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LIFTING THE BLACK CLOUD

Existing antidepressants leave a lot to be desired. They can take weeks to start working, and they fail many people. Researchers are scouting for better options

By Robin Marantz Henig

Click here to view the entire article

Structural changes in the hippocampus have long been implicated in depression. Brain autopsies of clinically depressed people often show atrophy in that region and a significant reduction in volume. The SSRIs and SNRIs already in use ease depression not only by manipulating serotonin levels but also by increasing new hippocampal cell growth. That growth happens slowly, though, which is probably part of why the pills’ benefits take so long to kick in. Scientists at the small pharmaceutical company Neuralstem in Rockville, Md., are hoping they have found a different way to spark neurogenesis—and to maintain it even after the drug has been stopped.

To find their spark, Neuralstem researchers relied on cultures of neural stem cells derived from human hippocampal cells—the only such cultures in the world, according to the company. First, they screened some 10,000 compounds for their effect on the hippocampal
cells in culture. The goal, chief scientific officer Karl Johe says, was to see which compounds increased the rate of cell proliferation after seven days. Fewer than 200 made the cut, he says, and from those the Neuralstem team devised a dozen candidate compounds that seemed most likely to stimulate hippocampal neurogenesis. In 2004 the workers began animal testing, injecting the preparations into healthy normal mice. The compounds best at provoking growth of new hippocampal cells were given to mice with depressive behavior, and from this protocol the single most promising one emerged.

Now Neuralstem is conducting early safety tests (phase I trials) of a pill form of the substance, called NSI-189, in humans. If all goes as planned, Neuralstem officials expect to begin tests of efficacy later this year. These studies will use magnetic resonance imaging to determine whether the drug increases neurogenesis and will use other measures to determine whether it relieves symptoms of depression. Even if NSI-189 works, though, it will not have rapid effects. “It’s not like somebody having epilepsy, where you give a drug to stop the epilepsy instantaneously,” Johe says. “This treatment requires changes in the cell at the genetic level.” Hippocampal atrophy takes years to occur, he adds, and “to reverse the process will also require a long period of time.” He hopes, however, that the effect will be long-lasting, so that NSI-189 may be needed only intermittently. That notion still has to be demonstrated, but it is “an exciting possibility,” Johe says.

A young woman who calls herself blueberryoctopus had been taking antidepressants for three years, mostly for anxiety and panic attacks, when she recounted her struggles with them on the Web site Experience Project. She said she had spent a year on Paxil, one of the popular SSRIs (selective serotonin reuptake inhibitors), but finally stopped because it destroyed her sex drive. She switched to Xanax, an antianxiety drug, which brought back her libido but at the cost of renewed symptoms. Then Paxil again, then Lexapro (another SSRI), then Pristiq, a member of a related class of antidepressants, the SNRIs (serotonin and norepinephrine reuptake inhibitors). At the time of the post, she was on yet another SSRI, Zoloft, plus Wellbutrin (a cousin of SNRIs that affects the activity of dopamine as well as norepinephrine), which was intended to counteract the sexual side effects of Zoloft. “I don’t notice much of a difference with the Wellbutrin, but I’m on the lowest dose now,” she wrote. “I’m going back to my psychiatrist next week, so maybe he’ll up it. Who knows.”

This is the typical trial-and-error approach to prescribing antidepressants, not only for depression per se but also for related disorders such as blueberryoctopus’s. The tactic, Andrew Solomon wrote in The Noonday Demon, his landmark book about depression,
“makes you feel like a dartboard.”

Troubling side effects are not the only reason for the dartboard approach. The SSRIs and SNRIs that have dominated the antidepressant market since their introduction in the 1980s and 1990s do not help everyone and eventually fail in more than a third of users. A pill that seems to be working today might well stop helping tomorrow. And the drugs can take several weeks to start having a marked effect, a waiting period that can be especially perilous. According to a 2006 report in the American Journal of Psychiatry, among depressed older adults (age 66 and older) taking SSRIs, the risk of suicide was fivefold higher during the first month of treatment than in subsequent months.

Clearly, patients critically need antidepressants that work faster and better, yet the pipeline for novel drugs is drying up. In fact, in the past couple of years such pharmaceutical giants as Glaxo-SmithKline have announced their intention to abandon psychiatric drug development, finding it too expensive, too hard and too much of a long shot.
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Some scientists in government and academic laboratories and at small pharmaceutical companies are trying to pick up the slack. Whether their efforts will succeed remains an open question.  But new drugs cannot come too fast for the nation’s approximately 15 million depressed patients. Many remain unhelped by talk therapy and medicines and are desperate to try anything to relieve the psychic pain, including such experimental treatments as putting electrodes in their head or burning holes in their brain.

IN SEARCH OF SPEED

investigators aiming to find faster-acting antidepressants have been studying compounds known to be lightning-quick mood lifters, hoping to figure out why they work so much more rapidly than the SSRIs, which enhance levels of serotonin, a signaling molecule, in the brain. One such compound is ketamine.

Ketamine is an anesthetic, an analgesic and a recreational drug known on the street as Special K. It can, among other things, affect consciousness and cause hallucinations, and experiments in rodents show it can be toxic to nerve cells—all of which make it a less than ideal candidate for an antidepressant. But it has proved to be a fascinating compound to study for ideas about how to make antidepressants reduce symptoms faster. As Ronald Duman and George Aghajanian of Yale University and their colleagues have demonstrated, within only two hours after an injection of ketamine lab rats start increasing production of proteins needed to build new synapses—the contact points through which signals flow between nerve cells—in the prefrontal cortex. This region of the brain, located right behind the eyes, is known to behave abnormally in depressed individuals. By 24 hours after the ketamine shot, the rats also start sprouting new synaptic spines, like cloves in a Christmas orange, along dendrites, which are the nerve cell projections that receive signals from other neurons. The more spines, the quicker the transmission. And in Duman and Aghajanian’s experiments, the more synaptic spines, the less the animals display depressionlike behavior (such as abandoning activities they would normally engage in).

