OCASCR scientists make progress in TSET-funded adult stem cell research – NewsOK.com

OCASCR scientist Lin Liu at work. Photo provided.

Working together, scientists from Oklahoma State University, the University of Oklahoma Health Sciences Center and the Oklahoma Medical Research Foundation are advancing adult stem cell research to treat some of todays most devastating diseases.

Under the umbrella of the Oklahoma Center for Adult Stem Cell Research (OCASCR), created with funding from the Oklahoma Tobacco Settlement Endowment Trust, these scientists have amassed groundbreaking findings in one of the fastest growing areas of medical research.

We have made exciting progress, said OCASCR scientist Lin Liu, director of the Oklahoma Center for Respiratory and Infectious Diseases and director of the Interdisciplinary Program in Regenerative Medicine at Oklahoma State University.

We can convert adult stem cells into lung cells using our engineering process in petri dishes, which offers the possibility to repair damaged lung tissues in lung diseases, said Liu, whose research primarily focuses on lung and respiratory biology and diseases.

Using our engineered cells, we can also reverse some pathological features. These studies give us hope for an eventual application of these cells in humans.

Adult stem cells in the body are capable of renewing themselves and becoming various types of cells.

Until recently, stem cell treatments were largely restricted to blood diseases. However, new studies suggest many other types of adult stem cells can be used for medical treatment, and the Oklahoma Center for Adult Stem Cell Research was created to promote this branch of research.

OCASCR scientist Lin Liu and his team discussing their work. Photo provided.

Liu said the discipline provides hope for many ailments.

What most fascinated me in stem cell research is the hope that we may be able to use stem cells from our own body; for example, bone marrow or fat tissues to cure lung diseases, Liu said.

It is impossible to know exactly which diseases will respond to treatments.However, results of early experiments suggest many diseases should benefit from this type of research, including lung, heart, Alzheimers and Parkinsons diseases, as well as cancer, diabetes and spinal cord injuries. The field is often referred to as regenerative medicine, because of the potential to create good cells in place of bad ones.

While the application of stem cells can be broad, Liu hopes that his TSET-funded work will help develop treatments for diseases caused by tobacco use.

The goal of my research team is to find cures for lung diseases, Liu said. One such disease is chronic obstructive pulmonary disease (COPD).

COPD is the third leading cause of death in the country and cigarette smoking is the leading cause of COPD.

Cigarette smoking is also a risk factor for another fatal lung disease, idiopathic pulmonary fibrosis (IPF), which has a mean life expectancy of 3 to 5 years after diagnosis, he added.

There is no cure for COPD or IPF. The current treatments of COPD and IPF only reduce symptoms or slow the disease progression.

Using OCASCR/TSET funding, my team is researching the possibility to engineer adult stem cells using small RNA molecules existing in the body to cure COPD, IPF and other lung diseases such as pneumonia caused by flu, Liu said.

This is vital research, considering that more than11 million peoplehave been diagnosed with COPD, but millions more may have the disease without even knowing it, according to the American Lung Association.

Despite declining smoking rates and increased smokefree environments, tobacco use continues to cause widespread health challenges and scientists will continue working to develop treatments to deal with the consequences of smoking.

We need to educate the public more regarding the harms of cigarette smoking, Liu said. My research may offer future medicines for lung diseases caused by cigarette smoking.

Under the umbrella of the Oklahoma Center for Adult Stem Cell Research (OCASCR), created with funding from the Oklahoma Tobacco Settlement Endowment Trust, these scientists have amassed groundbreaking findings in one of the fastest growing areas of medical research. Photo provided.

Liu has been conducting research in the field of lung biology and diseases for more than two decades.

However, his interests in adult stem cell therapy began in 2010 when OCASCR was established through a grant with TSET, which provided funding to Oklahoma researchers for stem cell research.

I probably would have never gotten my feet into stem cell research without OCASCR funding support, he said. OCASCR funding also facilitated the establishment of the Interdisciplinary Program in Regenerative Medicine at OSU.

These days, Liu finds himself fully immersed in the exciting world of adult stem cell research and collaborating with some of Oklahomas best scientific minds.

Dr. Liu and his colleagues are really thriving. It was clear seven years ago that regenerative medicine was a hot topic and we already had excellent scientists in the Oklahoma, said Dr. Paul Kincade, founding scientific director of OCASCR. All they needed was some resources to re-direct and support their efforts. OSU investigators are using instruments and research grants supplied by OCASCR to compete with groups worldwide. TSET can point to their achievements with pride.

The Oklahoma Center for Adult Stem Cell Research represents collaboration between scientists all across the state, aiming to promote studies by Oklahoma scientists who are working with stem cells present in adult tissues.

The center opened in 2010 and has enhanced adult stem cell research by providing grant funding for researchers, encouraging recruitment of scientists and providing education to the people of Oklahoma.

We are fortunate that the collaboration at the Oklahoma Center for Adult Stem Cell Research is yielding such positive results, said John Woods, TSET executive director. This research is leading to ground breaking discoveries and attracting new researchers to the field. TSET is proud to fund that investments for Oklahomans.

Funding research is a major focus for TSET and it comes with benefits reaching beyond the lab. For every $1 TSET has invested at OCASCR, scientists have been able to attract an additional $4 for research at Oklahoma institutions, TSET officials said.

TSET also supports medical research conducted by the Stephenson Cancer Center and the Oklahoma Tobacco Research Center.

For more information, visit http://www.ocascr.org.

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‘Economical stem cell treatment will revolutionise medicine’ – The Hindu

Cost-effective stem cell treatment has to be the next revolution to transform personalised treatment of patients, said Hunterian Professorship Awardee A.A.Shetty. Speaking at a felicitation function, Dr. Shetty said there is a need to create awareness about stem cells and patient-specific treatment specifically designed for individuals.

It is going to be simple, with minimal complications. Our role is to make it cost effective. Once it happens, it will revolutionise treatment, said Dr. Shetty.

Surgery using stem cell technology is developing at a rapid pace and the role of stem cell therapy in Orthopaedics is gaining importance, said Trauma and Orthopaedic Speciality Hospital (TOSH) Managing Director S.H. Jaheer Hussain. The ability of stem cells to transform into bone and cartilage has given a new dimension in the treatment of osteoarthritis, fracture non union, ligament tears. Stem cells have shown significant clinical results in osteoarthritis and cartilage defects. Recent advances in stem cells centrifuging techniques have lead to the introduction of the new concept of single- stage knee cartilage regeneration.

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SEQUEIRA: Stem cell research must remain in foreground – University of Virginia The Cavalier Daily

OPINION Where will studies fall in the Trump administrations line of immediacy? by Sean Sequeira | Feb 09 2017 | 17 hours ago | Updated 17 hours ago

As President Trumps cabinet ossifies into its final form, several Americans predict that many policy consistencies of the past are now at risk. One place of consistency is the landscape of stem cell research. The impacts Trumps administration might have on biomedical science are still uncertain. Indeed, some cabinet appointments have incited fear in Americans who rely on stem cell therapy or perform research or work at institutions where stem cell research is a vital component of grants and general revenue. While uniformly and staunchly conservative, the Trump administration must ensure continuity within stem cell research not only to protect jobs and research institutions from bankruptcy, but to also preserve a therapy that might actually be a panacea for a range of maladies.

Stem cells, while controversial and ethically precarious to the public, should be researched and ultimately implemented as a therapeutic solution for patients that simply have no alternative. Specifically, stem cells opponents are against embryonic stem cells, which no longer account for the majority of stem cell research. Currently, the majority of stem cell research is made up of induced pluripotent stem cells, somatic cells which can regress to an embryonic state through regenerative and genetic engineering. With the seminal work of Drs. Takahash and Yamanaka, the ethical rigors associated with embryonic stem cells need not be dealt with.

However, the question arises as to why embryonic stem cells are so insatiably invaluable and why they have immense potential to solve the worlds most enigmatic medical maladies. Indeed, after a zygote forms, the subsequent cells follow a pathway based upon environmental and biological cues similar to how a student follows a pathway to become a doctor, lawyer or businessman. Stem cells are categorized according to the broadness of cell they can become embryonic stem cells are the most versatile whereas adult stem cells, like those found in your bone marrow, are comparatively discrete in their differentiation scope. So, with embryonic stem cells, appropriate cues, and research, we could theoretically program these stem cells to become a pancreas, heart, brain or liver cells. On a macroscale, stem cells provide a conduit through which to build full pancreases for diabetic patients or hearts for heart failure patients, from the ground up. Essentially, with stem cells, we can turn the tide in a seemingly perennial battle with virulent pathologies.

Induced pluripotent stem cells, or iPSCs, are actually adult somatic cells like those found on your skin which revert back to their embryonic state through transcription factors or proteins necessary to develop or progress the fate or state of a cell to a new state. In this case, the Yamanaka factors are four transcription factors are those necessary to combine with adult somatic cells in order to revert the cells back into embryonic stem cells.

Granted, while the discovery of iPSC was a phenomenal one, there is a long road ahead in order to make them a mainstream therapy and to ensure that they are morphologically, molecularly, and functionally identical to their embryonic counterparts. During the Obama administration, research institutions like the National Institute of Health were not only provided the opportunity to research using stem cells, but were also less impeded than they were during the George W. Bush administration in the quantity and quality of research they were able to undertake.

With the new administration, it has become necessary that they scrap their conservative agenda against stem cells and biomedical research by demonstrating to the public they care and see their constituents as people in need of stem cell research. The administration must recognize the ultimate way to defeat unscrupulous stem cell utilization is to fund research to find novel ways to circumvent such controversy.

Sean Sequeira is an Opinion columnist for the Cavalier Daily. He can be reached at s.sequeira@cavalierdaily.com

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SEQUEIRA: Stem cell research must remain in foreground - University of Virginia The Cavalier Daily

Experimental stem cell therapy brings positive results – Manufacturer.com

Kris Boesen works out his upper body after being part of a new stem cell trial. Image courtesy of Greg Iger

USC researchers have potentially discovered the secret to treating paraplegic injuries using stem cells.

A team of doctors from the Keck Medical Center of USC have become the first in California to inject a patient with an experimental treatment made from stem cells as part of a multi-center clinical trial.

The patient in question is Kristopher (Kris) Boesen, a 21-year-old who on March 6 last year suffered a traumatic injury to his cervical spine after his car fishtailed on a wet road and slammed into both a tree and telephone pole.

Kris parents were told that there was a good chance their son would be permanently paralyzed from the neck down. That was until the Keck Medical Center of USCs surgical team offered them hope in the form of an injection of an experimental dose of 10 million AST-OPC1 cells directly into Kris cervical spinal cord just one month after his accident.

Now nine months after this injection and Kris is one of six patients to have lost all motor and sensory function below the injury site that have shown additional motor function improvement after both six months and nine months of treatment with 10 million AST-OPC1.

The stem cell procedure received by the six patients is part of a Phase 1/2a clinical trial which is evaluating the safety and efficacy of escalating doses of AST-OPC1 cells developed by biotechnology company Biotherapeutics Inc.

The positive efficacy results from this study and the effect it has had on the five patients were announced on January 24 at a press conference held by Biotherapeutics Inc.

The positive results in regards to improvements in upper extremity motor function were measured using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) scale. The trial saw improvements in Upper Extremity Motor Score and also Motor Level Improvement amongst the six patients.

For the five patients who completed at least six months of follow-up, all five patients saw early improvements in their motor score (UEMS) at three months maintained or further increased through their most recent data point of either six or nine months.

And for patients completing at least six months of follow-up, all five achieved at least one motor level improvement over baseline on at least one side, and two of the five had achieved two motor levels over baseline on at least one side, while one patient achieved a two motor level improvement on both sides.

The trial results reveal a positive safety profile for AST-OPC1, as there have been no serious adverse events from the study which indicates that AST-OPC1 can be safely administered to patients in the subacute period after severe cervical spinal cord injury.

Dr Richard Fessler is the professor in the department of neurosurgery at Rush University Medical Center, one of six centers in the US currently studying this new stem cell treatment.

Dr Fessler said the new treatment was bringing improvements to the patients lives involved in the trial: With these patients, we are seeing what we believe are meaningful improvements in their ability to use their arms, hands and fingers at six months and nine months following AST-OPC 1 administration.

Recovery of upper extremity motor function is critically important to patients with complete cervical spinal cord injuries, since this can dramatically improve quality of life and their ability to live independently.

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Engineering thyroid cells from stem cells may lead to new therapies – Medical News Today

Scientists have found a way to efficiently engineer new thyroid cells from stem cells. The discovery, performed in mice, is the first step toward engineering new human thyroid cells in order to better study and treat thyroid diseases.

A report on the work - led by Boston University School of Medicine (BUSM) in Massachusetts - is published in the journal Stem Cell Reports.

The thyroid is a gland in the middle of the lower neck. Although only small, it produces hormones that reach every cell, organ, and tissue to help control metabolism - the rate at which the body makes energy from nutrients and oxygen.

Thyroid diseases are common conditions in which the gland is either overactive and produces too much hormone (hyperthyroidism), or underactive and produces too little (hypothyroidism).

It is thought that around 20 million people in the United States are living with some form of thyroid disease, the causes of which are largely unknown.

Most thyroid disorders are chronic or life-long conditions that can be managed with medical attention. However, approximately 60 percent of cases are undiagnosed.

Undiagnosed thyroid diseases can lead to serious conditions, such as cardiovascular diseases, infertility, and osteoporosis.

Stem cells are cells that have the potential to mature into many different cell types. Particular patterns of genetic switches and signals direct the maturing stem cells toward their individual fates.

Fast facts about hyperthyroidism

Learn more about hyperthyroidism

In their study, the researchers found a way to coax genetically modified embryonic stem cells from mice to develop into thyroid cells.

They discovered that there is a "window of opportunity" for doing this efficiently that occurs during cell development.

As they guided the laboratory-cultured embryonic stem cells through various stages of development, the researchers switched a gene called Nkx2-1 on and off for short periods.

They discovered a small timeframe during which the Nkx2-1 gene is switched on that converts the majority of the stem cells into thyroid cells.

Researchers believe that the discovery is the first step toward an effective human stem cell protocol for creating research models and new treatments for thyroid diseases. The principle may also apply to other cell types, they add.

