When Karen Davis attended a presentation at a dental conference in 2013, she unexpectedly discovered a service that could help her daughter, Madeline: storing stem cells derived from her teeth that potentially could be used in the future to treat her Crohn's disease.
"Even though this isn't a viable option today, I know how rapidly things can change."
Throughout high school, Madeline suffered from the painful autoimmune disorder, which wreaks havoc on the gastrointestinal system and can lead to life-threatening complications.
"I leave no stone unturned when it comes to medical care and this resonated with me," says Davis, a Dallas-based dental hygienist who was encouraged by advances in stem cell research. Later that year, when Madeline got her wisdom teeth extracted, Davis shipped them off to the Store-A-Tooth company in Massachusetts, where they will be kept frozen until needed. "Even though this isn't a viable option today, I know how rapidly things can change," says Davis. "To me, this was a worthwhile investment—I didn't want to miss out on an opportunity that would provide a pathway to a cure."
Karen Davis pictured with her daughter Madeline.
(Courtesy of Karen Davis)
The process itself was straightforward. Madeline's newly extracted wisdom teeth--baby teeth can be saved, too—were bathed in a special solution, loaded into a Styrofoam container lined with cold packs and sent to the stem cell company. There, a team harvested the dental stem cells from the pulp, then grew them in culture and cryogenically preserved them. Store-A-Tooth charges $1500-1749 for tooth collection and $120 per year for storage, while other dental pulp stem cell tissue banks cost $500-$600 upfront and in the $120 range annually for storage.
The rationale here is that if you missed out on banking your baby's umbilical cord blood, this gives you another chance to harvest their stem cells. "If their child later develops an illness that could be managed or even cured with stem cell therapy, this is an insurance policy," says Amr Moursi, DDS, PhD, chair of the department of pediatric dentistry at New York University College of Dentistry.
But is there a genuine potential here for some effective treatments in the relatively near future—or is this just another trendy fad? Scientific opinion is decidedly mixed. Stem cells have been heralded as the next frontier in medicine because of their versatility: with a little chemical coaxing, they can be transformed into different cell types, such as heart, blood or brain cells, to create tissue that can mend damaged body parts. Because they're taken from your own body, there's little chance of rejection, which means patients don't have to take strong antirejection drugs that can have all sorts of unpleasant side effects for the rest of their lives.
However, while stem cells are immature cells found in different tissues, ranging from abdominal fat to bone marrow, there is a vast difference between the stem cells found in cord blood and in teeth. Cord blood, which is culled from the umbilical cord when a baby is born, contains what are called hematopoietic stem cells (HSCs), which can mature into other blood cells. These type of stem cells have already been approved by the U.S. Food and Drug Administration to treat patients—especially children--with blood cancers, such as leukemias and lymphomas, and certain blood disorders like sickle cell anemia.
In contrast, stem cells in teeth are called mesenchymal stem cells (MSCs), which are found in dental pulp, the tissue in the center of the tooth that's filled with nerves and blood vessels. MSCs are adult stem cells normally found in the bone marrow that can transform into bone, fat, and cartilage cells, and also aid in the formation of blood stem cells.
"Right now we just don't have rigorous evidence that they can be used in that fashion and have real benefit."
Small studies on lab animals suggest that MSCs secrete growth factors—hormonal steroids or proteins—that can nurture ailing cells, act as powerful anti-inflammatory agents that could tame autoimmune disorders like the one that plagues Karen Davis's daughter, and may even generate new nerve and muscle tissue. Preliminary research suggests they potentially could treat medical conditions as varied as heart disease, spinal cord injury and type 1 diabetes by generating new cells, which can replace damaged or dead cells.
But this is all very early research and there's a vast difference between how cells behave in the tightly controlled environment of a lab versus the real world in a diverse population of human patients. "Right now we just don't have rigorous evidence that they can be used in that fashion and have real benefit," says Pamela G. Robey, PhD, chief of the skeletal biology section at the National Institute of Dental and Craniofacial Research at the National Institutes of Health.
Robey should know—she headed the research team that discovered stem cells in human baby teeth and in wisdom teeth more than fifteen years ago. She believes prospects are better using these stem cells for tooth repair: research suggests they may be able to fix cracked teeth, repair bone defects caused by gum disease, or in root canal therapy, where they can be used to replace infected tissue with regenerated healthy pulp.
In the meantime, though, there are no clinical applications for MSCs. "These tooth banking companies aren't doing their own research," says Leigh Turner, a bioethicist at the University of Minnesota who monitors stem cell clinics. "They cobble together reports of early research in humans or from animal studies in an effort to provide a narrative to make it seem like it is evidence based."
