Stem cell therapy for COPD: challenges & hope

As long as I’ve been writing The Niche as a professor here at UC Davis School of Medicine, people have been asking me about stem cell therapy for COPD.

There is a lot of misinformation out there in this space.

Let’s clear things up as to where the biomedical science stands today.

What’s in this article

What is COPD? | How might stem cells help COPD? | Challenges to this approach | Inhaled cells | What cells to use?Cost of stem cell therapy for COPD $5,000-$10,000 | Future Perspectives | References

normal and COPD lung tissue, stem cell therapy for COPD
Normal and COPD lung tissue (left and right, respectively). Sections stained with H&E.

Current treatments for COPD include inhaled steroids and bronchodilators. They can be very helpful but mainly treat the symptoms even as the disease sometimes progresses.

Could stem cells or other cell therapies help COPD in a new, more effective way? Possibly but there’s a lot of hype in this area so caution is needed and tough obstacles.

Along with the challenges to making a successful stem cell therapy for COPD comes some hope.

What is COPD?

COPD is a group of respiratory diseases, often but not always associated with smoking. The full name is chronic obstructive pulmonary disease.

As its full name suggests, the airways can be obstructed in COPD.

Sometimes the tiny structures called alveoli that define the smallest airspaces in the lungs can also be damaged or destroyed such as in emphysema, a disease that falls under the broader COPD umbrella. Chronic bronchitis also can be part of COPD either alone or together with emphysema.

It is a chronic, often progressive disease in which the respiratory system has less capacity in part because it is inflamed and damaged.

The swelling and inflammation make the airspaces smaller so it’s harder to breathe.

Imagine trying to breathe air through a snorkel and the snorkel keeps getting a little smaller.

You can see histological images above of healthy and COPD lung tissue appearance. In COPD the lung tissue is swollen and sometimes damaged. Compared to the normal lung tissue, there isn’t much space for air and for air to interact with the tiny blood vessels of the thin walls of the lung.

How might stem cells help COPD?

The main way in which researchers and patients have hoped that stem cell therapy for COPD might work is by reducing the inflammation that shrinks the airways.

With less swelling the space to actually move air hopefully becomes bigger again.

However, although some kinds of stem cells can reduce inflammation in lab experiments and in some medical conditions stem cells might do tamp down inflammation in actual patients, it’s a tough task clinically.

There are difficult roadblocks.

Challenges to stem cell therapy for COPD

One challenge is how to get the stem cells to the right place.

For instance, simply injecting stem cells into the bloodstream probably won’t work for COPD generally or for emphysema.

While blood naturally travels throughout the body, that doesn’t mean that meaningful numbers of injected stem cells (or other cell therapies like PRP) will arrive into the lungs or bronchi. The huge volume of blood in the body dilutes any injected cells.

Unfortunately, IV injections of stem cells, despite their impracticality as a way to treat COPD, have been the most common offerings sold by the for-profit clinics out there. I fact-checked this is a recent YouTube video on our stem cell channel that you can watch above. Please subscribe to our channel.

This IV injection approach just doesn’t make common sense to help patients, but apparently it does make sense if you’re a clinic trying to make big profits.

stem cell therapy COPD trials
Stem cell therapy COPD trial listings map from Clincialtrials.gov. Note that some of the listings are not true clinical trials and some are from for-profit clinics.

Inhaled cell therapies?

A second delivery option is to have patients breathe in stem cells or other cellular preps.

While this might get more cells specifically into the respiratory system, it too faces challenges. Our airways are naturally coated in protective mucus and in COPD there can be even more than usual. Cells that are breathed in are almost all going to end up trapped in the mucus and just get coughed out or killed.

Nonetheless some clinics are now selling intranasal stem cell delivery for a variety of conditions including breathing problems. One of the risks of this approach is accidentally getting cells into the brain.

The inflammation associated with COPD could also mean that stem cells delivered to the right place might be more likely to die before having a chance to do anything helpful.

