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Professionals’ Frequently Asked Questions (FAQs) on Stem Cells

Answers prepared by Mary Pat Moyer, Ph.D., Chief Science Officer, Incell Corporation, LLC

Scientific Perspective Questions

  1. What is special about stem cells compared to other cells in the body (the somatic cells)?
  2. Considering the three sources of stem cells, embryo, fetal, and adult, are they limited as to the kinds of stem cells they can become? Is the ability to differentiate equal among the sources?
  3. Can scientists designate what kind of stem cells they want developed from these three sources? Is that a cell line?
  4. Sources for adult stem cells from somatic tissues: bone marrow, blood, skin, fat, muscle, liver, brain, cornea, retina, pancreas, and lining of gastrointestinal tract. Are these multi- or pluripotent?
  5. How are stem cells harvested from each of the stem cell sources?
  6. Stem cells from umbilical cord blood - can these stem cells only be used for children? Would they be rejected by adults?
  7. Is it necessary to continue stem cell cloning now that stem cells from bone marrow seem to be pluripotent?

Medical Perspective Questions

  1. Why can't the body repair itself the same way it naturally does for skin, bones and muscles?
  2. What are some of the successful uses of autologous transplantation of adult bone marrow and other types of stem cells?
  3. Is there other evidence of success using stem cell therapy for congestive heart failure or other diseases (Parkinson's) or injuries (spinal cord)?
  4. Considering the common sources of stem cells, are the risks of rejection the same from each source?
  5. Would a universal donor or stored stem cell source offer more chance of being ready for any patient and thus improve outcomes or recovery?
  6. Is the potential for tumors from unregulated growth of embryonic stem cells worth the risk?
  7. Is there a potential for tumors using adult stem cells or umbilical cord blood?

Professionals’ Frequently Asked Questions (FAQs) on Stem Cells

Scientific Perspective Questions

  1. What is special about stem cells compared to other cells in the body (the somatic cells)?

Somatic cells have become specialized for the jobs they have to perform to keep the "body machine" working properly. Stem cells have the ability to become a variety of cell types in a lineage with embryonic stem cells being able to become all cell types. New methods have led to re-programming of cells to be “stem-like” in their behavior, biomarkers, and their ability to become other cell types.

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  1. Considering the three sources of stem cells, embryo, fetal, and adult, are they limited as to the kinds of stem cells they can become? Is the ability to differentiate equal among the sources?

This is not really known, but the reprogramming of adult stem cells or somatic cells to be more "stem cell like" suggest that pluripotency can be reinstated in many if not all cells, but much more scientific work is needed. There are differences in adult and embryonic donors, and variability among donor sources. Only embryonic stem cells are known to produce every cell type (omnipotent), but manipulations of other cell sources to convey cell growth and differentiation signals for may cell types seem to allow multi-potent lineages of cells to develop. Outcomes are highly variable and all the factors to maintain proper controls are poorly or only partially defined. What also is still not clear are the cell-associated markers that define what is an omnipotent, pluripotent, multipotent or progenitor cell from the various organ sites and what is universally or specifically applicable, if anything, to regulatory growth controls of specific cell types, tissues, or organ sites.

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  1. Can scientists designate what kind of stem cells they want developed from these three sources? Is that a cell line?

Cells outside of the body and from many tissues or organ sites can be grown in culture and expanded to larger cell numbers. This is not true of all cell types. However, the ability to grow cells indefinitely in a continuous way is the usual definition of cell line. To complicate this further, however, some folks refer to any cultures that can be expanded for a few population doublings as a cell line. In the cell culture field those types of cultures have most commonly been called cell "strains". However, this can be a blurry area with regard to specific definitions. What also is still not clear are the cell-associated markers that define what is an omnipotent, pluripotent, multipotent or progenitor cell from the various organ sites and what is universally or specifically applicable, if anything, to regulatory growth controls of specific cell types, tissues, or organ sites.

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  1. Sources for adult stem cells from somatic tissues: bone marrow, blood, skin, fat, muscle, liver, brain, cornea, retina, pancreas, and lining of gastrointestinal tract. Are these multi- or pluripotent?

It depends on who is giving the definition. Multipotent usually refers to multiple cell lineages within a specific organ site (e.g., bone marrow and blood) from what may be referred to as a progenitor cell, whereas pluripotent usually means that "unrelated" cells like nerve cells and blood cells can come from the same stem cell. As we learn more about cell growth, differntiation, manipulation, etc. these definitions can become blurred. What also is still not clear are the cell-associated markers that define what is an omnipotent, pluripotent, multipotent or progenitor cell from the various organ sites and what is universally or specifically applicable, if anything, to regulatory growth controls of specific cell types, tissues, or organ sites.

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  1. How are stem cells harvested from each of the stem cell sources?

Stem cells and progenitor cells specific to a tissue are in very small numbers in all organ sites where there presence has been defined. Stem cells from blood are usually enriched by "calling up" cells from the bone marrow using specific growth factors. The patient is pre-treated, several days later blood is collected and the cells are separated from the blood plasma, then further purified using a variety of separation and purification methods. Cells from solid organ sites such as fat, skin, and bone marrow often need to be treated with enzymes or other agents that separate the cells from other cells and/or the cell matrix which holds them in place in the tissue. Although this is significant manipulation many of the techniques have been developed and improved over many years. What is becoming more clear are the cell-associated biomarkers that define what is an omnipotent, pluripotent, multipotent or progenitor cell from the various organ sites and what is universally or specifically applicable, if anything, to regulatory growth controls of specific cell types, tissues, or organ sites.

