6 ms·

It seems like we are so close to some huge breakthroughs in longevity. With stem cells we can do things like this. "The extent of change caused by a heart atta

It seems like we are so close to some huge breakthroughs in longevity. With stem cells we can do things like this. "The extent of change caused by a heart attack is too great for the heart to repair itself or to prevent further damage from occurring. Notably, however, cardiopoietic stem cell therapy reversed, either fully or partially, two-thirds of these disease-induced changes, such that 85% of all cellular functional categories affected by disease responded favorably to treatment," says Andre Terzic, M.D., Ph.D., director of Mayo Clinic's Center for Regenerative Medicine. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-research-discovers-how-stem-cells-repair-damage-from-heart-attacks/ https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-re...

haldujai 3y ago
We have been “close” to some breakthrough with stem cells for at least 15 years now except every time it either doesn’t work or ends up causing cancer (e.g. tumorigenicity and immunogenicity). I’ll believe it when I see it.
- tchaffee 3y ago
  We are already there. The FDA has approved hematopoietic stem cell transplantation. And there are over 3000 clinical trials under way. We know already that we can effectively treat some blindness. The reason I mentioned heart disease is because of how widespread it is and how dramatically it might increase average lifespan. For heart disease specifically it is indeed hard to tell how far away we might be from stem cell treatment being a success. But stem cell treatment as a whole has already delivered. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367472/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367472/
  - tired-turtle 3y ago
    Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease (stopping obesity via, say, ozempic) do more for longevity than repairing the heart after dysfunction has taken root? Not to mention the quality of life improvements from never being sick in the first place.
    - rolph 3y ago
      organ systems are interdependent, and failure or pathology can cause nonlocal effects. cardiac hepatocirrhosis is one example. https://emedicine.medscape.com/article/151792-overview https://emedicine.medscape.com/article/151792-overview https://www.sciencedirect.com/science/article/pii/S2213177918307650 https://www.sciencedirect.com/science/article/pii/S221317791... in such a case isolated treatment of pathos may help but would not be a complete treatment, and would result in chasing subsequent sequelae, over a protracted therepeutic effort.
      - haldujai 3y ago
        Not sure what the relevance of cardiac cirrhosis is to this discussion? You’re talking about an uncommon end stage complication of chronic severe right heart failure. To the parent comment’s question: yes, prevention is better. If you prevent right heart failure you will not get cardiac cirrhosis. The old adage of “an ounce of prevention is better than a pound of cure” is still true.
        rolph 3y ago
        >>Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease<< preventive and corrective measures, in response to health issues should be instituted in the context of the whole organism[patient] cardiac cirrhosis, is an example of secondary pathology related to a common set of disease conditions [heart disease]. correction of pathologic state of one organ via stem cell therapy, is a start but is not complete, heart disease is not always preventable by way of lifestyle choices, as genetic, and traumatic causes will effect occurence. protracted illness often leads to secondary, or even, systemic issues concurrently presenting, at time of first examination. any therapy must take this context into account. The old adage of “an ounce of prevention is better than a pound of cure” is only true, when prevention is possible.
        haldujai 3y ago
