STEM CELLS: A PERSONAL PERSPECTIVE
Wong SC1
*Corresponding Author: Shiu C. Wong, Stem Cell Link, Hong Lok Building, Block M, 1st Floor, 96 Chik Fuk
Street, Tai Wai, N.T., Hong Kong, People’s Republic of China; Tel.: +852-677-22933; E-mail: scwong555@
gmail.com
page: 7
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COMMENTARY
This is a personal account of my observation of
events associated with stem cells in recent years during
my stays in Singapore, Malaysia, Canada, Hong
Kong and China. It is based on my notes on the news
about stem cells from reports broadcast on television,
newspapers, magazines and medical journals. It is my
perception that the current large amount of news on the
developments and applications of stem cells may be
confusing to the general public, and that better government
regulations on the ‘businesses’ of stem cells are
urgently needed. I will start with a few personal matters
and then proceed to the subject proper.
My earlier professional interest was in hemoglobinopathies,
during my studies in the late Regents’
Professor Dr. Titus H.J. Huisman’s Protein Chemistry
Laboratory and Comprehensive Sickle Cell Center at
the Medical College of Georgia in Augusta, GA, USA.
In 2003, my interest turned to ‘stem cells’ on my appointment
as Scientific Director of StemLife, which, at
that time, was the only cord blood cryo-preservation
bank in Malaysia, with headquarters in Kuala Lumpur
and a laboratory in Cyberjaya. While there, I had regular
Saturday-open-house, so that potential clients, i.e.,
pregnant women and their husbands, could learn fully
the logistics involved in cord blood banking and view
the functioning laboratory through a glass partition.
Back then, StemLife was storing close to 100 umbilical
cord blood a month.
In 2004, I was involved in the successful use of
the umbilical cord blood from a newborn baby boy to
save his elder sister from the tragic effects of leukemia.
The parents were of Chinese-Malaysian ethnicity
in their 30’s. Their first child, born the previous year,
was a baby girl named Angel, who was diagnosed as
having leukemia a few months after birth and was assessed
to have less than 10% chance of survival by her
attending physicians. A younger brother, named Sam,
was born in April 2004, and when tested was found
to be a perfect HLA-match with Angel. Two months
later, his cord blood stem cells, which had been stored
at the StemLife Cord Blood Bank in Cyberjaya, were
retrieved, transported to Kuala Lumpur and transplanted
into the 14-month-old Angel at the Kuala Lumpur
General Hospital. “After the transplant in 2004/
June, Angel gained her health in months to become the This is a personal account of my observation of
events associated with stem cells in recent years during
my stays in Singapore, Malaysia, Canada, Hong
Kong and China. It is based on my notes on the news
about stem cells from reports broadcast on television,
newspapers, magazines and medical journals. It is my
perception that the current large amount of news on the
developments and applications of stem cells may be
confusing to the general public, and that better government
regulations on the ‘businesses’ of stem cells are
urgently needed. I will start with a few personal matters
and then proceed to the subject proper.
My earlier professional interest was in hemoglobinopathies,
during my studies in the late Regents’
Professor Dr. Titus H.J. Huisman’s Protein Chemistry
Laboratory and Comprehensive Sickle Cell Center at
the Medical College of Georgia in Augusta, GA, USA.
In 2003, my interest turned to ‘stem cells’ on my appointment
as Scientific Director of StemLife, which, at
that time, was the only cord blood cryo-preservation
bank in Malaysia, with headquarters in Kuala Lumpur
and a laboratory in Cyberjaya. While there, I had regular
Saturday-open-house, so that potential clients, i.e.,
pregnant women and their husbands, could learn fully
the logistics involved in cord blood banking and view
the functioning laboratory through a glass partition.
Back then, StemLife was storing close to 100 umbilical
cord blood a month.
In 2004, I was involved in the successful use of
the umbilical cord blood from a newborn baby boy to
save his elder sister from the tragic effects of leukemia.
The parents were of Chinese-Malaysian ethnicity
in their 30’s. Their first child, born the previous year,
was a baby girl named Angel, who was diagnosed as
having leukemia a few months after birth and was assessed
to have less than 10% chance of survival by her
attending physicians. A younger brother, named Sam,
was born in April 2004, and when tested was found
to be a perfect HLA-match with Angel. Two months
later, his cord blood stem cells, which had been stored
at the StemLife Cord Blood Bank in Cyberjaya, were
retrieved, transported to Kuala Lumpur and transplanted
into the 14-month-old Angel at the Kuala Lumpur
General Hospital. “After the transplant in 2004/
June, Angel gained her health in months to become the This is a personal account of my observation of
events associated with stem cells in recent years during
my stays in Singapore, Malaysia, Canada, Hong
Kong and China. It is based on my notes on the news
about stem cells from reports broadcast on television,
newspapers, magazines and medical journals. It is my
perception that the current large amount of news on the
developments and applications of stem cells may be
confusing to the general public, and that better government
regulations on the ‘businesses’ of stem cells are
urgently needed. I will start with a few personal matters
and then proceed to the subject proper.
