1
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Ikonomou L, Cuende N, Forte M, Grilley BJ, Levine AD, Munsie M, Rasko JEJ, Turner L, Bidkhori HR, Ciccocioppo R, Grignon F, Srivastava A, Weiss DJ, Zettler P, Levine BL. International Society for Cell & Gene Therapy Position Paper: Key considerations to support evidence-based cell and gene therapies and oppose marketing of unproven products. Cytotherapy 2023; 25:920-929. [PMID: 37517865 DOI: 10.1016/j.jcyt.2023.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 08/01/2023]
Abstract
The field of regenerative medicine, including cellular immunotherapies, is on a remarkable growth trajectory. Dozens of cell-, tissue- and gene-based products have received marketing authorization worldwide while hundreds-to-thousands are either in preclinical development or under clinical investigation in phased clinical trials. However, the promise of regenerative therapies has also given rise to a global industry of direct-to-consumer offerings of prematurely commercialized cell and cell-based products with unknown safety and efficacy profiles. Since its inception, the International Society for Cell & Gene Therapy Committee on the Ethics of Cell and Gene Therapy has opposed the premature commercialization of unproven cell- and gene-based interventions and supported the development of evidence-based advanced therapy products. In the present Guide, targeted at International Society for Cell & Gene Therapy members, we analyze this industry, focusing in particular on distinctive features of unproven cell and cell-based products and the use of tokens of scientific legitimacy as persuasive marketing devices. We also provide an overview of reporting mechanisms for patients who believe they have been harmed by administration of unapproved and unproven products and suggest practical strategies to address the direct-to-consumer marketing of such products. Development of this Guide epitomizes our continued support for the ethical and rigorous development of cell and cell-based products with patient safety and therapeutic benefit as guiding principles.
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Affiliation(s)
- Laertis Ikonomou
- Department of Oral Biology, University at Buffalo, The State University of New York, Buffalo, New York, USA; Cell, Gene and Tissue Engineering Center, University at Buffalo, The State University of New York, Buffalo, New York, USA.
| | - Natividad Cuende
- Andalusian Transplant Coordination, Servicio Andaluz de Salud; Sevilla, Spain
| | | | - Bambi J Grilley
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, Texas, USA; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Aaron D Levine
- School of Public Policy, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Megan Munsie
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - John E J Rasko
- Gene and Stem Cell Therapy Program Centenary Institute, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Cell & Molecular Therapies, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Leigh Turner
- Department of Health, Society, and Behavior, Program in Public Health; Stem Cell Research Center; Institute for Clinical and Translational Science; Department of Family Medicine; University of California, Irvine; Irvine, California, USA
| | - Hamid R Bidkhori
- Stem Cell and Regenerative Medicine Research Department, Academic Center for Education, Culture and Research (ACECR)-Khorasan Razavi, Mashhad, Iran
| | - Rachele Ciccocioppo
- Gastroenterology Unit, Department of Medicine, A.O.U.I. Policlinico G.B. Rossi & University of Verona, Verona, Italy
| | - Felix Grignon
- International Society for Cell & Gene Therapy, Vancouver, Canada
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Ranipet Campus, Ranipet & Centre for Stem Cell Research (a unit of inStem Bengaluru) CMC Campus, Vellore, India
| | - Daniel J Weiss
- University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Patricia Zettler
- Moritz College of Law, Drug Enforcement and Policy Center, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Bruce L Levine
- Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Matthews KRW, Kawam O, Sprung K, Perin EC, Master Z. Role of Physicians in Guiding Patients Away From Unproven Stem Cell Interventions. Tex Heart Inst J 2022; 49:478691. [PMID: 35258626 DOI: 10.14503/thij-21-7768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Omar Kawam
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
| | | | | | - Zubin Master
- Baker Institute for Public Policy, Rice University, Houston, Texas.,Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota.,Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota
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3
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Hynds RE, Zacharias WJ, Nikolić MZ, Königshoff M, Eickelberg O, Gosens R, de Coppi P, Janes SM, Morrisey E, Clevers H, Ryan AL, Stripp BR, Sun X, Kim CF, Lin QS. National Heart, Lung, and Blood Institute and Building Respiratory Epithelium and Tissue for Health (BREATH) Consortium Workshop Report: Moving Forward in Lung Regeneration. Am J Respir Cell Mol Biol 2021; 65:22-29. [PMID: 33625958 PMCID: PMC8320125 DOI: 10.1165/rcmb.2020-0397ws] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The National Heart, Lung, and Blood Institute of the National Institutes of Health, together with the Longfonds BREATH consortium, convened a working group to review the field of lung regeneration and suggest avenues for future research. The meeting took place on May 22, 2019, at the American Thoracic Society 2019 conference in Dallas, Texas, United States, and brought together investigators studying lung development, adult stem-cell biology, induced pluripotent stem cells, biomaterials, and respiratory disease. The purpose of the working group was 1) to examine the present status of basic science approaches to tackling lung disease and promoting lung regeneration in patients and 2) to determine priorities for future research in the field.
