An overview of stem cell-based clinical trials in China

Systematic evaluation of therapeutic effects of stem cell transplantation trials for heart diseases in China

BACKGROUND

To systematically assess the quality of reports of clinical trials of stem cell for heart diseases published in Chinese.

METHODS

The quality of reports was assessed according to the CONSORT statement and the Jadad score. The association between the CONSORT scores and the reported therapeutic effects was evaluated.

RESULTS

A total of 36 randomized clinical trials were identified, and 1552 patients were included. The mean CONSORT score was 7.06 (SD = 2.99). The proportion of reports with a Jadad score of 3 was 8.33%. The improvement of left ventricular function, myocardial perfusion area, left ventricular diastolic diameter, and cardiac output decreased with the increase in the CONSORT score.

CONCLUSIONS

The percentages of high-quality reports published in Chinese on stem cell therapy for heart diseases are low. Although stem cell transplantation seems promising for heart diseases, high-quality studies are needed to verify the conclusions．.

Raman imaging diagnosis of the early stage differentiation of mouse embryonic stem cell (mESC)

Raman microspectroscopy as a non-invasive and label-free technique was applied to diagnose the early stage differentiation of mouse embryonic stem cells. The differentiated and undifferentiated embryonic bodies (EBs) were cultured using handing drop method by the control of Leukemia Inhibitory Factor (LIF). Raman spectra of the periphery cells of differentiated EBs (PrE cells) and those of the interior of undifferentiated EBs (ES cells) were obtained to diagnose the stem cells of different differentiation. It was found from the spectra that the protein content increased as the cells differentiated. Principal component analysis (PCA) was carried out to further analyze the differences between ES cells and PrE cells. The first three principle components contained 98.19% from the total variance. Characteristic bands of ES and PrE cells were chosen to acquire Raman images of two cells according to the results of PCA. In the Raman images, PrE cells had a clear and bright outline in the peripheral areas while ES cells were difficult to identify, this could be a distinct characteristic to discriminate them. The result of the Raman images was consistent with the biological agreement that the differentiated cells were distributed around the periphery.

Lost in translation? Accountability and governance of clinical stem cell research in China

Despite China's regulatory initiatives to promote its research accountability, it still needs to prove itself as a trusted player in life science research. In addition, in contrast to its huge investment, China is losing the race in delivering quality application of stem cells. The trial implementation of the 2015 ministerial regulations seemed to offer hope in ending this dual 'lost-in-translation'. Yet skepticism remains. By examining China's regulatory trajectory in the last 15 years, this paper illustrates that it is a post hoc pragmatic policy rationale and a soft centralization regulatory approach that have hampered China's governance. To improve China's governance of accountability, policy-makers need to get beyond an 'act-in-response' regulatory ethos and to engage with diverse stakeholders.

Epigenetic changes of mesenchymal stem cells in three-dimensional (3D) spheroids

Mesenchymal stem cells (MSCs) hold profound promise in tissue repair/regeneration. However, MSCs undergo remarkable spontaneous differentiation and aging during monolayer culture expansion. In this study, we found that 2-3 days of three-dimensional (3D) spheroid culture of human MSCs (hMSCs) that had been expanded in monolayer for six passages increased their clonogenicity and differentiation potency to neuronal cells. Moreover, in accordance with these changes, the expression levels of miRNA which were involved in stem cell potency were changed and levels of histone H3 acetylation in K9 in promoter regions of Oct4, Sox2 and Nanog were elevated. Our results indicate that spheroid culture increases their multi-potency and changes the epigenetic status of pluripotent genes in hMSCs.

The dual reality of the Chinese knowledge economy

This paper draws on stem cell research and financial derivatives as two case studies to analyse the role of scientific knowledge and technology in the development of the Chinese knowledge economy. The findings suggest that, despite China's recent commitments in acquiring international expertise, there is a decoupling between knowledge acquisitions and applications in the institutionalisation of knowledge within these sectors. Scientific-based knowledge and professional know-how are on the one hand perceived as prime drivers of China's development, yet they on the other hand remain subordinate to existing administrative infrastructures. The paper further elucidates the causes and implications of this by describing the dual reality of knowledge in relation to an isomorphic process of rationalisation outlined by new institutional organisational theory.

