Tuesday, September 15, 2009

(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.”

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.

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)