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Affiliation(s)
- Robert E. Hynds
- Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, and
- Division of Medicine, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - William J. Zacharias
- Division of Pulmonary Biology, Department of Pediatrics, Cincinnati Children’s Hospital–College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Marko Z. Nikolić
- Division of Medicine, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Melanie Königshoff
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Lung Repair and Regeneration Research Unit, Comprehensive Pneumology Center, Helmholtz Zentrum München, Munich, Germany
| | - Oliver Eickelberg
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Reinoud Gosens
- Department of Molecular Pharmacology and
- Groningen Research Institute for Asthma and Chronic Obstructive Pulmonary Disease, University of Groningen, Groningen, the Netherlands
| | - Paolo de Coppi
- Stem Cell and Regenerative Medicine Section, National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre–University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sam M. Janes
- Division of Medicine, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Edward Morrisey
- Department of Medicine
- Department of Cell and Developmental Biology
- Lung Biology Institute, University of Pennsylvania–Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hans Clevers
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences–University Medical Center Utrecht, Utrecht, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
- The Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Amy L. Ryan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Hastings Center for Pulmonary Research, and
- Department of Stem Cell Biology and Regenerative Medicine, University of Southern California, Los Angeles, California
| | - Barry R. Stripp
- Lung Institute and
- Board of Governors Regenerative Medicine Institute, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Xin Sun
- Department of Pediatrics and
- Department of Biological Sciences, University of California San Diego, San Diego, California
| | - Carla F. Kim
- Division of Hematology/Oncology and
- Division of Respiratory Disease, Stem Cell Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Genetics, Harvard Medical School, Harvard University, Boston, Massachusetts
- Harvard Stem Cell Institute, Harvard University, Cambridge, Massachusetts; and
| | - Qing S. Lin
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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4
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Turner L. ISSCR's Guidelines for Stem Cell Research and Clinical Translation: Supporting development of safe and efficacious stem cell-based interventions. Stem Cell Reports 2021; 16:1394-1397. [PMID: 34048693 PMCID: PMC8190662 DOI: 10.1016/j.stemcr.2021.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/16/2021] [Accepted: 05/16/2021] [Indexed: 12/02/2022] Open
Abstract
The ISSCR’s revised Guidelines for Stem Cell Research and Clinical Translation reflect the organization’s commitment to opposing premature commercialization of stem cell-based interventions and supporting the development of products that meet stringent ethical, scientific, and regulatory standards. The Guidelines contain five important new recommendations concerning clinical translation of stem cell products.
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Affiliation(s)
- Leigh Turner
- University of Minnesota Center for Bioethics, School of Public Health, and College of Pharmacy, Minneapolis, MN 55455, USA.
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5
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Obstacles to the reuse of study metadata in ClinicalTrials.gov. Sci Data 2020; 7:443. [PMID: 33339830 PMCID: PMC7749162 DOI: 10.1038/s41597-020-00780-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023] Open
Abstract
Metadata that are structured using principled schemas and that use terms from ontologies are essential to making biomedical data findable and reusable for downstream analyses. The largest source of metadata that describes the experimental protocol, funding, and scientific leadership of clinical studies is ClinicalTrials.gov. We evaluated whether values in 302,091 trial records adhere to expected data types and use terms from biomedical ontologies, whether records contain fields required by government regulations, and whether structured elements could replace free-text elements. Contact information, outcome measures, and study design are frequently missing or underspecified. Important fields for search, such as condition and intervention, are not restricted to ontologies, and almost half of the conditions are not denoted by MeSH terms, as recommended. Eligibility criteria are stored as semi-structured free text. Enforcing the presence of all required elements, requiring values for certain fields to be drawn from ontologies, and creating a structured eligibility criteria element would improve the reusability of data from ClinicalTrials.gov in systematic reviews, metanalyses, and matching of eligible patients to trials.
