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Soni S, Antonescu L, Ro K, Horowitz JC, Mebratu YA, Nho RS. Influenza, SARS-CoV-2, and Their Impact on Chronic Lung Diseases and Fibrosis: Exploring Therapeutic Options. THE AMERICAN JOURNAL OF PATHOLOGY 2024:S0002-9440(24)00235-9. [PMID: 39032604 DOI: 10.1016/j.ajpath.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/11/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024]
Abstract
Respiratory tract infections represent a significant global public health concern, disproportionately affecting vulnerable populations such as children, the elderly, and immunocompromised individuals. RNA viruses, particularly influenza viruses and coronaviruses, significantly contribute to respiratory illnesses, especially in immunosuppressed and elderly individuals. Influenza A viruses (IAVs) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to pose global health threats due to their capacity to cause annual epidemics, with profound implications for public health. In addition, the increase in global life expectancy is influencing the dynamics and outcomes of respiratory viral infections. Understanding the molecular mechanisms by which IAVs and SARS-CoV-2 contribute to lung disease progression is therefore crucial. The aim of this review was to comprehensively explore the impact of IAVs and SARS-CoV-2 on chronic lung diseases, with a specific focus on pulmonary fibrosis in the elderly. It also outlines potential preventive and therapeutic strategies and suggests directions for future research.
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Affiliation(s)
- Sourabh Soni
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Laura Antonescu
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Kaylin Ro
- Scripps Research Institute, San Diego, California
| | - Jeffrey C Horowitz
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Yohannes A Mebratu
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio.
| | - Richard S Nho
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio.
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2
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Basil MC, Alysandratos KD, Kotton DN, Morrisey EE. Lung repair and regeneration: Advanced models and insights into human disease. Cell Stem Cell 2024; 31:439-454. [PMID: 38492572 PMCID: PMC11070171 DOI: 10.1016/j.stem.2024.02.009] [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: 12/05/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
The respiratory system acts as both the primary site of gas exchange and an important sensor and barrier to the external environment. The increase in incidences of respiratory disease over the past decades has highlighted the importance of developing improved therapeutic approaches. This review will summarize recent research on the cellular complexity of the mammalian respiratory system with a focus on gas exchange and immunological defense functions of the lung. Different models of repair and regeneration will be discussed to help interpret human and animal data and spur the investigation of models and assays for future drug development.
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Affiliation(s)
- Maria C Basil
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn, Children's Hospital of Philadelphia (CHOP) Lung Biology Institute, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Konstantinos-Dionysios Alysandratos
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02118, USA; The Pulmonary Center and Department of Medicine, Boston University and Boston Medical Center, Boston, MA 02118, USA.
| | - Darrell N Kotton
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02118, USA; The Pulmonary Center and Department of Medicine, Boston University and Boston Medical Center, Boston, MA 02118, USA.
| | - Edward E Morrisey
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn, Children's Hospital of Philadelphia (CHOP) Lung Biology Institute, University of Pennsylvania, Philadelphia, PA 19104, USA.
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3
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Dulak J, Pecyna M. Unproven cell interventions in Poland and the exploitation of European Union law on advanced therapy medicinal products. Stem Cell Reports 2023; 18:1610-1620. [PMID: 37390824 PMCID: PMC10444563 DOI: 10.1016/j.stemcr.2023.05.017] [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: 11/22/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 07/02/2023] Open
Abstract
The global threat of unproven "stem cell therapies" develops despite the repeated statements of scientific organizations and regulatory agencies warning about the improper rationale, lack of effectiveness, and potential health risks of such commercial activities. Here, this problem is discussed from Poland's perspective, where unjustified "stem cell medical experiments" have raised the concern of responsible scientists and physicians. The paper describes how the European Union law on advanced therapy medicinal products and the hospital exemption rule have been used improperly and unlawfully on a mass scale. The article indicates serious scientific, medical, legal, and social issues of these activities.
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Affiliation(s)
- Józef Dulak
- Department of Medical Biotechnology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland.
| | - Marlena Pecyna
- Chair of Civil Law, Faculty of Law and Administration, Jagiellonian University, Kraków, Poland.
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4
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Ikonomou L, Magnusson M, Dries R, Herzog EL, Hynds RE, Borok Z, Park JA, Skolasinski S, Burgess JK, Turner L, Mojarad SM, Mahoney JE, Lynch T, Lehmann M, Thannickal VJ, Hook JL, Vaughan AE, Hoffman ET, Weiss DJ, Ryan AL. Stem cells, cell therapies, and bioengineering in lung biology and disease 2021. Am J Physiol Lung Cell Mol Physiol 2022; 323:L341-L354. [PMID: 35762622 PMCID: PMC9484991 DOI: 10.1152/ajplung.00113.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022] Open
Abstract
The 9th biennial conference titled "Stem Cells, Cell Therapies, and Bioengineering in Lung Biology and Diseases" was hosted virtually, due to the ongoing COVID-19 pandemic, in collaboration with the University of Vermont Larner College of Medicine, the National Heart, Lung, and Blood Institute, the Alpha-1 Foundation, the Cystic Fibrosis Foundation, and the International Society for Cell & Gene Therapy. The event was held from July 12th through 15th, 2021 with a pre-conference workshop held on July 9th. As in previous years, the objectives remained to review and discuss the status of active research areas involving stem cells (SCs), cellular therapeutics, and bioengineering as they relate to the human lung. Topics included 1) technological advancements in the in situ analysis of lung tissues, 2) new insights into stem cell signaling and plasticity in lung remodeling and regeneration, 3) the impact of extracellular matrix in stem cell regulation and airway engineering in lung regeneration, 4) differentiating and delivering stem cell therapeutics to the lung, 5) regeneration in response to viral infection, and 6) ethical development of cell-based treatments for lung diseases. This selection of topics represents some of the most dynamic and current research areas in lung biology. The virtual workshop included active discussion on state-of-the-art methods relating to the core features of the 2021 conference, including in situ proteomics, lung-on-chip, induced pluripotent stem cell (iPSC)-airway differentiation, and light sheet microscopy. The conference concluded with an open discussion to suggest funding priorities and recommendations for future research directions in basic and translational lung biology.
