Think of skin growing back after an injury, lost blood being replaced and so on. Plus, adult stem cells seem to be more flexible than we originally understood them to be. Up until recently it was thought that adult stem cells could only reproduce the tissue specific to the organ they came from. However, recent studies have shown that adult stem cells can differentiate into different tissue types. For example: Neural stem cells have been induced to create blood and skeletal muscle and bone marrow cells can create muscle and liver cells.

So, actually there is a bright light in the stem cell arena these days, i.e., using adult stem cells not just for research but as a therapy to treat a variety of diseases that up until now, did not have many treatment options.

Sounds great …the problem is, much of adult stem cell therapy is not approved for use in the United States, Canada or the UK, so the treatments take place in other countries. The question becomes, do you risk getting unapproved therapies in an international setting or remain committed to proven therapies. Quite a dilemma!

1. Embryonic stem cells can contribute an endless supply of new cells; adult stem cells cannot.
2. Absent the controversy, embryonic stem cells are easily available in great quantity from fertility clinics. Adult stem cells, on the other hand, are much more limited in supply and more difficult to harvest.
3. Embryonic stem cells provide a pure, controlled line of new cells, an important characteristic for doing research. Adult stem cells are much more differentiated, making controlled experimentation more difficult.

1. In order for an embryonic stem cell to product a differentiated cell, a suitable environment must be engineered. Adult stem cells are already specialized so inducing growth is not as difficult.
2. Adult stem cells can be harvested then returned to the same individual, reducing the potential for rejection. Embryonic stem cells could be rejected.

• A major study has shown that treating heart muscle that has been damaged by a heart attack with stem cells can repair the injured heart tissue.  Patients who were studied showed a measurable improvement in heart and lung function. 1

• UCLA researchers reported the first successful adult neural stem cell transplantation to reverse the effects of Parkinson's disease and demonstrate the long term safety and therapeutic effects of this approach in spring 2009.2

•  Research has shown a variety of promising approaches to the treatment of Alzheimer’s with adult stem cells. Adult stem cell therapy may offer a safe and effective treatment for a disease which was previously considered to be irreversible.3

• In a breakthrough trial, 15 young patients with newly diagnosed type 1 diabetes were given drugs to suppress their immune systems followed by transfusions of stem cells drawn from their own blood. The results published in the Journal of the American Medical Association (JAMA) show that insulin-dependent diabetics can be freed from reliance on needles by an injection of their own stem cells. The therapy could signal a revolution in the treatment of the condition.4

• Twenty-three patients regained their eyesight following limbal (adult) stem cell transplants. This treatment has helped many suffering from blindness for years, including victims of Iraqi mustard gas attacks.5

• Ninety percent of 19 patients with various autoimmune disorders, such as systemic lupus, are in remission or have improved after treatment with their own blood stem cells.6

• Overshadowing by the embryonic stem cell debate;
• The field is very new and there has not been enough time to do the research;
• Limited funding, although adult stem cell research has received more funding than embryonic stem cell research and there are now plenty of private companies working on the problem.

At the beginning of 2009, Geron Inc. was the first biotechnology company to get approval from the regulators to commence Phase I studies, which meant it could start injecting living cells, as cell therapy, into the damaged spines of people suffering total paralysis from the chest down.   However, their timeline to market is about ten years. Osiris Therapeutics’ biologic drug candidate, Prochymal is in Phase III clinical trials for three indications, including acute and steroid refractory Graft versus Host Disease (GvHD), Crohn’s disease and for the repair of gastrointestinal injury resulting from radiation exposure, and is the only stem cell therapeutic granted both Orphan Drug and Fast Track status by the FDA.7

• Panama City
• Cologne, Germany
• Dominican Republic
• Bangkok, Thailand
• Lemana, Switzerland

• There are some amazing results being reported. If international treatment is your best chance for a longer life or better quality of life, it makes sense to do it.

• Many international facilities are affiliated with or owned primarily by physicians trained in the U.S., who are of the opinion that they can offer more options for their patients by offering stem cell therapy in a clinical setting that meets similar U.S. quality standards but takes place in an international medical facility.

