(PART 4) Stem Cells: Regenerative medicine--Hope or just hype

Read Part 1: Amazing healing power within our bodies 
(with side bar, "What are stem cells?")

Read Part 2: From science fiction to reality

Read Part 3: Lab nerd tweaks tiny particles to renew life

Human Face column: Stem cells from me, for me

 (Part 4-Conclusion)

Philippine Daily Inquirer/Special Report/by Ma. Ceres P. Doyo

IS THIS THE HOLY GRAIL of medicine in the 21st century? Is this new emerging field going to provide dramatic changes in the way diseases and injuries are studied and treated?

Stem cells and regenerative medicine are the new catch words in health care. Scientists have discovered the stem cells’ amazing characteristics and therapeutic potential.

But stem cell therapy in the Philippines is not without its skeptics for a variety of reasons. It could be a threat to drug-dependent therapy.

Doctors will have to get out of their comfort zones to learn new ways. It is still very expensive and labor intensive.

Dr. Alfredo Bengzon, president of The Medical City (TMC), is undaunted. He has flung the hospital’s doors open to the technology and eagerly awaits a new breed of Filipino scientists who will carry it through.

Leading Philippine universities are preparing scientists and doctors for this endeavor.

With Dr. Samuel D. Bernal leading the team, TMC recently acquired more high-tech laboratory machines to boost its regenerative medicine section of which stem cell therapy is one component. TMC’s “regen” department was introduced to the public on Aug. 19.

Convergence of disciplines

“Regenerative medicine is a convergence of disciplines—cell biology, electrophysiology, molecular biology, biochemistry,” Bernal explains.

“It is difficult to carry out, it involves a major investment for an institution and requires a culture that is committed to providing a customized, personalized approach. This is the advantage of TMC,” he said.

Regenerative medicine, which includes stem cell therapy, is defined as innovative medical therapies that involve the engineering of living cells, tissues and organs for the purpose of preserving and enhancing organ function.

It is meant to prevent disease and maintain wellness as well as to restore or replace organ function that has been lost or impaired due to disease, injury or aging and with the purpose of improving the quality of life.

Is this field meant for a special few who have the financial means? A study by experts shows that regenerative medicine can greatly benefit poor developing countries with huge unhealthy populations. But governments and institutions would have to invest in the technology.

Bioethical questions

Bioethical questions must be clarified. Only the use of human embryos as a source of stem cells is being questioned on moral grounds. Pope Benedict XVI, in his first meeting with US President Barack Obama in Rome last July, stressed opposition to abortion and stem cell research using human embryos which the Catholic Church considers to be human life.

And why is stem cell therapy very expensive? “Mabusisi (labor intensive),” Bernal quips.

The equipment, reagents and materials needed for this technology are costly and are imported. Personnel are not easy to come by and have to be trained. But in the future, when more people opt for the therapy, costs could be dramatically reduced.

10 promising applications

A couple of years ago an international panel of 44 experts embarked on a study to identify the 10 most promising applications of regenerative medicine in developing countries. The majority were from developing countries.

Among the areas identified for the application were: (1) insulin replacement and pancreatic islet cell regeneration for diabetes, (2) autologous cells (from the patient) for the regeneration of heart muscle after myocardial infarction and cardiomyopathies, (3) immune system enhancement by engineered immune cells and novel vaccination for infectious disease.

The study also showed that regenerative medicine could potentially be used to improve health conditions in poor countries. For this purpose local efforts in health biotechnology are ongoing in countries like India, China (with huge government funding) and the Philippines.

Government support

In the Philippines, government support has not been huge but the Department of Health and the Department of Tourism are promoting efforts in this area. National Kidney and Transplant Institute and Lung Center of the Philippines (LCP) have acquired expensive state-of-the-art equipment for stem cell therapy and research.

LCP’s bio-regenerative program began in the 1990s but it was shelved after the center was razed by a fire in 1998. Dr. Juanito A. Rubio, LCP director, revived the program.

LCP is the first and only government hospital in the Philippines that does intensive study of the treatment of lung diseases and multi-drug resistant TB through its bio-regenerative program.

LCP is now inviting cancer patients to volunteer for clinical trials.

