IN a 1962 experiment, microbiologist Dr. Leonard Hayflick made a
grim discovery that human cells grown in tissue culture would only divide a
certain number of times, presumably because the telomeres—special DNA sequences
found at the tips of chromosomes located within the nucleus of the
cells—shorten to a critical length.
In other words, if telomeres become too short to allow cell
replication, the cell stops dividing and will ultimately die.
This led Hayflick to realize that even if an individual gets
through life without contracting a deadly disease or succumbing to a fatal
accident, that person will still die when enough of his cells ceased dividing.
This phenomenon now known as the “Hayflick Limit”, sets an unsurpassable
lifespan for our species at just over 120 years.
Interestingly, this has not discouraged us from trying to
challenge the Hayflick Limit, learning new ways to live a healthier life as
well as using scientifically proven medication or procedure to fend off
diseases or at least keep in check what already ails us. Should the necessity
arise, we will not hesitate on getting our damaged tissue or organ “fixed” if
not totally replaced so long as we achieve the quality of life we desire.
Of course, there are experts and institutions to help us in our
quest to enjoy longer, healthier, happier lives—using stem cell based therapy.
New concept
“Stem cell-based therapy is emerging as a new concept for the
treatment of various diseases. Owing to the extraordinary advances taking place
in the field of cellular and molecular biology, we are slowly moving from just
offering mechanical care to biological solutions,” said Dr. Dante Dator, deputy
executive director of the National Kidney and Transplant Institute in East
Avenue, Quezon City.
The NKTI is a tertiary medical center under the Department of
Health which primarily specializes in kidney diseases and organ
transplantations. It was the first government hospital in the country to earn
an ISO certification and is currently considered as a leader in its field in
Asia.
The NKTI, which pioneered stem cell transplantation in the
country in 1990 (and has been performing peripheral blood stem cell transplant
since 2001), has upgraded and modernized its facilities with equipment at par
with those found in the United States: Molecular and Cellular Therapeutics lab,
which has already been working on Dendritic Cell Vaccine therapy for cancers
(prostate, kidney, breast, lung, liver, colon, gastric, pancreas, cervix,
uterine, ovary, myeloma, and lymphoma) together with its sister hospital Lung
Center of the Philippines.
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| Dr. Dante Dator |
“A lot of people may not know this, but NKTI’s Stem Cell
Transplantation Program has been performing blood and bone marrow
transplantation procedures for years and had improved survival for a number of
our patients who suffer from diseases like leukemias and lymphomas,” shared
Dator.
Faculty
capability
Dator reported that to further strengthen NKTI’s faculty’s
capability to match the modernization drive, the hospital has been sending off
staff to work with the world’s leading institutions.
“The Wake Forest Institute for Regenerative Medicine is a leader
in translating scientific discovery into clinical therapies and I had the
privilege to work with world-renowned physicians and scientists whose goal is
to find a cure, rather than merely to treat a disease. The WFIRM was the first
in the world to engineer laboratory-grown organs that were successfully
implanted into humans and this was the tissue-engineered bladder, which was
pioneered by Dr. Anthony Atala, the institute’s director and chair of the
Department of Urology of Wake Forest School of Medicine,” said Dr. Sigrid
Agcaoili of NKTI’s Department of Urology.
Atala had been working to build bladders from patient’s own
cells since 1990 and in 1999 implanted the first organ in a patient. In 2006,
Atala reported the long-term results in seven children who had the surgery,
which showed that the implanted bladders had improved function over time and
durable.
She reported that her two-year training at the institute has
given her the opportunity to learn the technology of tissue engineering, which
involves growing replacement organs and tissues in the lab to replace damaged
or diseased tissue.
“This process usually starts with a three-dimensional structure
called a scaffold that is used to support cells as they develop. I was involved
in a project, which aimed to create an implantable kidney that can restore
normal renal function. Shortage of organs for kidney transplantation has been a
problem worldwide—the Philippines included. We think that a regenerative
medicine approach using patient’s own renal cells seeded onto a kidney scaffold
can be an alternative to donor transplantation. In this case, there is no risk
of rejection because the cells grew from patient’s own cells,” reported
Agcaoili.
She said this is no longer science fiction considering the skin,
blood vessels, bladder, trachea, esophagus, muscle and other types of tissues
have been successfully engineered and in fact, been used in treating human
diseases.
“Armed with the right training and competent personnel, I
believe that we can incorporate regenerative medicine and tissue engineering in
the clinical armamentarium for the Filipino patients,” she said.
The NKTI is set to collaborate clinical trial with WFIRM using
tissue-engineered bladders for children who have poorly functional urinary
bladders (because of a congenital birth defect due to incomplete closure of the
spine). “We do hope that with this collaboration, we can give the same value of
care to Filipino patients,” hoped Agcaoili.
NKTI is currently working on a hybrid project where the
dendritic cell will be fused with a viral sector that attacks certain cancers
specially head and neck tumors.
