle1Ngstemcells1In this remarkable electron microscope image by Dr. Yorgos Nikas published recently in the National Geographic, a five-day-old embryo nestles inside a large gray cavity. Discussions about the use of embryonic stem cells focus on the status of the fertilized egg, but Nikas’ photo lets us see just what we’re talking about. Click on the image at left to see the full picture.

First Trial of Adult Stem Cells to Treat Heart Attack Patients

With $50 million raised in a new funding round, Osiris Therapeutics, Inc. has begun
a Phase 1 clinical trial of  Provacel, a new therapeutic
based on adult mesenchymal stem cells (MSCs) found in bone marrow.
Provacel
is a formulation of MSCs shown in preclinical trials to repair damaged tissue. It is given to patients through a standard IV line, and the delivered cells, responding to the body’s own signals, migrate to the area of
injury.

“We are extremely enthusiastic
about this study which represents the first use of an allogeneic adult stem cell
to treat the consequences of heart attack in humans,” said lead investigator Dr. Joshua Hare, Director of
Heart Failure and Cardiac Transplantation and the Cardiobiology Section of the
Institute for Cell Engineering at Johns Hopkins University School of
Medicine.

“We are investigating an exciting new approach to address
the unmet needs of cardiac patients,” said Dr. Nabil Dib, Chief of
Cardiovascular Research at the Arizona Heart Institute, another investigator in
the trial.  “According to the American Heart Association, about two thirds of
heart attack patients never completely recover. This is due to the fact that
heart cells can’t repair themselves, so we have to try innovative ways to treat
the damage that occurs at the time of heart attack. If the research conducted to
date is any indication, mesenchymal stem cells may be the answer.”

The stem cells
produced by Osiris are obtained from adult volunteer donors, not embryos, so there’s no controversy about their use. Cells are grown in culture to very high
numbers, allowing a single donor’s cells to treat hundreds of patients. These
cells are universal in that they can be used in patients unrelated to the donor,
without rejection, eliminating the need for donor matching and immune
suppression. Once transplanted, the cells promote healing of damaged or diseased
tissues.

Osiris’s goal is to use adult stem cells to improve
outcomes in bone marrow recipients being treated for leukemia, to promote
cardiac repair following a heart attack or congestive heart failure, and to
prevent arthritis. Osiris recently became the first company to receive Fast Track
designation from FDA for a similar stem cell product, Prochymal, for the
treatment of graft versus host disease in cancer patients.

For more about the the company and its money-raising, see "The other stem cells" by Diedtra Henderson in last month’s Boston Globe.

(Osiris’s web site at www.OsirisTX.com is not compatible with most web browsers. Use Microsoft’s Internet Explorer Version 6.0 to see the layout and graphics.)