In their paper, they note that stem cells hold great promise as a way to mass produce differentiated cells for research. However, a major roadblock to achieving high yields has been "the poor or variable differentiation efficiency of many differentiation protocols."

"This method resulted in high yield of our target cell type, thyroid cells, but it may be applicable for the derivation of other clinically relevant cell types such as lung cells, insulin-producing cells, liver cells, etc."

Senior author Prof. Laertis Ikonomou, BUSM

Learn how scientists used stem cells to restore testosterone.

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Experimental Stem Cell Therapy Stops Multiple Sclerosis In Its … – Vocativ

The prognosis for people affected by multiple sclerosis (MS), a degenerative autoimmune disorder that decimates the central nervous system, is a bleak one. The disease oftenbegins with a sudden burst of neurological symptoms like muscle spasms, vision problems, and trouble walking, then progresses differently, depending on which form of MS someone has. But eventually, nearly everyone with the disease comesto the point of being unable to move, breathe, or live independently. And sufferers on average live anywhere from five to ten years less than the general public.

Currently, the best medications we have available do little more than slow MS down, or tamp down peoples symptoms. But an experimental therapy continues to provide the first glimmers of something ground-breaking an actual way to stop one form of the disease in its tracks, and maybe even reverse some of the damage already done.

In this months Neurology, researchers detailed the final five-year-old results of a small clinical trial called HALT-MS. Twenty-four volunteers with MS who hadnt responded to conventional drugs were first given a powerful form of chemotherapy, high-dose immunosuppressive therapy (HDIT), that wiped out their immune system. Then they were given a transplant of their own stem cells taken out earlier, known as autologous hematopoietic cell transplant (HCT). These purified cells, the researchers theorized, would seed a new generation of uncorrupted white blood cells and reset the immune system, freezing MS in its place.

For the most part thats exactly what the combination HDIT/HCT therapy did. Nearly 70 percent of patients, five years in, have experienced no signs of the disease progressing. They havent had a relapse of symptoms, become more disabled, or had new brain lesions show up in imaging exams. Some have actually improved physically in the years since the treatment. And even those not in complete remission appear to be suffering less than before. Importantly, though the treatment isnt free of side-effects, there havent been severe ones. There were three deaths seen during the trial, all of whom experienced worsening MS, but none were attributed to the treatment.

The volunteers all had relapsing-remitting MS, the most common form, in which symptoms come and go with little rhyme or reason.

The evidence at this time is encouraging, but it isnt definitive, study author Dr. Linda Griffith, a researcher at the National Institute of Allergy and Infectious Diseases (NIAID), which sponsored the study, told Vocativ.

As Vocativ has previously reported, this isnt the first trial to find similar success rates for HDIT/HCT, though it does come with its own dangers. Patients can die from it, and like all kinds of chemotherapy, the deliberate weakening of the immune system often leads to more infections. It also doesnt seem to be as effective for more advanced types of MS, when the disease has stopped causing active inflammation, said Griffith. And while it could be promising for people in the earliest stages of MS, the research needed to promote it as a first-line treatment isnt there yet either, she added.

For now, the only trials of HDIT/HCT have been small and isolated. And though the effects of it when successful seem to extend as far out as 13 years later, its too early to call it a full-on cure. We still dont have a clear grasp of why MS happens in the first place, but its thought that multiple triggers like infections and unlucky genetics combine to increase peoples risk. So even if resetting someones immune system does treat MS completely, its plausible that some percentage of patients could fall victim to it again down the road, Griffith explained. We just dont know enough right now.

But Griffith is hopeful that larger, randomized studies will be underway within the next year or so. And if those prove to be as successful as the HALT-MS trial and others, the therapy could someday soon lead to a light at the end of tunnel for the millions of MS sufferers alive today.

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BioTime Acquires Retinal Repair Cell Therapy from UPMC – Genetic Engineering & Biotechnology News

Regenerative medicine company BioTime expanded its ophthalmology portfolio through the acquisition of global rights to the University of Pittsburgh Medical Centers (UPMC) stem cell-derived retinal repair platform IP. The cell therapy technology, developed in partnership with BioTime, generates 3-D retinal tissue from human pluripotent stem cells for use as implants to repair retinas in patients with advanced retinal degradation. The licensing deal has been made through UPMCs Innovation Institute.

We anticipate that this technology, co-developed with the UPMC lab for retinal repair and epigenetics, will allow us to generate three-dimensional laminated human retinal tissue in a controlled manufacturing process," said Michael D. West, Ph.D., co-CEO of BioTime. "This could lead to vision restoration treatments for a variety of blinding retinal degenerative diseases, particularly retinitis pigmentosa, macular degeneration, and diabetic retinopathy, among other diseases and conditions.

BioTime has developed its PureStem pluripotent stem cell technology for generating cell therapies against a range of degenerative diseases. The firms clinical pipeline includes cell therapies for human immunodeficiency virus (HIV)-related lipoatrophy, macular degeneration, leukemia, and spinal cord injury. The lead program, against HIV-related lipatrophy, is undergoing pivotal clinical trials. Preclinical programs are in development against non-small-cell lung cancer and orthopedics. BioTime is separately developing its HyStem hydrogel technology for culturing and delivering therapeutic cells. Its majority-owned OncoCyte subsidiary is leveraging stem cell expertise to develop noninvasive gene expression-based cancer diagnostics.

At the start of 2017, BioTime and its majority-owned subsidiary Cell Cure Neurosciences established a 8600-ft2 cGMP cell therapy manufacturing facility in Jerusalem.

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The next weapon against brain cancer may be human skin – The Verge

Human skin can be morphed into genetically modified, cancer-killing brain stem cells, according to a new study. This latest advance has only been tested in mice but eventually, its possible that it could be translated into a personalized treatment for people with a deadly form of brain cancer.

The study builds on an earlier discovery that brain stem cells have a weird affinity for cancers. So researchers, led by Shawn Hingtgen, a professor at University of North Carolina at Chapel Hill, created genetically engineered brain stem cells out of human skin. Then they armed the stem cells with drugs to squirt directly onto the tumors of mice that had been given a human form of brain cancer. The treatment shrank the tumors and extended survival of the mice, according to results recently published in the journal Science Translational Medicine.

The treatment shrank the tumors and extended survival

Usually we think about stem cell therapy in the context of rebuilding or regrowing a broken body part like a spinal cord. But if they could be modified to become cancer-fighting homing missiles, it would give patients with a deadly and incurable brain cancer called glioblastoma a better chance at survival. Glioblastomas typically affect adults, and are highly fatal because they send out a web of cancerous threads. Even when the main mass is removed, those threads remain despite chemotherapy and radiation treatment. This cancer has caused a number of high-profile deaths including Senator Edward (Ted) Kennedy in 2009, and possibly Beau Biden more recently. Approximately 12,000 new cases of glioblastoma are estimated to be diagnosed in 2017.

We really have no drugs, no new treatment options in years to even decades, Hingtgen says. [We] just really want to create new therapy that can stand a chance against this disease.

But theres a problem: brain stem cells arent exactly easy to get. Brain stem cells, more properly known as neural stem cells, hang out in the walls of the brains irrigation canals areas filled with cerebrospinal fluid, called ventricles. They generate the cells of the nervous system, like neurons and glial cells, throughout our lives.

They could be modified to become cancer-fighting homing missiles

A research group at the City of Hope in California conducted a clinical trial to make sure it was safe to treat glioblastoma patients with genetically engineered neural stem cells. But they used a neural stem cell line that theyd obtained from fetal tissue. Since the stem cells werent the patients own, people who were genetically more likely to reject the cells couldnt receive the treatment at all. For the people who could, treatment with the neural stem cells turned out to be relatively safe although at this phase of clinical trials, it hasnt been particularly effective.

More personalized treatments have been held up by the challenge of getting enough stem cells out of the patients own brains, which is virtually impossible, says stem cell scientist Frank Marini at the Wake Forest School of Medicine, who was not involved in this study. You cant really generate a bank of neural stem cells from anybody because you have to go in and resect the brain.

So instead, Hingtgen and his colleagues figured out a way to generate neural stem cells from skin which in the future, could let them make neural stem cells personalized to each patient. For this study, though, Hingtgen and his colleagues extracted the skin cells from chunks of human flesh leftover as surgical waste. That really is the magic piece here, Marini says. Now, all of a sudden we have a neural stem cell that can be used as a tumor-homing vehicle.

That really is the magic piece here.

Using a disarmed virus to infect the cells with a cocktail of new genes, the researchers morphed the skin cells into something in between a skin cell and a neural stem cell. People have turned skin cells back into a more generalized type of stem cell before. But then turning those basic stem cells into stem cells for a certain organ like the brain takes another couple of steps, which takes more time. Thats something that people with glioblastoma dont have.

The breakthrough here is that Hingtgens team figured out how to go straight from skin cells to something resembling a neural stem cell in just four days. The researchers then genetically engineered these induced neural stem cells to arm them with one of two different weapons: One group was equipped with an enzyme that could convert an anti-fungal drug into chemotherapy, right at the cancers location. The other was armed with a protein that binds to the cancer cells and makes them commit suicide in an orderly process called apoptosis.

The researchers tested these engineered neural stem cells in mice that had been injected with human glioblastoma cells, which multiplied out of control to create a human cancer in a mouse body. Both of the weaponized stem cell groups were able to significantly shrink the tumors and keep the mice alive by about an extra 30 days (for scale, mice usually live an average of two years).

Were working as fast as we can.

But injecting the cells directly into the tumor doesnt really reflect how the therapy would be used in humans. Its more likely that a person with glioblastoma would get the bulk of the tumor surgically removed. Then, the idea is that these neural stem cells, generated from the patients own skin, will be inserted into the hole left in the brain. So, the researchers tried this out in mice, and the tumors that regrew after surgery were more than three times smaller in the mice treated with the neural stem cells.

Its a promising start, but it could take a few years still before its in the clinic, Hingtgen says. He and his colleagues started a company called Falcon Therapeutics to drive this new therapy forward. Were working as fast as we can, Hingtgen says. We probably cant help the patients today. Hopefully in a year or two, well be able to help those patients.

One of the things theyll have to figure out first is whether the neural stem cells can travel the much bigger distances in human brains, and whether theyll be able to eliminate every remaining cancer cell. The caveats on this are that, of course, its a mouse study, and whether or not that directly converts to humans is unclear, Marini says. Still, he adds, Theres a very high probability in this case.

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The next weapon against brain cancer may be human skin - The Verge

Clinic claims it has used stem cells to treat Down’s syndrome | New … – New Scientist

Downs: an extra chromosome 21

Department of Clinical Cytogenetics, Addenbrookes Hospital/Science Photo Library

By Andy Coghlan

A CLINIC claims it has used stem cells to treat Downs syndrome in up to 14 people. As far as we know, its the first time that stem cells have been used to treat Downs syndrome, says Jyoti Titus, manager at Nutech Mediworld clinic in New Delhi, India.

The announcement has set alarm bells ringing. Its not clear to independent stem cell or Downs experts how stem cells which can form many types of tissue might treat Downs, a genetic disorder caused by having an extra chromosome. The use of these cells does not make biological sense and may place the babies at considerable risk of side effects,says John Rasko of the International Society for Cellular Therapy.

Clinically proven stem cell therapies are only just starting to become available. The first off-the-shelf stem cell treatment to gain regulatory approval was launched in Japan last year, and prevents transplanted organs from attacking their recipients. A number of research teams are putting other experimental stem cell therapies through stringent clinical trials.

But hundreds of clinics worldwide already offer stem cell treatments unvetted by regulatory authorities. A patent held by the clinics medical director, Geeta Shroff, from 2007 suggests that the cells offered by Nutech Mediworld could be helpful for over 70 types of conditions, from Downs syndrome to Alzheimers disease, and even vegetative states.

The use of stem cells doesnt make sense and may place the babies at considerable risk

Most treatments for children with Downs syndrome centre on support including speech and behavioural therapies. But in a study published last year Shroff, reported that a baby with Downs syndrome developed better understanding, improved limb muscle tone, and the ability to recognise his relatives after receiving stem cells (Journal of Medical Cases, doi.org/bx3v).

Theres no comparison to similar individuals with Downs syndrome, and no indication this therapy had any effect whatsoever, so the author has no basis at all for saying the injections were beneficial, says Elizabeth Fisher at University College London.

But since no other treatment was given, it is evident that the childs improvements were due to stem cell treatment, says Titus. He started babbling and crawling, and his facial features underwent a change. The boy, who lives in Singapore, is now 3 years old. He continues to develop age-appropriate skills, says Titus.

Shroffs study says she injected the cells, developed from a donated embryo, into his blood, back muscles and under his skin, as well as giving them as a nasal spray. Stem cells have an innate ability to repair and regenerate, and that is how the babys condition improved, says Titus.

Theres no obvious way in which this treatment would have worked, says Victor Tybulewicz at the Francis Crick Institute in London. To have any effect, neural stem cells would need to be injected into the brain, he says.

The author appears to have no idea of where [the cells] are going, or what theyre doing, says Fisher. Its even worse now we know theyve treated 14 patients, not just one.

Titus says that the way the cells were developed means recipients dont need immunosuppressants. But Tybulewicz disagrees. I expect the most likely outcome of the injections would have been that they were recognised as foreign and eliminated by the immune system, he says. More details of the biological impact of the stem cells will be revealed in a study that has been submitted for publication, says Titus.

Nutech Mediworld isnt the only clinic offering stem cells. An analysis led by Rasko last year identified 417 unique websites advertising stem cell treatments directly to patients. Of these, 187 were linked to 215 clinics in the US. Thirty-five websites were linked to organisations in India.

Although India introduced national guidelines on clinical stem cell research and treatments a decade ago, these are not legally binding.

This article appeared in print under the headline Clinic claims stem cells treat Downs syndrome

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Clinic claims it has used stem cells to treat Down's syndrome | New ... - New Scientist

From Down syndrome to ‘near normal’? New Delhi clinic makes stem cell claims that worry experts – National Post

A New Delhi clinic that has claimed to help paralyzed Canadians walk again by injecting them with stem cells now says it can use the same treatment to make children with Down syndrome almost near normal.