“A lot of work over the past 10 years or so has shown that in depression, there is atrophy, not growth, in the prefrontal cortex and also the hippocampus,” says Duman, who directs Yale’s Laboratory of Molecular Psychiatry. “Ketamine can rapidly reverse that atrophy” and restore normalcy. Just how rapidly is the subject of current research, as the Yale scientists examine rat brains only a few hours after the ketamine injection to see if the increase in synaptic spines occurs even sooner than 24 hours.

Additional research in a different group of depressed rats has revealed how ketamine makes these synaptic spines grow: by activating an enzyme in neurons known as mTOR. Duman and his colleagues discovered this connection by giving rats a drug that blocks the enzyme’s action. Then they gave ketamine to the mTOR-blocked rats. Nothing happened, which meant that when mTOR was inhibited, ketamine had no effect on synaptic spine proliferation or reversal of depressionlike behavior. In other words, mTOR needs to be functioning for the ketamine to do its spine-sprouting work.

Given that ketamine is too risky to use routinely as a medicine, the researchers began searching for other mTOR activators. They knew that ketamine stimulates the enzyme by preventing glutamate (the main excitatory neurotransmitter in the brain) from acting on a particular docking molecule—termed an NMDA receptor—on the surface of neurons. They therefore tested another NMDA blocker and found that it, too, led to mTOR activity and quickly promoted spine formation and produced antidepressant effects in rats. Now, Duman says, he and his co-workers are examining other compounds that block NMDA receptors to see if any have promise as safe, fast-acting antidepressants.

Another compound that elevates mood swiftly is, like keta-mine, already on the market for another purpose: scopolamine, sold as a skin patch for treating motion sickness.  Scopolamine influences a different brain circuitry than ketamine does: it impedes binding of the neurotransmitter acetylcholine—involved in attention and memory—to molecules known as muscarinic receptors.

Click here to view the entire article

 

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The Pill That Could Cure Depression by Growing Your Brain

http://gizmodo.com/5874433/the-pill-that-could-cure-depression-by-growing-your-brain

Kristen Philipkoski:  January 9, 2012

If you are depressed, or schizophrenic or have Alzheimer’s, scientists say you probably have a shrunken hippocampus. The good news: a drug that just entered human trials promises to re-grow that part of the brain.

It’s an entirely new approach to treating clinical depression, which is the first of several diseases scientists at biotech company Neuralstem are hoping to address with their experimental oral drug. Most antidepressants work on brain chemistry, tweaking levels of neurotransmitters including serotonin, norepinephrine, and dopamine. This is the first drug that aims to re-grow patients’ atrophied brains.

Dr. Karl Johe, Neuralstem’s CEO, believes that depression is a three-headed beast that affects neurotransmitter levels, neurons, and hippocampus size. And he says their new drug could address all three. He also hopes the drug will reverse the disease to the point that patients could permanently go off the drug.

“If we can show by MRI that we’ve increased hippocampus volume and at the same time reversed depression symptoms for six months after patients have stopped taking the drug, then we’ll have a cure.”
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That a too-small hippocampus causes depression and other diseases is still technically a theory in humans (though it’s been demonstrated in rats and chimps). So if the drug grows hippocampus volume and thereby treats depression, we’ll not only have a new treatment, but the study results would be proof that a shriveled hippocampus is at least in part the culprit.

The scientists showed first that the drug worked in the lab: They started with dishes of neural stem cells and added several compounds they thought might instigate growth. Seven showed promise, but they could only afford to develop one, so they chose NSI-189. They then tested it in mice; after taking the drug, the rodents had larger hippocampi.

Thirty-five healthy humans have now taken the drug with no ill effects, so the FDA gave the company the OK to start testing in depressed patients. They’ll give the pill to 18 volunteers (six will get a placebo) in three groups, each receiving a progressively larger dose, each over 28 days. They expect this phase, which is mainly to make sure the drugs is safe, to take about six months. If all goes well they hope to proceed to phase two clinical trials later this year, which will test to determine whether the drug is both safe and effective. (After that, a final phase three trial to confirm safety and efficacy will remain before the company can market the drug.)

I couldn’t help thinking about those healthy test subjects who took the drug. Will they get super brain powers? The healthy mice that received the drug did grow extra large hippocampi, the seahorse-shaped part of the brain involved with both short and longterm memory and spatial navigation. Johe isn’t ruling out the possibility of souped-up brains:

“It’s an exciting possibility and we’ll definitely be looking out for it.”

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Operation marks another step forward in stem cell research

Operation marks another step forward in stem cell research

http://www.cnn.com/2011/11/21/health/stem-cells-als/index.html?iref=allsearch

By Miriam Falco, CNN

updated 3:00 PM EST, Mon November 21, 2011

STORY HIGHLIGHTS

  • For the first time, stem cells are injected into the spinal cord in the neck
  • It is part of a trial to see if the procedure can be safely done
  • “I feel like we finally arrived,” says the surgeon who invented a key structure

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Atlanta (CNN) — A 50-year-old man from Trion, Georgia, is the first person to be injected with stem cells in the upper part of the spinal cord, making him yet another pioneer in the scientific quest to use stem cells to heal.

Richard Grosjean received the treatment Friday. He is part of an ongoing FDA-approved clinical trial that is testing the safety of injecting stem cells into the spinal cords of patients with amyotrophic lateral sclerosis, or ALS, also known as Lou Gehrig’s disease.

Grosjean was diagnosed a little over two years ago, his wife, Tracie, told CNN. He can still walk with a cane, but he has a lot of weakness on his left side and has trouble with his speech.

“I’m pretty much his voice for him,” Tracie Grosjean said.

Through his wife, Grosjean says “he has 100% confidence in Emory and Dr. (Jonathan) Glass and Dr. (Nicholas) Boulis and the good Lord that good things will come” from the trial.