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Affiliation(s)
- Laertis Ikonomou
- Department of Oral Biology, University at Buffalo, State University of New York, Buffalo, New York
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York
| | - Mattias Magnusson
- Division of Molecular Medicine and Gene Therapy, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Ruben Dries
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Erica L Herzog
- Yale Interstitial Lung Disease Center of Excellence, Pulmonary and Critical Care Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Robert E Hynds
- Epithelial Cell Biology in ENT Research Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Zea Borok
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, California
| | - Jin-Ah Park
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Janette K Burgess
- Department of Pathology and Medical Biology, Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Leigh Turner
- Department of Health, Society, and Behavior, University of California, Irvine Program In Public Health, Irvine, California
| | - Sarah M Mojarad
- Engineering in Society Program, Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | | | - Thomas Lynch
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Mareike Lehmann
- Institute of Lung Health and Immunity, Comprehensive Pneumology Center Munich, Helmholtz Zentrum München, Munich, Germany
| | - Victor J Thannickal
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jamie L Hook
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
- Global Health and Emerging Pathogens Institute, Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Andrew E Vaughan
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Evan T Hoffman
- Department of Medicine, University of Vermont, Burlington, Vermont
| | - Daniel J Weiss
- Department of Medicine, University of Vermont, Burlington, Vermont
| | - Amy L Ryan
- Hastings Center for Pulmonary Research, Department of Medicine, University of Southern California, Los Angeles, California
- Department of Stem Cell and Regenerative Medicine, University of Southern California, Los Angeles, California
- Department of Anatomy and Cell Biology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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5
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Chavez J, Shah NA, Ruoss S, Cuomo RE, Ward SR, Mackey TK. Online marketing practices of regenerative medicine clinics in US-Mexico border region: a web surveillance study. Stem Cell Res Ther 2021; 12:189. [PMID: 33736697 PMCID: PMC7977255 DOI: 10.1186/s13287-021-02254-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The potential of regenerative medicine to improve human health has led to the rapid expansion of stem cell clinics throughout the world with varying levels of regulation and oversight. This has led to a market ripe for stem cell tourism, with Tijuana, Mexico, as a major destination. In this study, we characterize the online marketing, intervention details, pricing of services, and assess potential safety risks through web surveillance of regenerative medicine clinics marketing services in Tijuana. Methods We conducted structured online search queries from March to April 2019 using 296 search terms in English and Spanish on two search engines (Google and Bing) to identify websites engaged in direct-to-consumer advertising of regenerative medicine services. We performed content analysis to characterize three categories of interest: online presence, tokens of scientific legitimacy, and intervention details. Results Our structured online searches resulted in 110 unique websites located in Tijuana corresponding to 76 confirmed locations. These clinics’ online presence consisted of direct-to-consumer advertising mainly through a dedicated website (94.5%) or Facebook page (65.5%). The vast majority of these websites (99.1%) did not mention any affiliation to an academic institutions or other overt tokens of scientific legitimacy. Most clinics claimed autologous tissue was the source of treatments (67.3%) and generally did not specify route of administration. Additionally, of the Tijuana clinics identified, 13 claimed licensing, though only 1 matched with available licensing information. Conclusions Regenerative medicine clinics in Tijuana have a significant online presence using direct-to-consumer advertising to attract stem-cell tourism clientele in a bustling border region between Mexico and the USA. This study adds to existing literature evidencing the unregulated nature of online stem cell offerings and provides further evidence of the need for regulatory harmonization, particularly to address stem cell services being offered online across borders. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02254-4.
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Affiliation(s)
- Javier Chavez
- Masters Program in Clinical Research, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Neal A Shah
- Department of Healthcare Research and Policy, UC San Diego - Extension, 8950 Villa La Jolla Drive Suite A124, San Diego, CA, 92037, USA.,Global Health Policy and Data Institute, San Diego, CA, USA
| | - Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, CA, USA.,Department of Anesthesiology and Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery and Department of Radiology, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Tim K Mackey
- Department of Healthcare Research and Policy, UC San Diego - Extension, 8950 Villa La Jolla Drive Suite A124, San Diego, CA, 92037, USA. .,Global Health Policy and Data Institute, San Diego, CA, USA. .,Department of Anesthesiology and Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA. .,S-3 Research, LLC, San Diego, CA, USA.
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6
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Abstract
The mammalian lung epithelium is composed of a wide array of specialized cells that have adapted to survive environmental exposure and perform the tasks necessary for respiration. Although the majority of these cells are remarkably quiescent during adult lung homeostasis, a growing body of literature has demonstrated the capacity of these epithelial lineages to proliferate in response to injury and regenerate lost or damaged cells. In this review, we focus on the regionally distinct lung epithelial cell types that contribute to repair after injury, and we address current controversies regarding whether elite stem cells or frequent facultative progenitors are the predominant participants. We also shed light on the newly emerging approaches for exogenously generating similar lung epithelial lineages from pluripotent stem cells.