My earlier professional interest was in hemoglobinopathies,
during my studies in the late Regents’
Professor Dr. Titus H.J. Huisman’s Protein Chemistry
Laboratory and Comprehensive Sickle Cell Center at
the Medical College of Georgia in Augusta, GA, USA.
In 2003, my interest turned to ‘stem cells’ on my appointment
as Scientific Director of StemLife, which, at
that time, was the only cord blood cryo-preservation
bank in Malaysia, with headquarters in Kuala Lumpur
and a laboratory in Cyberjaya. While there, I had regular
Saturday-open-house, so that potential clients, i.e.,
pregnant women and their husbands, could learn fully
the logistics involved in cord blood banking and view
the functioning laboratory through a glass partition.
Back then, StemLife was storing close to 100 umbilical
cord blood a month.
In 2004, I was involved in the successful use of
the umbilical cord blood from a newborn baby boy to
save his elder sister from the tragic effects of leukemia.
The parents were of Chinese-Malaysian ethnicity
in their 30’s. Their first child, born the previous year,
was a baby girl named Angel, who was diagnosed as
having leukemia a few months after birth and was assessed
to have less than 10% chance of survival by her
attending physicians. A younger brother, named Sam,
was born in April 2004, and when tested was found
to be a perfect HLA-match with Angel. Two months
later, his cord blood stem cells, which had been stored
at the StemLife Cord Blood Bank in Cyberjaya, were
retrieved, transported to Kuala Lumpur and transplanted
into the 14-month-old Angel at the Kuala Lumpur
General Hospital. “After the transplant in 2004/
June, Angel gained her health in months to become the bouncy baby that her parents had prayed for. Today,
Angel is a normal three-year-old who hardly suffers
from anything worse than a cough or cold.” [1].
In September 2008, while in Vancouver, British
Columbia, Canada, I saw on television that an American
mother with a sick baby daughter and an older son
were denied a flight to China for stem cell therapy, because
the Vancouver Airport Authority thought that the
baby girl was too sick to travel. However, a few days
later, this family was allowed to travel to China. This
started me to thinking that there must be other clients/
patients who may need professional consultation and
assistance in such matters, and, in June 2009, I started
Stem Cell Link in Hong Kong (www.stemcelllink.
com), specifically to address the concerns and problems
of patients seeking stem cell therapy.
In 1963, Andy J. Becker, Ernest A. McCulloch
and James E. Till discovered stem cells [2]. Since then,
developments in the field have resulted in the establishment
of umbilical cord blood stem cell cryo-preservation
banks (Cord Blood Banks), adult peripheral blood
stem cell cryo-preservation banks (PBSC Banks) and
Cellular Therapy Centers worldwide. Because of the
widespread information on stem cells, lay people have
become impressed by the possible impact and potential
benefit of stem cells.
Before the announcement of the 2010 Nobel Prize
for Medicine or Physiology, the September 21, 2010
issue of The Scientist reported that “Ernest McCulloch
and James Till, both senior scientists at the Ontario
Cancer Institute, and Shinya Yamanaka, Kyoto University
and University of California, San Francisco, stem cell researchers, for the discovery of stem cells and the
development of induced pluripotent stem cells,” were
possible winners [3]. However, 1 month later, the 2010
Nobel Prize for Medicine or Physiology was awarded
to Robert Geoffrey Edwards, for his pioneer work in
human IVF (in vitro fertilization) that resulted in the
birth of Louise Brown on July 25, 1978 [4].
In the same issue of The Scientist (October 4,
2010) that reported the Nobel prize winner, the question
“Is Nobel a nod for ESC (embryonic stem cell)
work?” was posed by Alison McCook, who drew ‘parallels’
between IVF and stem cells [5]. Work on IVF
had started more than 3 decades ago and had to run
the gauntlet of ethical, moral and religious groups, especially
with regard to its clinical applications. At one
point, the British Medical Research Council had cut
the funding for IVF, citing ethical concerns over the
project. Similarly, since their discovery in 1963, stem
cells have echoed all the same ethical, moral and religious
issues. Making the issues even more complicated
in recent years have been legal and political arguments
on embryonic stem cell research, its funding and its
clinical applications in treatment of diseases.
