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Welcome to Live Well with UCI Health.

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I am Ryan Manno from KOST 103.5

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and iHeartRadio.

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I am thrilled to be joined today

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by Doctor Stefan Ciurea,

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director of the Hematopoietic Stem Cell

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Transplant and Cellular Therapy Program.

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Correct.

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It's the first adult program

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in Orange County

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to use stem cells,

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which are found in blood and bone marrow,

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to treat blood and lymph cancers,

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genetic diseases and immune disorders.

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That sounds like important stuff.

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It provides life

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saving cell therapy infusions

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to more than 120 patients per year.

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Doctor Ciurea,

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thank you so much for your time today.

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Thank you for having me.

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Let's just get into it because I,

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you know,

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I think I'm going to speak

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for a lot of people here.

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You hear stem cell, stem cell, stem cell

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a lot.

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But I don't know that

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many people know what it is.

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So let's start there.

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What are stem cells?

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Stem cells are a small number of immature

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cells in different organs in

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the body that have renewal potential.

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They have specific characteristics.

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They are quiescent, we call them.

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And with self-renewal potential

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different than differentiated cells,

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which are cells

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that have gone through maturation

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and they are going to die.

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These cells are not dying cells.

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They are quiescent

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cells in a in a state that allows them

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to generate

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differentiated cells

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in different organs and tissues.

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Okay. Quiescent.

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Is that the word you use? Yes.

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What does that mean?

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Means that they are not rapidly dividing.

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They are in a dormant state if you want.

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Okay. So where do we find these cells.

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These stem cells.

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These are found in different tissues

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and organs as far as we are concerned

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in the bone marrow of a recipient.

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Okay.

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How do you know where

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which ones are the stem cells

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and which ones aren't.

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So we

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we are able

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to identify hematopoietic.

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So there are different

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types of stem cells

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in different organs and tissues

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as I mentioned.

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For hematopoietic stem

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cells we are able to identify them

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by a certain surface markers. Okay.

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So do you know going in

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where the stem cells

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are going to be harvested

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from for lack of a better word?

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Or is it kind of like,

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I don't know

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if you're trying to catch crab

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and you throw a net in

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and you just pull out what you get

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and then find them.

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Cells are in the bone

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marrow, hematopoietic stem cells.

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These are different, for example,

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than embryonic stem cells.

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Embryonic stem

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cells are the most immature

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and the cells

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that have the potential

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to differentiate

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in all cells

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from different organs in the body.

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Our stem cells are a little bit

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more programed to develop in blood cells,

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including red blood cells, platelets,

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white

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cells, and cells

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that are part of the immune system.

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Okay.

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So we we they are in the bone marrow.

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And in order to collect them

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and infuse them for this procedure,

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we either collect them from them

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directly from the bone marrow

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in the operating room or from the... one’s

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blood after stem cell mobilization.

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So what is stem cell transplantation?

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Stem cell transplantation is a procedure,

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a quite complex procedure,

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in which we give a patient

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high dose of chemotherapy

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to eliminate some residual disease

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or prevent relapse of a disease,

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followed by infusion

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of cells

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of these stem cells

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to reconstitute the bone

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marrow of the recipient.

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These stem cells

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can be collected from the patient

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when patient is in remission

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for certain diseases,

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or from a donor,

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in the form of an allogeneic stem

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cell transplant,

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which means stem

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cell transplant with a donor that

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donates normal stem cells

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for a

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disease that that requires this therapy.

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How do you know

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who's a good donor for somebody?

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Like if I needed stem cells,

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if you're like, okay,

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I think you need this, how where would

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how would we find a donor?

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So so it depends a lot on the disease

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the patient has.

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So would it be like my family?

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Would you start with my family

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because we know they were closer match.

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There are two main types of transplants

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okay.

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An autologous

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transplant is a transplant with

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with the patient's own stem cells.

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An allogeneic

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transplant

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is a transplant

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with stem cells from a donor.

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And these are

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we use these procedures

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based on one's disease.

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For example

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for patients with lymphoma or myeloma

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we do mostly autologous transplants.

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Transplants with own stem cells.

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So patient gets chemotherapy

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goes into remission.

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And we do to consolidate remission

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and/or prevent disease coming back.

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We collect their own stem cells and

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and do the transplant

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with their own stem cells.

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We give them high dose chemotherapy

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and infuse these cells back to them.

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For allogeneic transplants

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we use a donor to donate stem cells.

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And we admit the patient

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give the patient recipient

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high doses of chemotherapy

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and infuse the cells from the donor.

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And this is done for different diseases

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like leukemias

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or myelodysplastic syndromes.

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How do they work, then, to save lives?

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A life is saved

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by preventing a relapse

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or preventing progression of disease.

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In essence.

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Okay,

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so we do this procedure to prevent

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a relapse.

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Relapse will kill the patient.

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So tell me kind of like in basic terms.

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So you know

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just so everyone can kind of follow here

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you you put stem cells in somebody to

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you know,

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you've given them

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the high dose chemotherapy.

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You've got the stem cells in.

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What is occurring inside of their body,

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you know?

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To... That’s a good question.

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To to make these things do their job?

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Right.

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So so we rely for certain diseases

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like lymphomas and myeloma.

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As I mentioned,

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we rely on the chemotherapy to

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to eliminate any residual disease

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and prevent relapse. Got it.

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And the stem cells

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we give to reconstitute

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the one’s bone marrow

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and immune system and blood cells, we we

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we give them to reconstitute

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the the otherwise the bone marrow.

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If we don't infuse the stem

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cells, patient will remain...

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Maybe

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disease is not going to come back but

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will not have a bone

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marrow, will not have

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blood cells or immune system.

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And this is not compatible with life.

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So so it's it's also called high dose

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chemotherapy and stem cell rescue.

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In other words,

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we rescue the bone marrow for a patient

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after we gave high dose

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chemotherapy with the goal

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to eliminate the disease.

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When is it

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time to do stem cells

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like a transplantation? Right.

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Right.

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It again

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depends on on disease and disease type.

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And the general rule is

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we want to take a patient to transplant

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when is in remission

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for an autologous transplant

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and also for an allogeneic transplant.

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For example, a patient

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with acute myeloid leukemia.

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They usually go through induction

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chemotherapy

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and consolidation chemotherapy.

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They are in remission.

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And while

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they are in remission,

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we start to prepare

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for the actual transplant,

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contacting the donor

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and setting up the collection

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and the actual

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chemotherapy and infusion

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of cells in the hospital. Right.

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So are you

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the one that makes that decision

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and says, look, yes.

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Yeah, yeah.

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So cell transplant doctor. Right.

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Makes the decision

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which disease,

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what type of transplant is needed

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for patient’s condition. Yeah.

