10 Things You Need To Know About Stem Cells 

Stem cells have the potential to help us improve in many different areas of health, longevity and medical research. Further research will help us to understand how these amazing cells transform into the immense array of specialized cells that make us what we are, from skin to bone and heart to brain cells. Medical conditions, such as cancer and birth defects, are due to problems that occur somewhere in this process of cell differentiation. We need better understanding of normal cell development to allow us to understand and perhaps correct the errors that cause these medical conditions.

 Stem cells can now be guided into making cells and tissues for medical therapies. Currently, donated organs and tissues are often used to replace those that are diseased or destroyed. The number of people needing a transplant far exceeds the number of organs available for transplantation. In January of 2017 there were over 14,000 people on the liver transplant list in the U.S. Approximately 25% of these patients never lived to get the transplant. That means about 3,500 people on that list have likely died already. Stem cells offer the possibility of a renewable source of replacement cells and tissues to treat a multitude of diseases and disabilities including Parkinson’s disease, amyotrophic lateral sclerosis, spinal cord injury, burns, heart disease, diabetes, and osteoarthritis. 

 As with any other emerging technology, there are of course multiple concerns. Ethical concerns have played a major role in the stifling of further research. Safety of patients is paramount. We must also keep in mind the issue of over population of our planet. We only have limited space and the population of our planet continues to expand as our food quality continues to deteriorate. 

1. What Are Stem Cells 

These amazing cells have the remarkable potential to develop into many different cell types in the body. They serve as a sort of internal repair system for tissues and organs, dividing essentially without limit to replenish injured or dying cells as long as the person or animal is still alive. When a stem cell divides, these new daughter cells have the ability either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle, bone, cartilage, blood, or brain cell. However, as we age we do not have as many stem cells available and there are greater chances of aberrant differentiation due to many causes. Physiological stress, environment, food and toxic chemicals are all interfering with the proper division of these cells. In the last 20 years of researchers have discovered that only about 5% of the diseases we as humans suffer from are due to our original genetic make up.

 Stem cells are distinguished from other cell types by two important characteristics. First, they are unspecialized cells capable of renewing themselves through cell division. Second, under certain physiologic or experimental conditions, they can be guided or directed to become tissue- or organ-specific cells with special functions (specialized). In some organs, such as the gut and bone marrow, stem cells regularly divide to repair and replace worn out or damaged tissues. In other organs, however, such as the pancreas and the heart, stem cells only divide under special conditions.    

 These amazing cells do not have any tissue- or organ-specific structures that allow it to perform specialized functions. A stem cell cannot work with other cells to pump blood through the body (like a heart muscle cell), and it cannot carry oxygen molecules through the bloodstream (like a red blood cell). However, unspecialized stem cells can give rise to specialized cells, including heart muscle cells, blood cells, or nerve cells.

2. Where Do Stem Cells Come From

    Embryonic or non-embryonic 

  Embryonic stem cells, as their name suggests, are derived from embryos. Embryonic stem cells can derived from embryos that develop from eggs that have been fertilized in vitro, in an in vitro fertilization clinic and then donated for research purposes with informed consent of the donors. They are not derived from eggs fertilized in a woman’s body. 

 If fetal stem cells are obtained from miscarried or stillborn fetuses, or if it is possible to remove them from fetuses still alive in the womb without harming the fetuses, then no harm is done to the donor and such fetal stem cell use is considered ethical. Since umbilical cords are detached from infants at birth, umbilical cord blood is considered an ethical source of stem cells.

Adult stem cells (also referred to as “non-embryonic” stem cells) can be obtained from a donor or they can be autologous (from oneself) and are present in adults, children, infants, placentas, umbilical cords, and cadavers. Donor stem cells can be harvested from umbilical cords. Autologous (ones own) stem cells are harvested from bone marrow or fat.

3. How Does Stem Cell Therapy Work

 Stem cell therapy, when used for regenerative medicine, promotes the reparative response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. It is the next chapter of organ transplantation and uses cells instead of donor organs. 

 Stem cells can be manipulated to specialize into specific types of cells, such as heart muscle cells, blood cells or nerve cells. These specialized cells can then be implanted into a person. For example, if a person has liver disease, the cells could be injected into the liver. The healthy transplanted liver cells could then contribute to repairing defective liver cells.

4. What Is The Best Type Of Stem Cell To Use

  Autologous stem cells from bone marrow are the most common source for treating cartilage damage. These are collected easily without causing tissue damage, by drilling into bone and aspirating the bone marrow. Most common sites are the iliac crest, tibia and femur. 

 Adipose or stem cells harvested from fat can be used to help regenerate muscle, bone, liver, cartilage, pancreatic, endothelium and neurons. In nerve injuries these cells can help with regeneration of myelin and cell membrane stabilization. 

Umbilical cord stem cells from donor banks are now available. At a certain age umbilical cord stem cells may be a better option than the autologous bone marrow cells of an adult. The FDA is regulating claims from donor banks about the viability of these cells after processing, manipulation and freezing.

5. What Can Treated With Stem Cells

  Stem cells are currently being used for orthopedic cases for cartilage and other soft tissue injuries surrounding joints, reducing pain and increasing mobility. Cancer patients receive either autologous or donor stem cells after chemotherapy.  Auto-immune, neuro-degenerative, urological diseases such as interstitial cystitis have all been treated with stem cells. The P-shot and the O-shot are also being used to enhance sexual performance and experience in both men and women.

