All this month we are using our blog and social media to highlight a new chapter in CIRM’s life, thanks to the people of California approving Proposition 14. We are looking back at what we have done since we were created in 2004, and also looking forward to the future.
Dr. John Zaia, City of Hope stem cell researcher
The news that effective vaccines have been developed to help fight COVID-19 was a truly bright spot at the end of a very dark year. But it will be months, in some countries years, before we have enough vaccines to protect everyone. That’s why it’s so important to keep pushing for more effective ways to help people who get infected with the virus.
One of those ways is in a clinical study that CIRM is funding with City of Hope’s Dr. John Zaia. Dr. Zaia and his team, in partnership with the Translational Genomics Research Institute (TGen) in Flagstaff, Arizona, are using something called convalescent plasma to try and help people who have contracted the virus. Here’s the website they have created for the study.
Plasma is a part of our blood that carries proteins, called antibodies, that help defend our bodies against viral infections. When a patient recovers from COVID-19, their blood plasma contains antibodies against the virus. The hope is that those antibodies can now be used as a potential treatment for COVID-19 to help people who are newly infected.
For the study to succeed they’ll first need people who have recovered from the virus to donate blood. That’s particularly appropriate in January because this is National Volunteer Blood Donor Month.
The team has three elements to their approach:
A rapid-response screening program to screen potential COVID-19 convalescent plasma donors, particularly in underserved communities.
A laboratory center that can analyze the anti-SARS-CoV-2 antibodies properties in COVID-19 convalescent plasma.
An analysis of the clinical course of the disease in COVID-19 patients to identify whether antibody properties correlate with clinical benefit of COVID-19 convalescent plasma.
There’s reason to believe this approach might work. A study published this week in the New England Journal of Medicine, found that blood plasma from people who have recovered from COVID-19 can help older adults and prevent them from getting seriously ill with the virus if they get the plasma within a few days of becoming infected.
We are used to thinking of blood donations as being used to help people after surgery or who have been in an accident. In this study the donations serve another purpose, but one that is no less important. The World Health Organization describes blood as “the most precious gift that anyone can give to another person — the gift of life. A decision to donate your blood can save a life, or even several if your blood is separated into its components — red cells, platelets and plasma.”
That plasma could help in developing more effective treatments against the virus. Because until we have enough vaccines for everyone, we are still going to need as much help as we can get in fighting COVID-19. The recent surge in cases throughout the US and Europe are a reminder that this virus is far from under control. We have already lost far too many people. So, if you have recently recovered from the virus, or know someone who has, consider donating blood to this study. It could prove to be a lifesaver.
For more information about the study and how you can be part of it, click here.
Dr. Gil Sambrano, Vice President Portfolio & Review
All this month we are using our blog and social media to highlight a new chapter in CIRM’s life, thanks to the voters approving Proposition 14. We are looking back at what we have done since we were created in 2004, and also looking forward to the future.Today we take a look at our Review team.
Many people who have to drive every day don’t really think about what’s going on under the hood of their car. As long as the engine works and gets them from A to B, they’re happy. I think the same is true about CIRM’s Review team. Many people don’t really think about all the moving parts that go into reviewing a promising new stem cell therapy.
But that’s a shame, because they are really missing out on watching a truly impressive engine at work.
Just consider the simple fact that since CIRM started about 4,000 companies, groups and individuals have applied to us for funding. Just take a moment to consider that number. Four thousand. Then consider that at no time have there been more than 5 people working in the review team. That’s right. Just 5 people. And more recently there have been substantially fewer. That’s a lot of projects and not a lot of people to review them. So how do they do it? Easy. They’re brilliant.
First, as applications come in they are scrutinized to make sure they meet specific eligibility requirements; do they involve stem cells, is the application complete, is it the right stage of research, is the budget they are proposing appropriate for the work they want to do etc. If they pass that initial appraisal, they then move on to the second round, the Grants Working Group or GWG.
The GWG consists of independent scientific experts from all over the US, all over the world in fact. However, none are from California because we want to ensure there are no possible conflicts of interest. When I say experts, I do mean experts. These are among the top in their field and are highly sought after to do reviews with the National Institutes of Health etc.
