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Brinsfield TN, Pinson NR, Levine AD. The evolution and ongoing challenge of unproven cell-based interventions. Stem Cells Transl Med 2024; 13:851-858. [PMID: 39045646 PMCID: PMC11386208 DOI: 10.1093/stcltm/szae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/23/2024] [Indexed: 07/25/2024] Open
Abstract
Unproven cell-based interventions (CBIs) emerged early in the 2000s as a particularly problematic form of unproven therapy and remain a vexing policy problem to this day. These unproven interventions can harm patients both physically and financially and can complicate the process of developing a rigorous evidence base to support the translation of novel stem cell or other cell therapies. In this concise review, we examine the emergence of unproven CBIs and the various policy approaches that have been pursued or proposed to address this problem. We review the evolution of this field over the last 2 decades and explore why these policy efforts have proven challenging. We conclude by highlighting potential directions that the field could evolve and urging continued attention to both current and future forms of unproven CBIs to minimize future risks to patients and the field and to promote the development of evidence-based cell therapies.
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Affiliation(s)
- Taylor N Brinsfield
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA 30332-0345, United States
| | - Noah R Pinson
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA 30332-0345, United States
| | - Aaron D Levine
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA 30332-0345, United States
- Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332-0363, United States
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Turner L, Wang JC, Martinez JR, Najjar S, Rajapaksha Arachchilage T, Sahrai V. US businesses engaged in direct-to-consumer marketing of perinatal stem cell interventions following the Food and Drug Administration's enforcement discretion era. Cytotherapy 2024; 26:393-403. [PMID: 38340106 DOI: 10.1016/j.jcyt.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AIMS The goal of this study was to analyze online marketing representations made by 300 US businesses selling allogeneic perinatal stem cell products. The study was conducted after a period of enforcement discretion by the US Food and Drug Administration (FDA). METHODS Data mining and content analysis were used to identify, analyze and categorize marketing claims made on the websites of 300 businesses selling perinatal stem cell interventions. RESULTS The study identified types of perinatal interventions companies advertised, geographic locations of clinics selling such products, types of companies operating in this space, diseases and injuries such businesses claim to treat, prices companies charge for such interventions, brand names of advertised perinatal cell products and identities of suppliers. CONCLUSIONS A substantial number of US businesses market unapproved perinatal stem cell products for various indications. This widespread commercial activity occurred following the conclusion of a period of enforcement discretion by the FDA and suggests the need for more robust and comprehensive regulatory responses to businesses selling unapproved perinatal stem cell products.
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Affiliation(s)
- Leigh Turner
- Program in Public Health, University of California Irvine, Irvine, California, USA; Department of Health, Society and Behavior, University of California Irvine, Irvine, California, USA; Sue and Bill Gross Stem Cell Research Center, University of California Irvine, Irvine, California, USA; Department of Family Medicine, University of California Irvine, Irvine, California, USA.
| | - Jia Chieng Wang
- Program in Public Health, University of California Irvine, Irvine, California, USA
| | - Juan Ramon Martinez
- Program in Public Health, University of California Irvine, Irvine, California, USA
| | - Shemms Najjar
- Program in Public Health, University of California Irvine, Irvine, California, USA
| | | | - Victoria Sahrai
- Program in Public Health, University of California Irvine, Irvine, California, USA
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Bin Abdul Aziz MF, Morrison M, Kaye J. Creative regulatory practices to develop stem-cell technology: the way forward for Malaysia. Regen Med 2021; 17:91-105. [PMID: 34905952 DOI: 10.2217/rme-2021-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Malaysia aspires to develop regenerative medicine through stem-cell technology. It needs a regulatory system that could facilitate development and prevent unethical practices. A comparative legal analysis on the regulation of stem-cell technology, with a focus on stem-cell research in Malaysia and selected Commonwealth countries that are experienced in regulating this complex technology, demonstrates that the selected Commonwealth countries have adopted a hybrid of different regulatory mechanisms. This paper argues that Malaysia should consider adopting a similar approach to equip relevant authorities with different regulatory mechanisms that are able to promote innovation in stem-cell research activities and cultivate a successful and profitable regenerative medicine industry in the future. Such a strategic action can produce an optimal regulatory outcome and help Malaysia to realize its aspiration.
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Affiliation(s)
- Mohammad Firdaus Bin Abdul Aziz
- Centre for Law and Ethics in Science and Technology (CELEST), Faculty of Law, Universiti Malaya, Kuala Lumpur, Malaysia.,Centre for Health, Law and Ethics of Emerging Technologies (HeLEX), Faculty of Law, University of Oxford, Oxford, United Kingdom
| | - Michael Morrison
- Centre for Health, Law and Ethics of Emerging Technologies (HeLEX), Faculty of Law, University of Oxford, Oxford, United Kingdom
| | - Jane Kaye
- Centre for Health, Law and Ethics of Emerging Technologies (HeLEX), Faculty of Law, University of Oxford, Oxford, United Kingdom
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Abstract
Aim: Explore the nature and extent of web-based promotion of stem cell treatments marketed by clinics in the UK. Materials & methods: Web-based analysis of clinics in the UK using predefined variables, with analysis of eligible clinics according to preset criteria of ethical relevance. Results: A majority (79%) of UK clinics were judged to be problematic. Information was found to be lacking, misleading or otherwise problematic in several respects, including a lack of information on risks of adverse effects, unjustifiably optimistic depictions of therapeutic effectiveness, and questionable presentational approaches such as the use of celebrity patient testimonials. Conclusion: In a majority of cases, commercial clinics in the UK portray stem-cell therapies on their websites in ethically questionable ways.
