Is the largest affiliated group of stem cell clinics in America, Cell Surgical Network, now using laboratory-proliferated stem cells in patients?
Do they already have some kind of final FDA approval for this clinical approach given that lab-grown stem cells are generally viewed as drugs requiring premarket approval?
Over the years I’ve reached out to interview many members of our diverse community in the stem cell arena including those operating stem cell clinics. One past such past interview (here and here) was with the leaders of Cell Surgical Network, Drs. Mark Berman and Elliot Lander.
Even though more broadly those operating stem cell clinics across the U.S. and I don’t see eye to eye on many things, the interviews are valuable to the community, providing insights generally not otherwise found in the public domain.
Today’s post is a new, striking interview with Lander and Berman (pictured above). I invited them to do this short Q&A because there have been indications that their group of clinics may be gearing up to or already has been taking a different approach (at least compared to what I knew about in the past) to using stem cells in patients with the possible new approach involving laboratory-amplified stem cells.
For instance, on their website FAQ page they refer to using seemingly laboratory expanded cells (emphasis mine):
“Autologous lipo-aspirate can be frozen as SVF Stromal Vascular Fraction (contains mesenchymal and hematopoetic stem cells). SVF can be deployed for repeated treatments and also expanded under IRB approval as part of a safety trial providing vast quantities of autologous stem cells that could be used throughout that patient’s life.”
The question of lab expansion is such a crucial point because to my knowledge lab-expanded stem cells are considered a biological drug by the FDA requiring pre-market approval steps such as an IND, IDE, and/or BLA. Also, typically a safety trial of the type mentioned would be an FDA-approved, Phase I clinical trial based on an IND and I’m not aware of Cell Surgical Network having that.
To my knowledge, IRB approval alone is not a sufficient basis for doing a clinical trial on a biologic. Am I missing something here? Is Cell Surgical Network’s apparent IDE application with the FDA going to encompass data usually found in an IND as well? Why not do an IND and an IDE In this case?
The point of this interview was to try to clarify this situation. Thanks, to Berman and Lander of CSN for doing it.
PK: I’m hearing that you are apparently growing adipose stem cells in the lab these days for clinical use (transplantation) in patients. Is that correct?
CSN: Yes – Our patients receive re-implantation (not transplantation) of their own cells under this protocol.
PK: Any comment about the change in your practices?
CSN: Our practice has remained fundamentally the same and is based on the investigative studies of safety and efficacy for surgical deployment of autologous adipose derived cells. We function under IRB (with FWA) and we follow all outcomes on our online database. This database was used to help us publish our initial peer reviewed experience on 1524 patients and will be printed in the March issue of American Journal of Cosmetic Surgery. We had two other publications in the past year as well. One of our IRB approved safety studies includes expansion (in an FDA registered cryobank) of MSC’s derived from autologous SVF on 100 patients. While currently under investigational studies, these cells can be saved for possible use to potentially mitigate a number of degenerative conditions. We are simultaneously preparing an IDE application for the cryobank process but want to compile reasonable safety and outcomes data before filing. We also need to complete our “IDE for point of care” application as a prerequisite to that application. This is a fairly tedious process and we’ve been working with the FDA for the last year and a half and are nearly complete in our tasks to get approval.
We included information on that study for our sub- investigators in an educational webinar that was attended by a number of interested parties including an “outraged” competitive regenerative medicine group that moved their cell production and manufacturing offshore to avoid the financial and logistical difficulties of doing such studies in the US as a predicate to an FDA IDE application.
PK: Thoughts on how the FDA will react?
CSN: We believe the FDA supports clinical research and the rigorous collection of data and the quality control applied in the IRB studies we are doing since much of the information we have collected will be and has already been submitted to the FDA as part of an IDE application related to our arthritis work.
PK: Do you or your other business partners have an IND? A BLA?
CSN: No
PK: If not, why not?
CSN: Once we determine safety and efficacy, and which claims we wish to pursue, then we will be able to work with regulators to find the best way to help patients obtain access to their own cells stored or expanded under sterile conditions.
PK: What about the whole FDA v. Regenerative Sciences case?
CSN: Honestly? We’d be willing to informally discuss this over the phone. We know a lot about the situation, but prefer not to “litigate” it in a blog.
PK: Anything else you want to add?
CSN: Domestic autologous cell banking appears to be an economic threat to competing point of care technologies and even to certain pharmacologic industries. All we care about is our patients. Providing them with the best and safest regenerative medical care in the world is what Americans deserve. We are not interested in anyone who desires to slow or obstruct this patient care by manipulating regulators into criminalizing certain medical practices. Therefore, we continue on our mission and ignore the fake news and rumors that generate blog ratings and spread fear and mistrust.
