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Doug Brutlag 2011
Genomics, Bioinformatics & Medicine
http://biochem158.stanford.edu/
Doug Brutlag
Professor Emeritus of Biochemistry & Medicine
Stanford University School of Medicine
Stem Cell Therapies
http://biochem158.stanford.edu/Stem%20Cell%20Therapies.html
Doug Brutlag 2011
Stem Cell Promise & Stem Cell Therapeutics
http://www.stemcelltherapies.org/
 Parkinsons Disease with iPSCs
 Spinal Cord Injury with human embryonic stem cells (hESCs)
 Sickle Cell, Thalassemias, hemophilia and other blood diseases with
iPSCs
 Bone Marrow Transplants (BMT) & hematopoietic stem cell therapy
(HCT)
 Lymphomas and thymomas
 Hematopoietic cells
 Metastatic cancers of other origins
 Autoimmune Diseases with hematopoietic stem cells (HSCs)
 Rheumatoid arthritis
 Systemic Lupus Erythematosus
 Type 1 diabetes mellitus
 Multiple sclerosis
 Pernicious anemia
Doug Brutlag 2011
Geron Stem Cell Therapy
Tom Okarma - Geron
Doug Brutlag 2011
Human Embryonic Stem Cells
Tom Okarma - Geron
Doug Brutlag 2011
Spinal Cord Injury
Pathology at the Lesion
Tom Okarma - Geron
Doug Brutlag 2011
GRNOPC1 Improves Locomotor Behavior
after Spinal Cord Injury
Tom Okarma - Geron
Doug Brutlag 2011
Spinal Cord Injury
http://www.geron.com/GRNOPC1Trial/
Doug Brutlag 2011
GRNOPC1 Induces Remyelination after
Spinal Cord Lesions in Rodents
Tom Okarma - Geron
Doug Brutlag 2011
GRNOPC1 Promotes Neural Outgrowth
Tom Okarma - Geron
Doug Brutlag 2011
Human Embryonic Stem Cell (hESC)
Based Therapy
Tom Okarma - Geron
Doug Brutlag 2011
Geron Oligodendrocyte Progenitor Cells
GRNOPC1
Tom Okarma - Geron
Doug Brutlag 2011
GRNOP1 Phase 1 Multi-Center
Spinal Cord Injury Trial
Tom Okarma - Geron
Doug Brutlag 2011
Clinical Trials Database
http://clinicaltrials.gov/
Doug Brutlag 2011
Stem Cell Clinical Trials
http://clinicaltrials.gov/
Doug Brutlag 2011
Geron Clinical Trials
http://clinicaltrials.gov/
Doug Brutlag 2011
Clinical Trials of Hematopoietic Cell
Transplantation
Judith A. Shizuru, M.D., Ph.D.
Division of Blood and Marrow
Transplantation
Stanford University Medical Center
Judith Shizuru
Doug Brutlag 2011
Hematopoiesis
http://www.biocarta.com/pathfiles/h_stemPathway.asp
Doug Brutlag 2011
Bone Marrow Transplants to Cure
Lymphomas/Thymomas
 Whole Body Irradiation to remove endogenous immune
system and tumor
 Also total lymphoid irradiation with antithymocyte serum
 Injection of bone marrow from a well matched donor to
re-establish immune system
 Regulation of immune response to prevent graft versus
host reaction.
 Autologous donation possible if one can purify and
remove tumor cells, enriching for stem cells..
 Allogeneic donors have advantage of graft versus tumor
reaction to kill any remaining tumor cells.
 Allogeneic donors have the disadvantage of graft versus
host reaction if they are not well matched.
Judith Shizuru
Doug Brutlag 2011
Autologous vs. Allogeneic Transplants
Judith Shizuru
Unfractionated bone
marrow or mobilized blood
Donor blood formation,
graft-vs-tumor effect
Purify from
Tumor cells
Transplant Transplant
Autologous Allogenic
Healthy
Donor
Doug Brutlag 2011
Complications of Allogeneic Transplants
Transplant related mortality = 10 - 15%
 Regimen related toxicity
 Infectious complications
 Engraftment failure (resistance)
 Graft-versus-host disease
Judith Shizuru
Doug Brutlag 2011
Judith Shizuru
Doug Brutlag 2011
Cells of the Bone Marrow
Judith Shizuru
Doug Brutlag 2011
Regulation of hematopoiesis by cytokines
http://www.biocarta.com/pathfiles/h_stemPathway.asp
Doug Brutlag 2011
Isolation of Hematopoietic Stem Cells
Judith Shizuru
Doug Brutlag 2011
Fluorescent Activated Cell Sorter (FACS)
Herzenberg & Herzenberg
http://www.bio.davidson.edu/courses/genomics/method/FACS.html
Doug Brutlag 2011
Why Transplant Purified Allogeneic HSCs?