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Affiliation(s)
- Sami Kamel
- Division of Health Science, School of Applied Sciences, Abertay University, Dundee, DD1 1HG, UK
| | - Kevin R Smith
- Division of Health Science, School of Applied Sciences, Abertay University, Dundee, DD1 1HG, UK
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Cook M, Richey A, Brafman DA, Frow EK. Weighing up the evidence used by direct-to-consumer stem cell businesses. Stem Cell Reports 2021; 16:2852-2860. [PMID: 34767748 PMCID: PMC8693621 DOI: 10.1016/j.stemcr.2021.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/04/2022] Open
Abstract
Hundreds of businesses across the United States offer direct-to-consumer stem-cell-based interventions that have not been approved by the Food and Drug Administration. Here, we characterize the types of evidence used on the websites of 59 stem cell businesses in the Southwest United States to market their services. We identify over a dozen forms of evidence, noting that businesses are less likely to rely on “gold-standard” scientific evidence, like randomized clinical trials, and instead draw substantially on forms of evidence that we identify as being “ambiguous.” Ambiguous evidence has some scientific or medical basis, but its interpretation is highly context-dependent. These findings highlight the interpretive responsibility placed on prospective patients. We identify actions for regulators and professional societies to assist with evaluating evidence, but caution that focusing on the (in)validity of particular evidence types is unlikely to eliminate demand for stem-cell-based treatments in this complex marketplace. We characterize the evidence used by 59 stem cell businesses in the Southwest United States We identify that clinics rely on scientifically and medically “ambiguous” evidence Ambiguous evidence places interpretive responsibility on prospective patients We offer suggestions to help prospective patients navigate this complex landscape
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Affiliation(s)
- Margaret Cook
- School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Alexandra Richey
- School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - David A Brafman
- School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Emma K Frow
- School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA; School for the Future of Innovation in Society, Arizona State University, Tempe, AZ 85287, USA.
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Takashima K, Morrison M, Minari J. Reflection on the enactment and impact of safety laws for regenerative medicine in Japan. Stem Cell Reports 2021; 16:1425-1434. [PMID: 34019814 PMCID: PMC8190593 DOI: 10.1016/j.stemcr.2021.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023] Open
Abstract
Japan's Act on the Safety of Regenerative Medicine (ASRM) created an innovative regulatory framework intended to safely promote the clinical development of stem cell-based interventions (SCBIs) while subjecting commercialized unproven SCBIs to greater scrutiny and accountability. This article reviews ASRM's origins, explains its unprecedented scope, and assesses how it envisions the regulation of SCBIs. This analysis is used to highlight three key insights that are pertinent to the current revision of the ASRM: clarifying how the concept of safety should be defined and assessed in research and clinical care settings; revisiting risk criteria for review of SCBIs; and taking stronger measures to support the transition from unproven interventions to evidence-based therapies. Finally, the article reflects on lessons drawn from Japanese experiences in dealing with unproven SCBIs for international endeavors to regulate SCBIs.
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Affiliation(s)
- Kayo Takashima
- Uehiro Research Division of iPS Cell Ethics, Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan; Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba 277-856, Japan
| | - Michael Morrison
- Centre for Health, Law and Emerging Technologies (HeLEX), Faculty of Law, University of Oxford, Oxford OX2 7DD, UK; Institute for Science, Innovation and Society, School of Anthropology and Museum Ethnography, University of Oxford, Oxford OX2 6PN, UK.
| | - Jusaku Minari
- Uehiro Research Division of iPS Cell Ethics, Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan.
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Kader N, Asopa V, Baryeh K, Sochart D, Maffulli N, Kader D. Cell-based therapy in soft tissue sports injuries of the knee: a systematic review. Expert Opin Biol Ther 2021; 21:1035-1047. [PMID: 33399489 DOI: 10.1080/14712598.2021.1872538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION An ever-increasing number of clinics are offering purportedly 'regenerative' stem-cell treatments, although cell-based therapies may not primarily act as stem cells and have shown the ability to regenerate end-target tissues in some clinical studies only. We aim to systematically review the evidence for their use in soft-tissue sports injuries of the knee. AREAS COVERED A search for articles pertaining to the use of preparations of, or containing, mesenchymal stem cells (MSCs) in human subjects in sports knee injuries yielded 14 relevant results for inclusion after screening: 7 used cultured MSCs, 5 bone marrow concentrate (BMC), and the remaining 2 evaluated stromal vascular fraction (SVF) and tenocyte-like-cells. Most studies were level 3 or lower (n = 9). EXPERT OPINION There is insufficient high-quality evidence for the use of cell-based therapies that demonstrates either ligamentous or tendinous healing, meniscal volume restoration, or post-traumatic osteoarthritis amelioration/regression. Methods of cell harvesting, preparation, and application are highly heterogenous. Efforts should be directed toward standardization of protocols and their reporting, starting with more basic scientific investigations of MSCs and their niche, as well as rigorous, large clinical RCTs adhering to the reporting principles set out by recent expert consensus.
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Affiliation(s)
- Nardeen Kader
- South West London Elective Orthopaedic Centre, Epsom, UK
| | - Vipin Asopa
- South West London Elective Orthopaedic Centre, Epsom, UK
| | - Kwaku Baryeh
- South West London Elective Orthopaedic Centre, Epsom, UK
| | - David Sochart
- South West London Elective Orthopaedic Centre, Epsom, UK.,University of Salford, Manchester, UK
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK.,Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London, UK
| | - Deiary Kader
- South West London Elective Orthopaedic Centre, Epsom, UK.,Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
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