Nutech Mediworld says it has treated up to 16 newborns, toddlers and older children with Down syndrome. According to its medical director, Geeta Shroff, we have seen that patients actually start improving clinically they become almost at par for their age.

Canadian experts say the bold claim risks raising false expectations and public confusion, much like the now-discredited Liberation therapy for multiple sclerosis, and that its playing off the over-hyped belief stem cells have the potential to cure almost anything.

Its also the latest controversy over stem cell tourism, and the growing number of clinics worldwide marketing pricey, unregulated and unproven treatments.

Nutech Mediworld charges US$5,000 to $6,000 per week for its stem cell-based therapies. The clinic says it has treated such incurable conditions as spinal cord injury and cerebral palsy. Around 20 Canadians have sought treatment at the clinic for paralyzing spinal cord injuries, spending upwards of $US48,000 each. Shroff says some of her patients have regained the ability to walk with walkers.

More recently, she began working with Down syndrome, one of the most common chromosomal disorders worldwide.

Most cases are caused by a random error in cell division. The child ends up with three copies of chromosome 21, instead of the usual two.

That extra copy causes abnormal neuronal development and changes in the central nervous system, Shroff says, leading to persistent developmental delays.

Human embryonic stem cells injected into a childs muscles and bloodstreamcan regenerate and repair that damaged brain, she says. They also work at the genetic level, she claims.

In a single case published last year, Shroff reported treating a two-month-old baby boy in September 2014 diagnosed with Down syndrome at birth. The infant had delayed milestones, lack of speech, subnormal understanding and subnormal motor skills, she wrote.

After two stem cell therapy sessions, the baby started babbling and crawling, she reported. He had improved muscle tone. He was social and was able to recognize near ones.

The child became almost as near normal as possible cognitively

The child became almost as near normal as possible cognitively, Shroff told the Post in an interview. Today, hes talking; hes walking. He was at par with normal children on analysis.

The former infertility specialist uses embryonic stem cells developed from a single fertilized egg donated by an IVF patient 17 years ago. According to Shroff, We have witnessed no adverse events at all.

The Down syndrome treatments, reported by New Scientist, have raised skepticism and alarm. Its not at all clear what cells shes actually putting in patients, says renowned developmental biologist Janet Rossant, senior scientist at the Hospital for Sick Children Research Institute in Toronto.

By just putting them into the bloodstream theres no way to imagine they could contribute to the right tissues.

Embryonic stem cells can also form teratomas benign tumours and masses composed of lung cells, tufts of hair, teeth, bone and other tissues.

The gold standard for any therapy would be a clinical trial comparing treated with untreated children and vetted through proper regulatory systems that clearly she is not going through, Rossant says.

The Ottawa Hospitals Dr. Duncan Stewart, who is leading the first trial in the world of a genetically enhanced stem cell therapy for heart attack, says theres a remote chance embryonic stem cells could help with Down syndrome. But its a stretch. The injected cells would also likely be rejected and die off with days, he believes. If the cells are disappearing within days, how are they working?

This is a very vulnerable population Theyre very vulnerable to people who are selling hope and have no basis for it

This is a very vulnerable population, Stewart adds. Theyre very vulnerable to people who are selling hope and have no basis for it.

But stem cells have taken on almost mystical appeal.

Theyve become a pop culture phenomenon, says healthy policy expert Timothy Caulfield, of the University of Alberta. The field itself is guilty of making breathless announcements about breakthroughs and cutting edge, he says. And people can market that kind of language.

This kind of nonsense doesnt help.

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The Niche – Knoepfler lab stem cell blog

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Beloware the 2016 stem cell predictions I made last year and their status now color-coded near years end. Green is right, orange is mixed bag, and red is flat out wrong.

Overall, I did better than most past years with only having entirely blown it on four.

Stay tuned later this week for my2017 predictions, which looks to be a dramatic year in the field of stem cells and regenerative medicine.

The Score Card on 2016 Predictions

Screenshot from Go, go stem cells

The University of Utah has a nifty stem cell learning resource called Go, Go Stem Cells!

One of the things I like the most about it is that it is interactive. It is also a bit quirky and funny. Both kids and adults will enjoy learning about stem cells this way.

Ive taken a screenshot above to show you the kind of interface.

What do you think of Go, go stem cells?

Do you know of other stem cell educational resources on-line?

Some amniotic stem cell clinics seem to be trying to have their cake and eat it too.

Generally the amniotic stem cell clinics market their products as stem cells and the implication is that living stem cells are used to effectively treat many medical conditions. I have not seen it mentioned that what some of the clinics, perhaps most of them, inject into patients is really a dead extract of amniotic membranes instead. Not living cells.

Are the clinics injecting amniotic stem cells or just a mishmash of dead stuff fromwhat were once cells?For any given clinic selling amniotic stem cells, who knows if what they are injecting is alive or dead.

Continue reading

What are the hottest stem cell trends in the field today?

Depends who you ask, right?

One impartial way to look at stem cell trendsis through the lens of publication citations and the focuses of top stem cell papers. In that perhaps somewhat skewed, but interesting approach, the words used in the titles of the 50 most cited research publications of 2016 with the phrases stem cell(s) in their titles should tell us something interesting.

Fortunately publication citation platforms these days like ISI may it a snap to collect such data with a few tricks. Then I plugged the data into a word cloud generator and ta-da I got the image above.

Cancer is the biggest word. Apparently cancer stem cells arehot in 2016, along with studies specifically on human stem cells with human as the second biggest word.

Continue reading

Dear FDA,

The stem cell clinic clock is ticking on you.

Before the Trump administration rolls in to possibly tie your hands on many important areas of oversight including stem cell clinics, you should take bold action now.

Your CBER branch has been preternaturally quiet on taking actual regulatory actions on stem cell clinics for several years now even though there about 600 such clinics in the U.S. operating without any FDA approvals putting thousands of patients and the stem cell field at risk. Everyone knows that you are now aware of these clinics. One warning letter in a period of years is a drop in the bucket.

For these same past few years you have issued draft guidances that if implemented would substantially changehow you regulate stem cells in ways that would quite helpfully put a stop to the mushrooming stem cell clinic industry.

Youalso held two public meetings on stem cells in 2016, which was historic, and you received both verbal and written comments from stakeholders. The REGROW Act is history and the Cures Act is now law, with important language reinforcing your role in stem cell oversight. The clinics do not by any stretch of the imagination meet the hurdles specified in Cures.

In short, much uncertainty is over. And you havedone your due diligence. The time is rightto tackle the dangerous stem cell clinic problem. You havesent clear signals that you feel strongly about proper stem cell oversight including via a late November opinion piece in the NEJMonly a few weeks ago. But words are not enough.

Issue a large coordinated series of warning letters in the next couple weeks to the scores ofclinics grossly violating your regulations by experimenting on thousands of patients for profit with unapproved drugs.Now is the time.

After Trumps inauguration all bets are off as to whether the new administrations FDA could still do anything about this serious problem. Strike now before his inauguration and make a profound positive difference.

Best regards,

Paul Knoepfler

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The Niche - Knoepfler lab stem cell blog

the-stem-cell-center.com – Stem Cell Rejuvenation Center

Located in beautiful Phoenix, Arizona, we are the originalStem Cell Rejuvenation Center.We havebeenperformingstem cell therapies for over 10years and all of ourprocedures are done on site atour clinic herein Phoenix. Itis our top priority to provide you a safe, clean,sterile and friendly environment.Our Treatment Center is located just 8 minutes from the Phoenix Sky Harbor International Airport and many hotels provide shuttle service to and from our clinic making it ideal for out-of-town visitors. We provide stem cell therapy for a variety of conditions byusing our revolutionarytechnology and treatments to isolate and reinfuse stem cells from a patient's own adipose stroma or fat (also called the Stromal Vascular Fraction (SVF)). We combine the best of technology, nature, and medicine to help improve the quality of our patients' lives. Stem cell therapy is offered to those who are qualified candidates and whom desire treatment.

We are aStem Cell Therapy and Treatment Center, founded in the U.S.A., and performing all therapies within the United States. Neither our patients nor the stem cells that we harvest are transported outside the United States. We use less than minimally manipulated technology to provide Autologous Stem Cell and PRP therapies originally initiated during the 1990's.

To see if you are a candidate, please fill-out this form and provide as much detail as possible.

Our Integrative staff and Physicians use a variety of modalities including Anti-aging and Eclectic medicine. These approaches are usedto treat many injuries and conditions. Below are some links toa journal database maintained by theNIH thatrelate to current research on stem cells and particular conditions......

Degenerative and Debilitating Conditions:

Autoimmune Conditions:

Viral Conditions:

Musculoskeletal Injuries:

Cosmetic and Dermatological:

Please note that although we have supplied links to the research journals above on the use of stem cells for specific conditions, we are not saying that any of these studies would relate to your particular condition, nor that it would even be an effective treatment. Our Autologous Stem Cell Therapy is not an FDA approved treatment for any condition. We provide stem cell therapy (less than manipulated) as a service and as a practice of medicine only. We do not use collagenase in our clinic. Please see the bottom of the FAQ page for more information. Thesejournal articlesare for educational purposes only and are not intended to be used to sell or promote our therapy.

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the-stem-cell-center.com - Stem Cell Rejuvenation Center

Stem Cell Treatment May Help Ease Osteoarthritis Pain …

Last year, Patricia Beals was told she'd need a double knee replacement to repair her severely arthritic knees or she'd probably spend the rest of her life in a wheelchair.

Hoping to avoid surgery, Beals, 72, opted instead for an experimental treatment that involved harvesting bone marrow stem cells from her hip, concentrating the cells in a centrifuge and injecting them back into her damaged joints.

"Almost from the moment I got up from the table, I was able to throw away my cane," Beals says. "Now I'm biking and hiking like a 30-year-old."

A handful of doctors around the country are administering treatments like the one Beals received to stop or even reverse the ravages of osteoarthritis. Stem cells are the only cells in the body able to morph into other types of specialized cells. When the patient's own stem cells are injected into a damaged joint, they appear to transform into chondrocytes, the cells that go on to produce fresh cartilage. They also seem to amplify the body's own natural repair efforts by accelerating healing, reducing inflammation, and preventing scarring and loss of function.

Christopher J. Centeno, M.D., the rehab medicine specialist who performed Beals' procedure, says the results he sees from stem cell therapy are remarkable. Of the more-than-200 patients his Bloomfield, Colo., clinic treated over a two-year period, he says, "two thirds of them reported greater than 50 percent relief and about 40 percent reported more than 75 percent relief one to two years afterward."

According to Centeno, knees respond better to the treatment than hips. Only eight percent of his knee patients opted for a total knee replacement two years after receiving a stem cell injection. The complete results from his clinical observations will be published in a major orthopedic journal later this year.

The Pros and Cons

The biggest advantage stem cell injections seem to offer over more invasive arthritis remedies is a quicker, easier recovery. The procedure is done on an outpatient basis and the majority of patients are up and moving within 24 hours. Most wear a brace for several weeks but still can get around. Many are even able to do some gentle stationary cycling by the end of the first week.

There are also fewer complications. A friend who had knee replacement surgery the same day Beals had her treatment developed life-threatening blood clots and couldn't walk for weeks afterwards. Six months out, she still hasn't made a full recovery.

Most surgeries don't go so awry, but still: Beals just returned from a week-long cycling trip where she covered 20 to 40 miles per day without so much as a tweak of pain.

As for risks, Centeno maintains they are virtually nonexistent.

"Because the stem cells come from your own body, there's little chance of infection or rejection," he says.

Not all medical experts are quite so enthusiastic, however. Dr. Tom Einhorn, chairman of the department of orthopedic surgery at Boston University, conducts research with stem cells but does not use them to treat arthritic patients. He thinks the idea is interesting but the science is not there yet.

"We need to have animal studies and analyze what's really happening under the microscope. Then, and only then, can you start doing this with patients," he says.

The few studies completed to date have examined how stem cells heal traumatic injuries rather than degenerative conditions such as arthritis. Results have been promising but, as Einhorn points out, the required repair mechanisms in each circumstance are very different.

Another downside is cost: The injections aren't approved by the FDA, which means they aren't covered by insurance. At $4,000 a pop -- all out of pocket -- they certainly aren't cheap, and many patients require more than one shot.

Ironically, one thing driving up the price is FDA involvement. Two years ago, the agency stepped in and stopped physicians from intensifying stem cells in the lab for several days before putting them back into the patient. This means all procedures must be done on the same day, no stem cells may be preserved and many of the more expensive aspects of the treatment must be repeated each time.

Centeno says same day treatments often aren't as effective, either.

But despite the sky-high price tag and lack of evidence, patients like Beals believe the treatment is nothing short of a miracle. She advises anyone who is a candidate for joint replacement to consider stem cells first.

"Open your mind up and step into it," she says. "Do it. It's so effective. It's the future and it works."

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Stem Cell Treatment May Help Ease Osteoarthritis Pain ...

World Stem Cell Summit

Cellular Dynamics

Cellular Dynamics International (CDI), a FUJIFILM company, is a leading developer and manufacturer of human cells used in drug discovery, toxicity testing, stem cell banking, and cell therapy development. The Company partners with innovators from around the world to combine biologically relevant human cells with the newest technologies to drive advancements in medicine and healthier living. CDIs technology offers the potential to create induced pluripotent stem cells (iPSCs) from anyone, starting with a standard blood draw, and followed by the powerful capability to develop into virtually any cell type in the human body. Our proprietary manufacturing system produces billions of cells daily, resulting in inventoried iCell products and donor-specific MyCell Products in the quantity, quality, purity, and reproducibility required for drug and cell therapy development. Founded in 2004 by Dr. James Thomson, a pioneer in human pluripotent stem cell research, Cellular Dynamics is based in Madison, Wisconsin, with a second facility in Novato, California. For more information, please visit http://www.cellulardynamics.com, and follow us on Twitter @CellDynamics. FUJIFILM Holdings Corporation, Tokyo, Japan brings continuous innovation and leading-edge products to a broad spectrum of industries, including: healthcare, with medical systems, pharmaceuticals and cosmetics; graphic systems; highly functional materials, such as flat panel display materials; optical devices, such as broadcast and cinema lenses; digital imaging; and document products. These are based on a vast portfolio of chemical, mechanical, optical, electronic, software and production technologies. In the year ended March 31, 2015, the company had global revenues of $20.8 billion, at an exchange rate of 120 yen to the dollar. Fujifilm is committed to environmental stewardship and good corporate citizenship. For more information, please visit: http://www.fujifilmholdings.com.