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Affiliation(s)
- Konstantinos-Dionysios Alysandratos
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, Massachusetts 02118, USA;
- The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA
| | - Michael J Herriges
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, Massachusetts 02118, USA;
- The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA
| | - Darrell N Kotton
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, Massachusetts 02118, USA;
- The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA
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7
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Translating Basic Research into Safe and Effective Cell-based Treatments for Respiratory Diseases. Ann Am Thorac Soc 2020; 16:657-668. [PMID: 30917290 DOI: 10.1513/annalsats.201812-890cme] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Respiratory diseases, such as chronic obstructive pulmonary disease and pulmonary fibrosis, result in severely impaired quality of life and impose significant burdens on healthcare systems worldwide. Current disease management involves pharmacologic interventions, oxygen administration, reduction of infections, and lung transplantation in advanced disease stages. An increasing understanding of mechanisms of respiratory epithelial and pulmonary vascular endothelial maintenance and repair and the underlying stem/progenitor cell populations, including but not limited to airway basal cells and type II alveolar epithelial cells, has opened the possibility of cell replacement-based regenerative approaches for treatment of lung diseases. Further potential for personalized therapies, including in vitro drug screening, has been underscored by the recent derivation of various lung epithelial, endothelial, and immune cell types from human induced pluripotent stem cells. In parallel, immunomodulatory treatments using allogeneic or autologous mesenchymal stromal cells have shown a good safety profile in clinical investigations for acute inflammatory conditions, such as acute respiratory distress syndrome and septic shock. However, as yet, no cell-based therapy has been shown to be both safe and effective for any lung disease. Despite the investigational status of cell-based interventions for lung diseases, businesses that market unproven, unlicensed and potentially harmful cell-based interventions for respiratory diseases have proliferated in the United States and worldwide. The current status of various cell-based regenerative approaches for lung disease as well as the effect of the regulatory environment on clinical translation of such approaches are presented and critically discussed in this review.
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8
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Bartlett RD, Burley S, Ip M, Phillips JB, Choi D. Cell Therapies for Spinal Cord Injury: Trends and Challenges of Current Clinical Trials. Neurosurgery 2020; 87:E456-E472. [DOI: 10.1093/neuros/nyaa149] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 03/11/2020] [Indexed: 12/22/2022] Open
Abstract
Abstract
Cell therapies have the potential to revolutionize the treatment of spinal cord injury. Basic research has progressed significantly in recent years, with a plethora of cell types now reaching early-phase human clinical trials, offering new strategies to repair the spinal cord. However, despite initial enthusiasm for preclinical and early-phase clinical trials, there has been a notable hiatus in the translation of cell therapies to routine clinical practice. Here, we review cell therapies that have reached clinical trials for spinal cord injury, providing a snapshot of all registered human trials and a summary of all published studies. Of registered trials, the majority have used autologous cells and approximately a third have been government funded, a third industry sponsored, and a third funded by university or healthcare systems. A total of 37 cell therapy trials have been published, primarily using stem cells, although a smaller number have used Schwann cells or olfactory ensheathing cells. Significant challenges remain for cell therapy trials in this area, including achieving stringent regulatory standards, ensuring appropriately powered efficacy trials, and establishing sustainable long-term funding. However, cell therapies hold great promise for human spinal cord repair and future trials must continue to capitalize on the exciting developments emerging from preclinical studies.
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Affiliation(s)
- Richard D Bartlett
- Centre for Nerve Engineering, University College London, London, United Kingdom
- Department of Pharmacology, UCL School of Pharmacy, University College London, London, United Kingdom
- Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, United Kingdom
| | - Sarah Burley
- Centre for Nerve Engineering, University College London, London, United Kingdom
| | - Mina Ip
- Centre for Nerve Engineering, University College London, London, United Kingdom
| | - James B Phillips
- Centre for Nerve Engineering, University College London, London, United Kingdom
- Department of Pharmacology, UCL School of Pharmacy, University College London, London, United Kingdom
| | - David Choi
- Centre for Nerve Engineering, University College London, London, United Kingdom
- Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, United Kingdom
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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9
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Abstract
Abstract
Purpose of Review
Mesenchymal stromal cell (MSC)–based therapies provide a platform for new therapeutic strategies in lung diseases. This review provides an overview of the current status of the field, along with some of the challenges ahead including better understanding of MSC actions in different lung diseases, personalized approaches to select patients most likely to benefit, and the growing problem of stem cell tourism.
Recent Findings
A newly evolving concept suggests that MSCs shape their immunomodulatory actions depending on the environment they encounter. Furthermore, in some models, it appears that dying or dead cells may contribute to the therapeutic efficacy by activating the host response.
Summary
Despite many pre-clinical studies demonstrating that MSCs can be used to treat lung disorders, clinical trials have failed to show improved outcome. Understanding the complex interaction between MSCs and the host microenvironment is likely to be an important area for enhancing the efficacy of MSC-based cell therapies.
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10
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Ryan AL, Ikonomou L, Atarod S, Bölükbas DA, Collins J, Freishtat R, Hawkins F, Gilpin SE, Uhl FE, Uriarte JJ, Weiss DJ, Wagner DE. Stem Cells, Cell Therapies, and Bioengineering in Lung Biology and Diseases 2017. An Official American Thoracic Society Workshop Report. Am J Respir Cell Mol Biol 2020; 61:429-439. [PMID: 31573338 PMCID: PMC6775946 DOI: 10.1165/rcmb.2019-0286st] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The University of Vermont Larner College of Medicine, in collaboration with the National Heart, Lung, and Blood Institute (NHLBI), the Alpha-1 Foundation, the American Thoracic Society, the Cystic Fibrosis Foundation, the European Respiratory Society, the International Society for Cell & Gene Therapy, and the Pulmonary Fibrosis Foundation, convened a workshop titled "Stem Cells, Cell Therapies, and Bioengineering in Lung Biology and Diseases" from July 24 through 27, 2017, at the University of Vermont, Burlington, Vermont. The conference objectives were to review and discuss current understanding of the following topics: 1) stem and progenitor cell biology and the role that they play in endogenous repair or as cell therapies after lung injury, 2) the emerging role of extracellular vesicles as potential therapies, 3) ex vivo bioengineering of lung and airway tissue, and 4) progress in induced pluripotent stem cell protocols for deriving lung cell types and applications in disease modeling. All of these topics are research areas in which significant and exciting progress has been made over the past few years. In addition, issues surrounding the ethics and regulation of cell therapies worldwide were discussed, with a special emphasis on combating the growing problem of unproven cell interventions being administered to patients with lung diseases. Finally, future research directions were discussed, and opportunities for both basic and translational research were identified.