Epigenetic dysregulation in mesenchymal stem cell aging and spontaneous differentiation

Background

Mesenchymal stem cells (MSCs) hold great promise for the treatment of difficult diseases. As MSCs represent a rare cell population, ex vivo expansion of MSCs is indispensable to obtain sufficient amounts of cells for therapies and tissue engineering. However, spontaneous differentiation and aging of MSCs occur during expansion and the molecular mechanisms involved have been poorly understood.

Methodology/Principal Findings

Human MSCs in early and late passages were examined for their expression of genes involved in osteogenesis to determine their spontaneous differentiation towards osteoblasts in vitro, and of genes involved in self-renewal and proliferation for multipotent differentiation potential. In parallel, promoter DNA methylation and hostone H3 acetylation levels were determined. We found that MSCs underwent aging and spontaneous osteogenic differentiation upon regular culture expansion, with progressive downregulation of TERT and upregulation of osteogenic genes such as Runx2 and ALP. Meanwhile, the expression of genes associated with stem cell self-renewal such as Oct4 and Sox2 declined markedly. Notably, the altered expression of these genes were closely associated with epigenetic dysregulation of histone H3 acetylation in K9 and K14, but not with methylation of CpG islands in the promoter regions of most of these genes. bFGF promoted MSC proliferation and suppressed its spontaneous osteogenic differentiation, with corresponding changes in histone H3 acetylation in TERT, Oct4, Sox2, Runx2 and ALP genes.

Conclusions/Significance

Our results indicate that histone H3 acetylation, which can be modulated by extrinsic signals, plays a key role in regulating MSC aging and differentiation.

Non-invasive characterization of mouse embryonic stem cell derived cardiomyocytes based on the intensity variation in digital beating video

The interest in cardiomyocytes derived from differentiation of embryonic stem (ES) cells or induced pluripotent stem (iPS) cells is increasing due to their potential for regenerative therapeutics and as a pharmaceutical model of drug screening. Characterization of ES or iPS derived cardiomyocytes is challenging and inevitable for the intended usage of such cells. In this paper we have outlined a novel, non-invasive method for evaluating in vitro beating properties of cardiomyocytes. The method is based on the analysis of time dependent variation in the total pixel intensities in derivative images obtained from the consecutive systolic and diastolic frames from the light microscopic video recordings of beating tissue. Fast Fourier transform (FFT) yielded the frequency domains for these images. The signal to noise ratio for the analysis met the Rose criterion. We have successfully applied our method for monitoring mouse ES cell (mESC) derived cardiac muscle cells to determine the initiation of beating, organization and maturation of beating tissue, calculating the beating rhythms in terms of beating interval or frequency and the strength of beating. We have shown the successful application of our image analysis method in direct monitoring of the responses of differentiated cardiomyocytes towards caffeine hydrate, p-hydroxyphenylacetamide and calcium chloride dehydrate - respectively as positive, neutral and negative inotropic agents. This non-invasive method of characterization will be useful in studying the response of these cells to various external stimulations, such as differentiation promoting agents or treatments, as well as in preliminary drug screening in a quick and inexpensive manner without needing much expertise.

Cultivating regenerative medicine innovation in China

Aim: While China has become a significant contributor and prolific publisher in regenerative medicine, its role in the field is not well understood. We analyze how capacity in regenerative medicine was built in China to identify some of its main strengths and challenges. Materials & methods: This case study of regenerative medicine in China is primarily based on interviews with experts in China, including researchers, policy makers, clinicians, representatives of firms and regulators. Results: Our analysis shows that diverse groups are active in this field in China. Leading research groups are contributing extensively to international peer-reviewed journals. Strong governmental support and recruitment of highly trained Chinese scientists from abroad has made it possible for China to rapidly build up capacity in regenerative medicine. However, some hospitals in China are offering stem cell therapies with limited scientific evidence supporting their efficacy/safety, and international skepticism of medical research in China presents a challenge to the development of the field. Conclusion: China has been able to catapult itself into the forefront of regenerative medicine but needs to address current regulatory challenges in order to secure its position in this emerging field.