While the Grosjeans know this procedure is likely to be more helpful to others in the future who have to deal with this “horrible disease,” they have hope and faith that some good will come of this for them, too. In addition to praising Emory University, Tracie also praises her husband’s employer, Mount Vernon Mills, which she says has “bent over backwards” to keep him employed throughout his illness giving him a sense of purpose.

The cause of ALS is unknown, but the disease is fatal because nerve cells, or neurons, in the brain and spinal cord needed to tell muscles to move, waste away or die. Early in the disease, patients have difficulty speaking and walking, both symptoms Grosjean now has. Eventually, the disease cuts off communication between the brain and chest muscles, so patients can no longer breathe.

Most people die from respiratory failure, according the National Institutes of Health, and most patients die within three to five years of diagnosis.

The team of researchers in this clinical trial is headed by University of Michigan neurologist Dr. Eva Feldman, who designed the trial; neurologist Glass, who is in charge of the clinical trial at Emory University in Atlanta, where patients are getting the injections; and Emory neurosurgeon Boulis, who invented the structure used to safely inject the stem cells into the patient.

In an operation than lasted about four hours, Grosjean received five injections into the cervical, or neck, area of his spinal cord, each delivering 100,000 cells. The cells came from Maryland-based biotech company Neuralstem, which is funding this clinical trial and devised a procedure to grow millions and millions of motor neuron cells from the donated spinal cord tissue of an 8-week-old aborted fetus.

These are not embryonic stem cells, like the ones used by California-based company Geron, which has injected cells grown from human embryonic stem cells into the spines of at least four patients with complete spinal cord injuries.

Embryonic stem cells have the ability to become any type of cell in the body. One week ago, Geron decided to stop their trial because it was too expensive to continue.

The cells in this ALS trial were taken from the spinal cord of the fetus, so they have already gone down the path of becoming nerve cells. Researchers are hoping to show that injecting neural stem cells — the precursors to nerve cells — into the spinal cord of ALS patients is safe.

Ultimately, the hope is that by injecting the cells into the neck, above the lungs, where the mostly deadly damage is done by ALS, these neural stem cells will reconnect communication from the brain to the muscles, keeping patients alive longer and maybe, one day, curing them.

But that is not the point of the trial at this time. At this point the goal is still to establish that injecting stem cells is safe for the patient, won’t cause more damage to the patient, and won’t lead to the patient reject the cells. Early data from the first 12 patients, who had injections in the lower back, shows this procedure is safe.

Injecting anything into the spinal cord is very dangerous because it can cause serious damage. To avoid injuring the spinal cord, which is always moving as the patient breathes, the needle delivering the stem cells has to move along with the body.

Boulis invented an apparatus that resembles a miniature oil rig mounted on to the patient’s spine. It moves with every breath and holds a super-fine needle through which to inject the stem cells. To prepare for these surgeries, Boulis and his fellow surgeons practiced mounting the apparatus on pigs, which are close in size to humans.

The first 12 patients in this clinical trial had the “rig” mounted on their lower back, giving surgeons a flatter surface to work with.

But the injection site on Grosjean is on the neck, posing a new challenge for Boulis.

“It didn’t fit exactly as I had envisioned it,” he said immediately after the surgery. “In fact, I ended up applying it much in the same way that I had applied it in pigs, as opposed to how I had envisioned it in humans, and that gave us nice solid fixation.”

Boulis screwed the structure to the spine on one side, but to the skull on the other side.

With the spinal cord exposed after removing part the spine and peeling back layers of muscle and membranes protecting the cord, the injections slowly began. They have to be slow — injecting the cells too fast alone can damage the cord or the cells can spill out, never having a chance to nestle into the spinal cord.

After the third injection went smoothly, Boulis paused to note what they were accomplishing at this moment. After the surgery he said, “it is a big milestone for us. … I think the biggest thing about this is that I feel like we finally arrived.”

That’s because Boulis and his colleagues have come a long way, through trial design; to testing the cells in mice to ensure they don’t cause tumors, which sometimes happens with stem cells; to inventing the needle-holding oil-rig-like apparatus; to practicing on many pigs; to perfecting how attach the device to patients.

“Finally we’re beginning to inject cells into the segments that control the diaphragm, and to the extent that we are able to do that safely … this is where we keep people breathing,” Boulis said.

And that’s ultimately what this clinical trial is about.

Glass described Friday’s surgery as being at the beginning of crossing an important threshold. “I think it’s a huge step forward. I don’t want anyone to think that we have a cure for this disease. We don’t. But we now have a whole other way to approach it, and that’s really what’s exciting and important.”

Feldman described the day as the most momentous in their pursuit of using stem cells in the treatment of ALS.

“I have spent over 25 years taking care of patients with ALS, and I feel today I can go back to them and give them hope,” she said.

Alan Trounson, president of the California Institute for Regenerative Medicine in San Francisco, agrees, calling the progress in this clinical trial a “big step forward.”

Every clinical trial that can show a stem cell procedure to be safe is important, he said.

“These are tough diseases,” Trounson said. He agreed that being able to safely inject stem cells into the cervical area of the spinal cord is an important step forward for patients with ALS and potentially other neurodegenerative diseases such as multiple sclerosis.

Grosjean, Glass and Boulis are quick to point out that they have to replicate this surgery in other patients. Two more patients will receive the same cell dosages in the near future in this part of the clinical trial.

After telling Tracie Grosjean how well the surgery went, Glass was excited and cautiously optimistic.

“We’re moving forward,” he said. “We don’t have a treatment yet, we don’t have cure yet and there’s no evidence yet even putting these stem cells on the spinal cord is going to either slow the disease or prevent progression or even make it better.”

Three days after the surgery, Boulis said the patient was doing well. Neurologically he is where he was before the surgery. His legs and arms are moving, confirming what was monitored throughout the entire surgery. The spinal cord was not damaged.

Tracie Grosjean said her husband is still in pain, which doctors say is expected given the surgery. But she said the doctors tell them he’s doing great and they hope be home in time for Thanksgiving.

