All you wanted to know about Stem Cell therapy

What are Stem Cells?

These are the cells which have the potential to develop into some or many different cell types in the body, depending on whether they are multipotent or pluripotent. Serving as a sort of repair system, they can theoretically divide without limit to replenish other cells as long as the person is alive. When a stem cell divides, each "daughter" cell has the potential to either remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell.

What are the Various Classes of Stem Cells?

There are three classes of stem cells- totipotent, pluripotent and multipotent.

·         A totipotent cell has the potential to transform into an entire organism. Totipotency is a stem cell’s ability to divide and transform itself into any cell required for proper foetal development. Egg fertilization is the starting point of totipotent cells.

·         A pluripotent cell is derived from a totipotent cell. This cell has the capacity to divide and specialize into one of the three main types of body tissue: ectoderm (nervous system and skin tissues), mesoderm (bone, muscle, blood) and endoderm (interior gut lining).

·         The further specialization of a pluripotent cell results in a multipotent cell, which is a stem cell that is limited in the types of cells it can become. In effect, it becomes too specialized to be used as other bodily tissues.

What are the Different Types of Stem Cells?

Many different terms are used to describe various types of stem cells, often based on where in the body or what stage in development they come from. These are the most common terms-

·         Adult Stem Cells or Tissue-specific Stem Cells: Adult stem cells are tissue-specific, meaning they are found in a given tissue in our bodies and generate the mature cell types within that particular tissue or organ. It is not clear whether all organs, such as the heart, contain stem cells. The term ‘adult stem cells’ is often used very broadly and may include foetal and cord blood stem cells.

·         Foetal Stem Cells: As their name suggests, foetal stem cells are taken from the foetus. Most tissues in a foetus contain stem cells that drive the rapid growth and development of the organs. Like adult stem cells, foetal stem cells are generally tissue-specific, and generate the mature cell types within the particular tissue or organ in which they are found.

·         Cord Blood Stem Cells: At birth the blood in the umbilical cord is rich in blood-forming stem cells. The applications of cord blood are similar to those of adult bone marrow and are currently used to treat diseases and conditions of the blood or to restore the blood system after treatment for specific cancers. Like the stem cells in adult bone marrow, cord blood stem cells are tissue-specific.

·         Embryonic Stem Cells: Embryonic stem cells are derived from very early embryos and can in theory give rise to all cell types in the body. While these cells are already helping us better understand diseases and hold enormous promise for future therapies, there are currently no treatments using embryonic stem cells accepted by the medical community.

·         Induced Pluripotent Stem Cells (IPS cells): In 2006, scientists discovered how to “reprogram” cells with a specialized function (for example, skin cells) in the laboratory, so that they behave like an embryonic stem cell. These cells, called induced pluripotent cells or IPS cells, are created by inducing the specialized cells to express genes that are normally made in embryonic stem cells and that control how the cell functions.

Where do Stem Cells Come From?

Embryonic stem cells are derived from the inner cell mass of a blastocyst. The fertilized egg, called the zygote, divides and forms two cells; each of these cells divides again, and so on. Soon there is a hollow ball of about 150 cells called the blastocyst that contains two types of cells, the trophoblast and the inner cell mass. Embryonic stem cells are obtained from the inner cell mass.

Stem cells can also be found in small numbers in various tissues in the foetal and adult body. For example, blood stem cells are found in the bone marrow that give rise to all specialized blood cell types. Such tissue-specific stem cells have not yet been identified in all vital organs, and in some tissues like the brain, although stem cells exist, they are not very active, and thus do not readily respond to cell injury or damage.

Stem cells can also be obtained from other sources, for example, the umbilical cord of a newborn baby is a source of blood stem cells. Recently, scientists have also discovered the existence of cells in baby teeth and in amniotic fluid that may also have the potential to form multiple cell types. Research on these cells is at a very early stage.

What is Stem Cell Therapy?

Stem cell therapy is the use of stem cells to treat certain diseases. Stem cells are obtained from the patient’s own blood bone marrow, fat and umbilical cord tissue or blood. They are progenitor cells that lead to creation of new cells and are thus called as generative cells as well.

How does Stem Cell Therapy Work?

