Full Stem Ahead

Forbes India
Full Stem Ahead
Shishir Prasad, 02.12.10, 6:00 PM ET

Lakshmi, a 28-year-old woman from Guntur, finds it hard to forget June 19, 2009. That was the day she became a victim of an acid attack. Her face was burned and an eye damaged. Unless she manages a cornea donation, her loss is likely to be permanent. For Lakshmi and others like her, the work that is being done at L.V. Prasad Eye Institute in Hyderabad can mean a rescue from blindness. If the Eye Institute keeps to its path of progress in stem cell research, Lakshmi could grow her cornea back. "We have tackled almost 600 such cases using stem cells from corneal epithelium," says D. Balasubramanian, director of research at the institute. A combination of factors have made India one of the hotbeds of stem cell research in the world, with both the government and private firms working in very interesting areas to win the sweepstakes of life, as it were.

Stem cells have been touted the world over as the new medical technology with potential to change the way healing happens in a human body. The human body is made of cells, which carry genes. Genes are the carriers of inheritance (curly hair) and all characteristics (deep baritone voice, pouted lips) that make a human being distinct. Stem cells are specialized cells found in certain parts of the body--umbilical cord, bone marrow, embryo and even teeth--that have the capacity to become like any other cell in the body. If stem cell technology develops fully you would be able to grow back a malfunctioning lung, atrophied heart muscle, burned skin or failing kidney.

In the U.S. the Obama Administration has announced an increase in government funding for stem cell research. South Korea has a stem-cell program that is now eight years old and has provided close to $150 million dollars to develop stem-cell lines that can be used in a variety of therapies. The most heartening thing for Indians is that India is researching stem cells very aggressively.

Stem cells are the Holy Grail of medicine, and no country has a clear advantage yet. The U.S. could have had the lead, but the Bush administration delayed research into stem cells on ethical grounds. South Korea looked like it had a lead when Korean scientist Hwang Woo Suk claimed that he developed medically useful embryonic stem cells. Unfortunately, his claim was false. That set South Korea's stem-cell research back. India therefore has a chance to be one of the first to understand and use this technology.

The government of India realizes this, and the Indian Department of Biotechnology has allocated more than Rs. 300 crore (3 billion rupees) over the last five years towards basic and applied research in stem-cell technology. Since the program is government funded, it focuses on diseases that affect millions of Indians rather than exotic diseases and reminds one of its vaccine program.

The entire government-directed effort is in understanding the fundamentals of how stem cells work and conducting clinical trials to gauge the effectiveness of the therapy. The leading organization doing the fundamental work is the National Centre for Biological Sciences (NCBS) in Bangalore. "We are developing model systems--for example, planaria or hydra--to understand how stem cells work," says S. Ramaswamy, dean of InStem at NCBS. Model systems are simple systems that scientists study to derive principles that can be applied to more complex systems. For instance, bacteria and yeast are model systems to understand molecular biology.

Flanking InStem at NCBS are a variety of institutes like AIIMS, L.V. Prasad Eye Institute, Centre for Stem Cell Research at CMC Vellore and National Centre for Cell Sciences (NCCS) at Pune University. Most of these institutes are focusing on the applied part of the research. They are trying to focus on regeneration of damaged muscles due to heart attack, stroke or cornea damage. Given the prevalence of heart attacks, blindness and strokes, this seems a sensible strategy. The task of these institutes is to locate promising sources of stem cells, apply stem-cell therapy to cure patients and verify if the procedure is stable enough for wider application.

This is exactly the area where private effort, too, has come to the fore. Dr. Satish Patki, along with Dr. Ramesh Bhonde of NCCS, has shown that the membrane lining of the female genital tract (endometrium) is a rich source of stem cells. Dr. Patki is now trying to see whether these stem cells can be used to generate blood flow to the fetus. "Without this therapy the blood pressure of the mother can rise to extremely abnormal levels, and a doctor may have to abort the pregnancy to save the mother," he says. So far, he has only been able to use the tried and trusted bone marrow stem cells to do this.

Now he is beginning trials to see if he can use source stem cells. Dr. Naresh Trehan at Medanta Hospital in Gurgaon has used bone marrow stem cells to grow capillaries in patients who don't have alternate blood vessels for a bypass operation. Reliance Life Sciences has just been given the go ahead for using stem cells sourced from one's own body for therapy on a large scale.

If stem cells are going to be needed, then someone will have to store them. Companies like Reliance and Lifecell have created facilities to store stem cells from umbilical cord. Stemade is trying to store stem cells from milk teeth.

The explosion of enterprise in stem cells is not without worries. There are reports of people being given "stem cell" injections for Rs. 80,000 a pop! There are ethical worries on the side effects of such treatment. "Experimentation is good, but having regulatory framework is absolutely essential. Right now we only have guidelines," says Ramaswamy of NCBS.

THE STEM-CELL INDUSTRY VALUE CHAIN

STEM-CELL STORAGE
Institutions: Lifecell, Stemade (India) and Bioeden (U.S.)

What they do: Extraction, classification, quality checking, preservation

Business potential: Medium risk/medium returns, high cash flow business

R&D
Institutions: NCBS Bangalore, NCCS Pune, CSCR at CMC Vellore

What they do: Finding out what kind of stem cells hold maximum promise

Business potential: High-risk/high-returns business

CLINICAL TRIALS
Institutions: AIIMS, L.V. Prasad Eye Institute in Hyderabad, CSCR at CMC Vellore, Gangaram Hospital in Delhi, Reliance Life Sciences

What they do: Conduct field trials to ensure that the therapy works

Business potential: Low-risk/low-returns business

STEM-CELL THERAPY
Institutions: AIIMS, LV Prasad Eye Institute, CMC Vellore, Medanta, Patki Hospital, Reliance Life Sciences

What they do: Administer stem-cell therapy

Business potential: Low-risk/high return business

This article appears in the Feb. 19 issue of Forbes India, a Forbes Media licensee.

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