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And what's the most common condition.

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Disease that you that you would recommend

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stem cells.

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So autologous transplants are mostly done for

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my... multiple myeloma and lymphomas.

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Allogeneic transplants

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are mostly done for acute

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myeloid leukemia,

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acute lymphoblastic leukemia

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and myelodysplastic

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myeloproliferative diseases.

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Yeah.

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Which one of those would you say

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have you found...

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And maybe there's no answer to

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this has the best success rate

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like which one of those diseases

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is best treated by this?

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It's difficult to answer the question

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because

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because it really depends on on

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on the on the disease.

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Okay.

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So just I can give you some examples.

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But it also for, for

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allogeneic transplants

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for example depends a lot.

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Success depends a lot on one's risk.

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Disease risk.

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So there are different flavors I say

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in general of

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for example

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acute myeloid leukemia has different.

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It's it's a mixture of different diseases

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with different risks.

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So outcomes depend on disease

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risks also disease risk in general also.

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So we tend to do

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the same type of transplant.

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But outcomes may be different

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because somebody has higher

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risk disease than...

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Yes, that makes sense to me

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I get that now.

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So let's talk about like

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the procedure itself.

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Are there risks involved.

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There are actually

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and this is the main issue with this

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with stem cell transplantation.

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And the risks are derived

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from the fact that we're dropping

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blood counts

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and patients are exposed to

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infectious complications.

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And in addition,

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with changing the immune system

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with that of the donor. So in the.

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So the allogeneic transplant recipient

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gets a new immune system,

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which is immature.

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It's like a newborn immune system.

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Whoa. That's cool.

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And then we actually vaccinate

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these patients

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for a period of two years with all, all

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baby shots

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that... No way... one gets in.

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Yeah.

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So we

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they get a lot of shots

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over a period of two years.

00:10:09:04 - 00:10:10:08
Because it's like starting over.

00:10:10:08 - 00:10:12:14
Starting over for the

00:10:12:14 - 00:10:13:15
with a new immune system.

00:10:13:15 - 00:10:14:21
And because they have

00:10:14:21 - 00:10:17:18
an immature immune system,

00:10:17:18 - 00:10:20:16
they are at risk to develop different

00:10:20:16 - 00:10:21:18
types of infections,

00:10:21:18 - 00:10:22:22
which we monitor

00:10:22:22 - 00:10:25:13
very closely, prevent and treat

00:10:25:13 - 00:10:26:10
if they occur.

00:10:26:10 - 00:10:26:22
Yeah.

00:10:26:22 - 00:10:30:09
Is the process itself painful?

00:10:30:10 - 00:10:32:03
It's not painful really.

00:10:32:03 - 00:10:33:03
I mean, there's

00:10:33:03 - 00:10:34:07
there's some discomfort

00:10:34:07 - 00:10:37:07
related to using central lines or

00:10:37:13 - 00:10:39:09
but it's not a painful,

00:10:39:09 - 00:10:40:12
necessarily procedure.

00:10:40:12 - 00:10:42:05
It doesn't involve surgery.

00:10:42:05 - 00:10:44:05
It's not painful procedure.

00:10:44:05 - 00:10:45:02
How do you do it?

00:10:45:02 - 00:10:45:23
I mean, how do you like.

00:10:45:23 - 00:10:47:18
Because I would think that if you're

00:10:47:18 - 00:10:49:20
taking stem cells out of my bone marrow,

00:10:49:20 - 00:10:51:11
I can't imagine that that would be fun.

00:10:51:11 - 00:10:52:18
Or putting them in there.

00:10:52:18 - 00:10:53:12
Well, yes.

00:10:53:12 - 00:10:55:23
So if we take the stem cells

00:10:55:23 - 00:10:58:02
directly from the bone marrow

00:10:58:02 - 00:11:00:00
through a bone marrow harvest procedure,

00:11:00:00 - 00:11:01:16
procedure in the operating room,

00:11:01:16 - 00:11:02:06
we take

00:11:02:06 - 00:11:04:19
the patient gets a general anesthesia.

00:11:04:19 - 00:11:06:13
But it's really

00:11:06:13 - 00:11:08:10
rare nowadays to use stem cells

00:11:08:10 - 00:11:10:01
directly from the bone marrow.

00:11:10:01 - 00:11:11:06
We still do it

00:11:11:06 - 00:11:13:05
for very specific indications.

00:11:13:05 - 00:11:16:09
So that's probably the only situation

00:11:16:09 - 00:11:17:16
in which if we collect

00:11:17:16 - 00:11:18:22
we have to collect the cells.

00:11:18:22 - 00:11:20:20
We want to collect the cells

00:11:20:20 - 00:11:22:19
directly from the bone marrow.

00:11:22:19 - 00:11:23:11
Patient goes

00:11:23:11 - 00:11:24:17
to the operating room,

00:11:24:17 - 00:11:26:17
goes undergoes general anesthesia.

00:11:26:17 - 00:11:30:00
And with two needles we go into

00:11:30:00 - 00:11:32:12
pelvic bones... Pelvic bones, got it.

00:11:32:12 - 00:11:33:10
right in the back.

00:11:33:10 - 00:11:35:01
And why there?

00:11:35:01 - 00:11:38:19
Because there's the these are the points

00:11:39:15 - 00:11:41:19
with most stem cells

00:11:41:19 - 00:11:43:16
in the bone marrow. Really? Fascinating.

00:11:43:16 - 00:11:45:03
Pelvic bones have the most stem

00:11:45:03 - 00:11:45:14
cells. Right.

00:11:45:14 - 00:11:48:03
Look at that fun nugget.

00:11:48:03 - 00:11:50:19
How long is the patient hospitalized?

00:11:50:19 - 00:11:52:14
Patients usually are hospitalized

00:11:52:14 - 00:11:53:22
for about three weeks,

00:11:53:22 - 00:11:54:21
a little bit less

00:11:54:21 - 00:11:56:12
for an autologous transplant

00:11:56:12 - 00:11:58:13
and a little bit more

00:11:58:13 - 00:11:59:14
close to four weeks

00:11:59:14 - 00:12:01:21
for an allogeneic transplant. Okay.

00:12:01:21 - 00:12:04:06
And then once they go home, you know,

00:12:04:06 - 00:12:05:01
what's life

00:12:05:01 - 00:12:06:01
looking like when you go home?

