Stem cell therapy 'damage' seen in kidney disease case

[Zach]

http://news.bbc.co.uk/2/hi/health/10339138.stm

Stem cell therapy 'damage' seen in kidney disease case

21:09 GMT, Thursday, 17 June 2010 22:09 UK

There are hopes that stem cell therapy can be used
to tackle many diseases
 
A new complication has been seen in a patient with kidney disease who
received stem cell therapy, scientists have warned.

Stem cells were injected into the kidney, but the patient suffered tissue damage
and died from an infection.

The Canadian and Thai researchers said the findings published in the Journal of
the American Society of Nephrology showed caution was needed.
 
Experts said there was a gap between research and treatment.

Many scientists hope stem cell therapy can be used to treat a wide range of
diseases.

It has been shown that it is possible to reprogram adult stem cells, taken from bone
marrow, to become a range of specific cell types - including kidney cells.

We believe that this is either formed directly by the stem cells that were injected or
that the stem cells caused these masses to form 
Dr Duangpen Thirabanjasak, Chulalongkorn University

And animal studies have indicated that injecting stem cells directly into organs,
including the kidney, is safe.

The patient in this case had been treated by a private clinic.

Researchers from Chulalongkorn University in Bangkok, Thailand, and Paul Scott
Thorner, from the University of Toronto, were involved in removing and analysing
the kidney.

They found that the patient had not benefited at all from the treatment, but had
actually developed tissue damage called angiomyeloproliferative lesions at the
injection sites. These were found to be clusters of blood vessels and bone marrow
cells.

Enthusiasm 'premature'
Dr Duangpen Thirabanjasak, from Chulalongkorn University, who led the research,
said: "This type of lesion has never been described before in patients, and we
believe that this is either formed directly by the stem cells that were injected or that
the stem cells caused these masses to form."

And she warned that, because they had not been seen before, no-one knew how
the lesions might have developed over time.

The authors conclude that their findings should serve as a warning to clinical
investigators that the development of blood vessel and bone marrow masses may
be a possible complication of stem cell therapy.

And they said more work was needed to identify why the masses formed, and how
this could be avoided.

Writing in the journal, Andras Nagy, of Toronto's Mount Sinai Hospital, and Susan
Quaggin, of the University of Toronto, said caution was needed over stem cell
therapies - especially if they were being offered by unregulated private clinics.

They added: "Premature enthusiasm and protocols that are not fully vetted are
dangerous and result in negative publicity for the field of stem cell research, and
more importantly, may result in disastrous outcomes with no benefit to the patient.

"Although there is promise, a large gap still exists between scientific knowledge and
clinical translation for safe and effective stem cell-based therapies.

[cariad]

Flippin' marvellous.

I think I'll have to ask my surgeon about these findings. Let's hope he can think of something reassuring to say.

[MooseMom]

Flippin' marvellous.

I think I'll have to ask my surgeon about these findings. Let's hope he can think of something reassuring to say.

cariad, were stem cells injected directly into your kidneys?  I thought you had an infusion.  This article says nothing about how the patient was prepped, ie, did the patient have his immune system destroyed and then "retrained"?  These kinds of articles give just enough information to make you panic but not nearly enough to clarify anything.

[okarol]

Danger, Stem Cell Tourists: Patient in Thailand Dies From Treatment

A woman with kidney disease has died after receiving an experimental stem cell treatment at a private clinic in Thailand, and a postmortem examination of her kidneys revealed that the treatment was almost certainly responsible for her death. Last week we reported that Costa Rica’s health ministry had closed a stem cell clinic that catered to foreigners, which sparked lively debates around the Internet about whether patients should be able to willingly take on risks associated with experimental treatments. This new case offers a sobering reminder of what can happen when patients travel abroad looking for a miracle cure.

The woman suffered from lupus nephritis, a disease in which the immune system attacks the kidneys. When medications no longer controlled her disease, she went to a still-unnamed clinic in Bangkok where doctors said they could treat her disease using stem cells drawn from her own bone marrow. There was some medical rationale for this:

    Bona-fide trials in European clinics about six years ago showed that some people with similar kidney disease benefited if stem cells from their own bone marrow were injected into their blood. The body’s immune system was first deliberately destroyed with powerful immunosuppressive drugs, then the reinjected stem cells helped to stop the attacks on the kidney by rebuilding and rebalancing the immune system. [New Scientist]

However, the Thai clinic didn’t inject the stem cells into the patient’s blood stream, instead they injected them directly into her kidneys. That means the stem cells did nothing to stop the immune system’s attack on the organs–and they instead produced never-before-seen side effects.

According to a paper about the case just published in the Journal of the American Society of Nephrology, the woman went into a decline soon after her treatment. Within three months she required dialysis, within a year one kidney had failed, and within two years she was dead. A team of Thai and Canadian researchers performed a postmortem analysis of the kidneys, and found no evidence at all that the treatment had benefited the woman–and they found strange lumps and lesions at the sites of injection. Further investigation revealed that the masses were tangled mixtures of blood vessels and bone marrow cells.

Dr Duangpen Thirabanjasak, from Chulalongkorn University, who led the research, said: “This type of lesion has never been described before in patients, and we believe that this is either formed directly by the stem cells that were injected or that the stem cells caused these masses to form.” [BBC]

Susan Quaggin, who wrote a commentary about the case for the same nephrology journal, says this tragic incident doesn’t cast a pall on reputable medical research on stem cell therapies, as animal trials and safety studies are built in to the system to protect patients.

But she says that the Thai results are yet another reminder that sick people should not gamble with their safety, and money, by turning to stem-cell tourism peddled by unscrupulous operators. “The sad part is that many people are desperate, and what makes it even worse is that it costs lots of money,” says Quaggin [New Scientist].

http://blogs.discovermagazine.com/80beats/2010/06/18/danger-stem-cell-tourists-patient-in-thailand-dies-from-treatment/

[cariad]

Thanks for the article, Karol. I feel so much better. I guess I did not read Zach's article carefully enough, and thought they were saying that all adult stem trials were dangerous. A similar trial to mine done at another hospital saw four patients out of a mere 21 come down with either myelodysplatic syndrome, chronic myelogenous leukemia, or acute myeloid leukemia. When I first signed the consent from six months ago, there were only two patients out of those 21 that had come down with one of these. They are putting this down as a possible side effect to radiation, but I have to wonder if this is not a possible side effect of the stem cells themselves? Look up any of these conditions and you will find phrases such as "invariably fatal". I asked the research nurse about the results at my appointment last week, but she dodged the question. (I don't think she knows - it's not one of their trials.)  She said "I think those were heart transplants" which may be true, as they were doing either heart or kidney. Still has me worried for all the patients in that trial, and a bit concerned for my own future.

You're right, MM, it was an infusion. I really shouldn't read these articles too quickly. It is a bit shocking that adult stem cells can cause these complications. Why on earth they would inject right into the organ, I cannot guess. As luck would have it, I have no native kidneys to attempt to save, so there was no danger I would go for a procedure such as this one.