Mark Noble, PhD, the Director of the Stem Cell and Regenerative Medicine Institute at the University of Rochester, is a long-time member of the GWG. He says it’s a unique group of people:
“It’s a wonderful scientific education because you come to these meetings and someone is putting in a grant on diabetes and someone’s putting in a grant on repairing the damage to the heart or spinal cord injury or they have a device that will allow you to transplant cells better and there are people in the room that are able to talk knowledgeably about each of these areas and understand how this plays into medicine and how it might work in terms of actual financial development and how it might work in the corporate sphere and how it fits in to unmet medical needs . I don’t know of any comparable review panels like this that have such a broad remit and bring together such a breadth of expertise which means that every review panel you come to you are getting a scientific education on all these different areas, which is great.”
The GWG reviews the projects for scientific merit: does the proposal seem plausible, does the team proposing it have the experience and expertise to do the work etc. The reviewers put in a lot of work ahead of time, not just reviewing the application, but looking at previous studies to see if the new application has evidence to support what this team hope to do, to compare it to other efforts in the same field. There are disagreements, but also a huge amount of respect for each other.
Once the GWG makes its recommendations on which projects to fund and which ones not to, the applications move to the CIRM Board, which has the final say on all funding decisions. The Board is given detailed summaries of each project, along with the recommendations of the GWG and our own CIRM Review team. But the Board is not told the identity of any of the applicants, those are kept secret to avoid even the appearance of any conflict of interest.
The Board is not required to follow the recommendations of the GWG, though they usually do. But the Board is also able to fund projects that the GWG didn’t place in the top tier of applications. They have done this on several occasions, often when the application targeted a disease or disorder that wasn’t currently part of the agency’s portfolio.
So that’s how Review works. The team, led by Dr. Gil Sambrano, does extraordinary work with little fanfare or fuss. But without them CIRM would be a far less effective agency.
The passage of Proposition 14 means we now have a chance to resume full funding of research, which means our Review team is going to be busier than ever. They have already started making changes to the application requirements. To help let researchers know what those changes are we are holding a Zoom webinar tomorrow, Thursday, at noon PST. If you would like to watch you can find it on our YouTube channel. And if you have questions you would like to ask send them to info@cirm.ca.gov
3d illustration of brain nerve cells – Photo courtesy Science Photo
If you don’t know what’s causing a problem it’s hard to come up with a good way to fix it. Mental health is the perfect example. With a physical illness you can see what the problem is, through blood tests or x-rays, and develop a plan to tackle it. But with the brain, that’s a lot harder. You can’t autopsy a brain while someone is alive, they tend to object, so you often only see the results of a neurological illness when they’re dead.
And, says Consuelo Walss-Bass, PhD, a researcher at the University of Texas Health Science Center at Houston (UTHealth), with mental illness it’s even more complicated.
“Mental health research has lagged behind because we don’t know what is happening biologically. We are diagnosing people based on what they are telling us. Even postmortem, the brain tissue in mental health disorders looks perfectly fine. In Alzheimer’s disease, you can see a difference compared to controls. But not in psychiatric disorders.”
So Wals-Bass and her team came up with a way to see what was going on inside the brain of someone with schizophrenia, in real time, to try and understand what puts someone at increased risk of the disorder.
In the study, published in the journal Neuropsychopharmacology, the researchers took blood samples from a family with a high incidence of schizophrenia. Then, using the iPSC method, they turned those cells into brain neurons and compared them to the neurons of individuals with no family history of schizophrenia. In effect, they did a virtual brain biopsy.
By doing this they were able to identify five genes that had previously been linked to a potential higher risk of schizophrenia and then narrow that down further, highlighting one gene called SGK1 which blocked an important signalling pathway in the brain.
In a news release, Walss-Bass says this findings could have important implications in treating patients.
“There is a new antipsychotic that just received approval from the Food and Drug Administration that directly targets the pathway we identified as dysregulated in neurons from the patients, and several other antipsychotics also target this pathway. This could help pinpoint who may respond better to treatments.”
Finding the right treatment for individual patients is essential in helping them keep their condition under control. A study in the medical journal Lancet estimated that six months after first being prescribed common antipsychotic medication, as many as 50% of patients are either taking the drugs haphazardly or not at all. That’s because they often come with unpleasant side effects such as weight gain, drowsiness and a kind of restless anxiety.
By identifying people who have specific gene pathways linked to schizophrenia could help us better tailor medications to those who will benefit most by them.