00:12:06:01 - 00:12:07:13
So after they immediately

00:12:07:13 - 00:12:09:03
after they get discharged,

00:12:09:03 - 00:12:09:21
they come

00:12:09:21 - 00:12:11:01
very frequently

00:12:11:01 - 00:12:12:09
to the outpatient,

00:12:12:09 - 00:12:12:18
to the

00:12:12:18 - 00:12:14:11
an infusion center

00:12:14:11 - 00:12:15:20
to be monitored

00:12:15:20 - 00:12:17:10
because they're by the time

00:12:17:10 - 00:12:18:02
they are discharged,

00:12:18:02 - 00:12:20:11
the counts are just starting

00:12:20:11 - 00:12:21:12
to come back up.

00:12:21:12 - 00:12:24:06
As I mentioned before, the blood counts

00:12:24:06 - 00:12:26:08
will drop significant

00:12:26:08 - 00:12:27:13
to very low levels

00:12:27:13 - 00:12:28:20
during hospitalization.

00:12:28:20 - 00:12:30:09
And when the blood counts

00:12:30:09 - 00:12:32:16
are starting to come back up,

00:12:32:16 - 00:12:34:21
they are not fully up.

00:12:34:21 - 00:12:35:17
They are not normal.

00:12:35:17 - 00:12:37:07
They just start to come back up.

00:12:37:07 - 00:12:39:23
So they need to monitor patients

00:12:39:23 - 00:12:43:11
initially daily in the outpatient

00:12:44:07 - 00:12:47:07
area for a blood count recovery,

00:12:47:07 - 00:12:49:12
a need for blood products,

00:12:49:12 - 00:12:51:09
growth factors.

00:12:51:09 - 00:12:52:01
For how long?

00:12:52:01 - 00:12:52:14
When you say

00:12:52:14 - 00:12:54:21
daily, but like over over what time span?

00:12:54:21 - 00:12:56:18
Well, they usually

00:12:56:18 - 00:12:59:08
it takes probably a few weeks less

00:12:59:08 - 00:13:01:17
for an autologous transplant, a few more weeks

00:13:01:17 - 00:13:03:11
for allogeneic transplant - daily.

00:13:03:11 - 00:13:05:11
And then we space out the visits

00:13:05:11 - 00:13:07:06
as we see that patient is doing well.

00:13:07:06 - 00:13:08:20
Doesn't need to really be

00:13:08:20 - 00:13:11:05
every day in the infusion center. Right.

00:13:11:05 - 00:13:12:02
What indicators

00:13:12:02 - 00:13:13:17
do you get that

00:13:13:17 - 00:13:14:21
that what you've done

00:13:14:21 - 00:13:16:04
is working... Effective?

00:13:16:04 - 00:13:17:16
Yeah. It's a good question.

00:13:17:16 - 00:13:20:00
So early after transplant

00:13:20:00 - 00:13:21:16
we start to do what we call

00:13:21:16 - 00:13:23:07
we look at the disease.

00:13:23:07 - 00:13:25:06
For patients with lymphoma

00:13:25:06 - 00:13:26:03
for example,

00:13:26:03 - 00:13:26:12
we look

00:13:26:12 - 00:13:27:09
at their lymph nodes

00:13:27:09 - 00:13:30:11
with scans. With a PET scan or CT scans.

00:13:30:13 - 00:13:32:02
For patients with leukemia.

00:13:32:02 - 00:13:33:14
That is primarily the bone marrow.

00:13:33:14 - 00:13:35:03
We do bone marrow biopsies

00:13:35:03 - 00:13:36:04
at regular intervals.

00:13:36:04 - 00:13:38:23
So these evaluations start at one month

00:13:38:23 - 00:13:40:01
after transplant,

00:13:40:01 - 00:13:41:23
then continue three months, six months,

00:13:41:23 - 00:13:43:15
a year at the minimum.

00:13:43:15 - 00:13:44:22
And I've had friends

00:13:44:22 - 00:13:46:08
that have have battled,

00:13:46:08 - 00:13:47:00
you know, certain things.

00:13:47:00 - 00:13:49:01
And they talk about that scansiety.

00:13:49:01 - 00:13:50:13
They get anxious on scan days.

00:13:50:13 - 00:13:51:04
And that's what you're

00:13:51:04 - 00:13:51:16
referring to, right?

00:13:51:16 - 00:13:52:14
The scans and you compare.

00:13:52:14 - 00:13:53:06
You just compare.

00:13:53:06 - 00:13:54:06
Right. Right, right, right. Exactly.

00:13:54:06 - 00:13:55:09
And you can tell if it's working.

00:13:55:09 - 00:13:57:08
What other types of

00:13:57:08 - 00:13:58:23
of cellular therapies

00:13:58:23 - 00:14:00:19
do you guys do at UCI Health?

00:14:00:19 - 00:14:02:23
Well, we rarely do what we call

00:14:02:23 - 00:14:03:10
a donor

00:14:03:10 - 00:14:04:18
lymphocyte infusion,

00:14:04:18 - 00:14:05:19
which is a procedure

00:14:05:19 - 00:14:08:06
in which we collect lymphocytes

00:14:08:06 - 00:14:09:06
from a donor,

00:14:09:06 - 00:14:10:22
from the donor of transplant

00:14:10:22 - 00:14:14:06
donor and infuse to the recipient

00:14:14:06 - 00:14:15:02
for a reason.

00:14:15:02 - 00:14:15:19
For example,

00:14:15:19 - 00:14:18:15
we see sometimes an early relapse

00:14:18:15 - 00:14:19:14
or indication

00:14:19:14 - 00:14:21:04
that the patient might relapse.

00:14:21:04 - 00:14:22:16
So we've done this recently

00:14:22:16 - 00:14:23:17
for a patient.

00:14:23:17 - 00:14:27:11
We ask the donor to come back to collect

00:14:27:11 - 00:14:28:20
only lymphocytes,

00:14:28:20 - 00:14:29:19
not stem cells,

00:14:29:19 - 00:14:31:18
just lymphocytes from one's blood,

00:14:31:18 - 00:14:34:05
and infuse them to the recipient

00:14:34:05 - 00:14:35:07
to try to

00:14:35:07 - 00:14:38:18
to get a stronger anti-tumor effect,

00:14:38:19 - 00:14:39:22
also called graft

00:14:39:22 - 00:14:41:21
versus lymphoma, graft versus

00:14:41:21 - 00:14:43:22
leukemia effect. Okay.

00:14:43:22 - 00:14:46:01
We want to do other cells in the future

00:14:46:01 - 00:14:47:19
where we want to do

00:14:47:19 - 00:14:48:17
natural infusion

00:14:48:17 - 00:14:51:17
of natural killer cells from a donor.