Judith Shizuru
Doug Brutlag 2011
Engraftment Resistance is Significant
Obstacle to HSC Transplantation
Judith Shizuru
Doug Brutlag 2011
Experimental Autoimmune Encephalomyelitis (EAE)
Model for Multiple Sclerosis in Mice
Judith Shizuru
MOG
MOG
MOG
Doug Brutlag 2011
Partial Chimerism Results in
Disease Amelioration
0 1 0 2 0 3 0 4 0 5 0 6 0 7 0
0 .0 0
0 .2 5
0 .5 0
0 .7 5
1 .0 0
Time (days )
T cells
B cells
Macrop ha ges
Granulocytes
5
4
3
2
1
0
+60
-35 +60
TBI & HSC
TLI + ATG
TBI TLI + ATS
HSC
5
4
3
2
1
0
Judith Shizuru
Doug Brutlag 2011
Other Applications of
Hematopoietic Stem Cell Transplantation
 Treatment of autoimmune disease
 Patients treated with bone marrow transplants are
often cured of autoimmune disease
 Bone marrow transplant donors with autoimmune
disease can pass the disease on to recipients
 Organ tolerance induction
 Mice receiving organ transplant and HSC transplant
together are tolerant and no rejection occurs. No
immune suppressants are needed.
Judith Shizuru
Judith Shizuru
Doug Brutlag 2011
Combined HSC & islet transplantation
Judith Shizuru
Doug Brutlag 2011
Treatment of Diabetic Mice (NOD) with
Hematopoietic Stem Cell Transplants
NOD male controls
NOD female controls
Months after birth
Diabetes
free
(%) 100
80
60
40
20
0
0 2 4 6 8 10 12 14
NOD WBM NOD
AKR HSC NOD
txp
NOD HSC NOD
Judith Shizuru
Doug Brutlag 2011
Hematopoietic Cell Treatment Coupled with
High Dose Breast Cancer Chemotherapy
Stage Four Metastatic Breast Cancer
M端ller et al. (2011) Biol. Blood Marrow Transplant

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Stem Cell therapy.ppt

  • 1. Doug Brutlag 2011 Genomics, Bioinformatics & Medicine http://biochem158.stanford.edu/ Doug Brutlag Professor Emeritus of Biochemistry & Medicine Stanford University School of Medicine Stem Cell Therapies http://biochem158.stanford.edu/Stem%20Cell%20Therapies.html
  • 2. Doug Brutlag 2011 Stem Cell Promise & Stem Cell Therapeutics http://www.stemcelltherapies.org/ Parkinsons Disease with iPSCs Spinal Cord Injury with human embryonic stem cells (hESCs) Sickle Cell, Thalassemias, hemophilia and other blood diseases with iPSCs Bone Marrow Transplants (BMT) & hematopoietic stem cell therapy (HCT) Lymphomas and thymomas Hematopoietic cells Metastatic cancers of other origins Autoimmune Diseases with hematopoietic stem cells (HSCs) Rheumatoid arthritis Systemic Lupus Erythematosus Type 1 diabetes mellitus Multiple sclerosis Pernicious anemia
  • 3. Doug Brutlag 2011 Geron Stem Cell Therapy Tom Okarma - Geron
  • 4. Doug Brutlag 2011 Human Embryonic Stem Cells Tom Okarma - Geron
  • 5. Doug Brutlag 2011 Spinal Cord Injury Pathology at the Lesion Tom Okarma - Geron
  • 6. Doug Brutlag 2011 GRNOPC1 Improves Locomotor Behavior after Spinal Cord Injury Tom Okarma - Geron
  • 7. Doug Brutlag 2011 Spinal Cord Injury http://www.geron.com/GRNOPC1Trial/
  • 8. Doug Brutlag 2011 GRNOPC1 Induces Remyelination after Spinal Cord Lesions in Rodents Tom Okarma - Geron
  • 9. Doug Brutlag 2011 GRNOPC1 Promotes Neural Outgrowth Tom Okarma - Geron
  • 10. Doug Brutlag 2011 Human Embryonic Stem Cell (hESC) Based Therapy Tom Okarma - Geron
  • 11. Doug Brutlag 2011 Geron Oligodendrocyte Progenitor Cells GRNOPC1 Tom Okarma - Geron
  • 12. Doug Brutlag 2011 GRNOP1 Phase 1 Multi-Center Spinal Cord Injury Trial Tom Okarma - Geron
  • 13. Doug Brutlag 2011 Clinical Trials Database http://clinicaltrials.gov/
  • 14. Doug Brutlag 2011 Stem Cell Clinical Trials http://clinicaltrials.gov/
