WEBVTT
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Stem cells.
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They've been in the news.
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What do you...
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Go, Ashley.
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No, we saw a lot of stuff about stem cells on social media, and then I started asking Ashley about it, and Ashley turned to me and she was like,"You don't know this?
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Everybody knows this." And I was like,"Babe, nobody knows this.
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I think we better do a podcast episode about it
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I was like,"You don't know what the four Yamanaka factors are?
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Like, come on, babe.
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Like, how long have we been married?"
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She looked at me and she said,"I teach the Yamanaka paper." And I was like,"Okay, well, as a counterpoint, I'm on Blue Sky a lot, and I saw posts about this guy cloning himself into a baby.
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Can that happen?" And this is the kind of conversation that is leading you to this podcast
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Bow, bow, doo, doo, doo, ba, doo, ba, doo, ba, doo.
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That's the, that's the music
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Let's talk about a future where you can regrow organs and the scary, creepy stuff along the way.
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I think that there's a lot of, really, really interesting stuff happening in biology, and there's a lot of, excitement around possibilities here, and stem cells is one of these topics that, I mean, I feel almost like this frisson off it, like off the word, like off the...
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Maybe that's because of the religious and political objections to using stem cells.
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There's a really sort of scariness to this feeling, and I think part of it maybe is, like, the feeling that you could program cells or, like, reprogram cells.
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Like, that's getting very close to feeling like we can manipulate the body on a level that not all of us are comfortable with.
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Um, so I think it'd be really fun to just talk about what is the science of it and also, like, what's the gap between the speculation and the, the reality in biology and, you know, how can we interpret when we do see people, like billionaires claiming to have cloned themselves and have a little baby version of themselves?
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What does that even mean?
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Yeah.
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I feel like we're motivated to talk about this for kind of two reasons.
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Like, you see these big claims on social media, and then a few days after someone makes that claim, you also see that, there's this really unfortunate case of a child dying because they were genetically manipulated and you see the, the real significant downside of misunderstanding the power that we have
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Can you describe that case for us really fast?
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Sure.
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I mean, you know, there's been this, like, long-term dream in science that we could go in and we could edit the genome.
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And so our listeners might know about this technology called CRISPR, which allows us to do this very precise editing of specific base pairs, specific letters in your DNA.
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Go in, flip one.
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And this child had basically one of those letters flipped in a way that caused this one protein to, to misform and to cause really significant
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Yeah Had a rare disease, but like a rare, was born with this genetic condition, right?
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Yeah, was born with this genetic condition.
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And so we have for many years been using what's called gene therapy to bring this tool, this CRISPR tool, into cells to actually edit the genome of those cells.
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And so what they did was they used, um, this virus that I actually used to use in lab all the time.
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We use it in neuroscience to mostly trace the connections between neurons.
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Um, but we use viruses because what they're really good at doing is they're really good at, like, bringing genetic material into cells.
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That's what they do.
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They go in, they basically hijack cells, by, like, inserting their own DNA into that cell.
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So we can harness this technology to insert this gene-editing DNA into a cell.
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And so they did this with this child when the child was, like, really young, with the idea being that those genetic changes would then allow this, child to recreate the right proteins and maybe reverse the, um, deficit that they had.
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Who is, who's they?
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Like, who, who did this?
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The government did this?
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No, no.
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It was like this, this researcher that was hired.
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We could put the, the link to the Science investigation in the show notes maybe.
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But yeah, essentially this, you know, family hired this researcher to do this single person quote unquote clinical trial yeah
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So it was like a private thing kind of where they, they, they hired a scientist to do this
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They made a large donation.
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Yeah.
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Okay,
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Yeah
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Super murky.
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Yeah, totally.
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And, and there's been lots of other stuff like this,
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yeah, we obviously allow families of people with rare diseases to opt into clinical trials to try experimental treatments, at least in the US.
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I don't know how it works in other countries, but this is a, a thing that, you know, you might do
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yeah, they opted into this.
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Um, there was some proof of concept in mice and monkeys, which of course is how we test most therapeutics, right?
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We run them through the gamut of other creatures that are similar to us, most similar being non-human primates.
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This did work in primates, but they actually had significant kidney damage.
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And when they did this in the child, ultimately this child, um, too had complications probably for that same reason, or it might have also been an immune response, to the virus itself that is used to bring that gene-editing tool into cells.
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All of this is to say, you know, this stuff has tremendous promise, but it requires a ton of testing and a ton of very deliberate making sure that you're understanding all of the possible side effects of, of what you're manipulating, which sounds like edits...
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Sounds so simple, go in and edit the genome, but then cascades into these other effects throughout the body.
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I mean, of course it's a tough thing because it's easy for us as scientists to sit here and say,"We need a hundred years of work on this before we fully understand it." But as a patient, it, you know, speaking now as a patient, it- it's your life and your disease is progressing, so what is the balance of when we choose to use experimental therapies?
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I mean, that's not something that I have the answer to, but I do think that understanding, like, some of the promise and some of the excitement would be really interesting, you know, for folks.
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Like, you know, tell me a little bit about I mean, we started talking about stem cells.
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Like, tell me a little bit about what a stem cell is and why was this such an exciting breakthrough like 20 years ago?
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Well, stem cells are the cells that are there when you're a, a tiny, tiny organism before you're really a human, right?
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When you're in the womb and you're just a cluster of cells.
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You're a cluster of cells that are ready to become every other cell in your body, and those are called stem cells.
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Essentially, they're cells that are ready to what we call differentiate, to change into different other kinds of cells.
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So why is this an exciting possibility for medicine?
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The biggest promise of this has been the fact that you can make stem cells out of your own body, and we weren't sure we could do this until, around 2006.
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So, so folks might...
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folks who are, uh, a little bit older, about our age, might know that there was a ton of controversy in the early 2000s around using embryonic stem cells.
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So when George W.
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Bush was president...
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Yeah, uh, when George W.
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Bush was president, he passed a law that basically said we were not allowed to do research on embryonic stem cells.
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So what are embryonic stem cells?
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Like the name suggests, these are stem cells taken from embryos, taken from human embryos, right?
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And in most cases, these were aborted fetuses.
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It's not like we were going into healthy pregnant women and taking cells out of them, right?
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So there was, like, a, a lot of, like, misconceptions about what this meant at the time.
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Um, but it was really
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but that's still very loaded I can imagine
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It's, it's really loaded, right?
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this
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So it's early 2000s, and actually, you know, the outcome of this legislation I saw physically in lab, because what it meant was that there were a specific set of labs that were allowed to do embryonic stem cell research.
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And if you were one of those labs, if you had funding to do so, you had to have an entirely different set of equipment to do that research.
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So yeah, so one of the labs that I worked
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kitchen?
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Like
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Y- yes, literally.
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of this?
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Literally.
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No, you'd have, like, you know, the, equipment that was for stem cells and the, you know, equipment that wasn't
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Is this because the funding couldn't be used, so you couldn't buy your same equipment and use it on two different types of science?
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The science end to end had to only be funded by, like, stem cell approved funding or something?
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So we, we had these kosher kitchen labs basically.
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Yes.
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Yes, exactly.
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That's such a good analogy.
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Yeah.
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Yeah, exactly.
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So, so you know, like I saw that in, what?
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2008.
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I was, um, I spent the summer at Columbia, and yeah, I saw labs like that.
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Um, but that's around when things were changing because in 2006, this landmark paper came out, people will know it as like the Yamanaka paper, um, came out that showed that you could, rather than take stem cells from babies, you could actually take any old cell, like I could scrape some skin cells off of your skin, and just sprinkle in four little guys, they're called transcription factors, mix them up with those cells, and bring those cells back to their pluripotent state, to the state in which they can actually become any other kind of cell
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This feels like it must have been enormous news.
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This was enormous news
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Stem cells became an abundant resource.
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Yeah, exactly.
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And so it became the difference between having to extract them from fetuses to most labs being able to implement this using the equipment they currently have.
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Wow.
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Wow.
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What a revolution.
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Yeah
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So that kind of ended, you know, the controversy about embryonic stem cells.
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We don't need it anymore.
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Um, and, and since then, right, that was 2006, 20 years ago, since then we've made some changes, like we've kind of tweaked the recipe a little bit.
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We have some different things that we put in the mix to keep cells healthy.
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It works a little different for human cells.
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But at the end of the day, like the core logic is the same.
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You take cells that are differentiated into something like a skin cell or blood cell or a neural cell, you bring them back to the form where they're like the random card, they can become any other kind of card, and, and, then if you want, you can bring those cells all the way back up through something else.
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Like let's say I take a skin cell, I make it a stem cell, and then I wanna make it a neuron.
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I could do that.
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And so that's the kind of stuff that we're doing now that's really cool.
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So is this only happening in science labs or is this happening for real patients right now?
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There's not a ton of this happening for real patients yet, as far as I know.
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So, so most of the implementations of this kind of technology have been used to essentially study diseases in a dish.
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So for example, if I wanna understand what Parkinson's neurons are doing differently, I can take cells from Parkinson's patients, I can turn them into stem cells, I can then turn them into neurons.
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I can grow those neurons in a dish and ask,"Do these neurons act differently?
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Do they release different amounts of dopamine?
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Do they fire differently," right?
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It gives me this ability to study diseases in a dish separate from patients, which, you know, just gives us a lot more flexibility, gives us fine-tuned control over the biology.
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Right.
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Yeah.
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I would imagine lets you do, like, rapid experiments on an, you know, interesting scale or things like that.
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But, but I have a kind of a question about this.
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So you say, okay, you have a person who has Parkinson's, you take their cell, and you sort of reduce it back to stem cell.
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It sounds like a lot of interesting information could be lost in that process.
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So, you know, are you basically using this to study the genetic parts of Parkinson's?
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Like, are there pieces we're missing that you're losing in that transformation?
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Like, are there all kinds of lifestyle, environment, and, like, the specific adaptations that your cells make, you know, that put you in that disease state?
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Like, tell me about this.
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Or do we just have like, yeah, you- your Parkinson is, is Parkinson's in a dish right now?
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Yeah,
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that question make sense?