        Cardiac cirrhosis is just a bad example, it’s difficult to estimate prevalence but it’s very rare and even then most cases don’t matter as it reflects a state of severe systemic dysfunction (i.e. patient is on deaths door for several other reasons). Fixing the heart at that point won’t accomplish anything with respects to cirrhosis. Right sided heart failure is also rare outside of advanced LHF or preventable causes of pHTN. Congestive heart failure as a whole was attributable to preventable causes in something like 95% of cases in the NHANES cohort. The 5% of other cases is variable but sure, some are not preventable. Point being that prevention is possible and remains the preferred approach for the overwhelming majority of people, as the parent comment was inquiring about: > Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease (stopping obesity via, say, ozempic) do more for longevity than repairing the heart after dysfunction has taken root?
  - haldujai 3y ago
    > We are already there. The FDA has approved hematopoietic stem cell transplantation. Source? To my knowledge what’s approved is not iPSC. Hematopoietic progenitors are a different challenge and “low hanging fruit”. https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/approved-cellular-and-gene-therapy-products https://www.fda.gov/vaccines-blood-biologics/cellular-gene-t... > But stem cell treatment as a whole has already delivered. Clinical trials underway does not equal delivered. In the 3 years since your review article talking about future applications none of these hypothetical applications have been delivered yet.
- jf22 3y ago
  We are always "close" to a breakthrough. This is exactly what happens with every advancement in science and technology.
- photochemsyn 3y ago
  I imagine that in the future what will happen is that when a child is born, their stem cells (possibly from the umbilical cord) will be cryogenetically preserved and will form a reservoir from which medical interventions can be prepared as much as 50 years later. Of course, this assumes we will put a new premium on human life not just limited to the children of the privileged few, which in turn presumes some kind of limitation on human reproduction (steady state population in which births == deaths). Implies a high degree of rationality - who gets to reproduce, and who doesn't? It would take a lot of energy to preserve all those stem cells, after all, and energy supplies really are limited.
  - haldujai 3y ago
    That future was the same one advertised 13 years ago when I started medical school. We were already storing cord blood back then. I’m not saying it will never happen, but this is a really challenging treatment paradigm to get right and I don’t believe it’s “around the corner”. I don’t doubt we’ll have something in 50 years, it’s like battery tech.
- rbanffy 3y ago
  I lost my mother a couple weeks back, to two type 2 myocardial infarction about a week apart. Getting cancer and dying a couple months later certainly beats dying a week later. Don't think it'd have helped much in her case (a massive aortic stenosis, hard to fix at 87), but there are others who would love to have the chance to choose the lesser of two evils. I know she would.
SoftTalker 3y ago
The last thing we need right now is people living longer.
- tjlingham 3y ago
  That's very easy to say until it's your partner, mother/father, or child on the other side of that assertion. If you're curious and have time, I'd suggest the following excellent exploration of the idea of extinguishing natural death by CGP Grey. He uses an interesting analogy to help challenge the ingrained belief that natural death is just https://youtu.be/cZYNADOHhVY?si=oCqVGD5RX9Q0Cnrk https://youtu.be/cZYNADOHhVY?si=oCqVGD5RX9Q0Cnrk
  - SoftTalker 3y ago
    We only need to look at nature to see that everything dies. It is natural, and necessary. I am not in any way saying that people should be euthanized or disease not treated or that people not live out their natural lives. But artificial extension of life will only result in those who can afford it staying in power forever.
    - tchaffee 3y ago
      We only need to look to nature to find the immortal jellyfish. Much of medical science is "artificial" extension of life. Natural would be you dying of Smallpox at a young age. Instead you've artificially extended your life with a vaccine. https://en.m.wikipedia.org/wiki/Turritopsis_dohrnii https://en.m.wikipedia.org/wiki/Turritopsis_dohrnii
    - jdhendrickson 3y ago
      https://effectiviology.com/appeal-to-nature-fallacy/#:~:text=The%20appeal%20to%20nature%20is,because%20it's%20perceived%20as%20unnatural https://effectiviology.com/appeal-to-nature-fallacy/#:~:text....
      - dekhn 3y ago

