Stem Cell Therapy in Thailand

Doug Hanson,* a 55-year-old from the American Midwest, has spent most of the last 10 years battling heart problems. He has suffered several heart attacks and has had repeated coronary artery bypass operations and stenting procedures. At his last consultation with his cardiologist, he was told that his choices were either to have a heart transplant or to expect to die in the near future. With his history, Hanson had become somewhat of an authority on cardiac disease, and asked his doctor about stem cell therapy. Initially, his cardiologist was skeptical, but after some research, informed Hanson that the new technique was showing some promising results.

There is no advance in medical care that is generating as much interest and excitement as stem cell therapy. It is now moving from the world of laboratories and researchers into the world of hospitals and clinicians.

Stem Cells

Each organ in the body is composed of tissue whose cells are specially designed to perform the work that they do. These cells all originated from undifferentiated stem cells, which have the ability to develop into all the different specialist cells that the body needs. Throughout life, the body retains the ability to produce a few stem cells that can repair organs that have been damaged.

The use of embryonic stem cells from the blastocyst, which is undergoing development to form a fetus, creates an ethical concern, since the embryo needs to be sacrificed to obtain these cells. On the other hand, there is minimal ethical objection to the use of adult stem cells, because the cells used are the patient's own cells. Indeed, adult blood-forming stem cells from bone marrow have been used to treat blood diseases for over 30 years.

Recent research on adult stem cells has generated a great deal of excitement, particularly the realization that they occur in many more tissues than was once believed. This finding has led researchers to explore the possibility of them being used for transplantation into areas needing repair. Given the right conditions, certain kinds of adult stem cells have the ability to differentiate into a number of cell types. If this differentiation of adult stem cells can be controlled, and the cells placed into damaged tissue that needs rebuilding, amazing things can happen.

While embryonic stem cell therapy remains theoretical, trials of adult stem cell therapies are already underway and the potential for treating several clinical conditions is being explored. The technique is essentially assistive, and involves improving the normal ability of stem cells to repair damaged tissue by boosting the number of stem cells available to a damaged organ. Further, since the adult stem cells come from a patient's own cells, they do not produce any immune response or antigenic rejection, thus cause fewer medical side effects.

Stem Cell Therapy at the Bangkok Heart Hospital

As Hanson learned, cardiology is an area in which stem cell therapy is showing great promise. After each heart attack, Hanson's heart had healed, but the contractile heart muscle had been replaced with scar tissue that does not contract. Cardiomyopathy is another condition where the muscles of the heart lose their contractile ability and the strength to pump the blood effectively. The aim of the stem cell therapy is to encourage the heart to produce new heart muscle cells.

At the Bangkok Heart Hospital (BHH) in Thailand, a program has been established in association with the University of Pittsburgh. The BHH is headed by Dr. Kitipan Arom, who spent 30 years in Minneapolis before returning to Thailand and establishing a groundbreaking stem cell treatment program. Hanson had learned of the program and, like patients from all over the world, came to Bangkok to obtain this treatment. At the present time, 65% of the patients that have been treated are from the United States, the remainder from Thailand and other countries around the world. After assessment by the team of cardiologists for suitability for the treatment and having receiving counseling concerning stem cell therapy, Hanson was admitted to the program.

As in any other type of treatment, patient selection is very important. At the present time, the therapy is generally reserved for patients who have tried all the more established forms of treatment, and these methods have failed to help them. They are referred by doctors in their own countries who are familiar with the program, although some patients, like Hanson, have discovered the program for themselves. Currently, medical insurance is unlikely to pay for the treatment, because it is still considered experimental; although the safety of the therapy has been demonstrated to the satisfaction of the Medical Review Board of Thailand.

The Procedure & Results

Blood was drawn from Hanson's arm and sent to the laboratory. There, the stem cells were extracted – a very complicated procedure. These cells were then cultured to increase their numbers, and the blood returned to the hospital about a week later. In some cases, the blood is collected in the patient's home country, and the patient comes to Thailand when the stem cells are available.

After Hanson's blood had gone through this process of selection and culture of the cells, 15 ml of blood were made ready for injection; this can be divided into 30 doses. The cells have to be injected into the portion of the heart's wall where strengthening is required. These areas are defined accurately with the help of cardiac MRI, echocardiography, and heart muscle scanning. Injections are made into several areas of the myocardium, wherever it is considered that repair is needed.

When everything was prepared, a small incision was made in Hanson's chest wall. His heart was inspected and the cells injected directly into the heart's wall. This can be accomplished either by using a thorascope or with a robotic cardiac system. The stem cells can then go about their work, regenerating cardiac muscle cells and the blood vessels to serve them. Patients report that although they feel apprehensive about going to the operating room, there is almost no discomfort during the procedure and a minimal amount of post-operative discomfort from the small incision. Hanson felt that, compared with the other cardiac procedures that he had experienced in the past, it was a very benign procedure. The treatment for him was concluded in one session.

Patients usually stay in hospital for five to seven days after their operation, and often choose to spend extra time recuperating in Thailand before returning home. Hanson left the hospital after five days, and relocated to a nearby hotel.

The BHH is part of the Bangkok Hospital Medical Center, a modern tertiary care facility accredited by the JCI that provides medical, nursing and ancillary care equal to any in North America. The program started in May 2005 and more than 100 patients have been treated. As of today, as a result of the enhanced performance of their "renovated" heart muscle, 96% of the patients are still alive. Follow up studies performed six months after the treatment have shown an average increase in ejection fraction of 10%, the results from the patients that have benefited the most show a improvement of 30%. Dr. Kitipan and all the members of the hospital team are confident that this program will continue to make advances, and are proud to be leaders in pioneering such an exciting advance in cardiac care. Hanson feels that they have every right to be proud.

*not his real name

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