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Abstract
As the prevalence and impact of lung diseases continue to increase worldwide, new therapeutic strategies are desperately needed. Advances in lung-regenerative medicine, a broad field encompassing stem cells, cell-based therapies, and a range of bioengineering approaches, offer new insights into and new techniques for studying lung physiology and pathophysiology. This provides a platform for the development of novel therapeutic approaches. Applicability to chronic obstructive pulmonary disease of recent advances and applications in cell-based therapies, predominantly those with mesenchymal stromal cell-based approaches, and bioengineering approaches for lung diseases are reviewed.
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12
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Skolasinski SD, Panoskaltsis-Mortari A. Lung tissue bioengineering for chronic obstructive pulmonary disease: overcoming the need for lung transplantation from human donors. Expert Rev Respir Med 2019; 13:665-678. [PMID: 31164014 DOI: 10.1080/17476348.2019.1624163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) affects more than 380 million people, causing more than 3 million deaths annually worldwide. Despite this enormous burden, currently available therapies are largely limited to symptom control. Lung transplant is considered for end-stage disease but is severely limited by the availability of human organs. Furthermore, the pre-transplant course is a complex orchestration of locating and harvesting suitable lungs, and the post-transplant course is complicated by rejection and infection. Lung tissue bioengineering has the potential to relieve the organ shortage and improve the post-transplant course by generating patient-specific lungs for transplant. Additionally, emerging progenitor cell therapies may facilitate in vivo regeneration of pulmonary tissue, obviating the need for transplant. Areas Covered: We review several lung tissue bioengineering approaches including the recellularization of decellularized scaffolds, 3D bioprinting, genetically-engineered xenotransplantation, blastocyst complementation, and direct therapy with progenitor cells. Articles were identified by searching relevant terms (see Key Words) in the PubMed database and selected for inclusion based on novelty and uniqueness of their approach. Expert Opinion: Lung tissue bioengineering research is in the early stages. Of the methods reviewed, only direct cell therapy has been investigated in humans. We anticipate a minimum of 5-10 years before human therapy will be feasible.
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Affiliation(s)
- Steven D Skolasinski
- a Division of Pulmonary, Allergy, Critical Care and Sleep Medicine , University of Minnesota , Minneapolis , MN , USA
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13
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Clinical Application of Stem/Stromal Cells in COPD. STEM CELL-BASED THERAPY FOR LUNG DISEASE 2019. [PMCID: PMC7121219 DOI: 10.1007/978-3-030-29403-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive life-threatening disease that is significantly increasing in prevalence and is predicted to become the third leading cause of death worldwide by 2030. At present, there are no true curative treatments that can stop the progression of the disease, and new therapeutic strategies are desperately needed. Advances in cell-based therapies provide a platform for the development of new therapeutic approaches in severe lung diseases such as COPD. At present, a lot of focus is on mesenchymal stem (stromal) cell (MSC)-based therapies, mainly due to their immunomodulatory properties. Despite increasing number of preclinical studies demonstrating that systemic MSC administration can prevent or treat experimental COPD and emphysema, clinical studies have not been able to reproduce the preclinical results and to date no efficacy or significantly improved lung function or quality of life has been observed in COPD patients. Importantly, the completed appropriately conducted clinical trials uniformly demonstrate that MSC treatment in COPD patients is well tolerated and no toxicities have been observed. All clinical trials performed so far, have been phase I/II studies, underpowered for the detection of potential efficacy. There are several challenges ahead for this field such as standardized isolation and culture procedures to obtain a cell product with high quality and reproducibility, administration strategies, improvement of methods to measure outcomes, and development of potency assays. Moreover, COPD is a complex pathology with a diverse spectrum of clinical phenotypes, and therefore it is essential to develop methods to select the subpopulation of patients that is most likely to potentially respond to MSC administration. In this chapter, we will discuss the current state of the art of MSC-based cell therapy for COPD and the hurdles that need to be overcome.
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14
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Bauer G, Elsallab M, Abou-El-Enein M. Concise Review: A Comprehensive Analysis of Reported Adverse Events in Patients Receiving Unproven Stem Cell-Based Interventions. Stem Cells Transl Med 2018; 7:676-685. [PMID: 30063299 PMCID: PMC6127222 DOI: 10.1002/sctm.17-0282] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023] Open
Abstract
The promise of stem cell (SC) therapies to restore functions of damaged tissues and organs brings enormous hope to patients, their families, loved ones, and caregivers. However, limits may exist for which indications SC therapies might be useful, efficacious, and safe. Applications of innovative therapies within regulatory boundaries and within the framework of controlled clinical trials are the norm in the scientific and medical community; such a system minimizes patient risk by setting a clear and acceptable safety and efficacy profile for new therapeutics before marketing authorization. This careful clinical validation approach often takes time, which patients suffering from terminal or debilitating diseases do not have. Not validated, unproven stem cell interventions (SCI) that promise a working treatment or cure for severe diseases have therefore found their way into the patient community, and providers of such treatments often take advantage of the public's willingness to pay large amounts of money for the misguided hope of a reliable recovery from their illnesses. We conducted a review of scientific publications, clinical case reports, and mass media publications to assess the reported cases and safety incidents associated with unproven SCI. The review also analyzes the main factors that were identified as contributing to the emergence and global rise of the “stem cell tourism” phenomenon. stemcellstranslationalmedicine2018;1–10
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Affiliation(s)
- Gerhard Bauer
- University of California Davis, Institute For Regenerative Cures (IRC), Sacramento, California, USA
| | - Magdi Elsallab
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charite' - Universitatsmedizin Berlin, Berlin, Germany
| | - Mohamed Abou-El-Enein
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charite' - Universitatsmedizin Berlin, Berlin, Germany
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15
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De Santis MM, Bölükbas DA, Lindstedt S, Wagner DE. How to build a lung: latest advances and emerging themes in lung bioengineering. Eur Respir J 2018; 52:13993003.01355-2016. [PMID: 29903859 DOI: 10.1183/13993003.01355-2016] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 05/30/2018] [Indexed: 12/19/2022]
Abstract
Chronic respiratory diseases remain a major cause of morbidity and mortality worldwide. The only option at end-stage disease is lung transplantation, but there are not enough donor lungs to meet clinical demand. Alternative options to increase tissue availability for lung transplantation are urgently required to close the gap on this unmet clinical need. A growing number of tissue engineering approaches are exploring the potential to generate lung tissue ex vivo for transplantation. Both biologically derived and manufactured scaffolds seeded with cells and grown ex vivo have been explored in pre-clinical studies, with the eventual goal of generating functional pulmonary tissue for transplantation. Recently, there have been significant efforts to scale-up cell culture methods to generate adequate cell numbers for human-scale bioengineering approaches. Concomitantly, there have been exciting efforts in designing bioreactors that allow for appropriate cell seeding and development of functional lung tissue over time. This review aims to present the current state-of-the-art progress for each of these areas and to discuss promising new ideas within the field of lung bioengineering.
