Proposition 14: Pros and Cons of Stem Cell Research in California 2020

Editor's note: The author of this piece is Ben Kaplan of Palo Alto, who appeared in a TV ad for the 2004 ballot measure that created the California stem cell agency. I talked with him recently by phone and invited him to submit his thoughts on the latest stem cell ballot measure, Proposition 14. Here is his article. 

 

By Ben Kaplan

Ben Kaplan

My story begins when my twin brother Ollie and I were born ten weeks prematurely. Despite his early birth and low birth weight, Ollie never had any lasting health problems, but I did. Just five days after my birth, I had a brain hemorrhage, or stroke, which caused cerebral palsy, specifically “left hemiplegia,” or weakness and paralysis on the left side of my body. I have been a supporter of stem cell research and regenerative medicine for over 20 years, with the hope it may lead to new treatment for my condition. During this time, I have seen research make great strides, from initially being conducted mostly in laboratory studies, to its application in human clinical trials.

California has been a trailblazer in state ballot initiatives for over 40 years. These have set national trends for issues and are often copied or emulated by other states: Prop 13 (property taxation), Prop 187 (Immigration), 209 (Affirmative Action) 215 (medical cannabis), 227 (bilingual education), etc. Proposition 71 in 2004 did this for stem cell research by establishing the California Institute for Regenerative Medicine (CIRM). Since then, several other states have passed their own ballot initiatives or legislation to fund stem cell research. This has created new momentum for increased federal funding.

Another benefit of CIRM funding is the development of private and philanthropic partnerships. The demonstration of a commitment by California to fund and support research and laboratory construction has led private foundations and other donors to contribute funds, dramatically accelerating the pace of stem cell research. The investment in research following the passage of Prop 71 also attracted researchers, scientists and private companies to California, providing financial incentives to open offices and laboratories in the state. In addition, CIRM created a research infrastructure for California by developing a system to award grants and share research data and results, giving it a major advantage over other states, and some countries. These partnerships are important because embryonic stem cell research cannot always be conducted in facilities built using federal funds due to pro-life and taxpayer groups, who have raised ethical and fiscal concerns about using public funding for research on embryonic tissue. CIRM research centers are a way around this roadblock by increasing scientific freedom, promoting research collaboration and hastening the development of new therapies and treatments.

In addition, CIRM has created economic expansion, providing a major boost to the burgeoning field of regenerative medicine. Progress in research funded by CIRM has led to a growing body of scientific evidence that treatments from stem cells may be available to people with debilitating and life-threatening conditions in the near future.

Stem cell research funding is on the ballot in California in 2020 as Proposition 14. This proposition has both potential benefits and drawbacks. One argument in favor is that it will continue and enhance California’s leadership position in support of stem cell research. It can also boost the state’s economy. Treatments may lower healthcare costs and improve health, which may lead to increased employment, worker productivity and economic growth. While the long-term outcome of stem cell research remains uncertain, new discoveries are producing evidence that is leading to clinical trials, allowing treatments to move closer to realization.

However, the COVID19 outbreak has also made Proposition 14’s fate uncertain. While stem cell research may lead to new treatments, it has placed unanticipated stress on California’s budget. However, new research is demonstrating the potential application of stem cells as a possible treatment for the virus. Given this pandemic, how will Proposition 14 fare? While the ultimate outcome is yet to be determined, it may depend on a delicate balance between potential treatment outcomes in the future versus expenses for the COVID19 pandemic in the present.

Recently, physicians at Stanford University, in a clinical trial partially funded by CIRM, have found that neural stem cells injected in rats with a condition similar to CP will travel to the damaged part of the brain and repair it. A clinical trial is also currently in progress at the Mayo Clinic using neural stem cells derived from bone marrow to treat hemorrhagic stroke. Private companies are pursuing similar research, with an eye to developing new therapies and treatments.

As stem cell science progresses and it becomes possible to implant stem cells into the brain, it is possible that I could have improved mobility in my left hand and foot, balance and coordination. This would enable me to do so many things that are now challenging, if not impossible, and would greatly improve and enhance my quality of life and that of many others.

California Stem Cell Agency Approves Assault on "Terrorizing" Affliction: Huntington's Disease

Frances Saldana, at a stem cell agency meeting last year, spoke emotionally about the loss of her three children to Huntington's disease. 

Directors of the California stem cell agency this morning approved $18 million in clinical stage research awards, including a "high risk" plan to tackle a degenerative brain disease for which there is no treatment.

Action on the proposal to create a therapy for the genetic disorder, Huntington's disease, came after a woman who lost all of her three children to the affliction said it has "terrorized my family for generations."

Frances Saldana of Fountain Valley, Ca., wept as she pleaded for approval of the $6 million effort to treat the disease that  lingers in her family. 

Another patient advocate, Bill Waddington, whose mother died from the affliction, told the agency in a letter, 

"Huntington’s disease isn’t just death.  It’s complete and utter devastation to families."

Maria Millan, president of the stem cell agency, said later in a news release that children born to parents with Huntington's have a 50/50 chance of getting the disease.

Huntington's affects 30,000 persons with another 200,000 at risk. It  progresses slowly. Symptoms are unrelenting and include inability to control movement and declining cognition leading to dementia, according to experts. Affected persons usually die within 15 to 20 years after diagnosis,. 

The applicant for state stem cell funding, Leslie Thompson of UC Irvine, told the board in a letter,

Leslie Thompson
UC Irvine photo

"Given the relatively slow progression of HD, care-giving stretches over 10 years or more after the patient loses independence. Patients become completely dependent on family and caregivers, who in turn have an emotional and debilitating economic burden managing the physical, cognitive and psychiatric manifestations of the disease.  