Still, in all fairness, tooth banking companies aren't making the kind of extravagant claims made by stem cell clinics, which operate in a gray area of the law and purport to treat everything from chronic lung disease to Alzheimer's. "We don't know when therapies will be available using these cells because the pace of research is hard to predict," says Peter Verlander, PhD, a molecular geneticist and chief scientific officer of Provia Laboratories, the parent company of Store-A-Tooth. "But for parents who regretted not banking their child's cord blood, especially if they later develop a disease like diabetes, this is another opportunity."
But the jury is still out if this is truly a good investment. Moursi, a national spokesperson for the American Academy of Pediatric Dentistry who fields queries about this practice from a dozen or so families a year, concludes: "If you could afford it, and know the risks, benefits and current limitations, then it is something to consider."
Is Red Tape Depriving Patients of Life-Altering Therapies?
Rich Mancuso suffered from herpes for most of his adult life. The 49-year-old New Jersey resident was miserable. He had at least two to three outbreaks every month with painful and unsightly sores on his face and in his eyes, yet the drugs he took to control the disease had terrible side effects--agonizing headaches and severe stomach disturbances.
Last week, the FDA launched a criminal investigation to determine whether the biotech behind the vaccine had violated regulations.
So in 2016, he took an unusual step: he was flown to St. Kitt's, an island in the West Indies, where he participated in a clinical trial of a herpes vaccine, and received three injections of the experimental therapeutic during separate visits to the island. Within a year, his outbreaks stopped. "Nothing else worked," says Mancuso, who feels like he's gotten his life back. "And I've tried everything on the planet."
Mancuso was one of twenty genital herpes sufferers who were given the experimental vaccine in tests conducted on the Caribbean island and in hotel rooms near the campus of Southern Illinois University in Springfield where the vaccine's developer, microbiologist William Halford, was on the faculty. But these tests were conducted under the radar, without the approval or safety oversight of the Food and Drug Administration or an institutional review board (IRB), which routinely monitor human clinical trials of experimental drugs to make sure participants are protected.
Last week, the FDA launched a criminal investigation to determine whether anyone from SIU or Rational Vaccines, the biotech behind the vaccine, had violated regulations by aiding Halford's research. The SIU scientist was a microbiologist, not a medical doctor, which means that volunteers were not only injected with an unsanctioned experimental treatment but there wasn't even routine medical oversight.
On one side are scientists and government regulators with legitimate safety concerns....On the other are desperate patients and a dying scientist willing to go rogue in a foreign country.
Halford, who was stricken with a rare form of a nasal cancer, reportedly bypassed regulatory rules because the clock was ticking and he wanted to speed this potentially life-altering therapeutic to patients. "There was no way he had enough time to raise $100 million to test the drugs in the U.S.," says Mancuso, who became friends with Halford before he died in June of 2017 at age 48. "He knew if he didn't do something, his work would just die and no one would benefit. This was the only way."
But was it the only way? Once the truth about the trial came to light, public health officials in St. Kitt's disavowed the trial, saying they had not been notified that it was happening, and Southern Illinois University's medical school launched an investigation that ultimately led to the resignation of three employees, including a faculty member, a graduate student and Halford's widow. Investors in Rational Vaccines, including maverick Silicon Valley billionaire Peter Thiel, demanded that all FDA rules must be followed in future tests.
"Trials have to yield data that can be submitted to the FDA, which means certain requirements have to be met," says Jeffrey Kahn, a bioethicist at Johns Hopkins University in Baltimore. "These were renegade researchers who exposed people to unnecessary risks, which was hugely irresponsible. I don't know what they expected to do with the research. It was a waste of money and generated data that can't be used because no regulator would accept it."
But this story illuminates both sides of a thorny issue. On one side are scientists and government regulators with legitimate safety concerns who want to protect volunteers from very real risks—people have died even in closely monitored clinical trials. On the other, are desperate patients and a dying scientist willing to go rogue in a foreign country where there is far less regulatory scrutiny. "It's a balancing act," says Jennifer Miller, a medical ethicist at New York University and president of Bioethics International. "You really need to protect participants but you also want access to safe therapies."
"Safety is important, but being too cautious kills people, too—allowing them to just die without intervention seems to be the biggest harm."
