1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Geiselman LA, Wetherill L, Graham BH, Payne K, Hopewell EL. Survey of genetic counselors identifies a knowledge gap discerning properly regulated cell and gene therapy trials. Cytotherapy 2024; 26:88-95. [PMID: 37747395 DOI: 10.1016/j.jcyt.2023.08.012] [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: 03/10/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND AND AIMS As cell and gene therapy (CGT) has grown in availability and scope, more unapproved regenerative medicine is being marketed to the public. It is essential that health care providers have sufficient knowledge and comfort to determine whether treatments are properly regulated and address these topics with patients. Due to the applicability of CGT to genetic disease, genetic counselors could be key in providing education and answering patients' questions about these topics. However, previous studies have focused only on physicians' knowledge and comfort with CGT and unapproved regenerative medicine. The purpose of this study was to assess genetic counselors' self-reported knowledge and comfort discussing these topics with patients and to explore what factors predict increased knowledge and comfort. METHODS The authors designed an online survey distributed to genetic counselors who were part of the National Society of Genetic Counselors Student Research Program e-mail list. The survey addressed genetic counselors' demographics, practice experience with CGT, education about CGT, knowledge and comfort. RESULTS The survey was completed by 144 genetic counselors. The best predictor of increased knowledge and comfort was experience discussing CGT in practice. In addition, those who worked at an institution at which CGT trials were offered had greater knowledge and comfort. However, most genetic counselors reported their knowledge was not sufficient to address questions from patients, and most had little-to-no knowledge or comfort determining whether a trial was properly regulated. There was no correlation between education and either knowledge or comfort; however, most participants desired more education about these topics. CONCLUSIONS This study suggests that genetic counselors who (i) have experience with CGT in practice or (ii) work at institutions at which CGT trials are offered may have better knowledge regarding CGT. These results may help identify individuals and/or institutions in whom increasing knowledge regarding CGT could be beneficial. This is crucial as CGT becomes mainstream, leading to more widely marketed unapproved regenerative medicine. Several gaps in knowledge and comfort were identified, including participants' ability to determine whether a treatment is properly regulated. Further research is needed to better characterize the educational needs of genetic counselors surrounding these topics to address these gaps.
Collapse
Affiliation(s)
- Lily A Geiselman
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brett H Graham
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Katelyn Payne
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Emily L Hopewell
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| |
Collapse
|
4
|
Skin Rejuvenation with Cultured Melanocyte and Fibroblasts in a Medical Tourism Patient. World J Plast Surg 2022; 11:116-121. [PMID: 36694683 PMCID: PMC9840759 DOI: 10.52547/wjps.11.3.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/29/2022] [Indexed: 12/15/2022] Open
|
5
|
Loper K, Sugrue MW, Raval JS, Schwartz JY, Land K, Koh M, Mengling T, Greinix H, Halter JP, Celluzzi CM, Chaudhri M. Adverse event reporting for cellular therapy products: Current status and future directions. Transfusion 2020; 60:2815-2827. [PMID: 33063875 DOI: 10.1111/trf.16062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/23/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
Adverse event (AE) and adverse reaction (AR) reporting are key components of patient safety and surveillance systems. Review and analysis of this data yields opportunities for process improvement, product information and interventions, and can lead to improved patient outcomes and donor safety overall. AE and AR reporting for cellular therapy products is fragmented and not well characterized in a central reference. This review article, authored by experts from various organizations, serves to summarize the current state of reporting and offers opportunities for streamlining and coordination, as well as key reference for professionals in this field.
