The Adventures of Stem Cells in Russia
The phrase "stem cells" is now familiar even to schoolchildren. Not a day goes by that newspapers, magazines, television don't tell something uplifting about these truly magical cages. Russia has serious priorities in studying them. But are they destined to serve us, the Russians?
The news of recent days is that US President Barack Obama has lifted the ban on state funding for embryonic stem cell research. In 2001, it was introduced under pressure from believers by President George W. Bush.
The reason is no secret – "extra" embryos obtained during infertility treatment were used for the study. Believers consider them to be a full-fledged person, and their use for the needs of science, respectively, is murder. Since then, embryonic stem cells have been studied only in private laboratories in the USA. Meanwhile, they can become the main direction of medicine of the XXI century. Obama's executive order has yet to be approved by Congress.
And in Russia, completely different passions are boiling around stem cells.
The Hope of the CenturyFirst of all, why are these cells, discovered in 1908 by the Russian hematologist Alexander Maximov, called "stem cells"?
Because from them, like a tree from a tender sprout that has pierced the earth, the entire human body grows – hundreds of different tissues, billions of cells, all our organs. We never think about it, but after all, both hard bone, and the delicate substance of the brain, and flowing blood – all this turns out to be just two cells: one maternal and one paternal. When they meet, they give rise to the process of division. On the second or third day, embryonic stem cells appear - none yet, without their own individuality. But then a large living organism will grow out of them, unusually different, mysterious...
At first, scientists seized on these very embryonic stem cells. Take them, keep them in this "no" state and, as needed, specialize – that is, grow any tissue, any organ. This is an eternal factory of "spare parts" for an almost immortal person!
It didn't work out: it turned out that these cells, which still have no idea about their purpose, easily turn not only into necessary, but also into malignant...
Then we went the other way. In any of us, a small supply of "adult" stem cells is stored: in the blood, in muscles, in fat, in the brain. They seem to be dozing in this serene state of "nedo"... But if some of the working cells die due to illness, injury, stress, the spare ones immediately wake up and turn into brand-new cells of the type that is needed. But they can be isolated, multiplied and used...
Thus began a new stage in the scientific research of stem cells.
Why did the academics brawlThe venue is a meeting of the Presidium of the Russian Academy of Medical Sciences.
The validity period is the end of 2008. Venerable scientists listened to their colleagues who conducted a series of clinical trials of stem cells (SC) in patients with the most severe and untreatable diseases. Report followed report.
– Stem cells were received by 5 patients who had suffered severe traumatic brain injury, aged from 21 to 50 years, - reported from the Institute of the Human Brain of the Russian Academy of Sciences (St. Petersburg).
Anyone who has encountered such trouble knows what these slow-witted, partially paralyzed, speech-impaired, unhappy people look like. Three months after the introduction of SC, everyone's mood and well-being improved, two of them completely recovered their movements, one of them significantly improved his speech. Two have generally recovered enough to be able to work.
In the Main Military Clinical Hospital named after Burdenko (Moscow) stem cells were injected only once into 6 patients with Parkinson's disease. This is when the hands are shaking, it is difficult to walk, the intellect is gradually destroyed... The general condition of 5 patients improved, their gait improved, and three patients managed to reduce the dose of potent drugs.
And at the Russian Neurosurgical Institute. Polenov (St. Petersburg) stem cells were used to treat 10 children with cerebral palsy, developmental delay, dropsy of the brain, etc. Most of them had changes for the better: increased attention, fewer epileptic seizures, children moved better. The positive dynamics was especially noticeable in the three kids – they began to speak more clearly, freedom of movement increased, convulsions disappeared. And seven-year-old Pavlik Z., practically blind from birth, began to distinguish the outlines of objects, that is, he had a complex speech. Here's what his mom told him:
– The most important thing is that the child has learned to reason, logic has appeared in thinking. He became very calm, balanced. His features and expression even changed... I do not know that this is a miracle?
Positive changes were noted in all other scientific centers, where limited clinical trials of the new method were conducted.
Russian scientists were the first to receive all these effects in the world – nowhere else, even in the USA, which is leading in the field of cellular technologies, so far there are no such results. It would seem that academics should have hugged and rejoiced at the success of colleagues and Russian science in general. But instead, a heated debate, almost a scandal, broke out at the meeting. Some of the speakers just did not accuse the experimenters of adventurism: they say that the technique is untested, it is unclear what exactly works in stem cells and how.
Why did the obvious, albeit very first successes cause such an ambiguous reaction?
Magic Pharmacy of LoveWhen the baby is born, the midwife ties the umbilical cord – the channel through which the fetus received everything necessary for its development from the mother for all nine months.
The second end of the umbilical cord is connected with the placenta – a mysterious organ that nature gave to a woman precisely to create a new little man. The fact that in just 9 months a new life is being created from banal food, water and maternal love has not surprised us for a long time. But in vain.
