It’s been a long road, but the first ever IPS cell clinical study in humans is starting up again in a new incarnation. You might say it has been regenerated in a novel form.
Masayo Takahashi (高橋 政代) first started the pioneering IPS cell study a few years back in 2014, but it ended up getting put on holdin the summer of 2015 in the midst of changing regs in Japan and the discovery of some mutations in the IPS cell derivatives.
About a year after the hold was put in place, we got news that the study would be restarted in a new incarnation, and now more definitively the study is on track to start up again with 5 patients in Japan with the wet type of macular degeneration. You can read the RIKEN PR here.
The PR provides more info including a co-leader:
“The project will be led by Yasuo Kurimoto and Masayo Takahashi of Kobe City Medical Center General Hospital, and Osaka University’s Graduate School of Medicine/ Faculty of Medicine, and will be conducted in collaboration with the RIKEN Center for Developmental Biology (CDB) and Kyoto University’s Center for iPS Cell Research and Application (CiRA).”
This is great news.
Yasuo Kurimoto is the surgeon who did the initial surgery in the study before it stopped.
One of the most striking things about the new form of this IPSC study is that it will reportedly focus on allogeneic use of IPSC rather than autologous. The foundation for this switch is that allogeneic cells derived from the IPSC can be used in matched recipients and in a relatively genetically homogenous population such allogeneic cells can be used in a number of patients with a good possibility that there won’t be rejection of the transplant.
Embryonic stem cell-based therapies can be used in the same allogeneic way and those are being studied for macular degeneration as well. I still feel like in the long run that the most power and unique positive contribution from IPSC clinically speaking may come from autologous use, especially in diverse populations such as the U.S. Their use in disease modeling is quite impactful as well.
Has it really been 10 years since induced pluripotent stem cells (aka IPS cells or IPSC) came onto the scene in the stem cell field?
Yes, it was a decade ago that now Nobel Laureate Shinya Yamanaka (山中伸弥) published that seminal Cell paperon reprogramming to make mouse IPS cells and then human IPS cells came the next year.
From the moment I read that first mouse IPS cell paper, I was very excited about the science and the ideas in it. The domain name of this blog The Niche is named after those remarkable cells, www.ipscells.com.
In honor of the 10-year anniversary, below I outline the top 10 IPS cell related questions and key points as of today looking to the future.
IPSC and ESC as partners rather than competitors. Are IPS cells equivalent to hESC derived from leftover IVF embryos? Even if they are a bit different, does that matter? With both in the translational pipeline and available as the basis for research, we can achieve more as a field. Let’s see what develops. Will nuclear transfer ES cells (NT-ESC) ever fulfill the aspirational name of their production,” therapeutic cloning”? Or will they mainly be a cool, but somewhat esoteric tool for advancing knowledge and one used by only a few groups in the world? I hope there can be clinical impact from NT-ESC, but I’m very doubtful that it will become a reality any time soon.
IPS cell trials. How will clinical translation of IPS cell-based products proceed in the next 10 years and sooner? How soon will the Takahashi study get back up to speed in its new form? Will other trials get going relatively soon (i.e. in the coming 3-5 years)?
Diseases in a dish. Disease modeling using IPS cells continues to grow in importance. Will it continue to give the cell therapy side of IPS cells a challenge in terms of total positive translational impact from IPS cells? So far I would say disease modeling has had more impact, but that could change.
Auto and allo. Autologous versus allogeneic IPS cell approaches are both generating buzz. As to the latter, what about those IPS cell banks in various places?
Mutations matter but here’s the key context. Do IPS cell mutations matter? Of course they could, but most likely in the same way that ES cell mutations do. It’s more a question of genomic stability in general. What about mitochondrial mutations in IPS cells? The key thing here overall with genome issues is careful preparation and handling of cells and validating them rigorously. That doesn’t always happen.
IPS cell sex. What about female IPS cells? Can we somehow “put an X” through the problems that sometimes appear associated with loss of X inactivation in female IPS cells? What about issues with imprinted genes? We don’t hear much about these things lately. As with the previous point, the bigger issue is validation of anything stem cell-wise that you’re studying, particularly if you have clinical intent down the road. Epigenomic validation more generally is very important for IPS cells.
Patent big tent? Putting the IP in IPS cells or taking it out? Will there be any patent disputes of major significance moving forward or clinical research that is impeded by expensive licensing fees…or not so much?
Directed direction. Is direct reprogramming going to heat up more so that it becomes a major alternative to IPS cells in certain cases? I hope so. The more cell types and methods we have, the better as long as they are supported by rigorous data.