Collapse
Affiliation(s)
- Kathy Loper
- Center for Cellular Therapies, AABB, Bethesda, Maryland, USA
| | - Michele W Sugrue
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Joseph Yossi Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Kevin Land
- Vitalant, Phoenix, Arkansas, USA.,Department of Pathology, UT Health Sciences San Antonio, San Antonio, Texas, USA
| | - Mickey Koh
- St George's Hospital and Medical School, London, UK.,Health Sciences Authority, Singapore
| | | | | | - Jörg P Halter
- Hematology, University Hospital Basel, Basel, Switzerland
| | | | - Maysum Chaudhri
- Center for Cellular Therapies, AABB, Bethesda, Maryland, USA
| |
Collapse
|
6
|
Mah N, Seltmann S, Aran B, Steeg R, Dewender J, Bultjer N, Veiga A, Stacey GN, Kurtz A. Access to stem cell data and registration of pluripotent cell lines: The Human Pluripotent Stem Cell Registry (hPSCreg). Stem Cell Res 2020; 47:101887. [PMID: 32707486 DOI: 10.1016/j.scr.2020.101887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/19/2020] [Indexed: 01/15/2023] Open
Abstract
The value of human pluripotent stem cells (hPSC) in regenerative medicine has yet to reach its full potential. The road from basic research tool to clinically validated PSC-derived cell therapy products is a long and winding one, leading researchers, clinicians, industry and regulators alike into undiscovered territory. All stakeholders must work together to ensure the development of safe and effective cell therapies. Similarly, utilization of hPSC in meaningful and controlled disease modeling and drug screening applications requires information on the quality and suitability of the applied cell lines. Central to these common goals is the complete documentation of hPSC data, including the ethical provenance of the source material, the hPSC line derivation, culture conditions and genetic constitution of the lines. Data surrounding hPSC is scattered amongst diverse sources, including publications, supplemental data, researcher lab books, accredited lab reports, certificates of analyses and public data repositories. Not all of these data sources are publicly accessible nor associated with metadata nor stored in a standard manner, such that data can be easily found and retrieved. The Human Pluripotent Stem Cell Registry (hPSCreg; https://hpscreg.eu/) was started in 2007 to impart provenance and transparency towards hPSC research by registering and collecting standard properties of hPSC lines. In this chapter, we present a short primer on the history of stem cell-based products, summarize the ethical and regulatory issues introduced in the course of working with hPSC-derived products and their associated data, and finally present the Human Pluripotent Stem Cell Registry as a valuable resource for all stakeholders in therapies and disease modeling based on hPSC-derived cells.
Collapse
Affiliation(s)
- Nancy Mah
- Berlin-Brandenburger Centrum für Regenerative Therapien (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Stefanie Seltmann
- Berlin-Brandenburger Centrum für Regenerative Therapien (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Begoña Aran
- Stem Cell Bank, Regenerative Medicine Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Rachel Steeg
- Fraunhofer UK Research Ltd, Technology and Innovation Centre, Glasgow, UK
| | - Johannes Dewender
- Berlin-Brandenburger Centrum für Regenerative Therapien (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Bultjer
- Berlin-Brandenburger Centrum für Regenerative Therapien (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Veiga
- Stem Cell Bank, Regenerative Medicine Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Glyn N Stacey
- ISCBI, Barley, UKSSCBio Ltd, Barley, UK; National Stem Cell Resource Centre, Institute of Zoology, Chinese Academy of Sciences, Beijing 100190, China; Innovation Academy for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing 100101, China
| | - Andreas Kurtz
- Berlin-Brandenburger Centrum für Regenerative Therapien (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
7
|
Sola M, Sanchez-Quevedo C, Martin-Piedra MA, Carriel V, Garzon I, Chato-Astrain J, Garcia-Garcia OD, Alaminos M, Campos F. Evaluation of the awareness of novel advanced therapies among family medicine residents in Spain. PLoS One 2019; 14:e0214950. [PMID: 30943248 PMCID: PMC6447282 DOI: 10.1371/journal.pone.0214950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/22/2019] [Indexed: 01/18/2023] Open
Abstract