Legend has it that Thomas Edison “failed” 1,000 times before he managed to create the incandescent lightbulb. Edison says he didn’t get discouraged, instead he looked at each unsuccessful experiment as being one step closer to finding the method that really worked. That’s a lesson in optimism and persistence for all of us.
Lineage Cell Therapeutics has that same spirit. Lineage is trying to develop a stem cell therapy to help people with spinal cord injuries. CIRM invested $14.3 million in the first version of this approach which produced encouraging results. But encouraging is not enough. So, Lineage set about doing a complete overhaul of the therapy known as OPC1.
The idea behind it is to turn embryonic stem cells into oligodendrocyte progenitor cells (OPCs). These OPCs are precursors to cells that play an important role in supporting and protecting nerve cells in the central nervous system, the area damaged in a spinal cord injury. By transplanting these cells at the injury site it’s hoped they will help restore some of the broken connections, allowing patients to regain some movement and feeling.
In the original trial many patients, who had been paralyzed from the chest down, regained some use of their arms, hands and even fingers. This was better than any previous therapy had managed. But for Lineage it wasn’t good enough. So, they set about redesigning their whole manufacturing process, making improvements at every step along the way.
In a news release they outlined those improvements:
A new ready-to-inject formulation of OPC1, which enables clinical use at a much larger number of spinal cord treatment centers, accelerating enrollment for a larger and potentially registrational clinical trial.
Elimination of dose preparation, reducing overall preparation time from 24 hours to 30 minutes and cutting logistics costs by approximately 90%.
A 10 to 20-fold increase in OPC1 production scale, sufficient to support late-stage clinical development and which can be further scaled to meet initial commercial use.
A 50-75% reduction in product impurities.
Improvements in OPC1 functional activity, as assessed by cellular migration and secretion of key growth factors.
They also came up with new quality control tests to make sure everything was working well and eliminated all animal-based production reagents.
Brian Culley, Lineage CEO was, understandably, enthusiastic about the changes and its prospects for helping people with spinal cord injuries:
“Manufacturing is the foundation of cell therapy and the significant enhancements we have achieved with OPC1 marks the second time we have successfully transformed a research-grade production process into one capable of supporting a successful commercial product. Our objective is to be the premier allogeneic cell therapy company and our dedication to manufacturing excellence allows us not only to reduce or eliminate certain regulatory and commercial hurdles, but also establish strong competitive barriers in our field.”
Lineage are now hoping to go back to the Food and Drug Administration (FDA) in the near future and get permission to run another clinical trial.
Here are stories of the impact the first generation of this approach have already had on people.
Heart muscle cells in an uninfected mouse (left) and a mouse infected with SARS-CoV-2 (right) with mitochondria seen in pink. The disorganization of the cells and mitochondria in the image at right is associated with irregular heartbeat and death.
Image credit: UCLA Broad Stem Cell Center
As the worldwide coronavirus pandemic rages on, scientists are trying to better understand SARS-CoV-2, the virus that causes COVID-19, and the effects that it may have beyond those most commonly observed in the lungs. A CIRM-funded project at UCLA, co-led by Vaithilingaraja Arumugaswami, Ph.D. and Arjun Deb, M.D. discovered that SARS-CoV-2 can organ failure in the heart, kidney, spleen, and other vital organs of mice.
Mouse models are used to better understand the effects that a disease can have on humans. SARS-CoV-2 relies on a protein named ACE2 to infect humans. However, the virus doesn’t recognize the mouse version of the ACE2 protein, so healthy mice exposed to the SARS-CoV-2 virus don’t get sick.
To address this, past experiments by other research teams have genetically engineered mice to have the human version of the ACE2 protein in their lungs. These teams then infected the mice, through the nose, with the SARS-CoV-2 virus. Although this process led to viral infection in the mice and caused pneumonia, they don’t get as broad a range of other symptoms as humans do.
Previous research in humans has suggested that SARS-CoV-2 can circulate through the bloodstream to reach multiple organs. To evaluate this further, the UCLA researchers genetically engineered mice to have the human version of the ACE2 protein in the heart and other vital organs. They then infected half of the mice by injecting SARS-CoV-2 into their bloodstreams and compared them to mice that were not infected. The UCLA team tracked overall health and analyzed how levels of certain genes and proteins in the mice changed.
