Changing the future with stem cells | Crystal Ruff | TEDxLondonBusinessSchool

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Every single one of us is affected by diseases which stem cells could potentially treat in the future. Dr Crystal Ruff explains what stem cells are and how they are changing the way we treat diseases.

Crystal is a keen investigator in the field of regenerative neuroscience and translational health research, with a proven track record of academic and performance excellence. She concluded her MBA at the London Business School in July 2016.
Crystal's expertise lies in stem cell therapies and their transition from the lab to the clinic in order to help commercialize these strategies and get the best treatments out to the public. As a postdoctoral fellow in the Fehlings Laboratory for Neural Repair and Regeneration at the University of Toronto in Canada, she spearheaded the stem cell therapy for cerebral palsy animal initiative. Her work in knowledge translation of regenerative medicine involves several internationally-distributed documents, as well as information packages produced for the White House Office of Science & Technology Policy working group and CTV news.

For the past 12 years,

I have been a researcher
in the field of regenerative medicine.

As a doctor of neuroscience,

my work investigates
whether or not we can use stem cells

to help children who have had brain injury
or adults with spinal cord injury.

Today, I am going to speak with you

about how we are changing
the future with stem cells.

I believe that stem cells
are the new Internet.

Think about it.

Think about how the Internet completely
changed the way that we communicate,

the way that we do business,

and even the way
that we gather data and information.

Similarly, I believe that stem cells
have the power to revolutionize

the whole concept of healthcare.

So to start, let's have
a little audience participation.

Put your hand up: how many of you
have heard of the term "stem cells"?

Now leave your hand up
if you can tell me what they are.

This illustrates a very important part
of my work in science communications.

Most of us have heard
of the term stem cells

either through the media
or through our friends,

but very few of us
actually know what they are,

what they can do,
and, importantly, what they can't do.

So, today, we're going to speak
a little about what stem cells are,

we're going to look
at what they're currently being used for,

and where the future of the field lies.

So, you can't be expected to understand
about stem cell treatments

if you don't understand
what stem cells are to begin with.

This is something
that I like to call "Stem Cells: 101".

We all know that the hundreds of cells
in the human body

all originate from one fertilized egg.

If you think of this
as a ball rolling down a hill:

at the top of the hill, the ball can go
to any number of destinations downhill,

but as it rolls down guided by gravity,
it hits a series of forks in the road.

After which it must make a decision
to go one way or the other,

and that restricts its potential outcomes.

Similarly, stem cells
during the process of differentiation

face a series of fate decisions

where they must choose
which cell type to specialize into,

and they cannot go back.

Near the top of the hill,
you see pluripotent stem cells:

"pluri-" meaning "many";
"potent", "potencies".

Embryonic pluripotent stem cells

are the type of stem cell that people
most often associate with the word.

However, in reality, these cells
are virtually never used

in transplant paradigms.

Instead, we differentiate the cell down
into multipotent progenitors

that are very specialized for the type
of tissue that we want to get.

It's important to note
that one type of multipotent cell

cannot make adult cells of another type.

For example, fat stem cells
cannot make cells of the brain or the eye,

and vice versa.

So, you might ask,

if pluripotent stem cells can turn
into any cell in the body,

why don't we just inject those?

You know, they could go to the site,

they could travel to the site
of whatever is injured

and turn into the cells that we need.

Right?

Wrong!

Because they could turn
into something like this.

This is called a teratoma.

The problem is once we put stem cells in,

we cannot control where they go
or what cells they turn into.

They could turn
into all of the cells in the body

all at once, all in the same place.

Here you can see hair,
fat, tooth, gut, bone -

imagine if this were
in your brain or your eye.

This is why we must differentiate cells

into the specific progenitors
as much as possible

before we're thinking
of transplanting them in.

Now, all of our adult tissue has
its own multipotent cells within it,

that's what helps us to grow
or when we're repairing injury,

and these can be harvested
in many tissues,

and grown in the lab
for transplanting paradigms.

However, there are some tissues
that you can't harvest.

Think about the brain
or the heart or the eye.

Going in there to get cells
could kill you.

So we have to think of other alternative
cell sources for these cells.

And this is where
pluripotent cells come in.

Now, up until now, embryonic drive cells
have been differentiated down the hill

into the stem cell types that we need.

Recently, induced pluripotent
stem cells were developed

where you can take adult skin samples,
your own consenting adult,

push them back up the hill
using four chemical factors,

and then differentiate them down
to the cell type you need.

This was discovered recently
by Shinya Yamanaka,

who went on to win the Nobel Prize.

The good thing about this is
it uses non embryonic sources,

and it's your own tissue,
so your body is not likely to reject it.

Alternatively, direct lineage
reprogramming - there we go -

takes you from A to B

without this intermediate
step up the hill.

You can take adult skin samples

and differentiate them directly
into the cell type you choose

using different chemical triggers.

Now, this is only
in the lab phases, it's very new,

but it represents
a very interesting direction

into where the field is heading.

So, what we are we doing with stem cells?

Here's another audience participation.

How many of you are affected by,
or know someone who has been affected by,

any of these diseases?

Put up your hands.

Stroke, burns, diabetes,
injuries to joints.

Now look around.

Every single one of us
is affected by diseases

that stem cells could potentially
one day help treat.

Just because we are putting stem cells
into the first person in the first trial

doesn't mean these are a treatment,

doesn't mean it's
a regular accepted treatment.

As you can see here,

it can take up to ten years or over

to get through
the clinical trials pipeline.

Science is incremental,

but the good news is
we have a lot of treatments

that have been in the pipeline
for many years,

that are just now starting to come out.

