 Well, I think we're about ready to begin. If you'd please take your seats Continue to pass your questions to the center aisle and we'll begin by asking the members of the panel Have any questions or observations? Dr. Callahan well Over the past couple of years. I've seen reports in this country the many science and others saying Really switching the emphasis from the clinical benefits of stem cell research to the knowledge benefits Which I think has been a rather interesting shift because initially was all introduced This is the regenerative medicine the saving lives But but but I've seen more now reports of seeming to downgrading that aspect and talking more about knowledge As if the clinical problems are more daunting than originally thought I think the field is matured and people are realizing we need to learn much more on the science and avoid the high but we need to have hope and There are surprises like an engineer bladder the last day for eight years in children So it's moving not as the pace. It was thought in the early days And not on the face that we thought it will never happen So first they said this is madness that they said great curious everything Then I'm not going to give it even to my dog and I said well Maybe one day Dr. West. Yes, so in engineered tissues for transplantation there have been some remarkable successes like the skin replacement products Success in some cartilage applications and yet some of the more pressing issues like tissue engineering a heart a liver a kidney Have remained more daunting and I was wondering if you could just comment for the audience Why some tissues have been much easier to engineer than others? I can comment on the challenge of differentiation So it's easy to differentiate ectoderm the outer layer which also embolises skin and the brain and The middle layer the misoderm like bone not too bad Then you go to the inner organs the endodermic layer and it's quite difficult to differentiate like Liva or lung but it's happening slowly. They don't move at the same pace as far as I am aware and in terms of Tissue engineering organs that we can plant we need to consider that we will they engraft with the blood vessels We take in with the innovation taking and will they have nutrients there? So there are challenges that we need to be aware of Dr. Aaron Yesterday I was stumbled on to a conversation Between a couple of people based here at Gustavus What was a fundraiser who was? somewhat surprised because A potential funder had posed the question. Well, what would you do if you had? Significantly more money than you've requested Significantly more money than you were requested So that's my question in effect. What are the targets of opportunity that you would like to pursue? But for which current resources are insufficient what happened in the early days on tissue engineering there Was a lot of investment speaking to them There was a lot of investment On the early days great excitement, but the research and development on the companies Producing let's say a skin Both larger than reimbursement. So if it really outstreet the money can come back and We had to be real in a sense that to try to develop the product at the same time as the Process process and product should be developed at the same time and to have a product that will be robust and cheaper So the reimbursement and regulations can be overcome and at the moment this is where The field is trying to address. There were many companies that had a lot of money but they didn't fulfill the expectations and The the investor wanted the money back. It didn't come back in that respect now if we are able to develop a product which is easy to develop and The fourth company the cars and most exciting company That's how I started with a little thing and grew and grew and grew and different parts of it It was divided into it. So we weren't used to that We were used to having lots of money and spending all that and then nothing for what we were expecting Here's a question that's related to Costs in a way here our daughter and husband are soon her daughter and husband are soon to have a baby and They were told of saving the cord blood for possible stem cell use says it's expensive to do this What are your thoughts about this? There are many companies that they offer to collect There is no harm If you want to spend the money, but they cannot guarantee that they will be successful The only success is for blood disorders. The others hasn't been proven Efficiently, but you're not killing anybody by collecting your empty in your pocket. So if you want to spend my Well speaking of what other applications might be possible here Do you see stem cells is aiding in brain regeneration as a memory loss in Alzheimer's disease? It would be nice Not yet One day Here's another question that has to do with Basically the other research is conducted Are you aware of how many americans are in britain doing stem cell research? Having left the usa because of legal prohibitions I'm friendly with roger peders and California, I'm not sure. I'm not very sure if he left Because of the mega regulation because he left just the moment he derived the cells More of the He was already in I mean he could come back to california now So I don't know. I don't know if there are some There's some but not many but the problem in in in the uk Fantastic country has a great vision Has permissive thing. I think it's an illusion because there is no money So we should combine the americans It's another question With all the achievements in cell therapy, who will be the first recipients of these therapies? And what criteria will be employed in selecting the recipients of the