© 2011 Cable News Network. Turner Broadcasting System, Inc. All Rights Reserved.

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After Geron, Stem Cells’ New Saviors

Newsweek

http://www.thedailybeast.com/articles/2011/11/18/after-geron-stem-cells-new-saviors.html

After Geron, Stem Cells’ New Saviors

The biotech Geron may have abandoned its famous effort to treat paralyzed patients with stem cells—but two rivals are swooping in to do groundbreaking trials, Sharon Begley reports. So far, their results are even more promising.

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When the biotech company Geron announced this week that it was halting its pioneering stem-cell program—whose centerpiece is a clinical trial in which four paralyzed patients with spinal-cord injuries were injected with cells derived from embryonic stem cells—the chief scientist at a rival firm had one thought: “I guess that leaves us holding the flag,” Robert Lanza of Advanced Cell Technology told me. “There’s a lot of weight on us to deliver now.”

The Geron study was famous for being the first to treat patients with cells taken from human embryos, and its premature end, due to financial concerns, may seem like a disappointing finale. Fortunately, at least two lesser-known firms are swooping in to continue similar groundbreaking research—perhaps with even more promise and practical applications—and with the potential to revolutionize medicine. One is forging ahead with an extraordinary new test today.

The better known of the two, ACT, has the only other Food and Drug Administration–approved clinical trials using embryonic stem cells, as Newsweek recently described: one trial is for patients with Stargardt’s macular dystrophy and one is for age-related macular degeneration. Both diseases cause blindness. (The studies are notable because Catholic nuns are among the patients, even though the Vatican has condemned stem-cell research.)

stem-cells-begley
Ted Harada, stem-cell patient

But there’s also Neuralstem Inc., which is in the midst of a clinical trial for ALS (amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease). Today, if all goes as planned, the first ALS patient will receive an injection of stem cells into the upper part of his spine—the first step toward determining whether the experimental therapy can save ALS patients from dying when their motor neurons, which control muscles, become too weak to maintain breathing.

In ALS, motor neurons in the spinal cord and brain deteriorate to the point where, eventually, they can no longer signal muscles to move. As a result, patients become paralyzed and, when motor neurons controlling respiration die, unable to breathe; most die within three to five years of diagnosis, and only one quarter survive at least five years. There’s currently neither a treatment nor a cure for ALS.

Neuralstem, based in Rockville, Md., uses cells slightly older than the days-old embryonic stem cells Geron used, opting for “neural” stem cells. Unlike embryonic stem cells, which can differentiate into the 200-plus kinds of human cells, neural stem cells have already chosen their fate; they can become any of three kinds of cells in the central nervous system (neurons, astrocytes, or oligodendrocytes). Neuralstem obtained all the cells it has needed so far from an eight-week old fetus that was aborted in 2000.

The procedure has been attempted on 12 ALS patients so far, starting in January 2010. They received either five or 10 injections of 500,000 or 1 million neural stem cells, respectively, into the lower (lumbar) region of the spine, in a procedure developed and performed by neurosurgeon Nicholas Boulis of Emory University, under the direction of Emory neurologist Jonathan Glass. The patient lies on his belly, and Boulis makes an incision and removes two layers of bone covering the cable of nerves that is the spinal cord. Then, guided by an MRI that shows where the motor neurons are, Boulis injects the stem cells, which takes about two minutes.

Although the goal of this early trial is to determine whether the procedure is safe—which it seems to be, although two patients have since died of ALS—the scientists have also seen hints that the cells benefit the patients. Ted Harada, 39, was a manager at Shred-It, a mobile shredding service based near Atlanta, when he was diagnosed with ALS in 2010, and by the time he enrolled in the study he was able to walk only with the help of a cane. Climbing stairs was difficult, he recalls, and he was easily fatigued and often out of breath. He was unable to raise his left leg while sitting if someone pressed on it even lightly, and his left arm was also losing strength.

Since receiving 10 stem-cell injections last March, Harada has improved enough to complete Atlanta’s two-and-a-half mile Walk to Defeat ALS on Oct. 22. “I still have ALS, but I’m starting to see signs of hope,” said Harada.

Studies of lab animals suggest how the neural stem cells might be benefiting Harada and other patients. The cells remain where they are injected in the spine, says Karl Johe, chief scientific officer of Neuralstem, right beside a high concentration of the motor neurons that are being killed by ALS. There, although the stem cells cannot resurrect dead motor neurons, they can keep additional ones from dying, explains Johe: they produce protective molecules.

Protecting neurons only keeps ALS from getting worse, however—they don’t reverse it. One reason Harada regained movement and strength might have been that the injected stem cells also cause axons—the long tails on neurons that connect neuron to neuron as well as to muscle—to regrow. “The connection that the motor neuron makes to the muscle is the first thing that goes in ALS,” explained Glass, possibly because the neuron becomes too weak to support the long axon that connects to the muscle. “It might be that if you can rescue the cell body [with neural stem cells], you can rescue that connection,” said Glass.

Animal studies suggested just that, said Eva Feldman, director of the A. Alfred Taubman Medical Research Institute at the University of Michigan and an unpaid adviser to Neuralstem: “You can hypothesize that if the nerve cell is just about to give up the ghost, the stem cells preserve it and the axonal connection is restored, with the result that the patient has a restoration of function.”

Today, for the first time, Boulis is scheduled to inject neural stem cells not into the lower part of his patient’s spinal cord, to restore movement in the legs, but into the upper region, to target motor neurons that control respiration.

Neuralstem believes that neural stem cells could also treat spinal-cord injury—the condition Geron targeted—and Huntington’s disease, in which neurons in the brain are killed much as they are in ALS. The company has requested FDA permission to launch a spinal-cord injury trial.

‘Many of us were surprised Geron selected spinal-cord injury in the first place,’ said Lanza. ‘It didn’t really make a lot of sense, either commercially or biologically.’