No longer
impossible
“It is no longer impossible or beyond the realm of possibility
that the few of us could now provide the expertise and best services that patients
seek. The key word here is ‘personalized molecular medicine’. We should realize
that when it comes to treating patients, no two individuals and no two diseases
are the same. Thus, doctors can now select a therapy or treatment protocol
based on a patient’s molecular profile that may not only minimize harmful side
effects and ensure a more successful outcome, but can also help contain costs
compared with a ‘trial-and-error’ approach to disease treatment,” stressed Dr.
Samuel Bernal, a world-renowned Filipino-American cancer specialist and molecular
biologist, UCLA Professor Emeritus in Medicine and consultant-adviser to The
Medical City’s Regenerative Program.
Bernal passionately believes that personalized molecular
medicine holds the key to revolutionizing the treatment of diseases such as
cancer, diabetes, neurological diseases, diseases of the liver, bones, heart,
kidney and other degenerative diseases.
“The field has been spurred in recent years by rapid advances in
molecular medicine— such as biochemistry, biophysics, nanotechnology, molecular
genetics, molecular immunology, molecular pharmacology, biomaterials,
biomedical engineering —new possibilities open up for what can be accomplished. The key
to all these developments are our stem cells, which have the ability to become
various types of cells or be sensitized to attack diseased cells, including
malignant tumors,” he explained.
The doctor thank Dr. Alfredo Bengzon, president and CEO of The
Medical City in Pasig for his vision to establish a center of excellence that
would provide end to end solution for stem cell research, clinical research and
therapy here in the Philippines.
Many years
ago, the Philippines already conducted research in regenerative medicine,
starting in 1986 when Dr. Alfredo Bengzon was Secretary of Health, and now
President and CEO of The Medical City in Pasig.
The Regenerative Medicine Program has been expanded at The Medical City,
as part of Dr. Bengzon’s vision to establish a center of excellence in the
Philippines that would provide comprehensive range of clinical and laboratory
services in molecular and cellular therapeutics, including stem cell therapies,
for Filipino and International patients.
But with the Regenerative Medicine Program now established at
the The Medical City (with the whole 12th floor devoted to this center), the
hospital could now boast as one of the most advanced in the world, with only a
handful of institutions in the United States and Europe that could rival the
expertise and services it offer.
The Medical City’s Regenerative Medicine Program offers
cutting-edge procedures including Stem Cell Transplants wherein infused stem
cells harvested from the patient’s bone marrow are processed and “coaxed” to
become cells of a specific organ or tissue type and in turn, used to preserve,
repair or enhance the functions of the patient’s target organ. Another service
offered include the Dentritic Cell Therapy, wherein the patient body’s own
defense system (immune system) is utilized to effectively recognize and destroy
cancer cells.
The most effective and safest cells
to use for treatments in humans are human adult cells (especially the natural
healing cells from the bone marrow) and human umbilical cord cells, according
to Bernal. Human adult and umbilical
cord stem cells are also morally, ethically and legally acceptable, unlike
embryonic, aborted fetus, genetically altered,
and animal stem cells.
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Dr. Samuel Bernal, a world-renowned Filipino-American cancer specialist and molecular biologist, UCLA Professor Emeritus in Medicine and consultant-adviser to The Medical City’s Regenerative Program
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Leader
“Many Filipinos may not realize this but the Philippines is now
regarded as one of the leaders in regenerative medicine considering that a
number of medical institutions here, The Medical City included, have spent not
only hundreds of millions of dollars in acquiring the latest and most
sophisticated equipment but also in acquiring personnel who trained under the
watchful eye of world renowned experts if not pioneers in their respective
fields,” Bernal said.
In fact, many patients from
foreign countries, such as the U.S., Europe, Russia and Australia travel to
avail of services at The Medical City.
Some patients are foreign doctors with serious illnesses who already failed
treatments at other medical centers including the U.S.. But why would a foreign patient, say from New
York, travel all the way to the Philippines when that person could go to
Harvard, Johns Hopkins, Memorial Sloan-Kettering or MD Anderson? At the same time, why would a Filipino seeking
the very best care stay here in the Philippines and not to fly to the United
States? The answer is Personalized Molecular
Medicine – which is very labor intensive, requiring a large number of trained
molecular biologists and biochemists who work closely with clinicians in
customizing treatment according to the molecular characteristics of the
patient’s condition, says Bernal.
Aside from being a U.S. Board Certified
Internist and Medical Oncologist, Dr. Bernal himself is trained as a chemist
and has a Ph.D. in Biochemical Pathology from the University of Chicago, where
he worked with several Nobel Prize winners in Medicine and Chemistry. Later, he was a Principal Investigator in
Molecular Medicine at Harvard and UCLA, where he did molecular research and
trained many molecular biologists from the U.S., Europe, Japan and Korea, as
well as some scientists from the Philippines who are now working in various
Philippine institutions. Dr. Bernal continues to train many biochemists,
molecular biologists, and clinical specialists in the U.S., Europe and in the
Philippines, particularly at the Ateneo School of Science and Engineering and
the University of Santo Tomas.
