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Stem Cell Therapy for COVID-19 Is Gaining Steam in China, But Some Skeptical Scientists Urge Caution
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Stem Cell Therapy for COVID-19 Is
Gaining Steam in China, But Some Skeptical Scientists Urge Caution
David Cox March
25, 2020 5 MINUTE READ
31 COVID-19 patients in a Beijing trial have shown improvement after stem
cell therapy, but there was no control group. (© ustas/Adobe)
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David Cox
Over the past two
months, China’s frantic search for an effective COVID-19 treatment has seen
doctors trying everything from influenza drugs to traditional herbal remedies
and even acupuncture, in a bid to help patients suffering from
coronavirus-induced pneumonia.
"This
treatment is particularly aimed at older patients who are seriously ill. These
kinds of patients are in the danger zone."
Since mid February, one approach that has gained increasing traction is
stem cell therapies, treatments that have often been viewed as a potential
panacea by desperate patients suffering from degenerative incurable conditions
ranging from Parkinson’s to ALS. In many of these diseases, reality has yet to
match the hype.
In COVID-19, there are hopes it might, though some experts are warning not
to count on it. At Beijing’s YouAn Hospital, doctors have been treating
patients at various stages of the illness with intravenous infusions of
so-called mesenchymal stem cells taken from umbilical cord tissue, as part of
an ongoing clinical trial since January 21. The outcomes of the initial seven
patients – published last
month – appeared promising and the trial
has since been expanded to 31 patients according to Dr. Kunlin Jin, a
researcher at University of North Texas Health Science Center who is
collaborating with the doctors in Beijing.
“Sixteen of these patients had mild symptoms, eight are severe, and seven
are critically severe,” Jin told leapsmag. “But all patients have shown
improvements in lung function following the treatment, based on CT scans — most
of them in the first three days and seven have now been completely discharged
from hospital. This treatment is particularly aimed at older patients who are
seriously ill. These kinds of patients are in the danger zone; it’s essential
that they receive treatment, but right now we have nothing for most of them. No
drugs or anything.”
The apparent success of the very small Beijing trial has since led to a
nationwide initiative to fast-track stem cell therapies for COVID-19. Across
China, there are currently 36 clinical
trials intending to use mesenchymal stem
cells to treat COVID-19 patients that are either in the planning or recruiting
phases. The Chinese Medical Association has now issued guidelines
to standardize stem cell treatment for COVID-19, while Zhang Xinmin, an
official in China’s Ministry of Science and Technology, revealed in a
press conference last week that a stem
cell-based drug has been approved for clinical trials.
The thinking
behind why stem cells could be a fast-acting and effective treatment is due to
the nature of COVID-19. The thousands of fatalities worldwide are not from the
virus directly, but from a dysfunctional immune response to the
infection. Patients die because their respiratory systems become overwhelmed by
a storm of inflammatory molecules called cytokines, causing lung damage and
failure. However, studies in mice have long shown that stem cells have
anti-inflammatory properties with the ability to switch off such cytokine
storms, reducing such virus-induced lung injuries.
"There has
been an enormous amount of hype about these cells, and there is scant
scientific evidence that they have any therapeutic effect in any situation.
"
“The therapy can inhibit the overactivation of the immune system and promote
repair by improving the pulmonary microenvironment and improve lung function,”
explained Wei Hou, one of the doctors conducting the trial at YouAn Hospital.
However not everyone is convinced, citing the small number of patients
treated to date, and potential risks from such therapy. “We just don’t know
enough to believe that stem cells might be helpful with COVID-19,” said Paul
Knoepfler, professor of cell biology at UC Davis. “The new stem cell studies
are too small and lack controls, making it impossible to come to any solid
conclusions. The chance of benefit is low based on the little we know so far
and there are going to be risks that are hard to pin down. For instance, what
if a stem cell infusion impairs some kind of needed immune response?”
Other scientists are even more skeptical. “I am concerned about all
treatments that use mesenchymal stem cells,” warned Jeanne Loring, the Director
of the Center for Regenerative Medicine at Scripps Research in La Jolla, Calif.
“There has been an enormous amount of hype about these cells, and there is
scant scientific evidence that they have any therapeutic effect in any
situation. Typically, these treatments are offered to people who have diseases
without cures. I’m certain that there will be evidence-based treatments
for COVID19, but I understand that they are not yet available, people are
desperate, and they will try anything. I hope the sick are not taken advantage
of because of their desperation.”
Despite such concerns, the steadily rising death toll from COVID-19 means
other nations are preparing to proceed with their own clinical trials of
mesenchymal stem cells. Jin said he has been contacted by researchers and
clinicians around the world seeking information on how to conduct their own
trials, with the University of Cambridge’s Stem Cell Institute in the U.K.
reportedly looking to initiate a trial.
The scale of the global emergency has seen governments repeatedly calling
on the corporate world to invest in the search for a cure, and the Australian
company Mesoblast – a global leader in cell-based therapies for a range of
diseases – are expecting to receive the green light to initiate clinical trials
of their own stem cell based product against COVID-19.
“We’re talking to at least three major governments,” said Silviu Itescu,
CEO and Managing Director of Mesoblast. “We are working with groups in
Australia, the U.S. and the U.K., and I expect there’ll be trials starting
imminently in all those jurisdictions.”
Itescu is bullish that the therapy has a good chance of proving effective,
as it recently successfully completed Phase III trials for severe
steroid-refractory acute graft versus host disease (GVHD) – a condition which
leads to a very similar disease profile to COVID-19.
“The exact same
cytokine profile is occurring in the lungs of COVID-19 infected patients as in
GVHD which is destructive to the local lung environment,” he said. “If our
cells are able to target that in GVHD, they ought to be able to switch off the
cytokine response in COVID lung disease as well.”
"What we
should be focusing on now is not the possible boost to the stem cell field, but
rather doing rigorous science to test whether stem cells can help COVID-19
patients."
Jin is hopeful that if the imminent trials yield successful results, the
U.S. FDA could fast-track mesenchymal stem cells as an approved emergency
therapy for COVID-19. However, Knoepfler cautions that there is a need for far
more concrete and widespread proof of the benefit before regulatory bodies
start ushering through the green light.
“What we should
be focusing on now is not the possible boost to the stem cell field, but rather
doing rigorous science to test whether stem cells can help COVID-19 patients,”
he said. “During a pandemic, it’s reasonable to do some testing of unproven
interventions like stem cells in small studies, but results from them should be
discussed in a sober, conservative manner until there is more evidence.”
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David Cox
David Cox is a science and health writer based in the UK. He has a PhD in
neuroscience from the University of Cambridge and has written for newspapers
and broadcasters worldwide including BBC News, New York Times, and The
Guardian. You can follow him on Twitter @DrDavidACox.
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