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Cells of regeneration

The Royal College of Physicians of Thailand make their policy on stem-cell therapy clear. From third left, Dr Kriang Tungsanga and Dr Nipan Israsena.

The Royal College of Physicians of Thailand make their policy on stem-cell therapy clear. From third left, Dr Kriang Tungsanga and Dr Nipan Israsena.

Leading medical experts set out to explain the myths and realities of stem-cell therapy

"Turn the calendar back by 10 years," screams one Internet advertisement for stem cell therapy. "Better than Botox," shouts another, while a third promises that treatment with adipose stem cell therapy has proved effective in treating everything from Alzheimer's, autism and heart disease to erectile dysfunction.

The Royal College of Physicians of Thailand begs to differ, saying bluntly. "It's a scam".

Despite great advances in the field of stem cells and their therapeutic applications, much more research is needed before any such claims can be made.

Last week, the Royal College was joined by the five societies of medical specialities - dermatalogy, cardiology, haematology, nephrology and neurology - in issuing a position statement, which makes it clear that they endorse the therapeutic use of stem cells in humans only for the following blood diseases: leukaemia, malignant lymphoma, aplastic anemia, multiple myeloma and thalassaemia.

The Royal College's chairperson, Dr Kriang Tungsanga, is deeply concerned about the claims made about the miracles of stem cell therapy but admits the organisation has no authority to punish the clinics or physicians who make them.

"From the best research on medical and scientific advancements, it can be concluded that the sources of stem cells for clinically effective therapeutic use are the bone marrow, peripheral blood, and umbilical cord blood. Moreover, the therapy can be used only for patients affected with a certain group of blood diseases," he states.

"Although there is clinical research on the use of stem cells in various other diseases, there is no scientifically relevant evidence to confirm that stem cell therapy is significantly effective in man for increasing longevity, delaying organ degeneration or improving quality of life of the patients over a long-term period in such conditions as ageing and degenerative diseases of the brain, heart, kidney or other organs.

"Inappropriate use of stem cell therapy may in fact be harmful to patients. The patients may develop a hypersensitivity reaction (allergy) and clotting in the blood vessels. The blood may be contaminated with impurities, foreign protein materials and chemicals and in the worst scenario, cancer transforming cells," Kriang notes.

Dr Nipan Israsena, an expert with the Medical Council of Thailand, explains that there many different types of stem cells and these come from different places in the body or are formed at different times in our lives. They stimulate the creation of other cells. These include embryonic stem cells that exist only at the earliest stages of development and various types of "adult" stem cells that appear during foetal development and remain in our bodies throughout life so as to repair our bodies' organism.

"Our bodies use different types of tissue-specific stem cells to fit a particular purpose. For example, the blood-forming [haematopoietic] stem cells in the bone marrow regenerate the blood, while neural stem cells in the brain make brain cells. Only in the kidney and pancreas are stem cells not found. Thus, each type of stem cell fulfils a specific function in the body and cannot be expected to make cell types from other tissues. It is unlikely that a single type of stem cell treatment can treat multiple unrelated conditions, such as diabetes and Parkinson's disease.

"Currently, only haematopoietic stem cell transplantation has proven beneficial in treating diseases and conditions of the blood such as thalassaemia, aplastic anemia, lymphoma and leukaemia," says Dr Wanchai Wanachiwanawin, chairperson of the Thai Society of Hematology.

Dr Kriengkrai Hengrussamee, chairperson of the Heart Association of Thailand under the Royal Patronage of His Majesty the King, notes that a global study of stem cell treatment for heart disease has been running since 1996.

"The findings have shown that those who received stem cells did feel less tired but the therapy had no effect on reducing the rate of death. However, research is ongoing and will form the basis for studies in the future," he says.

Dr Anutra Chittinandana of the Nephrology Society of Thailand doubts that successful treatment with stem cell therapy will happen in his lifetime.

"There are no stem cells in the kidney. Most of the studies in animals with the use of stem cells have had unsatisfactory results and failures," he notes.

That hasn't stopped doctors from trying it on live patients though. In 2010, an end-stage kidney patient died after receiving stem cell injections at a private clinic in Bangkok and developing complications.

Nor is it stopping the advertising, with the beauty industry the worst offender in making fraudulent claims about the benefits of stem cell application.

Dr Rataporn Ungpakorn, secretary of the Dermatological Society of Thailand, warns patients to be wary of clinics that measure or advertise their results primarily through patient testimonials.

"The beauty business has nothing to do with disease. It is about satisfaction and changes all the time. So when a clinic advertises treatments using the embryonic stem cells of animals or plants, customers tend to think that these will restore their youth. This is absolutely not true. Quite apart from the fact that keeping stem cells alive requires very specific conditions, there is no scientific proof that stem cell therapy works in the beauty industry," he says.

The hype about stem cells has also led to an increasing number of mothers collecting and banking their newborns' cord blood. This is usually a pricey process and offers no guarantee of the future usage.

"Mothers need to look into all the details very carefully. They should also go to trustworthy medical sources not private clinics," Dr Nipan says.

Whether or not mothers, men and women determined to young look or those suffering from heart and other medical conditions will heed the experts' advice is difficult to predict.

Inappropriate use of stem cells is increasing not just in Thailand but in many other countries,

"There is a large gap between a patient's hope to be cured and the fact that current medical science and technology cannot fulfil all of their wishes," says Dr Kriang.

"But the therapeutic use of stem cells in humans is a delicate issue and may have serious consequences with respect to medical ethics, standard of clinical practice and patient health. Research must comply with accepted clinical practice, be approved by the ethical committee for research in humans and be in accordance with the rules and regulations previously declared by the Thai Medical Council. Also such clinical trials must be free-of-charge to the subjects enrolled in the study."






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