Why would a
Filipino seeking the very best care stay here in the Philippines and not to fly
to the United States? The answer is Personalized Molecular Medicine – which is very labor
intensive, requiring a large number of trained molecular biologists and
biochemists who work closely with clinicians in customizing treatment according
to the molecular characteristics of the patient’s condition
Beefing up
Of course, other leading medical institutions in the country are
also beefing up their facilities that involved stem cell-based therapy. In line
with the 2015 mission of the Makati Medical Center, the hospital recently
inaugurated the Cellular Therapeutics Lab (located at the 6th floor of Tower 2)
that is set to give hope to those with cancer, diabetes Type 1, neurologic
diseases and joints disorders.
“Before we could even convince patients, we need to assure them
that their cells will be processed by one of the most experienced staff and
advanced facilities in the region. We offer ultraclean room facility (class
100) that can handle cell-based products and culture facility; sophisticated
procedure to isolate stem cell (magnetic-activated cell sorting); meticulous
quality control and documentation; high-end equipment that are operated by
experienced scientists; and established system to monitor the patient’s
progress,” enumerated Dr. Eric Flores, head of MMC Cellular Therapeutics
Laboratory.
Ensuring that the more than 170 sq.m. facility is free from
biological and non-living contaminants is crucial considering that most of
their patients suffers from a weakened immune system.
“We put premium importance in the quality and sterility of the
product. Compared to other facilities in the Philippines, our laboratory is
unmatched in terms of providing the best cellular product or quality. In
comparison with other laboratories, the lab is at least three notches better in
providing a sterile environment. In fact, the Biosafety Level 5 instituted here
is at least one or two notches higher than what is recommended by the US Food
and Drug Administration. Moreover, as part of the routine procedure, the
facility is continuously monitored for its sterility,” assured Dr. Francis
Chung, scientific officer of the Cellular Therapeutics Laboratory’s Stem Cell
Lab.
He related that in cases wherein the stem cells will be sourced
out from a donor, the MMC Cellular Therapeutics Laboratory has the ability to
identify a possible cross-match—using 10-point DNA matching—for the recipient.
“We have the technology to push this cellular transplantation process that will
significantly minimize complications,” said Chung.
Stem cell transplant
for eyes
In 2006, St. Luke’s Medical Center made history when the
hospital’s International Eye Institute successfully performed a conjuctival
stem cell transplant on a 52-year-old indigent male—harvesting healthy stem
cells from his remaining good eye and then transplanted to his injured eye,
replacing the missing cells.
Presently, the hospital’s Stem Cell Research and Biotechnology
Division is busy doing a lot of work on stem cell-based therapy and at the same
time working closely with cardiology, vascular medicine, cancer, neurology,
ophthalmology and dermatology department in order to explore and document their
experience in their respective field.
Dr. Mark Pierre Dimamay of St. Luke’s Medical Center Stem Cell
Research and Biotechnology Division reported that the hospital has also
established collaborations with leading institutions namely, Singapore’s Eye
Research Institute, Korea’s Hanyang University, United States’ University of
Miami, and Germany’s TICEBA (a highly innovative German life science company,
working in the field of stem-cell research and regenerative medicine).
Dimamay also shared that the hospital also completed its
equipment and requirements for growing human cells. “The entire process of
collecting cells from the patient, processing and growing them can be done at
SLMC. We have also applied for the Philippine Food and Drug Administration’s
Good Manufacturing Practice certification to ensure that the cells that we
generate are made in accordance to international standards. We also acquired a
cell-sorting equipment—known as the CliniMACS—and applied the standard cell
culture techniques for growing the stem cells. To develop the technical skills
in growing stem cells, we underwent training abroad like Singapore Eye Research
Institute for growing ocular stem cells,” he explained.
Dimamay added that being able to grow stem cells and get pure
stem cell populations is helpful in treating a variety of degenerative
diseases. “One should realize that adult stem cells are few in number and if
these cells can be grown and allowed to multiply in the laboratory, more stem
cells can be potentially used for treatment. The cell sorter that we acquired
will ensure that the cells being given to the patient are pure stem cells,
without any other cellular contaminants.”
Dr. Joven Cuanang, St. Luke’s Medical Center (SLMC) chief
medical officer and SVP for medical affairs said that considering stem cell
therapy using adult stem cells has not yet been clinically proven to be
effective and safe, the hospital is conducting clinical trials as well as
testing to gather evidence and data on a per disease basis to show if such
treatments really work.
Cuanang and Dimamay believe this will increase the credibility
of the treatments offered here in the Philippines adding that in the absence of
such clinical trials, anyone can offer stem cell therapy at a high premium, and
just leave the results of the treatment by chance. “If the treatments don’t
work, then the reputation of the institution and even the Philippines would be
at stake,” Dimamay explained.
Processing stem cells in St. Luke’s Stem Cell Research and
Biotechnology Division
x x x
