Medical Files
‘Is stem cell therapy worth the gamble?’
By Rafael CastilloPhilippine Daily Inquirer
This was the question Dr. Ramon F. Abarquez, professor emeritus of the University of the Philippines College of Medicine and academician of the National Academy of Science and Technology, raised in his commentary about the current status of stem cell therapy, which will be published in the August issue of H&L (Health & Lifestyle) magazine. In his article, he clearly bridged the gap between the highly technical aspect of this promising, yet still experimental form of therapy, and the public’s appreciation of its up-side and down-side.
Stem cells are actually amazing precursor cells present in the embryo of any species, and they have the remarkable potential to develop into many different cell types in the body during early life and growth. Scientists describe them as “a sort of internal repair system,” which divides and multiplies itself almost without limit to replenish other cells provided the person or animal is still alive. Each new stem cell produced by the division of the original stem cells has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a heart or nerve cell.
From the medical standpoint, the potential is that stem cell therapy can literally replace old malfunctioning cells and make them like those of a young healthy person. They can be used to replace cells that are lost or damaged from disease, old age or injury. Indeed, the therapy is very promising, which unfortunately, is being exploited by some unscrupulous clinics offering it as if they’re already tried-and-tested, charging a hefty sum of money running into millions of pesos for a course of stem cell treatment.
The following are excerpts from Dr. Abarquez’ commentary:
“Anent comments from certain prominent personalities alluding to perceived quality of life improvement to be presumably related to stem cell therapy, what is the true score? Being a novel with possible breakthrough medical option despite absence of long-term survival benefits at present, certain questions should be asked by the public before considering or accepting stem cell therapy.
• Is the number needed to treat with benefit compared to the number needed to harm already established?
• Are the colonies of cells harvested from the patient or other donors clarified to be ‘healthier cells’ that can positively control or improve the impaired function of the diseased organs or tissues of the patient?
• Is the technique to harvest the stem cells already standardized and considered the best approach?
• Is the best media for culturing the cell colonies already known and determined to be the ‘gold standard’?
• Is the harvested cells determined to have a longer life span in the laboratory’s ‘new and foreign environment’?
• Would the harvested cells live longer than before if programmed to replicate or differentiate much faster in the laboratory?
• What are the odds that the laboratory cultured cells will perform as well or better when reintroduced or transplanted back to the patient?
• What are the chances of ‘rejection’ by the body since the new cultured cells are being returned to a known ‘hostile’ or diseased environment?
• What is the ‘inter- and intra-observer variability’ in determining the success or failure of the procedures?
• How ‘long is long’ before repeating any or all of the above steps?
“The implanted colony of cells micro-environment can stimulate negatively or positively the stem cell functions resulting in uncertain or variable outcomes in those who receive them. (Dimmeler, Arterioscler Thromb Vasc Biol. 2010;30:1088). Furthermore, the areas of the transplanted cells can remain ‘hostile’ due to radical oxygen species or oxidative stress which may cause another disease or medical complication. (Wei, J Cell Biochem 2011;111: 967)
“Recent reviews of clinical trials of stem cell therapy for heart attacks and ischemic heart disease restoration reported that less than half of the trials found ‘only small improvements in cardiac function.’ (Hoover-Plow, Vascular Health and Risk Management 2012:8 99) Even in heart failure studies, immune rejection of the transplanted stem cells is a major concern. (Vassa, Swiss Med Wkly. 2011;141:w13209) More importantly, stem cells dosages and administration methods have to be standardized for clinical application stability and efficacy. (Choi, Circ J 2012; 76: 1307)
In answer to Dr. Abarquez’ question, we can quote British professor, Sir Martin Evans, one of the pioneers of embryonic stem-cell and gene targeting research which earned him a Nobel Prize for medicine. He said: “The scenario of a cell-based therapy or medical intervention using cells is very sound but there’s still a long way to go before it’s a safe therapy. There’s also quite a lot of jumping the gun and early adoption going on, some of which is quite cynical.”
So before you sign in for stem cell treatment for whatever indication, just make sure you don’t fall victim to those who’re “jumping the gun” and making you face the consequences. Much more so if you’re only having it for cosmetic or “feeling young” indications.
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