00:14:52:04 - 00:14:54:08
We also are interested to infuse

00:14:54:08 - 00:14:57:19
other cells, like modified T cells

00:14:57:19 - 00:15:00:19
to recognize certain viruses,

00:15:00:21 - 00:15:03:15
called viral specific T cells, to

00:15:03:15 - 00:15:04:18
to treat patients

00:15:04:18 - 00:15:06:05
with a viral illness

00:15:06:05 - 00:15:07:00
that otherwise

00:15:07:00 - 00:15:10:03
maybe may not have medical... may not have...

00:15:10:13 - 00:15:11:13
Yeah.

00:15:11:13 - 00:15:12:13
Drug treatments

00:15:12:13 - 00:15:14:18
or is refractory to drug therapy.

00:15:14:18 - 00:15:17:04
Do you run into a lot of

00:15:17:04 - 00:15:18:08
a lot of like red tape

00:15:18:08 - 00:15:19:11
with with what you're doing.

00:15:19:11 - 00:15:20:08
Because I feel like it's

00:15:20:08 - 00:15:21:22
kind of a it's a very cutting edge thing.

00:15:21:22 - 00:15:22:20
Are people skeptical

00:15:22:20 - 00:15:23:20
of what you're doing?

00:15:23:20 - 00:15:25:10
No, I don't think so.

00:15:25:10 - 00:15:27:07
No, we don't have

00:15:27:07 - 00:15:27:16
I mean,

00:15:27:16 - 00:15:30:16
we we obviously do everything either.

00:15:30:17 - 00:15:31:13
That is novel

00:15:31:13 - 00:15:33:06
has to be on a clinical trial.

00:15:33:06 - 00:15:35:01
Sure. Or or.

00:15:37:12 - 00:15:39:13
Or it's standard procedure.

00:15:39:13 - 00:15:42:01
And we really don't have

00:15:42:01 - 00:15:43:04
this type of issues.

00:15:43:04 - 00:15:44:12
One of the places I hear about stem

00:15:44:12 - 00:15:45:15
cells is like,

00:15:45:15 - 00:15:47:16
you'll hear of athletes who, you know,

00:15:47:16 - 00:15:48:22
their knees are shot or whatever,

00:15:48:22 - 00:15:49:14
and they get

00:15:49:14 - 00:15:51:01
they get a hip replacement or whatever.

00:15:51:01 - 00:15:51:12
And they'll,

00:15:51:12 - 00:15:53:09
they'll do like stem cell treatment.

00:15:53:09 - 00:15:53:23
Is that

00:15:53:23 - 00:15:55:17
is that good or is that good for them?

00:15:55:17 - 00:15:57:16
I hear about it in that context.

00:15:57:16 - 00:15:59:15
This is an unproven therapy.

00:15:59:15 - 00:16:00:08
That's what I thought.

00:16:00:08 - 00:16:02:04
And it's it's not

00:16:02:04 - 00:16:04:06
there are no studies that I'm aware of.

00:16:04:06 - 00:16:05:18
And in general,

00:16:05:18 - 00:16:07:03
I cannot recommend

00:16:07:03 - 00:16:08:21
these type of therapies

00:16:08:21 - 00:16:11:03
because they've not been studied

00:16:11:03 - 00:16:12:06
systematically.

00:16:12:06 - 00:16:15:07
And... to know the efficacy of this.

00:16:15:08 - 00:16:15:23
Yes.

00:16:15:23 - 00:16:17:00
And you're only dealing

00:16:17:00 - 00:16:18:19
in the things that you know are.

00:16:18:19 - 00:16:20:04
Working or approved.

00:16:20:04 - 00:16:22:04
How do we tell,

00:16:22:04 - 00:16:24:22
you know, the legitimate from the fake.

00:16:24:22 - 00:16:26:05
In general,

00:16:26:05 - 00:16:27:19
valid procedure

00:16:27:19 - 00:16:30:03
should be approved by the FDA.

00:16:30:03 - 00:16:31:17
And it's,

00:16:31:17 - 00:16:32:03
you know,

00:16:32:03 - 00:16:32:16
it's used

00:16:32:16 - 00:16:34:12
as the standard of care procedure.

00:16:34:12 - 00:16:37:13
So if if not approved and not studied,

00:16:37:13 - 00:16:41:03
I don't think it's... I think any procedure

00:16:41:04 - 00:16:42:05
should either be on

00:16:42:05 - 00:16:45:00
an investigational trial or

00:16:46:09 - 00:16:47:15
if has gone already through

00:16:47:15 - 00:16:48:14
the process

00:16:48:14 - 00:16:50:15
has FDA approval and it can be

00:16:50:15 - 00:16:51:15
can be used...

00:16:51:15 - 00:16:52:05
Like if your neighbor

00:16:52:05 - 00:16:53:00
is trying to sell you

00:16:53:00 - 00:16:54:04
some stem cells on Facebook,

00:16:54:04 - 00:16:55:22
it's probably. Not not a good idea.

00:16:55:22 - 00:16:57:17
I... Don't buy that. Yeah. Okay. Thought so.

00:16:57:17 - 00:17:01:06
So what sets, you know, UCI

00:17:01:06 - 00:17:03:18
Health apart from from anywhere else

00:17:03:18 - 00:17:05:07
really in Southern California

00:17:05:07 - 00:17:07:14
or as far as you can see? Right.

00:17:07:14 - 00:17:09:21
So we have some unique approaches

00:17:09:21 - 00:17:11:00
to what we do.

00:17:11:00 - 00:17:14:21
One of them is to prevent one of the main

00:17:14:21 - 00:17:16:03
complications of transplantation

00:17:16:03 - 00:17:18:04
called graver versus host disease.

00:17:18:04 - 00:17:19:15
Say it one more time what's it called?

00:17:19:15 - 00:17:21:10
Graft versus host disease.

00:17:21:10 - 00:17:23:14
So graft versus host disease. Got it.

00:17:23:14 - 00:17:25:13
This disease is caused by the donor

00:17:25:13 - 00:17:27:01
cells in the allogeneic

00:17:27:01 - 00:17:28:08
transplant setting.

00:17:28:08 - 00:17:30:04
When you infuse the donor cells,

00:17:30:04 - 00:17:31:17
sometimes the donor cells

00:17:31:17 - 00:17:35:08
can react against the recipient's body.

00:17:35:08 - 00:17:38:17
And we try to prevent this. This can be... Severe

00:17:38:17 - 00:17:39:22
forms of graft vs host

00:17:39:22 - 00:17:42:03
disease can be life threatening.

00:17:42:03 - 00:17:45:09
So one of the main goals is to prevent

00:17:45:09 - 00:17:48:15
this life threatening complication.