imagine, but you know, it's just a speculation That um bon maru stem cells will be First in the clinic before the embryonic stem cells There are a number of clinical trials for heart disorders Most please for acute myocardial infert and there are there some for um heart failure The trials the latest new england journal of medicine shows three double blind control trials One said it doesn't work And the other the other two said it works a little Um early days it probably cardiac maybe neural, but what is likely that the bon maru stem cells Will be the one Here's another question. How quickly will a body be able to regenerate an organ through the new process? Would regenerative therapy be appropriate for someone who is very Nobody knows the mechanisms of regeneration the Postulated services that you give the cell and maybe you give bulk So we you bulk up the heart And that helps other said Maybe the cells become That cell like a myocardium another said Maybe they release site chemicals that helps Produce new blood vessels or something nobody knows exactly what are the mechanisms So by which means and how long will it take? And whether you will last all these trials a rather short term Maybe good for the short term, but it's totally unexplored field Okay Can I ask a question? Is it likely that the therapies that emerge will be dependent on each person's individual cells so that it's in the nature of personalized medicine Or is it likely to take the form of therapies that can be tailored to serve a large population with a given instrument or cell type The reason i'm asking is the former is likely cumulatively to be far more costly than the latter I think We know that Individuals are individuals. They have genetic variations and so I think it will be in some broad personalization that respect, but it needs to be generated We need to have an ability to have all the shared products that will Really cater for the needs of a large population The maybe the response could be very because we know as medics and it may be a combination of cerebrous as well But as many we know not everybody responds the same way life Other question here. Can embryonic stem cells be tested for tumors? And sorted good from bad Yes, it's quite a bit of literature Some papers said that the tumor does develop from the stem cells And others said maybe The stem cells will be good to regenerate when the tumor is The area is still being explored. It's a lot of interest on that Okay, not definitive answers Okay So give you a somewhat of an idea of the the diversity of our audience here Do you know about stem cell technologies that are developed in russia? It turns out we have a russian md in our audience here I think We need to be we need to be very careful We had not to go the route of gene therapy when he got discredited And it was unjust. It was very unjustifiable because it has great potential. So no hide And um, let's have hope so there are places in In the world in thailand or russia barbados and others they offer Cell therapy But nobody can really find out exactly what it is they're given I don't see the casualty, but will they work? People that they do see your signs. There's some ways the money, but you know, it's the start But the us wouldn't do it Okay How does aging and telomere shortening Relate to regenerative capacity of stem cells it relates enormously because The the cells are aged And this is why and the telomeres are short. This is why bone marrow stem cells have Great clinical applications, but they have the problem that they aged the pluripotent stem cells are used the continuous source of use so None of the cell types are perfect. They all have pros and cons and that's why Okay So stem cells are needed where the micro environment is damaged in humans How do the stem cells continue to differentiate into functional cells when the micro environment is damaged itself? Nobody knows. Nobody knows the mechanics It could be that the site of cancer damage Encourages the cells to continue growing and Differences nobody knows it could be that they kill them. Nobody has demonstrated We certainly that they are totally alive that they continue the proliferates. They do the function in a very systematic way Here's a fairly personal question 22 year old daughter has Crohn's disease kept for admission by lots of drugs Any predictions as to whether her damaged intestines can be healed by replacement in the future? There's a lots of research on local stem cells in the gut and people have produced Have engineered pieces of gut, but these early days not for clinical applications as far as I'm aware not yet But there is a lot of data Okay You mentioned in your talk that no study has been done on What type of stem cell is best for regenerative applications? Why has no study been done on this? It's pretty impossible to organize. I mean the problem is we have Very very backwards techniques and now we are In the forefront years they take a long time to differentiate themselves to have a clinic a single clinical Application with lots of patients or animals on that and use of the enormous amount of different cell types they are It could be an international collaboration, but then you need to have it in the same laboratory in the same condition This doesn't seem to be a difficult task, but maybe somebody with a lot of drive will do it One last question here. I think this is probably one that many of People in the audience have been thinking about Uh, do you think we'll be able to regenerate youth? You can teach your hair You can wear contact glasses Yeah, it's not necessary Well, thank you very much And we we will be reassembling about one o'clock to hear from Dr. Aaron