The Stem Cell Human Body Shop

Imagine what stem cells might be able to do in terms of revolutionizing medicine and society in coming decades. It’s an exciting time.

car parts

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One cool notion that’s been out there for a long time (e.g. see this Tech Review piece from 2001) is The Human Body Shop.

I’d extend that to The Stem Cell Human Body Shop as I’ve discussed in my book and in this 2013 radio interview. How would this work?In the future it may literally be possible to replace human body parts that otherwise may have led to our deaths. Have a liver problem? In twenty years perhaps scientists can grow you a new one from your stem cells and pop it in after taking out the old one like a replacement part for your car. Same goes for heart, lungs, kidney, pancreas, and more.

VC-01 post-implant final

Even now, the biotech ViaCyte is testing in humans an encapsulated form of essentially a bioengineered pancreas in a new, exciting clinical trial (see image above). Infusions of laboratory-grown young blood may in coming decades aid the fight against aging.

What might the risks be?

A few years back I held a stem cell essay contest and one of the winners, then 14-year-old Claire August, wrote an inspired piece invoking the Ship of Theseus in this context. If we start replacing many of our body parts and there are few left that are original, are we the same person?

Another issue revolves around price and access. Could we end up in a future where 1%er’s live say 150 years due to the Human Stem Cell Body Shop, while most people live about 80 years on average?

Still, overall the notion of organ replacement via bioengineering and stem cells provides real hope looking to the next few decades. In decades to come if we need a part to replace an old or diseased one, the process of getting a new one “installed” may not be so different than fixing a car part now except the new part will have to be grown first.

What countries are ‘punching above their weight’ in stem cell space?

By Heather Main

When reading through the ISSCR 2015 program you can understand why everyone wants to go to the US for their postdoc as it seems like most of the work being presented is US-based. In fact, this is more than true with 78 of 156 speakers being USA based, a straight 50% of the program. Coming in second is Germany with 11 speakers. Being an Aussie I wanted to see how Australia stacked up against this and thus made a simple calculation on the ‘success’ of a country in the stem cell space based on the assumption that speaking at ISSCR reflects your success in the field. It’s not rocket science, it goes;

  • Number of speakers from the country/number of speakers = % speakers
  • % speakers/% ‘population’ relative to other countries included = speaker:population ratio

A ratio above 1.0 means the country is over-performing based on its population number. Considering not all countries had representation in the ISSCR 2015 program and this is intended to be a happy post not a basher I have only shown the top 11 performing countries here (couldn’t leave Australia out).

stem cell countries

Being the host country we may not be surprised that Sweden is the top performer. However, hosting the event is itself kind of evidence of the great research going on in Sweden with Stockholm-based Karolinska Institutet highly regarded for its medical science innovations and Sweden’s being very supportive of medical science funding. More recently Astra Zeneca also invested $240 million for a Stockholm-based Integrated Cardio Metabolic Centre (ICMC), demonstrating confidence in Swedish medical science research.

Moa StenuddJonas Frisen popped in to give a plenary talk on his great work in neurogenesis and regeneration and the Swedish Karolinska PhD students Moa Stenudd (JF’s student; see image from Frisen lab), Lakshmi Sandhow and Nigel Kee (presenting on spinal ependymal cells, MSCs and dopaminergic neurons respectively) showed that it’s not only the big names who get the chance to talk about their work. Katarina Le Blanc also presented work on the clinical testing of MSC therapies in humans, groundwork that will determine how we go about cellular therapies in the future. Finally from Sweden, Agnete Kirkeby (Lund University) and Iwan Jones (Umeå (Oomeaw) University), studying neural tube and neural crest respectively, solidified Sweden’s top spot in stem cells at ISSCR 2015.

Number 2, Israel is definitely an interesting space to watch. For good reasons here, it was the next best performer. Strong links with the US have no doubt driven investment in research in Israel as opposed to neighbouring countries. The closest country to Israel that is represented in the ISSCR program is Greece, making Israel an island of high quality stem cell research in a rather tumultuous part of this world. A diversity of topics were represented by Israel including epigenetic disorders, neural stem cell ontogeny, RNA methylation, Fragile X and, of course, pluripotency. An interesting mix, demonstrating the diversity of high quality stem cell research going on in Israel.