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World Stem Cell Summit

Regenerative Medicine Conferences | Tissue Engineering …

Sessions/Tracks

The 7th International Conference on Tissue Engineering & Regenerative Medicine which is going to be held during October 02-04, 2017 at Barcelona, Spain will bring together world-class personalities working on stem cells, tissue engineering and regenerative medicine to discuss materials-related strategies for disease remediation and tissue repair.

Tissue Regeneration

In the field of biology, regeneration is the progression of renewal, regeneration and growth that makes it possible for genomes, cells, organ regeneration to natural changes or events that cause damage or disturbance.This study is carried out as craniofacial tissue engineering, in-situtissue regeneration, adipose-derived stem cells for regenerative medicine which is also a breakthrough in cell culture technology. The study is not stopped with the regeneration of tissue where it is further carried out in relation with cell signaling, morphogenetic proteins. Most of the neurological disorders occurred accidental having a scope of recovery by replacement or repair of intervertebral discs repair, spinal fusion and many more advancements. The global market for tissue engineering and regeneration products such as scaffolds, tissueimplants, biomimetic materials reached $55.9 billion in 2010 and it is expected to reach $89.7 billion by 2016 at a compounded annual growth rate (CAGR) of 8.4%. It grows to $135 billion by 2024.

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Designs for Tissue Engineering

The developing field of tissue engineering aims to regenerate damaged tissues by combining cells from the body withbioresorbablematerials, biodegradable hydrogel, biomimetic materials, nanostructures andnanomaterials, biomaterials and tissue implants which act as templates for tissue regeneration, to guide the growth of new tissue by using with the technologies. The global market for biomaterials, nanostructures and bioresorbable materials are estimated to reach $88.4 billion by 2017 from $44.0 billion in 2012 growing at a CAGR of 15%. Further the biomaterials market estimated to be worth more than 300 billion US Dollars and to be increasing 20% per year.

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Organ Engineering

This interdisciplinary engineering has attracted much attention as a new therapeutic means that may overcome the drawbacks involved in the current artificial organs and organtransplantationthat have been also aiming at replacing lost or severely damaged tissues or organs. Tissue engineering and regenerative medicine is an exciting research area that aims at regenerative alternatives to harvested tissues for organ transplantation with soft tissues. Although significant progress has been made in thetissue engineeringfield, many challenges remain and further development in this area will require ongoing interactions and collaborations among the scientists from multiple disciplines, and in partnership with the regulatory and the funding agencies. As a result of the medical and market potential, there is significant academic and corporate interest in this technology.

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Cancer Stem Cells

The characterization of cancer stem cell is done by identifying the cell within a tumor that possesses the capacity to self-renew and to cause theheterogeneous lineagesof cancer cells that comprise the tumor. This stem cell which acts as precursor for the cancer acts as a tool against it indulging the reconstruction of cancer stem cells, implies as the therapeutic implications and challenging the gaps globally. The global stem cell market will grow from about $5.6 billion in 2013 to nearly $10.6 billion in 2018, registering a compound annual growth rate (CAGR) of 3.6% from 2013 through 2018. The Americas is the largest region of globalstem cellmarket, with a market share of about $2.0 billion in 2013. The region is projected to increase to nearly $3.9 billion by 2018, with a CAGR of 13.9% for the period of 2013 to 2018. Europe is the second largest segment of the global stem cell market and is expected to grow at a CAGR of 13.4% reaching about $2.4 billion by 2018 from nearly $1.4 billion in 2013.

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Bone Tissue Engineering

Tissue engineering ofmusculoskeletal tissues, particularly bone and cartilage, is a rapidly advancing field. In bone, technology has centered on bone graft substitute materials and the development of biodegradable scaffolds. Recently, tissue engineering strategies have included cell and gene therapy. The availability of growth factors and the expanding knowledge base concerning the bone regeneration with modern techniques like recombinant signaling molecules, solid free form fabrication of scaffolds, synthetic cartilage, Electrochemical deposition,spinal fusionand ossification are new generated techniques for tissue-engineering applications. The worldwide market for bone and cartilage repairs strategies is estimated about $300 million. During the last 10/15 years, the scientific community witnessed and reported the appearance of several sources of stem cells with both osteo and chondrogenic potential.

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Scaffolds

Scaffolds are one of the three most important elements constituting the basic concept of regenerative medicine, and are included in the core technology of regenerative medicine. Every day thousands of surgical procedures are performed to replace or repair tissue that has been damaged through disease or trauma. The developing field of tissue engineering (TE) aims to regeneratedamaged tissuesby combining cells from the body with highly porous scaffold biomaterials, which act as templates for tissue regeneration, to guide the growth of new tissue. Scaffolds has a prominent role in tissue regeneration the designs, fabrication, 3D models, surface ligands and molecular architecture, nanoparticle-cell interactions and porous of thescaffoldsare been used in the field in attempts to regenerate different tissues and organs in the body. The world stem cell market was approximately 2.715 billion dollars in 2010, and with a growth rate of 16.8% annually, a market of 6.877 billion dollars will be formed in 2016. From 2017, the expected annual growth rate is 10.6%, which would expand the market to 11.38 billion dollars by 2021.

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Tissue Regeneration Technologies

Guided tissue regeneration is defined as procedures attempting to regenerate lost periodontal structures through differential tissue responses. Guidedbone regenerationtypically refers to ridge augmentation or bone regenerative procedures it typically refers to regeneration of periodontal therapy. The recent advancements and innovations in biomedical and regenerative tissue engineering techniques include the novel approach of guided tissue regeneration and combination ofnanotechnologyand regenerative medicine.

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Regeneration and Therapeutics

Regenerative medicinecan be defined as a therapeutic intervention which replaces or regenerates human cells, tissues or organs, to restore or establish normal function and deploys small molecule drugs, biologics, medical devices and cell-based therapies. It deals with the different therapeutic uses like stem cells for tissue repair, tissue injury and healing process, cardiacstem cell therapyfor regeneration, functional regenerative recovery, effects of aging on tissuerepair/regeneration, corneal regeneration & degeneration. The global market is expected to reach $25.5 billion by 2011 and will further grow to $36.1 billion by 2016 at a CAGR of 7.2%. It is expected to reach $65 billion mark by 2024.

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Regenerative medicine

Regenerative medicine is a branch oftranslational researchin tissue engineering and molecular biology which deals with the process of replacing, engineering or regenerating human cells, tissues or organs to restore or establish normal function. The latest developments involve advances in cell and gene therapy and stem cell research, molecular therapy, dental and craniofacial regeneration.Regenerative medicineshave the unique ability to repair, replace and regenerate tissues and organs, affected due to some injury, disease or due to natural aging process. These medicines are capable of restoring the functionality of cells and tissues. The global regenerative medicine market will reach $ 67.6 billion by 2020 from $16.4 billion in 2013, registering a CAGR of 23.2% during forecast period (2014 - 2020). Small molecules and biologics segment holds prominent market share in the overall regenerative medicine technology market and is anticipated to grow at a CAGR of 18.9% during the forecast period.

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Applications of Tissue Engineering

The applications of tissue engineering and regenerative medicine are innumerable as they mark the replacement of medication andorgan replacement. The applications involve cell tracking andtissue imaging, cell therapy and regenerative medicine, organ harvesting, transport and transplant, the application of nanotechnology in tissue engineering and regenerative medicine and bio banking. Globally the research statistics are increasing at a vast scale and many universities and companies are conducting events on the subject regenerative medicine conference like tissue implants workshops, endodontics meetings, tissue biomarkers events, tissue repair meetings, regenerative medicine conferences, tissue engineering conference, regenerative medicine workshop, veterinary regenerative medicine, regenerative medicine symposiums, tissue regeneration conferences, regenerative medicine congress.

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Tumor & Cancer Immunology and Immunotherapy July 17-19, 2017 Chicago, USA; 2nd World Congress on Connective Tissue Diseases Sep 27-29, 2017 Chicago, USA; International Conference on Cell Signalling and Cancer Therapy Aug 20-22, 2017 Paris, France; 14th International Conference on Clinical & Experimental Cardiology November 14-16, 2016 Orlando, Florida, USA; 7th InternationalConference on Tissue Engineering and Regenerative Medicine October 02-04, 2017 Barcelona, Spain; 8th World Congress on Molecular Pathology June 26-28, 2017 San Diego, USA; 2nd International Conference on Tumor & Cancer Immunology and Immunotherapy July 17-19, 2017 Chicago, USA ;9th Annual Conference on Stem Cell and Regenerative Medicine Sep 05-06, 2017 Paris, France; International Conference on Restorative & Alternative Medicine October 24-25, 2016 Chicago, Illinois, USA; 3rd International Conference & Exhibition on Tissue Preservation and Biobanking August 23-24, 2017 San Francisco, USA; 6th International Conference onCell and Gene Therapy Mar 2-3, 2017 Madrid, Spain; 2nd International Conference on Tumor & Cancer Immunology and ImmunotherapyJuly 17-19, 2017 Chicago, USA; 13th European Cardiology Conference December 05-06, 2016 Madrid, Spain; InternationalConference on Molecular BiologyOctober 13-15, 2016 Dubai, UAE; 8th World Congress on Molecular Pathology June 26-28, 2017 San Diego, USA

Regenerative Medicine Market

There are strong pricing pressures from public healthcare payers globally as Governments try to reduce budget deficits. Regenerative medicine could potentially save public health bodies money by reducing the need for long-term care and reducing associated disorders, with potential benefits for the world economy as a whole.The global market fortissue engineeringand regeneration products reached $55.9 billion in 2010, is expected to reach $59.8 billion by 2011, and will further grow to $89.7 billion by 2016 at a compounded annual growth rate (CAGR) of 8.4%. It grows to $135 billion to 2024. The contribution of the European region was 43.3% of the market in 2010, a value of $24.2 billion. Themarketis expected to reach $25.5 billion by 2011 and will further grow to $36.1 billion by 2016 at a CAGR of 7.2%. It grows to $65 billion to 2024.

Related Regenerative Medicine Conferences | Stem Cell Conferences | Stem Cell Congress | Tissue Science Conferences | Europe Conferences | Conference Series LLC

Related Conferences

Tumor & Cancer Immunology and Immunotherapy July 17-19, 2017 Chicago, USA; 7th InternationalConference on Tissue Engineering and Regenerative Medicine October 02-04, 2017 Barcelona, Spain; 6th International Conference onCell and Gene Therapy Mar 2-3, 2017 Madrid, Spain; 2nd International Conference on Tumor & Cancer Immunology and ImmunotherapyJuly 17-19, 2017 Chicago, USA; 13th European Cardiology Conference December 05-06, 2016 Madrid, Spain; InternationalConference on Molecular BiologyOctober 13-15, 2016 Dubai, UAE; 8th World Congress on Molecular Pathology June 26-28, 2017 San Diego, USA; 2nd World Congress on Connective Tissue Diseases Sep 27-29, 2017 Chicago, USA; International Conference on Cell Signalling and Cancer Therapy Aug 20-22, 2017 Paris, France; 14th International Conference on Clinical & Experimental Cardiology November 14-16, 2016 Orlando, Florida, USA; 8th World Congress on Molecular Pathology June 26-28, 2017 San Diego, USA; 2nd International Conference on Tumor & Cancer Immunology and Immunotherapy July 17-19, 2017 Chicago, USA ;9th Annual Conference on Stem Cell and Regenerative Medicine Sep 05-06, 2017 Paris, France; International Conference on Restorative & Alternative Medicine October 24-25, 2016 Chicago, Illinois, USA; 3rd International Conference & Exhibition on Tissue Preservation and Biobanking August 23-24, 2017 San Francisco, USA

Regenerative Medicine Europe

Leading EU nations with strong biotech sectors such as the UK and Germany are investing heavily in regenerative medicine, seeking competitive advantage in this emerging sector. The commercial regenerative medicine sector faces governance challenges that include a lack of proven business models, an immature science base and ethical controversy surrounding hESC research. The recent global downturn has exacerbated these difficulties: private finance has all but disappeared; leading companies are close to bankruptcy, and start-ups are struggling to raise funds. In the UK the government has responded by announcing 21.5M funding for the regenerative medicine industry and partners. But the present crisis extends considerably beyond regenerative medicine alone, affecting much of the European biotech sector. A 2009 European Commission (EC) report showed the extent to which the global recession has impacted on access to VC finance in Europe: 75% of biopharma companies in Europe need capital within the next two years if they are to continue their current range of activities.

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Related Conferences

Tumor & Cancer Immunology and Immunotherapy July 17-19, 2017 Chicago, USA; 2nd World Congress on Connective Tissue Diseases Sep 27-29, 2017 Chicago, USA; International Conference on Cell Signalling and Cancer Therapy Aug 20-22, 2017 Paris, France; 14th International Conference on Clinical & Experimental Cardiology November 14-16, 2016 Orlando, Florida, USA; 7th InternationalConference on Tissue Engineering and Regenerative Medicine October 02-04, 2017 Barcelona, Spain; 6th International Conference onCell and Gene Therapy Mar 2-3, 2017 Madrid, Spain; 2nd International Conference on Tumor & Cancer Immunology and ImmunotherapyJuly 17-19, 2017 Chicago, USA; 13th European Cardiology Conference December 05-06, 2016 Madrid, Spain; InternationalConference on Molecular BiologyOctober 13-15, 2016 Dubai, UAE; 8th World Congress on Molecular Pathology June 26-28, 2017 San Diego, USA;

Embryonic Stem Cell

Embryonic stem cells are pluripotent, meaning they are able to grow (i.e. differentiate) into all derivatives of the three primary germ layers: ectoderm, endoderm and mesoderm. In other words, they can develop into each of the more than 200 cell types of the adult body as long as they are specified to do so. Embryonic stem cells are distinguished by two distinctive properties: their pluripotency, and their ability to replicate indefinitely. ES cells are pluripotent, that is, they are able to differentiate into all derivatives of the three primary germ layers: ectoderm, endoderm, and mesoderm. These include each of the more than 220 cell types in the adult body. Pluripotency distinguishes embryonic stem cells from adult stem cells found in adults; while embryonic stem cells can generate all cell types in the body, adult stem cells are multipotent and can produce only a limited number of cell types. Additionally, under defined conditions, embryonic stem cells are capable of propagating themselves indefinitely. This allows embryonic stem cells to be employed as useful tools for both research and regenerative medicine, because they can produce limitless numbers of themselves for continued research or clinical use.