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No, it does, and I actually, I, I wanna put it a different way, the way that you asked when we were talking about it yesterday, which was, you were like,"Does it make a difference if I take a stem cell from, like, a baby versus from that same person when they're 80 years old and they have Parkinson's?"
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Totally.
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Yeah.
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Pre-Parkinson's baby, but who's going to get it versus they're fully into it
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Right.
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Totally.
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So something like Parkinson's, I think this is a pretty good example.
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Something like
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the kinds of conversations we have, by the way, when, when you're married to a scientist.
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Yeah, we saw,
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me be clear.
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Let me be clear.
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Ashley and I are not actually taking cells from babies at any point.
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Who said that?
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It's only theory.
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I just felt like...
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just,
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was that a, a lot of questions already answered by my T-shirt?
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Just thought it was sounding a little mad scientist-y.
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Put the cells back, babe.
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Um, okay.
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that baby is leaving cells all over the place in its saliva.
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I think we could run this home experiment
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look, the moment this technology hits any sort of commercial viability, we are cloning yeti.
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There is absolutely no question about it it
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I don't know how to feel about that.
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Oh my gosh.
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We haven't had this c- I don't know how to feel about that.
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I'm just kidding.
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I actually have really complicated feelings about it too.
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Um, but Yeah, so
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he's our dog.
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yesterday when you asked this, you know, we were like, yeah, we were chatting about the, the BJ tweet and, um, the possibility of it, and I, I think this is really good.
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So it raises the question of like, what's different between your cells when you're a baby and your cells when you're an 80-year-old with Parkinson's, let's say.
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And obviously, as you just raised, there are environmental, and I'll also throw developmental things that happen as you grow, right?
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Your body changes in response to its own internal environment and what's happening in that body, and that internal environment is changing in response to the external environment, how much you eat, what air you breathe, like all of this stuff, the people you see, right?
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Like, all of these things are factors that change our biology.
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So if you're modeling a disease in a dish, you don't obviously have any of those factors, right?
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But you have the same genome of the person, Which doesn't change throughout your lifeline, right?
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Your genes are your genes.
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One thing changes, which is that as you age, you get these little like tags on your genome.
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We call them epigenetic tags.
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You accumulate these as you get older.
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This is the way that people, quote unquote, like age your cells.
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Like, you might know that you can like
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Oh.
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age, right?
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Because as you grow older, you get these, um, they're called like methylation tags.
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You get these little like things that hang on your genome.
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So that changes on your genome, but your genome itself doesn't change, right?
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So
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Hmm.
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The simplest answer to your question is your genome is the same when you're a baby and when you're an 80-year-old.
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And that genome dictates the kinds of proteins that your body produces, and the kind of proteins that your bodies produce are the receptors on your cells.
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They're the composition of your cell membrane.
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They're dictating how much neurotransmitter you have floating around.
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In the case of like another system, I'm showing my bias as a neuroscientist, right?
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But in the case of like in the immune system, they dictate the kinds of immune cells that you have, you know, specifically, and if you have a different composition of particular cells or balance of different cells in your body, et cetera.
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Okay.
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So your genome actually does dictate quite a bit, but of course, as a human growing up in the world, all of those things, right, the proteins, the cellular-level stuff, all of that can change in response to your environment.
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Hmm.
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Okay.
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Do we know, like, how much different diseases are genetic versus result from epigenetic factors plus genetic fac- like, like I know we know, oh, certain diseases are more genetic than others.
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I don't know the right way to describe this.
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Is that, is that accurate that, you know, we think some are really gene-driven and others aren't?
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Or are we still figuring that out?
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Yeah, we have many really good examples of diseases that we know to be genetically linked.
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Huntington's disease is caused by repeating sequences of DNA in the genome that wouldn't normally be there.
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Polycystic kidney disease is caused by r- some really specific mutations that change the cells in your kidney.
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So those are examples of things where if you have those changes in your genome, they almost always result in something, turning into a disease later on, right?
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But then there's diseases that have some genetic component.
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These are diseases that maybe are, more likely to show up in people that are related.
00:18:35.153 --> 00:18:37.943
So something like multiple sclerosis, for example.
00:18:38.294 --> 00:18:46.453
There's some heritable component, like your chances go up if you have a family member with it, but not totally dictated by your genome.
00:18:46.564 --> 00:18:52.483
Probably much more complex, probably systemic, environmental, in response to all of those things.
00:18:53.335 --> 00:18:57.595
So when someone says they're gonna make stem cells from their own body, right?
00:18:57.644 --> 00:19:01.464
You have to remember that it's still their same genome.
00:19:01.825 --> 00:19:08.075
So if they want to, say, like, generate a new kidney from those stem cells, you could totally do that.
00:19:08.075 --> 00:19:14.355
But if you're someone with polycystic kidney disease, that kidney is gonna carry that same mutation, right?
00:19:14.565 --> 00:19:16.315
So then you have to introduce something else.
00:19:16.315 --> 00:19:23.775
Like, you have to introduce gene editing to fix the kidney cells, and then generate a kidney that is fixed, right?
00:19:23.775 --> 00:19:26.345
And, and, and working as expected.
00:19:27.424 --> 00:19:34.214
So the possibility of someone being able to, like, grow their own organs from their own stem cells is great.
00:19:34.224 --> 00:19:43.015
It means that you can potentially avoid things like your body rejecting an organ because it seems genetically different, which your immune system is built to do.
00:19:43.414 --> 00:19:48.194
But it also means you're carrying all of the baggage that your genome already had, unless you fix it.
00:19:48.724 --> 00:19:52.694
Unless you do something and you go in and you, you manipulate things even further.
00:19:53.782 --> 00:20:04.153
Sort of a larger point here, but this is just making me think about, you know, we've been talking about this idea of personalized medicine and precision medicine, which are, like, slightly different things, right?
00:20:04.482 --> 00:20:11.512
Personalization is more tailoring things because we know information about the individual that's maybe different from other individuals.
00:20:11.863 --> 00:20:21.143
Precision is a little bit more like, you know, instead of targeting a really big systematic thing hap- or systemic thing happening, we're gonna, like, target a very specific mechanism.
00:20:21.143 --> 00:20:22.472
We've gotten more precise about it.
00:20:22.843 --> 00:20:29.113
But those two things often go together, so you might hear, like, personalized medicine and precision medicine altogether.
00:20:29.823 --> 00:20:33.232
And there's just this really wild gap.
00:20:33.252 --> 00:20:36.222
I think people can feel it even if they don't know all the science, right?
00:20:36.462 --> 00:21:04.232
People can feel that there's this gap of who gets to have information about their body and who doesn't, who gets to have, like, this personalization of healthcare to their body and who doesn't, and we're like, we're starting to see the beginnings of it for things like you could have your tumor, you know, sent to an academic lab in the United States, at least, if you're the right kind of cancer patient in the right situation.
00:21:04.843 --> 00:21:25.116
There are these really life-saving, life-changing therapies that maybe aren't stem cells, right, yet, but there are, like- Personalized cancer vaccines is a real thing that is happening, but it is also happening inside of a system and a world that has no idea how to do it at scale.
00:21:25.477 --> 00:21:52.646
So like, it's currently very, very academic and then when you see these people kind of like leap the queue or, you know, post about how they're the ultimate quantified man, and they've hired their own doctors and their own scientists who'll do whatever, I mean, I think the ick that you get is not just about the biology, but it's about the feeling that some people are getting access to this information and this intervention landscape.
00:21:53.237 --> 00:21:59.797
I, I certainly don't think they're gonna do it well necessarily, as they're like being cowboy biohackers out there.
00:22:00.596 --> 00:22:16.207
But it's such a, it's such a wild world where there's, on the one hand, very serious, rigorous, incredible science, and on the other hand, like the worst person you've ever seen in your life announcing that they're gonna, do this to themselves or something.
00:22:16.616 --> 00:22:42.336
I don't know how people are supposed to make sense of it, but I see this information equity problem, and you think about like, how is it possible that one of my friends could fight for like three years to get some imaging done for an obvious thing that might be cancer, whereas on the other hand, we're personalizing cancer vaccines for other people, happening in the same country and sometimes the same state, and sometimes in the same healthcare system.
00:22:43.017 --> 00:23:11.207
I think as scientists, it's really frustrating and sad because you want this frontier of knowledge that we're pushing to go be put into practice, but it's like there's this whole chasm between what we know in the lab and what we actually implement in, you know, giving care to patients, You see the downside, the significant downside of what happens when someone just goes ahead and tries something, right?
00:23:11.227 --> 00:23:14.807
With what happened with the death of the girl, um, in China.
00:23:14.856 --> 00:23:15.896
But ba- but babe
00:23:15.989 --> 00:23:16.848
strongly,
00:23:17.547 --> 00:23:22.777
how many people are dying because they're not getting completely figured out things?
00:23:23.106 --> 00:23:24.666
Many, many people
00:23:25.010 --> 00:23:25.320
yeah.
00:23:25.361 --> 00:23:25.550
No,
00:23:25.676 --> 00:23:26.467
because no one's
00:23:26.471 --> 00:23:27.411
some point there's like...
00:23:28.010 --> 00:23:28.730
Yeah, yeah.
00:23:28.961 --> 00:23:36.391
No, I, I totally hear you and I, and I think your point earlier about like, you know, if you have a rare disease that's like ruining your life, like what else are you gonna do?
00:23:37.265 --> 00:23:37.414
Right.
00:23:37.414 --> 00:23:40.815
You might be willing to try something that even has a high risk.
00:23:40.894 --> 00:23:41.305
Yeah.
00:23:41.330 --> 00:23:41.961
Absolutely.
00:23:41.961 --> 00:23:51.000
And, and every- almost everything that we do medically has had sacrifices along the way, minimally animals that we use in research, right?
00:23:51.121 --> 00:23:54.611
And in some cases, like human life as well.
00:23:55.290 --> 00:23:59.070
So yeah, absolutely there, there are trade-offs.
00:23:59.371 --> 00:24:01.340
I don't think you need to conflate the two.
00:24:01.351 --> 00:24:01.990
You know what I mean?
00:24:01.990 --> 00:24:14.040
It's, we're not, we're not looking at a world where the choice is do rigorous science or have one scientist be paid a million dollars by terrified parents to, like, fool them into doing a procedure that really isn't safe.