However, both Sweden and Israel had a member on the program committee, unlike Switzerland or Finland, coming in third and fourth. Switzerland is well known for it’s biotech and solid investments into research and translational development but Finland, I have always felt, is a quiet achiever…regardless of the fact that they are probably some of the quieter people on earth, thus the old paradox of the Scandinavian countries developing mobile communication… The land of Nokia is doing great per capita in the stem cell space. Coming in at number 5 is the US. Won’t spend too much time here as with 50% of the program and 41% of the program committee, we all know who they are.

To give a little perspective, when adding a second timepoint to this analysis ie. ISSCR 2014, we see a slightly different spread;

stem cell countries 2

Still in the ‘top 11’ are Sweden, Israel, Switzerland, USA, Canada, Singapore, the UK and Australia, with 2014-2015 positive movement by Sweden (6-1, not surprising), Israel (5-2) and the USA (7-5). Also Finland, Denmark and Germany appear in 2015 at the expense of the Netherlands, Austria and Spain. It may be surprising that Japan is not in either of these lists, in fact sitting at 15 in 2014 and 17 in 2015. This does not remove in any way from the amazing work they do, it is purely the handicap of a large population with Japan matching the UK (ranked 9 in 2015) with 9 speakers each in 2015.

Personally I’m very proud of Australia who maintains a spot in the top 11 both years, 4 in 2014 and 11 in 2015. For a country of 23 million and only 5 cities with more than a million people we are a very proud technological nation (though our current government has more in common with Vatican City than science and technology), we have some great stem cell work going on, including a surprising number of innovating stem cell companies. As they say in the ads, if you haven’t been to Australia, ‘where the bloody hell are ya?’ There is lots of collaboration to be had.

To conclude, being an Aussie I was aware that Nigel Kee from Karolinska Institutet is also Aussie as well as Allan Robins from Viacyte and Alan Trounson who received the ISSCR public service award. Similarly I’m sure those representing many ‘countries’ are not nationals but have travelled for opportunities and to be involved in ground-breaking work. Thus, maybe the ‘success’ of a country should be how good they are at training and recruiting great people, national or not. Would be great to see where the best minds are coming from but that is not an easy numbers game for today!

Review of Biotech/Translational Talks #ISSCR2015: StemCells Inc, Semma, ViaCyte, & Le Blanc

By Heather Main

The path to the clinic is a slow and arduous activity, frustrating not only to the researcher and patient, but investors. Successful clinical translation of technologies requires a balance of science, streamlined translation and funding. To develop fantastic science and then realise the most important components cannot be adapted to the clinical environment is as disastrous as having a great product but no cash to get it past the post. The fruitful interaction of researchers, companies and clinics will save a lot of pain in streamlining technologies to patients. Thus, it was nice to see an ISSCR 2015 plenary session on stem cell therapies including companies StemCells, Inc. and ViaCyte, Inc. The topics were a good spread of autologous and allogeneic cell sources as well as therapies directed at inflammation and immune reactions versus integrative cell replacement technologies.stemcellsinc-logo

StemCells, Inc. presented progress in clinical trials with allogeneic neural stem cells in brain, spinal cord and eye disorders. As is the reality for companies giving talks some data and beautiful pictures is not disclosed. Though there were no revolutionary data sets on efficacy, what was clear was that grafts could persist 1.5 years post removal of immunosuppression (this was determined with HLA-mismatch begging the development of a Shinya Yamanaka style allogeneic HLA cell bank). It should not be a surprise that there were no amazing efficacy leaps in these first trials. There would be a lot of luck in getting the right cell, the right dose and the right transplantation method in the first go. Even the development of reliable measures of graft behaviour and efficacy will take time to develop and standardise.

