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Stem Cell Treatment in India

What is Stem Cell ?

A stem cell is a cell from the embryo called first cell or master cell of the body. More than 200 cell types could be formed by the ability to divide and differentiate of these master cells. Researchers have found that adult stem cells having a unique capabilities to transform or differentiate in to mature cell type and make identical copies of themselves. It has also found that under some specific physiologic or experimental conditions, they can be induced to become tissue and organ specific cells with significant functions. For example pancreas cell, cartilage cells, blood cells, nerve cells etc.

Where do stem cells come from ?

Researchers have discovered several sources of stem cells:
Embryonic stem cells.Derived from the inner cell mass Pluripotent can develop into more than 200 different cells. Differentiate into cells of the 3 germ cell layers because of their capacity of unlimited expansion and pluripotency – useful in regenerative medicine. These cells are being coaxed to differentiate into cardiomyocytes, neural stem cells, insulin producing cell and even germ cells. Potential to form teratomas after transplantation hence to produce pure differentiated cells. Risk of transfer of xenopathogens. Embryonic Stem Cells still under extensive research.

Adult stem cells. Adult Stem Cells are multipotent and derived from many sources, e.g. umbilical cord, bone marrow, fat, skin etc. Though the potentially of these stem cells are limited than the embryonic stem cells but still it is Proving to be beneficial for brain injuries and a number of other difficult to treat disorders.
Emerging evidence suggests that adult stem cells may be able to create unrelated types of cells. For instance, bone marrow stem cells may be able to create bone or heart muscle cells. This research has led to early-stage clinical trials to test usefulness and safety in people. For example, adult stem cells are currently being tested in people with neurological or heart disease.

Classification of Stem Cells

Potency of Stem Cell ?

Totipotent – These stem cells creates when sperm and egg unite. The most significant quality of this Primordial Totipotent Stem Cells is it can make any type of cell in the body and without losing its potentially Totipotent Stem Calls replicate in unlimited numbers. These stem cells are obtained by sacrificing a live embryo. Ethical, moral, legal, religious issues prohibit its use except under strict laws of a formal FDA / Equivalent authority.

Pluripotent – Embryonic Pleuripotent Stem Cells can become many types of cells in body and very potent in nature. But Embryonic stem cells have numerous challenges, including contamination, genetic instability, mutation inductions and cancer risk.

Multipotent – Adult Multi-potent Stem cells from marrow / cord blood /Peripheral Blood. Can differentiate into a limited range of cell types. May be from self (Autologous) or donor (Allogenic).

Oligopotent – Oligopotent Stem Cells are having limited abilities to differentiate. Lymphoid or Myeloid stem cells are in this categories.

Unipotent -In normal condition Adult Muscle Stem Cells give rise just one cell type. So Unipotent Stem Cells only produce cells of their own type.

Why is there a controversy about using embryonic stem cells ?

Embryonic stem cells are obtained from early-stage embryos — a group of cells that forms when a woman’s egg is fertilized with a man’s sperm in an in vitro fertilization clinic. Because human embryonic stem cells are extracted from human embryos, several questions and issues have been raised about the ethics of embryonic stem cell research. The National Institutes of Health created guidelines for human stem cell research in 2009. Guidelines included defining embryonic stem cells and how they may be used in research and donation guidelines for embryonic stem cells. Also, guidelines stated embryonic stem cells may only be used from embryos created by in vitro fertilization when the embryo is no longer needed. In India, Embryonic Stem Cell is still under clinical research. As per ICMR (Indian Council of Medical Research) Guidelines , Embryonic Stem Cell can’t be used in Clinical Therapies until it is approved by Regulatory Authorities like DCGI. and today our scientist find the Stem Cell Treatment in India.

What is Mesenchymal Stem cell (MSC) ?

Mesenchymal Stem Cells (MSC), also termed Mesenchymal Stromal Cells, are multipotent cells that can differentiate into a variety of cell types and have the capacity for self renewal. MSC have been shown to differentiate in vitro or in vivo into adipocytes, chondrocytes, osteoblasts, myocytes, neurons, hepatocytes, and pancreatic islet cells.

Sources of Human Mesenchymal Stem Cell

In addition to distinct adult tissues (adipose tissue, bone marrow, peripheral blood), MSC can be obtained from several birth-associated tissues including placenta, amnion, umbilical cord (UC) and cord blood (CB)

Potency of Human Mesenchymal Stem cells

Human MSCs ability to become numerous different cell types, they also have the ability to:

★Fight inflammation
★Prevent cell death
★Form new blood vessels
★Direct the immune system, using other repair cell types to aid in healing
★Self-Regenerate

In summary, the multilineage potential of MSCs, their ability to allude detection by the host’s immune system, and their relative ease of expansion in culture make MSCs a very promising source of stem cells for transplantation. Ideally, MSCs can be harvested, expanded, and cryopreserved.

