Wound Healing

Diseases and injuries to the skin can take many different forms, some as a primary illness, such as a burn, cut or genetic skin disorders, and others that are a side effect or secondary symptom of a different disease, such as diabetic ulcers. Wound management has greatly advanced over the years but treatments still fall short of healing about half of all chronic wounds. 

Currently, skin grafts grown from epidermal stem cells can be used to treat severe burns and other similar types of sores. But although this has saved lives, these grafts are expensive and come with additional challenges: first, the graft does not replace all of the layers and functions of the skin (for example, hair follicles and sweat glands), and second, if the replacement skin comes from a donor there is risk of rejection by the patient. Research is underway, some with early stage clinical trials, aimed at overcoming these challenges and in making skin grafts and wound healing more effective and less expensive in the future.

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Most strokes are caused by a blood clot in the brain that interrupts the flow of blood and delivery of oxygen to brain tissue, causing minor to severe damage, even death. A smaller percentage of strokes are caused by a rupture that causes bleeding in the brain. Regardless of the type of stroke, immediate medical attention is required to stem the tide of damage to the brain.  There are many factors that can lead to a stroke, including high blood pressure, irregular heartbeat, diabetes and smoking, many of which can be managed through lifestyle choices. Current treatments for stroke aim to restore the flow of blood to the brain, such as clot-busting enzymes, surgery and drugs for thinning blood, stopping clots and protecting neurons.

Currently there are no Health Canada or FDA approved stem cell treatments available for stroke. Since an incident of stroke cannot be predicted, the kind of research involving stem cells to treat stroke centres around repair after a stroke has occurred. There are two main approaches: the first is to stimulate stem cells already in the body to repair damaged tissue and the second is to transplant specific stem cells directly to the site of injury in hopes that they will help stimulate repair. In both cases, more research to identify the best kind of stem cells to use, how and when to deliver them is necessary.

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Spinal Cord Injury

Spinal cord injuries can range in severity, from partial damage to full paralysis, depending on the extent of damage to the spinal cord. But, no matter how severe the initial injury, spinal injuries all have one thing in common – the body cannot replace the cells after injury. It is generally understood that the earlier a spinal cord injury can be treated, the greater the chance of minimizing the damage, since some of the cells may not be affected immediately and may take days or weeks before the full damage is realized. For this reason, researchers believe that the sooner a treatment can be initiated, the better the odds of success.

Currently there are no Health Canada or FDA approved stem cell treatments available for spinal cord injury, however, given the capacity of stem cells to regenerate tissue, researchers believe that stem cells could be introduced to the site of injury and coaxed into helping repair some of the damaged nerves and surrounding tissue. They are working to find the best kind of stem cell to do the job and the best way to either inject them or get them to migrate to the site of injury. Some clinical trials have begun to test these methods but approved treatments are still many years away.

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Parkinson’s Disease

Parkinson’s is a disease that affects the brain cells that produce dopamine. Dopamine helps send messages to the part of the brain that controls movement, and people with Parkinson’s will experience tremors, imbalance, loss of facial and other muscle control, as well as a number of other symptoms. Even though the cause of the disease is not known, because the disease affects one single type of cell – the dopamine producing neuron – it is a good candidate for stem cell therapy.

Currently there are no Health Canada or FDA approved stem cell treatments available for Parkinson’s disease, but researchers are working with transplanted stem cells as a way to reboot the affected neurons, with some success. More work needs to be done to identify the best type of stem cell to use, the best way to grow the cells into neurons and the best way to transplant them into patients before such treatments can become routinely available.

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Muscular Dystrophy

Muscular dystrophy is a group of inherited neuromuscular diseases that attacks the muscles and heart. The most common form of the disease is Duchenne’s Muscular Dystrophy (DMD), which primarily affects boys and is caused by a mutation in the dystrophin gene. This mutation prevents the body from producing dystrophin protein, which functions as a stabilizer for the muscles and keeps them intact during regular wear and tear. Without dystrophin, muscle cells cannot regenerate properly and they become progressively more inflamed and waste away over time. Few patients with DMD survive into their twenties or thirties. There are no therapies to treat the disease and most treatments are aimed at controlling symptoms.

Currently there are no Health Canada or FDA approved stem cell treatments available for muscular dystrophy. Researchers have found a type of stem cell in muscle that helps build and maintain the tissue, however, the intensity of the disease causes these stem cells to tire out and eventually lose their ability to replace and repair cells. The two main approaches currently being studied involved the use of stem cells to regenerate the damaged muscle or as vehicles to deliver gene therapies that replace or repair the defective gene.