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Affiliation(s)
- Martina M De Santis
- Lung Bioengineering and Regeneration, Dept of Experimental Medical Sciences, Lund University, Lund, Sweden.,Lung Repair and Regeneration (LRR), Comprehensive Pneumology Center (CPC), Helmholtz Zentrum Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.,Stem Cell Centre, Lund University, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Deniz A Bölükbas
- Lung Bioengineering and Regeneration, Dept of Experimental Medical Sciences, Lund University, Lund, Sweden.,Stem Cell Centre, Lund University, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Sandra Lindstedt
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Dept of Cardiothoracic Surgery, Heart and Lung Transplantation, Lund University Hospital, Lund, Sweden
| | - Darcy E Wagner
- Lung Bioengineering and Regeneration, Dept of Experimental Medical Sciences, Lund University, Lund, Sweden .,Lung Repair and Regeneration (LRR), Comprehensive Pneumology Center (CPC), Helmholtz Zentrum Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.,Stem Cell Centre, Lund University, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
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16
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Bobba S, Di Girolamo N, Munsie M, Chen F, Pébay A, Harkin D, Hewitt AW, O'Connor M, McLenachan S, Shadforth AMA, Watson SL. The current state of stem cell therapy for ocular disease. Exp Eye Res 2018; 177:65-75. [PMID: 30029023 DOI: 10.1016/j.exer.2018.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/16/2018] [Accepted: 07/16/2018] [Indexed: 12/13/2022]
Abstract
Herein, we review the safety, efficacy, regulatory standards and ethical implications of the use of stem cells in ocular disease. A literature review was conducted, registered clinical trials reviewed, and expert opinions sought. Guidelines and codes of conduct from international societies and professional bodies were also reviewed. Collated data is presented on current progress in the field of ocular regenerative medicine, future challenges, the clinical trial process and ethical considerations in stem cell therapy. A greater understanding of the function and location of ocular stem cells has led to rapid advances in possible therapeutic applications. However, in the context of significant technical challenges and potential long-term complications, it is imperative that stem cell practices operate within formal clinical trial frameworks. While there remains broad scope for innovation, ongoing evidence-based review of potential interventions and the development of standardized protocols are necessary to ensure patient safety and best practice in ophthalmic care.
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Affiliation(s)
- Samantha Bobba
- Prince of Wales Hospital Clinical School, High Street, Randwick, Sydney, New South Wales, 2031, Australia.
| | - Nick Di Girolamo
- School of Medical Sciences, University of New South Wales, Kensington, Sydney, New South Wales, 2052, Australia
| | - Megan Munsie
- Centre for Stem Cell Systems, School of Biomedical Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Fred Chen
- Lions Eye Institute, 2 Verdun Street, Nedlands, Western Australia, 6009, Australia
| | - Alice Pébay
- Centre for Stem Cell Systems, School of Biomedical Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia; Centre for Eye Research Australia, Level 7/32 Gisborne Street, East Melbourne, Victoria, 3002, Australia
| | - Damien Harkin
- School of Biomedical Sciences, Queensland University of Technology, 2 George Street, Brisbane, Queensland, 4000, Australia
| | - Alex W Hewitt
- Centre for Eye Research Australia, Level 7/32 Gisborne Street, East Melbourne, Victoria, 3002, Australia; School of Medicine, University of Tasmania, Churchill Avenue, Hobart, Tasmania, 7005, Australia
| | - Michael O'Connor
- School of Medicine, Western Sydney University, Victoria Road Parramatta, New South Wales, Parramatta, 2150, Australia
| | - Samuel McLenachan
- Centre for Ophthalmology and Visual Science, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Audra M A Shadforth
- School of Biomedical Sciences, Queensland University of Technology, 2 George Street, Brisbane, Queensland, 4000, Australia
| | - Stephanie L Watson
- Prince of Wales Hospital Clinical School, High Street, Randwick, Sydney, New South Wales, 2031, Australia; Save Sight Institute, University of Sydney, 8 Macquarie Street, Sydney, New South Wales, 2000, Australia; Sydney Eye Hospital, 8 Macquarie Street, Sydney, New South Wales, 2000, Australia.
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17
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Datta S. An endogenous explanation of growth: direct-to-consumer stem cell therapies in PR China, India and the USA. Regen Med 2018; 13:559-579. [PMID: 30129871 DOI: 10.2217/rme-2017-0144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The recent expansion of direct-to-consumer stem cell therapies (DSCTs) across nations where medical malpractice laws are the strongest globally challenges the causal assumption that low regulatory standards in developing countries bolster DSCTs. Drawing on firm-level data of existing biopharmaceuticals, approved stem cell therapies (SCTs) and DSCT clinics across the USA, PR China and India, this paper provides an innovation studies perspective of the ways in which the paradigmatic shift in fundamental knowledge production - from in vitro to in vivo stem cells - is transforming SCT discovery and delivery. It argues that the endogenous and inherent disruptive attributes of SCTs, rather than exogenous conditions like regulations, provide a substantive explanation for the recent expansion of DSCTs and urges regulatory adaptation to endogenous imperatives for effective governance of SCTs.