Press Release from Penn School of Medicine https://www.pennmedicine.org/news/news-releases/2017/february/stem-cells-collected-from-fat-may-have-use-in-anti-aging-treatments
“In a paper published this week in Stem Cell Reports, they caution that the large-scale clinical manufacturing of cell lines—a process often guarded as a trade secret—can change stem cells in unpredictable ways, and they argue for more thorough animal testing on the exact cell lines destined for patients.”
http://science.sciencemag.org/content/355/6326/679
@Jonathan, It’s not clear to me how much QC that different stem cell clinics do on their cells prior to administering them to patients. Such QC is really important to know what is going into the patients, but clinics may view it as too expensive. Paul
VetStem has performed 10,000 procedures on animals, and CSN has deployed over 4000 SVF cases. Other groups have performed many SVF procedures outside of CSN, if there were indeed issues, we would have heard of them. Time to cultivate and expand adipose cells to provide better care to those debilitating conditions like Parkinson’s, MS, diabetes, etc.
With an FDA application and peer-reviewed reporting of results this might be more legitimate than your average stem cell clinic. But who is paying for these studies, are desperate patients depleting their savings?
The majority of the studies are patient funded research, but many wounded warriors and patients with debilitating diseases have received multiple SVF deployments for free. Wish the docs would talk more about their world class database where they use the data they have collected over the years to propel this field forward.
I’d be interested to hear how they use the data they have collected to propel the field forward. Is it controlled clinical trial data or peer-reviewed publication or something else? What does propelling the field forward mean?
Hi Archie,
Yeah, exactly the right questions. I’m skeptical that much propelling has occurred so far.
Paul
Paul,
You have had discussions with Mark Berman and Elliot Lander about their process of studying the safety and efficacy of adipose-derived stem cells. CSN has been collecting patient data for over five years, which has provided the field of regenerative medicine move forward and allow patients to have options for their debilitating diseases. You continue to state that people are dying, being blinded, or have tumor growths from stem cell clinics, why do you never name names or clinic locations about these adverse events? Could it be that these doctors are truly fringe characters operating below the radar or outside the reach of the USFDA?
In the beginning, you tried to smear the Cell Surgical Network by associating them with the wrong doings of other organizations (i.e., StemMD). You would only use the examples of StemMD like their website stating their stem cells were FDA approved and their use of patient testimonials, both clear violations of FDA regulations.
Now people are questioning what the “path” should be to move this field forward, again you leave out facts, data, or any real arguments about stem cell clinics and continue to fight from the weeds.
The Cell Surgical Network, consisting of 90 Treatment Centers in 20 countries, 74 TC’s in 24 States here in the US, connecting 150 physicians together to work on providing patients with better care than traditional medicine allows and at a fraction of the cost. All Affiliates of CSN use the same equipment, enzymes, and follow the same protocols. All affiliates in the US are under CSN’s malpractice insurance policy for the harvesting of adipose tissue and the deployment of Stromal Vascular Fraction. Patient-funded research is for those individuals who do not have ten years to wait for the scientist to create a bill that will cost insurance companies what? $89,000 a year? $150,000?
I would love to hear about the Embryonic and IPS Networks in the scientific community who are using a method like the one I laid out above? Could there be a personal conflict with those scientists not wanting to share their information with others because of grants or personal wealth potential?
You continue to lump all stem cell clinics together when there are a few groups out there doing it the right way, and you refuse to recognize their importance to society.
@Lodgers,
It’s important that you identify yourself as Chris Lindholm, the COO of Cell Surgical Network, as that’s important context for your comments.
Paul
Former COO of CSN, I’m only a shareholder now.
Chris
(@Lodgers) Hi Chris,
What is the “right way”? Who decides?
For instance, I’m not comfortable with the idea of charging patients for investigational stem cell offerings, with giving stem cells to patients with medical conditions outside of one’s area of medical speciality, with injecting patients with non-FDA approved stem cells that may be more than minimally manipulated and used in a non-homologous fashion, etc.
Perhaps some have counter arguments for these kinds of key issues or feel comfortable with aspects that in my opinion are concerning.
Thanks for commenting,
Paul
In reading this blog, it’s hard to determine if this Paul fellow has any heartfelt feelings for the truly hopeless people who could be helped.
I’d be interested to know Lander and Berman’s scientific rationale for treating a genetic disorder like Stargardt’s using a patient’s own SVF.
Good for Drs. Lander and Berman for doing what is right for their patients!
Im cool with it. I’m not a fan of SVF but I am all for it with proper disclosure.
Expanded cells are provided by a separate company called COI. CSN is a separate entity.
What does “COI” stand for and can you please provide more information about the IRB that approved using expanded cells?
Cells on Ice