Jul 23 2015

Stem Cells and the Arc of Technology

I have noticed a common arc to many technologies. First they are known and discussed only by scientists and experts in the field. Then they are picked up technophiles who read nerdy magazines and websites. This is all while the research is preliminary and the technology just a distant hope for the future.

Then something happens that makes awareness of the potential technology go mainstream. This is often a movie depicting the technology, but can also be just an article in a more mainstream magazine or newspaper, an early demonstration of the potential for the technology, or a political controversy surrounding it. Then the hype begins.

The hype phase is driven by the researchers looking for more funding, the technophiles who have already been salivating over the technology for years, and a sensationalist media.

We then get into the dark phase of a technology’s arc – the exploitation phase. At this point the hype is running way ahead of the technology, and the public has this false sense that we are on the cusp of major applications. ┬áThis makes them vulnerable to charlatans who will claim that they have the technology, long before the tech actually exists.

As the hype and exploitation phase linger, the public is likely to move on to disillusionment. They have been waiting for years for the new technology, and nothing real has manifested. This often leads to the feeling that the whole thing was hype and will never manifest. Even the technophiles may be getting frustrated at this point.

Finally, we start to see real applications of the technology as it comes into its own. The application phase may be rapid – suddenly all the promises and hype of two decades before are not only met but exceeded. Of course, some technologies fizzle and never get to this phase, or may require fundamental advances in other areas to become viable, requiring many decades.

Stem cell technology has been following this arc. In the 1990s (probably earlier) the idea that stem cells could have broad therapeutic uses was certainly buzzing around the labs and hospitals among experts. Stem cells are cells that can turn into other cells. They could potentially replace damaged or diseased cells, affecting a real cure.

Stem cells were already in use in a very basic sense. Bone marrow transplants, for example, essentially replace the blood stem cells that live in the bone marrow. The idea, however, that stem cells could be injected into the heart to repair heart failure, or into the brain to repair the damage from a stroke or even reverse Alzheimer’s disease was starting to take hold. Researchers started to talk about using stem cells to build organs from scratch.

As the basic science steadily progressed, we rapidly moved into the hype phase. This was accelerated by the political battle over stem cell research in the early years of the younger Bush presidency.

Before long fake stem cell clinics were cropping up all over the world, and we were rapidly into the exploitation phase. Stimulating native stem cells also became a popular claim for various snake-oil products and supplements.

We are now in the late hype/exploitation phase of stem cell technology. Over the last 20 years, however, the science has steadily progressed. We may truly be on the cusp of some killer apps for stem cells. There are still challenges, however. The main one is keeping transplanted stem cells from turning into cancer.

Perhaps the low-hanging fruit for stem cell therapy is to inject stem cells into a failing organ to enhance its ability to heal itself. A recent study in mice shows this potential in treating liver damage. The liver has incredible regenerative ability, but in severe liver disease the liver cells may be too worn out to regenerate.

The new study transplants stem cells derived from the biliary duct into the diseased livers of mice and finds that this treatment restored the livers to “near normal function.” The researchers now need to progress to human trials (which means that actually treatments, if all goes well, is still at least 5 years away).

The heart is another low-hanging target. Heart cells are not complicated, and new cells automatically will synchronize with the rest of the heart and beat to the same rhythm. As long as the basic structure is intact, adding more heart cells to replace ones damaged by a heart attack, viral infection, or other process should be straightforward. Progress is being made in this area as well, as we are in a dead heat to see whether the heart or the liver is the first real breakthrough application for regeneration through stem cell therapy. I give the edge to heart treatments, as they are already in human trials.

Conclusion

An entirely new technology may take decades to manifest, which can lead to the hype being premature by 20 or more years. My favorite example of this is smartphone technology. We were given a glimmer of this in the 1980s, but only technophiles really paid attention. Then in the 1990s everyone was expecting one, but early models were disappointing.

The first iPhone was released in 2007 (that’s right, just 8 years ago) and that was probably the tipping point. Now it seems everyone has one, the promises have been fulfilled and exceeded – it just took 20 years.

I do think stem cell therapies will fulfill and exceed all their hype, it will just take about 20 years longer than most people assumed. We are already about 15 years into the stem cell hype, and we are about 5 years away from the first of the promised applications.

It will come, but science takes time so we need to be a little patient, and be wary of the stem cell quackery in the meantime.

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