00:24:14.070 --> 00:24:25.480
I mean, those are not, like, the only two options to me, I mean, those, that's a symptom of how desperate the need is, and it shouldn't work this way, but we can have compassion for why, you know?
00:24:25.800 --> 00:24:33.020
And why parents would be so d- I mean, who, who among us would not, you know, try everything to save a loved one?
00:24:33.040 --> 00:24:36.340
I mean, it's really, it's really, really tough.
00:24:36.371 --> 00:24:38.701
But that is why we, we need better systems.
00:24:38.701 --> 00:24:46.461
I mean, I think it's very cold and, and divorced from reality when scientists say,"Well, just wait.
00:24:46.471 --> 00:24:57.151
Just wait 100 years, you know, just wait." I mean, am I supposed to just wait for all of the, like, faculty arguments and slow bullshit of science?
00:24:57.709 --> 00:24:58.219
Hmm.
00:24:58.709 --> 00:24:59.979
No, I think this is fair.
00:25:00.058 --> 00:25:00.328
Yeah
00:25:00.641 --> 00:25:11.161
I deeply believe that, like, you know, we have a responsibility to, to translate knowledge into things that benefit people.
00:25:11.181 --> 00:25:17.471
And, you know, you do see it happen when you see, like, large public health investments.
00:25:17.471 --> 00:25:36.381
You see, like, the COVID vaccine, as much as it was, like, terrifying and politicized in so many ways, took advantage of so much of our, of our ability to rapidly gain understanding of a virus, and that maybe could not have happened in another era.
00:25:36.750 --> 00:25:39.480
And I mean, it just saved so many lives doing that.
00:25:40.131 --> 00:25:46.431
a huge part of the anger for me is that we actually do have so many figured-out things.
00:25:46.431 --> 00:26:18.871
We have so many ways to understand the body that even people like us, a PhD, you know, incredibly privileged people in one of the best healthcare systems in the country, living in Southern California, like, you and I have to go into the doctor's office and be treated like morons and, you know, accept sitting there and having them tell us,"No, I'm not gonna do this basic imaging," imaging that you could do, like, in the lab to give us, like, a diagnostic signal, you know?
00:26:18.931 --> 00:26:20.421
I mean, it's just infuriating.
00:26:21.030 --> 00:26:24.560
Sorry, this has turned into a cat rant, and we said we weren't gonna do that episode today, but
00:26:26.096 --> 00:26:37.626
No, but I, I see the link that you're making, which is like there's this terrible gap between the kinds of things that we know work in research labs and the kinds of things we have access to as patients.
00:26:38.227 --> 00:26:48.967
It's a wide fucking gap, and I think what you're asking us to do is to imagine a world in which there are things bridging that gap.
00:26:49.356 --> 00:27:05.777
Like, there are ways in which people actually have access to the information about their own bodies, to information about the science, the, the possible science even, you know, the next five-year science about their condition, right?
00:27:05.856 --> 00:27:08.457
Like, that's not what happens in a doctor's office.
00:27:08.457 --> 00:27:11.906
What happens in a doctor's office is you hear the 10 years ago science.
00:27:13.017 --> 00:27:14.967
You know nothing about the next chapter.
00:27:15.255 --> 00:27:16.605
you know even if you get...
00:27:16.855 --> 00:27:21.244
I've been thinking about this a lot because I've been talking to so many patients and, and helping them.
00:27:21.255 --> 00:27:24.744
I've become a person all of my patient friends talk to.
00:27:24.775 --> 00:27:26.454
I mean, it's kind of always what happens to me.
00:27:26.454 --> 00:27:31.884
I'm like i- an infinite big sister out there, never gonna ever escape that pattern.
00:27:32.275 --> 00:27:43.204
But I joined these patient communities, and I was like,"I need some support for what I'm going through." And then I turned into the person who could, like, read all of the science papers or, like, help them figure out how to talk to their doctors.
00:27:43.845 --> 00:27:51.275
But it was incredible learning for me because I realized even when you get an intervention, you get a treatment plan, who's following up with you?
00:27:51.734 --> 00:27:53.484
Who's tracking if it's working?
00:27:53.944 --> 00:28:06.025
Absolutely frigging nobody, unless you are perhaps a cancer patient with a very dedicated oncology team and the right situation and, like, motivated about your own care and you're doing your own project management.
00:28:06.414 --> 00:28:20.535
But, like, I have many, many friends at this point who have incredibly serious things going on, and it is basically completely on them to track the efficacy of whether the medication is actually working for them.
00:28:21.055 --> 00:28:24.815
And then they go into the doctor, and they just have to argue about population averages.
00:28:25.285 --> 00:28:38.724
And the doctor's like,"Oh, well, you know, for 35-year-old women, you know, who are Caucasian in your class, the paper that I'm having, like, my AI assistant pull up in my por- terminal right now is telling me that it...
00:28:38.744 --> 00:28:43.654
this medicine should work." And they are like,"Okay, but we've been doing it for six months.
00:28:43.664 --> 00:28:46.704
It's not working." And there's a subset, you know, of people for...
00:28:46.954 --> 00:28:53.204
I mean, I'm helping them have these conversations, and it's infuriating to me that it's, like, at the scale of me right now.
00:28:54.048 --> 00:28:55.449
Yeah, yeah, yeah.
00:28:55.479 --> 00:28:58.128
There's a really significant translation layer that's missing
00:29:08.866 --> 00:29:09.386
We could do better at just helping patients track even what's happening to them, you know?
00:29:09.386 --> 00:29:18.567
'Cause like it's really hard to hold this in your mind and you're not a professional at tracking symptoms and all of that could inform personalized medicine and our understanding of like does someone have this certain genetic thing happening?
00:29:18.807 --> 00:29:21.737
Does a certain class of medicine work better for that person?
00:29:22.247 --> 00:29:25.626
Like, we're not making the match between the people and the science here.
00:29:26.593 --> 00:29:38.593
Yeah, and I think the frustration that people feel leads them into things like going to a med spa and getting stem cells, you know, injected in them, right?
00:29:39.163 --> 00:30:00.222
And that's, uh, also a really significant problem, like this gap again between like the sort of, um, one, people getting the care that they need, and then two, the understanding of like what a stem cell therapy would do for them is just, um, yeah, it's, it's jarring, and it's like a really significant problem right now.
00:30:01.088 --> 00:30:05.429
Did you look at all into like med spa, s-what they mean when they say stem cells?
00:30:05.439 --> 00:30:17.058
Like if you, for listeners, like if you Google just like,"Oh, can I get stem cell therapy shot into my face or into my joints?" You'll probably find, a business offering that, right?
00:30:17.820 --> 00:30:21.471
Yeah, I think we were listening to something about this, weren't we?
00:30:21.631 --> 00:30:21.871
Like
00:30:22.702 --> 00:30:25.262
Uh, John Oliver did a bit about med spas that
00:30:25.272 --> 00:30:26.532
Oh, that's what it was.
00:30:26.553 --> 00:30:27.613
Yes, that's what it was.
00:30:27.633 --> 00:30:28.012
Yeah.
00:30:28.012 --> 00:30:38.962
So yeah, I mean, places will, like, claim they're injecting stem cells, but a lot of times it's, like, platelet-rich plasma, which is not the same thing, um, or God knows what.
00:30:39.022 --> 00:30:42.542
Like, I mean, it, it's not regulated, so it could be literally anything.
00:30:42.553 --> 00:30:44.093
It could be sheep's blood or something.
00:30:44.403 --> 00:30:44.833
Um,
00:30:45.856 --> 00:30:58.673
well, i think some places actually are like pulling your own blood and doing something with it and, you know um, shooting something back into you for PRP, they do take your own blood, right?
00:30:58.673 --> 00:31:00.262
And, and get the platelets from that.
00:31:00.843 --> 00:31:08.942
And so if you're just a patient kinda navigating this, you're probably feeling like,"This is my way to access the cutting edge.
00:31:08.942 --> 00:31:31.343
Like, it's not, it's not available to me in the regular healthcare system, but it is available to me in the private system, and I'm willing to pay for it'cause it could change my life." And, and that means you're walking into a system with, like, no oversight and no regulation for a lot of this, um, or, or unevenly, you know, policed regulation.
00:31:31.977 --> 00:31:38.027
Yeah, a lot of times what they're doing is they're actually taking components of cells, like from cell culture.
00:31:38.047 --> 00:31:45.366
So, so when you grow stem cells in a dish you grow them with like a bunch of things that cells need to grow.
00:31:45.727 --> 00:31:54.767
And, what a lot of these places are doing is they're like taking that kind of solution and like maybe distilling some part of it.
00:31:54.767 --> 00:31:56.626
Like there's one part called an exosome.
00:31:56.987 --> 00:32:02.086
Um, so they might take that component and inject it into your cell, into your face rather.
00:32:02.386 --> 00:32:12.666
So like it's not stem cells, it's just like a cellular like, like fresh cells that they're injecting, but they are n- not stem cells.
00:32:12.750 --> 00:32:13.471
so they're lying
00:32:14.457 --> 00:32:15.076
Yes.
00:32:16.567 --> 00:32:27.376
I, I remember hearing on a different podcast we were listening to about, like, a cosmetic product that said it had stem cells in it and what they had was, like, cells from the stem of a plant
00:32:28.247 --> 00:32:28.547
Yes.
00:32:28.557 --> 00:32:30.186
So that's another thing that they'll do.
00:32:30.207 --> 00:32:31.366
No, exactly, exactly.
00:32:31.626 --> 00:32:36.406
They're like,"We have stem," space,"cells in this product."
00:32:37.509 --> 00:32:39.159
Pure, marketing sleight of hand.
00:32:39.308 --> 00:32:39.648
Yeah.
00:32:39.729 --> 00:32:40.118
Yeah, yeah.
00:32:40.118 --> 00:32:43.989
So, like, they take, like, apple stem cells and they'll inject them into your face.
00:32:44.019 --> 00:32:44.328
Yeah.
00:32:45.269 --> 00:32:47.189
Okay, stop with the facial injection.
00:32:47.699 --> 00:32:50.409
Some of that, that was like you apply it to your face.
00:32:50.409 --> 00:32:52.088
It's in a moisturizer or something.