Background Advanced therapies are increasingly demanded by patients with the intent of treating some incurable conditions. Because family medicine professionals play an important role as health educators, their residency programs should incorporate new knowledge related to advanced therapies. To successfully implement these programs, how family medicine residents perceive these therapies should be investigated. The main components of perception, i.e. conceptual, procedural and attitudinal, refer to knowledge, skills and feelings, respectively. Methods and findings We designed a specific questionnaire to assess the components of perceptions of advanced therapies in 300 medical residents enrolled in the Spanish National Family Medicine Residency Program. Each component consisted of 4 or 5 topics and each topic contained 6 items. Respondents scored highest in the procedural component (average 4.12±1.00), followed by the attitudinal (3.94±1.07) and conceptual component (3.04±1.43). Differences among the three components were statistically significant (p<0.00017). Family medicine residents perceived that procedures to implement advanced therapies are well established, especially their application. However, they felt their cognitive background was insufficient to respond efficiently to the expectations generated by these new therapeutic tools, especially in the regulatory framework. High awareness of the risks and limitations of these treatments was reflected by residents’ preference for clinically tested therapies. Although they appropriately situated treatment with these therapies within hospital care, they associated the biofabrication of novel products with research centers, although these therapeutic tools can be produced in different facilities. Conclusions These results are potentially useful for designing future training programs and health policies for family medicine residents, and suggest the need to implement specific training programs in advanced therapies at the conceptual, procedural and attitudinal level.
Collapse
Affiliation(s)
- Miguel Sola
- Family Medicine Unit, School of Medicine, University of Granada, Granada, Spain
| | - Carmen Sanchez-Quevedo
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Histology (Tissue Engineering Group), School of Medicine, University of Granada, Granada, Spain
| | - Miguel A. Martin-Piedra
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Histology (Tissue Engineering Group), School of Medicine, University of Granada, Granada, Spain
| | - Victor Carriel
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Histology (Tissue Engineering Group), School of Medicine, University of Granada, Granada, Spain
| | - Ingrid Garzon
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Histology (Tissue Engineering Group), School of Medicine, University of Granada, Granada, Spain
| | - Jesus Chato-Astrain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Histology (Tissue Engineering Group), School of Medicine, University of Granada, Granada, Spain
| | - Oscar-Dario Garcia-Garcia
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Histology (Tissue Engineering Group), School of Medicine, University of Granada, Granada, Spain
| | - Miguel Alaminos
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Histology (Tissue Engineering Group), School of Medicine, University of Granada, Granada, Spain
- * E-mail:
| | - Fernando Campos
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Histology (Tissue Engineering Group), School of Medicine, University of Granada, Granada, Spain
| |
Collapse
|
8
|
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
Collapse
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
| |
Collapse
|
9
|
Scolding NJ, Pasquini M, Reingold SC, Cohen JA. Cell-based therapeutic strategies for multiple sclerosis. Brain 2017; 140:2776-2796. [PMID: 29053779 PMCID: PMC5841198 DOI: 10.1093/brain/awx154] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/03/2017] [Accepted: 05/06/2017] [Indexed: 12/23/2022] Open
Abstract
The availability of multiple disease-modifying medications with regulatory approval to treat multiple sclerosis illustrates the substantial progress made in therapy of the disease. However, all are only partially effective in preventing inflammatory tissue damage in the central nervous system and none directly promotes repair. Cell-based therapies, including immunoablation followed by autologous haematopoietic stem cell transplantation, mesenchymal and related stem cell transplantation, pharmacologic manipulation of endogenous stem cells to enhance their reparative capabilities, and transplantation of oligodendrocyte progenitor cells, have generated substantial interest as novel therapeutic strategies for immune modulation, neuroprotection, or repair of the damaged central nervous system in multiple sclerosis. Each approach has potential advantages but also safety concerns and unresolved questions. Moreover, clinical trials of cell-based therapies present several unique methodological and ethical issues. We summarize here the status of cell-based therapies to treat multiple sclerosis and make consensus recommendations for future research and clinical trials.