Within seven days, all of the mice infected with the virus had stopped eating, were completely inactive, and had lost an average of about 20% of their body weight. The genetically engineered mice that had not been infected with the virus did not lose a significant amount of weight. Furthermore, the infected mice had altered levels of immune cells, swelling of the heart tissue, and deterioration of the spleen. All of these are symptoms that have been observed in people who are critically ill with COVID-19.
What’s even more surprising is that the UCLA team also found that genes that help cells generate energy were shut off in the heart, kidney, spleen and lungs of the infected mice. The study also revealed that some changes were long-lasting throughout the organs in mice with SARS-CoV-2. Not only were genes turned off in some cells, the virus made epigenetic changes, which are chemical alterations to the structure of DNA that can cause more lasting effects. This might help explain why some people that have contracted COVID-19 have symptoms for weeks or months after they no longer have traces of the virus in their body.
In a UCLA press release, Dr. Deb discusses the importance and significance of their findings.
“This mouse model is a really powerful tool for studying SARS-CoV-2 in a living system. Understanding how this virus can hijack our cells might eventually lead to new ways to prevent or treat the organ failure that can accompany COVID-19 in humans.”
The full results of this study were published in JCI Insight.
Gaurav Shah, M.D., CEO and President of Rocket Pharmaceuticals
Leukocyte Adhesion Deficiency-I (LAD-I) is a rare pediatric disease caused by a mutation in a specific gene that causes low levels of a protein called CD18. Due to low levels of CD18, the adhesion of immune cells is affected, which negatively impacts the body’s ability to combat infections.
Rocket Pharmaceuticals is conducting a CIRM-funded ($6.56 M) clinical trial that is testing a treatment that uses a gene therapy called RP-L201. The therapy uses a patient’s own blood stem cells and inserts a functional version of the gene. These modified stem cells are then reintroduced back into the patient. The goal is to establish functional immune cells, enabling the body to combat infections. Previous studies have indicated that an increase in CD18 to 4-10% is associated with survival into adulthood.
The company presented interim data from the trial at the 62nd American Society of Hematology (ASH) Annual Meeting in the form of an oral presentation. The data presented is from three pediatric patients with severe LAD-I, which is defined by CD18 expression of less than 2%. The patients were all treated with RP-L201. Patient One was 9-years of age at enrollment and had been followed for 12-months as of a cutoff date of November 2020. Patient Two was 3-years of age at enrollment and had been followed for over 6-months. Patient Three was 7-months of age at enrollment and was recently treated with RP-L201.
Key highlights from the presentation include:
RP-L201 was well tolerated, no safety issues reported with infusion or post-treatment
All patients achieved hematopoietic (blood) reconstitution within 5-weeks
12 months post-treatment, Patient One demonstrated durable CD18 expression of approximately 40%,
6-months post-treatment, Patient Two demonstrated CD18 expression of 23%
2-months post-treatment, Patient Three demonstrated CD18 expression of 76%
In a press release from Rocket, Gaurav Shah, M.D., CEO and President of Rocket, expressed excitement about these results.
“…we continue to see encouraging evidence of efficacy for RP-L201 for the treatment of LAD-I. Patients have shown sustained CD18 expression of 23% to 40%, far exceeding the 4-10% threshold associated with survival into adulthood…”
To view the presentations at the conclusion of the oral presentation, click the link here.
Biomedical specialist Mamadou Dialio at work in the Cedars-Sinai Biomanufacturing Center. Photo by Cedars-Sinai.
Following the race to develop a vaccine for COVID-19 has been a crash course in learning how complicated creating a new therapy is. It’s not just the science involved, but the logistics. Coming up with a vaccine that is both safe and effective is difficult enough, but then how do you make enough doses of it to treat hundreds of millions of people around the world?
That’s a familiar problem for stem cell researchers. As they develop their products they are often able to make enough cells in their own labs. But as they move into clinical trials where they are testing those cells in more and more people, they need to find a new way to make more cells. And, of course, they need to plan ahead, hoping the therapy is approved by the Food and Drug Administration, so they will need to be able to manufacture enough doses to meet the increased demand.
We saw proof of that planning ahead this week with the news that Cedars-Sinai Medical Center in Los Angeles has opened up a new Biomanufacturing Center.
Dr. Clive Svendsen, executive director of the Cedars-Sinai Board of Governors Regenerative Medicine Institute, said in a news release, the Center will manufacture the next generation of drugs and regenerative medicine therapies.