haldujai 3y ago

We have been “close” to some breakthrough with stem cells for at least 15 years now except every time it either doesn’t work or ends up causing cancer (e.g. tumorigenicity and immunogenicity). I’ll believe it when I see it.

tchaffee 3y ago
We are already there. The FDA has approved hematopoietic stem cell transplantation. And there are over 3000 clinical trials under way. We know already that we can effectively treat some blindness. The reason I mentioned heart disease is because of how widespread it is and how dramatically it might increase average lifespan. For heart disease specifically it is indeed hard to tell how far away we might be from stem cell treatment being a success. But stem cell treatment as a whole has already delivered. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367472/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367472/
- tired-turtle 3y ago
  Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease (stopping obesity via, say, ozempic) do more for longevity than repairing the heart after dysfunction has taken root? Not to mention the quality of life improvements from never being sick in the first place.
  - rolph 3y ago
    organ systems are interdependent, and failure or pathology can cause nonlocal effects. cardiac hepatocirrhosis is one example. https://emedicine.medscape.com/article/151792-overview https://emedicine.medscape.com/article/151792-overview https://www.sciencedirect.com/science/article/pii/S2213177918307650 https://www.sciencedirect.com/science/article/pii/S221317791... in such a case isolated treatment of pathos may help but would not be a complete treatment, and would result in chasing subsequent sequelae, over a protracted therepeutic effort.
    - haldujai 3y ago
      Not sure what the relevance of cardiac cirrhosis is to this discussion? You’re talking about an uncommon end stage complication of chronic severe right heart failure. To the parent comment’s question: yes, prevention is better. If you prevent right heart failure you will not get cardiac cirrhosis. The old adage of “an ounce of prevention is better than a pound of cure” is still true.
      - rolph 3y ago
        >>Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease<< preventive and corrective measures, in response to health issues should be instituted in the context of the whole organism[patient] cardiac cirrhosis, is an example of secondary pathology related to a common set of disease conditions [heart disease]. correction of pathologic state of one organ via stem cell therapy, is a start but is not complete, heart disease is not always preventable by way of lifestyle choices, as genetic, and traumatic causes will effect occurence. protracted illness often leads to secondary, or even, systemic issues concurrently presenting, at time of first examination. any therapy must take this context into account. The old adage of “an ounce of prevention is better than a pound of cure” is only true, when prevention is possible.
        haldujai 3y ago
        Cardiac cirrhosis is just a bad example, it’s difficult to estimate prevalence but it’s very rare and even then most cases don’t matter as it reflects a state of severe systemic dysfunction (i.e. patient is on deaths door for several other reasons). Fixing the heart at that point won’t accomplish anything with respects to cirrhosis. Right sided heart failure is also rare outside of advanced LHF or preventable causes of pHTN. Congestive heart failure as a whole was attributable to preventable causes in something like 95% of cases in the NHANES cohort. The 5% of other cases is variable but sure, some are not preventable. Point being that prevention is possible and remains the preferred approach for the overwhelming majority of people, as the parent comment was inquiring about: > Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease (stopping obesity via, say, ozempic) do more for longevity than repairing the heart after dysfunction has taken root?
- haldujai 3y ago
  > We are already there. The FDA has approved hematopoietic stem cell transplantation. Source? To my knowledge what’s approved is not iPSC. Hematopoietic progenitors are a different challenge and “low hanging fruit”. https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/approved-cellular-and-gene-therapy-products https://www.fda.gov/vaccines-blood-biologics/cellular-gene-t... > But stem cell treatment as a whole has already delivered. Clinical trials underway does not equal delivered. In the 3 years since your review article talking about future applications none of these hypothetical applications have been delivered yet.
jf22 3y ago
We are always "close" to a breakthrough. This is exactly what happens with every advancement in science and technology.
photochemsyn 3y ago
I imagine that in the future what will happen is that when a child is born, their stem cells (possibly from the umbilical cord) will be cryogenetically preserved and will form a reservoir from which medical interventions can be prepared as much as 50 years later. Of course, this assumes we will put a new premium on human life not just limited to the children of the privileged few, which in turn presumes some kind of limitation on human reproduction (steady state population in which births == deaths). Implies a high degree of rationality - who gets to reproduce, and who doesn't? It would take a lot of energy to preserve all those stem cells, after all, and energy supplies really are limited.
- haldujai 3y ago
  That future was the same one advertised 13 years ago when I started medical school. We were already storing cord blood back then. I’m not saying it will never happen, but this is a really challenging treatment paradigm to get right and I don’t believe it’s “around the corner”. I don’t doubt we’ll have something in 50 years, it’s like battery tech.
rbanffy 3y ago
I lost my mother a couple weeks back, to two type 2 myocardial infarction about a week apart. Getting cancer and dying a couple months later certainly beats dying a week later. Don't think it'd have helped much in her case (a massive aortic stenosis, hard to fix at 87), but there are others who would love to have the chance to choose the lesser of two evils. I know she would.

SoftTalker 3y ago

The last thing we need right now is people living longer.

tjlingham 3y ago
That's very easy to say until it's your partner, mother/father, or child on the other side of that assertion. If you're curious and have time, I'd suggest the following excellent exploration of the idea of extinguishing natural death by CGP Grey. He uses an interesting analogy to help challenge the ingrained belief that natural death is just https://youtu.be/cZYNADOHhVY?si=oCqVGD5RX9Q0Cnrk https://youtu.be/cZYNADOHhVY?si=oCqVGD5RX9Q0Cnrk
- SoftTalker 3y ago
  We only need to look at nature to see that everything dies. It is natural, and necessary. I am not in any way saying that people should be euthanized or disease not treated or that people not live out their natural lives. But artificial extension of life will only result in those who can afford it staying in power forever.
  - tchaffee 3y ago
    We only need to look to nature to find the immortal jellyfish. Much of medical science is "artificial" extension of life. Natural would be you dying of Smallpox at a young age. Instead you've artificially extended your life with a vaccine. https://en.m.wikipedia.org/wiki/Turritopsis_dohrnii https://en.m.wikipedia.org/wiki/Turritopsis_dohrnii
  - jdhendrickson 3y ago
    https://effectiviology.com/appeal-to-nature-fallacy/#:~:text=The%20appeal%20to%20nature%20is,because%20it's%20perceived%20as%20unnatural https://effectiviology.com/appeal-to-nature-fallacy/#:~:text....
    - dekhn 3y ago