ACT, too, “remains committed to embryonic stem2cell research,” said Lanza. “We have no intention of letting [Geron’s decision] interfere with our mission.” The company’s clinical trial, at UCLA, uses what are called retinal pigment epithelial cells, grown from embryonic stem cells, to treat two causes of blindness, Stargardt’s disease and macular degeneration. (Stem cells from a human embryo are grown in the lab, and after they differentiate into the kind of cell needed for the disease being targeted, they’re injected into patients.) “We’re moving full steam ahead,” said Lanza, making final arrangements for other sites to enroll patients. Although results have not been formally reported yet, the first patients—who received stem cell–derived treatment this summer—are doing well enough, Lanza said, that “both want us to treat their other eye.”

In contrast, it would have taken years for Geron to see whether the cells it had derived from embryonic stem cells helped spinal-cord patients regain movement. “Many of us were surprised Geron selected spinal-cord injury in the first place,” said Lanza. “It didn’t really make a lot of sense, either commercially or biologically. So it’s not too surprising they didn’t obtain any biological effect. Although treating spinal-cord injury has a kind of sex appeal, you have to take reality into account, including not only the market but the chances of success.”

 

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Could This Be the End of Embryonic Stem Cell Research?

Could This Be the End of Embryonic Stem Cell Research?

By Kristen Philipkoski

Nov 15, 2011 3:40 PM

A biotech company that after much turmoil and huge expense launched the first human embryonic stem cell clinical trial in the United States is getting out of the stem cell business.

Geron led the charge to push the U.S. government and society at large to allow use of embryonic stem cells. Scientists believed they could treat myriad diseases because of their ability to become any cell in the human body. But the company has accumulated losses of almost $300 million over the past four years and has halted its stem cell efforts. With few scientists pursuing stem cell research of the embryonic variety, many are wondering if commercial embryonic stem cell research will soon take its final breath.

The cells are controversial because human embryos are destroyed to obtain them. But the company persevered amidst years of public outcry and political punditry and in October 2011 launched the first-ever FDA-approved human trial to treat acute spinal cord injuries. Just four of the 10 approved patients have been treated with Geron’s cells, and now it looks like the other six won’t have their chance. A recently-launched Swiss trial run by Geron will also presumably be halted. The company has laid off 34 percent of its staff and will focus now on cancer treatments. Many patients who held out hope for a paralysis cure will be sorely disappointed.

Advanced Cell Technology is one of the only companies (Stem Cells is another) still using embryonic stem cells. It has human clinical trials active in macular dystrophy and macular degeneration.
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But other companies, like Neuralstem, are poised to pick up the slack using a different and less controversial type of stem cell. Neuralstem uses neural rather than embryonic stem cells, and has already seen remarkable success treating ALS (AKA Lou Gehrig’s disease) patients, which I wrote about here. Neural stem cells are not completely free of controversy: they are taken from a voluntarily aborted fetus. But embryos are not destroyed in order to obtain them. And Neuralstem’s technology allows them to proliferate all the cells they need from a single fetus.

“This was not a surprise to me,” Richard Garr, CEO of Neuralstem, said about the Geron news. “I think the writing was on the wall when Tom Okarma was either pushed out or left on his own. It was pretty clear the they were not interested in being a stem cell company at that point.”

Okarma was Gerons’s CEO for 13 years and was the public face of the company’s fight to use embryonic stem cells.

Meanwhile, Neuralstem has already treated 12 ALS patients, and doctors will treat number 13 on Friday. Garr believes his cells are easier to control and target than embryonic stem cells for treating neural diseases.

Next up for Neuralstem is a human trial testing their cells in chronic spinal cord patients. So we might be saying goodbye to Geron, but not to the hope of spinal cord injured folks getting out of their wheelchairs. [San Francisco Business Times]

Image: Shutterstock/Andrea Danti

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* If You Can’t Get an Organ, an Organoid Might Do

http://gizmodo.com/5851454/if-you-cant-get-an-organ-an-organoid-might-do

Oct 19, 2011

If You Can’t Get an Organ, an Organoid Might Do

The line waiting for organ donors is 112,381 people long and growing, and 18 people daily die waiting. To help patients survive the interim, scientists are working on “organoinds”—mini organs that would temporarily operate outside the body.

Dr. Rober Hariri, a surgeon and CEO of Celgene Cellular Therapeutics, is using stem cells derived from placentas (a refreshingly non-conroversial source of stem cells), to build the temporary organs. He devised a method for implanting the stem cells into a tissue matrix made from cells taken from cadavers. If the matrix is made of, say, kidney cells, the stem cells will take cues from their environment and also transform into kidney cells.

Full size

 
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The drawing depicts stem cells being extracted from a placenta.

The resulting glob is a mini-organ that could temporarily perform the functions of a failing human liver, kidney, heart, and possibly any other human organ. The patients’ blood would be filtered through the organ through tubes.

“This could be the way we build replacement parts,” Hariri said.

You can check out their patent here. Hariri will talk more about his progress with organoids at the Tissue Engineering and Regenerative Medicine Society annual meeting in Houston in December.

[Images: Celgene, US Patent 7914779]

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U.S. Stem Cell Companies Find Partners and Revenues Beyond the Water’s Edge

http://www.genengnews.com/analysis-and-insight/us-stem-cell-companies-find-partners-and-revenues-beyond-the-water-b-b/77899444/

Analysis & Insight : Aug 16, 2011

U.S. Stem Cell Companies Find Partners and Revenues Beyond the Water’s Edge

Firms find it easier to navigate regulatory requirements in Asia as well as Europe.

  • Alex Philippidis

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American companies focused on stem cell treatments and technology platforms have met with success in finding partnerships and revenues overseas in the past decade. And it’s not for the reason many people might think, namely the controversy over U.S. federal funding of human embryonic stem cell (hESC) research.

Two other factors better explain why U.S. stem cell companies have been looking beyond their borders to Asia, according to Bernard Siegel, founder and full-time executive director of the nonprofit Genetics Policy Institute (GPI).