These issues and arguments have had significant
consequences in the US in the past decade, where former
US President George W. Bush imposed a ban on federal
funding for embryonic stem cell research in 2001 [6].
To the great joy of many stem cell researchers, President
Obama lifted the ban on stem cell research and signed
an Executive Order on March 9, 2009, which stipulated:
“We will lift the ban on federal funding for promising
embryonic stem cell research. We will also vigorously
support scientists who pursue this research. And we will
aim for America to lead the world in the discoveries it
one day may yield.” [7]. A few months later, The Scientist
reported: “27 more hESC (human embryonic stem
cell) lines approved” by the National Institute of Health
(NIH) Director, Francis Collins, making a total of 40
new lines of hESC eligible for federal research funding
[8]. However, only 1 year later, new legal proceedings
challenging the federal funding of ESC research appeared.
In August 2010, federal funding was barred by
a District of Columbia judge, but the ban was later lifted
by an appeal court. However, this saga continues [9]. It
was depicted as the “America’s Stem Cell mess” in a
recent article in The Scientist, and another titled “Whiplash
for stem cell researchers” in Science [10,11].
In spite of the American situation, two new Federal
Drug Administration (FDA)-approved clinical trials were initiated towards the end of 2010. The Geron
Corporation in Menlo Park, CA, USA, announced
on October 11, 2010 that the first patient with a spinal
cord injury had been treated with stem cells at
the Shepherd Center in Atlanta, GA, USA [12]. One
month later, the Massachusetts-based Advanced Cell
Technology (ACT) in Marlborough, MA, USA, also
received approval from the FDA to use hESCs to treat
patients with Stargardt’s macular dystrophy (SMD).
According to Robert Lanza, ACT’s chief medical officer,
“We can generate a virtually unlimited supply of
healthy retinal pigment epithelium (RPE) cells, which
are the first cells to die off in SMD and other forms of
macular degeneration.” [13]. At the same time, there
was news from the UK on first stem cell therapy for
stroke patients [14].
Other clinical uses of stem cells have also been
making news. Doctors at the University of Utah have
been testing stem cell spray to heal burns, and suggest
that synthetic skin derived from a person’s own
cells may be a reality within 5 years [15]. Moreover,
cardiomyocytes from iPSC (induced pluripotent stem
cells) are being produced by the Wisconsin-based Cellular
Dynamics International in Madison, WI, USA,
and these heart muscle cells are available at US$1,500
for 1.5 million cells [16]. In connection with iPSC, the
contribution of Shinya Yamanaka was acknowledged
in the November 27, 2010 Los Angeles Times: “Perhaps
no scientist has had a greater impact on stem cell
research than Dr. Shinya Yamanaka. His 2006 discovery
of induced pluripotent stem cells, or iPS cells,
paves the way for pursuing regenerative medicine
therapies without the need to destroy embryos.” [17].
Within 4 years after their discovery, the use of iPSC
has resulted in the production of three generations of
live mice [18]. Meanwhile, more information on iPSC
is being reported, and one can expect that more will be
forthcoming in the near future [19,20].
Such positive publicity on stem cells has given
hope and expectation to those who are sick. Television
also had its share of news and advertisement on the use
of stem cells. Early in 2010, the American weekly TV
investigative program 60 Minutes reported the use of
stem cells to build tissue-scaffolds that could eventually
lead to the generation of complete human organs.
This was followed by another 60 Minutes report on the
successful use of stem cells to regenerate leg muscles
in severely injured American soldiers at the Walter
Reed Army Medical Center in Washington, DC, USA.
Meanwhile, certain cosmetic companies are claiming
the association of their ‘beauty’ products with ‘stem
cell technology’ in their TV commercials.
Nevertheless, in the midst of its positive reports on
potential uses of stem cells, 60 Minutes had some bad
news as well. In a story broadcast in April 2010, Scott
Pelley of 60 Minutes exposed a ‘doctor’ in California
and his partner-in-crime, who were offering stem cell
treatment, to be performed in Mexico, to patients with
amyotrophic lateral sclerosis (ALS) for US$125,000. In
September 2010, a Dutch-trained doctor, with medical
practices in London and Rotterdam, was banned from
practice in the UK, after he was found to have made
“unsubstantiated and exaggerated claims to patients
suffering from degenerative and devastating illnesses,
and to charge them thousands of pounds for unproven
stem cell treatments” [21,22]. Meanwhile, it took 2
years after the August 2008 death of an 18-month-old
child with cerebral palsy, who had received stem cell
injection in a private hospital in Dusseldorf, Germany,
that the question “why the Government had not reacted
more quickly, while the doctor was under criminal
investigation for the death” was raised in the German
Parliament in October 2010 [23].