The biological task of stem cells is to repair and regenerate damaged cells. Stem cell therapy exploits this function by administering these cells systematically and in high concentrations directly into the damaged tissue, where they advance its self-healing. The process that lies behind this mechanism is largely unknown, but it is assumed that stem cells discharge certain substances which activate the diseased tissue. It is also conceivable that single damaged somatic cells, e.g. single neurocytes in the spinal cord or endothelium cells in vessels, are replaced by stem cells. Most scientists agree that stem cell research has great life-saving potential and could revolutionize the study and treatment of diseases and injuries.

What are the Diseases that can be treated by Stem Cell Therapy?

Stem cell therapy is useful in certain degenerative diseases like –

·         Cerebral Palsy- spastic, hypertonic and ataxic.

·         Diabetes Mellitus

·         Duschene Muscular Dystrophy and other Myopathies

·         Motor Neuron Diseases

·         Mental retardation

·         Alzheimer’s

·         Multiple sclerosis

·         Transverse myelitis

·         Hemiplegia (Stroke)

·         Autism spectrum disorders

·         Neurological disorders due to hypoxic brain damage.

·         Brain Haemorrhage and Cerebral -Infarct 

·         Spinal Cord Injury and Paraplegia

·         Dementia

·         Post-Surgical Neuro-deficit

What is the Procedure of Stem Cell Therapy?

If stem cell therapy is an option, a detailed treatment plan is prepared depending on the type of treatment necessary. Once the patient has consented to the treatment plan, an appointment is scheduled for bone marrow extraction. Please note that this is a minimally invasive surgical procedure, so it is important that patients do not take any blood-thinning medication in the ten days prior to the appointment. It is necessary for each patient to consult their own doctor before discontinuing this type of medication. The treatment procedure includes:

·         Bone Marrow Extraction

·         Isolation, Analysis and Concentration of the Stem Cells in the Laboratory

·         Stem Cell Implantation

Bone Marrow Extraction: Bone marrow is extracted from the hip bone by the physicians. This procedure normally takes around 30 minutes. First, local anaesthetic is administered to the area of skin where the puncture will be made. Then, a thin needle is used to extract around 150-200 ml of bone marrow. The injection of local anaesthetics can be slightly painful, but the patient usually does not feel the extraction of bone marrow.

Isolation, Analysis and Concentration of the Stem Cells in the Laboratory: The quality and quantity of the stem cells contained in the collected bone marrow are tested at the laboratory. First, the stem cells are isolated. Then a chromatographical procedure is used to separate them from the red and white blood corpuscles and plasma. The sample is tested under sterile conditions so that the stem cells, which will be administered to the patient, are not contaminated with viruses, bacteria or fungi. Each sample is also tested for the presence of viral markers such as HIV, hepatitis B and C and cytomegalia. The cleaned stem cells are counted and viability checks are made. If there are enough viable stem cells, i.e. more than two million CD34+ cells with over 80% viability, the stem cell concentrate is approved for patient administration.

Stem Cell Implantation: The method of stem cell implantation depends on the patient's condition. There are four different ways of administering stem cells:

·         Intravenous administration

·         Administration via catheter using angiography

·         Direct injection into the target area

·         Retrobulbar injection

It is important to understand that while stem cell therapy can help alleviate symptoms in many patients and slow or even reverse degenerative processes, it does not work in all cases. Based on additional information, patient's current health situation and/or unforeseen health risks, the medical staff can always, in the interest of the individual patient, propose another kind of stem cell transplantation or in exceptional situations cancel the treatment.

What are the Side Effects of Stem Cell Therapy?

The side effects of stem cell therapy differ from person to person. Listed below are the side effects of stem cell therapy:

·         Risk of mild infection

·         Anaemia

·         A sore mouth

·         Difficulty eating and drinking

·         Feeling tired and exhausted

·         Infertility

Is Stem Cell Therapy Legal in India?

According to the Indian Council of Medical Research, all stem cell therapy in India is considered to be experimental, with the exception of bone marrow transplants. Regardless, stem cell therapy is legalized in India. Umbilical cord and adult stem cell treatment are considered permissible. Embryonic stem cell therapy and research is restricted.

What is the success rate of Stem Cell therapy in India?

There is about a 60% to 80% overall success rate in the use of stem cell therapy in both India and around the world. However, success rates vary depending on the disease being treated, the institute conducting the procedures, and the condition of the patient.

What is the cost of Stem Cell therapy in India?

People across the world are looking to India as a hub for Medical tourism for affordable stem cell therapy. Treatment here costs just 25 % of what it costs In Western countries, besides practically no waiting period for surgery here. The price varies depending upon the implantation method(s) employed. Standard procedures and prices are approximately 12,000 USD.