√ 10 For 10 On Stem Cell Day: Top 10 Issues For Coming 10 Years

It’s stem cell day!

Or more accurately, it is stem cell awareness day. It’s a good time to think about where our field stands and where we’ll be in 10 years. Below, I’ve outlined 10 for 10: 10 things to ponder about stem cells in a 10-year timeframe.

• Approved Therapies. How many new stem cell therapies will be approved as safe and effective in 10 years? I hope at least 10! These may include proven transformative regenerative medicine treatments for macular degeneration, Type 1 diabetes, paralysis, arthritis and other orthopedic conditions.Will there be a stem cell-based treatment for cancer such as stem cells that home in on tumors and directly deliver chemo in a proven effective, safe manner? As a stem cell and cancer researcher and cancer survivor, I’m very curious to see where we’ll be in 10 years.


• Biotechs. How many successful stem cell biotechs will be flourishing in 2027?


• Keeping the stem cell research fun in funders. Will CIRM and other state agencies still be actively funding stem cell research and biotechs in 2027? I hope so! How much will NIH be funding stem cell research? Private foundations?


• Trials & training. How many more promising stem cell clinical trials will be ongoing then versus now? Even if there are fewer, will a higher percentage be promising and get to later stages? Will there be medical residency and/or fellowship programs in stem cells and regenerative medicine as I proposed a few years back? We urgently need more physicians properly trained in stem cells and regenerative medicine, at least in part to be involved in all those trials and to administer the approved treatments.


• IPS cells. What will we all be thinking about IPS cells around their 20th anniversary? How many of the trials and approved new stem cell therapies mentioned above will be specifically IPS cell-based?


• CRISPR. How much will genetics come into play with regenerative medicine with CRISPR joining up with stem cell technologies to define approved new combination gene-cell therapies? Will CRISPR be used in the human germline therapeutically in 2027?


• Organoids. How much will organoids have changed the field within 10 years? On stem cell day 2027, will we be talking about organoids?


• FDA. How will the FDA conduct oversight of the stem cell and regenerative medicine field in 2027? Will it be a more effective agency, both promoting promising investigational work to help patients sooner and protecting patients from sketchy stuff? That regulatory sweet spot is a challenge.


• Non-compliant clinics. How many ‘stem cell clinics’ will there be in the US in 10 years and will that now difficult, risky side of the stem cell universe still be seen as a major problem? What about more globally?


• What will be the big stem cell debate of 2027? There surely will be something being debated in our field! Something to do with genetics and/or germ cells? Maybe the anti-aging stuff (young blood, etc.)?

What do you think will be on our minds about stem cells and regenerative medicine in 10 years when we celebrate stem cell day in 2027?

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√ Stem-Ish Cells: What’S The Real Thing?

Ain’t nothing like the real thing…right?

No, by the ‘real thing’ I’m not talking about Coke versus Pepsi or Coke versus Diet Coke, but rather stem cells. (On a side note there’s still some people who apparently believe the stem cell myth that there are stem cells in Pepsi).

I get a regular stream of emails from patients and sometimes phone calls asking questions about stem cells and especially stem cell treatments, but at times I’m not sure the treatment in question really involves stem cells. There are also thousands of papers published on “stem cells.”

Maybe those doing research on the cells in question or selling the cells at a clinic or writing about the cells as a journalist all think that the cells are stem cells, but how do we know? Even things that are mostly really stem cells have some progenitor or differentiated cells in the mix too that spontaneously pop up.

Many things are called “stem cells” when they aren’t the real thing or when they are a mixture of cell types of which only one is really a stem cell. For example, there has been a whole debate about MSCs or mesenchymal stem cells. Some have proposed changing the meaning of the MSC acronym to no longer include “stem” because MSCs as typically purified and used may only contain a minority population of actual stem cells unless they are carefully sorted. As a result, other names such as “mesenchymal stromal cells” and even “medicinal signaling cells” have been used or proposed to replace the standard meaning of the MSC acronym. One other issue with the MSC name is that it is an umbrella term that is often applied to very different preparations of cells.

This “not the real thing” reality of some MSCs not being pure stem cells isn’t necessarily a bad thing depending on context and how they are portrayed, but it does make life complicated. Each type of MSCs should be thought about for what they actually are in terms of research and then in addition in marketing by for-profits. It’s important for patients to know that generally the clinics selling MSCs are not using pure populations of actual stem cells with wide potency to address health issues throughout the body related to diverse tissues generally unrelated to MSCs.

The bottom line is that “MSCs” are often not going to be pure stem cells. I’d say they are generally stem-ish cells with the important exception that some researchers do purify stem cells that are referred to as MSCs.

A product called platelet rich plasma (PRP) is often portrayed as being the basis of stem cell therapies too. While PRP is frequently combined with MSCs and so the combined product might have some actual stem cells in it, PRP is largely an acellular fluid product with molecules from platelets that might have some useful properties. For this reason, I’d say that PRP is not even stem-ish even though it is sometimes even alone called a stem cell therapy.

Then there is the whole “birth-related” stem cell arena that is very tricky. There are an increasing number of clinic firms injecting stuff that is marketed as “stem cells” into customers, when in fact there not only aren’t stem cells in it but also there are no living cells at all. It’s just an extract from placenta or amniotic membrane.

As I discussed before, the irony here is that many clinics know that their product isn’t living stem cells, but they market it that manner anyway to attract customers even though if regulators were to come knocking the firms would probably often point to the fact that they aren’t really using living stem cells since that changes how regulators handle biologic products (see, “Wanted both dead & alive: amniotic stem cell clinics sell zombie cells?“). I’m still not even sure that living amnion has many stem cells to start with in utero.

Finally, there’s the special case of fat-derived stromal vascular fraction or SVF, which is generally portrayed as “stem cells”. Actually SVF is often kind of a mystery product that I’d guess has a dozen or more cell types in it, only maybe one or two of which are stem cells. For instance, many of the MSCs in SVF may not be stem cells. I suppose SVF is stem-ish and it is probably a useful product for some narrow applications, but not some stem cell-centric panacea.

So when we read, hear, write, or say, “stem cells”, we should think about what is being referred to and perhaps ask yourself, “is that the real thing or just stem-ish cells?”

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