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  1. Stem cells from umbilical cord blood - can these stem cells only be used for children? Would they be rejected by adults?

Stem cells and progenitor cells specific to a tissue are in very small numbers in all organ sites where there presence has been defined. Stem cells from blood are usually enriched by "calling up" cells from the bone marrow using specific growth factors. The patient is pre-treated, several days later blood is collected and the cells are separated from the blood plasma, then further purified using a variety of separation and purification methods. Cells from solid organ sites such as fat, skin, and bone marrow often need to be treated with enzymes or other agents that separate the cells from other cells and/or the cell matrix which holds them in place in the tissue. Although this is significant manipulation many of the techniques have been developed and improved over many years. What is becoming more clear are the cell-associated biomarkers that define what is an omnipotent, pluripotent, multipotent or progenitor cell from the various organ sites and what is universally or specifically applicable, if anything, to regulatory growth controls of specific cell types, tissues, or organ sites.

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  1. Is it necessary to continue stem cell cloning now that stem cells from bone marrow seem to be pluripotent?

Our scientific knowledge is still very limited on all the ways that cells are regulated for growth and differentiation alone and with regard to all the details distinguishing use for cells of autologous (self) or allogeneic (other human) donors. There are no master banks of universal donor cells for all recipient patients who might need help. Clinical studies have not been done to show that all types of "replacement parts" can come from autologous marrow (unlikely in cases of certain diseases such as cancer and old age). Thus, we must continue the scientific work to get the answers and move forward. In my opinion, anything less is irresponsible, scientifically and medically unsound, unconscionable and unethical.

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Scientific Perspective Questions

  1. Why can't the body repair itself the same way it naturally does for skin, bones and muscles?

We only have partial knowledge of how all these things work at the molecular, cell, tissue, organ and organism levels. Much more scientific work is needed. To understand all the regulatory pathways for various lineages of cell growth, differentiation, etc. we need to know the environmental and other conditions, as well as the cell-associated markers or receptors that characterize or control pluripotent, multipotent or progenitor cells from the various organ sites and what is universally applicable, if anything, and what is specific.

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  1. What are some of the successful uses of autologous transplantation of adult bone marrow and other types of stem cells?

Bone marrow cells and mesenchymal stem cells have been used therapeutically to renew marrow and blood cells in patients who have cancer, and/or have been irradiated, and need a transplant to replace tumor cells and/or to be activated to fight the tumor cells during replacement, or who are transplanted after high dose chemotherapy or radiation therapy. The cells are also used to repair some bone or cartilage lesions during surgery, and have recently been used to repair heart muscle defects.

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  1. Is there other evidence of success using stem cell therapy for congestive heart failure or other diseases (Parkinson's) or injuries (spinal cord)?

There have been reports of various types of cells being successfully used for treating heart failure, Parkinson's and other injuries (e.g., spinal cord) in animal models and human patients. Results have been variable and complex, and often are apples and oranges compared to each other. However, specific protocols that would be reproducibly used clinically have yet to be agreed upon because more research work is needed in both pre-clinical and clinical studies.

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  1. Considering the common sources of stem cells, are the risks of rejection the same from each source?

Autologous stem or progenitor cells stored earlier by the recipient or obtained during a surgical procedure from the recipient have the least risk of rejection, provided they do not become contaminated during processing or handling so that the body recognizes them as foreign, rather than part of itself. If the cells can be re-programmed to be the "appropriate" cell type they have the highest probability for success.

Stem cells of fetal, embryonic, or cord blood origin express lower amounts of antigens that might cause transplant rejection and therefore may be more suitable and require fewer immune suppression drugs in the patients who receive them compared to unrelated (allogeneic) cells or tissues (from other, unrelated people) or from animal (xenogeneic) cell or tissue donors.

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  1. Would a universal donor or stored stem cell source offer more chance of being ready for any patient and thus improve outcomes or recovery?

Much more scientific work and well-designed comparative studies are needed to answer this question.

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  1. Is the potential for tumors from unregulated growth of embryonic stem cells worth the risk?

Much more scientific work and well-designed comparative studies are needed to answer this question because we still do not know everything about regulated and unregulated growth control. All therapies have risk-benefit ratios, and many suffering people might have longer lives and higher quality of life with treatment. If we understood all the regulatory mechanisms that define cell growth and regulation and could harness them for optimal use, then the potential benefits are staggering.

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  1. Is there a potential for tumors using adult stem cells or umbilical cord blood?

Yes, there is a potential that any donor cell source might contain tumor cells or cells with unregulated growth. Furthermore, it is known that as cell populations get older they are more prone to have mutated cells in the group. Much more scientific work and well-designed comparative studies are needed to answer this question. All therapies have risk-benefit ratios, and many suffering people might have longer lives and higher quality of life with treatment. If we understood all the regulatory mechanisms that define cell growth and regulation and could harness them for optimal use, then the potential benefits are staggering.

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