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Cell Therapy — Is it any better than Tribal Medicine?
Two hundred years back, the shaman would say to the patient, "Oh, unfortunate man, give me your blood and bring me the blood of a new born, and I shall mix the two and use my magical chants and my secret potions to teach your blood to heal thyself and put it back into you. I tell you that it will work, if you come to me early in your illness, and if you trust me do as told and if you have pure heart and good liver. And if you heal, you will give me your goat, in return."
Fast-forward to 2012: The chief scientific officer of the biotech company says, "We use our patented technology to trans-differentiate cord blood stem cells into desirable cell lines so that these cells assist endogenous stem cells in regeneration. The results of the clinical trial showed favorable outcomes when treatment was administered early on in the course of the disease and when subjects had better cardiac indexes. The secondary outcome was better in those patients who participated in a post-treatment rehabilitation program. We expect to commercialize this therapy over the next few years."
Cell therapy is a process that introduces new live cells into a tissue in order to treat a disease and/or promote regeneration. It is hypothesized that the cells will help either by replacing damaged cells, or by secreting growth factors, or by reducing tissue destruction. The most important commonality between tribal medicine and cell therapy are that in both cases we do not know exactly how it works.
Cell therapy, as it stands today, has more similarity with ancient tribal medicine than with pharmaceutical therapeutics. In drug therapeutics, when a molecule is patented, it remains essentially the same across all generic brands. That way one brand can be compared to another, and the differences in therapeutic results can be explained. This is not at all the case with cell therapeutics, where the exclusivity of a patented product is not just its processing methodology but also its source of the cells. The "medicine" itself is largely proprietary in nature. Just like a tribal medicine man, who guards the sources of key ingredients in his potion, like some exotic plant or animal, the protection of an exclusive cellular product lies in guarding the seed cell lines, which are owned by the biotech company. Like tribal medicine, one cell therapy concoction cannot be compared against another and the differences cannot be explained.
While tribal medicine and cell therapy are both essentially empirical therapies, tribal medicine has the advantage that a large body of human data has been handed down over centuries, and the therapy has been refined by trial and error. In the case of cell therapy, an extensive amount of short term animal data is available, but cell therapies in humans are mostly at experimental stages or costly, with the notable exception of hematopoietic stem cell transplantation.
It could be said that tribal medicine is practiced with conviction but hardly discussed, while stem cell therapy is discussed with enthusiasm but hardly practiced. Yet in the future, cell therapy has the potential to change the face of human disease and alleviate suffering.
So how can cell therapies do better than tribal medicine? The most important change that is needed to advance the status of cell therapy beyond empiricism is to reexamine our theories of disease causation and healing. If one drug is one molecule, then one stem cell is a bag of a thousand different molecules of different concentrations, and these concentrations are changing every minute depending on its niche, which varies in the dynamic micro-environment of the body. Since nature achieves healing by way of mobilizing intrinsic cells, stem cell therapy is intuitive and makes a lot of sense. But in order to work with cells that heal, we need to go beyond the single molecule and single disease model that has dominated pharmaceuticals and modern medicine. We need a science and a philosophy of stem-cell healing, so that we can work with medicines that have minds of their own.
Dr. Vaijayantee Belle is amongst the first ten women neurosurgeons of India. She has served as chief neurosurgeon at S.P. Institute of Neuroscience, in central part of India- one of the very few private centers of its kind serving the rural population with state-or-art super-specialty care at subsidized cost. There she established and directed a neurosurgery unit from 2004 to 2010. Starting in 2007, she designed clinical trials that used adult stem cells to treat patients for various traumatic and neuro-degenerative neurological conditions. Among these patients, she has treated children with cerebral palsy using cord blood stem cells from the patient, a sibling, or an unrelated donor. Since Oct. 2010, Dr. Belle is conducting research at Case Western Reserve University on the use of mesenchymal stem cells for regeneration of tissues.