One is the attractiveness of Asian countries as markets for stem cell treatments. That reflects both high population concentrations as well as willingness by national governments to invest in stem cell research as well as companies commercializing such treatments and encourage additional research by outside parties. The other is Asia’s lower regulatory hurdles when compared to the U.S.

“It’s easier to move toward the translational process and get clinical trials cranked up in Asia than the United States,” Siegel pointed out. “I think that’s one aspect of it.”

U.S. companies can do that and more in Europe as well, if one company’s experience is any indication. Cytori Therapeutics has won both initial and expanded indication approval in Europe for its Celution® System family of medical devices and instruments, which is not yet available in the U.S. Celution extracts and separates stem and regenerative cells from a patient’s own adipose tissue.

“What we found as we moved through the European market is that that head-start was really important relative to the U.S. or other places,” Cytori president Marc H. Hedrick, M.D., told GEN.

Japan’s Position

The initial European approval allowed Cytori to expand into Japan where, Dr. Hedrick noted, the company obtained its first clinical experience. The company capitalized on the fact that doctors in Japan can, with a prescription, import technologies approved elsewhere.

“And it just so happened we had a relationship with one of the preeminent surgeons in Japan. In fact, our first 20 patients had breast cancer reconstructions performed in Japan at his university hospital,” Dr. Hedrick recalled.

“At the same time, we identified someone to lead the charge in Japan, that we were very fortunate to get, who was a business leader at Baxter in Japan. One thing led to another, and we now have the majority of our revenues from Japan. And it was all tied back to that original regulatory approval in Europe that allowed us to get into that market very quickly,” Dr. Hedrick added.

Japan’s share of Cytori’s sales tumbled during the first quarter to 30% from 72% a year earlier due to the March 11 Tohoku earthquake and resulting tsunami. Japan is where Cytori, which maintains a Tokyo office, found two investors among some of the country’s corporate giants. Last year Astellas agreed to buy $10 million of Cytori stock. And in 2008, Olympus, a medical device company, led a $17 million private placement financing. Two years prior Olympus made an $11 million milestone payment to Cytori for obtaining CE Mark approval for the original Celution system.

“They provided a significant amount of capital to Cytori, and that was another reason why it made sense to focus on the Japanese market,” Dr. Hedrick said.

Other Countries in Asia

Neuralstem is also involved in partnerships with Asian companies, with deals initially focused on research. While Neuralstem last year established a wholly owned subsidiary in China, it has yet to come to terms with commercial or regulatory collaborators.

By year-end the firm plans to start a clinical trial in China focused on transplantation of cells into the brain to treat stroke. The trial would take place at Beijing’s BaYi Brain Hospital, which has been working with Neuralstem to prepare a clinical protocol for treatment of motor deficits due to ischemic stroke.

In Japan the company came to terms with the wholly owned subsidiary of Sumitomo, Summit Pharmaceuticals, to market development and licensing rights for NSI-189, Neuralstem’s lead small molecule neurogenic compound. It is currently in an FDA-approved Phase I trial for major depression. The company has said it intends to take NSI-189 through Phase II trials before seeking a partner for worldwide rights.

Neuralstem has also entered into collaborations in Taiwan, including one with China Medical University & Hospital, to advance development of its human spinal cord neural stem cell therapies for amyotrophic lateral sclerosis. It is also working with the hospital to commence a clinical trial focused on treating stroke.

Additionally, in India, the company is planning a clinical trial for later this year to assess the ability of its cell therapy to treat spinal cord injury. The Indian market is so large that companies like Neuralstem need to find a technological partner first to ensure access to the best neurosurgeons it can find, according to Richard Garr, CEO. “We’re happy to do the proof of principle human studies ourselves before we look for a commercial and regulatory partner.”

Neuralstem notes that it has done most of its proof of principle collaborations with American universities such as the University of California, San Diego and the University of Michigan. “We haven’t gone overseas because we can’t do it here in the U.S.,” Garr remarked. “We went overseas because we believe those are their own independent markets.” Garr points out that commercialization efforts for each country are independent of each other.

“The other reason” to move into Asian countries, he added, “is because if you don’t, someone else will. And then you end up in a fight trying to protect it.”

Neuralstem broke into Asia in 2008, when Korean conglomerate CJ CheilJedang (CJ) bought $2.5 million worth of Neuralstem stock. CJ has an exclusive option to Neuralstem’s spinal cord cell products for five Asian nations: South Korea, Vietnam, Indonesia, Malaysia, and Singapore.

CJ would have the responsibility to take the products through regulatory approvals and commercialization in their markets. Garr expects CJ to decide what its first clinical trial will be and where later this year.

Another U.S. stem cell company that has teamed up with a Korean company is Advanced Cell Technology (ACT). In 2008, ACT joined with CHA Biotech to form a joint venture aimed at developing ACT’s hESC-based hemangioblast (HG) platform for the treatment of blood and cardiovascular diseases.

On July 21, the companies announced that their venture, Stem Cell & Regenerative Medicine International (SCRMI), exclusively licensed the rights to the HG program to ACT for the U.S. and Canada and to CHA Biotech for Korea and Japan.

“The partnership itself had research scientists working on trying to get things ready for starting human trials. And the way the deal works, ACT has hired substantially all the scientists that were working in the joint venture”—10 SCRMI employees in all, Gary Rabin, ACT’s interim chairman and CEO, told GEN.

Rabin said the first IND will be filed for using the HG platform to generate renewable sources of transfusable blood platelets. The platelets could unlock a significant opportunity for ACT, namely in the military wound-care market.

Last year, Robert Lanza, M.D., ACT’s CSO, and Kwang-Soo Kim, Ph.D., of Harvard University’s McLean Hospital and the CHA Stem Cell Institute, won a $1.9 million NIH director’s opportunity award to explore the potential of induced pluripotent stem cells (iPSCs) as a source of universal red blood cells and platelets for transfusion.