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Dal-Ré R, Palau F, Guillén-Navarro E, Ayuso C. Participant-funded clinical trials on rare diseases. An Pediatr (Barc) 2020; 93:267.e1-267.e9. [PMID: 34092344 DOI: 10.1016/j.anpede.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/28/2020] [Indexed: 10/23/2022] Open
Abstract
The development of medicines for certain rare diseases can be cut short by lack of funding. In certain cases the patients themselves, or their relatives, occasionally fund the clinical trial in which they will be treated with the investigational medicine. There are three models of self-funded clinical research: two of them, 'pay to try' and 'pay to participate', have already been put into practice. The third, the 'plutocratic' proposal, which has been recently put forward is still a theoretical model. In this work the scientific, social and ethical benefits and risks of the two clinical research models, 'pay to participate and the 'plutocratic' proposal, are reviewed. Patient-funded clinical trials are frequently performed through crowdfunding. The most controversial aspects of this funding modality are also addressed in this article from several perspectives. Finally, a future scenario that would allow the launching of self-funded clinical trials in Spain by the 'plutocratic' proposal is proposed.
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Affiliation(s)
- Rafael Dal-Ré
- Unidad de Epidemiología, Instituto de Investigación Sanitaria, Hospital Universitario Fundación Jiménez Díaz, IIS-UAM, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Francesc Palau
- Servicio de Medicina Genética y Molecular, Instituto Pediátrico de Enfermedades Raras (IPER), Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Spain; Unidad de Pediatría, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | - Encarna Guillén-Navarro
- CIBER de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain; Sección de Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - Carmen Ayuso
- CIBER de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain; Departamento de Genética y Genómica, Instituto de Investigación Sanitaria, Hospital Universitario Fundación Jiménez Díaz, IIS-UAM, Universidad Autónoma de Madrid, Madrid, Spain
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7
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Dal-Ré R, Palau F, Guillén-Navarro E, Ayuso C. Ensayos clínicos en enfermedades raras financiados por los participantes. An Pediatr (Barc) 2020; 93:267.e1-267.e9. [DOI: 10.1016/j.anpedi.2020.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/19/2020] [Accepted: 03/28/2020] [Indexed: 01/17/2023] Open
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8
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Wagner DE, Ikonomou L, Gilpin SE, Magin CM, Cruz F, Greaney A, Magnusson M, Chen YW, Davis B, Vanuytsel K, Rolandsson Enes S, Krasnodembskaya A, Lehmann M, Westergren-Thorsson G, Stegmayr J, Alsafadi HN, Hoffman ET, Weiss DJ, Ryan AL. Stem Cells, Cell Therapies, and Bioengineering in Lung Biology and Disease 2019. ERJ Open Res 2020; 6:00123-2020. [PMID: 33123557 PMCID: PMC7569162 DOI: 10.1183/23120541.00123-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022] Open
Abstract
A workshop entitled "Stem Cells, Cell Therapies and Bioengineering in Lung Biology and Diseases" was hosted by the University of Vermont Larner College of Medicine in collaboration with the National Heart, Lung and Blood Institute, the Alpha-1 Foundation, the Cystic Fibrosis Foundation, the International Society for Cell and Gene Therapy and the Pulmonary Fibrosis Foundation. The event was held from July 15 to 18, 2019 at the University of Vermont, Burlington, Vermont. The objectives of the conference were to review and discuss the current status of the following active areas of research: 1) technological advancements in the analysis and visualisation of lung stem and progenitor cells; 2) evaluation of lung stem and progenitor cells in the context of their interactions with the niche; 3) progress toward the application and delivery of stem and progenitor cells for the treatment of lung diseases such as cystic fibrosis; 4) progress in induced pluripotent stem cell models and application for disease modelling; and 5) the emerging roles of cell therapy and extracellular vesicles in immunomodulation of the lung. This selection of topics represents some of the most dynamic research areas in which incredible progress continues to be made. The workshop also included active discussion on the regulation and commercialisation of regenerative medicine products and concluded with an open discussion to set priorities and recommendations for future research directions in basic and translation lung biology.