Related Regenerative Medicine Conferences | Stem Cell Conferences | Stem Cell Congress | Tissue Science Conferences | Europe Conferences | Conference Series LLC

Related Conferences

8th World Congress on Molecular Pathology June 26-28, 2017 San Diego, USA; 2nd International Conference on Tumor & Cancer Immunology and Immunotherapy July 17-19, 2017 Chicago, USA ;9th Annual Conference on Stem Cell and Regenerative Medicine Sep 05-06, 2017 Paris, France; International Conference on Restorative & Alternative Medicine October 24-25, 2016 Chicago, Illinois, USA; 3rd International Conference & Exhibition on Tissue Preservation and Biobanking August 23-24, 2017 San Francisco, USA; Tumor & Cancer Immunology and Immunotherapy July 17-19, 2017 Chicago, USA; 7th InternationalConference on Tissue Engineering and Regenerative Medicine October 02-04, 2017 Barcelona, Spain; 6th International Conference onCell and Gene Therapy Mar 2-3, 2017 Madrid, Spain; 2nd International Conference on Tumor & Cancer Immunology and ImmunotherapyJuly 17-19, 2017 Chicago, USA; 13th European Cardiology Conference December 05-06, 2016 Madrid, Spain; InternationalConference on Molecular BiologyOctober 13-15, 2016 Dubai, UAE; 8th World Congress on Molecular Pathology June 26-28, 2017 San Diego, USA; 2nd World Congress on Connective Tissue Diseases Sep 27-29, 2017 Chicago, USA; International Conference on Cell Signalling and Cancer Therapy Aug 20-22, 2017 Paris, France; 14th International Conference on Clinical & Experimental Cardiology November 14-16, 2016 Orlando, Florida, USA

Stem Cell Transplant

Stem cell transplantation is a procedure that is most often recommended as a treatment option for people with leukemia, multiple myeloma, and some types of lymphoma. It may also be used to treat some genetic diseases that involve the blood. During a stem cell transplant diseased bone marrow (the spongy, fatty tissue found inside larger bones) is destroyed with chemotherapy and/or radiation therapy and then replaced with highly specialized stem cells that develop into healthy bone marrow. Although this procedure used to be referred to as a bone marrow transplant, today it is more commonly called a stem cell transplant because it is stem cells in the blood that are typically being transplanted, not the actual bone marrow tissue.

Related Regenerative Medicine Conferences | Stem Cell Conferences | Stem Cell Congress | Tissue Science Conferences | Europe Conferences | Conference Series LLC

Related Conferences

7th InternationalConference on Tissue Engineering and Regenerative Medicine October 02-04, 2017 Barcelona, Spain; Tumor & Cancer Immunology and Immunotherapy July 17-19, 2017 Chicago, USA; 2nd World Congress on Connective Tissue Diseases Sep 27-29, 2017 Chicago, USA; 7th InternationalConference on Tissue Engineering and Regenerative Medicine October 02-04, 2017 Barcelona, Spain; 6th International Conference onCell and Gene Therapy Mar 2-3, 2017 Madrid, Spain; 2nd International Conference on Tumor & Cancer Immunology and ImmunotherapyJuly 17-19, 2017 Chicago, USA; 13th European Cardiology Conference December 05-06, 2016 Madrid, Spain; InternationalConference on Molecular BiologyOctober 13-15, 2016 Dubai, UAE; 8th World Congress on Molecular Pathology June 26-28, 2017 San Diego, USA; International Conference on Cell Signalling and Cancer Therapy Aug 20-22, 2017 Paris, France; 14th International Conference on Clinical & Experimental Cardiology November 14-16, 2016 Orlando, Florida, USA

Market Analysis Report:

Tissue engineering is an interdisciplinary field that applies the principles of engineering and life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function or a whole organ. Regenerative medicine is not one discipline. It can be defined as a therapeutic intervention which replaces or regenerates human cells, tissues or organs, to restore or establish normal function and deploys small molecule drugs, biologics, medical devices and cell-based therapies

Currently it has emerged as a rapidly diversifying field with the potential to address the worldwide organ shortage issue and comprises of tissue regeneration and organ replacement. Regenerative medicine could potentially save public health bodies money by reducing the need for long-term care and reducing associated disorders, with potential benefits for the world economy as a whole.The global tissue engineering and regeneration market reached $17 billion in 2013. This market is expected to grow to nearly $20.8 billion in 2014 and $56.9 billion in 2019, a compound annual growth rate (CAGR) of 22.3%. On the basis of geography, Europe holds the second place in the global market in the field of regenerative medicine & tissue engineering. In Europe countries like UK, France and Germany are possessing good market shares in the field of regenerative medicine and tissue engineering. Spain and Italy are the emerging market trends for tissue engineering in Europe.

Tissue engineering is "an interdisciplinary field that applies the principles of engineering and life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function or a whole organ. Currently it has emerged as a rapidly diversifying field with the potential to address the worldwide organ shortage issue and comprises of tissue regeneration and organ replacement. A novel set of tissue replacement parts and implementation strategies had shown a great revolution in this field. Cells placed on or within the tissue constructs is the most common methodology in tissue engineering.

Regenerative medicine is not one discipline. It can be defined as a therapeutic intervention which replaces or regenerates human cells, tissues or organs, to restore or establish normal function and deploys small molecule drugs, biologics, medical devices and cell-based therapies

This field continues to evolve. In addition to medical applications, non-therapeutic applications include using tissues as biosensors to detect biological or chemical threat agents, and tissue chips that can be used to test the toxicity of an experimental medication. Tissue Engineering and Regenerative Medicine is the major field in Medicine, which is still under research and the advancements are maximizing day to day.

Regenerative Medicine-2016 is an engrossed a vicinity of cognizant discussions on novel subjects like Tissue Regeneration, Materials & Designs for Tissue Engineering, Stem CellTools to Battle Cancer, Bioreactors in Tissue Engineering, Regeneration & Therapeutics, Cord Blood & Regenerative Medicine and Clinical Medicine, to mention a few. The three days event implants a firm relation of upcoming strategies in the field of Tissue Science & Regenerative Medicine with the scientific community. The conceptual and applicable knowledge shared, will also foster organizational collaborations to nurture scientific accelerations.We bring together business, creative, and technology leaders from the tissue engineering, marketing, and research industry for the most current and relevant.

Meet Your Target MarketWith members from around the world focused on learning about Advertising and marketing, this is the single best opportunity to reach the largest assemblage of participants from the tissue engineering and regenerative medicine community. The meeting engrossed a vicinity of cognizant discussions on novel subjects like Tissue Regeneration, Materials & Designs for Tissue Engineering, Stem CellTools to Battle Cancer, Bioreactors in Tissue Engineering, Regeneration & Therapeutics, Cord Blood & Regenerative Medicine and Clinical Medicine, to mention a few. The three days event implants a firm relation of upcoming strategies in the field of Tissue Engineering & Regenerative Medicine with the scientific community. The conceptual and applicable knowledge shared, will also foster organizational collaborations to nurture scientific accelerations.Conduct demonstrations, distribute information, meet with current and potential customers, make a splash with a new product line, and receive name recognition.

International Stem Cell Forum (ISCF)

International Society for Stem Cell Research (ISSCR)

UK Medical Research Council (MRC)

Australian Stem Cell Center

Canadian Institutes of Health Research (CIHR)

Euro Stem Cell (ACR)

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Regenerative Medicine Conferences | Tissue Engineering ...

Guidelines for Preventing Opportunistic Infections Among …

Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail.

Please note: An erratum has been published for this article. To view the erratum, please click here.

Clare A. Dykewicz, M.D., M.P.H. Harold W. Jaffe, M.D., Director Division of AIDS, STD, and TB Laboratory Research National Center for Infectious Diseases

Jonathan E. Kaplan, M.D. Division of AIDS, STD, and TB Laboratory Research National Center for Infectious Diseases Division of HIV/AIDS Prevention --- Surveillance and Epidemiology National Center for HIV, STD, and TB Prevention

Clare A. Dykewicz, M.D., M.P.H., Chair Harold W. Jaffe, M.D. Thomas J. Spira, M.D. Division of AIDS, STD, and TB Laboratory Research

William R. Jarvis, M.D. Hospital Infections Program National Center for Infectious Diseases, CDC

Jonathan E. Kaplan, M.D. Division of AIDS, STD, and TB Laboratory Research National Center for Infectious Diseases Division of HIV/AIDS Prevention --- Surveillance and Epidemiology National Center for HIV, STD, and TB Prevention, CDC

Brian R. Edlin, M.D. Division of HIV/AIDS Prevention---Surveillance and Epidemiology National Center for HIV, STD, and TB Prevention, CDC

Robert T. Chen, M.D., M.A. Beth Hibbs, R.N., M.P.H. Epidemiology and Surveillance Division National Immunization Program, CDC

Raleigh A. Bowden, M.D. Keith Sullivan, M.D. Fred Hutchinson Cancer Research Center Seattle, Washington

David Emanuel, M.B.Ch.B. Indiana University Indianapolis, Indiana

David L. Longworth, M.D. Cleveland Clinic Foundation Cleveland, Ohio

Philip A. Rowlings, M.B.B.S., M.S. International Bone Marrow Transplant Registry/Autologous Blood and Marrow Transplant Registry Milwaukee, Wisconsin

Robert H. Rubin, M.D. Massachusetts General Hospital Boston, Massachusetts and Massachusetts Institute of Technology Cambridge, Massachusetts

Kent A. Sepkowitz, M.D. Memorial-Sloan Kettering Cancer Center New York, New York

John R. Wingard, M.D. University of Florida Gainesville, Florida

John F. Modlin, M.D. Dartmouth Medical School Hanover, New Hampshire

Donna M. Ambrosino, M.D. Dana-Farber Cancer Institute Boston, Massachusetts

Norman W. Baylor, Ph.D. Food and Drug Administration Rockville, Maryland

Albert D. Donnenberg, Ph.D. University of Pittsburgh Pittsburgh, Pennsylvania

Pierce Gardner, M.D. State University of New York at Stony Brook Stony Brook, New York

Roger H. Giller, M.D. University of Colorado Denver, Colorado

Neal A. Halsey, M.D. Johns Hopkins University Baltimore, Maryland

Chinh T. Le, M.D. Kaiser-Permanente Medical Center Santa Rosa, California

Deborah C. Molrine, M.D. Dana-Farber Cancer Institute Boston, Massachusetts

Keith M. Sullivan, M.D. Fred Hutchinson Cancer Research Center Seattle, Washington

CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation have cosponsored these guidelines for preventing opportunistic infections (OIs) among hematopoietic stem cell transplant (HSCT) recipients. The guidelines were drafted with the assistance of a working group of experts in infectious diseases, transplantation, and public health. For the purposes of this report, HSCT is defined as any transplantation of blood- or marrow-derived hematopoietic stem cells, regardless of transplant type (i.e., allogeneic or autologous) or cell source (i.e., bone marrow, peripheral blood, or placental or umbilical cord blood). Such OIs as bacterial, viral, fungal, protozoal, and helminth infections occur with increased frequency or severity among HSCT recipients. These evidence-based guidelines contain information regarding preventing OIs, hospital infection control, strategies for safe living after transplantation, vaccinations, and hematopoietic stem cell safety. The disease-specific sections address preventing exposure and disease for pediatric and adult and autologous and allogeneic HSCT recipients. The goal of these guidelines is twofold: to summarize current data and provide evidence-based recommendations regarding preventing OIs among HSCT patients. The guidelines were developed for use by HSCT recipients, their household and close contacts, transplant and infectious diseases physicians, HSCT center personnel, and public health professionals. For all recommendations, prevention strategies are rated by the strength of the recommendation and the quality of the evidence supporting the recommendation. Adhering to these guidelines should reduce the number and severity of OIs among HSCT recipients.

In 1992, the Institute of Medicine (1) recommended that CDC lead a global effort to detect and control emerging infectious agents. In response, CDC published a plan (2) that outlined national disease prevention priorities, including the development of guidelines for preventing opportunistic infections (OIs) among immunosuppressed persons. During 1995, CDC published guidelines for preventing OIs among persons infected with human immunodeficiency virus (HIV) and revised those guidelines during 1997 and 1999 (3--5). Because of the success of those guidelines, CDC sought to determine the need for expanding OI prevention activities to other immunosuppressed populations. An informal survey of hematology, oncology, and infectious disease specialists at transplant centers and a working group formed by CDC determined that guidelines were needed to help prevent OIs among hematopoietic stem cell transplant (HSCT)* recipients.

The working group defined OIs as infections that occur with increased frequency or severity among HSCT recipients, and they drafted evidence-based recommendations for preventing exposure to and disease caused by bacterial, fungal, viral, protozoal, or helminthic pathogens. During March 1997, the working group presented the first draft of these guidelines at a meeting of representatives from public and private health organizations. After review by that group and other experts, these guidelines were revised and made available during September 1999 for a 45-day public comment period after notification in the Federal Register. Public comments were added when feasible, and the report was approved by CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. The pediatric content of these guidelines has been endorsed also by the American Academy of Pediatrics. The hematopoietic stem cell safety section was endorsed by the International Society of Hematotherapy and Graft Engineering.

The first recommendations presented in this report are followed by recommendations for hospital infection control, strategies for safe living, vaccinations, and hematopoietic stem cell safety. Unless otherwise noted, these recommendations address allogeneic and autologous and pediatric and adult HSCT recipients. Additionally, these recommendations are intended for use by the recipients, their household and other close contacts, transplant and infectious diseases specialists, HSCT center personnel, and public health professionals.

For all recommendations, prevention strategies are rated by the strength of the recommendation (Table 1) and the quality of the evidence (Table 2) supporting the recommendation. The principles of this rating system were developed by the Infectious Disease Society of America and the U.S. Public Health Service for use in the guidelines for preventing OIs among HIV-infected persons (3--6). This rating system allows assessments of recommendations to which adherence is critical.

