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Stem Cells – Canadian Perspective
John LaffeyCritical Illness and Injury Research Centre, Keenan
Research Centre, St Michael’s Hospital.
Departments of Anesthesia, Physiology and Interdepartmental Division of Critical Care Medicine,
University of Toronto.
Conflict of Interest
• Tissue Regeneration Therapeutics, Toronto, Canada
• Orbsen Therapeutics Ltd, Galway, Ireland
• CommenceBio, California, USA
• Council member, Ontario Institute of Regenerative
Medicine
Stem Cells – A Canadian discovery
Griffiths M et al. Lancet 2005;366:245
Differentiation
Proliferation
Stem cell
Mature
cells
What are STEM CELLS?
Resident Lung Stem Cells
Embryonic Stem Cells
Induced Pluripotent Stem Cells
Endothelial Progenitor Cells
Mesenchymal Stromal Cells
www.stemcells.nih.gov/info/
Bone Marrow Stem/Stromal Cells
Advantages of MSCs
Stem Cell Therapies –
focusing on lung Repair?
?
Anaesthetize
Intubate
IV MSC
TherapyAnaesthetize
High Stretch
Ventilation
Assessment of
Recovery from
ARDS
48hrs
Compliance
ed 50%
Recover and
extubate
MSCs enhance injury resolution
following VILI
Curley et al, Thorax 2012
Hayes, Masterson et al, Anesthesiology 2014
Gupta, Krasnodembskaya et al, Thorax 2012
Time (Hours)0 12 24 36 48
Su
rviv
al
0.0
0.2
0.6
0.7
0.8
0.9
1.0
hMSCs (10-20 million/kg)
Vehicle/Fibroblast
Devaney et al, Thorax 2015
Devaney et al, Thorax 2015
• Ease of accessibility
• Absence of risk for the
donor
• Absence of pain for
donor
• Consistency in terms of
age at collection
Umbilical cord MSCs
Sham E.Coli + Vehicle E.Coli + UC-MSC
How do MSCs work?
Curley et al, Anesthesiology 2013
Krasnodembskaya et al, Stem Cells 2010
Devaney et al, Thorax 2015
MSCs enhance Macrophage Phagocytosis of
Bacteria
UNTREATED MSC TREATEDBACTERIA INFECTION
Laffey & Matthay AJRCCM 2017
MSCs – Key mechanisms of Action
hMSCs for ARDS…where
are we now?
©2015 by American Society of Hematology
Blood 2015;126:2220
• Understanding mechanisms of action
• Scaling MSC production for Clinical Trials
• Cryopreservation versus Fresh Cells
• Batch to batch variability
• Potency assays
• Optimal cell source
• Cost of large scale Clinical Trials for cell therapies
• Need for flexible approaches
• Turning critical care doctors into transplant physicians…
Stem Cells for ARDS – Challenges
Laffey and Matthay, AJRCCM 2017
• Canadian…..contributions to health research and medicine. Two stand out as landmarks: the discovery of insulin in the 1920s and the discovery of stem cells in the 1960s.
• Canada founded the entire field of stem-cell science…….discovering neural stem cells, skin stem cells and cancer stem cells.
• Canada does this for a dime….The “all in” investment in stem-cell research in Canada …..is about $75-million [2012 Figures].
• Funding still seriously lags behind California, which, with roughly the same population as Canada, has committed $3-billion over 10 years for stem-cell research.
Cell therapy trials in Ontario 2015-16
Brain and/or nerves Phase II using MSCs for Multiple
Sclerosis: Toronto*
Phase III using diabetes drug to
stimulate brain repair for malignant
brain tumours: Toronto*
Digestive systemPhase III using MSCs to induce
remission of Crohn’s disease:
London and Toronto
HeartPhase II using genetically modified
stem cells following heart attack:
Ottawa and Toronto*
Phase II using MSCs for advanced
heart failure with left ventricular
assist device: Toronto*
SpinePhase I/II using neural stem
cells for spinal cord trauma:
Toronto*
BloodPhase I using immune cells for
blood cancer relapse after
bone marrow transplantation:
Toronto*
JointsPhase I-II using stem cells mid-
to late-stage knee osteoarthritis;
Toronto*
2015-16
9 trials
11 partners
3 Ontario
cities
655+ patients
Billions of
stem cells
* OIRM researchers leading trial
Critical carePhase I using MSCs for septic
shock: Ottawa*
Hematopoietic stem cell transplantation
First Animal
studies
1954
First Human
studies
1957
First Proof
of efficacy
(in AML)
1977 1982/6
Proof of
efficacy
in CML
Ongoing Discoveries
e.g. MSCs for GVHD
2001-16
Human Allogenic
BM Transplant
1971
• Stem cells offer considerable potential for Critical Illnesses
– Pre-clinical studies highly encouraging
– MSCs now in early phase Clinical Studies for ARDS
• Clinical Translational pathway likely to be lengthy and there
will be setbacks...
• Twin-track strategy of pre-clinical research and early phase
clinical translational studies in progress
• Canada’s role in realizing clinical potential of stem cells
– World leading Preclinical/Discovery science
– CISS-1 Study a major step forward in Sepsis
Stem Cells – A Canadian Perspective
Laffey and Matthay, AJRCCM 2017
Acknowledgements
Gerard Curley
Mirjana Jerkic
Stephane Gagnon
Claire Masterson
Allen Volchuk
Grace Hogan
Lindsey Ormsher
Linda Garces
Haibo Zhang
Wolfgang Kuebler
Sergio Grinstein
Timothy O’Brien