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Stem Cell: The Body As Clinic

The therapy may hold the cure for many dreaded ills

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Stem Cell: The Body As Clinic
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Andrew Kisana, an American suffering from Parkinson's disease, was implanted with 1.5 million stem cells at Manipal Hospital, Bangalore

"After my stem cell treatment, I can type on my laptop. Now, even my handwriting has improved and I can walk independently."

Encouraged by the initial results of the AIIMS study, the Department of Biotechnology (DBT) has commissioned the country's first multi-centre study of stem cell therapy (SCT) in heart attacks, or myocardial infarction in medical parlance. Christian Medical College (CMC), Vellore, will be the nodal centre and four other hospitals in different parts of the country will participate. The patient size for the study would be about 300. "Dr Alok Shrivastava's team at Vellore has also successfully used stem cells to treat people who are severely anaemic," says Dr Balasubramanian, chairman of the stem cell taskforce set up by the central government.

Other than eye, heart and anaemia cases, private and government hospitals across India have reported encouraging trends in the treatment of spinal cord injuries. Dr Satish Totey of Manipal Hospital in Bangalore presented two such cases in 2007. One was of Ramesh, an engineer, who was severely paralysed due to a spinal cord injury he sustained in an August 2005 accident. But after injection of stem cells into his body, there has been steady progress: "There has been an overall improvement in the left side of my body. I have regained bladder control. I could not sit, but now that is possible. My legs have regained sensation. I hope by next year I can walk," says Ramesh.

The other case was of Prabhaben from Gujarat. She became a paraplegic after falling from a Ferris wheel at a holiday resort in September 2004. She has regained partial mobility after a bone marrow SCT: "I now use a calliper and a walker to move around. My urine bag has been removed. The neurosurgeon who had operated on me in Surat said that I will not be able to walk all my life and there was no cure for my condition. I tried to handle my problem initially through physiotherapy, pranayama and by taking the lord's name, but then stem cell treatment happened and it has done wonders," says Prabhaben, eagerly awaiting the second dose of stem cells to be put into her body.

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Ramesh suffered severe spinal cord injury resulting in paralysis after an accident in 2005. He went through stem cell therapy at Manipal Hospital, Bangalore.

"Ever since, there has been steady improvement in my condition. My legs have regained sensation. I hope by next year I will walk."

Chennai's Lifeline Institute of Stem Cell Therapy and Research similarly reported success in June 2007 in the case of Prabhdeep Singh of Ludhiana who had suffered spinal cord injuries in an accident in October 2006. Singh came to Lifeline after reading the story of Akbar Ali who had been paralysed waist-down and treated by the hospital. As in Prabhaben's case, stem cells used for treatment were taken from the patient's own bone marrow.

Then Chennai's Frontier Life Line Hospital, home to renowned cardiac surgeon Dr K.M. Cherian, made medical history in November 2006. Four-month-old Aarohi underwent corrective surgery for a rare cardiac disease called ALCAPA. "Since the child's heart was damaged, we decided to improve the cardiac function by injecting stem cells into the heart," the doctors say. In Aarohi's case, since she was just about 4.5 kg and could not offer her own stem cell resource, the cells were harvested after matching her father's blood. It was the first time that a child weighing less than 5 kg and below 6 months had undergone a complicated cardiac surgery—it was also an extremely rare case of stem cells being taken from outside the patient.

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Farhad Jalil of Moradabad suffered from Buerger’s syndrome, which usually affects adult males, leading to gangrene in the legs. He came to Gangaram Hospital in Delhi to join a stem cell trial.

"The doctor told me about stem cells, that an experiment was going on, if you want we will do it on you. Two months after the injection, I’m walking five kilometres a day."

Most often, the stem cells used in therapy are autologous—cells from the patients themselves. This is to avoid rejection and other medical complications. "Autologous-homologous applications are the safest, that is, using one's own skin tissue to repair one's skin or your own cells in the eye to repair your eye," says Dr Geeta Vemuganti. In the case of paraplegics like Prabhaben, the application is autologous but non-homologous because the stem cells are from the bone marrow of the patient, but are applied elsewhere. The bone marrow stem cells permit this as they are foundation cells that do not have any specific function and they are believed to take on the function of the area in which they are deployed.

Since both stem cell therapy and research are in their infancy the world over, cell biologists are still debating the abilities of different kinds of stem cells and how they network, and have yet to reach firm conclusions. The three most common stem cell categories are adult stem cells, embryonic stem cells and cord blood cells. Most therapy in India is happening with adult stem cells, while an unresolved ethical conundrum related to embryonic cells hampers research in this wing. The stem cells found in the umbilical cord of a newborn are the cord blood cells. They are being collected for different uses by private companies.