Collapse
Affiliation(s)
- Neil J Scolding
- Department of Neurology, University of Bristol Southmead Hospital, Bristol BS10 5NB, UK
| | - Marcelo Pasquini
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Stephen C Reingold
- Scientific and Clinical Research Associates, LLC, Salisbury, CT 06068, USA
| | - Jeffrey A Cohen
- Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|
10
|
Chan S. Current and emerging global themes in the bioethics of regenerative medicine: the tangled web of stem cell translation. Regen Med 2017; 12:839-851. [PMID: 29119870 PMCID: PMC5985499 DOI: 10.2217/rme-2017-0065] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/08/2017] [Indexed: 12/21/2022] Open
Abstract
Probably the most serious problem facing the field of regenerative medicine today is the challenge of effective translation and development of viable stem cell-based therapies. Particular concerns have been raised over the growing market in unproven cell therapies. In this article, I explore recent developments in the stem cell therapy landscape and argue that while the sale of unproven therapies undoubtedly poses ethical concerns, it must be understood as part of a larger problem at the interface between biomedicine, healthcare, publics, policy and the market. Addressing this will require a broader perspective incorporating the shifting relationships between different stakeholder groups, the global politics of research and innovation, and the evolving role of publics and patients with respect to science.
Collapse
Affiliation(s)
- Sarah Chan
- Usher Institute for Population Health Sciences & Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| |
Collapse
|
11
|
Bibliography. Stem Cell Res 2017. [DOI: 10.1201/9781315152943-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
12
|
Abstract
The last decade has seen considerable changes in the Regenerative Medicine industry, but unfortunately the hope for numerous treatments that ‘replace or regenerate human cells, tissues or organs to restore or establish normal function’ has not yet emerged. In contrast to this, there have been major advances in the field of cellular immunotherapy though some do not consider these to be Regenerative Medicines. Regulatory changes have in some cases improved the route to a marketing license but they have not been matched by clarification of the complex, national reimbursement processes for cell-based treatments and this has adversely affected a number of leading Regenerative Medicine Companies. The review considers the direction that the industry may go in the future in relation to scientific, manufacturing and clinical strategies which may improve the rate of success of new therapies..
Collapse
Affiliation(s)
- Paul Kemp
- HairClone, 70 Quay St, Manchester, M3 3EJ, UK
| |
Collapse
|
13
|
Powell AB, Williams K, Cruz CRY. Gene-modified, cell-based therapies—an overview. Cytotherapy 2016; 18:1351-1359. [DOI: 10.1016/j.jcyt.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
14
|
Dominici M, Nichols KM, Levine AD, Rasko JE, Forte M, O'Donnell L, Koh MB, Bollard CM, Weiss DJ. Science, ethics and communication remain essential for the success of cell-based therapies. Brain Circ 2016; 2:146-151. [PMID: 30276292 PMCID: PMC6126268 DOI: 10.4103/2394-8108.192525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 09/28/2016] [Accepted: 09/28/2016] [Indexed: 12/15/2022] Open
Abstract
Cell-based therapeutics, such as marrow or peripheral blood stem cell transplantation, are a standard of care for certain malignancies. More recently, a wider variety of cell-based therapeutics including the use of mesenchymal stromal/stem cells, T-cells, and others show great promise in a wider range of diseases. With increased efforts to expand cell-based treatments to several clinical settings, many institutions around the world have developed programs to explore cellular therapy's potential for safe and effective applications. In legitimate investigations, usually conducted through academic centers or biotechnology industry-sponsored efforts, these studies are regulated and peer-reviewed to ensure safety and clear determination of potential efficacy. However, in some cases, the use of cell-based approaches is conducted with insufficient preclinical data, scientific rationale, and/or study plan for the diseases claimed to be treated, with patients being charged for these services without clear evidence of clinical benefit. In this context, patients may not be properly informed regarding the exact treatment they are receiving within a consenting process that may not be completely valid or ethical. Here, the authors emphasize the importance of distinguishing "proven cell-based therapies" from "unproven" and unauthorized cell-based therapies. This publication also addresses the necessity for improved communication between the different stakeholders in the field, patient associations, and advocacy groups in particular, to favor medical innovation and provide legitimate benefits to patients. Considering the progressive growth of cell-based treatments, their increasing therapeutic value and the expectation that society has about these therapies, it is critically important to protect patients and ensure that the risk/benefit ratio is favorable. This paper is a review article. Literature referred to in this paper has been listed in the references section. The datasets supporting the conclusions of this article are available online by searching PubMed. Some original points in this article come from the laboratory practice in our research centers and the authors' experiences.