00:32:53.671 --> 00:32:54.070
Yeah.
00:32:54.260 --> 00:33:10.861
But the, so, so the existence of this stuff pisses me off because there is real, very good, cool science with stem cells that is probably years away, not decades, years away from actually, like, working really well.
00:33:10.871 --> 00:33:17.351
So, you know, uh, I got, for example, my ACL in my knee replaced.
00:33:17.800 --> 00:33:25.810
Um, and to do so, the common thing is they, like, take a little piece of tissue from somewhere else and they plug it in where your ACL was.
00:33:26.250 --> 00:33:35.721
But my surgeon was actually using stem cell therapy to help your body regrow that ligament instead, right?
00:33:35.730 --> 00:33:37.191
So that's, like, one example.
00:33:37.401 --> 00:33:50.480
Another example is, we can grow retinas in a dish and potentially in the near future, use those retinas to, like, replace someone's degenerative retina.
00:33:50.971 --> 00:34:04.280
So, you know, there's, like, very cool real examples of this stuff out in the world, and the presence of, like, med spa plant stem cell hacking is just obscuring, the very real science that's out there.
00:34:05.217 --> 00:34:05.977
I love that point.
00:34:09.893 --> 00:34:11.943
So this is messy.
00:34:12.023 --> 00:34:18.882
There's these gaps we've identified, there's the promise of stem cells, there's also the scary side of it.
00:34:19.322 --> 00:34:24.902
I guess a question I have is can you give us a little glimpse into the future?
00:34:24.902 --> 00:34:28.813
Like, you are closer to this than a lot of people probably get to be.
00:34:28.813 --> 00:34:41.103
Like, you know people who work on this, you know, when you say that some exciting things are just years away instead of decades away, like can you unpack that a little bit for me and tell me like what, what is exciting?
00:34:41.103 --> 00:34:42.083
What is happening?
00:34:42.583 --> 00:34:49.483
So I am really excited about personalized medicine, about precision medicine, right?
00:34:49.503 --> 00:34:56.932
Like, tools that we haven't even talked about today, but including CRISPR, are going to allow us to do this in the near future, for sure.
00:34:57.483 --> 00:35:04.833
Um, we're also starting to do things like grow organs or pieces of organs in a dish.
00:35:05.023 --> 00:35:07.753
So this is budding technology.
00:35:07.753 --> 00:35:18.572
As I mentioned, we can do this with the retina, which has this really nice two-dimensional, very sort of systemic structure that cells know how to build on their own.
00:35:18.583 --> 00:35:23.422
So we've been able to do it with a retina, but it's gonna be a little harder for other tissues.
00:35:23.422 --> 00:35:34.833
But, like, in theory, yeah, in theory, we could start growing organs in dishes, and we could start editing those in a way that's precise and personalized, and I think that that's really, really amazing.
00:35:34.833 --> 00:35:38.643
And I think it's, in the future, maybe in our lifetimes.
00:35:39.663 --> 00:35:40.132
You know?
00:35:40.172 --> 00:35:44.972
It, it could be, I don't know, 20 years from now, 50 years.
00:35:44.992 --> 00:35:45.503
Who knows?
00:35:45.552 --> 00:35:52.242
I, I think that the big unknown here is the biology, right?
00:35:52.273 --> 00:35:58.983
And, and with, AI, we're able to automate a lot of pieces of this equation, right?
00:35:59.032 --> 00:36:12.432
We're able to model the pathways that we know about and, like, try to figure out what kinds of things we should cut out and what factors we do need to add to our cell culture, et cetera.
00:36:12.713 --> 00:36:14.652
That's gonna speed things up to some degree.
00:36:14.682 --> 00:36:24.753
But it doesn't take away, one, the uncertainty of biology, the fact that we don't know everything there is to know, and two, it doesn't take away the time that it just takes.
00:36:24.802 --> 00:36:28.333
Like, these experiments, when you grow cells in a dish, it takes time.
00:36:28.483 --> 00:36:31.543
You literally, if you're a researcher, you have to, like...
00:36:31.833 --> 00:36:33.693
You think about, like, taking care of a plant, right?
00:36:33.693 --> 00:36:42.103
You have to go in, you have to water it, you have to feed it, Sometimes people have to go in, in like, 12-hour shifts, depending on the cells.
00:36:42.432 --> 00:36:45.052
It's actually very arduous to take care of these cells.
00:36:45.052 --> 00:36:49.172
We might be able to automate that with robots, and, and people are certainly trying to do that, right?
00:36:49.922 --> 00:36:50.733
But I remain hopeful.
00:36:50.742 --> 00:36:52.483
There's pieces of this that are gonna move fast.
00:36:52.512 --> 00:36:56.983
There's pieces of this that are gonna be inherently complicated, but, like, we can get through that as scientists.
00:36:57.503 --> 00:37:07.003
And I think the piece that we've uncovered today and that a lot of people are thinking about is just the ethics of it, too, and, like, what makes sense?
00:37:07.023 --> 00:37:08.163
What do we bring to patients?
00:37:08.193 --> 00:37:17.882
How do we bring these things to patients in a way that doesn't need to go through the arduous medical system that we're dealing with in this country?
00:37:18.132 --> 00:37:18.367
Yeah
00:37:18.393 --> 00:37:20.202
the odds be ever in your favor, you know?
00:00:00.100 --> 00:00:00.910
Stem cells.
00:00:01.030 --> 00:00:02.160
They've been in the news.
00:00:05.389 --> 00:00:05.809
What do you...
00:00:06.629 --> 00:00:07.629
Go, Ashley.
00:00:08.650 --> 00:00:17.460
No, we saw a lot of stuff about stem cells on social media, and then I started asking Ashley about it, and Ashley turned to me and she was like,"You don't know this?
00:00:17.760 --> 00:00:21.850
Everybody knows this." And I was like,"Babe, nobody knows this.
00:00:21.879 --> 00:00:24.260
I think we better do a podcast episode about it
00:00:25.059 --> 00:00:27.949
I was like,"You don't know what the four Yamanaka factors are?
00:00:27.949 --> 00:00:28.850
Like, come on, babe.
00:00:28.859 --> 00:00:30.629
Like, how long have we been married?"
00:00:31.012 --> 00:00:45.252
She looked at me and she said,"I teach the Yamanaka paper." And I was like,"Okay, well, as a counterpoint, I'm on Blue Sky a lot, and I saw posts about this guy cloning himself into a baby.
00:00:45.752 --> 00:00:50.161
Can that happen?" And this is the kind of conversation that is leading you to this podcast
00:00:50.161 --> 00:00:52.942
Bow, bow, doo, doo, doo, ba, doo, ba, doo, ba, doo.
00:00:55.142 --> 00:00:56.411
That's the, that's the music
00:01:04.712 --> 00:01:12.621
Let's talk about a future where you can regrow organs and the scary, creepy stuff along the way.
00:01:13.121 --> 00:01:32.808
I think that there's a lot of, really, really interesting stuff happening in biology, and there's a lot of, excitement around possibilities here, and stem cells is one of these topics that, I mean, I feel almost like this frisson off it, like off the word, like off the...
00:01:33.078 --> 00:01:38.168
Maybe that's because of the religious and political objections to using stem cells.
00:01:38.168 --> 00:01:49.599
There's a really sort of scariness to this feeling, and I think part of it maybe is, like, the feeling that you could program cells or, like, reprogram cells.
00:01:49.599 --> 00:01:56.778
Like, that's getting very close to feeling like we can manipulate the body on a level that not all of us are comfortable with.
00:01:56.899 --> 00:02:16.579
Um, so I think it'd be really fun to just talk about what is the science of it and also, like, what's the gap between the speculation and the, the reality in biology and, you know, how can we interpret when we do see people, like billionaires claiming to have cloned themselves and have a little baby version of themselves?
00:02:16.799 --> 00:02:17.868
What does that even mean?
00:02:18.368 --> 00:02:18.859
Yeah.
00:02:18.938 --> 00:02:21.758
I feel like we're motivated to talk about this for kind of two reasons.
00:02:21.758 --> 00:02:43.128
Like, you see these big claims on social media, and then a few days after someone makes that claim, you also see that, there's this really unfortunate case of a child dying because they were genetically manipulated and you see the, the real significant downside of misunderstanding the power that we have
00:02:43.516 --> 00:02:45.776
Can you describe that case for us really fast?
00:02:46.276 --> 00:02:46.776
Sure.
00:02:46.787 --> 00:02:54.076
I mean, you know, there's been this, like, long-term dream in science that we could go in and we could edit the genome.
00:02:54.167 --> 00:03:06.947
And so our listeners might know about this technology called CRISPR, which allows us to do this very precise editing of specific base pairs, specific letters in your DNA.
00:03:07.097 --> 00:03:08.806
Go in, flip one.
00:03:08.826 --> 00:03:19.447
And this child had basically one of those letters flipped in a way that caused this one protein to, to misform and to cause really significant
00:03:19.600 --> 00:03:24.420
Yeah Had a rare disease, but like a rare, was born with this genetic condition, right?
00:03:24.621 --> 00:03:26.450
Yeah, was born with this genetic condition.
00:03:26.450 --> 00:03:39.281
And so we have for many years been using what's called gene therapy to bring this tool, this CRISPR tool, into cells to actually edit the genome of those cells.
00:03:39.770 --> 00:03:44.260
And so what they did was they used, um, this virus that I actually used to use in lab all the time.
00:03:44.260 --> 00:03:49.260
We use it in neuroscience to mostly trace the connections between neurons.
00:03:49.531 --> 00:03:55.110
Um, but we use viruses because what they're really good at doing is they're really good at, like, bringing genetic material into cells.
00:03:55.110 --> 00:03:55.790
That's what they do.
00:03:55.790 --> 00:04:00.980
They go in, they basically hijack cells, by, like, inserting their own DNA into that cell.
00:04:01.631 --> 00:04:06.471
So we can harness this technology to insert this gene-editing DNA into a cell.
00:04:06.850 --> 00:04:21.180
And so they did this with this child when the child was, like, really young, with the idea being that those genetic changes would then allow this, child to recreate the right proteins and maybe reverse the, um, deficit that they had.
