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- W2051860428 abstract "Benedetto Falsini and Silvia Bisti remind us of the current understanding of pathogenic mechanisms underlying Stargardt's disease and atrophic age-related macular degeneration (AMD), and suggest that transplanted retinal pigment epithelium derived from human embryonic stem cells (hESC) will not overcome these underlying mechanisms. In fact, we postulated that, if the treatment under study were to be proven safe and effective, “new” retinal pigment epithelium would theoretically confer decades of protection against these pathological mechanisms. For example, in patients with Stargardt's disease, visual loss is commonly identified in the second or third decade of life, although the ABCA4 malfunction is present from birth. Similarly, the mechanisms underlying AMD take five to eight decades to adversely affect retinal pigment epithelium. Another way to look at this is that we are studying a treatment for an unmet medical need, and not necessarily a cure. However, we agree in principle with Falsini and Bisti that future stem-cell therapies might in some instances be combined with pharmacological therapies. We wish to clarify some points in response to Jinhai Huang and colleagues. At no point in our paper do we claim evidence of a therapeutic response to the transplantation of hESC-derived retinal pigment epithelium into our two patients. The report focuses on preliminary safety findings. Functional improvements seen in our patients are qualified as very difficult to measure and as perhaps being due to other factors, including the placebo effect. Measurement of visual improvement in patients with very low vision is difficult. Consensus on the best methods for measuring vision in such patients has not been reached. We appreciate the suggestion to consider the Berkeley Rudimentary Vision Test as a clinical research tool. However, we are hopeful that if our strategy proves safe, we might migrate to studying patients with earlier-stage disease and better visual acuities, thus obviating the stated challenges while theoretically improving the chances for meaningful visual improvements. Huang and colleagues are correct that multifocal electroretinographic data are being collected as part of our protocol. However, at this point, without reliable fixation and tracking technology, these studies are impossible to interpret. Our strategy in translating stem-cell therapies towards clinical use involves a step-by-step approach, asking one scientific and regulatory question at a time. In this instance, we report on preliminary safety findings in the first two patients at 4 months after transplantation. We agree with regulatory agencies such as the US Food and Drug Administration that only one variable should be studied at a time. In our opinion, this strategy holds particularly true when dealing with complex biological therapeutic agents such as stem cells. RL is an employee of Advanced Cell Technology—a biotechnology company in the area of stem cells and regenerative medicine. The other authors declare that they have no conflicts of interest. Embryonic stem-cell-derived retinal pigment epithelial cells for macular degenerationSteven Schwartz and colleagues' study on transplantation of retinal pigment epithelium derived from human embryonic stem cells (hESCs) for the treatment of macular degeneration (Feb 25, p 713)1 is an important step towards treatment of such disorders. We believe, however, that a basic issue regarding the rationale of this approach should be addressed. Full-Text PDF Embryonic stem-cell-derived retinal pigment epithelial cells for macular degenerationThe results of the preliminary trial by Steven Schwartz and colleagues1 add to the evidence from in-vitro and animal studies in suggesting that transplantation of retinal pigment epithelium derived from human embryonic stem cells could be used to treat macular degeneration. The question remains whether Schwartz and colleagues' two human cases can be taken to illustrate a therapeutic response. The outcome measures used were anatomical appearance, visual acuity, and subjective response. Full-Text PDF" @default.
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- W2051860428 title "Embryonic stem-cell-derived retinal pigment epithelial cells for macular degeneration – Authors' reply" @default.
- W2051860428 doi "https://doi.org/10.1016/s0140-6736(12)60892-7" @default.
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