On the other hands, these negative reports on unprofessional
conducts of a few individuals should not
hinder one’s appreciation of the potential clinical applications
of stem cells in the emerging field of Regenerative
Medicine. More than 20 years ago, Dr. H.E.
Broxmeyer (Indiana University School of Medicine,
Indianapolis, IN, USA) started the first US Umbilical
Cord Blood Bank, and Dr. E. Gluckman (Hôpital
Saint-Louis, Paris, France) performed the first umbilical
cord blood stem cell transplant to treat a patient
with Fanconi’s Anemia [24,25]. A cord blood bank resembles
a commercial bank where the clients and/ or
parents rent a safety deposit box held at a temperature
of –196°C to keep safe the umbilical cord blood of their
newborn for future use. While kept in liquid nitrogen
tanks that are maintained at a constant temperature of
–196°C with a continued supply of liquid nitrogen, the
cryo-preserved stem cells are viable for years to come
[26]. Now, umbilical cord blood banks and adult peripheral
blood banks are to be found around the world,
and thousands of cord blood transplants are being performed
each year [27].
Although some new cord blood banks may have
resorted to automation and robots in their operation,
most banks still use manual procedures to harvest,cryo-preserve, track and retrieve the stem cells kept in
their facilities. Like other medical laboratories, quality
assurance of the laboratory procedures in a cord blood
bank can be achieved via accreditation by a professional
agency. The College of American Pathologists
(CAP) has a long history of accrediting medical laboratories
around the world on a voluntary subscription
basis [http://www.cap.org]. Its checklists are gold standards
for the on-site inspection before accreditation is
granted. Similarly, the Foundation for the Accreditation
of Cellular Therapy (FACT) also has accreditation
programs, which are subscribed by cord blood banks
in Canada, USA, UK, The Netherlands, France, Germany,
Italy, Spain, Greece, Belgium, Australia, Taiwan
and Singapore, as well as by cellular therapy centers in
Canada, USA and UK [http://www.factwebsite.org].
There may now be about 200 public or private
clinics offering stem cell treatments around the world.
Government regulations and oversight, albeit slow, are
being gradually implemented, especially after exposure
to the public of unprofessional conducts and after media
reports of tragic incidents. For example, Germany has
tightened and revised laws to regulate treatments using
adult stem cells [28]. In The Netherlands, the Dutch
Healthcare Inspectorate has been keeping a close watch
on clinics offering stem cell treatments to patients [29].
Back in 2007, The Netherlands already had laws that
banned “private stem cell therapy for conditions such
as amyotrophic lateral sclerosis and multiple sclerosis”
[30]. The Health Department in China established
laws and regulations on cord blood banking as far back
in 1999 and revises them continually [31].
However, the existence of such external accreditation
agencies to ensure high professional standards
as well as government laws and health inspectorates to
oversee the operations of cord blood banks and stem
cell therapy centers, does not seem to be totally effective
in controlling fraudulent claims and misrepresentations
of stem cells. The problem is that implementation
and enforcement of these laws and regulations
are difficult worldwide. The January 2010 issue of The
Economist has highlighted such a problem in China,
while acknowledging that the stem cell work in China
is ‘world-class’ and government regulations are in
place [32].
New discoveries in the rapidly developing field of
Regenerative Medicine are being reported frequently.
Clinical applications and therapeutic uses of stem cells
are being tried and carried out with promising results. Because of the high degree of media attention to, and
publicity on, stem cells, the public should be aware that
unscrupulous opportunists do prey on seriously ill patients
and their loved ones by exaggerating the potential
(but unproven) applications of these cells and that
some producers of cosmetics purposely use the term
‘stem cell technology’ in their marketing materials.
I have highlighted the amazing discoveries in
stem cells and the immense possibilities in Regenerative
Medicine for the future practice of medicine. In
view of the great potential and promise of human stem
cells and in order to protect the public from falling prey
to unscrupulous individuals and business operators, I
would like to reiterate that clear and strict government
laws and regulations must be put in place for licence
and medical/business operation requirements. Moreover,
an independent stem cell inspectorate needs to be
established and empowered with the mandate and legal
authority to: a) monitor and enforce total ‘compliance’
with the government laws and regulations, and
b) charge and prosecute any ‘non-compliance’ to the
fullest extent of the law. With these mandates in place,
I look forward to hearing more exciting news about
stem cells.
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