00:04:21.350 --> 00:04:22.071
Who is, who's they?
00:04:22.081 --> 00:04:23.091
Like, who, who did this?
00:04:23.120 --> 00:04:24.321
The government did this?
00:04:24.471 --> 00:04:25.120
No, no.
00:04:25.120 --> 00:04:26.980
It was like this, this researcher that was hired.
00:04:27.300 --> 00:04:31.091
We could put the, the link to the Science investigation in the show notes maybe.
00:04:31.091 --> 00:04:40.391
But yeah, essentially this, you know, family hired this researcher to do this single person quote unquote clinical trial yeah
00:04:40.875 --> 00:04:46.464
So it was like a private thing kind of where they, they, they hired a scientist to do this
00:04:46.617 --> 00:04:47.956
They made a large donation.
00:04:48.146 --> 00:04:48.416
Yeah.
00:04:48.855 --> 00:04:49.345
Okay,
00:04:49.857 --> 00:04:50.197
Yeah
00:04:50.855 --> 00:04:51.675
Super murky.
00:04:53.048 --> 00:04:54.129
Yeah, totally.
00:04:54.129 --> 00:04:56.949
And, and there's been lots of other stuff like this,
00:04:57.144 --> 00:05:05.125
yeah, we obviously allow families of people with rare diseases to opt into clinical trials to try experimental treatments, at least in the US.
00:05:05.125 --> 00:05:10.435
I don't know how it works in other countries, but this is a, a thing that, you know, you might do
00:05:10.723 --> 00:05:12.194
yeah, they opted into this.
00:05:12.254 --> 00:05:19.353
Um, there was some proof of concept in mice and monkeys, which of course is how we test most therapeutics, right?
00:05:19.353 --> 00:05:26.064
We run them through the gamut of other creatures that are similar to us, most similar being non-human primates.
00:05:26.694 --> 00:05:32.124
This did work in primates, but they actually had significant kidney damage.
00:05:32.223 --> 00:05:50.363
And when they did this in the child, ultimately this child, um, too had complications probably for that same reason, or it might have also been an immune response, to the virus itself that is used to bring that gene-editing tool into cells.
00:05:51.413 --> 00:06:11.564
All of this is to say, you know, this stuff has tremendous promise, but it requires a ton of testing and a ton of very deliberate making sure that you're understanding all of the possible side effects of, of what you're manipulating, which sounds like edits...
00:06:11.923 --> 00:06:18.593
Sounds so simple, go in and edit the genome, but then cascades into these other effects throughout the body.
00:06:19.223 --> 00:06:39.843
I mean, of course it's a tough thing because it's easy for us as scientists to sit here and say,"We need a hundred years of work on this before we fully understand it." But as a patient, it, you know, speaking now as a patient, it- it's your life and your disease is progressing, so what is the balance of when we choose to use experimental therapies?
00:06:39.874 --> 00:06:49.913
I mean, that's not something that I have the answer to, but I do think that understanding, like, some of the promise and some of the excitement would be really interesting, you know, for folks.
00:06:49.913 --> 00:06:54.533
Like, you know, tell me a little bit about I mean, we started talking about stem cells.
00:06:54.543 --> 00:07:01.053
Like, tell me a little bit about what a stem cell is and why was this such an exciting breakthrough like 20 years ago?
00:07:02.959 --> 00:07:12.500
Well, stem cells are the cells that are there when you're a, a tiny, tiny organism before you're really a human, right?
00:07:12.720 --> 00:07:15.279
When you're in the womb and you're just a cluster of cells.
00:07:15.639 --> 00:07:20.870
You're a cluster of cells that are ready to become every other cell in your body, and those are called stem cells.
00:07:21.310 --> 00:07:27.959
Essentially, they're cells that are ready to what we call differentiate, to change into different other kinds of cells.
00:07:28.459 --> 00:07:31.040
So why is this an exciting possibility for medicine?
00:07:31.540 --> 00:07:44.750
The biggest promise of this has been the fact that you can make stem cells out of your own body, and we weren't sure we could do this until, around 2006.
00:07:45.199 --> 00:07:46.649
So, so folks might...
00:07:46.660 --> 00:07:56.029
folks who are, uh, a little bit older, about our age, might know that there was a ton of controversy in the early 2000s around using embryonic stem cells.
00:07:56.389 --> 00:07:57.170
So when George W.
00:07:57.170 --> 00:07:58.029
Bush was president...
00:07:58.180 --> 00:07:59.670
Yeah, uh, when George W.
00:07:59.670 --> 00:08:06.009
Bush was president, he passed a law that basically said we were not allowed to do research on embryonic stem cells.
00:08:06.339 --> 00:08:08.459
So what are embryonic stem cells?
00:08:08.579 --> 00:08:14.180
Like the name suggests, these are stem cells taken from embryos, taken from human embryos, right?
00:08:14.459 --> 00:08:17.490
And in most cases, these were aborted fetuses.
00:08:17.490 --> 00:08:21.850
It's not like we were going into healthy pregnant women and taking cells out of them, right?
00:08:22.069 --> 00:08:26.149
So there was, like, a, a lot of, like, misconceptions about what this meant at the time.
00:08:26.319 --> 00:08:27.300
Um, but it was really
00:08:27.687 --> 00:08:29.947
but that's still very loaded I can imagine
00:08:30.589 --> 00:08:32.100
It's, it's really loaded, right?
00:08:32.148 --> 00:08:32.298
this
00:08:32.950 --> 00:08:47.779
So it's early 2000s, and actually, you know, the outcome of this legislation I saw physically in lab, because what it meant was that there were a specific set of labs that were allowed to do embryonic stem cell research.
00:08:48.200 --> 00:08:56.669
And if you were one of those labs, if you had funding to do so, you had to have an entirely different set of equipment to do that research.
00:08:56.980 --> 00:09:00.440
So yeah, so one of the labs that I worked
00:09:00.583 --> 00:09:01.124
kitchen?
00:09:01.234 --> 00:09:01.594
Like
00:09:01.740 --> 00:09:02.620
Y- yes, literally.
00:09:02.953 --> 00:09:03.443
of this?
00:09:03.789 --> 00:09:04.279
Literally.
00:09:04.460 --> 00:09:10.980
No, you'd have, like, you know, the, equipment that was for stem cells and the, you know, equipment that wasn't
00:09:11.676 --> 00:09:18.716
Is this because the funding couldn't be used, so you couldn't buy your same equipment and use it on two different types of science?
00:09:19.046 --> 00:09:25.285
The science end to end had to only be funded by, like, stem cell approved funding or something?
00:09:25.285 --> 00:09:28.885
So we, we had these kosher kitchen labs basically.
00:09:29.009 --> 00:09:29.450
Yes.
00:09:29.500 --> 00:09:30.299
Yes, exactly.
00:09:30.450 --> 00:09:31.450
That's such a good analogy.
00:09:31.450 --> 00:09:31.779
Yeah.
00:09:32.120 --> 00:09:33.009
Yeah, exactly.
00:09:33.009 --> 00:09:35.799
So, so you know, like I saw that in, what?
00:09:36.179 --> 00:09:36.399
2008.
00:09:36.419 --> 00:09:41.269
I was, um, I spent the summer at Columbia, and yeah, I saw labs like that.
00:09:41.370 --> 00:10:18.120
Um, but that's around when things were changing because in 2006, this landmark paper came out, people will know it as like the Yamanaka paper, um, came out that showed that you could, rather than take stem cells from babies, you could actually take any old cell, like I could scrape some skin cells off of your skin, and just sprinkle in four little guys, they're called transcription factors, mix them up with those cells, and bring those cells back to their pluripotent state, to the state in which they can actually become any other kind of cell
00:10:19.025 --> 00:10:22.446
This feels like it must have been enormous news.
00:10:23.538 --> 00:10:24.768
This was enormous news
00:10:24.865 --> 00:10:26.905
Stem cells became an abundant resource.
00:10:27.826 --> 00:10:28.745
Yeah, exactly.
00:10:28.745 --> 00:10:39.625
And so it became the difference between having to extract them from fetuses to most labs being able to implement this using the equipment they currently have.
00:10:40.470 --> 00:10:40.860
Wow.
00:10:41.009 --> 00:10:41.450
Wow.
00:10:41.690 --> 00:10:42.549
What a revolution.
00:10:42.669 --> 00:10:42.980
Yeah
00:10:43.442 --> 00:10:46.542
So that kind of ended, you know, the controversy about embryonic stem cells.
00:10:46.542 --> 00:10:47.532
We don't need it anymore.
00:10:47.812 --> 00:10:56.831
Um, and, and since then, right, that was 2006, 20 years ago, since then we've made some changes, like we've kind of tweaked the recipe a little bit.
00:10:56.861 --> 00:11:00.292
We have some different things that we put in the mix to keep cells healthy.
00:11:00.292 --> 00:11:02.272
It works a little different for human cells.
00:11:02.491 --> 00:11:05.011
But at the end of the day, like the core logic is the same.
00:11:05.022 --> 00:11:26.221
You take cells that are differentiated into something like a skin cell or blood cell or a neural cell, you bring them back to the form where they're like the random card, they can become any other kind of card, and, and, then if you want, you can bring those cells all the way back up through something else.
00:11:26.221 --> 00:11:30.981
Like let's say I take a skin cell, I make it a stem cell, and then I wanna make it a neuron.
00:11:31.772 --> 00:11:32.642
I could do that.
00:11:32.721 --> 00:11:35.302
And so that's the kind of stuff that we're doing now that's really cool.
00:11:35.953 --> 00:11:41.423
So is this only happening in science labs or is this happening for real patients right now?
00:11:41.923 --> 00:11:45.854
There's not a ton of this happening for real patients yet, as far as I know.
00:11:45.864 --> 00:11:54.214
So, so most of the implementations of this kind of technology have been used to essentially study diseases in a dish.
00:11:54.394 --> 00:12:08.964
So for example, if I wanna understand what Parkinson's neurons are doing differently, I can take cells from Parkinson's patients, I can turn them into stem cells, I can then turn them into neurons.
00:12:09.203 --> 00:12:14.313
I can grow those neurons in a dish and ask,"Do these neurons act differently?