Another Asian market ACT is keeping an eye on is China. In March the company reported that China’s State Intellectual Property Office allowed its patent application to provide broad intellectual property protection for the manufacturing and pharmaceutical preparations of retinal pigment epithelial (RPE) cells from hESCs for degenerative retinal disease.

ACT has initiated a Phase I study with the RPE therapy in the U.S. Additionally, ACT has launched human trials for Stargardt macular dystrophy and advanced dry age-related macular degeneration. Data from those trials is expected to be published this fall, after the first three patients are tested in both trials.

Working in Europe

In Europe, Cytori won expanded approval for Celution last year. The sanction included new indications such as breast reconstruction, repair of soft tissue defects, as well as the facilitation of healing certain types of wounds such as those resulting from Crohn disease.

“We’re relatively close, we think, to getting approval for cardiac disease,” Dr. Hedrick added. “And we’re actually beginning to get reimbursement and working toward our own diagnosis-related group payments for the technology in Europe. So that series of decisions, predicated all on the early regulatory approval of the device, has really pushed us down the road of being very active in Europe.”

Cytori sees more potential partnerships among global medical device companies across Europe, particularly in Switzerland, where the company has an office in Zug. Neuralstem is collaborating with Albert-Ludwigs-University in Freiburg, Germany, on a treatment for Huntington disease. It also plans on undertaking a chronic spinal cord injury trial using spinal cord cells being developed at the Czech Institute of Experimental Medicine.

The ability of the European market to grow as a stem cell mecca will hinge, Siegel said, on the outcome of a pending court case that—while different on specifics—parallels the U.S. debate over hESC funding.

Later this year the Court of Justice of the European Union is expected to decide whether to side with its advocate general, who termed stem cell patents “contrary to ethics and public policy,” or with Oliver Brüstle, Ph.D., who since 2004 has fought to maintain a 1997 patent covering methods for deriving neural cells from hESCs despite a challenge from Greenpeace. Dr. Brüstle is director of the Institute of Reconstructive Neurobiology at the University of Bonn.

A decision against Dr. Brüstle would cement Asia’s place on the hESC end of stem cell research and commercialization. The U.S. remains schizophrenic, with President Barack Obama’s administration scrambling to approve new hESC lines, while the Sherley v. Sebelius court case and the nation’s political divide keep federal funding from being a certainty.

Yet all of that doesn’t necessarily hurt U.S. stem cell companies. As the past few years have demonstrated, they are perfectly capable of following the money and partners in pursuit of the science and show no signs of pulling back from their overseas activity.

Alex Philippidis is senior news editor at Genetic Engineering & Biotechnology News.

Posted on

UM researcher to test stem cell treatment for Alzheimer’s

8:00 pm, May 2, 2010

Results from ALS trials spur optimism
By Ryan Beene And Tom Henderson

http://www.crainsdetroit.com/article/20100502/FREE/305029968/1069

Buoyed by early results of stem cell-based trials on patients with Lou Gehrig’s disease, Eva Feldman, M.D., co-director of the A. Alfred Taubman Medical Research Institute at the University of Michigan Medical School, is now taking aim at a far bigger target: Alzheimer’s disease.

In late April, Feldman began raising $1.5 million from private donors to fund animal trials for a stem cell-based treatment of Alzheimer’s, a progressive degenerative disease that severely impacts brain function and afflicts more than 5.3 million people in the U.S. It is the seventh-leading cause of death in the nation.

Animal trials are required before Feldman can begin Phase I U.S. Food and Drug Administration trials for Alzheimer’s on humans. Tests on both safety and efficacy are done first on small rodents and then, if successful, on larger mammals.

Feldman said she hopes to apply for approval in 2013 for human Alzheimer’s trials and begin them in 2014.

The investigation into an Alzheimer’s treatment piggybacks on current Phase I human trials for patients with Lou Gehrig’s disease led by Feldman that are under way at Emory University Hospital in Atlanta.

The trials test the safety of injecting neural progenitor cells, essentially stem cells that have developed beyond the embryonic phase and are predisposed to becoming nerve cells, into the spinal cords of patients with Lou Gehrig’s disease.

Feldman will continue to serve as principal investigator on that trial — the first FDA-approved trial using stem cells on Lou Gehrig’s patients in the U.S. — as she and her team begin work on Alzheimer’s trials.

Eighteen Lou Gehrig’s patients will be tested in all. The disease, known formally as amyotrophic lateral sclerosis, or ALS, afflicts as many as 30,000 patients in the U.S.

Feldman sped up her timetable for taking on Alzheimer’s after seeing promising early results with three Lou Gehrig’s patients. The first patient was injected on Jan. 19. The third operation, on April 14, was filmed by CNN.

Feldman said she is prohibited from discussing whether patients report such results as increases in strength or sensation. But there have been no ill effects from the three surgeries.

Each patient is injected at five spots on the spinal cord, with about 100,000 cells per injection.

Feldman said she is excited about expanding stem cell trials to Alzheimer’s because of the far larger pool of would-be patients.

The nerves and tissues also are narrowed due to fast delivery cialis http://foea.org/wp-content/uploads/2014/12/FEA-2012-ANNUAL-REPORT-PDF.pdf growing age. It is a serious health concern, which can ruin your generic cialis Visit Website sexual life. 2. However, almost viagra free pill all of them have some limitation of recurrence and certain side effects to affect the female fertility to some degree. By reducing acid production in stomach this not only helps cialis generika 20mg in enlargement of the penis but also treats for lesser ejections and other related erectile issues. “Alzheimer’s is going to be easier to do than ALS,” said Feldman.

She said that the brain can be injected with far more stem cells than the spinal cord, promising greater and faster benefits, and she said the surgery is far less invasive. Instead of needing to remove bone from the back, a tiny hole is cut into the skull in a relatively safe, easy procedure.