HSCT is the infusion of hematopoietic stem cells from a donor into a patient who has received chemotherapy, which is usually marrow-ablative. Increasingly, HSCT has been used to treat neoplastic diseases, hematologic disorders, immunodeficiency syndromes, congenital enzyme deficiencies, and autoimmune disorders (e.g., systemic lupus erythematosus or multiple sclerosis) (7--10). Moreover, HSCT has become standard treatment for selected conditions (7,11,12). Data from the International Bone Marrow Transplant Registry and the Autologous Blood and Marrow Transplant Registry indicate that approximately 20,000 HSCTs were performed in North America during 1998 (Statistical Center of the International Bone Marrow Transplant Registry and Autologous Blood and Marrow Transplant Registry, unpublished data, 1998).

HSCTs are classified as either allogeneic or autologous on the basis of the source of the transplanted hematopoietic progenitor cells. Cells used in allogeneic HSCTs are harvested from a donor other than the transplant recipient. Such transplants are the most effective treatment for persons with severe aplastic anemia (13) and offer the only curative therapy for persons with chronic myelogenous leukemia (12). Allogeneic donors might be a blood relative or an unrelated donor. Allogeneic transplants are usually most successful when the donor is a human lymphocyte antigen (HLA)-identical twin or matched sibling. However, for allogeneic candidates who lack such a donor, registry organizations (e.g., the National Marrow Donor Program) maintain computerized databases that store information regarding HLA type from millions of volunteer donors (14--16). Another source of stem cells for allogeneic candidates without an HLA-matched sibling is a mismatched family member (17,18). However, persons who receive allogeneic grafts from donors who are not HLA-matched siblings are at a substantially greater risk for graft-versus-host disease (GVHD) (19). These persons are also at increased risk for suboptimal graft function and delayed immune system recovery (19). To reduce GVHD among allogeneic HSCTs, techniques have been developed to remove T-lymphocytes, the principal effectors of GVHD, from the donor graft. Although the recipients of T-lymphocyte--depleted marrow grafts generally have lower rates of GVHD, they also have greater rates of graft rejection, cytomegalovirus (CMV) infection, invasive fungal infection, and Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disease (20).

The patient's own cells are used in an autologous HSCT. Similar to autologous transplants are syngeneic transplants, among whom the HLA-identical twin serves as the donor. Autologous HSCTs are preferred for patients who require high-level or marrow-ablative chemotherapy to eradicate an underlying malignancy but have healthy, undiseased bone marrows. Autologous HSCTs are also preferred when the immunologic antitumor effect of an allograft is not beneficial. Autologous HSCTs are used most frequently to treat breast cancer, non-Hodgkin's lymphoma, and Hodgkin's disease (21). Neither autologous nor syngeneic HSCTs confer a risk for chronic GVHD.

Recently, medical centers have begun to harvest hematopoietic stem cells from placental or umbilical cord blood (UCB) immediately after birth. These harvested cells are used primarily for allogeneic transplants among children. Early results demonstrate that greater degrees of histoincompatibility between donor and recipient might be tolerated without graft rejection or GVHD when UCB hematopoietic cells are used (22--24). However, immune system function after UCB transplants has not been well-studied.

HSCT is also evolving rapidly in other areas. For example, hematopoietic stem cells harvested from the patient's peripheral blood after treatment with hematopoietic colony-stimulating factors (e.g., granulocyte colony-stimulating factor [G-CSF or filgastrim] or granulocyte-macrophage colony-stimulating factor [GM-CSF or sargramostim]) are being used increasingly among autologous recipients (25) and are under investigation for use among allogeneic HSCT. Peripheral blood has largely replaced bone marrow as a source of stem cells for autologous recipients. A benefit of harvesting such cells from the donor's peripheral blood instead of bone marrow is that it eliminates the need for general anesthesia associated with bone marrow aspiration.

GVHD is a condition in which the donated cells recognize the recipient's cells as nonself and attack them. Although the use of intravenous immunoglobulin (IVIG) in the routine management of allogeneic patients was common in the past as a means of producing immune modulation among patients with GVHD, this practice has declined because of cost factors (26) and because of the development of other strategies for GVHD prophylaxis (27). For example, use of cyclosporine GVHD prophylaxis has become commonplace since its introduction during the early 1980s. Most frequently, cyclosporine or tacrolimus (FK506) is administered in combination with other immunosuppressive agents (e.g., methotrexate or corticosteroids) (27). Although cyclosporine is effective in preventing GVHD, its use entails greater hazards for infectious complications and relapse of the underlying neoplastic disease for which the transplant was performed.

Although survival rates for certain autologous recipients have improved (28,29), infection remains a leading cause of death among allogeneic transplants and is a major cause of morbidity among autologous HSCTs (29). Researchers from the National Marrow Donor Program reported that, of 462 persons receiving unrelated allogeneic HSCTs during December 1987--November 1990, a total of 66% had died by 1991 (15). Among primary and secondary causes of death, the most common cause was infection, which occurred among 37% of 307 patients (15).**

Despite high morbidity and mortality after HSCT, recipients who survive long-term are likely to enjoy good health. A survey of 798 persons who had received an HSCT before 1985 and who had survived for >5 years after HSCT, determined that 93% were in good health and that 89% had returned to work or school full time (30). In another survey of 125 adults who had survived a mean of 10 years after HSCT, 88% responded that the benefits of transplantation outweighed the side effects (31).

During the first year after an HSCT, recipients typically follow a predictable pattern of immune system deficiency and recovery, which begins with the chemotherapy or radiation therapy (i.e., the conditioning regimen) administered just before the HSCT to treat the underlying disease. Unfortunately, this conditioning regimen also destroys normal hematopoiesis for neutrophils, monocytes, and macrophages and damages mucosal progenitor cells, causing a temporary loss of mucosal barrier integrity. The gastrointestinal tract, which normally contains bacteria, commensal fungi, and other bacteria-carrying sources (e.g., skin or mucosa) becomes a reservoir of potential pathogens. Virtually all HSCT recipients rapidly lose all T- and B-lymphocytes after conditioning, losing immune memory accumulated through a lifetime of exposure to infectious agents, environmental antigens, and vaccines. Because transfer of donor immunity to HSCT recipients is variable and influenced by the timing of antigen exposure among donor and recipient, passively acquired donor immunity cannot be relied upon to provide long-term immunity against infectious diseases among HSCT recipients.

During the first month after HSCT, the major host-defense deficits include impaired phagocytosis and damaged mucocutaneous barriers. Additionally, indwelling intravenous catheters are frequently placed and left in situ for weeks to administer parenteral medications, blood products, and nutritional supplements. These catheters serve as another portal of entry for opportunistic pathogens from organisms colonizing the skin (e.g., . coagulase-negative Staphylococci, Staphylococcus aureus, Candida species, and Enterococci) (32,33).

Engraftment for adults and children is defined as the point at which a patient can maintain a sustained absolute neutrophil count (ANC) of >500/mm3 and sustained platelet count of >20,000, lasting >3 consecutive days without transfusions. Among unrelated allogeneic recipients, engraftment occurs at a median of 22 days after HSCT (range: 6--84 days) (15). In the absence of corticosteroid use, engraftment is associated with the restoration of effective phagocytic function, which results in a decreased risk for bacterial and fungal infections. However, all HSCT recipients and particularly allogeneic recipients, experience an immune system dysfunction for months after engraftment. For example, although allogeneic recipients might have normal total lymphocyte counts within >2 months after HSCT, they have abnormal CD4/CD8 T-cell ratios, reflecting their decreased CD4 and increased CD8 T-cell counts (27). They might also have immunoglobulin G (IgG)2, IgG4, and immunoglobulin A (IgA) deficiencies for months after HSCT and have difficulty switching from immunoglobulin M (IgM) to IgG production after antigen exposure (32). Immune system recovery might be delayed further by CMV infection (34).

During the first >2 months after HSCT, recipients might experience acute GVHD that manifests as skin, gastrointestinal, and liver injury, and is graded on a scale of I--IV (32,35,36). Although autologous or syngeneic recipients might occasionally experience a mild, self-limited illness that is acute GVHD-like (19,37), GVHD occurs primarily among allogeneic recipients, particularly those receiving matched, unrelated donor transplants. GVHD is a substantial risk factor for infection among HSCT recipients because it is associated with a delayed immunologic recovery and prolonged immunodeficiency (19). Additionally, the immunosuppressive agents used for GVHD prophylaxis and treatment might make the HSCT recipient more vulnerable to opportunistic viral and fungal pathogens (38).

Certain patients, particularly adult allogeneic recipients, might also experience chronic GVHD, which is graded as either limited or extensive chronic GVHD (19,39). Chronic GVHD appears similar to autoimmune, connective-tissue disorders (e.g., scleroderma or systemic lupus erythematosus) (40) and is associated with cellular and humoral immunodeficiencies, including macrophage deficiency, impaired neutrophil chemotaxis (41), poor response to vaccination (42--44), and severe mucositis (19). Risk factors for chronic GVHD include increasing age, allogeneic HSCT (particularly those among whom the donor is unrelated or a non-HLA identical family member) (40), and a history of acute GVHD (24,45). Chronic GVHD was first described as occurring >100 days after HSCT but can occur 40 days after HSCT (19). Although allogeneic recipients with chronic GVHD have normal or high total serum immunoglobulin levels (41), they experience long-lasting IgA, IgG, and IgG subclass deficiencies (41,46,47) and poor opsonization and impaired reticuloendothelial function. Consequently, they are at even greater risk for infections (32,39), particularly life-threatening bacterial infections from encapsulated organisms (e.g., Stre. pneumoniae, Ha. influenzae, or Ne. meningitidis). After chronic GVHD resolves, which might take years, cell-mediated and humoral immunity function are gradually restored.

HSCT recipients experience certain infections at different times posttransplant, reflecting the predominant host-defense defect(s) (Figure). Immune system recovery for HSCT recipients takes place in three phases beginning at day 0, the day of transplant. Phase I is the preengraftment phase (<30 days after HSCT); phase II, the postengraftment phase (30--100 days after HSCT); and phase III, the late phase (>100 days after HSCT). Prevention strategies should be based on these three phases and the following information:

Preventing infections among HSCT recipients is preferable to treating infections. How ever, despite recent technologic advances, more research is needed to optimize health outcomes for HSCT recipients. Efforts to improve immune system reconstitution, particularly among allogeneic transplant recipients, and to prevent or resolve the immune dysregulation resulting from donor-recipient histoincompatibility and GVHD remain substantial challenges for preventing recurrent, persistent, or progressive infections among HSCT patients.

Preventing Exposure

Because bacteria are carried on the hands, health-care workers (HCWs) and others in contact with HSCT recipients should routinely follow appropriate hand-washing practices to avoid exposing recipients to bacterial pathogens (AIII).

Preventing Disease

Preventing Early Disease (0--100 Days After HSCT). Routine gut decontamination is not recommended for HSCT candidates (51--53) (DIII). Because of limited data, no recommendations can be made regarding the routine use of antibiotics for bacterial prophylaxis among afebrile, asymptomatic neutropenic recipients. Although studies have reported that using prophylactic antibiotics might reduce bacteremia rates after HSCT (51), infection-related fatality rates are not reduced (52). If physicians choose to use prophylactic antibiotics among asymptomatic, afebrile, neutropenic recipients, they should routinely review hospital and HSCT center antibiotic-susceptibility profiles, particularly when using a single antibiotic for antibacterial prophylaxis (BIII). The emergence of fluoquinolone-resistant coagulase-negative Staphylococci and Es. coli (51,52), vancomycin-intermediate Sta. aureus and vancomycin-resistant Enterococcus (VRE) are increasing concerns (54). Vancomycin should not be used as an agent for routine bacterial prophylaxis (DIII). Growth factors (e.g., GM-CSF and G-CSF) shorten the duration of neutropenia after HSCT (55); however, no data were found that indicate whether growth factors effectively reduce the attack rate of invasive bacterial disease.

Physicians should not routinely administer IVIG products to HSCT recipients for bacterial infection prophylaxis (DII), although IVIG has been recommended for use in producing immune system modulation for GVHD prevention. Researchers have recommended routine IVIG*** use to prevent bacterial infections among the approximately 20%--25% of HSCT recipients with unrelated marrow grafts who experience severe hypogamma-globulinemia (e.g., IgG < 400 mg/dl) within the first 100 days after transplant (CIII). For example, recipients who are hypogammaglobulinemic might receive prophylactic IVIG to prevent bacterial sinopulmonary infections (e.g., from Stre. pneumoniae) (8) (CIII). For hypogammaglobulinemic allogeneic recipients, physicians can use a higher and more frequent dose of IVIG than is standard for non-HSCT recipients because the IVIG half-life among HSCT recipients (generally 1--10 days) is much shorter than the half-life among healthy adults (generally 18--23 days) (56--58). Additionally, infections might accelerate IgG catabolism; therefore, the IVIG dose for a hypogammaglobulinemic recipient should be individualized to maintain trough serum IgG concentrations >400--500 mg/dl (58) (BII). Consequently, physicians should monitor trough serum IgG concentrations among these patients approximately every 2 weeks and adjust IVIG doses as needed (BIII) (Appendix).

Preventing Late Disease (>100 Days After HSCT). Antibiotic prophylaxis is recommended for preventing infection with encapsulated organisms (e.g., Stre. pneumoniae, Ha. influenzae, or Ne. meningitidis) among allogeneic recipients with chronic GVHD for as long as active chronic GVHD treatment is administered (59) (BIII). Antibiotic selection should be guided by local antibiotic resistance patterns. In the absence of severe demonstrable hypogammaglobulinemia (e.g., IgG levels < 400 mg/dl, which might be associated with recurrent sinopulmonary infections), routine monthly IVIG administration to HSCT recipients >90 days after HSCT is not recommended (60) (DI) as a means of preventing bacterial infections.

Other Disease Prevention Recommendations. Routine use of IVIG among autologous recipients is not recommended (61) (DII). Recommendations for preventing bacterial infections are the same among pediatric or adult HSCT recipients.

Preventing Exposure

Appropriate care precautions should be taken with hospitalized patients infected with Stre. pneumoniae (62,63) (BIII) to prevent exposure among HSCT recipients.