Heading LCP’s bio-regenerative team is Dr. Ma. Teresa Barzaga. Also in the team is Dr. Francisco Chung Jr., doctor of pathology and molecular medicine. Pulmonologist Dr. Sullian S. Naval heads research and development.

Medical tourism

Tourism Undersecretary Cynthia Carreon and Director Cynthia Lazo are working hard “to get the word out” that the Philippines is very much in the health and wellness revolution.

Regenerative medicine is in the list of health services the Philippines could offer. A good number of health institutions have international accreditation.

Medical tourism had its bad days especially when underground organ trafficking in developing countries was exposed.

But stem cells in regenerative medicine is exposing the amazing potential and expertise in countries like the Philippines. Soon it will no longer be for a select few who have the access and the wherewithal, but for the many.

There all the time

Are stem cells hope or hype? Has the Holy Grail been found? The quest for new cures will never be over, but one discovery always leads to another. In the case of stem cells, they were right in there all the time, inside each one of us, from the moment we became life.

(Editor’s Note: The writer’s account of her dendritic stem cell therapy is in her Human Face column Thursday, Sept. 17, 2009. Feedback to cerespd@gmail.com)

(PART 3)Stem Cells: Lab nerd tweaks tiny particles to renew life

Read Part 1: Amazing healing power within our bodies
Read side bar to Part 1

Read Part 2: From science fiction to reality
Read Part 4: Regenerative medicine: hope or just hype
Read Human Face column: Stem cells from me, for me

(Third of a series)

Philippine Daily Inquirer/Special Report/by Ma. Ceres P. Doyo

MANILA, Philippines—Physician, lawyer, chemist, molecular biologist, Ph.D. and MBA holder, professor of medicine, cancer director in US hospitals, leading figure in stem cell research, cancer therapy and bioregenerative medicine. Cancer survivor.

“Before I became a medical doctor,” says Dr. Samuel D. Bernal, “I was a hard-core chemist.” As a lab nerd, he poked, coaxed and tweaked the smallest particles of life. He then segued into medicine. His specialization: Stem cells in regenerative medicine and oncology, or the treatment of cancer. But he never really left behind the amazing world of molecules.

This Filipino-American doctor is a moving force in the regenerative medicine department of The Medical City (TMC) where he holds clinic when he’s not abroad.

Whether health practitioners and medical schools realize it or not, molecular is the way to go in the brave new world of medicine. In the smallest and basic particles of the human body—the cells—are contained a wealth of information and potent forces that could open doors to new ways of treating ailments.

Bernal, 59, brings to his medical practice an approach that is personalized and customized down to the molecular level. This means debunking the one-size-fits all standard-of-care approach that puts patients in neat categories or assembly lines.

Impersonal care

“When I ask how a patient is and an intern just gives figures, I become red. I want to know how is the patient faring emotionally, spiritually? Is he comfortable, happy, sad, in pain?” Bernal says.

He rues the way patient care has become impersonal.

This is what moved him to file on behalf of a Filipino-American family, a landmark malpractice suit against a group of doctors, a hospital and a health insurance group in the United States that he accused of hiding behind so-called standard of care procedures. The respondents settled out of court for an unprecedented sum.

Born in Iloilo, Bernal went abroad after his father became a US consultant.

The third of four siblings, Bernal finished chemistry at the University of Illinois in 1969. He already had a doctorate in biochemical pathology when he took up medicine at the University of Chicago.

In 1979 he was a fellow in internal medicine at Harvard Medical School and, later, in medicine at the Peter Brent Brigham Hospital in Boston. He trained in oncology at the Dana-Farber Cancer Institute at Harvard.

Multidimensional person

Bernal is a board-certified oncologist and is a diplomate of the American Board of Cancer Specialists. He has authored papers and books on cancer.

Bernal earned his Doctorate in Jurisprudence from Loyola University and is a licensed attorney. He also has an MBA degree from the Pepperdine University on biotechnology business strategies.

Since 1992, Bernal has been with the University of California in Los Angeles where he is professor of medicine. He is connected with several hospitals and biotechnology institutions and still finds time to teach at the Ateneo School of Medicine.