Semma TherapeuticsDoug Melton was clear to state that they “haven’t (just) done an academic study”. That while they are not yet in the clinic and even though they present a more classical academic study, showing a complex defined differentiation and detailed functional analyses, that they recognise the importance of not just talking the talk but walking the walk. Doug presented their in-vitro beta-cell body technology that show functional characteristics equivalent to, if not better than, cadaveric islets. They were able to upscale this technology and are now on the prowl for encapsulation technologies to move into the clinical space, which will happen through their new start-up Semma Therapeutics.

ViaCyte New LogoIt’s always nice to hear an Aussie accent ;), giving additional benefits to listening to Alan Robins present the progress of ViaCyte in clinical trials of their pancreatic progenitor and encapsulation technologies. Following on from Doug, Alan made a couple of comments to assure the audience that there was a lot of vigorous science behind their technology, the curse of not being able to disclose and thus somewhat unfairly being seen as less careful. The ViaCyte technology is based on the major phase of expansion in pluripotent cells followed by mass differentiation and subsequent encapsulation. Interestingly in their pre-clinical animals studies the grafts were able to regulate insulin levels at the standard human blood concentrations, indicating not only functionality but also species specific functionality.

Katarina Le BlancKatarina Le Blanc presented her work on MSCs for GVHD, diabetes and vocal cord scarring. Somewhat disappointingly I heard the comments of someone leaving this talk with the all too common disregard that MSC technologies are inferior to pluripotent technologies rather than recognising them as complementary technologies. Katarina showed epithelial cell death and inflammatory markers were reduced with maximal effect at 3 weeks after IV injection for GVHD, even though they also prove that IV infused cells have mostly disappeared already at 3 days post infusion. She also showed that while coagulation and complement cascades are activated in response to IV infusion of MSCs blood clotting is not a common occurrence. The risk of clotting was cell number, dose and passage number dependent, which is a little scary when many autologous therapy clinics do not standardise the cell number they IV inject.

It’s great to see both academics and companies being recognised as the drivers of cellular therapies. Working in a stem cell company myself, I was surprised 2 years in a row to see talks from academics about skeletal muscle differentiation protocols that do not come close to our technology. It’s somewhat understandable that when it is not possible to disclose a lot of details of your research, the companies are often not taken seriously and are relegated to paid presentations during the lunch break. It is fantastic however, to see positive movement in reputable exposure for the companies attempting to drive research to patients.

New biotech Semma Therapeutics joins ViaCyte & Betalogics in stem cell Diabetes arena

Semma Therapeutics

Semma’s technology director Felicia Pagliuca, with CEO Robert Millman. Boston Globe Picture

A new biotech startup, Semma Therapeutics, announced that it seeks to fight diabetes via translating technology from the lab of Doug Melton at Harvard to the clinic.

Another major player in cell therapy-based arena for Diabetes is most likely good news for patients.

Quoted in the Boston Globe, there is a good deal of enthusiasm about the potential of this kind of therapeutic approach:

“This would be a huge breakthrough,” said Dr. George L. King, a Harvard Medical School professor and research director at Joslin Diabetes Center. “It could cure diabetes.”

Semma TherapeuticsSemma will have to compete with ViaCyte and Betalogics, which could prove challenging given, for example, that ViaCyte already has an ongoing FDA-approved clinical trial. Still Semma has raised more than $40 million, which is a good start, and this capital came from some known bio-investment players:

“Sensing a business opportunity at the juncture of stem cells and diabetes, venture firms MPM Capital, Fidelity Biosciences of Cambridge, and Arch Venture Partners of Chicago are teaming with Minneapolis-based medical technology giant Medtronic plc to back Semma in the company’s first round of financing.”

Two of the leaders of Semma are former Melton lab postdoc Felicia Pagliuca, and CEO Robert Millman. Pagliuca was first author on a high-profile Melton lab paper in Cell published just about half a year ago and post-pub reviewed on this blog.

The Semma website has more information.

Why the name Semma?

I’m not sure.

There is a SEMMA acronym in high-tech:

Sample, Explore, Modify, Model, Assess.