6. Where Are Stem Cell Treatments Performed 

 For the most part, stem cell treatments are performed in doctors’ offices and outpatient surgical centers. These treatments are performed by highly trained doctors and staff. Centers offering these services can be found by searching for Regenerative Medicine in your area. There are also other countries offering similar treatments around the world as part of the medical tourism industry. Some countries offer directed donor stem cell therapies from first line relatives, where stem cells are harvested from a first line relative. These can be stored and expanded as needed for future use. This is not allowed in the U.S. 

7. Results

 For years, Doctors have performed stem cell transplants, also known as bone marrow transplants. In stem cell transplants, stem cells replace cells damaged by chemotherapy or disease or as a way for the donor’s immune system to fight some types of cancer and blood-related diseases, such as leukemia. These transplants use adult stem cells or umbilical cord blood.

 Researchers have already shown that adult bone marrow cells guided to become heart-like cells can repair heart tissue in people. More research is ongoing.

 In recent clinical procedure involving over 1600 patients, the percentage of positive responses were as follows.

Orthopedics 80%

Cardiac 68%

Pulmonary 57%

Auto-immune 75%

Neuro-degenerative 63%

Interstitial Cystitis 84%

Erectile Dysfunction 63%

 8. Are Stem Cells Safe

 All medical treatments have benefits and risks and must be carefully weighed out between patient and doctor. 

 One concern with stem cell therapy is the potential of tumors. The delivery of a cell with unlimited potential for renewal and the capacity to differentiate into any human cell type carries a burden of safety concern not associated with any other class of treatment. Another safety issue that needs to be tackled by stem cell therapy providers is that of immune response. Both of these risks are mitigated by the use of Autologous Stem Cells. 

The FDA continues to increase its oversight and enforcement of regulations to protect patients, while continuing to encourage innovation so that the medical industry can properly harness the potential of stem cell products.

As written in Cell Stem Cell, https://www.cell.com/cell-stem-cell/issue?pii=S1934-5909(11)X0006-1 

It is not clear whether the state of our understanding is sufficient to appraise the safety of these therapies in a comprehensive manner, and we therefore require further sensitive and robust approaches in bio-analysis to monitor them. At a broader level, it is also important to raise the question of whether we are setting a higher bar for the clinical implementation of stem cell-derived therapeutics than we currently apply for other types of cellular therapy. There is a danger that if perfection is a prerequisite for beginning, then we will never begin. Ultimately, while stem cell therapy is an area of rapid advancement, the science of stem cell safety assessment must also evolve, not to hinder progress, but to support, guide, and expedite patient treatment. The development of such technology is necessary to ensure that we can proceed with appropriate safeguards in place and allow that stem cell-based therapeutic approaches develop in a way that benefits society overall.

9. Experimental treatment VS. Clinical Trial

 The fact that a procedure is experimental does not automatically mean that it is part of a research study or clinical trial. Insurance companies for example deem procedures experimental as an excuse not to pay for them.  As an example, some insurance companies have designated visco-supplementation as experimental despite the fact that visco-supplementation has a proven track record of over 20 years in reducing knee pain related to cartilage damage. 

 Responsibly conducted clinical trials are necessary for the development of new treatments and allow us to learn whether these treatments are safe and effective. Responsible clinical trials are characterized by a number of key factors. Number one, there must be preclinical data supporting that the treatment being tested is likely to be safe and effective. Before starting, there is oversight by an independent group, such as an Institutional Review Board or medical ethics committee that protect participants’ rights, and in many countries the trial is assessed and approved by a national regulatory agency, such as the U.S. Food and Drug Administration (FDA). The study must be designed to answer specific questions about a new treatment or a new way of using current treatments. 

10. The Placebo Effect 

  As with any therapy or trial, the placebo effect must be taken into consideration. There are four main reasons why a person might feel better that are unrelated to the actual treatment. Concomitant treatments (such as physical therapy), natural fluctuations of the disease or condition, the desire or belief that a treatment will work and the high cost of a procedure can cause a person to feel like it has to work and to even feel physical changes, such as improved movement and/or less pain. This is called the placebo effect. Sometimes just having a positive conversation with a doctor or spiritual guide can cause a person to feel better. Additional therapies offered in conjunction with stem cell treatment, such as changes to diet, relaxation, meditation, physical therapy, medication, etc. have the ability to help a person feel better in a way that is unrelated to the stem cells. Severity of symptoms of many conditions can change over time, waxing and waning resulting in either temporary improvement or decline.

Ref:

NIH Stem Cell Information Home Page. In Stem Cell Information [World Wide Web site]. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2016 [cited October 15, 2018]

Linda K. Bevington, MA, by CBHD in April 2005 under the title “Stem Cell Research and ‘Therapeutic’ Cloning: A Christian Analysis.” The piece was subsequently revised and updated by CBHD research staff in August 2009. 

Orlando G. Florete Jr., M.D. Therapeutic Options In Regenerative Medicine. August 2018

https://www.mayoclinic.org/tests-procedures/bone-marrow-transplant/in-depth/stem-cells/art-20048117

BiologyWise Staff Last Updated: Mar 7, 2018. Fascinating Facts About Stem Cell Research

International Society for Stem Cell Research http://www.isscr.org/

Assessing the Safety of Stem Cell Therapeutics 

https://doi.org/10.1016/j.stem.2011.05.012