One of the most exciting types of stem cells are mesenchymal stem cells or MSCs. Although there is some debate about these cells (e.g. I once heard Irv Weissman say at a meeting he wasn’t sure they really existed as such), a consensus would seem to be that they have great potential medical potential. Perhaps not surprisingly then there are a lot of clinical trials ongoing with MSCs. There are in fact 281 to be exact on the clinicaltrials.gov website.
If one uses the map tool you generate the MSC/mesenchymal stem cell clinical trial image below, which I find quite surprising and informative.
Most MSC trials are going on in China by far (35%), with the U.S. (21% ) slightly behind the whole of Europe (23% ). One other striking thing is the lack of trials in Mexico and Latin America, when we know that a massive number of MSC treatments are ongoing there.
Then, if you compare the MSC map to the “stem cells” (4316 total trials) more general map, the differences are remarkable (below).
Overall, the U.S. (61%) is by far the world leader in stem cell clinical trials, followed by Europe (23%), China (7%), followed closed by Canada, with India and Australia after that.
Why such a big global disconnect between MSC trials and stem cell trials more generally?
It’s hard to say. MSCs are very big in China it appears relatively speaking.
Another interesting question is whether MSCs are really the same cells across the globe? Thus, an MSC trial in one country may not be using the same cells as an MSC trial in another country. Of course the same goes for stem cells more generally.
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If I were to guess, I think this phenomenon could be explained because MSCs are generally simple to manufacture without expensive equipment. No sorting devices, just plastic adherence and expansion. I would bet that some labs do not even use flow markers for product release, just simple count and viability.
As we all know, different culture protocols can generate cells of different phenotype and function, and that donor-to-donor variability has a greater impact than many culture differences. So it is unlikely that there is consistency in flow markers, cytokine secretion, or immunomodulatory activity between labs. However, I am more interested in understanding differences in the number of cells given (dose) per patient per indication, how many population doubling s the cells have gone through prior to treatment, how those cells were formulated (fresh or cryo preserved) and ultimately delivered to the patients (infused or direct injection). My gut tells me that these are just as important as the culture methods.
Great post- made me think!