The placenta creates all the baby's cells, including spare stem cells, as well as thousands of biologically active substances that are needed in the course of human development.
And then one smart head exclaimed: "Eureka!" Adult single stem cells still need to be found, multiplied – it's expensive and long. And the small amount of blood that remains in the umbilical cord after childbirth is the most valuable and almost waste source of ready–made stem cells! It just needs to be saved.
Of course, this topic is delicate. Not every person who is far from medicine and science will calmly accept such information. Some of us (especially men) turn pale at the sight of even one drop of blood. But try to imagine what would happen if there were no donated blood? So the umbilical cord blood, although there is only literally a small test tube of it, is the most valuable donor blood in the world. Perhaps it is she who will be able to defeat all the incurable terrible diseases today.
About 20 years ago, the idea was born to preserve the umbilical cord blood of every newborn "just in case". When he becomes an adult, he gets sick – and for him there is already a portion of a universal magic cure for many diseases. At that time, it was not yet clear which ones – science was only getting closer to understanding all the possibilities of stem cells.
Cord blood cryobanks (PCs) began to appear around the world. At first, they were commercial, and they were perceived the same way as buying a plot on the Moon – the rich are freaking out, well, God be with them. But scientists quickly proved that umbilical cord blood stem cells (SKPC) can be used to treat oncohematological diseases, bone marrow lesions, immunodeficiency, congenital metabolic disorders – more than 30 diseases in total. And then came the results of the use of SKPC on animals with models of other diseases, the most common – stroke, heart attack, cerebral palsy, Parkinsonism, spinal cord injury... They were very encouraging.
And cryobanks in civilized countries began to multiply. In 2005, the US Congress decided to finance the collection and storage of 150,000 cord blood samples for the needs of the state. It has already been completed in three years. More than 700 thousand samples are stored in commercial banks there, Americans have stored them for their children. The stocks will allow almost any US citizen to obtain suitable stem cells – if necessary.
The first to prove the effectiveness of these cells (albeit so far on a small number of patients and a small number of diseases) were Russian scientists. But this has not increased cryobanks in our country. But the idea of storing "biological insurance" for the future has not only ardent supporters, but also powerful opponents.
How much does the bone marrow costEvery now and then in the newspapers you read letters from mothers begging to help save children who need a bone marrow transplant.
The amounts required are huge, and only in foreign currency. But this is often the only method that gives hope for severe hematological diseases. Cancer-killing drugs also destroy a child's immune system, including his bone marrow, which produces blood. If the dead bone marrow is not replaced with a healthy one, the child will die.
But why is this very brain absolutely necessary to buy for currency? Because it is selected by a dozen characteristics, and they do not always coincide with relatives. And if relatives are not suitable for this, it is necessary to look among millions of non-native donors. But we do not have the necessary number of bone marrow donor volunteers in our country. He is taken under general anesthesia, the procedure is painful, complications are possible – there are few willing. And the moral state of our society is such that the circle is narrowing even more. So far, no more than 4 thousand volunteers have been found. And we need hundreds of thousands. So we have to look for donors abroad, where there are 13 million of them.
The state does not finance the purchase of bone marrow, so parents are forced to walk with an outstretched hand – the selection of one sample costs from 20 to 25 thousand euros and lasts from 3 to 6 months. And the full treatment abroad is already hundreds of thousands. About a thousand children need bone marrow transplants a year, but they receive it from unrelated donors at most 70-75 per year. Those who find the right amounts.
The new Federal Center for Pediatric Hematology, Oncology and Immunology, which is being built within the framework of the national priority project "Health", in which it is planned to treat up to 400 children at the same time, will very soon face this problem. But why do oncohematologists not sound the alarm about this, do not demand the allocation of public funds for the purchase of bone marrow abroad or the treatment of our children there, or for the creation of their own donor register? More on that later.
Because it is worth telling that an alternative to unrelated bone marrow is increasingly being used in the world – the same umbilical cord blood. More precisely, her stem cells.
There is an alternative, but there is noneStrictly speaking, a sick child does not need bone marrow, but his stem cells.
As soon as they get into the body, they themselves will begin to build a new bone marrow, treat inflammation, and restore the immune system. But all this can be done by the SKPC.
Only they have advantages. In the treatment of oncohematological diseases, the selection of the right sample suitable for immunological indications of SCPC takes not months, but only a few days, and in Japan, for example, a day at all. (And in the treatment of other diseases, even this is not necessary – it is enough that the blood type and the Rh factor coincide.) They are less likely to give a "graft versus host" complication, which occurs in 30-60% of children during brain transplantation.
Finally, they are 10 times cheaper than bone marrow if you harvest them here in Russia. And if you create the right stock – about 50-100 thousand samples, they will probably be even cheaper. The world experience of 8000 SKPC transplants (2007 data) in oncohematological diseases has shown: they may well replace the bone marrow in the vast majority of cases.
