One of the big issues related to using induced pluripotent stem (iPS) cells is cost.
To make iPS cells from each patient for subsequent stem cell-based treatment would cost a fortune, by some estimates $200,000 or more per patient if done one-by-one. It could easily end up not being covered by insurances companies and Medicare, and only be a rich person’s treatment.
The idea of using iPS cells as an individualized therapy still has traction though so it was interesting today to read the quote below from Shinya Yamanaka, who first made iPS cells and recently won the Nobel Prize for this achievement, in a news piece:
“In theory, we can make iPS cells from each patient. But it would be very expensive and take six months to prepare the cells from each patient. So in reality, we cannot do that,” he said.
That seems clear enough.
The alternative?
Yamanaka says it is iPS cell banks that would have enough donors to be almost universal. In that scenario, iPS cells would be no better than ES cells. Both would be allogeneic therapies possibly requiring immunosuppression. The only advantage? iPS cells could be made without using human blastocysts. Does this outweigh potential disadvantages of iPS cells related to safety? At this point we just don’t know. I hope so.
In the same article Yamanaka discusses potential ethical issues related to making sperm and eggs from human iPS cells.
Maybe autologous could still be made to work. Even a 200.000$ price tag could result in a net gain if it was cheaper than whatever chronic disease was afflicting the recipient. To bring up an old example: hemodyalisis treatments cost around 50.000€ a year. Even if short-term the hypothetical ips treatment was more expensive, you’d cover that in around three years, even without improvements in technique cost (this is also why kidney grafts, at 21k € a shot, are actually regarded not only as life improving, but actually a good trade for healthcare services.
As for the bank, it has been discussed in the past, I think. It probably is a good idea on its own, as many urgent conditions would likely require the issue of pre-produced cells, not wait until an ipsc line was developed and grown. I don’t know to what extent we can talk about having an universal bank, though, as there is not a clear “universality” criteria.
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