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Affiliation(s)
- Darcy E. Wagner
- Lung Bioengineering and Regeneration, Dept of Experimental Medicine, Wallenberg Center for Molecular Medicine and Lund Stem Cell Center, Faculty of Medicine, Lund University, Lund, Sweden
- These authors contributed equally
| | - Laertis Ikonomou
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA, USA
- These authors contributed equally
| | - Sarah E. Gilpin
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA
| | - Chelsea M. Magin
- Depts of Medicine and Bioengineering, University of Colorado, Denver, Aurora, CO, USA
| | - Fernanda Cruz
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Allison Greaney
- Dept of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Mattias Magnusson
- Molecular Medicine and Gene Therapy, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Ya-Wen Chen
- Hastings Center for Pulmonary Research, Dept of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian Davis
- Center for Stem Cell and Regenerative Medicine, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Kim Vanuytsel
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA, USA
| | - Sara Rolandsson Enes
- Dept of Medicine, University of Vermont, Burlington, VT, USA
- Dept of Experimental Medical Science, Division of Lung Biology, Lund University, Lund, Sweden
| | | | - Mareike Lehmann
- Comprehensive Pneumology Center, Lung Repair and Regeneration Unit, Helmholtz Center Munich, Munich, Germany
| | | | - John Stegmayr
- Lung Bioengineering and Regeneration, Dept of Experimental Medicine, Wallenberg Center for Molecular Medicine and Lund Stem Cell Center, Faculty of Medicine, Lund University, Lund, Sweden
| | - Hani N. Alsafadi
- Lung Bioengineering and Regeneration, Dept of Experimental Medicine, Wallenberg Center for Molecular Medicine and Lund Stem Cell Center, Faculty of Medicine, Lund University, Lund, Sweden
| | - Evan T. Hoffman
- Dept of Medicine, University of Vermont, Burlington, VT, USA
| | - Daniel J. Weiss
- Dept of Medicine, University of Vermont, Burlington, VT, USA
| | - Amy L. Ryan
- Hastings Center for Pulmonary Research, Dept of Medicine, University of Southern California, Los Angeles, CA, USA
- Dept of Stem Cell and Regenerative Medicine, University of Southern California, Los Angeles, CA, USA
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9
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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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10
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Multipotent Mesenchymal Stromal Cells and Lung Disease: Not Ready for Prime Time. Ann Am Thorac Soc 2020; 16:669-671. [PMID: 30786224 DOI: 10.1513/annalsats.201811-843ps] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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11
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Unsworth DJ, Mathias JL, Dorstyn DS, Koblar SA. Are patient educational resources effective at deterring stroke survivors from considering experimental stem cell treatments? A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2020; 103:1373-1381. [PMID: 32081514 DOI: 10.1016/j.pec.2020.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate whether online resources developed to educate people about the risks associated with experimental stem cell (SC) treatments influence stroke survivors' attitudes about the safety and effectiveness of these treatments. METHODS Adult stroke survivors who had not previously received SC treatments (N = 112) were recruited from international stroke advocacy/support groups for a prospective, parallel-group randomized controlled trial. Participants indicated whether they were considering SC treatments (yes/no) prior to, immediately following, and 30-days after reading/viewing the International Society for Stem Cell Research booklet or Stem Cell Network video. Participant attitudes regarding the safety, effectiveness, accessibility and affordability of SC treatments were examined on each occasion, and compared to those of a waitlist control group. RESULTS Significantly fewer participants were considering SC treatments immediately after reading the SC research booklet (p =.031), although neither intervention had any impact after 30-days (p >.05). Waitlist and intervention groups reported positive attitudes toward SC treatments at each assessment. CONCLUSIONS Stroke survivor attitudes toward SC treatments were initially influenced by the patient booklet, however these changes were not maintained. PRACTICAL IMPLICATIONS Clinicians are encouraged to initiate discussions about experimental SC treatments during inpatient rehabilitation and to reinforce the risks throughout subsequent care.