Collapse
Affiliation(s)
- Massimo Dominici
- Laboratory of Cellular Therapy, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Aaron D Levine
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | - John Ej Rasko
- Gene and Stem Cell Therapy Program, Centenary Institute, University of Sydney, Australia.,Sydney Medical School, University of Sydney, NSW 2006, Australia.,Department of Cell and Molecular Therapies, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | | | - Lynn O'Donnell
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Mickey Bc Koh
- Department of Haematology, St. George's Hospital, London, UK.,Cell Therapy Program, Health Sciences Authority, Singapore
| | - Catherine M Bollard
- Center for Cancer and Immunology Research, Sheikh Zayed Institute, Children's National Health System, Washington, DC, USA
| | - Daniel J Weiss
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont, USA
| |
Collapse
|
15
|
Nitkin CR, Bonfield TL. Concise Review: Mesenchymal Stem Cell Therapy for Pediatric Disease: Perspectives on Success and Potential Improvements. Stem Cells Transl Med 2016; 6:539-565. [PMID: 28191766 PMCID: PMC5442806 DOI: 10.5966/sctm.2015-0427] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 08/04/2016] [Indexed: 12/19/2022] Open
Abstract
Mesenchymal stem cells (MSCs) represent a potentially revolutionary therapy for a wide variety of pediatric diseases, but the optimal cell-based therapeutics for such diversity have not yet been specified. The published clinical trials for pediatric pulmonary, cardiac, orthopedic, endocrine, neurologic, and hematologic diseases provide evidence that MSCs are indeed efficacious, but the significant heterogeneity in therapeutic approaches between studies raises new questions. The purpose of this review is to stimulate new preclinical and clinical trials to investigate these factors. First, we discuss recent clinical trials for pediatric diseases studying MSCs obtained from bone marrow, umbilical cord and umbilical cord blood, placenta, amniotic fluid, and adipose tissue. We then identify factors, some unique to pediatrics, which must be examined to optimize therapeutic efficacy, including route of administration, dose, timing of administration, the role of ex vivo differentiation, cell culture techniques, donor factors, host factors, and the immunologic implications of allogeneic therapy. Finally, we discuss some of the practicalities of bringing cell-based therapy into the clinic, including regulatory and manufacturing considerations. The aim of this review is to inform future studies seeking to maximize therapeutic efficacy for each disease and for each patient. Stem Cells Translational Medicine 2017;6:539-565.
Collapse
Affiliation(s)
- Christopher R. Nitkin
- Division of Neonatology, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Tracey L. Bonfield
- Division of Pulmonology, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
16
|
Srivastava A, Mason C, Wagena E, Cuende N, Weiss DJ, Horwitz EM, Dominici M. Part 1: Defining unproven cellular therapies. Cytotherapy 2016; 18:117-9. [PMID: 26719202 DOI: 10.1016/j.jcyt.2015.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Alok Srivastava
- Center for Stem Cell Research (a unit of inStem, Bengaluru), Department of Hematology, Christian Medical College, Vellore, India. Member at large of the ISCT Presidential Task Force on the Use of Unproven Cellular Therapies.