• Many mistakenly believe that the only quality care is available in the United States/Canada. But, that’s simply not the case. Many countries, both industrialized and emerging, have excellent medical facilities and stellar reputations for quality and innovation.

• Physician advocates for stem cell therapy say that using stem cells is not very different from ordering a special formulation from a compounding pharmacy or prescribing a drug for an off-label use; it’s the way the practice of medicine evolves over time.

• Clinical trials are difficult to qualify for and you could be in the control group, which can mean that you don’t receive the real treatment.  However, if you are in a no-treat control group, you are often offered the opportunity for treatment after the study is completed.

Cons:

• People need to remember that when an international clinic touts its success stories, they are just that, stories. There may be three or four failures or disasters for every success. There’s no way to know that because there are usually no rules for how the clinic provides information.

• Although there are certainly many very fine institutions internationally, it’s hard to know if the stem cell therapy clinic that pops up to cater to medical tourism falls into the “very fine” category or not.

• You may be paying exorbitant fees for procedures that have no record of performance, or at least no record that has been reviewed by physicians who are capable of making determinations about treatment value.

• You may be paying for less value than you are expect, depending on the clinic’s methods of obtaining/managing cells and their method of introducing cells into the body.  

• Unlike Canada, the UK or the U.S.,  there are usually no ongoing clinical trials.

• International stem cell therapy can be enormously expensive. If your situation is dire or you have access to funds, the cost may be a lesser concern to you. However,  if you are managing with conventional treatments, it may make much more sense to save your time and money.

Success is never guaranteed. But once you have made the decision to seek international treatment you can increase your chances of success by  following these simple guidelines.

1. Stem cells are collected from the body (from bone marrow, for example, then centrifuged to concentrate the cells. This method produces a mixture of cells, both stem and non-stem.
2. Stem cells are isolated from the specimen and treated with growth factors to stimulate their activity.
3. Stem cells are both cultured in the lab to expand yield and treated with growth factors as in #2. This method is the gold standard for stem cell therapy. If your facility is using methods one or two, you will receive less benefit.

1. By intravenous line or injection under the skin. These methods are simple and inexpensive but least effective. IV administration causes many cells to be lost in the lungs. Under skin injection does not have therapeutic value for distant sites such as heart, lungs, etc.
2. By direct injection to the organ or site. This is another relatively inexpensive technique and results in cells being in closer proximity to the area of need, but it is still imprecise.
3. Injection under imaging. This is the most challenging technique but has the best results. The injection of cells is guided by imaging, so the physician can locate the cells precisely where they need to be, to function optimally.

Adult stem cell therapy holds the promise of eradicating many of the diseases that continue to plague people. However, the research to realize that potential is still underway, making the treatment largely unavailable in Canada, the U.S and the UK.  If you are considering traveling internationally to seek treatment that is unregulated, be sure that you understand exactly what kind of therapy you are purchasing and who will be providing the service before making the commitment.

References:

1 “Adult Stem Cell Therapy Shows Promise for Heart Attack Patients” Feb 25, 2010, Wake Forest Baptist University

2 Ertelt, Steven, “Adult Stem Cell Research Reverses Effects of Parkinson's Disease in Human Trial”, February 16, 2009, Lifenews.com

3 Alzheimer's Disease and Stem Cells http://www.cellmedicine.com/alzheimers.asp

4 “Diabetics cured in stem cell treatment advance” The Times, April 11, 2007, timesonline.co.uk

5 Holland, Edward J et al., “Management of Aniridic Keratopathy With Keratolimbal Allograft: a Limbal Stem CellTransplantation Technique,”

6 Rosen, O et al., “Autologous Stem-Cell Transplantation in Refractory Autoimmune Diseases After in Vivo Immunoablation and Ex Vivo Depletion of Mononuclear Cells,” Arthritis Research 2, 2000, p. 327 - 336.

7 Hill, Elizabeth, “The Stem Cell Therapy Market: Picking the Winners” Cambridge Consultants

8 “Offshore Stem Cell Survey Report”, International Cellular Medicine Society, 2010

9 "Guidelines for the Clinical Translation of Stem Cells"  December 3, 2008, The International Society for Stem Cell Research