00:12:14.344 --> 00:12:16.604
Do they release different amounts of dopamine?
00:12:16.703 --> 00:12:18.443
Do they fire differently," right?
00:12:18.793 --> 00:12:28.403
It gives me this ability to study diseases in a dish separate from patients, which, you know, just gives us a lot more flexibility, gives us fine-tuned control over the biology.
00:12:28.618 --> 00:12:29.107
Right.
00:12:29.168 --> 00:12:29.567
Yeah.
00:12:29.697 --> 00:12:34.857
I would imagine lets you do, like, rapid experiments on an, you know, interesting scale or things like that.
00:12:34.857 --> 00:12:37.197
But, but I have a kind of a question about this.
00:12:37.197 --> 00:12:44.798
So you say, okay, you have a person who has Parkinson's, you take their cell, and you sort of reduce it back to stem cell.
00:12:45.298 --> 00:12:49.918
It sounds like a lot of interesting information could be lost in that process.
00:12:49.918 --> 00:12:56.798
So, you know, are you basically using this to study the genetic parts of Parkinson's?
00:12:56.807 --> 00:13:01.788
Like, are there pieces we're missing that you're losing in that transformation?
00:13:01.788 --> 00:13:10.817
Like, are there all kinds of lifestyle, environment, and, like, the specific adaptations that your cells make, you know, that put you in that disease state?
00:13:10.817 --> 00:13:12.648
Like, tell me about this.
00:13:12.658 --> 00:13:17.597
Or do we just have like, yeah, you- your Parkinson is, is Parkinson's in a dish right now?
00:13:18.563 --> 00:13:18.923
Yeah,
00:13:18.967 --> 00:13:19.868
that question make sense?
00:13:20.153 --> 00:13:36.693
No, it does, and I actually, I, I wanna put it a different way, the way that you asked when we were talking about it yesterday, which was, you were like,"Does it make a difference if I take a stem cell from, like, a baby versus from that same person when they're 80 years old and they have Parkinson's?"
00:13:37.028 --> 00:13:37.587
Totally.
00:13:37.618 --> 00:13:37.898
Yeah.
00:13:37.918 --> 00:13:43.148
Pre-Parkinson's baby, but who's going to get it versus they're fully into it
00:13:43.596 --> 00:13:43.905
Right.
00:13:44.046 --> 00:13:44.515
Totally.
00:13:44.566 --> 00:13:47.916
So something like Parkinson's, I think this is a pretty good example.
00:13:47.926 --> 00:13:48.336
Something like
00:13:48.437 --> 00:13:53.388
the kinds of conversations we have, by the way, when, when you're married to a scientist.
00:13:54.725 --> 00:13:55.475
Yeah, we saw,
00:13:55.717 --> 00:13:56.347
me be clear.
00:13:56.418 --> 00:13:57.177
Let me be clear.
00:13:57.197 --> 00:14:00.798
Ashley and I are not actually taking cells from babies at any point.
00:14:02.125 --> 00:14:02.836
Who said that?
00:14:03.357 --> 00:14:04.408
It's only theory.
00:14:05.238 --> 00:14:06.418
I just felt like...
00:14:08.916 --> 00:14:09.176
just,
00:14:09.538 --> 00:14:12.508
was that a, a lot of questions already answered by my T-shirt?
00:14:13.738 --> 00:14:15.878
Just thought it was sounding a little mad scientist-y.
00:14:17.809 --> 00:14:19.000
Put the cells back, babe.
00:14:19.259 --> 00:14:21.440
Um, okay.
00:14:21.628 --> 00:14:25.457
that baby is leaving cells all over the place in its saliva.
00:14:25.467 --> 00:14:28.018
I think we could run this home experiment
00:14:28.179 --> 00:14:34.000
look, the moment this technology hits any sort of commercial viability, we are cloning yeti.
00:14:34.090 --> 00:14:37.279
There is absolutely no question about it it
00:14:37.384 --> 00:14:39.073
I don't know how to feel about that.
00:14:39.073 --> 00:14:39.703
Oh my gosh.
00:14:39.844 --> 00:14:42.004
We haven't had this c- I don't know how to feel about that.
00:14:42.812 --> 00:14:43.381
I'm just kidding.
00:14:43.402 --> 00:14:45.611
I actually have really complicated feelings about it too.
00:14:46.022 --> 00:14:48.522
Um, but Yeah, so
00:14:48.663 --> 00:14:49.333
he's our dog.
00:14:50.591 --> 00:14:59.792
yesterday when you asked this, you know, we were like, yeah, we were chatting about the, the BJ tweet and, um, the possibility of it, and I, I think this is really good.
00:14:59.792 --> 00:15:08.201
So it raises the question of like, what's different between your cells when you're a baby and your cells when you're an 80-year-old with Parkinson's, let's say.
00:15:08.751 --> 00:15:20.341
And obviously, as you just raised, there are environmental, and I'll also throw developmental things that happen as you grow, right?
00:15:20.381 --> 00:15:35.701
Your body changes in response to its own internal environment and what's happening in that body, and that internal environment is changing in response to the external environment, how much you eat, what air you breathe, like all of this stuff, the people you see, right?
00:15:35.701 --> 00:15:38.922
Like, all of these things are factors that change our biology.
00:15:39.782 --> 00:15:46.172
So if you're modeling a disease in a dish, you don't obviously have any of those factors, right?
00:15:46.912 --> 00:15:53.471
But you have the same genome of the person, Which doesn't change throughout your lifeline, right?
00:15:53.831 --> 00:15:55.121
Your genes are your genes.
00:15:56.032 --> 00:16:02.201
One thing changes, which is that as you age, you get these little like tags on your genome.
00:16:02.392 --> 00:16:04.711
We call them epigenetic tags.
00:16:05.621 --> 00:16:07.711
You accumulate these as you get older.
00:16:07.721 --> 00:16:11.881
This is the way that people, quote unquote, like age your cells.
00:16:11.912 --> 00:16:13.302
Like, you might know that you can like
00:16:13.570 --> 00:16:14.500
Oh.
00:16:15.022 --> 00:16:15.861
age, right?
00:16:16.682 --> 00:16:20.942
Because as you grow older, you get these, um, they're called like methylation tags.
00:16:20.951 --> 00:16:23.211
You get these little like things that hang on your genome.
00:16:23.942 --> 00:16:28.022
So that changes on your genome, but your genome itself doesn't change, right?
00:16:28.022 --> 00:16:28.331
So
00:16:28.559 --> 00:16:28.570
Hmm.
00:16:29.721 --> 00:16:35.081
The simplest answer to your question is your genome is the same when you're a baby and when you're an 80-year-old.
00:16:35.841 --> 00:16:45.251
And that genome dictates the kinds of proteins that your body produces, and the kind of proteins that your bodies produce are the receptors on your cells.
00:16:45.251 --> 00:16:47.341
They're the composition of your cell membrane.
00:16:47.371 --> 00:16:52.302
They're dictating how much neurotransmitter you have floating around.
00:16:52.672 --> 00:16:55.881
In the case of like another system, I'm showing my bias as a neuroscientist, right?
00:16:56.131 --> 00:17:10.291
But in the case of like in the immune system, they dictate the kinds of immune cells that you have, you know, specifically, and if you have a different composition of particular cells or balance of different cells in your body, et cetera.
00:17:10.511 --> 00:17:10.811
Okay.
00:17:10.981 --> 00:17:25.612
So your genome actually does dictate quite a bit, but of course, as a human growing up in the world, all of those things, right, the proteins, the cellular-level stuff, all of that can change in response to your environment.
00:17:26.284 --> 00:17:26.713
Hmm.
00:17:27.064 --> 00:17:27.453
Okay.
00:17:28.153 --> 00:17:40.834
Do we know, like, how much different diseases are genetic versus result from epigenetic factors plus genetic fac- like, like I know we know, oh, certain diseases are more genetic than others.
00:17:41.054 --> 00:17:42.854
I don't know the right way to describe this.
00:17:43.074 --> 00:17:48.163
Is that, is that accurate that, you know, we think some are really gene-driven and others aren't?
00:17:48.173 --> 00:17:49.503
Or are we still figuring that out?
00:17:50.443 --> 00:17:56.814
Yeah, we have many really good examples of diseases that we know to be genetically linked.
00:17:56.933 --> 00:18:05.463
Huntington's disease is caused by repeating sequences of DNA in the genome that wouldn't normally be there.
00:18:05.824 --> 00:18:12.653
Polycystic kidney disease is caused by r- some really specific mutations that change the cells in your kidney.
00:18:13.094 --> 00:18:23.253
So those are examples of things where if you have those changes in your genome, they almost always result in something, turning into a disease later on, right?
00:18:24.144 --> 00:18:29.223
But then there's diseases that have some genetic component.
00:18:29.584 --> 00:18:34.953
These are diseases that maybe are, more likely to show up in people that are related.
00:18:35.153 --> 00:18:37.943
So something like multiple sclerosis, for example.
00:18:38.294 --> 00:18:46.453
There's some heritable component, like your chances go up if you have a family member with it, but not totally dictated by your genome.
00:18:46.564 --> 00:18:52.483
Probably much more complex, probably systemic, environmental, in response to all of those things.
00:18:53.335 --> 00:18:57.595
So when someone says they're gonna make stem cells from their own body, right?
00:18:57.644 --> 00:19:01.464
You have to remember that it's still their same genome.
00:19:01.825 --> 00:19:08.075
So if they want to, say, like, generate a new kidney from those stem cells, you could totally do that.
00:19:08.075 --> 00:19:14.355
But if you're someone with polycystic kidney disease, that kidney is gonna carry that same mutation, right?
00:19:14.565 --> 00:19:16.315
So then you have to introduce something else.
00:19:16.315 --> 00:19:23.775
Like, you have to introduce gene editing to fix the kidney cells, and then generate a kidney that is fixed, right?
00:19:23.775 --> 00:19:26.345
And, and, and working as expected.
00:19:27.424 --> 00:19:34.214
So the possibility of someone being able to, like, grow their own organs from their own stem cells is great.
00:19:34.224 --> 00:19:43.015
It means that you can potentially avoid things like your body rejecting an organ because it seems genetically different, which your immune system is built to do.