  • 15. Doug Brutlag 2011 Geron Clinical Trials http://clinicaltrials.gov/
  • 16. Doug Brutlag 2011 Clinical Trials of Hematopoietic Cell Transplantation Judith A. Shizuru, M.D., Ph.D. Division of Blood and Marrow Transplantation Stanford University Medical Center Judith Shizuru
  • 18. Doug Brutlag 2011 Bone Marrow Transplants to Cure Lymphomas/Thymomas Whole Body Irradiation to remove endogenous immune system and tumor Also total lymphoid irradiation with antithymocyte serum Injection of bone marrow from a well matched donor to re-establish immune system Regulation of immune response to prevent graft versus host reaction. Autologous donation possible if one can purify and remove tumor cells, enriching for stem cells.. Allogeneic donors have advantage of graft versus tumor reaction to kill any remaining tumor cells. Allogeneic donors have the disadvantage of graft versus host reaction if they are not well matched. Judith Shizuru
  • 19. Doug Brutlag 2011 Autologous vs. Allogeneic Transplants Judith Shizuru Unfractionated bone marrow or mobilized blood Donor blood formation, graft-vs-tumor effect Purify from Tumor cells Transplant Transplant Autologous Allogenic Healthy Donor
  • 20. Doug Brutlag 2011 Complications of Allogeneic Transplants Transplant related mortality = 10 - 15% Regimen related toxicity Infectious complications Engraftment failure (resistance) Graft-versus-host disease Judith Shizuru
  • 22. Doug Brutlag 2011 Cells of the Bone Marrow Judith Shizuru
  • 23. Doug Brutlag 2011 Regulation of hematopoiesis by cytokines http://www.biocarta.com/pathfiles/h_stemPathway.asp
  • 24. Doug Brutlag 2011 Isolation of Hematopoietic Stem Cells Judith Shizuru
  • 25. Doug Brutlag 2011 Fluorescent Activated Cell Sorter (FACS) Herzenberg & Herzenberg http://www.bio.davidson.edu/courses/genomics/method/FACS.html
  • 26. Doug Brutlag 2011 Why Transplant Purified Allogeneic HSCs? Judith Shizuru
  • 27. Doug Brutlag 2011 Engraftment Resistance is Significant Obstacle to HSC Transplantation Judith Shizuru
  • 28. Doug Brutlag 2011 Experimental Autoimmune Encephalomyelitis (EAE) Model for Multiple Sclerosis in Mice Judith Shizuru MOG MOG MOG
  • 29. Doug Brutlag 2011 Partial Chimerism Results in Disease Amelioration 0 1 0 2 0 3 0 4 0 5 0 6 0 7 0 0 .0 0 0 .2 5 0 .5 0 0 .7 5 1 .0 0 Time (days ) T cells B cells Macrop ha ges Granulocytes 5 4 3 2 1 0 +60 -35 +60 TBI & HSC TLI + ATG TBI TLI + ATS HSC 5 4 3 2 1 0 Judith Shizuru
  • 30. Doug Brutlag 2011 Other Applications of Hematopoietic Stem Cell Transplantation Treatment of autoimmune disease Patients treated with bone marrow transplants are often cured of autoimmune disease Bone marrow transplant donors with autoimmune disease can pass the disease on to recipients Organ tolerance induction Mice receiving organ transplant and HSC transplant together are tolerant and no rejection occurs. No immune suppressants are needed. Judith Shizuru Judith Shizuru
  • 31. Doug Brutlag 2011 Combined HSC & islet transplantation Judith Shizuru
  • 32. Doug Brutlag 2011 Treatment of Diabetic Mice (NOD) with Hematopoietic Stem Cell Transplants NOD male controls NOD female controls Months after birth Diabetes free (%) 100 80 60 40 20 0 0 2 4 6 8 10 12 14 NOD WBM NOD AKR HSC NOD txp NOD HSC NOD Judith Shizuru
  • 33. Doug Brutlag 2011 Hematopoietic Cell Treatment Coupled with High Dose Breast Cancer Chemotherapy Stage Four Metastatic Breast Cancer M端ller et al. (2011) Biol. Blood Marrow Transplant