A multidimensional person, he is also into theater and literature.

Cancer strikes

In 2000, Bernal was stricken with cancer.

“I had no clue, I was completely healthy, writing a book,” he remembers. “I was doing the chapter on kidney cancer.” He noticed a change in the color in his urine and looked at a sample in the microscope. He could not believe what he saw.

Examinations later showed the cancer had invaded his abdomen, left kidney, liver and lung.

“You could be dying and you don’t know it. My head was floating, my mind went numb. It was a totally surreal experience. I was given a pronouncement of death, three to four months,” he says.

“I was on top of my profession and in control. Suddenly I was vulnerable. It was a setback. I had several papers and two more books in progress. I kept telling myself that my work was not finished.”

Customized treatment

Bernal consulted colleagues all over the world. He was advised to enter into a protocol. “I had to customize my own treatment,” Bernal says.

He went for abdominal and thoracic surgery even if it meant working around a major blood vessel to scrape and carve out the damaged parts.

“I was in the ICU for three weeks because my lungs would not re-expand,” he said.

“During the operation they got live cancer cells that were then cultured so we could observe their behavior and response to treatment. This is not ordinarily done,” he says.

Bernal’s cancer was the type that will not respond to radiotherapy or chemotherapy. The treatment he drew up for himself was admittedly expensive and difficult.

“A lot of it was based on molecular biology work of scientists and this knowledge was not available to clinicians,” he says.

Bernal devised his own dendritic immune therapy, using his own stem cells.

“The experts around the world encouraged me to do it myself. But at that time, they wouldn’t recommend it to their own hospitals. They said it was difficult, impractical and expensive. It was being done but on an experimental basis,” he says.

Intimations of mortality

“I prepared myself to face my mortality. I fixed my finances and properties. I was already divorced then,” Bernal says.

He lost 40 pounds. But after six months things began to clear up. After more than a year, Bernal was back on his feet.

No wonder Bernal is passionate about customized medicine and is on a personal mission to promote it. “The one-size-fits all protocol for serious diseases does not work. But 99 percent of cancer specialists cannot do it if their hospitals cannot do it,” he says.

Stem cell therapy, Bernal points out, is only one of the components of regenerative medicine. And because cells are not drugs that are mass-produced, they are not for food-and-drug approval.

He shares a 2006 study that shows the significant impact stem cell technology could have on poor, developing countries in addressing their health concerns.

“Even if 99.99 percent of doctors here would say it is inappropriate, here are these world experts saying otherwise,” he says. “The most powerful force for healing our body is in our own body.” (To be continued)

(PART 2) Stem Cells: From science fiction to reality

Read Part 1: Amazing healing power within our bodies
Read side bar to Part 1: What are stem cells?
Read Part 3: Lab nerd tweaks tiny particles to renew life
Read Part 4: Regenerative medicine: hope or just hype
Read Human Face column: Stem cells from me, for me


(Second of a series)
Philippine Daily Inquirer/Special Report/by Ma. Ceres P. Doyo

IN THE PHILIPPINES, a name that has become synonymous with stem cells, and in a bigger dimension, with molecular and regenerative medicine, is Dr. Samuel D. Bernal. 

“Molecular medicine,” Bernal proclaims, “is now, the present. Not the future. In this era of molecular biology, we are now recognizing even more that personalized medicine involves analyzing the molecular characteristics of a patient.”

The Filipino-American doctor is a cancer survivor who applied on himself his knowledge of regenerative medicine and stem cell therapy when he was thought to be dying nine years ago. He stresses that the body holds a potent army for healing that needs to be harnessed and trained to recognize the enemy.

Bernal holds clinics at The Medical City (TMC) in Pasig City when he is not treating patients in Los Angeles or Prague. (More on Bernal tomorrow)

“We constantly gather objective data so that we have a basis to follow scientifically what is happening to the patients’ bodies and their cells,” Bernal emphasizes. “We recognize the uniqueness of individuals at the molecular level.”

He cites the case of a 38-year-old patient from Las Vegas who was “essentially dying.”