00:17:49:11 - 00:17:52:18
Another approach which is unique to UCI

00:17:52:18 - 00:17:53:23
and we have an ongoing

00:17:53:23 - 00:17:54:18
clinical trial,

00:17:54:18 - 00:17:56:07
is to customize

00:17:56:07 - 00:17:57:21
the conditioning regimen,

00:17:57:21 - 00:17:59:12
which is the chemotherapy part

00:17:59:12 - 00:18:02:22
of the transplant, to tailor to receive

00:18:03:02 - 00:18:06:02
to the recipient and to the disease.

00:18:06:03 - 00:18:08:03
So we say that we are

00:18:09:04 - 00:18:11:11
modifying the the

00:18:11:11 - 00:18:14:10
chemotherapy based on one's disease

00:18:14:10 - 00:18:15:23
and disease

00:18:15:23 - 00:18:16:22
characteristics

00:18:16:22 - 00:18:18:23
and patient's characteristics,

00:18:18:23 - 00:18:20:06
because obviously patients

00:18:20:06 - 00:18:21:02
are very different

00:18:21:02 - 00:18:22:21
from 19 year

00:18:22:21 - 00:18:25:17
old with leukemia to a 75 year old

00:18:25:17 - 00:18:26:14
with leukemia.

00:18:26:14 - 00:18:29:00
So these people are going to, you know,

00:18:29:00 - 00:18:29:15
they cannot

00:18:29:15 - 00:18:31:15
tolerate the same conditioning

00:18:31:15 - 00:18:33:01
and same intensity

00:18:33:01 - 00:18:34:17
of chemotherapy, for example.

00:18:34:17 - 00:18:37:23
But taking to one step forward

00:18:38:00 - 00:18:41:04
is to also take into consideration

00:18:41:05 - 00:18:42:06
the risk of disease.

00:18:42:06 - 00:18:43:00
I mentioned

00:18:43:00 - 00:18:45:08
there's no one acute myeloid leukemia.

00:18:45:08 - 00:18:46:17
There are many forms of leukemia

00:18:46:17 - 00:18:47:17
with different risks.

00:18:47:17 - 00:18:50:10
So we want to incorporate all these

00:18:50:10 - 00:18:54:08
in an algorithm to maximize transplant

00:18:54:08 - 00:18:55:04
outcomes. Okay.

00:18:55:04 - 00:18:56:12
So we were talking about the

00:18:56:12 - 00:18:59:05
how you know if if it's effective, right.

00:18:59:05 - 00:19:00:14
If it's working in somebody.

00:19:00:14 - 00:19:03:14
If you see that it's not are

00:19:03:14 - 00:19:05:16
you able to course correct and go,

00:19:05:16 - 00:19:07:06
well let me let me try it again

00:19:07:06 - 00:19:07:23
or do this.

00:19:07:23 - 00:19:10:20
Like if it doesn't work once,

00:19:10:20 - 00:19:12:08
does that mean it doesn't work

00:19:12:08 - 00:19:13:12
always in this person

00:19:13:12 - 00:19:14:12
or do you just come at it

00:19:14:12 - 00:19:15:14
from a different angle?

00:19:15:14 - 00:19:16:20
That's a great question.

00:19:16:20 - 00:19:19:03
And it really depends again

00:19:19:03 - 00:19:21:03
on the clinical situation.

00:19:21:03 - 00:19:25:00
But one example is if somebody fails

00:19:25:01 - 00:19:26:09
an autologous transplant,

00:19:26:09 - 00:19:28:10
for example, with lymphoma, right.

00:19:28:10 - 00:19:29:23
If a patient has lymphoma,

00:19:29:23 - 00:19:32:20
we do autologous transplant. Relapses.

00:19:32:20 - 00:19:35:06
We made may give that patient

00:19:35:06 - 00:19:36:19
CAR T-cell therapy

00:19:36:19 - 00:19:38:13
or we may take that person

00:19:38:13 - 00:19:40:23
to an allogeneic transplant this time,

00:19:40:23 - 00:19:44:08
which is in addition to the autologous transplant

00:19:44:08 - 00:19:46:00
has this graft versus

00:19:46:00 - 00:19:47:12
lymphoma effect,

00:19:47:12 - 00:19:49:00
which is an immunologic effect

00:19:49:00 - 00:19:50:11
caused by the donor cells.

00:19:50:11 - 00:19:54:01
And that in itself can help

00:19:54:01 - 00:19:54:18
prevent disease

00:19:54:18 - 00:19:57:03
coming back the second time.

00:19:57:03 - 00:19:58:01
Just on a personal note,

00:19:58:01 - 00:19:59:05
because you're very knowledgeable,

00:19:59:05 - 00:20:00:10
do you just think about stem cells

00:20:00:10 - 00:20:02:03
all the time, or do you do stuff like

00:20:02:03 - 00:20:03:03
what do you like to do for fun?

00:20:03:03 - 00:20:05:05
Do you fish or like you watch sports?

00:20:05:05 - 00:20:06:02
Like, what's your thing?

00:20:06:02 - 00:20:08:04
I like photography, so. You do.

00:20:08:04 - 00:20:09:00
Yeah. That's awesome.

00:20:09:00 - 00:20:11:23
I will show you soon a book with

00:20:11:23 - 00:20:14:20
about 50... 50

00:20:14:20 - 00:20:17:19
photos from Orange... from around.

00:20:17:19 - 00:20:18:22
Oh, that's so cool.

00:20:18:22 - 00:20:20:14
That's awesome. I love that.

00:20:20:14 - 00:20:21:21
And just a quiz for the room.

00:20:21:21 - 00:20:22:23
What spot on our body

00:20:22:23 - 00:20:24:13
has the most stem cells? Pelvis.

00:20:24:13 - 00:20:24:23
That's it.

00:20:24:23 - 00:20:27:01
Good to go, guys. I'll buy you lunch.

00:20:27:01 - 00:20:27:18
What do you want

00:20:27:18 - 00:20:29:07
everyone to know about stem cells

00:20:29:07 - 00:20:32:04
as we sign off here? I think we need to.

00:20:32:04 - 00:20:35:05
I think we can extend this treatment

00:20:35:05 - 00:20:37:04
to patients with autoimmune diseases.

00:20:37:04 - 00:20:38:20
This is one of our one...

00:20:38:20 - 00:20:40:20
By the way of your question,

00:20:40:20 - 00:20:42:21
this is another interest of us.

00:20:42:21 - 00:20:47:19
I think this is actually a huge trend in

00:20:47:20 - 00:20:49:02
our field,

00:20:49:02 - 00:20:51:03
is a movement towards treating patients

00:20:51:03 - 00:20:54:17
with autoimmune diseases, with with

00:20:54:17 - 00:20:56:23
CAR-T therapy, but also

00:20:56:23 - 00:20:58:05
with autologous transplant.