“The Cedars-Sinai Biomanufacturing Center leverages our world-class stem-cell expertise, which already serves scores of clients, to provide a much-needed biomanufacturing facility in Southern California. It is revolutionary by virtue of elevating regenerative medicine and its therapeutic possibilities to an entirely new level-repairing the human body.”
This is no ordinary manufacturing plant. The Center features nine “clean rooms” that are kept free from dust and other contaminants. Everyone working there has to wear protective suits and masks to ensure they don’t bring anything into the clean rooms.
The Center will specialize in manufacturing induced pluripotent stem cells, or iPSCs. Dhruv Sareen, PhD, executive director of the Biolmanufacturing Center, says iPSCs are cells that can be turned into any other kind of cell in the body.
“IPSCs are powerful tools for understanding human disease and developing therapies. These cells enable us to truly practice precision medicine by developing drug treatments tailored to the individual patient or groups of patients with similar genetic profiles.”
The Biomanufacturing Center is designed to address a critical bottleneck in bringing cell- and gene-based therapies to the clinic. After all, developing a therapy is great, but it’s only half the job. Making enough of it to help the people who need it is the other half.
CIRM is funding Dr. Svendsen’s work in developing therapies for ALS and other diseases and disorders.
Jasper Therapeutics, Inc., a biotechnology company focused on blood stem cell therapies, and Graphite Bio, Inc., a biotechnology company focused on gene editing therapies to treat or cure serious diseases, announced a research and clinical collaboration for a treatment for X-SCID.
X-SCID, which stands for X-linked severe combined immunodeficiency, is a genetic disorder that interferes with the normal development of the immune system, leaving infants vulnerable to infections that most people can easily fight off. One treatment for X-SCID involves a blood stem cell transplant, in which the patient’s defective stem cells are wiped out with chemotherapy or radiation to make room for normal blood stem cells to take their place. Unfortunately, the problem with chemotherapy or radiation in young infants is that it can lead to lifelong effects such as neurological impairment, growth delays, infertility, and risk of cancer.
Fortunately, Jasper Therapeutics has developed JSP191, a non-toxic alternative to chemotherapy and radiation. It is an antibody that works by targeting and removing the defective blood forming stem cells. The approach has previously been used in a CIRM-funded clinical trial ($20M award) for X-SCID.
Graphite Bio has developed GPH201, the first-in-human investigational blood stem cell treatment that will be evaluated as a potential cure for patients suffering from X-SCID. GPH201 is generated using precise and efficient gene editing technology, It works by directly replacing a defective gene that causes problems with the immune system. The hope is that GPH201 will ultimately lead to the production of fully functional, healthy immune cells.
The ultimate goal of this collaboration is to use JSP191 as the non-toxic alternative to chemotherapy in patients in order to remove their defective blood stem cells. After that, the gene editing blood stem cell technology developed by Graphite Bio can be introduced to patients in order to treat X-SCID. The two companies have agreed to collaborate on research, and potentially a clinical study, evaluating JSP191 as the non-toxic conditioning agent for GPH201.
In a press release, Josh Lehrer, M.Phil., M.D., chief executive officer at Graphite Bio, expressed excitement about the collaboration between the two companies.
“This collaboration with Jasper demonstrates our shared commitment to pioneering novel therapeutic approaches with the potential to significantly improve the treatment experiences of individuals with devastating conditions who stand to benefit from gene replacement therapies, initially for patients with XSCID. GPH201 harnesses our targeted gene integration platform to precisely target the defective gene that causes XSCID and replace it with a normal copy.”
In the same press release, Bill Lis, executive chairman and CEO of Jasper Therapeutics, also expressed optimism in regards to the two companies teaming up.
“Our collaboration with Graphite Bio is an exciting opportunity to further advance the field of curative gene correction by combining a targeted gene integration platform with our first-in-class targeted CD117 antibody, JSP191, that has already demonstrated preliminary clinical efficacy and safety as a conditioning agent in X-SCID patients and those with blood cancers undergoing allogeneic hematopoietic stem cell transplant.”
Graphite Bio is also developing gene editing technology to help treat sickle cell disease. It is currently supported by a CIRM late stage preclinical grant ($4.8M award). Th goal is to complete the final preclinical studies, which will allow Graphite Bio to start clinical studies of the sickle cell disease gene therapy in sickle cell patients in 2021.