A vision for vision and beyond. Will the eyes continue to have it? Will IPS cell therapy development go beyond vision-related conditions soon? I’m sure it will, but eye conditions are dominant now as a focus for products made from IPS cells and ES cells. I can’t wait to see more trials for other conditions.
Differentiation destination. In nearly all cases IPS cells will themselves not be used for therapies. Instead, differentiated cells made from IPS cells will be the actual therapeutic product. As with ES cells, a challenge with IPS cells is consistently making pure differentiated cells of the desired type. For instance, if you make 98% of say a neuronal cell type that you want and 2% of some undefined mesoderm or endoderm cells, that’s going to be a hurdle to overcome. The goal of cellular purity and specificity achievable with human pluripotent stem cell differentiation, but it can also be a real challenge.
Overall, I predict the IPS cell field will continue to mature and have even more impact in the next decade. A growing fraction of that impact will hopefully be coming from cell therapy-based clinical trials. There are likely going to be bumps in the road and even setbacks in the coming decade, but overall I’m very optimistic about IPS cells.
Something very unusual and positive just happened at this year’s ISSCR meeting.
Every year in December I give out an award for the Stem Cell Person of the Year to the individual with the strongest positive impact in the stem cell field generated specifically from outside-the-box thinking and actions.
Dr. Jeanne Loring was the recipient in 2015. The award comes with a $2,000 prize that I pay myself. Jeanne declined it, but that money is now going to support an innovative Parkinson’s patient research group called Summit for Stem Cell.
Jeanne and her lab work with Parkinson’s Disease patient advocates together as the overall Summit for Stem Cell team toward the goal of IPS cell-based therapies for Parkinson’s. This is a very exciting area of research. Part of the reason Jeanne got the Stem Cell Person of the Year Award is her unique combination of great translational science and a bigger picture sense of how to make stem cell therapies become a reality.
Putting our heads together regarding the $2,000 prize from last year, Jeanne and I decided along with Summit for Stem Cell leader Jenifer Raub that the money would go to that group to support their outstanding efforts.
The three of us just met up a few hours ago at ISSCR 2016 for me to give a $2,000 check to Jenifer (see picture above with me, Jeanne, and Jenifer from left to right).
Some good newstoday as the pioneering induced pluripotent stem (IPS) cell trial led by Dr. Masayo Takahashi will resume.
This clinical study with a focus on macular degeneration has been on holdfor quite some time due to regulatory changes in Japan. There had also been concerns over mutations in the 2nd patient’s IPS cell product.
As previous signs had indicated, the new clinical work will have an allogeneic focus, most likely drawing IPS cells from a bank.
According to a Japan Times article:
For the second trial, the CDB will develop retinal tissues from iPS cells supplied by Kyoto University’s Center for iPS Cell Research and Application, headed by Nobel laureate Shinya Yamanaka, the creator of the pluripotent cells.
Transplants of CDB-developed retinal tissues will be conducted at Kobe City Medical Center General Hospital and Osaka University Hospital.
This is exciting and I’m very curious to see how this clinical work develops.
In a major shift earlier this year, the induced pluripotent stem (IPS) cell trial in Japan for treatment of macular degeneration (MD) switched gears from using the patients’ own cells (called “autologous”) to using banked cells from other people, termed “allogeneic”.
Dr. Masayo Takahashi, the leader of this MD trial indicated the main reason was due to regulatory changes related to stem cells in Japan. This decision has delayed the clinical study, but there is hope it will restart soon. It appears for some as yet unknown reason the Japanese government has decided to only allow the use of allogeneic, matched IPS cells from cryobanks.
Now a second clinical study in the works in Japan also using IPS cells but as the basis for treatment of Parkinson’s Disease (PD) appears to be following suit. The PD trial, run by Dr. Jun Takahashi (pictured above; spouse of Masayo Takahashi, making them the world’s stem cell power couple), reportedly will also switch to focus on allogeneic cells.
The advantages of allogeneic cells include the fact that they can be validated and batch prepared in advance. In theory in this allogeneic system there might be no waiting period for patients while their own cells are turned into IPS cells. However, finding matches from a bank of IPS cells may prove somewhat difficult for allogeneic use for some patients. Even with major HLA type matching, minor mismatches could lead to some level of rejection. This could necessitate the use of immunosuppression. By contrast, autologous use of IPS cell-based products would likely require no immunosuppression after transplantation.
Together these changes in IPS cell clinical plans suggest a significant, broader shift in the field potentially toward allogeneic use of IPS cells. It’s not clear if other groups with IPS cell-based therapies in the translational pipeline, including in other countries, will follow suit or stick with the originally hoped for autologous focus.