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Multiple Sclerosis

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. MS is considered an autoimmune disease, as it is the patient’s own immune system that creates inflammation in the brain or spinal cord, which breaks down the protective covering (myelin) around the nerves. MS is unpredictable: It can evolve rapidly or slowly with attacks that are infrequent or steadily increasing, but eventually, the regenerative capacity of the cells that contain myelin ceases, leading to loss of motor skills and/or brain function, and eventually to permanent disability and death. MS is generally treated with drugs that slow the progression of the disease or reduce symptoms, but there is no cure.

Currently there are no Health Canada or FDA approved stem cell treatments available for multiple sclerosis, although there are several areas of active investigation, which include early stage clinical trials. Researchers are looking at hematopoietic (blood) stem cell transplants as one possible way to reset the immune system, and although this is a very aggressive therapy, it has shown some promising results. Other areas of active research include the use of stem cells to repair or even replace the damaged parts of the nervous system. The best approach may depend on the version of the disease affecting each patient.

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Liver Failure

The liver is the largest organ in the body, responsible for filtering toxins from the blood, aiding digestion and helping to fight infection. It is also the only organ that can regenerate itself after damage, and it can withstand a lot. However, when liver damage occurs, the normal repair function is affected and scar tissue develops. Liver failure occurs when the damage becomes so severe that the liver can no longer function. This can be the result of an acute health condition that develops in a matter of days or a chronic condition that evolves slowly over time. The causes can include alcohol, viruses, obesity, genetics, autoimmune diseases, drugs, toxins and cancer. Currently, the only treatment for liver failure is a liver transplant.

Currently there are no Health Canada or FDA approved stem cell treatments available for liver failure, but researchers believe that stem cells may be useful in helping to overcome liver damage.  While hepatic (liver) stem cells have been found in mice and successfully grown in the lab, this is not the case with their human counterparts.  Further challenges are that not enough is known about how the cells in the liver function, what other kinds of stem cells might be used to help reverse the damage, how to effectively scale up the cells for transplant, and even the method of transplantation. It may take decades before these challenges are solved and stem cell therapies become a possible option to treat liver disease.

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Heart Failure

Heart failure occurs when damage to the heart tissue prevents it from filling or pumping blood normally. Even though heart tissue is the first to grow in a developing human, current research suggests that heart stem cells can only be replaced at a very slow rate and our ability to make new heart cells declines as we age. This means that when a heart is damaged, it has little chance for self-repair before the damage becomes permanent.

Currently there are no Health Canada or FDA approved stem cell treatments available for heart failure. Researchers are looking at various ways to help repair heart tissue, either by coaxing our existing stem cells to become more efficient, or by introducing additional stem cells to help them out. Some early clinical trials have begun to test these processes, but it may yet be many years before such therapies are readily available to patients.

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Graft-versus-host Disease (GVHD)

Graft-versus-host disease (GVHD) arises from an immune response in patients who have received donated tissues (i.e. a graft or blood stem cell transplant) that is not identical to their own. In such cases, the patient’s body undergoes a natural response, which is to defend against the intruding tissue by attacking it. GVHD can develop very quickly or slowly and in either case, the symptoms can be numerous and severe. The best way to prevent GVHD is to match the transplanted cells or tissues as closely as possible to the host patient.

Health Canada has given conditional approval for the use of Prochymal, a mesenchymal stem cell product for the treatment of steroid-resistant and/or immunosuppressant-resistant acute GVHD in pediatric patients. Final approval is conditional on the results of clinical studies currently underway. In the meantime, researchers are looking at umbilical cord stem cells (a source of blood and mesenchymal stem cells) as a promising transplant option and are continuing to study both the still-unknown properties of mesenchymal stem cells as well as methods to improve the yield of stem cells in cord blood units to ensure sufficient numbers of cells are available for transplant.

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Eye Injury and Disease

The eye is a complex organ and damage or disease to any of its parts – including the cornea, retina and optic nerve – can cause vision loss. Some eye diseases can be traced to a genetic defect (i.e., Stargardt’s disease and retinitis pigmentosa) while others may arise from complications related to aging (i.e., cataracts and glaucoma) or illnesses such as diabetes. For some conditions, such as cataracts, surgery is available to improve vision, but many eye diseases and injuries have few, if any, treatment options.

Currently there are no Health Canada or FDA approved stem cell treatments available for eye disease or injury, although the European Commission recently gave conditional approval for Holoclar, a stem-cell graft tissue used to treat patients with burns or abrasive injuries to the eye. Other research and early stage clinical trials is looking at the use of stem cells to treat conditions such as age-related macular degeneration.

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