It’ll be exciting to see how Semma performs and more broadly how cell therapy-based approaches to Diabetes evolve. I view Semma coming on the scene as a positive.

ViaCyte CEO Paul Laikind Interview: Trial Update, Melton’s Concerns, & Future

Paul LaikindIt’s been exciting to watch the recent developments in using stem cells as the basis for treatments for Type I Diabetes. One of the major players in this arena is the privately-held company, ViaCyte.

In this post, I interview ViaCyte President and CEO, Paul Laikind. The topics include their VC-01 product, the Encaptra device, an update on their clinical trial, the healthy competition with Doug Melton, and future perspectives.

  1. Can you give an update on the VC-01 clinical trial?

Answer: We’ve enrolled four patients in the trial as of last week. The first cohort is receiving a sub-therapeutic dose with the focus on safety and tolerance. We are also including sentinels. Enrollment is currently limited to adults (age 18-55), male or female (of non-child bearing potential). They must be C-peptide negative and thus have essentially no ability to produce insulin. We are seeking to enroll patients with a stable presentation.

  1. Is there a target date for full enrollment of 40 patients?

Answer: We will most likely have six patients in the first cohort (met by mid this year) and then another 36 in the second cohort (filled sometime in 2016). Patient numbers could change though. While it is difficult to predict this early in the study, based on current projections, we expect that an initial evaluation of efficacy could occur in mid to late 2016 However, patients will continue with the implanted device for two years.

  1. Can you tell me more about the details of the trial?

Answer: It’s a dose-escalation trial. The first cohort is sub-therapeutic and these patients will have two Encaptra-250 (EN250) “dose ranging” implants. The second cohort will have an increased dose where we seek to achieve efficacy. For the second cohort we estimate patients will have four to six dose ranging units implanted. Looking to the future for the predicted actual commercial product, it will have a larger capacity with three to four times as many cells as in one current EN250. With the commercial product, the goal is to treat patients with only one or two units implanted.EN20 EN250 Quarter w labels white

  1. The sentinels are a novel approach to monitoring and data collection. How do these work and what is their make up?

Answer: The sentinels are called EN20s. They are a smaller size, about the size of a dime versus EN250, which is about half the size of a business card. During the trial, the EN20s will be withdrawn periodically from patients and analyzed histologically. The sentinels are a tremendous tool for maximizing the potential of the product. With them, we can monitor progress, troubleshoot issues, examine different surgical techniques, location, etc. The sentinels were met with enthusiasm by regulators.

  1. What are the product placement options?

Answer: There are several product placement options. We are currently focusing on placement in the lower back. The reason for that placement is that while the device can withstand the impact of a 60 mph baseball (based on cadaver testing), a needle could go right through it, so we want to put it where patients don’t typically inject insulin.

  1. What about the function of the capsule?

Answer: The theory is that the capsule will protect the cells from the patient’s immune system and thus avoid the need for immunosuppression. We are testing that in this trial. It prevents cells going in or out, but allows for proteins and smaller molecules to traverse the semipermeable membrane.

  1. Doug Melton has been quoted as being “worried” that ViaCyte technology won’t work (e.g. He raised concerns more specifically about the Encaptra capsule, for example, functionally becoming fibrotic and mentioned worries about your cells being immature and taking a long time to mature. Any response on capsule and cells? He also has suggested that his beta cells will be a better option.

Answer: Dr. Melton’s work on the beta cell is very interesting. As to the cells, we made the choice to use the pancreatic progenitor cells. An important consideration is that when you first put in cells, they are in a hypoxic environment. Beta cells are sensitive to low oxygen levels, which can negatively affect their survival and function. Beta cells typically exist in a mature highly vascularized organ. The pancreatic progenitor cells that we use undergo an organogenesis-like process, more similar to how they behave in nature, and thus we believe they should be better able to handle low oxygen. They also are believed to release angiogenic and other factors to promote vascularization.VC-01 post-implant final

In regards to the capsule, we do expect there to be a foreign body reaction in patients after implantation, which will generate a fibrotic capsule. In fact, we see a thin fibrotic capsule around the device in mice. But in the mouse model this capsule around the device is very well vascularized. The vasculature is right up against the device membrane on the outside, allowing for oxygen and nutrient diffusion to the cells inside.

