Over three decades after the world discovered stem cells, Vietnam began its first research. Tuoi Tre’s weekend magazine reports on the development of stem cell technology in Vietnam.

A blood cancer patient treated by stem cell at the HCM City Hospital for Blood Transfusion and Hematology.

The first applications of stem cells

The HCM City Blood Transfusion and Hematology Hospital blazed the trail. In 1995, the first bone marrow transplants were done there on a cancer patient from nearby Dong Nai province. Fifteen years later, this patient is in good health and living with his wife and two children.

A little later, the hospital sent a group of doctors and technicians to Japan to study stem cell transplant procedures. Eight of the nine stem cell transplants that the hospital implemented from 2001 to 2009 have been successful. One patient died owing to liver failure. The hospital used umbilical cord blood samples provided by the Japan umbilical cord blood bank in four operations and then from the HCM City umbilical cord blood bank for the subsequent cases.

Dr. Huynh Nghia, who has participated in many stem cell transplant operations, said that in successful cases, transplanted cells grow well. However, the lifespan and the quality of the transplanted cells and the life of patients depend on many factors. Patients with cancer of the blood often survive for eighteen to twenty-four months more after the transplantation. Some child patients of blood cancers are still alive after operations in 2002 and 2005.

Dr. Nguyen Dinh San, a lecturer at the Hanoi University for Natural Sciences, is one of six heart patients who received stem cell therapy and are very healthy now.

In late 2007, San had a coronary. Doctors of the National Cardiovascular Hospital decided to treat this case by inserting a stent. Because San’s heart was still only pumping weakly, doctors decided to additionally treat him by injecting stem cells.

Dr. Pham Manh Hung of the National Cardiovascular Hospital, who chairs the experimental project to treat heart disease with stem cells, said that doctors took 200 milliliters of San’s bone marrow and from this, extracted 10 milliliters of stem cells for injection to the patient’s coronary artery.

After over two years of treatment with stem cells, “I can teach 8-12 hours a week. I also supervise final essays and tutor high-school students for university entrance exams,” Dr. San said.

The first research groups

At the age of 75, Professor Tran Van Be talks animatedly about stem cell research. Be wears many hats; he is chairman of the Vietnam Blood Transfusion and Hematology Association, Chairman of the Hematology Faculty of Pham Ngoc Thach Medical University and Director Emeritus of the HCM City Center for Blood Transfusion and Hematology. In the latter post, Be has chaired many projects on hematology, blood transfusion and stem cell transplants.

Whether doctors could use blood from the umbilical cords of newborn babies for transfusions was the subject of research work carried out from 1997-2000. The answer was ‘yes.’ Current research projects at the HCM City Hospital for Blood Transfusion and Hematology started from this answer.

Though Professor Be is technically retired, he and co-workers are still working to find out the answer to another difficult question: how to multiply the volume of stem cells. The volume of stem cells taken from each blood sample is only enough to transplant to a person of less than 50kg in weight.

“Some countries combine stem cells from the blood in two or three umbilical cords which have the same Human Leukocyte Antigen (HLA) when they transfuse a patient. Because its hard to match HLA, we are trying to multiply stem cells, but the biggest worry is hidden infection, which can cause genetic variability in the future,” Prof. Be said.

Dr. Nguyen Tan Binh, director of the HCM City Blood Transfusion and Hematology Hospital and Director of the Pham Ngoc Thach Medical University, performed the first stem cell transplant operations with Prof. Be. Recently, the HCM City Blood Transfusion and Hematology Hospital inaugurated its umbilical cord blood bank, which can keep over 10,000 umbilical cord blood samples.

“We have prepared everything that’s needed, from equipment to human resources, to build a standard laboratory on hematology and immunology in transplants,” said Dr. Binh. His group and Prof. Be are learning to differentiate stem cells extracted from umbilical cord blood samples into various tissues like skin, cartilage, bone and myocardium tissues.

Phan Kim Ngoc, chief of the stem cell laboratory at the HCM City University for Natural Sciences, said that a small started researching stem cells in 1999 with several members. The group now has grown to include nearly 60 members.

“We aren’t doing basic research, but rather we are learning what the world has done to see whether we can do it in Vietnam or not,” Ngoc said.

In 2002, Ngoc’s team announced that it had extracted stem cells from the bone marrow of white mice and in 2003, from women’s skin tissue.

“We can differentiate the stem cells extracted from mouse embryos into myocardial cells, cells similar to nerve cells, muscle, bone and fat cells, as well as cells that secrete insulin,” Ngoc said. “With stem cells extracted from umbilical cord blood, we can differentiate to get cells that are similar to bone cells and fat cells.”

Dr. Tran Cong Toai, vice chief of the Tissue-Embryo-Genetics Faculty of Pham Ngoc Thach Medical University, said that he has researched stem cell differentiation into bone and keratin cells for use in skin and bone transplant technology (this research was published in the June 2009 issue of the journal Cell and Tissue Banking). Other research work by Toai is differentiating stem cells to treat patients of Stevens- Johnson syndrome, a life-threatening skin disease.

Toai and doctors of several HCM City hospitals are working together to use stem cell technology to transplant skin to burn victims. Ten patients have been successfully treated by this method.

Recently, Dr. Phan Toan Thang has returned home from study in Singapore with a technology to extract stem cells from the membranes of umbilical cords. Mekophar, a local pharmaceutical firm, bought this technology to build the MekoStem stem cell bank.

Biological insurance?

Stem cell research at a laboratory of the HCM City University for Natural Sciences.

Stem cell technology has been successfully used but the world is still learning “which diseases does this technology serve the best? What are the best kinds of stem cells? How much is enough?,” explains Dr. Pham Manh Hung.

This year the National Cardiovascular Hospital will seek funding to expand its project to use stem cell therapy to prevent heart failure after coronaries to a sample of 30 patients, enough to draw initial conclusions about the effectiveness of this technology.

Hung said that it is still unclear whether stem cell technology is effective for other heart diseases.

“In principle, only five or six percent of stem cells that are injected into the organ that needs treatment remain there. The remaining volume will go everywhere with the blood and will degenerate. Some say that harm may result if stem cells circulate extensively into the body, but no one has proved that,” Hung said.

The MekoStem stem cell bank, though it is advertising future applications of stem cells, admits that the lack of reseach on applying stem cells in treatment will makes its establishment still “incomplete”.

Mekophar, the operator of MekoStem stem cell bank, has delayed planning on “building an umbilical cord stem cell bank in the southern region and applying stem cells to treat diseases in humans” because of the shortage of actual treatment projects using stem cells in Vietnam.

When clients send their umbilical cord stem cells to MekoStem, they “sign biological insurance contracts.” Application of the therapy depends on Vietnamese hospitals’ ability.

So far, no stem cell sample has been taken from this bank to serve treatment. The first experimental cases are scheduled in 2010. MekoStem said that it has only one project with the HCM City Blood Transfusion and Hematology Hospital to use stem cell in treatment.

Meanwhile, Dr. Phan Toan Thang said he would cooperate with local hospitals like Bach Mai in Hanoi, the National Burn Hospital, HCM City Medical University and Military Hospital 108 to implement stem cell technology.

“The opportunity is quite clear to use stem cells in transplants of cornea and cartilege, but we need more time to research other applications of stem cells like treating cardiovascular and mental diseases or diabetes,” Thang said.

“Stem cells are not a panacea,” he added.

VietNamNet/TTCT