The transition from Lou Gehrig’s to Alzheimer’s disease is a natural one because the treatment potentially addresses the same problem. The neural progenitor stem cells work by surrounding specific large nerve cells that are sick and halting further degeneration caused by the disease, Feldman said.

“In the spinal cord, these nerve cells produce the nerve tissue fibers that extend through the muscles of our body, and in the brain, the same type of nerve cell facilitates thinking processes,” Feldman said.

“The kind of stem cells we’re using have a particular proclivity to rescue cholinergic neurons, and it’s cholinergic neurons that degenerate and become diseased in Lou Gehrig’s disease and Alzheimer’s disease.”

The surgeon in the current trials is Dr. Nicholas Boulis, an associate professor at Emory University who was formerly a fellow in Feldman’s research lab at UM.

Boulis specializes in movement disorders, such as Parkinson’s and Huntington’s diseases, and performs about 300 operations a year. He also heads a gene-therapy research lab and is involved in a project that aims to use gene therapy to treat Alzheimer’s.

Boulis said he hopes, if the FDA approves human tests, to do Feldman’s Phase I Alzheimer’s operations, too.

“If Eva thinks we can make progress, I’m her man,” he said.

The Phase I Lou Gehrig’s disease trials are scheduled to finish by the end of June 2011. If they go as hoped, Phase II trials, which assess efficacy, can begin as early as January 2012. Feldman said Phase II trials could add the UM hospital as a test site in addition to Emory.

Investigating a treatment for Alzheimer’s using stem cells is an “interesting approach” and a logical next step to investigate, said Dr. Ken Maiese, professor in the departments of neurology and anatomy and cell biology at Wayne State University Medical School.

“There’s really no good treatment for Alzheimer’s, although there are many trials going on” for drugs that deal with chemicals in the brain related to Alzheimer’s, Maiese said.

But those treat the symptoms, not the underlying issue of rapid brain cell degeneration that is a hallmark of Alzheimer’s.

Maiese cautioned that the science behind a stem cell treatment still has a long way to go, as in any treatment. Going from animal to human trials involves many unknowns.

Feldman said she recently took on a new, young ALS patient, to whom she could, for the first time in her 20 years of treating patients at UM, offer some encouraging words about future treatments.

“For 20 years, there has been little hope I could offer patients. Now there is truly tangible hope. We are truly beginning to try a therapy that can allow us to help halt the progress of this dangerous disease,” she said.

“Patients ask me “what will the future hold?’ I told my new patient, things are extremely hopeful now. The future is very bright. And not just with ALS or Alzheimer’s, but with Parkinson’s and Huntington’s, too.”

Posted on

Stem Cell Medical Breakthrough?


Added On April 30, 2010

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CNN’s Dr. Sanjay Gupta reports on a new stem cell clinical trial that is making history.

Dr Sanjay Gupta
Stream from CNN Here

http://www.cnn.com/video/#/video/health/2010/04/30/gupta.medical.breakthrough.cnn?iref=allsearch

Download Video Here (Right Click and Save Link As to your computer)

http://planetcommunications.us/media/stemcells.avi

Posted on

FDA green lights stem-cell clinical trial for Lou Gehrig’s disease

NATURE PUBLICATIONS

FDA green lights stem-cell clinical trial for Lou Gehrig’s disease 

September 22, 2009

http://blogs.nature.com/news/thegreatbeyond/2009/09/fda_green_lights_stemcell_clin.html

Monya Baker

The Maryland company NeuralStem has the U.S. Food and Drug Administration’s permission to test its spinal cord stem cells in twelve patients with amyotrophic lateral sclerosis. The approval comes a month after the FDA placed Geron’s planned clinical trial on hold for a second time. NeuralStem’s trial had also previously been placed on hold by the FDA in February before receiving the go-ahead in September.

Though both trials involve placing cells into the spinal cord, NeuralStem’s product is made of cultured neural stem cells derived from a single 8-week fetus; Geron’s product, intended to treat spinal cord injury, is derived from embryonic stem cells that have been differentiated into precursors of neuron-support cells.

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ALS has not funded NeuralStem’s work directly, Briujn says, but has advised the company and funded academic scientists who’ve been involved with the company.

NeuralStem’s chief scientific officer Karl Johe says tests of large animal models show that the transplanted cells exert a neuroprotective effect over motor neurons, but it’s not entirely clear how. Earlier this year, Neuralstem and collaborators published results in a rat model of ALS showing that transplanted cells could develop into interneurons that formed synapses with the rats’ motor neurons.

However, Johe emphasized that the upcoming trial will assess safety rather than efficacy. The first few patients selected for the procedure will be those who are no longer able to walk. Because the injected cells protect rather than replace motor neurons, these sicker patients are less likely to benefit from treatment, but they are less able to lose function if something goes wrong. Cells will be injected only on one side of the spinal cord in order to minimize the number of injections into the spinal cord. Only one patient will be injected each month, so that researchers can monitor for effects over a longer period. Eventually, Johe says, the goal is to be able to inject cells in both lower and upper regions of the spinal cord in healthier patients, and see if the injections can keep motor neurons healthy.

The trial is expected to take place at Emory University in Atlanta, Georgia. Though the FDA is allowing the trial to go forward, the university’s patient-safety board will also need to approve the trial before it can proceed. Johe declined to say when that would be but said discussions were well underway.

Other companies using neural cells include ReNeuron, which received permission from UK authorities this January to start clinical trials for stroke. Its cell product is made from genetically modified cultures of neural stem cells, also of fetal origin.

StemCells Inc is conducting trials in Batten’s disease, a neurodegenerative disease that strikes children, and recently received approval for a clinical trial for a similar disease. It also uses neural stem cells from material originally derived from fetuses and has recently published results showing that its cell product delayed some symptoms of the disease by about three weeks.

As with human embryonic stem cells, the patent situation for neural stem cells is contentious. In a pair of dueling press releases this May, NeuralStem and Stem Cells Inc both claimed key intellectual property on these cells.