00:20:58:05 - 00:20:59:17
So I really believe

00:20:59:17 - 00:21:00:18
that autologous

00:21:00:18 - 00:21:03:03
transplants can be extremely effective

00:21:03:03 - 00:21:06:02
in wiping out an autoimmune disease

00:21:06:02 - 00:21:08:08
because of this immunologic reset

00:21:08:08 - 00:21:10:15
that I mentioned before,

00:21:10:15 - 00:21:11:05
an immune

00:21:11:05 - 00:21:12:17
reset of a patient

00:21:12:17 - 00:21:14:05
with an autoimmune disease.

00:21:14:05 - 00:21:17:05
So we are really into

00:21:17:11 - 00:21:20:04
into providing the... in helping patients with

00:21:20:04 - 00:21:21:17
autoimmune diseases now.

00:21:21:17 - 00:21:23:10
And we have in fact an abstract

00:21:23:10 - 00:21:26:10
that we submitted to last

00:21:27:09 - 00:21:28:15
tandem meeting

00:21:28:15 - 00:21:31:22
American Society of Transplant Cell Therapy

00:21:31:22 - 00:21:34:08
meeting on approximately

00:21:34:08 - 00:21:36:00
25 patients

00:21:36:00 - 00:21:38:03
with different autoimmune diseases.

00:21:38:03 - 00:21:40:06
We transplanted with

00:21:40:06 - 00:21:41:16
we think very good success.

00:21:41:16 - 00:21:43:06
So we're talking what like M.S.

00:21:43:06 - 00:21:44:19
and lupus and things of that nature?

00:21:44:19 - 00:21:47:16
Exactly yeah. MS.

00:21:47:16 - 00:21:49:03
Stiff Persons Syndrome.

00:21:49:03 - 00:21:50:21
Oh yeah, the thing Celine Celine Dion has.

00:21:50:21 - 00:21:52:12
Yeah.

00:21:52:12 - 00:21:56:08
Yes, we're talking myasthenia gravis.

00:21:56:17 - 00:21:58:09
CIDP,

00:21:58:09 - 00:21:59:08
there's a

00:21:59:08 - 00:22:01:04
multitude of autoimmune diseases

00:22:01:04 - 00:22:03:11
that could potentially be treated with

00:22:03:11 - 00:22:05:10
with an autologous transplant.

00:22:05:10 - 00:22:06:03
As you're talking.

00:22:06:03 - 00:22:06:09
I'm sorry.

00:22:06:09 - 00:22:06:23
I'm just going to

00:22:06:23 - 00:22:08:17
maybe have another question or two.

00:22:08:17 - 00:22:10:23
Why do we call them stem cells?

00:22:10:23 - 00:22:11:12
What is the

00:22:11:12 - 00:22:13:01
what is the significance of the name.

00:22:13:01 - 00:22:14:13
Because the cells

00:22:14:13 - 00:22:16:06
these are as I mentioned,

00:22:16:06 - 00:22:18:07
they have certain characteristics

00:22:18:07 - 00:22:20:19
different than differentiated cells,

00:22:20:19 - 00:22:22:03
red blood cells,

00:22:22:03 - 00:22:23:20
white cells in the blood.

00:22:23:20 - 00:22:26:01
platelets are differentiated cells.

00:22:26:01 - 00:22:28:03
They have a certain lifespan, a lifespan.

00:22:28:03 - 00:22:29:23
And they are going to die

00:22:29:23 - 00:22:32:22
in a matter of days... OK... to few weeks.

00:22:32:22 - 00:22:35:14
Stem cells are quiescent cells. They’re.

00:22:35:14 - 00:22:38:02
They are not dividing cells. They are

00:22:39:05 - 00:22:40:18
residing in tissues

00:22:40:18 - 00:22:43:18
and they generate these.

00:22:43:21 - 00:22:46:12
There are some sort of

00:22:46:12 - 00:22:48:05
mother cells that

00:22:48:05 - 00:22:51:08
that would give rise to these cells,

00:22:51:08 - 00:22:52:14
that differentiate

00:22:52:14 - 00:22:54:07
the cells that do their function

00:22:54:07 - 00:22:56:21
and eventually are eliminated.

00:22:56:21 - 00:22:57:16
I want to talk

00:22:57:16 - 00:22:58:05
just a little bit

00:22:58:05 - 00:23:02:04
more about about who gets to be a donor.

00:23:02:06 - 00:23:04:10
How can how can someone be a stem

00:23:04:10 - 00:23:05:14
cell donor? Right.

00:23:05:14 - 00:23:07:14
So we're talking about donor

00:23:07:14 - 00:23:09:15
for allogeneic transplants.

00:23:09:15 - 00:23:13:06
Donor donors can be related or unrelated.

00:23:13:17 - 00:23:15:16
Related donors are family members.

00:23:15:16 - 00:23:19:06
Usually we look at brothers or sisters,

00:23:19:18 - 00:23:21:19
first degree relatives.

00:23:21:19 - 00:23:23:17
And we ideally

00:23:23:17 - 00:23:25:01
and this is how the field

00:23:25:01 - 00:23:26:08
evolve over time.

00:23:26:08 - 00:23:29:12
We wanted to look at what tissue match

00:23:29:12 - 00:23:32:12
or we call it HLA matching.

00:23:32:22 - 00:23:35:13
HLA system is a system of 12 markers

00:23:35:13 - 00:23:36:01
on surface

00:23:36:01 - 00:23:37:06
of the white cells

00:23:37:06 - 00:23:39:23
that we matched against.

00:23:39:23 - 00:23:41:10
So we want your markers

00:23:41:10 - 00:23:44:11
to be the same as the your donor’s marker.

00:23:44:16 - 00:23:47:15
This is called HLA compatibility.

00:23:47:15 - 00:23:49:02
And this in general

00:23:49:02 - 00:23:50:12
has been associated

00:23:50:12 - 00:23:52:10
historically with better

00:23:52:10 - 00:23:53:22
transplant outcomes.

00:23:53:22 - 00:23:57:04
So historically the better matching

00:23:57:06 - 00:23:59:02
the better outcomes.

00:23:59:02 - 00:24:02:22
Past ten plus years we have started to do

00:24:02:23 - 00:24:05:04
half match transplants, which

00:24:06:05 - 00:24:07:18
a recipient is matched with

00:24:07:18 - 00:24:11:12
the donor only had half of these markers.

00:24:11:12 - 00:24:14:12
And and outcomes we have shown recently.

00:24:14:13 - 00:24:15:23
Actually there is a paper

00:24:15:23 - 00:24:17:17
in a journal, Clinical Oncology

00:24:17:17 - 00:24:19:22
that we just published

00:24:19:22 - 00:24:23:21
showing that if you do not have an HLA

00:24:23:21 - 00:24:25:07
matched donor,

00:24:25:07 - 00:24:26:22
you may proceed to transplant

00:24:26:22 - 00:24:28:09
with half match donor.