| | - Chris Mason
- Advanced Centre for Biochemical Engineering, University College London, London, United Kingdom. Member at large of the ISCT Presidential Task Force on the Use of Unproven Cellular Therapies
| | - Edwin Wagena
- Voorburg, Netherlands. ISCT Europe, Regional Vice President 2014-2016
| | - Natividad Cuende
- Andalusian Initiative for Advanced Therapies, Junta de Andalucía, Sevilla, Spain. Chair, ISCT EU LRA Committee, 2014-2016
| | - Daniel J Weiss
- Department of Medicine, University of Vermont, Burlington, Vermont, USA. ISCT Chief Scientific Officer 2014-2016. Chair, ISCT Pulmonary Committee 2013-2015
| | - Edwin M Horwitz
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Departments of Pediatrics and Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA. ISCT Past President 2010-2012
| | - Massimo Dominici
- Division of Oncology, Laboratory of Cellular Therapy, University of Modena & Reggio Emilia, Modena, Italy. ISCT President 2014-2016. Chair, ISCT Presidential Task Force on the Use of Unproven Cellular Therapies
| |
Collapse
|
17
|
Monsarrat P, Vergnes JN, Planat-Bénard V, Ravaud P, Kémoun P, Sensebé L, Casteilla L. An Innovative, Comprehensive Mapping and Multiscale Analysis of Registered Trials for Stem Cell-Based Regenerative Medicine. Stem Cells Transl Med 2016; 5:826-35. [PMID: 27075765 DOI: 10.5966/sctm.2015-0329] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/13/2016] [Indexed: 12/21/2022] Open
Abstract
UNLABELLED We aim to provide an innovative, comprehensive way of mapping the profusion of stem cell-based clinical trials registered at ClinicalTrials.gov to explore the diversity of the fields of application and the temporal complexity of the domain. We used a chord diagram and phylogenetic-like tree visualizations to assist in data mining and knowledge discovery. The search strategy used the following terms: "stromal OR stem OR mesenchymal OR progenitor." The Medical Subject Headings (MeSH) thesaurus was used to more finely classify diseases treated by stem cells, from large fields of application to specific diseases. Of the 5,788 trials screened, 939 were included, 51.1% of which were related to mesenchymal stem cells (MSCs). No real specificity emerged as to the therapeutic uses of the different types of stem cells. More than half the MSC studies concerned allogeneic MSCs and received more support from industry than autologous MSC studies (p < .001). Over time, the uses of cultured cells have increased greatly, particularly since 2009. Cells derived from adipose tissue are also increasingly used in trials compared with bone marrow cells. The use of adipose-derived stromal cells was predominantly autologous (p < .001), restricted to European countries (p < .01), and supported by industry (p = .02) compared with other MSCs. Details about MeSH keywords are available at http://multireview.perso.sfr.fr/. In conclusion, mapping may reveal a lack of global strategy despite the regulations and the related costs associated with good manufacturing practices. A systematic approach to preclinical data, intended to objectively and robustly reveal the most appropriate fields with the most efficient cells, is needed. Repeated exchanges between the bench and the bedside are necessary. SIGNIFICANCE Except for a few trials concerning specific tissue stem cells used in their corresponding tissues, this global analysis revealed no real specificity of stem cell uses (including mesenchymal stromal cells). This raised the question of the physiopathological rationale for these uses and the lack of a global strategy despite the regulations and the related costs associated with good manufacturing practices. This original method, leading to the development of new concepts from already available data, would help policymakers to optimize resources and investments in terms of public health priorities. Such an approach should draw parallels between in vitro, in vivo, and human data. Exchanges in both directions between preclinical and clinical research could optimize the parameters of clinical trials step by step.