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Affiliation(s)
- Saheli Datta
- King's College London, Global Health & Social Medicine Strand, London WC2R 2LS, UK
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18
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Wagner DE, Turner L, Panoskaltsis-Mortari A, Weiss DJ, Ikonomou L. Co-opting of ClinicalTrials.gov by patient-funded studies. THE LANCET RESPIRATORY MEDICINE 2018; 6:579-581. [PMID: 29934051 DOI: 10.1016/s2213-2600(18)30242-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Darcy E Wagner
- Department of Experimental Medical Sciences, Wallenberg Center for Molecular Medicine, and Lund Stem Cell Center, Faculty of Medicine, Lund University, Lund, Sweden
| | - Leigh Turner
- Center for Bioethics, School of Public Health and College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | | | - Daniel J Weiss
- University of Vermont College of Medicine, Burlington, VT, USA
| | - Laertis Ikonomou
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; Center for Regenerative Medicine of Boston University and Boston Medical Center, Boston, MA 02118, USA.
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19
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Broekman W, Khedoe PPSJ, Schepers K, Roelofs H, Stolk J, Hiemstra PS. Mesenchymal stromal cells: a novel therapy for the treatment of chronic obstructive pulmonary disease? Thorax 2018; 73:565-574. [PMID: 29653970 PMCID: PMC5969341 DOI: 10.1136/thoraxjnl-2017-210672] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 03/18/2018] [Accepted: 03/26/2018] [Indexed: 12/11/2022]
Abstract
COPD is characterised by tissue destruction and inflammation. Given the lack of curative treatments and the progressive nature of the disease, new treatments for COPD are highly relevant. In vitro cell culture and animal studies have demonstrated that mesenchymal stromal cells (MSCs) have the capacity to modify immune responses and to enhance tissue repair. These properties of MSCs provided a rationale to investigate their potential for treatment of a variety of diseases, including COPD. Preclinical models support the hypothesis that MSCs may have clinical efficacy in COPD. However, although clinical trials have demonstrated the safety of MSC treatment, thus far they have not provided evidence for MSC efficacy in the treatment of COPD. In this review, we discuss the rationale for MSC-based cell therapy in COPD, the main findings from in vitro and in vivo preclinical COPD model studies, clinical trials in patients with COPD and directions for further research.
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Affiliation(s)
- Winifred Broekman
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Padmini P S J Khedoe
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen Schepers
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Helene Roelofs
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Stolk
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
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20
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Sipp D, Caulfield T, Kaye J, Barfoot J, Blackburn C, Chan S, De Luca M, Kent A, McCabe C, Munsie M, Sleeboom-Faulkner M, Sugarman J, van Zimmeren E, Zarzeczny A, Rasko JEJ. Marketing of unproven stem cell-based interventions: A call to action. Sci Transl Med 2018; 9:9/397/eaag0426. [PMID: 28679655 DOI: 10.1126/scitranslmed.aag0426] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 11/06/2016] [Accepted: 02/27/2017] [Indexed: 11/03/2022]
Abstract
Commercial promotion of unsupported therapeutic uses of stem cells is a global problem that has proven resistant to regulatory efforts. Here, we suggest a coordinated approach at the national and international levels focused on engagement, harmonization, and enforcement to reduce the risks associated with direct-to-consumer marketing of unproven stem cell treatments.
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Affiliation(s)
- Douglas Sipp
- Riken Center for Developmental Biology, 2-2-3 Minatojima Minamimachi, Kobe 650-0047, Japan. .,Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.,Global Initiatives, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.,Riken Center for Advanced Intelligence Project, 1-4-1 Nihonbashi, Chuo-ku, Tokyo 103-0027, Japan
| | - Timothy Caulfield
- Faculty of Law and School of Public Health, 461 Law Centre, University of Alberta, Edmonton, Alberta T6G 2H5, Canada.,Faculty of Law and School of Public Health, 461 Law Centre, University of Alberta, Edmonton, Alberta T6G 2H5, Canada
| | - Jane Kaye
- Department of Public Health, University of Oxford, Oxford, UK
| | - Jan Barfoot
- Medical Research Council Centre for Regenerative Medicine, School of Biological Sciences, University of Edinburgh, 5 Little France Drive, Edinburgh EH16 4UU, UK
| | - Clare Blackburn
- Medical Research Council Centre for Regenerative Medicine, School of Biological Sciences, University of Edinburgh, 5 Little France Drive, Edinburgh EH16 4UU, UK
| | - Sarah Chan
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Nine Bioquarter, 9 Little France Road, Edinburgh EH16 4UX, UK
| | - Michele De Luca
- Center for Regenerative Medicine "Stefano Ferrari," Department of Life Sciences, University of Modena and Reggio Emilia, Via G. Gottardi 100, 41125 Modena, Italy
| | - Alastair Kent
- Genetic Alliance UK, Level 3 Barclay House, 37 Queen Square, London WC1N 3BH, UK
| | - Christopher McCabe
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada
| | - Megan Munsie
- Centre for Stem Cell Systems, Department of Anatomy and Neuroscience, School of Biomedical Science, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Level 2, Kenneth Myer Building, 30 Royal Parade Parkville, 3010 Victoria, Australia.,Education, Ethics, Law and Community Awareness Unit, Stem Cells Australia, University of Melbourne, Level 2, Kenneth Myer Building, 30 Royal Parade Parkville, 3010 Victoria, Australia
| | | | - Jeremy Sugarman
- Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Esther van Zimmeren
- University of Antwerp, Faculty of Law, Research Group Government and Law, Venusstraat 23, 2000 Antwerp, Belgium
| | - Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, 110-2 Research Drive, Regina, Saskatchewan S4S 7H1, Canada
| | - John E J Rasko
- Sydney Medical School, University of Sydney, Sydney, Australia. .,Gene and Stem Cell Therapy Program, Centenary Institute, Sydney, Australia.,Department of Cell and Molecular Therapies, Royal Prince Alfred Hospital, Level 2, Building 89, Missenden Road, Camperdown, New South Wales 2050, Australia
