In a major first for the stem cell and regenerative medicine fields, a patient in Japan today received a pioneering transplant of a retinal pigmented epithelial (RPE) sheet made from induced pluripotent stem (iPS) cells, also known by the acronym IPSC.
This is the first ever iPS cell-based transplant into a human.
The patient is reported to be a 70-something Japanese woman suffering from macular degeneration and the procedure was performed by Dr. Yasuo Kurimoto and other specialists. I highly recommend the article by David Cyranoski, one of my favorite science writers, linked to in the previous sentence for more on the transplant.
The patient is clearly a brave hero. The team transplanted a huge (from a bioengineering perspective) 1.3 x 3.0 mm sheet of RPEs into the retina of the patient, who did not have any clear immediate side effects from the procedure. Keep in mind again that this sheet was made indirectly from the patients own skin cells so it is an autologous (or self) transplant, a notion that 10 years ago would have seemed entirely like sci-fi.
This is not only a huge milestone, but also an astonishingly fast translation of iPS cell technology from the bench to the bedside. Talk about warp speed science.
Nobel laureate Shinya Yamanaka first reported the creation of mouse and human iPS cells just eight and seven years ago, respectively. To get to the clinic so soon thereafter is one of the fastest biomedical translational pathways in history.
How was this possible?
In part this is a story of an extraordinary level of commitment to iPS cell technology by Japan and its scientists including the team led by the amazing Dr. Masayo Takahashi (pictured above) and of course Yamanaka too.
The work was also made possible by Yoshiki Sasai, who did pioneering work in retinal differentiation from pluripotent stem cells. So we are talking about fantastic scientists dedicated to translation and a government willing to fund them generously to make this a reality.
Another important element to this story is that Japan has a clinical translation pipeline that is now faster with recent changes in regulations than that of the US. For example, this and future iPS cell-based transplants were approved as part of a clinical study, a type of clinical research mechanism that doesn’t exist in the US. It is safe to say that the same technology with the same research team and outstanding level of funding would still be at least a few years away from their first patient in the US due to the different regulatory scheme. Another indication of the unusual speed here was indicated in the Cyranoski piece:
Kurimoto performed the procedure a mere four days after a health-ministry committee gave Takahashi clearance for the human trials (see ‘Next-generation stem cells cleared for human trial‘).
With this difference between regulatory frameworks not only comes the potential for speedier clinical innovations, but also the uncertain potential for risks from first in-human studies.
In a sense we have an experiment inside of an experiment here.
We have the actual clinical studies as an experiment and then we have the larger context of a regulatory experiment too. Nobody knows how it will turn out. One can certainly have hope from the fact that the Takahashi team’s preclinical studies were reportedly encouraging from a safety perspective, although that data has not yet been published. Also, on the positive side we have the encouraging results from the ongoing clinical trials from Advanced Cell Technology (ACT) using a similar approach to macular degeneration, but employing human embryonic stem cells to make the RPEs.
For the vision impaired and the broader stem cell field, it is heartening to have two such capable teams working to cure blindness with pluripotent stem cells.
Admittedly, we are now in uncharted territory, which is both exciting and a bit unsettling too. That’s the reality with cutting edge biomedical science and going after huge goals like curing blindness. What an exciting time to be in the stem cell field.
Yes, the OCATA trials. I’ll be digging up those cites in December anyway, so if comments can still be left here then, I’ll post them here. And here’s one good reason why I think the iPSC trials are moving too fast. It’s a quote from a post ON THIS BLOG. And it’s only one of many. Here’s what Paul said just two years ago:
iPS cells not quite ready for primetime?
Posted on August 8, 2012
Are we ready to start using iPS cells in patients in the near future? Say in just a couple years?
Are they ready for primetime?
I think the answer is clearly “no”.
I believe that iPS cells, a new type of stem cells, are one of the most exciting and important developments in biomedical sciences in decades, but they are still far from being ready for clinic use.
So two years ago, Paul said that iPS cells would not be ready for use IN TWO YEARS. Which is exactly the present time. He said basically the same things in at least three more articles in 2012 and 2013… I have all the cites. People… .come on. We know better than to just jump on the bandwagon here. There are so many questions and concerns that have not been addressed at all.
My doctor has told me that this is basically the exact procedure that I should have (rare condition that behaves like wet amd.) I still cannot believe this is anything but a bad idea at this point. We have absolutely no way of knowing what the longterm effects might be. But we do know that other autologous cell transplants have ended up being disasters. Terrible and incredibly dangerous idea imho… again, nobody could want this to work more than I do.
What autologous cell therapies have ended up being disasters? Are you thinking about the nasal graft into the spine? That has no similarity to the approved iPSC-derived cell therapy.
Not really. .. I’m thinking more of the old retinal transplants and experiments that all failed within 2 years. Look… I understand why people would get excited about this. .. I really do… and I have a huge personal stake in whether or not the treatment could succeed. I am the one who should be indulging in wishful thinking. .. I have so much more motivation than those who do NOT need this treatment. So it means something when l say that i think there are too many potential problems.
Retinal transplants do not sound like an autologous cell therapy- they sound more like tissue was taken from one individual and transplanted to another. Do you have details or citations for actual autologous cell therapies for macular degeneration that failed disastrously, or an actual reason why you would expect that the iPSC-derived cell therapy trial would be doomed to disaster? Also, did you know that there is currently an ES cell therapy trial for AMD and SMD in which the first patients were transplanted more than 3 years ago? The trial is still ongoing (with no apparent disaster), and early reports suggest that the patients have experienced some improvement of visual acuity.
It is a benefit that the eye is an encapsulated organ for these types of technologies. If the iPS derived cells start misbehaving, removing them rapidly and without giving them a way to spread is crucial.
Do you think IPS cells (made from the skin) have the same quality as own stem cells, which you can get from the milk teeth or the cord blood?
Great and exciting news
Look forward to follow up of the patient
please let us know if the iPS cells used for the transplant were patient specific-
My understanding is they were patient specific