September 27, 2020

The Niche

Knoepfler lab stem cell blog

Scandalous stem cell behavior?

Secret Service ProstituteWhether it is people or cells, how much control do we really have over their behavior?

Very little.

The Secret Service is at the center of a huge international scandal involving prostitution and potentially compromised nationally security.

Clearly, the Secret Service failed to do their incredibly important job of protecting the President and national security, and this failure could have had disastrous and deadly consequences.

Call me stem cell obsessed, but I see lessons in the Secret Service scandal about stem cells.

Bear with me.

In advance of a Presidential trip abroad, the U.S. sends/transplants scads of Secret Service agents to insure the President has a safe trip. However, apparently once we send those agents abroad we have relatively little control over them. Shenanigans ensue and the agents misbehave on foreign turf on a regular basis. Misbehavior involves alcohol, prostitution, and who knows what else.

The end result of such bad behavior could range from compromised national security leading to American deaths to an assassination. In short, we need those agents to behave, but knowing human nature, even after this scandal leads to an inevitable crackdown (new rules have already been publicly announced and Secret Service agents will now take ethics training), you can bet that there will be a certain fraction that won’t behave.

In the analogy I’m pitching here, the same kind of phenomenon is true of stem cells transplanted into a patient. For the stem cells as healing agents to help patients we not only need them to do good things, but also we need them to avoid doing harmful things. Achieving those two goals is very difficult. In addition, unlike for people such as secret service agents, for cells we cannot enforce rules or give them the equivalent of “ethics training”. Once transplanted, cells will do whatever they will do and barring the use of a suicide gene, we have zero control of them post-transplant.

Once you put stem cells into a patient, even in an autologous setting of a person getting a transplant of their own stem cells from one domain of the body to another (e.g. abdominal fat to neck), not all of the cells will behave. Away from their home a certain fraction will do bad things. Imagine the stem cells like those Secret Service agents in Columbia….away from the constraints of home some will change how they act and not in good ways. Their new context of the recipient’s body may change how they behave as well.

In terms of numbers, how many transplanted cells will misbehave?

If you transplant a few million stem cells into foreign “territory” of a patient, it is reasonable to expect that perhaps a few thousand (0.1%) will not do what they are “supposed to”.

We may never know about such scandalous stem cell behavior until a disaster such as a patient death occurs, but proper scientific study and vetting of stem cell-based therapeutic products can reduce the risk.

I, for one, want a high degree of regulation of stem cell transplants to minimize the risk of stem cells going to the dark side in patients. I understand we need to balance risk and reward, including from the patient’s perspective, and some patients are seriously or terminally ill so a higher degree of risk is justifiable, but I still think we have to err on the side of caution.