Oncologist Dr. Marina Chua-Tan says of the case: “He had cancer in the lungs, spleen, brain, spine. He had already stayed at a hospice and was expected to die in a few months. His father checked us out and brought him to TMC. On his fourth stem cell injection the CTscan imaging showed that his tumor had receded, then the spinal fluid became clear of cancer cells. He is alive, functional, jogging. He even got married.”

“We are not saying that he is completely cured,” Bernal adds, “but his quality of life dramatically improved. Prolongation of life—that is a major achievement. There are patients that doctors have given up on. Four years ago we had this doctor who had cancer all over her body. Now she is free of the disease.”

Dendritic

Another patient at TMC, Androclus Ranises, 69, has been receiving dendritic cell therapy using his own adult stem cells. Autologous, it is called, or reimplanting cells that have gone through a laboratory process. The businessman from Cagayan de Oro City was diagnosed in 2007 as having Stage 3-4 multiple myeloma or cancer of the bone marrow.

He now raises his arms to show how increasingly strong he has become and how the disease has been kept at bay. “I hope to live beyond 80,” he exclaims.

Interior designer Marisa Oreta, 53, was diagnosed in 2006 as having stage 4 colon cancer. In the Philippines, she underwent resectioning of the colon and in Singapore she went through peritonectomy, a high-risk surgery to clean out her affected peritoneum. She had chemotherapy, six stem cell injections plus three boosters at TMC. So far, she’s been holding up well, enjoying life and traveling every now and then.

Former Labor Secretary Nieves Confesor, now associate dean at Asian Institute of Management, was discovered in 2006 to have Stage 1 leiomyosarcoma, a rare form of cancer in her uterus. “It took five months for doctors to discover what was wrong,” Confesor says. “I had lost 45 pounds and I had fevers of unknown origin.”

Confesor had surgery and six cycles of chemotherapy but in 2007, nodes were discovered in her left lung and she again had to go under the knife. Before that she had thyroidectomy. She decided to have stem cell therapy.

“It has really helped me,” Confesor says. “It’s been three years.” She continues to teach and to participate in peace negotiations involving groups in conflict.

Innovative

More than 100 patients had either undergone or are undergoing stem cell therapy at TMC. The procedure does not come cheap and because it is classified as “innovative,” it is not covered by insurance. But it is hoped that in the future, just like all breakthroughs in technologies, it will be within the reach of many.

At St. Luke’s Medical Center (SLMC) in Quezon City, scientists and doctors broke new ground in 2006 with the use of stem cells in treating patients that have been blinded or partially blinded because of surface damage.

Dr. Jessica Abano headed the transplant which successfully resurfaced the left eye of a 52-year-old man who had been blinded by a chemical burn years before and could not be effectively treated with conventional surgery. It was the first limbal stem cell transplant in the country.

Abano describes the procedure while showing an actual video: “A small biopsy (1mm x 2mm) of stem cells was harvested from the healthy conjunctiva of the patient’s right eye in a painless procedure that lasted less than 10 minutes. The biopsy was then brought to the hospital’s Research and Biotechnology Division.”

Using a piece of amniotic membrane (the wrapping of newborns) as medium, scientists coaxed the cells to grow over two weeks into a film of tissue about 25mm x 25mm. After the abnormal fibrovascular growth was removed from the patient’s damaged eye, Abano stitched the bioengineered epithelial sheet on the eye.

Bioengineered tissues

Says Dr. Mark Pierre Dimaymay: “With ocular stem cells, we demonstrate our ability to perform cutting edge basic laboratory research with direct clinical applications.” Set up in 2004, St. Luke’s stem cell lab is the first in the Philippines.

This is an important step toward the stage when tissue engineers may be able to produce readily cornea replacements that can be easily transplanted whole into patients with severe cornea damage, says Dimaymay. “Today we can do ocular surface tissue. In the future we could learn to do the retina. The technology to replace diseased cells in various organs with bioengineered tissues is rapidly moving from the realm of science fiction to reality.”

This breakthrough is significant in the Philippines where eye surface injuries are more common than in more developed countries.

SLMC is now pursuing a study using stem cells from the buccal mucosa (inner part of the cheek) to treat patients with injury on both eyes.