00:24:28:09 - 00:24:30:02
And this has huge implications

00:24:30:02 - 00:24:33:17
because the number of matched donors

00:24:33:18 - 00:24:35:10
is about 25%.

00:24:35:10 - 00:24:37:15
So one has about 25% chance

00:24:37:15 - 00:24:40:15
to have an HLA match related donor.

00:24:41:07 - 00:24:43:16
In fact, you're much more likely

00:24:43:16 - 00:24:46:16
to have a half match, which is a

00:24:47:07 - 00:24:49:05
which is either a sibling

00:24:49:05 - 00:24:50:13
that is only half match,

00:24:50:13 - 00:24:52:11
not full match, or one of your children.

00:24:52:11 - 00:24:53:23
Or if you're a child,

00:24:53:23 - 00:24:56:03
one of your parents are for sure

00:24:56:03 - 00:24:56:18
half match.

00:24:56:18 - 00:24:57:22
So this extends

00:24:57:22 - 00:24:59:05
the donor pool

00:24:59:05 - 00:25:01:14
tremendously and is very important

00:25:01:14 - 00:25:04:22
for underdeveloped countries

00:25:04:22 - 00:25:08:04
because because they do not have access

00:25:08:04 - 00:25:09:11
to unrelated donors

00:25:09:11 - 00:25:10:14
or the registries

00:25:10:14 - 00:25:11:14
in other countries

00:25:11:14 - 00:25:14:20
like India, China, Pakistan,

00:25:14:20 - 00:25:15:07
and so

00:25:15:07 - 00:25:17:06
others is really

00:25:17:06 - 00:25:19:05
not so developed as United States.

00:25:19:05 - 00:25:21:02
So the likelihood of being able

00:25:21:02 - 00:25:22:08
to access a donor

00:25:22:08 - 00:25:26:07
from the registry is, is much lower.

00:25:26:07 - 00:25:27:16
So we rely a lot.

00:25:27:16 - 00:25:30:02
They rely a lot on half matched donors.

00:25:30:02 - 00:25:32:09
This has made a huge difference... Sure.

00:25:32:09 - 00:25:33:22
because in fact

00:25:33:22 - 00:25:36:06
we now can offer this procedure

00:25:36:06 - 00:25:39:06
to all those in need

00:25:39:17 - 00:25:42:11
as compared with, let's say, 20 years ago

00:25:42:11 - 00:25:45:04
when if you did not have an HLA

00:25:45:04 - 00:25:45:21
matched donor,

00:25:45:21 - 00:25:47:03
you did not get this and,

00:25:47:03 - 00:25:48:07
disease may come back

00:25:48:07 - 00:25:50:05
and we are not going to be able to save you.

00:25:50:05 - 00:25:51:10
You mentioned

00:25:51:10 - 00:25:52:04
CAR T-cells,

00:25:52:04 - 00:25:54:13
and I've heard that term from even,

00:25:54:13 - 00:25:55:15
like a different cancer events

00:25:55:15 - 00:25:56:00
I've hosted.

00:25:56:00 - 00:25:56:07
I've met

00:25:56:07 - 00:25:56:18
many people

00:25:56:18 - 00:25:58:11
that have have gone through CAR T-cell

00:25:58:11 - 00:25:59:09
therapy.

00:25:59:09 - 00:26:00:11
What can you explain

00:26:00:11 - 00:26:01:17
what CAR T cells are?

00:26:01:17 - 00:26:02:06
Right.

00:26:02:06 - 00:26:06:13
So CAR Ts are modified T cells with a CAR.

00:26:06:19 - 00:26:09:04
A CAR stands for a chimeric

00:26:09:04 - 00:26:10:18
antigen receptor.

00:26:10:18 - 00:26:13:21
This is just a marker, a receptor

00:26:13:23 - 00:26:17:15
that recognizes a two more antigen.

00:26:19:02 - 00:26:20:14
It basically this CAR

00:26:20:14 - 00:26:22:15
recognizes the cancer cell

00:26:22:15 - 00:26:27:02
and it's made its put in a in a recipient

00:26:27:03 - 00:26:27:23
T-cells

00:26:27:23 - 00:26:31:03
to direct the T-cells to the tumor.

00:26:31:03 - 00:26:34:03
So you simply direct

00:26:34:03 - 00:26:35:16
the immune system to

00:26:35:16 - 00:26:37:18
to the tumor to eliminate the tumor.

00:26:37:18 - 00:26:38:14
So it's like a car

00:26:38:14 - 00:26:39:08
like they're driving a.

00:26:39:08 - 00:26:40:17
CAR is like driving.

00:26:40:17 - 00:26:41:07
Go there.

00:26:41:07 - 00:26:43:19
Go to the tumor. Yes. Wow. Okay.

00:26:43:19 - 00:26:45:20
And then what are NK cells?

00:26:45:20 - 00:26:47:14
NK cells

00:26:47:14 - 00:26:50:07
in this case stands for natural killer cells.

00:26:50:07 - 00:26:53:18
Oh. These are actually specialized

00:26:53:18 - 00:26:57:21
cells, lymphoid cells from our blood.

00:26:57:21 - 00:26:59:08
Everybody has NK cells in their

00:26:59:08 - 00:27:02:08
blood that recognize malignantly

00:27:02:15 - 00:27:05:10
transformed cells or virally

00:27:05:10 - 00:27:07:17
infected cells and eliminate them.

00:27:07:17 - 00:27:09:06
So for example

00:27:09:06 - 00:27:10:18
you get a viral illness

00:27:10:18 - 00:27:11:21
respiratory illness.

00:27:11:21 - 00:27:13:15
It goes in your blood.

00:27:13:15 - 00:27:16:00
It may go into some of your cells but...

00:27:16:00 - 00:27:16:20
And they’re

00:27:16:20 - 00:27:18:05
if you if they are unchecked

00:27:18:05 - 00:27:19:23
they're going to kill you.

00:27:19:23 - 00:27:23:14
So these NK cells go after, recognize

00:27:23:14 - 00:27:25:06
these virally infected cells

00:27:25:06 - 00:27:29:04
or they recognize cells that are starting

00:27:29:04 - 00:27:32:05
to be transformed, malignantly.

00:27:32:15 - 00:27:36:04
They recognize them as non-self anymore

00:27:36:04 - 00:27:38:00
and then and eliminate them.