This requirement—that tests show a drug is safe and effective before it can win regulatory approval--dates back to 1962, when the sedative thalidomide was shown to have caused thousands of birth defects in Europe. But clinical trials can be costly and often proceed at a glacial pace. Typically, companies shell out more than $2.5 billion over the course of the decade it normally takes to shepherd a new treatment through the three phases of testing before it wins FDA approval, according to a 2014 study by the Tufts Center for the Study of Drug Development. Yet only 11.8 percent of experimental therapies entering clinical tests eventually cross the finish line.
The upshot is that millions can suffer and thousands of people may die awaiting approvals for life saving drugs, according to Elizabeth Parrish, the founder and CEO of BioViva, a Seattle-based biotech that aims to provide data collection platforms to scientists doing overseas tests. "Going offshore to places where it's legal to take a therapeutic can created expedited routes for patients to get therapies for which there is a high level of need," she says. "Safety is important, but being too cautious kills people, too—allowing them to just die without intervention seems to be the biggest harm."
Parrish herself was frustrated with the slow pace of gene therapy trials; scientists worried about the risks associated with fixing mutant DNA. To prove a point, she traveled to a clinic in Colombia in 2015 where she was injected with two gene therapies that aim to improve muscle function and lengthen telomeres, the caps on the end of chromosomes that are linked to aging and genetic diseases. Six months later, the therapy seemed to have worked—her muscle mass had increased and her telomeres had grown by 9 percent, the equivalent of turning back 20 years of aging, according to her own account. Yet the treatments are still unavailable here in the U.S.
In the past decade, Latin American countries like Columbia, and Mexico in particular, have become an increasingly attractive test destination for multi-national drug companies and biotechs because of less red tape.
In the past decade, Latin American countries like Columbia, and Mexico in particular, have become an increasingly attractive test destination for multi-national drug companies and biotechs because of less red tape around testing emerging new science, like gene therapies or stem cells. Plus, clinical trials are cheaper to conduct, it's easier to recruit volunteers, especially ones who are treatment naïve, and these human tests can reveal whether local populations actually respond to a particular therapy. "We do have an exhaustive framework for running clinical trials that are aligned with international requirements," says Ernesto Albaga, an attorney with Hogan Lovells in Mexico City who specializes in the life sciences. "But our environment is still not as stringent as it is in other places, like the U.S."
The fact is American researchers are increasingly testing experimental drugs outside of the U.S., although virtually all of them are monitored by local scientists who serve as co-investigators. In 2017 alone, more than 86 percent of experimental drugs seeking FDA approval have been tested, at least in part, in foreign countries, like Mexico, China, Russia, Poland and South Africa, according to an analysis by STAT. However, in places without strict oversight, such as Russia and Georgia, results may be fraudulent, according to one 2017 report in the New England Journal of Medicine. And in developing countries, the poor can become guinea pigs. In the early 2000s, for example, a test in Uganda of an AIDS drug resulted in thousands of unreported serious adverse reactions and 14 deaths; in India, eight volunteers died during a test of the anti-clotting drug, Streptokinase—and test subjects didn't even know they were part of a clinical trials.
Still, "the world is changing," concludes Dr. Jennifer Miller of NYU. "We need to figure out how to get safe and effective drugs to patients more quickly without sacrificing too much protection."
Your Beloved Pet Is Old. Should You Clone It?
Melvin was a special dog. A mixture of Catahoula and Doberman with black and tan markings, he was the office greeter, barking hellos to everyone who visited the Dupont Veterinary Clinic in Lafayette, Louisiana, which is owned by his human companions, Dr. Phillip Dupont and his wife, Paula. The couple say he's the best dog they ever owned.
When Melvin passed away, having two identical replicas helped ease the couple's grief.
He seemed to have an uncanny knack for understanding what they were saying, he could find lost car keys in tall grasses and the Duponts trusted him so much they felt comfortable having him babysit their grandson unattended in the backyard.
So when the 75-pound canine turned 9 and began to show signs of age, the Duponts sent off some of his skin cells to a lab in South Korea, the Sooam Biotech Research Foundation, to have him cloned. The Duponts toured the South Korean facilities and were satisfied that the animals were being treated well. While the first cloned puppy died from distemper, the second attempt produced two healthy animals—which the couple named Ken and Henry. When Melvin did pass away nearly two years later, in 2014, having two identical replicas helped ease the couple's grief. Even though it cost about $70,000 to clone Melvin, it was well worth it. "Melvin gave us a lot of pleasure," says Paula Dupont, "and this was less than the price of a new Land Cruiser."
As the technology improves, costs will tumble, making pet cloning more affordable for the mainstream.