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Affiliation(s)
- D J Unsworth
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - J L Mathias
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - D S Dorstyn
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - S A Koblar
- Stroke Research Programme, University of Adelaide School of Medicine, South Australian Health and Medical Research (SAHMRI), Adelaide, South Australia, Australia; Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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12
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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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13
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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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14
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Zarzeczny A, Tanner C, Barfoot J, Blackburn C, Couturier A, Munsie M. Contact us for more information: an analysis of public enquiries about stem cells. Regen Med 2019; 14:1137-1150. [DOI: 10.2217/rme-2019-0092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: This study examines online enquiries received by two prominent stem cell science initiatives operating in different geographical jurisdictions. Materials & methods: Combined quantitative and qualitative analysis undertaken of internet-based queries (n = 1047) received by Stem Cells Australia and EuroStemCell from members of the public over a two-year period (May 2014–2016). Results: Findings reveal striking similarities between the two datasets and highlight the range of uncertainties, priorities and needs of those seeking information about stem cells online. Conclusion: Sustained and in-depth tailored guidance is needed to effectively meet the diverse stem cell-related information-based needs of communities internationally. Such efforts should be prioritized by regenerative medicine research initiatives and organizations, given the trust and hope diverse publics appear to place in these groups.
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Affiliation(s)
- Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, SK, S4S 0A2, Canada
| | - Claire Tanner
- Department of Anatomy & Neuroscience, Center for Stem Cell Systems, The University of Melbourne, Parkville, Victoria, Australia
| | - Jan Barfoot
- EuroStemCell, MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Clare Blackburn
- EuroStemCell, MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Anna Couturier
- EuroStemCell, MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Megan Munsie
- Department of Anatomy & Neuroscience, Center for Stem Cell Systems, The University of Melbourne, Parkville, Victoria, Australia
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15
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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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16
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Fernandez Lynch H, Joffe S. Pay-to-Participate Trials and Vulnerabilities in Research Ethics Oversight. JAMA 2019; 322:1553-1554. [PMID: 31545335 DOI: 10.1001/jama.2019.14703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Holly Fernandez Lynch
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Nirwan RS, Albini TA, Sridhar J, Flynn HW, Kuriyan AE. Assessing "Cell Therapy" Clinics Offering Treatments of Ocular Conditions using Direct-to-Consumer Marketing Websites in the United States. Ophthalmology 2019; 126:1350-1355. [PMID: 30904542 DOI: 10.1016/j.ophtha.2019.03.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE "Cell therapy" is becoming increasingly available to the public via online direct-to-consumer advertisement within the United States (U.S.). The current study investigates the scope of "cell therapy" clinics across the U.S. that advertise and offer "cell therapy" for ocular conditions based on information provided on their websites. DESIGN Cross-sectional study. PARTICIPANTS The study included companies that are U.S.-based, participate in direct-to-consumer online marketing, have websites that can be data-mined with content analysis, and advertise therapy for ocular conditions. METHODS Using a systematic, extensive keyword-based Internet search, content analysis of company websites was utilized to identify, document, and analyze U.S. businesses marketing "cell therapy" for ocular conditions as of September 16, 2017. MAIN OUTCOME MEASURES Clinic locations, source of stem cells used, route of administration, marketed ocular conditions, and cost of treatment. RESULTS Forty companies with 76 clinics use "cell therapy" to treat ocular conditions. California (23), Florida (12), and Illinois (10) contain the most clinics. All 40 companies specified sources of cells, which included autologous adipose-derived stem cells (35; 67%), autologous bone marrow-derived stem cells (8; 15%), amniotic stem cells (2; 4%), peripheral blood-derived stem cells (2; 4%), umbilical cord blood stem cells (2; 4%), allogenic bone marrow-derived stem cells (1; 2%), placental stem cells (1; 2%), and xenocells (1; 2%). The most commonly marketed ocular conditions included macular degeneration (35), optic neuritis (18), retinitis pigmentosa (17), and diabetic retinopathy (16). The most common routes of administration were intravenous (22) and "unspecified" (12); however, other companies listed more ocular-specific routes such as intravitreal injections (2), retrobulbar injections (2), eye injections (2), retrofundal injection (1), sub-Tenon injection (1), intraocular injection with vitrectomy (1), and eye drops (1). The cost of advertised "cell therapy" ranged from $4000 to $10 500. CONCLUSIONS "Cell therapy" for ocular conditions is readily available via direct-to-consumer marketing strategies across the United States. The "cells" are harvested from numerous sources and administered through different methods for multiple ocular conditions at these "cell therapy" clinics. Limited data for these treatments necessitates advocating caution to physicians and patients about treatments offered at commercial "cell therapy" clinics.
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Affiliation(s)
| | - Thomas A Albini
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Harry W Flynn
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Ajay E Kuriyan
- Flaum Eye Institute, University of Rochester, Rochester, New York.
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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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