00:27:38:00 - 00:27:39:11
So this is

00:27:40:10 - 00:27:42:03
I believe that this is

00:27:42:03 - 00:27:43:19
there's an incredibly incredible

00:27:43:19 - 00:27:44:21
potential for

00:27:44:21 - 00:27:48:06
to to use these cells for therapeutic purposes.

00:27:48:06 - 00:27:51:22
And one major issue, I think, is

00:27:53:14 - 00:27:56:04
the fact that we do not have enough

00:27:56:04 - 00:27:56:23
of these cells

00:27:56:23 - 00:27:58:09
for therapeutic purposes,

00:27:58:09 - 00:28:00:02
and we are trying

00:28:00:02 - 00:28:01:19
to expand them in the lab

00:28:01:19 - 00:28:06:08
and infuse them to a patient with cancer.

00:28:06:09 - 00:28:06:16
Yes.

00:28:06:16 - 00:28:10:11
And there. It is...

00:28:11:00 - 00:28:13:13
they can be used in a broad

00:28:13:13 - 00:28:15:03
range of, of cancer

00:28:15:03 - 00:28:16:12
for therapeutic purposes.

00:28:16:12 - 00:28:19:05
So in terms of the autoimmune disease

00:28:19:05 - 00:28:20:03
what happens

00:28:20:03 - 00:28:22:04
what's occurring with this stem

00:28:22:04 - 00:28:24:19
cells to basically stop or arrest

00:28:24:19 - 00:28:26:03
something like an MS or...

00:28:26:03 - 00:28:28:00
So the main

00:28:28:00 - 00:28:29:12
that is a characteristic

00:28:29:12 - 00:28:29:23
of all

00:28:29:23 - 00:28:32:00
autoimmune diseases, which is

00:28:32:00 - 00:28:33:18
there are some

00:28:33:18 - 00:28:36:10
B cells, part of the immune system

00:28:36:10 - 00:28:37:15
that are generating

00:28:37:15 - 00:28:42:08
antibodies, that are misplaced.

00:28:42:08 - 00:28:44:05
Mistarget... that mistarget

00:28:44:05 - 00:28:45:10
different tissues

00:28:45:10 - 00:28:48:10
and organs in the body, for example,

00:28:49:05 - 00:28:50:03
MS.

00:28:50:03 - 00:28:52:01
In MS.

00:28:52:01 - 00:28:54:19
it is believed MS is caused by...

00:28:57:00 - 00:29:01:12
By antibodies against the general

00:29:01:15 - 00:29:03:16
after for example,

00:29:03:16 - 00:29:06:14
an infectious monoclonal an EBV

00:29:06:14 - 00:29:09:03
Epstein-Barr virus generates

00:29:09:03 - 00:29:12:09
an immune response from someone that

00:29:12:10 - 00:29:13:21
in most of the time

00:29:13:21 - 00:29:16:02
the aim is to eliminate the virus,

00:29:16:02 - 00:29:17:11
but through

00:29:17:11 - 00:29:18:03
a process

00:29:18:03 - 00:29:21:03
called molecular mimicry targets

00:29:21:20 - 00:29:24:20
some.

00:29:25:01 - 00:29:28:01
Tissues that in the

00:29:28:07 - 00:29:31:07
in the central nervous system,

00:29:31:10 - 00:29:34:09
causing the MS, causing destruction of

00:29:34:11 - 00:29:35:19
causing neural damage

00:29:35:19 - 00:29:38:19
and patchy typical patchy

00:29:39:16 - 00:29:42:06
demyelinating lesions that cause

00:29:42:06 - 00:29:43:01
nerve damage

00:29:43:01 - 00:29:44:21
and progressive debilitation MS.

00:29:44:21 - 00:29:47:21
So what I'm trying to say is

00:29:47:22 - 00:29:50:16
in autoimmune diseases in general,

00:29:50:16 - 00:29:53:19
there are antibodies of different types

00:29:53:19 - 00:29:54:16
that generate

00:29:54:16 - 00:29:56:00
different disease, for example.

00:29:56:00 - 00:29:58:18
Another example is in diabetes.

00:29:58:18 - 00:29:59:18
In type one diabetes

00:29:59:18 - 00:30:00:02
there are

00:30:00:02 - 00:30:03:15
antibodies against pancreatic cells. In

00:30:04:22 - 00:30:07:06
in autoimmune thyroiditis

00:30:07:06 - 00:30:09:22
there are antibodies against

00:30:09:22 - 00:30:11:01
thyroid tissue.

00:30:11:01 - 00:30:12:07
What we're trying to do

00:30:12:07 - 00:30:14:02
is with an autologous transplant

00:30:14:02 - 00:30:18:15
is to stop this immune attack,

00:30:19:07 - 00:30:21:19
eliminate the cells that cause

00:30:21:19 - 00:30:23:07
these antibodies.

00:30:23:07 - 00:30:25:10
The immune system will recover

00:30:25:10 - 00:30:29:11
without these B cells that generate

00:30:29:11 - 00:30:30:23
these antibodies

00:30:30:23 - 00:30:32:17
that are causing the disease.

00:30:32:17 - 00:30:34:10
The problem we find

00:30:34:10 - 00:30:37:14
is that in some cases,

00:30:37:15 - 00:30:40:01
there is irreversible damage

00:30:40:01 - 00:30:41:14
that has already occurred.

00:30:41:14 - 00:30:43:19
That's why intuitively makes

00:30:43:19 - 00:30:47:13
sense to act early and stop...

00:30:48:15 - 00:30:51:02
Stop the autoimmune attack

00:30:51:02 - 00:30:53:03
early in the course of the disease

00:30:53:03 - 00:30:55:08
to prevent organ damage.

00:30:55:08 - 00:30:56:09
Okay.

00:30:56:09 - 00:30:58:21
We for example, in MS,

00:30:58:21 - 00:31:01:19
if one has progressed

00:31:01:19 - 00:31:04:02
to a certain degree of debilitation

00:31:04:02 - 00:31:05:13
through extensive

00:31:05:13 - 00:31:07:11
plaque burden, for example,

00:31:07:11 - 00:31:08:18
it's very difficult to

00:31:08:18 - 00:31:10:17
to to reverse this

00:31:10:17 - 00:31:11:22
with an autologous transplant.

00:31:11:22 - 00:31:16:09
So the goal is to stop this

00:31:16:16 - 00:31:19:23
autoimmune attack early on and eliminate

00:31:19:23 - 00:31:20:18
these antibodies,

00:31:20:18 - 00:31:22:10
plus the cells that are producing

00:31:22:10 - 00:31:23:04
these antibodies.

00:31:23:04 - 00:31:25:12
I just came up with a little acronym

00:31:25:12 - 00:31:28:12
here: Simply The Expert Man - STEM.

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That's this guy right here.

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Thank you doctor. Thank you so much.