Cell Therapy

Bay Area researchers are using a particular cancer to produce neuronlike cells that, when injected into the brain, seem to reverse the effects of stroke. Is the treatment a historic medical breakthrough, or a reckless ploy to attract investors?

"People do have concerns about potential consequences of their genetic abnormality," Andrews says. "In the long run, cells derived by differentiation of normal human embryonic stem cells seem a better prospect. Nevertheless, I think the human teratocarcinoma cell work has provided valuable groundwork on which to build the studies of human embryonic stem cells."

For now, cell therapy scientists remain enamored of the promise of embryonic and fetal stem cells, which display more versatility and are thought to be less risky for transplantation than cancer-derived cells. That could change, however, with Layton's findings.

"At the end of the day, we don't know whether this is going to work," Sean Cullen says. "But we do know already that it's safe. We do know already that it's feasible -- we can make them. If you look at stem cells, we're asking: "Can we make them? Are they safe? And do they work?' It's like somebody trying to guess 50 years ago when we're going to put somebody on the moon. There are so many unknowns."

On a warm August afternoon almost four months after Bill Perrin received some of Layton's cancer-created, neuronlike cells, the study in his Hollister home is filled with sunlight, the tweeting of backyard birds, and stacks upon stacks of medical books. Stroke-related magazines and pamphlets lie everywhere. Even a baseball autographed by his one-time neighbor Don Larson (the only pitcher to toss a perfect game in a World Series) sits on a stack of scientific journals, perched on a bookcase stuffed full of medical encyclopedias and weighty tomes like Gray's Anatomy. The homemade library backs up the 59-year-old's claim that his stroke turned him into an expert on neurology; it also provides plenty of textbook examples to illustrate stroke's ability to debilitate.

"When it hits you, when you look in the mirror, you know you're not the same," says Perrin, whose 1996 stroke causes him to speak with a slight slur. As he recalls those first frightening months after his stroke, confined to a wheelchair with a right arm and leg that wouldn't budge, his smile wanes and his stocky frame sags in the armchair. "I had a hell of a time. You read a paragraph or two, a minute later it's gone. I'd get lost in stores, disoriented. I didn't trust myself. You find yourself asking, "Which way is out?' That's pretty bad."

So are the statistics. Stroke, one of the leading causes of adult disability in the United States, attacks about 750,000 Americans a year and claims almost 160,000 lives. The country's third leading cause of death, stroke costs the government roughly $30 billion annually in research, treatment, and lost work-force productivity.

But for a disease as studied and severe as stroke, doctors have come up with remarkably few treatments. Strokes comprise several complex events, beginning when the brain's blood supply gets cut off or when a vessel in the brain bursts, spilling blood into the spaces surrounding the cells. Brain cells die when they no longer receive oxygen and nutrients from blood. The loss of neurons is crippling; neurons don't divide and regenerate. When they die, they're gone for good.

The only effective drug to fight stroke is tissue plasminogen activator, tPA for short, which breaks up blood clots, but it must be administered within three hours of the attack and only to patients whose strokes are clot-related. Researchers are trying to develop drugs to combat cell death and inflammation, and Stanford doctors are testing whether freezing the brain prevents further injury, but these are experiments, not therapies.

Perrin, a physician's assistant who has lent a hand in countless minor surgeries, had never gone under the knife before May 1. He gleefully parts his thinning hair -- blond on top and gray over the ears -- to show off the slim scar that remains from the brain surgery. "It made me my old self again," he says. Well, not quite. Straining like a man lifting a 50-pound boulder, he now can raise his right arm and hold it, quivering, above his head. He can grip a pen, use a spoon, steady the steering wheel. He can even assist in surgeries, although he can't stitch up wounds.

But even this minimal progress has convinced him that he made the right decision by enlisting in Layton's study. He has no doubt: This science works.

"It's the beginning of all help," Perrin says. "It's the only thing we can do for a problem that we couldn't do anything about before."

Two days after the terrorist attacks in New York and Washington, the plaza outside the Stanford Medical Center buzzes with white-gowned nurses, blue-gowned doctors, patients still attached to their IV stands, and perplexed construction workers drawn to the commotion from nearby sites. Word spreads quickly: Someone called in a bomb threat on the Stanford Hospital emergency room.

Twenty minutes later, authorities have scanned the buildings and are allowing the crowd to trickle back in. Despite the interruption to his hectic schedule, Dr. Gary Steinberg, chairman of Stanford's department of neurosurgery, appears unfazed by -- and uninterested in -- the bomb scare. Sipping a Coke in his office, the co-leader of Layton's clinical study projects the confidence, competence, and calm his patients ascribe to him. Perrin says two minutes in Steinberg's presence convinced him of the study's promise. In other words, Steinberg exudes the serenity and self-assurance you look for in a guy who wants to drill a hole in your head and fill it with experimental cells made from a cancer.

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