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21
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Very Small Embryonic-like Stem Cells Are Mobilized in Human Peripheral Blood during Hypoxemic COPD Exacerbations and Pulmonary Hypertension. Stem Cell Rev Rep 2018; 13:561-566. [PMID: 28285391 DOI: 10.1007/s12015-017-9732-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Very small embryonic-like stem cells (VSELs) are major pluripotent stem cells involved in vascular and tissue regeneration and constitute a recruitable pool of stem/progenitor cells with putative instrumental role in organ repair. Here, we hypothesized that VSELs might be mobilized from the bone marrow (BM) to peripheral blood (PB) in patients with hypoxic lung disease or pulmonary hypertension (PH). The objective of the present study was then to investigate the changes in VSELs number in peripheral blood of patients with hypoxic lung disease and PH. We enrolled 26 patients with Chronic Obstructive Pulmonary Disease (COPD) with or without hypoxemia, 13 patients with PH and 20 controls without any respiratory or cardiovascular diseases. In PH patients, VSELs levels have been determined during right heart catheterization in pulmonary blood and PB. For this purpose, mononuclear cells were separated by density gradient and VSELs have been quantified by using a multiparametric flow cytometry approach. The number of PB-VSELs in hypoxic COPD patients was significantly increased compared with non-hypoxic COPD patients or controls (p = 0.0055). In patients with PH, we did not find any difference in VSELs numbers between arterial pulmonary blood and venous PB (p = 0.93). However, we found an increase in VSELs in the peripheral blood of patients with PH (p = 0.03). In conclusion, we unraveled that circulating VSELs were increased in peripheral blood of patients with hypoxic COPD or with PH. Thus, VSELs may serve as a reservoir of pluripotent stem cells that can be recruited into PB and may play an important role in promoting lung repair.
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22
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Murdoch B, Zarzeczny A, Caulfield T. Exploiting science? A systematic analysis of complementary and alternative medicine clinic websites' marketing of stem cell therapies. BMJ Open 2018; 8:e019414. [PMID: 29490963 PMCID: PMC5855243 DOI: 10.1136/bmjopen-2017-019414] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/02/2018] [Accepted: 01/09/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify the frequency and qualitative characteristics of stem cell-related marketing claims made on websites of clinics featuring common types of complementary and alternative medicine practitioners. The involvement of complementary and alternative medicine practitioners in the marketing of stem cell therapies and stem cell-related interventions is understudied. This research explores the extent to which they are involved and collaborate with medical professionals. This knowledge will help with identifying and evaluating potential policy responses to this growing market. DESIGN Systematic website analysis. SETTING Global. US and English-language bias due to methodology. MAIN OUTCOME MEASURES Representations made on clinic websites in relation to practitioner types, stem cell therapies and their targets, stem cell-related interventions. Statements about stem cell therapies relating to evidence of inefficacy, limited evidence of efficacy, general procedural risks, risks specific to the mode of therapy, regulatory status, experimental or unproven nature of therapy. Use of hype language (eg, language that exaggerates potential benefits). RESULTS 243 websites offered stem cell therapies. Many websites advertised stem cell transplantation from multiple sources, such as adipose-derived (112), bone marrow-derived (100), blood-derived (28), umbilical cord-derived (26) and others. Plant stem cell-based treatments and products (20) were also advertised. Purposes for and targets of treatment included pain, physical injury, a wide range of diseases and illnesses, cosmetic concerns, non-cosmetic ageing, sexual enhancement and others. Medical doctors (130), chiropractors (53) and naturopaths (44) commonly work in the clinics we found to be offering stem cell therapies. Few clinic websites advertising stem cell therapies included important additional information, including statements about evidence of inefficacy (present on only 12.76% of websites), statements about limited evidence of efficacy (18.93%), statements of general risks (24.69%), statements of risks specific to the mode(s) of therapy (5.76%), statements as to the regulatory status of the therapies (30.86%) and statements that the therapy is experimental or unproven (33.33%). Hype language was noted (31.69%). CONCLUSIONS Stem cell therapies and related interventions are marketed for a wide breadth of conditions and are being offered by complementary and alternative practitioners, often in conjunction with medical doctors. Consumer protection and truth-in-advertising regulation could play important roles in addressing misleading marketing practices in this area.
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Affiliation(s)
- Blake Murdoch
- Faculty of Law, Health Law Institute, University of Alberta, Edmonton, Canada
| | - Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada
| | - Timothy Caulfield
- Faculty of Law, Health Law Institute, University of Alberta, Edmonton, Canada
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23
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The malignant niche: safe spaces for toxic stem cell marketing. NPJ Regen Med 2017; 2:33. [PMID: 29302366 PMCID: PMC5736713 DOI: 10.1038/s41536-017-0036-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 02/01/2023] Open
Abstract
Many tumors are sustained by microenvironments, or niches, that support and protect malignant cells, thus conferring a competitive advantage against both healthy cells and therapeutic interventions (for a brief review, see Yao and Link (Stem Cells 35: 3–8, 2017)). The global industry engaged in the commercial promotion of unproven and scientifically implausible cell-based “regenerative” therapies has developed a number of self-protective strategies that support its survival and growth in ways that are broadly analogous to the functions of the malignant niche.