00:19:43.414 --> 00:19:48.194
But it also means you're carrying all of the baggage that your genome already had, unless you fix it.
00:19:48.724 --> 00:19:52.694
Unless you do something and you go in and you, you manipulate things even further.
00:19:53.782 --> 00:20:04.153
Sort of a larger point here, but this is just making me think about, you know, we've been talking about this idea of personalized medicine and precision medicine, which are, like, slightly different things, right?
00:20:04.482 --> 00:20:11.512
Personalization is more tailoring things because we know information about the individual that's maybe different from other individuals.
00:20:11.863 --> 00:20:21.143
Precision is a little bit more like, you know, instead of targeting a really big systematic thing hap- or systemic thing happening, we're gonna, like, target a very specific mechanism.
00:20:21.143 --> 00:20:22.472
We've gotten more precise about it.
00:20:22.843 --> 00:20:29.113
But those two things often go together, so you might hear, like, personalized medicine and precision medicine altogether.
00:20:29.823 --> 00:20:33.232
And there's just this really wild gap.
00:20:33.252 --> 00:20:36.222
I think people can feel it even if they don't know all the science, right?
00:20:36.462 --> 00:21:04.232
People can feel that there's this gap of who gets to have information about their body and who doesn't, who gets to have, like, this personalization of healthcare to their body and who doesn't, and we're like, we're starting to see the beginnings of it for things like you could have your tumor, you know, sent to an academic lab in the United States, at least, if you're the right kind of cancer patient in the right situation.
00:21:04.843 --> 00:21:25.116
There are these really life-saving, life-changing therapies that maybe aren't stem cells, right, yet, but there are, like- Personalized cancer vaccines is a real thing that is happening, but it is also happening inside of a system and a world that has no idea how to do it at scale.
00:21:25.477 --> 00:21:52.646
So like, it's currently very, very academic and then when you see these people kind of like leap the queue or, you know, post about how they're the ultimate quantified man, and they've hired their own doctors and their own scientists who'll do whatever, I mean, I think the ick that you get is not just about the biology, but it's about the feeling that some people are getting access to this information and this intervention landscape.
00:21:53.237 --> 00:21:59.797
I, I certainly don't think they're gonna do it well necessarily, as they're like being cowboy biohackers out there.
00:22:00.596 --> 00:22:16.207
But it's such a, it's such a wild world where there's, on the one hand, very serious, rigorous, incredible science, and on the other hand, like the worst person you've ever seen in your life announcing that they're gonna, do this to themselves or something.
00:22:16.616 --> 00:22:42.336
I don't know how people are supposed to make sense of it, but I see this information equity problem, and you think about like, how is it possible that one of my friends could fight for like three years to get some imaging done for an obvious thing that might be cancer, whereas on the other hand, we're personalizing cancer vaccines for other people, happening in the same country and sometimes the same state, and sometimes in the same healthcare system.
00:22:43.017 --> 00:23:11.207
I think as scientists, it's really frustrating and sad because you want this frontier of knowledge that we're pushing to go be put into practice, but it's like there's this whole chasm between what we know in the lab and what we actually implement in, you know, giving care to patients, You see the downside, the significant downside of what happens when someone just goes ahead and tries something, right?
00:23:11.227 --> 00:23:14.807
With what happened with the death of the girl, um, in China.
00:23:14.856 --> 00:23:15.896
But ba- but babe
00:23:15.989 --> 00:23:16.848
strongly,
00:23:17.547 --> 00:23:22.777
how many people are dying because they're not getting completely figured out things?
00:23:23.106 --> 00:23:24.666
Many, many people
00:23:25.010 --> 00:23:25.320
yeah.
00:23:25.361 --> 00:23:25.550
No,
00:23:25.676 --> 00:23:26.467
because no one's
00:23:26.471 --> 00:23:27.411
some point there's like...
00:23:28.010 --> 00:23:28.730
Yeah, yeah.
00:23:28.961 --> 00:23:36.391
No, I, I totally hear you and I, and I think your point earlier about like, you know, if you have a rare disease that's like ruining your life, like what else are you gonna do?
00:23:37.265 --> 00:23:37.414
Right.
00:23:37.414 --> 00:23:40.815
You might be willing to try something that even has a high risk.
00:23:40.894 --> 00:23:41.305
Yeah.
00:23:41.330 --> 00:23:41.961
Absolutely.
00:23:41.961 --> 00:23:51.000
And, and every- almost everything that we do medically has had sacrifices along the way, minimally animals that we use in research, right?
00:23:51.121 --> 00:23:54.611
And in some cases, like human life as well.
00:23:55.290 --> 00:23:59.070
So yeah, absolutely there, there are trade-offs.
00:23:59.371 --> 00:24:01.340
I don't think you need to conflate the two.
00:24:01.351 --> 00:24:01.990
You know what I mean?
00:24:01.990 --> 00:24:14.040
It's, we're not, we're not looking at a world where the choice is do rigorous science or have one scientist be paid a million dollars by terrified parents to, like, fool them into doing a procedure that really isn't safe.
00:24:14.070 --> 00:24:25.480
I mean, those are not, like, the only two options to me, I mean, those, that's a symptom of how desperate the need is, and it shouldn't work this way, but we can have compassion for why, you know?
00:24:25.800 --> 00:24:33.020
And why parents would be so d- I mean, who, who among us would not, you know, try everything to save a loved one?
00:24:33.040 --> 00:24:36.340
I mean, it's really, it's really, really tough.
00:24:36.371 --> 00:24:38.701
But that is why we, we need better systems.
00:24:38.701 --> 00:24:46.461
I mean, I think it's very cold and, and divorced from reality when scientists say,"Well, just wait.
00:24:46.471 --> 00:24:57.151
Just wait 100 years, you know, just wait." I mean, am I supposed to just wait for all of the, like, faculty arguments and slow bullshit of science?
00:24:57.709 --> 00:24:58.219
Hmm.
00:24:58.709 --> 00:24:59.979
No, I think this is fair.
00:25:00.058 --> 00:25:00.328
Yeah
00:25:00.641 --> 00:25:11.161
I deeply believe that, like, you know, we have a responsibility to, to translate knowledge into things that benefit people.
00:25:11.181 --> 00:25:17.471
And, you know, you do see it happen when you see, like, large public health investments.
00:25:17.471 --> 00:25:36.381
You see, like, the COVID vaccine, as much as it was, like, terrifying and politicized in so many ways, took advantage of so much of our, of our ability to rapidly gain understanding of a virus, and that maybe could not have happened in another era.
00:25:36.750 --> 00:25:39.480
And I mean, it just saved so many lives doing that.
00:25:40.131 --> 00:25:46.431
a huge part of the anger for me is that we actually do have so many figured-out things.
00:25:46.431 --> 00:26:18.871
We have so many ways to understand the body that even people like us, a PhD, you know, incredibly privileged people in one of the best healthcare systems in the country, living in Southern California, like, you and I have to go into the doctor's office and be treated like morons and, you know, accept sitting there and having them tell us,"No, I'm not gonna do this basic imaging," imaging that you could do, like, in the lab to give us, like, a diagnostic signal, you know?
00:26:18.931 --> 00:26:20.421
I mean, it's just infuriating.
00:26:21.030 --> 00:26:24.560
Sorry, this has turned into a cat rant, and we said we weren't gonna do that episode today, but
00:26:26.096 --> 00:26:37.626
No, but I, I see the link that you're making, which is like there's this terrible gap between the kinds of things that we know work in research labs and the kinds of things we have access to as patients.
00:26:38.227 --> 00:26:48.967
It's a wide fucking gap, and I think what you're asking us to do is to imagine a world in which there are things bridging that gap.
00:26:49.356 --> 00:27:05.777
Like, there are ways in which people actually have access to the information about their own bodies, to information about the science, the, the possible science even, you know, the next five-year science about their condition, right?
00:27:05.856 --> 00:27:08.457
Like, that's not what happens in a doctor's office.
00:27:08.457 --> 00:27:11.906
What happens in a doctor's office is you hear the 10 years ago science.
00:27:13.017 --> 00:27:14.967
You know nothing about the next chapter.
00:27:15.255 --> 00:27:16.605
you know even if you get...
00:27:16.855 --> 00:27:21.244
I've been thinking about this a lot because I've been talking to so many patients and, and helping them.
00:27:21.255 --> 00:27:24.744
I've become a person all of my patient friends talk to.
00:27:24.775 --> 00:27:26.454
I mean, it's kind of always what happens to me.
00:27:26.454 --> 00:27:31.884
I'm like i- an infinite big sister out there, never gonna ever escape that pattern.
00:27:32.275 --> 00:27:43.204
But I joined these patient communities, and I was like,"I need some support for what I'm going through." And then I turned into the person who could, like, read all of the science papers or, like, help them figure out how to talk to their doctors.
00:27:43.845 --> 00:27:51.275
But it was incredible learning for me because I realized even when you get an intervention, you get a treatment plan, who's following up with you?
00:27:51.734 --> 00:27:53.484
Who's tracking if it's working?
00:27:53.944 --> 00:28:06.025
Absolutely frigging nobody, unless you are perhaps a cancer patient with a very dedicated oncology team and the right situation and, like, motivated about your own care and you're doing your own project management.
00:28:06.414 --> 00:28:20.535
But, like, I have many, many friends at this point who have incredibly serious things going on, and it is basically completely on them to track the efficacy of whether the medication is actually working for them.
00:28:21.055 --> 00:28:24.815
And then they go into the doctor, and they just have to argue about population averages.
00:28:25.285 --> 00:28:38.724
And the doctor's like,"Oh, well, you know, for 35-year-old women, you know, who are Caucasian in your class, the paper that I'm having, like, my AI assistant pull up in my por- terminal right now is telling me that it...
00:28:38.744 --> 00:28:43.654
this medicine should work." And they are like,"Okay, but we've been doing it for six months.
00:28:43.664 --> 00:28:46.704
It's not working." And there's a subset, you know, of people for...
00:28:46.954 --> 00:28:53.204
I mean, I'm helping them have these conversations, and it's infuriating to me that it's, like, at the scale of me right now.
00:28:54.048 --> 00:28:55.449
Yeah, yeah, yeah.