Lab monkeys

Since 1997, SLMC, the University of Medicine and Dentistry of New Jersey and the Simian Conservation and Breeding Center have been working together to develop a protocol to induce myocardial infarction (heart muscle damage) in monkeys. Stem cell technology is then used to treat the damaged heart.

Dr. Filipina Natividad explains that the monkeys (macaques) in the SLMC lab are the source of the stem cells and are also the recipients of the stem cell transplants. This is an autologous cell transplantation where the monkey patient is both the donor and the recipient.

Before damaging the monkey’s heart, scientists harvest stem cells from its bone marrow. These are then cultured in the lab and made to grow as heart muscle cells. Experiments are still ongoing. It will still be a while before this could be replicated on humans here in the Philippines.

Dr. Joven R. Cuanang, SLMC senior vice president and chief medical officer, discloses that SLMC has also performed stem cell therapy on someone with spinal cord injury. The stem cells were taken from the patient’s bone marrow and injected near the injury.

“We had to go through an ethical review of its value and risks,” Cuanang says. The stem cells were processed with the help of a Singapore partner. (To be continued)

(PART 1) Stem Cells: Amazing healing power within our bodies

Read side bar: What are stem cells?
Read Part 2: From science fiction to reality
Read Part 3: Lab nerd tweaks tiny particles to renew life
Read Part 4: Regenerative medicine--hope or just hype
Read Human Face column: Stem cells from me, for me

(First of a series)

Philippine Daily Inquirer/Special Report/by Ma. Ceres P. Doyo

MANILA, Philippines—Who’s afraid of stem cell therapy?

Not me. I went through it—with the use of my very own adult stem cells. It was part of the therapeutic package—radical, immediate and customized—meant to battle a life-threatening health condition that I faced in late 2007. I was next door, so to speak, to the pre-departure area.

I underwent surgery, chemotherapy, radiotherapy—the so-called “slice, poison and burn” procedures—plus stem cell therapy, which was the most customized and personalized and the least invasive.

My doctors and I believe stem cells had helped significantly not just to reduce the impact of the three radical procedures, but, more importantly, they played their own independent role in targeting the enemy without collateral damage. They helped restore my health and made me hit the ground running again, go out to sea, climb hills, travel far. From “on the verge” to “very clean.”

 

God is the ultimate healer, but doctors say that within each one of us are amazing microscopic molecular components called stem cells that could help reverse, regenerate and restore what had been diseased, damaged or destroyed. They were in our body when we were born.

Stem cell therapy and research have been in place in the Philippines for many years. Abroad, particularly in the United States , bioethical questions have been raised regarding the use of one of its sources—human embryos. Not in the Philippines , where human embryos and aborted fetuses are not being used by hospitals that are into stem cells.

An important reason is that there are other safe, acceptable and effective sources. One is a patient’s own body cells and tissues (blood and skin, among them). The other is blood and stem cells from umbilical cords—those amazing lifelines in the womb that come with newborns.

In step with the world

Some Filipino proponents of stem cell therapy and research say that the Philippines is in step with, if not a step ahead of its neighbors and countries that are more economically advanced.

Two premier private hospitals—The Medical City (TMC) and St. Luke’s Medical Center (SLMC)—and two government institutions—National Kidney and Transplant Institute (NKTI) and Lung Center of the Philippines (LCP)—are now pushing stem cell technology into the mainstream.

Although the Philippines is faced with enormous health and nutrition woes because of poverty, advocates of the procedure say this does not mean that advances in science and technology have to be put on hold until all the primary health care concerns have been addressed.

Dr. Alfredo Bengzon, a former health secretary and TMC president, says: “This is our contribution to our country. We considered this when we decided to invest in this technology. This is also about patriotism. We will have to stand up to the rest of the world.”

Obama and embryos

Other Asian countries openly doing both stem therapy and research are China , Japan , South Korea and India . Singapore and Taiwan are into research while therapy is still in the experimental stage.

Supporters of this medical endeavor agree that the Philippines cannot be left behind because this country has the technology, the expertise, the manpower and the culture of care-giving. Tertiary hospitals here have girded up for the burgeoning of medical tourism.