The news has been filled recently with stories of celebrities such as Barbra Streisand or billionaire Barry Diller and his fashion icon wife, Diane von Furstenberg, spending big bucks to preserve their beloved pets—a practice New York magazine called "a laughable, extravagant waste of money." But cloning Fido isn't just for the ultra-wealthy anymore. Texas-based ViaGen now offers a domestic cloning service that will replicate Lassie for $50,000 and Garfield's kittens for a mere $25,000. While the exact number of cloned pets isn't known, the South Korean company says it has cloned about 800 pets while ViaGen has cloned about 100 cats and dogs. And as the technology improves, costs will tumble, making it more affordable for the mainstream, says Ron Gillespie, who heads PerPETuate, a Massachusetts-based outfit that collects and cryo preserves pet DNA, and works closely with ViaGen.
Even if the animals are genetic twins, biologists say, there are no guarantees their personalities will match, too.
While replicating Fido is becoming more feasible, should you? Animal rights organizations like The Humane Society and PETA are sharply critical of the practice, which is largely unregulated, and think it's outrageous to spend $50,000 or more to preserve Fluffy's genetic makeup when millions of cats and dogs are languishing in shelters and millions more are euthanized every year. And even if the animals are genetic twins, biologists say, there are no guarantees their personalities will match, too. Like humans, dogs' personalities are influenced by their environment and there are always variations in how the genes are expressed--although the Duponts say that Ken and Henry seem more like Melvin every day. "Their personalities are identical," says Paula.
Clones Ken and Henry, with Dr. Dupont and 10-year-old Melvin. Though all three dogs are genetic twins, their markings differ because the environment can influence how genes are expressed.
Still, the loss of a beloved pet can be incredibly painful, and in some cases, cloning can help deal with deep psychological wounds. When Monni Must's daughter died suddenly at age 28, the Michigan-based photographer adopted her child's black Lab, Billy Bean. As the dog got older and frailer, Must realized she couldn't handle losing her last link to her daughter—so she ponied up $50,000 to have the animal cloned. "I knew that I was falling apart," Must told Agence France-Presse. "The thought of Billy dying was just more than I could handle."
But these heated disputes miss what bioethicists believe is the real ethical dilemma—the fate of the female animals that provide the eggs and gestate the cloned puppies. "This issue tends to get framed as 'it's their personal choice, it's their money and they can do what they want with it,'" says Jessica Pierce, a bioethicist and author of Run, Spot, Run: The Ethics of Keeping Pets. "But this whole enterprise has all this collateral damage and behind-the-scenes impacts that people ignore. No one is talking about the dogs who are sacrificing themselves for this indulgence, and are suffering and being tormented just to have your clone."
"Even in the best-case scenarios, the cloned pet may go through several rounds of failed reproductive attempts—failed pregnancies, still births, and deformities."
Animal cloning, of course, is not new. Dolly, the sheep, made her debut in 1996 as the first cloned mammal. In 2005, Korea's Sooam Biotech cloned the first dog, and cloning horses and cows has become almost routine. Typically, the cloning process for dogs is fairly uncomplicated. It entails the use of a group of female dogs whose hormones are artificially manipulated with drugs to promote them to produce eggs. The eggs are then surgically harvested from donor dogs' ovaries. The immature eggs are stripped of their genetic information and then the pet's DNA is fused with the egg. When the embryo begins to develop, it is then transplanted to the womb of a surrogate dog.
However, cloning can have a high failure rate. When South Korea's Sooam Biotech lab cloned the first dog in 2005, there were 1000 failures—which means that number of eggs were fertilized and began to gestate, but at some point their development failed. And this figure doesn't include the number of dogs born with deformities serious enough that they are incompatible with life and need to be euthanized. "Even in the best-case scenarios, the cloned pet may go through several rounds of failed reproductive attempts—failed pregnancies, still births, and deformities," says Insoo Hyun, a bioethicist at Case Western Reserve University in Cleveland. "You can't do just one egg and one transfer. That won't happen. There is no guarantee that the very first time you will have a healthy animal. They're not miracle workers and you can't fight biology."
"You just have to let your pet go. It's all part of the experience."
But Ron Gillespie, who's been in the animal breeding business for decades, thinks these fears are overblown and that cloning is similar to the selective breeding that goes on all the time with cattle and even with champion racehorses. "We're really the victim of a lot of misinformation and misunderstanding," he says. "Right now, on average, we're dealing with three dogs: two that supply eggs and one to carry the embryo to term."
Still, this debate skirts the hard realities: dogs and cats simply have shorter lifespans than humans, and ethicists and animal rights activists believe there are better ways to deal with that grief. "You just have to let your pet go," says Hyun. "It's all part of the experience."