Still, there is legitimate research on trying to develop inhaled cell therapies for a variety of diseases.

What cells to use?

Another challenge for trying to treat COPD with cells is what kind of stem cells to use.

It might seem that respiratory stem cells could be best, but again how do you deliver them to the needed places?

What would those respiratory cells do if they got there? In emphysema it is possible that stem cells could help grow new healthy lung tissues to replace damaged ones.

What clinics sell most often is mesenchymal cells or MSCs for COPD and other respiratory diseases.  It’s hard to imagine MSCs helping the lungs or bronchi long term. Even if they could do something positive like reducing inflammation and do so in the right places, one would have to inject or breathe them in regularly. Up goes the cost and risks.

Cost of stem cell therapy for COPD $5,000-$10,000

If someone decides to roll the dice and go to an unproven stem cell clinic to get some kind of intervention for COPD, what will it cost? (Note that I’m not a physician and this post is not intended as medical advice; as a stem cell biologist I do urge caution on going to unproven clinics.)

The typical cost for one “treatment” is $5,000-$10,000. However, many of the people I’ve talked to over the years ended up getting far more than one of these supposed therapies. That, of course, can greatly multiply the cost.

Does insurance or Medicare cover stem cell therapy for COPD? I have never seen any indication that Medicare or even health insurance of any kind will cover this kind of unproven approach for respiratory disease.

Future perspectives

There’s a vast amount of research ongoing related to stem cells and other cells for COPD and other respiratory conditions.

Some of this has accelerated with the COVID pandemic.

So far there has been no “home run” clinical trial of cells for COVID or COPD.

Companies should not be selling stem cells for COPD today as it’s very premature given the state of the clinical data.

In a search I found 33 clinical trial listings for COPD and stem cells. Not all of them are real clinical trials and some are from for-profit stem cell clinics that I recognize. The Mayo Clinic is doing some interesting clinical trials in this space. While to my knowledge there is no stem cell treatment for COPD at Mayo Clinic, in 5-10 years that could change for the better.

Be cautious about people who claim they can already treat COPD with stem cells and ask for money. Note in the references section below the warnings from professional medical associations against going the stem cell route for COPD or other lung disease.

Ending on a more positive note, the good news is that there are solid trials ongoing and all that preclinical research. Let’s see how the data look as things proceed.

References

2 thoughts on “Stem cell therapy for COPD: challenges & hope”

  1. Dear Paul PhD,
    I thought that a process in the development of COPD was that the cells in the lungs were made up of scar tissue and fibrosis due to cell death, due to exposure to a toxic substance such as tobacco smoke, or other harmful inhaled material. Would the body need to remove the scar tissue and fibrosis to allow a stem cell treatment to be effective ?

    My father had multiple myeloma and I was told by a physician that he died because of the fibrosis that developed in his lungs due to the full body radiation he had as an applied therapy at the time of his initial diagnosis in 1963. He died 10 years later due to his lungs finally filled with fibrotic scar tissue and not due to the multiple myeloma.

    Do mesenchymal cells have the ability stimulate a repair function to dissolve fibrotic and/or scar tissue in the body ?

    Do MSCs stimulate the formation of new blood vessels such as to increase capillary blood vessels, or repair those areas scarred by chemotherapy and/or chronic GVHD ? or stimulate formation of new arteries and veins ?

    For instance, the body has approximately 30 trillion cells, if a person received 300 million MSCs by IV would these cells circulate in the body via the blood system, and continue to divide and grow ? I understand that the allogeneic MSCs do not evoke an immune response. Is this a correct viewpoint ?

    I have been told, and read about, that the infused allogenic MSCs circulate in the body, initially some stay in the lungs, some in the coronary system, some make it to the liver, and some make it to the capillaries. Then about a year later when they start to differentiate into various forms of blasts they are removed by the immune system. Is this summation correct ?

    Looking forward to your take on the questions offered in the above text.
    Sincerely, Neil

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