Stem Cell Therapy Sparks Hope in Ailing Hearts

By Chawadee Nualkhair

BANGKOK — Esteban Bonilla feels no trepidation as he is wheeled into the operating room of a Bangkok hospital, despite the fact he is only minutes away from starting an experimental stem cell procedure he hopes will keep him alive.

"I really don’t feel nervous at all," said the 37-year-old scuba instructor from Florida, who discovered his heart was failing at 32. "For the last five years, I’ve been waiting to die. This is the first time I’ve been hopeful to live."

The source of Bonilla’s new-found hope is a novel therapy that involves injecting stem cells culled from the patient’s own blood into the heart to try to regenerate ailing heart muscle.

The two-hour procedure, which involves a patient’s own adult stem cells, skirts the risk of rejection by the body and thorny ethical issues surrounding the use of embryonic stem cells posed by some who equate using embryos with destroying human life.

"We have not lost a single patient," said Suphachai Chaithiraphan, chairman of Chao Phya Hospital and president of the Heart Association of Thailand. "If you can offer help to desperate people, then I think you should."

The destination for many of the heart patients seeking stem cell therapy is Thailand, where doctors have staked their reputations on a procedure they say could save thousands of people but has yet to be approved in the United States.

"With stem cell therapy, people who have not had access to heart transplants or resources to go to the hospital on a regular basis can be helped," said Kitipan V. Arom, chief cardio-thoracic surgeon at Bangkok Heart Hospital.

Kitipan, who has performed the procedure on 27 patients since May, including Bonilla, estimates up to 500,000 Americans a year suffer from heart failure, which leaves them winded after performing routine activities such as climbing stairs.

But the use of stem cells — master cells in the body which can develop into any cell type — remains a touchy subject for many since very early human embryos are considered the most promising for treating human diseases.

South Korean stem cell scientist Hwang Woo-Suk, who published a landmark study on tailored human stem cells in May, resigned from his post at Seoul National University on December 23 after a probe panel said results in his paper had been fabricated.

BODY BUILDING BLOCKS

Some scientists fret the controversy over Hwang’s case could provide fodder for opponents of embryonic stem cell research, which is seen as a vital step toward treatment of a host of ailments such as spinal injuries.

Their concerns cast some skepticism over the advocates of adult stem cell use due to fears the research may be politicized.

"Several opponents previously have claimed that any adult stem cell could turn into any other tissue," rendering embryonic stem cell research unnecessary, said Irving Weissman, director of the Stanford Institute for Stem Cell Biology and Regenerative Medicine in recent comments on the Web site, mednews.stanford.edu.

"Although this notion has been thoroughly disproved by several independent groups, those advocates persist in their claims."

Kitipan said the long-term effects of the stem cell procedure were uncertain, and the possibility remained that patients who have had the surgery must go under the knife again.

"The problem is only a small number of patients are being done so far," he said. "No place else around the world, to the best of my knowledge, does this."

The stem cell controversy is a world away for Wisconsin crop duster pilot George Efaw, 65, who thinks this particular treatment works.

"I thought I would die when I went to sleep. I feel better now than I did," said Efaw, whose heart was only working at 20 percent of its capacity before the surgery.

"I’d probably be dead in six months, maybe a year. I would have sat in my house, listened to my doctor like everyone else and died," said Efaw, who took out a mortgage on his home to help pay for the $31,500 operation.

Theravitae, the company whose technology separates adult stem cells from the blood, said the focus should be on therapy proven to work in humans.

"Embryonic cells, by their very definition, are not from your body," said Robert Clark, Theravitae’s chairman. "Right now, inside your body, you have everything necessary to build what you need now."

Theravitae is set to begin clinical trials with Thai doctors in January to treat peripheral vascular disease, a circulatory ailment which can lead to amputations.

Next up: Parkinson’s disease by mid-2006 and some forms of blindness in the first quarter of 2007. Eventually, Theravitae thinks, the technology could be used to treat emphysema, broken bones, renal failure and diabetes.

"When I say some day, it’s not some day a million years from now," said Clark, a Texan who has lived in Thailand for three years. "It’s some day five years from now or 10 years from now at the very latest."

TARZAN CALLING

While skeptics remain, 70 heart patients worldwide have undergone the therapy, which does not pose the risk of sparking irregular heartbeats, unlike similar adult stem cell treatments involving muscle or bone marrow, doctors say.

More are set to follow.

Theravitae, which says it will become profitable in January 2006, expects 100 people a month will be coming to Thailand to seek the stem cell treatment by June next year, and say its own patient base has exploded by 600 percent.

One patient, Calvin Miller, a 56-year-old ex-firefighter, was dreaming of Tarzan pounding on his chest when he awoke to discover he was having his fifth heart attack in six weeks.

"I woke up to find a 250-pound nurse pounding on my chest," he said. When doctors asked what he wanted after being revived, "I said I wanted the nurse arrested for assault."

Miller, who now keeps a diagram of his heart in his front shirt pocket at all times, says the experience has helped him bond with other patients, who now keep in touch regularly.

"The commonality of our illness, it brings people together."

A day after his own heart surgery, Bonilla is looking forward to returning home to his family.

"I would love to just get back into the water and dive again," he said.

(Additional reporting by Karishma Vyas and Noppawan Bunluesilp)