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24
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Brandsma CA, de Vries M, Costa R, Woldhuis RR, Königshoff M, Timens W. Lung ageing and COPD: is there a role for ageing in abnormal tissue repair? Eur Respir Rev 2017; 26:26/146/170073. [PMID: 29212834 DOI: 10.1183/16000617.0073-2017] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/20/2017] [Indexed: 11/05/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide, with increasing prevalence, in particular in the elderly. COPD is characterised by abnormal tissue repair resulting in (small) airways disease and emphysema. There is accumulating evidence that ageing hallmarks are prominent features of COPD. These ageing hallmarks have been described in different subsets of COPD patients, in different lung compartments and also in a variety of cell types, and thus might contribute to different COPD phenotypes. A better understanding of the main differences and similarities between normal lung ageing and the pathology of COPD may improve our understanding of the mechanisms driving COPD pathology, in particular in those patients that develop the most severe form of COPD at a relatively young age, i.e. severe early-onset COPD patients.In this review, after introducing the main concepts of lung ageing and COPD pathology, we focus on the role of (abnormal) ageing in lung remodelling and repair in COPD. We discuss the current evidence for the involvement of ageing hallmarks in these pathological features of COPD. We also highlight potential novel treatment strategies and opportunities for future research based on our current knowledge of abnormal lung ageing in COPD.
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Affiliation(s)
- Corry-Anke Brandsma
- University of Groningen, University Medical Center Groningen, Dept of Pathology and Medical Biology, Groningen, The Netherlands .,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - Maaike de Vries
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Dept of Epidemiology, Groningen, The Netherlands
| | - Rita Costa
- Comprehensive Pneumology Center, Helmholtz Zentrum München, University Hospital of the Ludwig Maximilians University, Munich, Germany
| | - Roy R Woldhuis
- University of Groningen, University Medical Center Groningen, Dept of Pathology and Medical Biology, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - Melanie Königshoff
- Comprehensive Pneumology Center, Helmholtz Zentrum München, University Hospital of the Ludwig Maximilians University, Munich, Germany.,Division of Pulmonary Sciences and Critical Care Medicine, Dept of Medicine, University of Colorado, Denver, CO, USA.,Both authors contributed equally
| | - Wim Timens
- University of Groningen, University Medical Center Groningen, Dept of Pathology and Medical Biology, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,Both authors contributed equally
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25
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Weiss DJ, Turner L, Levine AD, Ikonomou L. Medical societies, patient education initiatives, public debate and marketing of unproven stem cell interventions. Cytotherapy 2017; 20:165-168. [PMID: 29239793 DOI: 10.1016/j.jcyt.2017.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/28/2017] [Accepted: 10/24/2017] [Indexed: 02/06/2023]
Abstract
Businesses marketing unproven stem cell interventions proliferate within the U.S. and in the larger global marketplace. There have been global efforts by scientists, patient advocacy groups, bioethicists, and public policy experts to counteract the uncontrolled and premature commercialization of stem cell interventions. In this commentary, we posit that medical societies and associations of health care professionals have a particular responsibility to be an active partner in such efforts. We review the role medical societies can and should play in this area through patient advocacy and awareness initiatives.
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Affiliation(s)
- Daniel J Weiss
- University of Vermont College of Medicine, Burlington, Vermont, USA; International Society for Cellular Therapy Presidential Task Force on the Use of Unproven Cellular Therapies, Vancouver, British Columbia, Canada
| | - Leigh Turner
- International Society for Cellular Therapy Presidential Task Force on the Use of Unproven Cellular Therapies, Vancouver, British Columbia, Canada; Center for Bioethics, School of Public Health & College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron D Levine
- International Society for Cellular Therapy Presidential Task Force on the Use of Unproven Cellular Therapies, Vancouver, British Columbia, Canada; School of Public Policy, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Laertis Ikonomou
- International Society for Cellular Therapy Presidential Task Force on the Use of Unproven Cellular Therapies, Vancouver, British Columbia, Canada; The Pulmonary Center, Boston University School of Medicine and Center for Regenerative Medicine of Boston University and Boston Medical Center, Boston, Massachusetts, USA.
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26
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Abstract
Clinical application of autologous cells by businesses promoting unproven stem cell treatments represents the largest growth sector in this problematic industry, but also presents special challenges to regulators. Patients frequently identify autologous cells as personal property, using the language of 'ownership'. Through an analysis of comments submitted to the US FDA in 2016 in response to recent draft guidance documents, I show that a sense of ownership and identity in autologous cells is consistently expressed by stakeholders. In the USA and other countries, regulation of cell and tissue biologics as 'drugs' relies substantially on whether a given product has been modified in ways that alter its biological properties, which has direct implications for property and ownership rights. Competing views on property rights in 'natural' and modified autologous cells have profound implications for the future of regulation of marketed autologous cells.
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Affiliation(s)
- Douglas Sipp
- RIKEN Center for Developmental Biology, Kobe 651-1212, Japan.,Keio University School of Medicine, Department of Physiology, Tokyo 160-8582, Japan.,Keio Global Research Initiative, Tokyo 160-8582, Japan.,RIKEN Center for Advanced Intelligence Project, Tokyo 103-0027, Japan
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27
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Developmental pathways in lung regeneration. Cell Tissue Res 2016; 367:677-685. [PMID: 27957616 DOI: 10.1007/s00441-016-2537-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/13/2016] [Indexed: 01/10/2023]
Abstract
The key processes of lung development have been elucidated in the past several decades, helping to identify and characterize the resident progenitor cells that ultimately generate the mature organ. The adult lung is a complex organ consisting in scores of different cell lineages that are remarkably quiescent in the absence of injury. Despite low cellular turnover, the lung can respond quickly and dramatically to acute damage, with spatially restricted stem and progenitor cells re-entering the cell cycle and differentiating to promote repair. The findings from lung developmental biology are now being used to examine the mechanisms that underlie lung regeneration. The use of in vitro models such as pluripotent stem cells and new methods of gene editing have provided models for understanding lung disease and exploring the mechanisms of lung regeneration and have raised the prospect of correcting lung dysfunction. We outline the way that basic studies into lung developmental biology are now being applied to lung regeneration, opening up new avenues of research that may ultimately be harnessed for treatments of lung disease.
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