Is Stem Cell Therapy is an established Line of Treatment ?

Please note that Stem Cell Therapy procedures are investigational and may not result in your improvement or prevent the progression of your disease. The benefit of participating in this procedure is that you will receive a therapy or dose of medication not currently offered as standard medical care.

Stem Cell Therapy is one such research effort to help you to manage the disorder and to increase your quality of life. .

Before trying out Stem Cell Therapy :

a) You will have to submit your required medical records (asked by the Clinician) for evaluation and analysis and whether you are fit for experimental Stem Cell Therapy.

b) After assessment of your medical records scientific evidence based Counselling will be done by concerned clinician as per your appointment schedule along with all known risk and side effects of the treatment.

c) Your treating doctor will decide your therapy module as per the protocol approved for the specific disease by IEC (Institutional Ethical Committee) of the Hospital. Your inclusion in this Stem Cell Therapy will be solely depending on the inclusion criteria as per the therapy protocol.

d) You will be allocated the phone numbers, email Ids concerned doctor, medical coordinator and nurse for future communication if you have any further queries.

e) It is necessary to carry out certain screening tests such as HIV, HBV, HCV, CMV, and VDRL (Infection Profiles) before Stem Cell Therapy. It may be necessary to repeat some of the screening tests if there is a delay in conducting therapy or you opt for longer time for this therapy. If your clinician thinks it is necessary to check your health condition for safety reasons. These additional evaluations may include laboratory tests, pulmonary function tests, or an echocardiogram, MRI, PET-SCAN or any other tests that your clinician feels useful and necessary.

f) 2nd Phase of counselling will be done after getting all of your required test reports, in which the concerned clinician explained the therapy procedure to you and take your official consent to fix the date for your treatment.

At the Time of Stem Cell Therapy :

a) Two days before the therapy you will be admitted in the hospital. Clinician may ask you to do some basic tests before initiate the therapy. These tests will be treated as a base line data before your treatment.

b) Route of intervention will depend on the type of disease. There are possibilities that in some conditions such as spinal cord injury or any complicated neurological disorders clinician may go for surgical interventions. (As explained to you at your 2nd Phase of Counselling).

c) In addition to medications given to you as part of your standard medical care.

After Stem Cell Therapy :

a) You likely will be hospitalized until your CBC values are normal and monitor closely by clinician for any adverse reactions if any. This may take at least 2-3 days. You may get discharge and come for second time procedure as per the schedule or you may continue in the hospital until your clinician complete the treatment procedure.

b) After hospital discharge, you will need to stay in touch to your concerned clinician for another 1–2 months for follow-up visits.

Key Points about Stem Cell Therapy :

a) This treatment may be ineffective in your case

b) Although we have not observed any serious side effects of Stem Cell Therapy till date, though there is a small risk of developing adverse reaction depending on the person.

c) This therapy will weaken your immune system for some time. You may have to protect yourself against any infection.

d) You may receive antibiotics to protect against infection and to treat an infection if it occurs.

e) Stem Cell Therapy is off level therapy module. So it is absolutely on your willingness to participate in it or NOT.

f) Before you decide to participate, it is essential that you have all of your questions answered. (Please read your consent form carefully)

Will your Progress be Monitored ?

Will your Progress be Monitored ?
Yes, you will be provided detailed schedule for your follow-up visits to monitor your progress after the treatment.

Will your Clinical Evaluation be Done ?
You will have a comprehensive evaluation performed over the first year. You will have to visit 1, 3, 6, 9 and 12month after therapy. Assigned doctor or nurse will contact you by phone to ask you questions regarding your health status.

Assessment of your Quality of Life :
In addition to the follow-up assessments described in the consent form, you will be asked to complete quality-of life surveys. These will be used to evaluate how you feel and how well you are able to do your usual activities.

References

Comparison of Allogeneic vs Autologous BoneMarrow–Derived Mesenchymal StemCells Delivered by Transendocardial Injection in Patients With Ischemic Cardiomyopathy The POSEIDON Randomized Trial
Potential clinical applications of adult human mesenchymal stem cell (Prochymal) Therapy
Advances and Developments in the Use of Human Mesenchymal Stem Cells – A Few Considerations
Mesenchymal Stem Cells as Gene Delivery Vehicles
Mesenchymal stromal cells as treatment for chronic GVHD
Mesenchymal stem cell injections improve symptoms of knee osteoarthritis.
Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study.
Effects of Bone Marrow Mesenchymal Stem Cell Transplantation on Light-Damaged Retina
Stem cells in human neurodegenerative disorders — time for clinical translation?