  1. How do you view the time to maturation issue?

Answer: We do not feel the maturation time of two to three months for our cells in vivo is a concern. For example, the comment has been made by some that by implanting a more mature beta cell you avoid a delay. We question that. One, while the in vitro beta cells that have been described in recent publications are relatively more mature, they are still not actually fully mature differentiated beta cells. Two, maybe more important is the issue that, more generally, grafts take time. If you put in a product made with beta cells that’s not vascularized, it will likely take time to become effective, assuming it survives the implant. Furthermore, in talking with patients, if you’ve been living with this disease your whole life, a couple months is a relatively negligible amount of time to have to wait for function.

  1. Another issue raised has been that progenitor cells produce mixed cell populations. Thoughts?

Answer: We do put in cells that are designed to form the mixed cell population of the islet with multiple hormones produced. We view that as an upside. By producing something more like a full islet we have a potentially more effective way to treat the disease. For example, glucagon-producing alpha cells can be dysfunctional in type 1 diabetes as well, and we believe these can help prevent dangerous hypoglycemic episodes. Yes, this may impact the total cell numbers needed to produce blood sugar control, but based on our calculations it is within the capacity of our approach. Of course, that remains to be demonstrated in the clinical study.

  1. What about BetaLogics?

Answer: With both Dr. Melton and BetaLogics, we view it as healthy competition. Type 1 diabetes is a disease for which we need to find a better treatment and ideally a cure. There’s room in this area for multiple efforts and we aren’t especially concerned with competition. Yet we do feel we are ahead of others and we have substantial intellectual property that they will need to navigate (~50 patents issued in the United States, and a couple hundred pending patent applications, including international). At ViaCyte we view the real competition as the biology rather than with the efforts of others as we seek to cure this devastating disease.

  1. What has been the role of CIRM and JDRF funding?

Answer: I can’t say enough about how important their support has been for the company. It has played a crucial role. We are focused on development of a transformative treatment for type 1 diabetes with stem cells. The valley of death is a real challenge to biotechs, and there is a very difficult financing environment for early stage, unproven technologies. CIRM and JDRF providing capital and in effect their endorsement has been crucial.

  1. What about the partnership with J&J?

Answer: J&J has had an interest in this sector for some time. They became investors in the company via J&J Development Corporation. They’ve been strong investors for some time, and this last year we did a transaction with them that brought in $20 million. They have the right of first refusal. Overall, I view this as a long-standing and productive association.

  1. What about projecting price or costs during the commercialization phase?

Answer: Should it be approved, the price will be partly dependent on how effective the product is. If animal data directly translate to humans (which admittedly doesn’t always happen) and there’s a functional cure where patients no longer have to use insulin, or have a reduction in insulin use, and do not have to constantly do blood tests, etc., then that would translate to savings for the healthcare system and influence how the product is priced. We also see value in how we are able to improve the quality of life for patients. If our product is able to reduce the drastic highs and lows that are so life threatening, we believe that could be very significant for patients as well.

  1. Where do you see ViaCyte in 5 years?

Answer: Obviously, at this stage, predictions are very speculative. Five years from now we hope that we will have seen success with the VC-01 product and be moving to the market. Ideally it will have proven to be a major new approach for managing type 1 diabetes and possibly a functional cure. In addition, success with the VC-01 product will validate our two platform technologies, each with strong IP. The first is directed differentiation of embryonic stem cells to a target cell (e.g. pancreatic progenitor cells) in a regulatory compliant, reproducible, and scalable manner.

The second platform is the Encaptra delivery device. We foresee multiple applications derived from these platform technologies. In summary, five years from now we hope to have made progress with the VC-01 product and have a pipeline of other new products. These could involve a variety of cell types but for the time being I’d say 95% of our efforts remain focused on the VC-01 product.