Furthermore, now more than ever before,

scientists, clinicians,
members of the public, policymakers,

are all working together
to streamline this process.

That means we can get
the best stem cell treatments out

to the people who need them the most
in the shortest amount of time.

So here you see these diseases
are colour-coded

based on where they are on the pipeline.

You can see that we have
two current treatments using stem cells

here in green.

The first for bone and blood cancer

you might know of
as a bone marrow transplant.

Been used for decades.

The next stem cell product
to come out of the pipeline

is for burns and wound healing.

This uses skin tissue
and helps with vision burns as well.

Today we're going to focus
on two major areas

that we're using stem cells in.

The first is stroke.

This is my work in childhood brain injury.

Did you know that cerebral palsy
is more common

than juvenile AIDS, childhood leukaemia,
muscular dystrophy,

and juvenile diabetes combined.

Cerebral palsy, which means
problems sending signals

from the brain to the muscles
creating movement

is the most common
neurodevelopmental disability.

What my work does,

is we inject stem cells into the brain

which are able to incorporate
and turn into the site types of cells

that are lost in the most
common forms of brain injury.

They can enhance function
and restore brain tissue.

And what my work in particular
has been able to show

is that we are able to functionally
double the signal speed

in the brains of animals.

What could this mean for a child
with cerebral palsy?

This could mean the potential
for normal movement,

the ability to go out and run and jump,
to play with their friends.

Very exciting stuff.

Right now, these cells are being used
in clinical trials only.

There are trials in adults
looking at stroke,

and there are adult trials
looking in spinal cord injury.

The same cells are lost in these models.

Importantly, the first clinical trial
using these types of cells

has now started in children.

Next, I want to focus
on a very interesting area

that's combining 3D bioprinting
with stem cell regenerative medicine.

This is in red, because it is
only in the early stages,

but I think it represents
a very exciting avenue

through which the field is heading.

With improvements
in imaging software and technology,

we are now able to make accurate 3D images

and take scans of body structures
inside the body.

Using AutoCAD and 3D software,

we are able to make CAD designs
which can be printed using 3D bioprinters.

These bioprinters are kind of like
the printers you have at home,

only, instead of using ink,
they use special biogels

to create the structures
that you have in the body.

After that, you can seed them
with stem cells.

Here you see a heart valve being printed

which can then later be seeded,
possibly with your own stem cells.

There's an image on the inset
of the heart valve.

There's also an image of an ear
being seeded with stem cells

which can be your own.

Underneath, you see
a 3D printed image of a trachea.

On the bottom right, you see an interview
that I recently did with CTV national news

on the youngest ever
transplant recipient of a trachea

seeded with her own stem cells.

It's important to note
that while this is very exciting,

it is still in its infancy.

We cannot make complicated structures
with multiple cell types,

and right now, it is just very basic.

But think about where this can head.

Think about whether we could
use it in the future

to print structures in the body
and use our own cells for transplant.

So this is a very exciting field,

but as with every potentially
game-changing technology,

there are challenges.

This used to centre around the use
of embryonic drive stem cells,

but, recently, with the advent
of the induced pluripotent stem cells

and direct lineage reprogramming,

which can use your own adult
consenting tissues,

this conversation has become
less and less relevant.

What we see,

especially with the the increase
of treatments coming out of the pipeline,

is misrepresentation
of stem cell strategies.

Here, some doctors are offering
unproven treatments using stem cells

for profit.

Unproven - that means
a) not proven to work,

and b) not proven to be safe.

Recently, "Scientific American"
had an article

about a woman who went
to a very fancy clinic in Beverly Hills

and got the latest stem cell facelift
that they were offering.

The doctors took advantage
of a loophole in the law,

sucked out her fat,
and put the stem cells in her face

to make her rejuvenated,
or healthier or something.

And while they were under the hood,
they gave her dermal filler.

What the doctors didn't take into account

is that dermal filler

differentiates fat stem cells

into bone.

So this woman was left
with bone fragments in her eyelids.

This is why we need clinical trials
to make sure that treatments are safe.

if you were to take a drug,
and you had a bad side effect,

you could stop taking the drug,
and that side effect would go away.

But it's not the case with stem cells.

Once stem cells are put in,
they can never be taken back out.

Furthermore, going
to an unregulated clinic

can exclude you
from future legitimate trials.

So, how do you know
whether or not what you're looking at

is a real stem cell treatment
or misrepresentation?

Here are some hints that can help you,
it's a difficult field to navigate.

The first: look at
how many cell types per injury.

We mentioned that cell types need to be
very specific to replace damaged tissue,

and one stem cell type
cannot turn into cells of another.

So it's very important if someone's saying

they're going to suck out
one type of stem cell

and use it for 12 different indications,

it's likely something you should question.

Second of all: you can check out
their preclinical track record;

clinicaltrials. gov
is a comprehensive database

of all of the clinical trials
if they want to get FDA approval.

And the third and most important
thing that you can do

is to be knowledgeable.

Do your research and get consensus.

Ask your doctors, all of them,
because they are here to help you.

So, overall stem cells have the potential

to change life as we know it.

Every single one of us
is affected by diseases

which stem cells could potentially
help to treat in the future.

And now that you have the knowledge,
you have the power.

It is up to you to spread
the word about stem cells

and to support reputable clinical trials,

so that we can work hard
to get the best treatments out

to the people who need them the most
in the shortest possible amount of time.

Right now, there are
many - more than ever before - treatments

in the pipeline, ready to come out.

And the field of regenerative medicine
is at critical mass.

So I ask you to come join me
on this journey.

Come with me as newly-minted purveyors
of stem cell knowledge

as we turn science fiction
into science fact.

Thank you.

(Applause)