What are stem cells?

Stem cells are characterized by the ability to differentiate into different cell types. They undergo a special type of cell division, which give rise to daughter cells. These are either endowed with stem cell properties or they mature to a special cell type, depending on certain physiologic conditions.

Stem cells are important during all stages of human development. The first cells which are produced from the fusion of an egg and a sperm cell provide a basis for all processes of develpment and maturation. Hence, so-called embryonic stem cells are able to construct all types of organs and tissues, thus all cell types of an organism. Consequently, these cells are called totipotent. Elder stem cell generations which are found in maturing and adult organisms are more specialised. Hence, so-called adult stem cells have the ability to heal and regenerate the organ in which they are found, their spectrum of differentiation is limited. For example, stem cells found in the nervous system are able to differentiate to all neural cell types but not to hepatic or muscle cells. Adult stem cells are hence only multipotent

The research on embryonic stem cells has generated a world-wide ethical debate. Corresponding legislation is as a matter of fact highly different in different countries. In Germany, research on embryonic stem cells is limited and only possible under strict control. Studies of embryonic stem cells are particularly important for understanding the fundamental mechanism of stem cell functioning. Adult stem cells, however, are already used in cell therapy. Thereby autologous stem cells are taken from patients and are usually derived from the bone marrow. After a preparatory treatment, patient's own stem cells are then returned to his body, where they stimulate the diseased organ to self-renew. An area of application is for example the myocard after a myocardial infarction. Such a treatment has the advantage that no exogenous cells are required and any risk of graft-versus-host disease is eliminated because the patients are treated with their own cells. At the RTC, we work exclusively with adult stem cells.

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Stem Cell Therapies- State of the art and future perspectives

Stem cells are interesting for the medical application because they offer the possibility to achieve sustained healing of diseased organs or body functions. Stem cells are able to stimulate the organism to regenerate itself whereas conventional pharmaceuticals are not able to do this. They simply alleviate the symptoms. Stem cell treatments are novel cell therapies and embedded into regenerative medicine. This field faces a promising future.

For some diseases stem cell therapies have already been etablished, e.g. to treat patients with leukemia. Further applications have been intensively studied, e.g. the treatment of Type 1 diabetes mellitus, Parkinson's disease, multiple sclerosis, breast cancer or cardiovascular disease.
Progress in these different areas can be very different, i.e., in some fields studies are in the stage of basic research, whereas in other fields clinical trials have already begun. As an example, research on cardiovascular diseases show promising results. In this field, standardised therapies are about to be established which will also be accepted as regular treatments by health insurance authorities.

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What is cardiac stem cell therapy?

The RTC focuses on reseach on stem cell therapy for cardiovascular diseases. In Germany around 280.000 people suffer a myocardial infarction every year, and over 60.000 people die from an acute myocardial infarction. Myocardial infarction occurs when the coronary blood vessel is occluded. This is followed by oxygen shortage and restriction in blood supply of the surrounding myocardial tissue such that the tissue dies. The heart is not able to repair the destroyed or injured tissue without enthetic help. At present, the common treatment of myocardial infarction is able to improve the quality and duration of life but can not achieve the heart performance before the myocardial infarction.

An innovative approach of treatment is the intracardiac stem cell therapy. Patients receive autologous stem cells directly injected into the myocardial tissue. There, the stem cells are to foster the regeneration of destroyed or weak tissue. Once successful, myocardial infarction and cardiac insufficiency would be curable. Indeed, several independent studies promise that this overall goal may in fact be achievable. This approach of treatment has been investigated for many years and scientists from the University of Rostock have been leaders of this field from the very beginning.
As of today, already 100 patients were successfully treated with stem cells at the Clinic and Policlinic for Cardiac Surgery of Rostock.
In 2009, the RTC has started a multicentric study together with the Clinic and Policlinic for Cardiac Surgery of Rostock. The intention of this study is to systematically circumstantiate that stem cells are able to regenerate destroyed tissue after a myocardial infarction. This study is important for two reasons: On the one hand it will be an important prerequisite for authorisation as a standardised and quality-assured therapy by the legal authorities, and on the other hand it is to break ground for the general reimbursement possibility by the compulsory health insurance fund. Only if both requirements will be met, this treatment will be made available to all corresponding patients.

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What kind of research is done at the RTC?

According to German Medicines Act proof of the pharmaceutical quality, efficacy, and safety of the pharmaceutical product must be provided before placing on the market.
The autologous stem cells which have been investigated and succesfully applied in clinical trials at the University of Rostock already since 2001 are in fact drugs and therewith are subject to strict regulations of the legislator. Before authorisation, these stem cell therapies must be proven regarding efficacy and safety at patients including the performance of clinical trials according to the GCP Ordinance (Good Clinical Practice). An example for this is the clinical multicentric study which is currently being prepared by the RTC at the present.

Complementary to this study, the RTC will continue the study of fundamental questions of stem cell therapy. For example, it is to be clarified which factors control a successful cardiac stem cell therapy: Is it the ability of stem cells to self-renew cardiovascular cells resulting in the regeneration of diseased tissue or are there other yet unknown responsible mechanisms?
Therefore the scientists at the RTC focus on the mechanisms of stem cell differentiation and analyse the applied stem cells regarding purity and type. In addition, they monitor the long-term efficacy at animal models to investigate how the stem cells function and to prove the safety of the therapy. This work is conducted together with the Clinic and Policlinic for Cardiac Surgery of Rostock in collaboration with the German Heart Institute Berlin, the Hannover Medical School, and partners from industry. Furthermore, the RTC is integrated in the world-wide network of stem cell research.

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