The public’s expectations for advances and cures in the stem cell field are ahead of reality, biotechnology executives and venture capitalists said Monday.
I attended a discussion at the BIO convention now underway in Atlanta on stem cell technology. It was worthwhile to get an idea what top industry people are saying, even if there wasn’t a ton of breaking news.
Scientists are forging ahead, most obviously with the recent discovery that it is possible to convert differentiated cells back into stem cells without introducing new DNA. Still, regulatory, patent and financial issues will probably slow the clinical development of stem cell technology over the next decade, said venture capitalist Steve Burrill, part of a four-member panel at BIO Monday.
Every company smaller than $1 billion, and that includes much of the field, the capital markets will neglect, Burrill said.
“These are some of the most complex biologics anyone has worked with. Cells are just going to be harder,” said Richard Gregory of Genzyme.
Other panelists: Paul Grayson of Fate Therapeutics, Ian Ratcliffe of StemGent
Outside the United States, desperate patients are being offered unproven stem cell “treatments” as a way to treat several neurological diseases. Someone on the panel (Gregory?) said he’d been to Beijing and was apprehensive about possible outcomes. But at the same time, some US companies may look to more flexible regulatory regimes as a way around a conservative FDA.
Some suggested that a field emphasizing transdifferentiation, directly converting one type of donated differentiated cells from patients into another that can be used for therapy, may grow out of the stem cell field. (Harvard’s Doug Melton was mentioned reverently.) This would have the advantages of avoiding early-stage embryos and probably reduce the ability of introduced cells to cause tumors.
Moderator Aaron Rowe, a writer with Wired, at one point asked the panel “How would you reform the FDA,” since the regulatory environment was so uncertain.
Panelists discussed the wisdom of allowing patients to take on considerable risks of volunteering for stem cell trials. Although I did not mention it during the discussion, I worry about a potential Jesse Gelsinger scenario. If a patient dies, everyone will ratchet back risk, even if he/she could grasp what he was getting into.
James Wilson makes this point in an essay in Science. Well worth reading.
(Commentary on Wilson)
Burrill had a elegant summary, saying that AIDS activists had changed the risk vs reward profile of clinical research, allowing patients in urgent need to take on more risk. Then Vioxx came along and made the FDA and industry more conservative, swinging the pendulum back.
Rowe tried to get panelists to come up with a two-word catchy phrase describing small molecules that can guide stem cell differentiation. He conjured up an image of postdocs poring over heat maps, playing the appropriate signaling pathways like violinists, but the panel rejected this picture as too ambitious.
Some of the products the panelists discussed:
Genzyme’s Mozobil, a stem cell mobilizer
Fate Therapeutics is planning a phase Ib trial for a small molecule that could aid homing by stem cells in bone marrow transplants.
Technology challenges discussed:
Growing pluripotent cells in suspension culture (without feeder cells) – I don’t know if this is really possible, because stem-ish cells will always need various ligands, properly arranged, to make them happy. Maybe some kind of artificial matrix.
I would add: quality control assays to ensure that a batch of cells is not tumorigenic, isn’t missing chromosomes, stuff like that.