Collapse
Affiliation(s)
- Paul Monsarrat
- Department of Anatomical Sciences and Radiology, Dental Faculty, Toulouse University Hospital, Toulouse, France STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, INP-ENVT, Inserm, UPS, Toulouse, France
| | - Jean-Noel Vergnes
- Department of Epidemiology and Public Health, Dental Faculty, Toulouse University Hospital, Toulouse, France Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Valérie Planat-Bénard
- STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, INP-ENVT, Inserm, UPS, Toulouse, France
| | - Philippe Ravaud
- Faculty of Medicine, Paris Descartes University, Paris, France Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Philippe Kémoun
- Department of Biological Sciences, Dental Faculty, Toulouse University Hospital, Toulouse, France
| | - Luc Sensebé
- STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, INP-ENVT, Inserm, UPS, Toulouse, France
| | - Louis Casteilla
- STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, INP-ENVT, Inserm, UPS, Toulouse, France
| |
Collapse
|
18
|
Part 5: Unproven cell therapies and the commercialization of cell-based products. Cytotherapy 2016; 18:138-42. [DOI: 10.1016/j.jcyt.2015.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 11/20/2022]
|
19
|
Dominici M, Nichols K, Srivastava A, Weiss DJ, Eldridge P, Cuende N, Deans RJ, Rasko JE, Levine AD, Turner L, Griffin DL, O'Donnell L, Forte M, Mason C, Wagena E, Janssen W, Nordon R, Wall D, Ho HN, Ruiz MA, Wilton S, Horwitz EM, Gunter KC. Positioning a Scientific Community on Unproven Cellular Therapies: The 2015 International Society for Cellular Therapy Perspective. Cytotherapy 2015; 17:1663-6. [DOI: 10.1016/j.jcyt.2015.10.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
20
|
|
21
|
Salter B, Zhou Y, Datta S. Hegemony in the marketplace of biomedical innovation: consumer demand and stem cell science. Soc Sci Med 2015; 131:156-63. [PMID: 25771483 DOI: 10.1016/j.socscimed.2015.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The global political economy of stem cell therapies is characterised by an established biomedical hegemony of expertise, governance and values in collision with an increasingly informed health consumer demand able to define and pursue its own interest. How does the hegemony then deal with the challenge from the consumer market and what does this tell us about its modus operandi? In developing a theoretical framework to answer these questions, the paper begins with an analysis of the nature of the hegemony of biomedical innovation in general, its close relationship with the research funding market, the current political modes of consumer incorporation, and the ideological role performed by bioethics as legitimating agency. Secondly, taking the case of stem cell innovation, it explores the hegemonic challenge posed by consumer demand working through the global practice based market of medical innovation, the response of the national and international institutions of science and their reassertion of the values of the orthodox model, and the supporting contribution of bioethics. Finally, the paper addresses the tensions within the hegemonic model of stem cell innovation between the key roles and values of scientist and clinician, the exacerbation of these tensions by the increasingly visible demands of health consumers, and the emergence of political compromise.
Collapse
Affiliation(s)
- Brian Salter
- Department of Political Economy, King's College London, United Kingdom.
| | - Yinhua Zhou
- Department of Political Economy, King's College London, United Kingdom.
| | - Saheli Datta
- Department of Political Economy, King's College London, United Kingdom
| |
Collapse
|
22
|
Salter B, Zhou Y, Datta S. Health consumers and stem cell therapy innovation: markets, models and regulation. Regen Med 2015; 9:353-66. [PMID: 24935045 DOI: 10.2217/rme.13.99] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Global health consumer demand for stem cell therapies is vibrant, but the supply of treatments from the conventional science-based model of innovation is small and unlikely to increase in the near future. At the same time, several models of medical innovation have emerged that can respond to the demand, often employing a transnational value chain to deliver the product. Much of the commentary has approached the issue from a supply side perspective, demonstrating the extent to which national and transnational regulation fails to impose what are regarded as appropriate standards on the 'illicit' supply of stem cell therapies characterized by little data and poor outcomes. By contrast, this article presents a political economic analysis with a strong demand side perspective, arguing that the problem of what is termed 'stem cell tourism' is embedded in the demand-supply relationship of the health consumer market and its engagement with different types of stem cell therapy innovation. To be meaningful, discussions of regulation must recognize that analysis or risk being sidelined by a market, which ignores their often wishful thinking.