US President Barack Obama’s lifting of the ban on embryonic stem cell research has rekindled fears that this could open a Pandora’s box and the cloning of humans. There has been renewed interest in US media on stem cells and how they could help battle diabetes, heart disease, Parkinson’s and other conditions.

But an expert says that some stories created more confusion rather than better understanding of the safety and bioethical issues.

The bioethical problem has to do with the use of stem cells from human embryos (embryonic stem cells) and deliberately aborted fetuses as well as the use of genetically modified stem cells (induced pluripotent stems cells or iPS cells). There are bioethical and biosafety issues regarding iPS cells because of immune rejection and risk of developing cancer.

Cells could now be reprogrammed to become cells in an embryo-like state without ever using embryos (fertilized eggs that are considered to be life in the making). This was first done in Japan and, through a different process, in the United States . These stem cells could then produce daughter cells that can potentially become any specialized cell to repair/replace diseased or damaged body parts (heart, bone, muscle, brain). With iPS, the moral debate over embryonic stem cells could be rendered moot.

But, and there is a big but, these so-called iPS cells have not been sufficiently tried and tested and could pose dangers.

On the other hand, the use of the umbilical cord (blood and stem cells) of newborn babies and the patient’s own (adult stem cells) do not pose a bioethical dilemma as no human embryos are being tampered with. Theologians and bioethicists are clear on this. Moreover, adult and umbilical stem cells have established records of safety and efficacy.

Stem cells for health

At TMC, cancer patients could avail themselves of dendritic stem cell therapy as an immune-system-boosting procedure. TMC also offers stem cell therapy for heart ailments and spine injury. For about five years now, more than 100 patients have received stem cell therapy at the hospital.

At SLMC, stem cells are being used to repair injured eyes—for free for volunteer patients. Its nearly 100 percent success in this procedure could make it become mainstream and available to many—but at a cost.

Stem cell research involving monkeys is also one of SLMC’s promising ongoing scientific projects that could offer breakthroughs.

Stem cell banking (from umbilical cords) is offered in both TMC and SLMC. There are biotech companies that now offer the technology, but a doctor of molecular biology warns those who use the name stem cells in vain and who are out for profit.

NKTI and LCP have acquired high-tech machines that are a dream-come-true for Filipino molecular biologists. Lung cancer and TB patients, being among the main concerns of LCP, could benefit from procedures using stem cells.

Major proponents of stem cell therapy in the Philippines look forward to partnership and sharing of facilities that would reduce cost and benefit patients.

How far have Philippine efforts gone in the brave new world of stem cells? (To be continued)

What are stem cells? (Side bar to Part 1)

STEM CELLS ARE the primary cells in the human body from which all other tissues “stem” from. They could be programmed in the laboratory to potentially become any other kind of cell and could be used to repair damaged tissues and replace diseased organs.

Stem cells are found in most, if not all, multicellular organisms and are characterized by their ability to renew themselves into a diverse range of specialized cell types. The field developed from the findings of Canadian scientists Ernest A. McCulloch and James E. Till in the 1960s.

There are two broad types of mammalian stem cells: Embryonic stem cells that are isolated from the inner cell mass of blastocysts, and adult stem cells that are found in adult tissues.

In a developing embryo, stem cells can differentiate into all of the specialized embryonic tissues. In adult organisms, stem cells and progenitor cells act as a repair system for the body, replenishing specialized cells, but also maintain the normal turnover of regenerative organs, such as blood, skin or intestinal tissues.

Stem cells can now be grown and differentiated into specialized cells, among them, heart muscles, nerve cells and blood cells. Stem cells from the bonemarrow, umbilical cord blood and highly plastic adult stem cells from a variety of sources are now routinely used in a variety of medical therapies. This holds a lot of promise in treating a variety of conditions in the future, among them, Parkinson’s disease, diabetes, spinal injuries, heart disease, vision and hearing loss.

Stem cells from blood is harvested with the use of a machine to which a person is intravenously connected. White blood cells (WBC) are collected while the rest of the blood components are returned to the body. In the lab, the WBC go into a special growth broth that could be used to kill cancerous cells.

Source: National Institutes of Health resource for stem cell research