Sunday, April 15, 2007

Dr. Ildstad's Universal Bone Marrow Cure

Dr. Suzanne Ildstad is the Director of the Institute for Cellular Therapeutics at the University of Louisville.

She may have made a discovery which will garner her universal acclaim as the discoverer of greatest medical advance since penicillin. If her discovery is as impressive as it initially appears, she will have a Nobel Prize in ten years or less. All of us in the autoimmune community should pray that she is correct. If so, we will have life-time cures.

She claims to have discovered a kind of immune cell (bone marrow cell) which could allow for the transplantation of adult tissues and organs from any human being to any other without the use of anti-rejection drugs or HLA tissue matching. She calls this cell a “Facilitating Cell.” (The medical research shorthand for her Facilitating Cell is CD8+/TCR-).

Her discovery would allow any patient with an autoimmune disease to receive bone marrow from any healthy, non-autoimmune patient. The donor blood marrow would be incorporated into the recipient’s bone marrow. With the help of Facilitating Cells, the two bone marrows could live contently without conflict.

That may sound easy. But it is not. Imagine putting young male Bagdad Shias and Sunnis, each one armed with loaded AK 47s, in the same dining hall and expecting them to sit calmly together to eat. Each Shia passing the serving bowls politely to the Sunni sitting next to him and vice versa. The chances of our Bagdad friends eating peacefully together are far higher than the chances of two different adult bone marrow tissues existing happily inside of our bones.

Yet, Dr. Ildstad says she has found a way to do just that. She says she can get bone marrows from different adults to co-exist contently together in the same bone. In fact she has known how to make bone marrows exist happily together since 1994! The year she first discovered Facilitating Cells.

Tissues from different animals living together happily inside of one animal is known as mixed chimerism.* If the process is perfected, it holds the hope of being a pemanent life time cure for most chronic diseases.

Dr. Ildstad’s technique would mean that a few healthy bone marrow cells living mixed in with our own might be enough to put a stop to the autoimmune cascade. Our own bone marrow cells apparently are unable to secrete the needed "stop" signal. A few of her facilitating cells would allow healthy donor bone marrow to live compatibly with our own. The transplanted bone marrow would control the cascade and restore immune tolerance (homeostasis).

Just think how a few signal lights and police officers giving tickets can change traffic chaos into a controlled and managed flow. So, too, would are immune responses be—controlled and managed.

It has been known for the last five years that giving a kidney (or any organ) transplant patient an infusion of the donor’s blood marrow can often greatly reduce or eliminate the need for anti-rejection drugs. Until now no one has understood why giving both worked better than donating a kidney alone.

Dr. Ildstad says she knows. If the donor bone marrow given to recipient contains “facilitating cells” then there is no rejection. Facilitating cells are very rare in the bone marrow. Sometimes giving a donor bone marrow infusion does not help. In those cases Dr. Ildstad’s facilitating cells were either not in the bone marrow donated or they did not survive. For organ or bone marrow transplants, the bone marrow must be “facilitator rich.”

Complete bone marrow transplants have been know to cure MS, RA, Lupus and autoimmune diabetes for more than thirty years.

The discovery was made by chance. Some patients with leukemia who needed a bone marrow transplant also had an autoimmune disease. In patient’s who survived the transplant, both the leukemia and autoimmune disease were cured. Physician’s were astonished and thrilled that the autoimmune disease was also cured. However, bone marrow transplant has yet to become a "best practices" standard of autoimmune treatment due to the high rate of "complications."

The death rate for a complete bone marrow transplant is still between ten to 25 % of patients who receive it. Many patients who do live, do not re-grow a fully functioning immune system from the donor’s bone marrow. They remain vulnerable to infections for the rest of their lives. The death rate among patients who re-grow only a partial immune system is many times the background death rate of adults of the same age. (A complete bone marrow transplant means the recipient’s bone marrow is completely eliminated in a process call ablation using chemicals like liquid mustard gas—cyclophophamide and whole body radiation.)

Because of the high complication rate an alternative to complete destruction of the recipient’s bone marrow has been sought for some time. Other researchers have tried partial destruction of the patient’s and letting the patient’s existing bone marrow grow back. The process has been called “rebooting” the immune system. This month researchers in Brazil and Israel announced they had “cured” type I diabetes in human patients using this process.* * The hope is that the malfunctioning cells in the bone marrow are killed and only healthy bone marrow grows back.

It is a random shot. The partial bone marrow destruction is not targeted to the malfunctioning cells because no one knows exactly where they are located. However, this technique (using low doses of cyclophosphamide) works more than half of the time. It is not new it has been used successfully in research centers in the United States for nearly a decade.

Some researchers have tried the partial destruction of the immune system with an infusion of donor bone marrow. Some times this process works and a cure is achieved some times it doesn’t and death results.

Dr. Ildstad’s work would allow for the partial destruction and implantation of donor bone marrow to happen much more safely. There would be no risk of rejection. There would be no deadly Graft Versus Host disease. Her technique depends on her claim that her “facilitating cells” are the magic mediators of mixed bone marrow conflicts. If she is right, a revolution in cures will happen. (Now we just need some “facilitating humans” to send to Iraq to stop the sectarian killing.)

Both the NIH and the Keck Foundation are impressed enough to have given her large grants to pursue this discovery. The NIH grant is for the development of a treatment for sickle cell anemia (another kind of bone marrow disease). The Keck foundation will finance “facilitating cells” as a cure for autoimmune diabetes.

Next planned blog entries include
(1) B cell cures,
(2) IVIG cures,
(3) new medications to correct malfunction immune cells,
(4) the need for a new AMA licensed specialty in immunity,
(5) the danger (for patients) of mis-informed physicians who were trained in last century’s medical schools,
(6) the problems with US medical insurance industry,
(7) problems with FDA clinical trial and approval processes, and
(8)the terrible burden of autoimmune on families and society.

*Mixed chimerism is actual not rare. Virtually all of us have a few our mother’s genetic cells living peacefully in and among our genetically distinct body cells. We may even have a grandmother’s cell or two. Our mother also has a few of our cells inside of her.

Every women who ever had a baby, had some of the baby’s cells cross the placenta and take up residence inside her.

The discovery of cross placental exchange of cells was made less than ten years ago, when healthy Y chromosome (male) cells were found in the blood of women who had previously given birth to boys. Decades later the Y chromosome cells were still alive.

At the time it was thought that this maternal mixed chimeric state might be one of the “irritants” that caused autoimmune disease to be several times higher in women than in men. Now many researches believe that mixed chimerism instead of causing autoimmune disease could cure it.


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