Collapse
Affiliation(s)
- Brian Salter
- Global Biopolitics Research Centre, Department of Political Economy, King's College London, London, UK
| | | | | |
Collapse
|
23
|
Valediction for Herbert Gottweis. BIOSOCIETIES 2014. [DOI: 10.1057/biosoc.2014.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
24
|
Nayar HS, Caplan AL, Eaves FF, Rubin JP. The Ethics of Stem Cell-Based Aesthetic Surgery: Attitudes and Perceptions of the Plastic Surgery Community. Aesthet Surg J 2014; 34:926-31. [PMID: 25085851 DOI: 10.1177/1090820x14539971] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The emerging field of stem cell-based aesthetics has raised ethical concerns related to advertising campaigns and standards for safety and efficacy. OBJECTIVES The authors sought to characterize the attitudes of plastic surgeons regarding the ethics of stem cell-based aesthetics. METHODS A cross-sectional electronic survey was distributed to 4592 members of the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons. Statements addressed ethical concerns about informed consent, conflicts of interest, advertising, regulation, and stem cell tourism. An agreement score (AS) from 0 to 100 was calculated for each statement. Majority agreement was designated as ≥60 and majority disagreement as ≤40. RESULTS A total of 770 questionnaires were received (16.7%). The majority of respondents indicated that knowledge regarding the risks and benefits of stem cell procedures is insufficient to obtain valid informed consent (AS, 29) and that direct-to-consumer advertising for these technologies is inappropriate and unethical (AS, 23). Most respondents reported that patients should be actively warned against traveling abroad to receive aesthetic cell therapies (AS, 86) and that registries and evaluations of these clinics should be made publicly available (AS, 71). Even more respondents noted that financial conflicts of interest should be disclosed to patients (AS, 96) and that professional societies should participate in establishing regulatory standards (AS, 93). CONCLUSIONS The plastic surgeons surveyed in this study support a well-regulated, evidence-based approach to aesthetic procedures involving stem cells.
Collapse
Affiliation(s)
- Harry S Nayar
- Dr Nayar is a resident in the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin in Madison, Wisconsin
| | - Arthur L Caplan
- Dr Caplan is Chair of the Division of Medical Ethics at New York University Langone Medical Center in New York, New York
| | - Felmont F Eaves
- Dr Eaves is a Professor of Surgery in the Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - J Peter Rubin
- Dr Rubin is Chair of the Department of Plastic Surgery at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
25
|
New developments in cell and gene therapy. Pathology 2012. [DOI: 10.1016/s0031-3025(16)32677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
26
|
Sipp D. The unregulated commercialization of stem cell treatments: a global perspective. Front Med 2011; 5:348-55. [PMID: 21964637 DOI: 10.1007/s11684-011-0150-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 07/14/2011] [Indexed: 11/27/2022]
Abstract
Research into the biological properties and clinical potential of stem cells has spurred strong public investment, industry development, media coverage, and patient interest in recent years. To date, however, few clinical applications of demonstrated safety and efficacy have been developed with the exception of uses of hematopoietic stem cells in the treatment of diseases of the blood and immune systems. This lack of an evidence basis notwithstanding, hundreds of companies and private clinics around the world now sell putative stem cell treatments for an enormously broad range of medical and quality-of-life conditions. This represents a major challenge for legitimate scientists working in the field, for authorities seeking to protect their constituencies, and for patients and consumers targeted by such companies' marketing strategies. In this review, I provide an overview of the global industry in pseudomedical stem cell treatments, with an investigation of claims in a single disease area (amyotrophic lateral sclerosis), and make recommendations for the introduction and enforcement of appropriate regulatory responses to this problem.
Collapse
Affiliation(s)
- Douglas Sipp
- Research Unit for Science Policy and Ethics Studies, RIKEN Center for Developmental Biology, 2-2-3 Minatojima Minamimachi, Chuo-ku, Kobe 650-0047, Japan.
| |
Collapse
|
27
|
|