Why, then, do some of our oncohematologists oppose the creation of cord blood cryobanks, and sometimes behind their eyes accuse their creators and supporters of commercial interest and even fervor? Here I enter the shaky ground of rumors, conversations "on the sidelines" and hints. But the trouble is that no one blames anyone directly in medical circles - it's unethical. But behind his back... So where is the truth in this whole story?
Where is whose interestIn our country there are only two state-owned cord blood cryobanks (one is still working) and several more commercial ones.
This means that if you want to save the blood of your newborn child, which may be needed for treatment in the future, you will have to pay for the procedure of collecting it, tests for infections, isolation of SC from it and freezing 50-60 thousand rubles. And then for each year of storage – another 3-5 thousand rubles.
For this, according to the contract, you will be able to use these cells to treat everything that medicine will be able to treat with them in the next 20 years. (It is not yet known whether these cells retain their properties for longer, there is simply no storage experience, but theoretically nothing should happen to them in a hundred years.)
Some say that these amounts are overstated, they say, the entire processing of a blood sample costs 500 rubles, no more. It should be noted that only midwives who collect blood after childbirth, cryobanks pay more than 500 rubles for each sample. But that's not the point.
At the expense of hundreds of commercial samples, the cryobank can process and store several hundred more per month – from the voluntary donation of women who do not want or cannot pay, and this is 99% of women in labor. "Free" samples are used for the needs of science. They were used in those scientific projects conducted by the Central Scientific and Practical Laboratory of Stem Cells of the Ministry of Health and Social Development of Russia together with clinics in Moscow and St. Petersburg and which caused such a storm of emotions at the Presidium of the Russian Academy of Medical Sciences. And these funds also pay for the work of research doctors, insurance of volunteer patients, rental of premises and much more.
For example, our oldest cryocenter at the National Center of Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences spends more than a quarter of its income on scientific research, since the state does not finance them. And this despite the fact that it was also created not on state funds, but on a bank loan. And for 7 years of its existence, it managed to return it.
However, the supporters of cryobanks do not remain in debt. And the opposition of some oncohematologists is explained by the fact that they were hostages of a shortage of state funds for the treatment of children. When the only means of saving a child is an unrelated bone marrow transplant, doctors offer exhausted parents an alternative: find sponsorship money. And we will help you either go abroad for treatment, or choose a suitable bone marrow sample abroad. Evil tongues claim that these channels have been well-established for a long time. The role of intermediaries is often performed by former colleagues or relatives who now live abroad. Is it not very nice? But we all know that doctors are trying to earn as much as they can not from a good life. I don't want to think that this interest turned out to be a stone in the way of the development of an important direction, but...
The President's order has not been fulfilledToday it is already clear that the use of stem cells is one of the main directions of modern medicine.
And that the simplest, most affordable and cheapest source of them is umbilical cord blood. In Moscow alone, up to 100 thousand babies are born every year, but the umbilical cord blood, whose cells could save lives, is simply destroyed. And by country?
Many scientists understand this and try to reach out to people who "make decisions". For several years, Academician Vladimir Kulakov, the recently deceased director of the National Center of Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences, proved the need to create cryobanks of PCs throughout the country.
Today, his successor, Academician of the Russian Academy of Medical Sciences Gennady Sukhoi, rector of the MMA named after him, is defending the same position. Sechenova is an academician of the Russian Academy of Sciences and RAMS Mikhail Fingers. And in general, the Presidium of the Russian Academy of Sciences approved the program of work with the SCPC and even decided to expand the research. Projects have already been launched or will begin in the near future to study the effectiveness of SCPC in patients with stroke, spinal cord injury, multiple sclerosis, heart attack, with natural aging of the brain...
– In order to use cord blood stem cells in medicine, we need not two or three small cryobanks, but 25-30, - says Vladimir Smirnov, head of the Central Stem Cell Laboratory of the Ministry of Health and Social Development of Russia, Corresponding Member of the Russian Academy of Sciences and Academician of the Russian Academy of Medical Sciences. – And it is not worth burdening the state with their creation now. Cryobanks may well be commercial, self–supporting, as long as the state gives them an order for a certain number of samples - for those patients who will not be able to prepare samples for themselves, but will need them.
Academician Smirnov's proposals were supported by First Deputy Prime Minister Dmitry Medvedev back in 2006. Twice he instructed the Minister Mikhail Zurabov "to make a final decision on the problem raised. The project is important" – this is the resolution on the last address of the academician. Vnesheconombank has agreed to lend to the project – the creation of a network of cryobanks and a national register of cord blood. But an important project first drowned in bureaucratic approvals, then Zurabov left, and Tatyana Golikova, who replaced him, did not add anything to the solution of the issue.
Dmitry Medvedev has already become president, and almost three years have passed since his attentive visa. It is simply amazing how we are able to ignore even the instructions of the leaders of the state. Maybe it's time to treat this disease too? Only, I'm afraid stem cells won't help here...
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