Preventing Disease

Information regarding the currently available 23-valent pneumococcal polysaccharide vaccine indicates limited immunogenicity among HSCT recipients. However, because of its potential benefit to certain patients, it should be administered to HSCT recipients at 12 and 24 months after HSCT (64--66) (BIII). No data were found regarding safety and immunogenicity of the 7-valent conjugate pneumococcal vaccine among HSCT recipients; therefore, no recommendation regarding use of this vaccine can be made.

Antibiotic prophylaxis is recommended for preventing infection with encapsulated organisms (e.g., Stre. pneumoniae, Ha. influenzae, and Ne. meningitidis) among allogeneic recipients with chronic GVHD for as long as active chronic GVHD treatment is administered (59) (BIII). Trimethoprim-sulfamethasaxole (TMP-SMZ) administered for Pneumocystis carinii pneumonia (PCP) prophylaxis will also provide protection against pneumococcal infections. However, no data were found to support using TMP-SMZ prophylaxis among HSCT recipients solely for the purpose of preventing Stre. pneumoniae disease. Certain strains of Stre. pneumoniae are resistant to TMP-SMZ and penicillin. Recommendations for preventing pneumococcal infections are the same for allogeneic or autologous recipients.

As with adults, pediatric HSCT recipients aged >2 years should be administered the current 23-valent pneumococcal polysaccharide vaccine because the vaccine can be effective (BIII). However, this vaccine should not be administered to children aged <2 years because it is not effective among that age population (DI). No data were found regarding safety and immunogenicity of the 7-valent conjugate pneumococcal vaccine among pediatric HSCT recipients; therefore, no recommendation regarding use of this vaccine can be made.

Preventing Exposure

Because Streptococci viridans colonize the oropharynx and gut, no effective method of preventing exposure is known.

Preventing Disease

Chemotherapy-induced oral mucositis is a potential source of Streptococci viridans bacteremia. Consequently, before conditioning starts, dental consults should be obtained for all HSCT candidates to assess their state of oral health and to perform any needed dental procedures to decrease the risk for oral infections after transplant (67) (AIII).

Generally, HSCT physicians should not use prophylactic antibiotics to prevent Streptococci viridans infections (DIII). No data were found that demonstrate efficacy of prophylactic antibiotics for this infection. Furthermore, such use might select antibiotic-resistant bacteria, and in fact, penicillin- and vancomycin-resistant strains of Streptococci viridans have been reported (68). However, when Streptococci viridans infections among HSCT recipients are virulent and associated with overwhelming sepsis and shock in an institution, prophylaxis might be evaluated (CIII). Decisions regarding the use of Streptococci viridans prophylaxis should be made only after consultation with the hospital epidemiologists or infection-control practitioners who monitor rates of nosocomial bacteremia and bacterial susceptibility (BIII).

HSCT physicians should be familiar with current antibiotic susceptibilities for patient isolates from their HSCT centers, including Streptococci viridans (BIII). Physicians should maintain a high index of suspicion for this infection among HSCT recipients with symptomatic mucositis because early diagnosis and aggressive therapy are currently the only potential means of preventing shock when severely neutropenic HSCT recipients experience Streptococci viridans bacteremia (69).

Preventing Exposure

Adults with Ha. influenzae type b (Hib) pneumonia require standard precautions (62) to prevent exposing the HSCT recipient to Hib. Adults and children who are in contact with the HSCT recipient and who have known or suspected invasive Hib disease, including meningitis, bacteremia, or epiglottitis, should be placed in droplet precautions until 24 hours after they begin appropriate antibiotic therapy, after which they can be switched to standard precautions. Household contacts exposed to persons with Hib disease and who also have contact with HSCT recipients should be administered rifampin prophylaxis according to published recommendations (70,71); prophylaxis for household contacts of a patient with Hib disease are necessary if all contacts aged <4 years are not fully vaccinated (BIII) (Appendix). This recommendation is critical because the risk for invasive Hib disease among unvaccinated household contacts aged <4 years is increased, and rifampin can be effective in eliminating Hib carriage and preventing invasive Hib disease (72--74). Pediatric household contacts should be up-to-date with Hib vaccinations to prevent possible Hib exposure to the HSCT recipient (AII).

Preventing Disease

Although no data regarding vaccine efficacy among HSCT recipients were found, Hib conjugate vaccine should be administered to HSCT recipients at 12, 14, and 24 months after HSCT (BII). This vaccine is recommended because the majority of HSCT recipients have low levels of Hib capsular polysaccharide antibodies >4 months after HSCT (75), and allogeneic recipients with chronic GVHD are at increased risk for infection from encapsulated organisms (e.g., Hib) (76,77). HSCT recipients who are exposed to persons with Hib disease should be offered rifampin prophylaxis according to published recommendations (70) (BIII) (Appendix).

Antibiotic prophylaxis is recommended for preventing infection with encapsulated organisms (e.g., Stre. pneumoniae, Ha. influenzae, or Ne. meningitidis) among allogeneic recipients with chronic GVHD for as long as active chronic GVHD treatment is administered (59) (BIII). Antibiotic selection should be guided by local antibiotic-resistance patterns. Recommendations for preventing Hib infections are the same for allogeneic or autologous recipients. Recommendations for preventing Hib disease are the same for pediatric or adult HSCT recipients, except that any child infected with Hib pneumonia requires standard precautions with droplet precautions added for the first 24 hours after beginning appropriate antibiotic therapy (62,70) (BIII). Appropriate pediatric doses should be administered for Hib conjugate vaccine and for rifampin prophylaxis (71) (Appendix).

Preventing Exposure

HSCT candidates should be tested for the presence of serum anti-CMV IgG antibodies before transplantation to determine their risk for primary CMV infection and reactivation after HSCT (AIII). Only Food and Drug Administration (FDA) licensed or approved tests should be used. HSCT recipients and candidates should avoid sharing cups, glasses, and eating utensils with others, including family members, to decrease the risk for CMV exposure (BIII).

Sexually active patients who are not in long-term monogamous relationships should always use latex condoms during sexual contact to reduce their risk for exposure to CMV and other sexually transmitted pathogens (AII). However, even long-time monogamous pairs can be discordant for CMV infections. Therefore, during periods of immuno-compromise, sexually active HSCT recipients in monogamous relationships should ask partners to be tested for serum CMV IgG antibody, and discordant couples should use latex condoms during sexual contact to reduce the risk for exposure to this sexually transmitted OI (CIII).

After handling or changing diapers or after wiping oral and nasal secretions, HSCT candidates and recipients should practice regular hand washing to reduce the risk for CMV exposure (AII). CMV-seronegative recipients of allogeneic stem cell transplants from CMV-seronegative donors (i.e., R-negative or D-negative) should receive only leukocyte-reduced or CMV-seronegative red cells or leukocyte-reduced platelets (<1 x 106 leukocytes/unit) to prevent transfusion-associated CMV infection (78) (AI). However, insufficient data were found to recommend use of leukocyte-reduced or CMV-seronega tive red cells and platelets among CMV-seronegative recipients who have CMV-seropositive donors (i.e., R-negative or D-positive).

All HCWs should wear gloves when handling blood products or other potentially contaminated biologic materials (AII) to prevent transmission of CMV to HSCT recipients. HSCT patients who are known to excrete CMV should be placed under standard precautions (62) for the duration of CMV excretion to avoid possible transmission to CMV-seronegative HSCT recipients and candidates (AIII). Physicians are cautioned that CMV excretion can be episodic or prolonged.

Preventing Disease and Disease Recurrence

HSCT recipients at risk for CMV disease after HSCT (i.e., all CMV-seropositive HSCT recipients, and all CMV-seronegative recipients with a CMV-seropositive donor) should be placed on a CMV disease prevention program from the time of engraftment until 100 days after HSCT (i.e., phase II) (AI). Physicians should use either prophylaxis or preemptive treatment with ganciclovir for allogeneic recipients (AI). In selecting a CMV disease prevention strategy, physicians should assess the risks and benefits of each strategy, the needs and condition of the patient, and the hospital's virology laboratory support capability.

Prophylaxis strategy against early CMV (i.e., <100 days after HSCT) for allogeneic recipients involves administering ganciclovir prophylaxis to all allogeneic recipients at risk throughout phase II (i.e., from engraftment to 100 days after HSCT). The induction course is usually started at engraftment (AI), although physicians can add a brief prophylactic course during HSCT preconditioning (CIII) (Appendix).

Preemptive strategy against early CMV (i.e., <100 days after HSCT) for allogeneic recipients is preferred over prophylaxis for CMV-seronegative HSCT recipients of seropositive donor cells (i.e., D-positive or R-negative) because of the low attack rate of active CMV infection if screened or filtered blood product support is used (BII). Preemptive strategy restricts ganciclovir use for those patients who have evidence of CMV infection after HSCT. It requires the use of sensitive and specific laboratory tests to rapidly diagnose CMV infection after HSCT and to enable immediate administration of ganciclovir after CMV infection has been detected. Allogeneic recipients at risk should be screened >1 times/week from 10 days to 100 days after HSCT (i.e., phase II) for the presence of CMV viremia or antigenemia (AIII).

HSCT physicians should select one of two diagnostic tests to determine the need for preemptive treatment. Currently, the detection of CMV pp65 antigen in leukocytes (antigenemia) (79,80) is preferred for screening for preemptive treatment because it is more rapid and sensitive than culture and has good positive predictive value (79--81). Direct detection of CMV-DNA (deoxyribonucleic acid) by polymerase chain reaction (PCR) (82) is very sensitive but has a low positive predictive value (79). Although CMV-DNA PCR is less sensitive than whole blood or leukocyte PCR, plasma CMV-DNA PCR is useful during neutropenia, when the number of leukocytes/slide is too low to allow CMV pp65 antigenemia testing.

Virus culture of urine, saliva, blood, or bronchoalveolar washings by rapid shell-vial culture (83) or routine culture (84,85) can be used; however, viral culture techniques are less sensitive than CMV-DNA PCR or CMV pp65 antigenemia tests. Also, rapid shell-viral cultures require >48 hours and routine viral cultures can require weeks to obtain final results. Thus, viral culture techniques are less satisfactory than PCR or antigenemia tests. HSCT centers without access to PCR or antigenemia tests should use prophylaxis rather than preemptive therapy for CMV disease prevention (86) (BII). Physicians do use other diagnostic tests (e.g., hybrid capture CMV-DNA assay, Version 2.0 [87] or CMV pp67 viral RNA [ribonucleic acid] detection) (88); however, limited data were found regarding use among HSCT recipients, and therefore, no recommendation for use can be made.

Allogeneic recipients <100 days after HSCT (i.e., during phase II) should begin preemptive treatment with ganciclovir if CMV viremia or any antigenemia is detected or if the recipient has >2 consecutively positive CMV-DNA PCR tests (BIII). After preemptive treatment has been started, maintenance ganciclovir is usually continued until 100 days after HSCT or for a minimum of 3 weeks, whichever is longer (AI) (Appendix). Antigen or PCR tests should be negative when ganciclovir is stopped. Studies report that a shorter course of ganciclovir (e.g., for 3 weeks or until negative PCR or antigenemia occurs) (89--91) might provide adequate CMV prevention with less toxicity, but routine weekly screening by pp65 antigen or PCR test is necessary after stopping ganciclovir because CMV reactivation can occur (BIII).

Presently, only the intravenous formulation of ganciclovir has been approved for use in CMV prophylactic or preemptive strategies (BIII). No recommendation for oral ganciclovir use among HSCT recipients can be made because clinical trials evaluating its efficacy are still in progress. One group has used ganciclovir and foscarnet on alternate days for CMV prevention (92), but no recommendation can be made regarding this strategy because of limited data. Patients who are ganciclovir-intolerant should be administered foscarnet instead (93) (BII) (Appendix). HSCT recipients receiving ganciclovir should have ANCs checked >2 times/week (BIII). Researchers report managing ganciclovir-associated neutropenia by adding G-CSF (94) or temporarily stopping ganciclovir for >2 days if the patient's ANC is <1,000 (CIII). Ganciclovir can be restarted when the patient's ANC is >1,000 for 2 consecutive days. Alternatively, researchers report substituting foscarnet for ganciclovir if a) the HSCT recipient is still CMV viremic or antigenemic or b) the ANC remains <1,000 for >5 days after ganciclovir has been stopped (CIII) (Appendix). Because neutropenia accompanying ganciclovir administration is usually brief, such patients do not require antifungal or antibacterial prophylaxis (DIII).

Currently, no benefit has been reported from routinely administering ganciclovir prophylaxis to all HSCT recipients at >100 days after HSCT (i.e., during phase III). However, persons with high risk for late CMV disease should be routinely screened biweekly for evidence of CMV reactivation as long as substantial immunocompromise persists (BIII). Risk factors for late CMV disease include allogeneic HSCT accompanied by chronic GVHD, steroid use, low CD4 counts, delay in high avidity anti-CMV antibody, and recipients of matched unrelated or T-cell--depleted HSCTs who are at high risk (95--99). If CMV is still detectable by routine screening >100 days after HSCT, ganciclovir should be continued until CMV is no longer detectable (AI). If low-grade CMV antigenemia (<5 positive cells/slide) is detected on routine screening, the antigenemia test should be repeated in 3 days (BIII). If CMV antigenemia indicates >5 cells/slide, PCR is positive, or the shell-vial culture detects CMV viremia, a 3-week course of preemptive ganciclovir treatment should be administered (BIII) (Appendix). Ganciclovir should also be started if the patient has had >2 consecutively positive viremia or PCR tests (e.g., in a person receiving steroids for GVHD or who received ganciclovir or foscarnet at <100 days after HSCT). Current investigational strategies for preventing late CMV disease include the use of targeted prophylaxis with antiviral drugs and cellular immunotherapy for those with deficient or absent CMV-specific immune system function.

If viremia persists after 4 weeks of ganciclovir preemptive therapy or if the level of antigenemia continues to rise after 3 weeks of therapy, ganciclovir-resistant CMV should be suspected. If CMV viremia recurs during continuous treatment with ganciclovir, researchers report restarting ganciclovir induction (100) or stopping ganciclovir and starting foscarnet (CIII). Limited data were found regarding the use of foscarnet among HSCT recipients for either CMV prophylaxis or preemptive therapy (92,93).