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Kiran Taneja was diagnosed with multiple myeloma, a fatal blood cancer. She underwent an autologous stem cell transplant at AIIMS two years ago and has recovered completely.

"For me it was a case of do-or-die. There was no alternative. Now, after stem cell transplant, I am as good as new."

Another area coming under cell therapy in the country is in treating different kinds of cancers. Kiran Taneja, 52, who works for a pharma company, was diagnosed with multiple myeloma, a cancer of the blood. She underwent an autologous stem cell transplant at AIIMS about two years ago, and has experienced an almost miraculous recovery: "For me it was a case of do or die—there was no alternative. Now I am as good as new. I sent my reports to a radio oncologist in New York, they said 'we couldn't have done it betterhere."

Parkinson's Disease is yet another ailment for which stem cell therapy shows promise. Andrew Kisana, an American suffering from Parkinson's, had tremors of the head for 13 years and severe speech disturbances. He had had access to the best treatment available for his ailment, like DBS (deep brain stimulation). But he came to Manipal in search of SCT. Nearly 1.5 million stem cells were implanted through surgery, and both he and the hospital claim remarkable results. Kisana typed out his progress report himself on his laptop when he came for a follow-up dose: "I can walk independently, my bowel movement is better and my handwriting too has improved." Dr Totey says the hospital was reluctant to take up his case, but they agreed only after he insisted. They had to secure special permission of the ethics committee of the ICMR to do so. His was the first in India by a hospital for Parkinson's. Kisana also confesses there is a great "price advantage" that India offers to those undergoing cell therapy. Encouraged by these successes, Manipal Hospital has started a separate company called Stemputics. It has also outsourced trials in the areas of heart attacks, spinal cord injuries, optic nerve injury and limb ischemia.

Gangaram Hospital in Delhi is also planning trials in limb ischemia or what is called Buerger's disease. It usually affects young adult males who are in the workforce. It is an inflammation resulting in the total erasure of smaller blood vessels in the leg. "In our case it is not going to be 'I did it first,' because Buerger's is very common in Japan and it has been written about in international journals," says Dr Rajeev Parekh of the Vascular Surgery Department.

Dr Balasubramanian outlines some of the emerging focus areas for SCT and research in India: "One is retinal reconstruction, Dr Taraprasad and Dr Geetha at lvpei are working on it; Dr Madhuri Bihari of AIIMS is pushing the case of neuro-muscular difficulties; Dr Shiv Sarin at the G.B. Pant Hospital in Delhi is routing for liver, and a clutch of hospitals with CMC Vellore are looking at heart. We are most likely to make good progress over the years in these areas." But diabetes is not yet a thrust area though there is a high incidence of it in India. Dr Balasubramanian says it is still a big question whether stem cell biology is required at all to tackle it. "But there are two or three centres looking into this area too," he noted.

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Dr Sangwan, Dr Vemuganti, Dr Das at a video play of stem cells

There is no doubt that SCT is today the most "happening" area of medicine, across the globe and in India. The market projections too reflect this. According to a study by consulting firm Frost and Sullivan, the global market for SCT is expected to reach $20 billion by 2010. The market estimation for India is around $540 million and is expected to grow at 15 per cent a year. This is why companies like Stemputics, Reliance Life Sciences and LifeCell are trying to make an early dent. They are busy applying for patents. Stemputics even aims at off-the-shelf solutions in the future. SCT is very expensive because the economies of scale have to be achieved. But as Dr Balasubramanian says: "India has an edge in SCT because there is a great clinician-basic researcher dialogue happening, and the department of biotechnology is proactive here in seeking proposals and offering grants. Nowhere else in the world is the environment so encouraging."

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Kuldeep Singh saved many lives by throwing out a bomb planted in his bus during the 2005 Delhi blasts. He has undergone corneal transplant through stem cell therapy.

Amidst all this hype about SCT, a big dose of caution too is offered by every surgeon and researcher. In fact, participants at the Stem Cell Research Forum of India's first conference recently in Bangalore felt this therapy was being saddled with the image of a panacea for all diseases known to humankind. As ICMR member Dr S.S. Agarwal said, "There have been reports that diagnostic solutions are being provided the world over based on stem cells. This should not be the case until clinical trials prove successful. "

Hospitals are in some ways party to this hype as they rush to the media with their trial cases. At this stage, in India and world over, everything is still at the trial stage; it just early evidence. But if that is anything to go by, there is every hope that stem cell therapy will fulfil its promise of finally providing cures for some of the most intractable diseases.

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