00:28:55.479 --> 00:28:58.128
There's a really significant translation layer that's missing
00:29:08.866 --> 00:29:09.386
We could do better at just helping patients track even what's happening to them, you know?
00:29:09.386 --> 00:29:18.567
'Cause like it's really hard to hold this in your mind and you're not a professional at tracking symptoms and all of that could inform personalized medicine and our understanding of like does someone have this certain genetic thing happening?
00:29:18.807 --> 00:29:21.737
Does a certain class of medicine work better for that person?
00:29:22.247 --> 00:29:25.626
Like, we're not making the match between the people and the science here.
00:29:26.593 --> 00:29:38.593
Yeah, and I think the frustration that people feel leads them into things like going to a med spa and getting stem cells, you know, injected in them, right?
00:29:39.163 --> 00:30:00.222
And that's, uh, also a really significant problem, like this gap again between like the sort of, um, one, people getting the care that they need, and then two, the understanding of like what a stem cell therapy would do for them is just, um, yeah, it's, it's jarring, and it's like a really significant problem right now.
00:30:01.088 --> 00:30:05.429
Did you look at all into like med spa, s-what they mean when they say stem cells?
00:30:05.439 --> 00:30:17.058
Like if you, for listeners, like if you Google just like,"Oh, can I get stem cell therapy shot into my face or into my joints?" You'll probably find, a business offering that, right?
00:30:17.820 --> 00:30:21.471
Yeah, I think we were listening to something about this, weren't we?
00:30:21.631 --> 00:30:21.871
Like
00:30:22.702 --> 00:30:25.262
Uh, John Oliver did a bit about med spas that
00:30:25.272 --> 00:30:26.532
Oh, that's what it was.
00:30:26.553 --> 00:30:27.613
Yes, that's what it was.
00:30:27.633 --> 00:30:28.012
Yeah.
00:30:28.012 --> 00:30:38.962
So yeah, I mean, places will, like, claim they're injecting stem cells, but a lot of times it's, like, platelet-rich plasma, which is not the same thing, um, or God knows what.
00:30:39.022 --> 00:30:42.542
Like, I mean, it, it's not regulated, so it could be literally anything.
00:30:42.553 --> 00:30:44.093
It could be sheep's blood or something.
00:30:44.403 --> 00:30:44.833
Um,
00:30:45.856 --> 00:30:58.673
well, i think some places actually are like pulling your own blood and doing something with it and, you know um, shooting something back into you for PRP, they do take your own blood, right?
00:30:58.673 --> 00:31:00.262
And, and get the platelets from that.
00:31:00.843 --> 00:31:08.942
And so if you're just a patient kinda navigating this, you're probably feeling like,"This is my way to access the cutting edge.
00:31:08.942 --> 00:31:31.343
Like, it's not, it's not available to me in the regular healthcare system, but it is available to me in the private system, and I'm willing to pay for it'cause it could change my life." And, and that means you're walking into a system with, like, no oversight and no regulation for a lot of this, um, or, or unevenly, you know, policed regulation.
00:31:31.977 --> 00:31:38.027
Yeah, a lot of times what they're doing is they're actually taking components of cells, like from cell culture.
00:31:38.047 --> 00:31:45.366
So, so when you grow stem cells in a dish you grow them with like a bunch of things that cells need to grow.
00:31:45.727 --> 00:31:54.767
And, what a lot of these places are doing is they're like taking that kind of solution and like maybe distilling some part of it.
00:31:54.767 --> 00:31:56.626
Like there's one part called an exosome.
00:31:56.987 --> 00:32:02.086
Um, so they might take that component and inject it into your cell, into your face rather.
00:32:02.386 --> 00:32:12.666
So like it's not stem cells, it's just like a cellular like, like fresh cells that they're injecting, but they are n- not stem cells.
00:32:12.750 --> 00:32:13.471
so they're lying
00:32:14.457 --> 00:32:15.076
Yes.
00:32:16.567 --> 00:32:27.376
I, I remember hearing on a different podcast we were listening to about, like, a cosmetic product that said it had stem cells in it and what they had was, like, cells from the stem of a plant
00:32:28.247 --> 00:32:28.547
Yes.
00:32:28.557 --> 00:32:30.186
So that's another thing that they'll do.
00:32:30.207 --> 00:32:31.366
No, exactly, exactly.
00:32:31.626 --> 00:32:36.406
They're like,"We have stem," space,"cells in this product."
00:32:37.509 --> 00:32:39.159
Pure, marketing sleight of hand.
00:32:39.308 --> 00:32:39.648
Yeah.
00:32:39.729 --> 00:32:40.118
Yeah, yeah.
00:32:40.118 --> 00:32:43.989
So, like, they take, like, apple stem cells and they'll inject them into your face.
00:32:44.019 --> 00:32:44.328
Yeah.
00:32:45.269 --> 00:32:47.189
Okay, stop with the facial injection.
00:32:47.699 --> 00:32:50.409
Some of that, that was like you apply it to your face.
00:32:50.409 --> 00:32:52.088
It's in a moisturizer or something.
00:32:53.671 --> 00:32:54.070
Yeah.
00:32:54.260 --> 00:33:10.861
But the, so, so the existence of this stuff pisses me off because there is real, very good, cool science with stem cells that is probably years away, not decades, years away from actually, like, working really well.
00:33:10.871 --> 00:33:17.351
So, you know, uh, I got, for example, my ACL in my knee replaced.
00:33:17.800 --> 00:33:25.810
Um, and to do so, the common thing is they, like, take a little piece of tissue from somewhere else and they plug it in where your ACL was.
00:33:26.250 --> 00:33:35.721
But my surgeon was actually using stem cell therapy to help your body regrow that ligament instead, right?
00:33:35.730 --> 00:33:37.191
So that's, like, one example.
00:33:37.401 --> 00:33:50.480
Another example is, we can grow retinas in a dish and potentially in the near future, use those retinas to, like, replace someone's degenerative retina.
00:33:50.971 --> 00:34:04.280
So, you know, there's, like, very cool real examples of this stuff out in the world, and the presence of, like, med spa plant stem cell hacking is just obscuring, the very real science that's out there.
00:34:05.217 --> 00:34:05.977
I love that point.
00:34:09.893 --> 00:34:11.943
So this is messy.
00:34:12.023 --> 00:34:18.882
There's these gaps we've identified, there's the promise of stem cells, there's also the scary side of it.
00:34:19.322 --> 00:34:24.902
I guess a question I have is can you give us a little glimpse into the future?
00:34:24.902 --> 00:34:28.813
Like, you are closer to this than a lot of people probably get to be.
00:34:28.813 --> 00:34:41.103
Like, you know people who work on this, you know, when you say that some exciting things are just years away instead of decades away, like can you unpack that a little bit for me and tell me like what, what is exciting?
00:34:41.103 --> 00:34:42.083
What is happening?
00:34:42.583 --> 00:34:49.483
So I am really excited about personalized medicine, about precision medicine, right?
00:34:49.503 --> 00:34:56.932
Like, tools that we haven't even talked about today, but including CRISPR, are going to allow us to do this in the near future, for sure.
00:34:57.483 --> 00:35:04.833
Um, we're also starting to do things like grow organs or pieces of organs in a dish.
00:35:05.023 --> 00:35:07.753
So this is budding technology.
00:35:07.753 --> 00:35:18.572
As I mentioned, we can do this with the retina, which has this really nice two-dimensional, very sort of systemic structure that cells know how to build on their own.
00:35:18.583 --> 00:35:23.422
So we've been able to do it with a retina, but it's gonna be a little harder for other tissues.
00:35:23.422 --> 00:35:34.833
But, like, in theory, yeah, in theory, we could start growing organs in dishes, and we could start editing those in a way that's precise and personalized, and I think that that's really, really amazing.
00:35:34.833 --> 00:35:38.643
And I think it's, in the future, maybe in our lifetimes.
00:35:39.663 --> 00:35:40.132
You know?
00:35:40.172 --> 00:35:44.972
It, it could be, I don't know, 20 years from now, 50 years.
00:35:44.992 --> 00:35:45.503
Who knows?
00:35:45.552 --> 00:35:52.242
I, I think that the big unknown here is the biology, right?
00:35:52.273 --> 00:35:58.983
And, and with, AI, we're able to automate a lot of pieces of this equation, right?
00:35:59.032 --> 00:36:12.432
We're able to model the pathways that we know about and, like, try to figure out what kinds of things we should cut out and what factors we do need to add to our cell culture, et cetera.
00:36:12.713 --> 00:36:14.652
That's gonna speed things up to some degree.
00:36:14.682 --> 00:36:24.753
But it doesn't take away, one, the uncertainty of biology, the fact that we don't know everything there is to know, and two, it doesn't take away the time that it just takes.
00:36:24.802 --> 00:36:28.333
Like, these experiments, when you grow cells in a dish, it takes time.
00:36:28.483 --> 00:36:31.543
You literally, if you're a researcher, you have to, like...
00:36:31.833 --> 00:36:33.693
You think about, like, taking care of a plant, right?
00:36:33.693 --> 00:36:42.103
You have to go in, you have to water it, you have to feed it, Sometimes people have to go in, in like, 12-hour shifts, depending on the cells.
00:36:42.432 --> 00:36:45.052
It's actually very arduous to take care of these cells.
00:36:45.052 --> 00:36:49.172
We might be able to automate that with robots, and, and people are certainly trying to do that, right?
00:36:49.922 --> 00:36:50.733
But I remain hopeful.
00:36:50.742 --> 00:36:52.483
There's pieces of this that are gonna move fast.
00:36:52.512 --> 00:36:56.983
There's pieces of this that are gonna be inherently complicated, but, like, we can get through that as scientists.
00:36:57.503 --> 00:37:07.003
And I think the piece that we've uncovered today and that a lot of people are thinking about is just the ethics of it, too, and, like, what makes sense?
00:37:07.023 --> 00:37:08.163
What do we bring to patients?
00:37:08.193 --> 00:37:17.882
How do we bring these things to patients in a way that doesn't need to go through the arduous medical system that we're dealing with in this country?
00:37:18.132 --> 00:37:18.367
Yeah
00:37:18.393 --> 00:37:20.202
the odds be ever in your favor, you know?