Infusion of donor-derived CMV-specific clones of CD8+ T-cells into the transplant recipient is being evaluated under FDA Investigational New Drug authorization; therefore, no recommendation can be made. Although, in a substantial cooperative study, high-dose acyclovir has had certain efficacy for preventing CMV disease (101), its utility is limited in a setting where more potent anti-CMV agents (e.g., ganciclovir) are used (102). Acyclovir is not effective in preventing CMV disease after autologous HSCT (103) and is, therefore, not recommended for CMV preemptive therapy (DII). Consequently, valacyclovir, although under study for use among HSCT recipients, is presumed to be less effective than ganciclovir against CMV and is currently not recommended for CMV disease prevention (DII).

Although HSCT physicians continue to use IVIG for immune system modulation, IVIG is not recommended for CMV disease prophylaxis among HSCT recipients (DI). Cidofovir, a nucleoside analog, is approved by FDA for the treatment of AIDS-associated CMV retinitis. The drug's major disadvantage is nephrotoxicity. Cidofovir is currently in FDA phase 1 trial for use among HSCT recipients; therefore, recommendations for its use cannot be made.

Use of CMV-negative or leukocyte-reduced blood products is not routinely required for all autologous recipients because most have a substantially lower risk for CMV disease. However, CMV-negative or leukocyte-reduced blood products can be used for CMV-seronegative autologous recipients (CIII). Researchers report that CMV-seropositive autologous recipients be evaluated for preemptive therapy if they have underlying hematologic malignancies (e.g., lymphoma or leukemia), are receiving intense conditioning regimens or graft manipulation, or have recently received fludarabine or 2-chlorodeoxyadenosine (CDA) (CIII). This subpopulation of autologous recipients should be monitored weekly from time of engraftment until 60 days after HSCT for CMV reactivation, preferably with quantitative CMV pp65 antigen (80) or quantitative PCR (BII).

Autologous recipients at high risk who experience CMV antigenemia (i.e., blood levels of >5 positive cells/slide) should receive 3 weeks of preemptive treatment with ganciclovir or foscarnet (80), but CD34+-selected patients should be treated at any level of antigenemia (BII) (Appendix). Prophylactic approach to CMV disease prevention is not appropriate for CMV-seropositive autologous recipients. Indications for the use of CMV prophylaxis or preemptive treatment are the same for children or adults.

Preventing Exposure

All transplant candidates, particularly those who are EBV-seronegative, should be advised of behaviors that could decrease the likelihood of EBV exposure (AII). For example, HSCT recipients and candidates should follow safe hygiene practices (e.g., frequent hand washing [AIII] and avoiding the sharing of cups, glasses, and eating utensils with others) (104) (BIII), and they should avoid contact with potentially infected respiratory secretions and saliva (104) (AII).

Preventing Disease

Infusion of donor-derived, EBV-specific cytotoxic T-lymphocytes has demonstrated promise in the prophylaxis of EBV-lymphoma among recipients of T-cell--depleted unrelated or mismatched allogeneic recipients (105,106). However, insufficient data were found to recommend its use. Prophylaxis or preemptive therapy with acyclovir is not recommended because of lack of efficacy (107,108) (DII).

Preventing Exposure

HSCT candidates should be tested for serum anti-HSV IgG before transplant (AIII); however, type-specific anti-HSV IgG serology testing is not necessary. Only FDA-licensed or -approved tests should be used. All HSCT candidates, particularly those who are HSV-seronegative, should be informed of the importance of avoiding HSV infection while immunocompromised and should be advised of behaviors that will decrease the likelihood of HSV exposure (AII). HSCT recipients and candidates should avoid sharing cups, glasses, and eating utensils with others (BIII). Sexually active patients who are not in a long-term monogamous relationship should always use latex condoms during sexual contact to reduce the risk for exposure to HSV as well as other sexually transmitted pathogens (AII). However, even long-time monogamous pairs can be discordant for HSV infections. Therefore, during periods of immunocompromise, sexually active HSCT recipients in such relationships should ask partners to be tested for serum HSV IgG antibody. If the partners are discordant, they should consider using latex condoms during sexual contact to reduce the risk for exposure to this sexually transmitted OI (CIII). Any person with disseminated, primary, or severe mucocutaneous HSV disease should be placed under contact precautions for the duration of the illness (62) (AI) to prevent transmission of HSV to HSCT recipients.

Preventing Disease and Disease Recurrence

Acyclovir. Acyclovir prophylaxis should be offered to all HSV-seropositive allogeneic recipients to prevent HSV reactivation during the early posttransplant period (109--113) (AI). Standard approach is to begin acyclovir prophylaxis at the start of the conditioning therapy and continue until engraftment occurs or until mucositis resolves, whichever is longer, or approximately 30 days after HSCT (BIII) (Appendix). Without supportive data from controlled studies, routine use of antiviral prophylaxis for >30 days after HSCT to prevent HSV is not recommended (DIII). Routine acyclovir prophylaxis is not indicated for HSV-seronegative HSCT recipients, even if the donors are HSV-seropositive (DIII). Researchers have proposed administration of ganciclovir prophylaxis alone (86) to HSCT recipients who required simultaneous prophylaxis for CMV and HSV after HSCT (CIII) because ganciclovir has in vitro activity against CMV and HSV 1 and 2 (114), although ganciclovir has not been approved for use against HSV.

Valacyclovir. Researchers have reported valacyclovir use for preventing HSV among HSCT recipients (CIII); however, preliminary data demonstrate that very high doses of valacyclovir (8 g/day) were associated with thrombotic thrombocytopenic purpura/hemolytic uremic syndrome among HSCT recipients (115). Controlled trial data among HSCT recipients are limited (115), and the FDA has not approved valacyclovir for use among recipients. Physicians wishing to use valacyclovir among recipients with renal impairment should exercise caution and decrease doses as needed (BIII) (Appendix).

Foscarnet. Because of its substantial renal and infusion-related toxicity, foscarnet is not recommended for routine HSV prophylaxis among HSCT recipients (DIII).

Famciclovir. Presently, data regarding safety and efficacy of famciclovir among HSCT recipients are limited; therefore, no recommendations for HSV prophylaxis with famciclovir can be made.

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Guidelines for Preventing Opportunistic Infections Among ...

NY Stem Cell Treatment | Stem Cell Therapy Clinics …

Welcome to the New York Stem Cell Treatment Center. I am David Borenstein, MD, founder of the center, which is part of my practice, Manhattan Integrative Medicine.

Whether we are treating patients from New York City, Montreal or Toronto, we are dedicated to the advancement of quality care in the area of adult stem cell regenerative medicine. Our mission is to use advanced stem cell technology in order to improve the bodys ability to regenerate, heal and overcome a variety of inflammatory and degenerative conditions.

Therapies are provided at our stem cell clinic for patientsfrom all over the U.S. and around the world. Locations we serve includethe surrounding areas of Manhattan, Brooklyn, Queens, the Bronx, Staten Island, Nassau County, Suffolk County, Long Island, Westchester, New Jersey, Connecticut and Pennsylvania. We treat patientswho visit us from Canada as well, from cities such as Montreal and Toronto.

Feel free to learn more about our stem cell treatments and our stem cell clinic. If you have further questions please go ahead andcontact us, and if you would like to schedule an initial consultation, please fill out acandidate application.

Financing and banking options for stem cell therapy procedures with the New York Stem Cell Treatment Center are available through United Medical Credit. Thousands of patients have trusted United Medical Credit to secure affordable payment plans for their procedures. United Medical Credit can do the same for you!

Below are some of the benefits of choosing United Medical Credit to finance your stem cell therapy:

Dr. David Borenstein obtained his medical degree from the Technion Faculty of Medicine in Haifa, Israel and completed his internship at Staten Island University Hospital. He has completed residencies at: University Hospital at Stony Brook; Westchester County Medical Center; and St. Charles Hospital and Rehabilitation Center.

During the course of his career he has attended numerous specialized training courses in order to expand the scope of his medical expertise that he uses every day at his stem cell treatment center. He is board certified in Physical Medicine and Rehabilitation, certified in Medical Acupuncture, and is a member of numerous professional societies.

Dr. Borenstein has held many prestigious clinical appointments and positions in leading medical facilities. He has been published in the European Journal of Ultrasound and has been the Chief Investigator on a research project on Spinal Cord Injuries. He has conducted medical missions in North Korea, Ghana, Cuba, and other countries.

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NY Stem Cell Treatment | Stem Cell Therapy Clinics ...

Stem Cell Therapy | Adult Stem Cell Treatments

In order to self-repair, living organisms have stem cells in central andperipheral locations which can be attracted to sites of injured tissues by alarm signals. In this way, these cells proliferate, migrate, and accumulate in those damaged sites. If this situation of alarm perpetuates, stem cells could be permanently exhausted from their original locations leading to irreversible disease.

Basically, it could be a matter of stem cell quantity and effective availability at a certain time point when active regeneration is needed. The expectedconsequences of this situation could be the lack of an appropriate number of stem cells for further tissue replacement and regeneration and eventually the development of disease and aging.

For example, we could think that any alteration of this stem cell homeostasis by constant and repetitive trauma, physical hyperactivity, chronic inflammation and chronic disease could provoke a persistent disequilibrium inside all these reserve locations. This could promote an irreversible and premature stem cell exhaustion, being impossible then for the organism to self-repair and survive.

As we age we have less circulating stem cells. Introduction of new stem cells to our bodies circulation can improve health and repopulate our stem cell pool.

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Stem Cell Therapy | Adult Stem Cell Treatments

Stem Cell Therapy || Spinal Cord Injury || Stem Cell …

Spinal Cord Injury

Damage to the spinal cord usually results in impairments or loss of muscle movement, muscle control, sensation and body system control.

Presently, post-accident care for spinal cord injury patients focuses on extensive physical therapy, occupational therapy, and other rehabilitation therapies; teaching the injured person how to cope with their disability.

A number of published papers and case studies support the feasibility of treating spinal cord injury with allogeneic human umbilical cord tissue-derived stem cells and autologous bone marrow-derived stem cells.

Feasibility of combination allogeneic stem cell therapy for spinal cord injury: a case report co-authored by Stem Cell Institute Founder Dr. Neil Riordan references many of them. Published improvements include improved ASIA scores, improved bladder and/or bowel function, recovered sexual function, and increased muscle control.

The adult stem cells used to treat spinal cord injuries at the Stem Cell Institute come from two sources: the patients own bone marrow (autologous mesenchymal and CD34+) and human umbilical cord tissue(allogeneic mesenchymal). Umbilical cords are donated by mothers after normal, healthy births.

A licensed anesthesiologist harvests bone marrow from both hips under light general anesthesia in a hospital operating room. This procedure takes about 1 1/2 2 hours. Before they are administered to the patient, these bone marrow-derived stem cells must pass testing for quality, bacterial contamination (aerobic and anaerobic) and endotoxin.

All donated umbilical cords are screened for viruses and bacteria to International Blood Bank Standards.

Only about 1 in 10 donated umbilical cords pass our rigorous screening process.

Through retrospective analysis of our cases, weve identified proteins and genes that allow us to screen several hundred umbilical cord donations to find the ones that we know are most effective. We only use these cells and we call them golden cells.

We go through a very high throughput screening process to find cells that we know have the best anti-inflammatory activity, the best immune modulating capacity, and the best ability to stimulate regeneration.

The bodys immune system is unable to recognize umbilical cord-derived mesenchmyal stem cells as foreign and therefore they are not rejected. HUCT stem cells have been administered thousands of times at the Stem Cell Institute and there has never been a single instance rejection (graft vs. host disease). Umbilical cord-derived mesenchymal stem cells also proliferate/differentiate more efficiently than older cells, such as those found in the fat and therefore, they are considered to be more potent.

VIDEO Watch Professor Arnold Caplan explain how this works.

Our stem cell treatment protocol for spinal cord injury calls for a total of 16 injections over the course of 4 weeks.

The bone marrow-derived and umbilical cord tissue-derived stem cells are both administered intravenously by a licensed physician.

They are also injected intrathecally (into the spinal fluid) by an experienced anesthesiologist. Intrathecal injection enables the stem cells to bypass the blood-brain barrier and migrate to the injury site within the spinal canal.

*Upon availability

Proper follow-up is essential for us to monitor your condition after treatment. It also helps us evaluate treatment efficacy and improve our protocols based on reported outcomes over time.

Therefore, one of our medical staff will be contacting you at the following intervals: 1 month, 3 months, 4 months, and 1 year.

Yes, we do. Several of our spinal cord injury patients currently volunteer to speak with prospective patients. Your patient coordinator will be happy to put you in touch with them once your treatment evaluation has been completed.

Weve also published written testimonials, news articles and videos from our spinal cord injury patients. Please take a look!

You may contact us by telephone 1 (800) 980-STEM (toll-free in US) and 1 (954) 358-3382.

To apply for stem cell treatment, please complete this stem cell therapy patient application form.

*Please not that the above treatment outline is typical. However, actual treatment scheduling might vary slightly.

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Stem Cell Therapy || Spinal Cord Injury || Stem Cell ...

Overview of Stem Cell Therapy

By: Ian Murnaghan BSc (hons), MSc - Updated: 24 Dec 2015 | *Discuss

With the wealth of information available on stem cell therapy, it can be overwhelming to read through what is often complex and confusing material. A quick fact sheet on stem cell therapy is a good way to familiarise yourself with the subject and decide if further reading is of interest or benefit.

Finally, there are additional issues even when cells are identified, isolated and grown. The new cells require implantation in a person and they must then essentially learn how to effectively function alongside a person's own tissues. For instance, if you imagine a cardiac cell being implanted, think about the fact that it may not beat with the same rhythm of a person's heart cells and is thus ineffective. A person's immune system may also recognise the transplanted cells as foreign bodies and this can trigger an immune reaction that results in rejection of the new cells.

The potential of stem cell therapy to ease human suffering and dramatically affect disease has motivated scientists to research ways of enhancing current stem cell therapies and develop new ones. Stem cell therapy remains a new science but the results have thus far been impressive enough that scientists are eagerly studying ways to treat the many diseases that you or a loved one may suffer from one day.

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Overview of Stem Cell Therapy