"HD can lead to catastrophic events such as homelessness, prolonged hospitalization awaiting placement, or long-term psychiatric placement. The length and severity of the disease has a profound financial and emotional impact on families and health systems. The direct medical costs and costs of disability and care giving for each patient are substantial and pass from one generation to the next."

Members of the governing board of the agency, formally known as the California Institute for Regenerative Medicine (CIRM), discussed the application at some length because of a split involving the application reviewers. The summary of comments by reviewers said,

"Reviewers disagreed on whether the treatment offers a significant value to the patients and caregivers. Some reviewers thought the immunosuppression and surgical risk that is required for this cell therapy may outweigh any potential therapeutic benefits given that there are other less invasive treatment options being tested. Others thought that despite the stated risks, any potential treatment for slowing down disease progression is worth pursuing as current alternative therapeutic approaches are still many years away from commercial use."

Last month, the agency's reviewers, meeting behind closed doors, approved the award on an 8-1-5 vote with five against funding, eight for funding and one saying the application needs improvement and could be resubmitted. The latest application was, in fact, a resubmission after changes were made to deal with reviewers' concerns.  The summary of the latest version described the effort as "high risk."

In one of the six letters of support for Thompson's research, Michael West, CEO of AgeX Therapeutics, Inc., of Alameda, Ca., said the work could have application in treatment of other neurodegenerative diseases such as Alzheimers and Parkinson's.

Six is a relatively high number of letters for the board to receive on an application.  Advocates dealing with Huntington's have been active in the past, appearing before the CIRM board on a number of occasions.

The second award today went to Everett Meyer of Stanford and totalled $12 million. It involves a clinical trial for renal failure. 

Here are links to review summaries for each application considered today, the principal investigator, institution and other information. 

Application number, CLIN1-10953; amount, $6.0 million; title, "An hESC-derived hNSC Therapeutic for Huntington’s Disease;" principal investigator, Leslie Thompson; institution, UC Irvine; review summary; letters of support, letter to the board CLIN1-10953, letter to the board #2 CLIN1-10953,​ letter to the board #3 CLIN1-10953, letter to the board #4 CLIN1-10953, letter to the board #5 CLIN1-10953, letter to the board #6 CLIN1-10953, letter to the board CLIN2-11431, other CIRM funding for the PI, $12 million.

Application number, CLIN2-11400; amount, $12.0 million; title, "Induction of Tolerance by Combinatorial Therapy w/ Donor Stem Cells and Expanded Recipient Treg cells in HLA-mismatched Kidney Transplant Recipients;" principal investigator, Everett Meyer; institution, Stanford; review summary; letters of support, none; other CIRM funding for the PI, none.

Action on the following application was put off until Feb. 21 to provide time to answer financial questions raised by board members today: 
Application number, CLIN2-11431; amount, $6.0 million; title, "A monoclonal antibody that depletes blood stem cells and enables chemotherapy free transplants;" principal investigator, Judith Shizuru; institution, Stanford; review summary; one letter of support; other CIRM funding for the PI, $20.4 million.

'Better Than Hope' -- An Advocate's View of California's $3 Billion Stem Cell Research Program

Don Reed 

Longtime patient advocate Don Reed appealed to California lawmakers last week to support the state's stem cell research effort, which expects to run out of money for new awards at the end of next year.

He said,

"Today, thanks to the 7.2 million voters who authorized the California Institute for Regenerative Medicine, or CIRM, we have something better than hope; we have results, accomplishments, people made well—and a systematic way to fight chronic disease."

Reed was among the persons testifying last week before the state Assembly Select Committee on Biotechnology.

He  is vice president of Americans for Cures, a nonprofit group founded by Robert Klein, a real estate investment banker and who ran the ballot initiative campaign that created the $3 billion California stem cell agency. Klein was also the agency's first chairman and may lead another ballot initiative in November 2020 to renew the agency with an additional $5 billion.

Here are links to the remarks at the hearing by CIRM CEO Maria Millan, Art Torres, vice chairman of the CIRM board, and David Jensen, publisher of this web site.  Tomorrow the California Stem Cell Report will carry a look at the remarks by Jan Nolta, head of the stem cell program at UC Davis.  

The full hearing can be seen here and downloaded with closed captioning. An audio file is also available at the same URL. Here is the text of Reed's remarks.
(Some readers have reported that they cannot download Reed's comments shown below. However, I cannot detect any problem with that process. If you would like a PDF of Reed's remarks, please email me at djensen@Californiastemcellreport.com.)

   2018-08-15 Reed Assembly Biotech Hearing by DavidJensen on Scribd

Parkinson's Patient Advocate Pitches for More California Stem Cell Funding

Sometimes things move quickly at meetings of the governing board of the California stem cell agency, which is formally known as the California Institute for Regenerative Medicine(CIRM).  At the meeting this month, it ended before a patient advocate had a chance to make her voice heard.

She is Jenifer Raub, president of the Summit for Stem Cell Foundation of San Diego. She requested that this web site carry the comments she would have made to the board. We are delighted to provide them below.

“On behalf of Summit for Stem Cell Foundation we applaud the efforts of CIRM to move Stem Cell Research forward. We task you specifically with addressing and funding a stem cell-based cell therapy for Parkinson’s Disease  (PD) Research. There is tremendous enthusiasm within the PD community for an autologous iPSC-based therapy. Parkinson’s Advocates are a vocal group as you well know. Funding assistance from CIRM for an autologous iPSC-based therapy for PD would easily result in Parkinson’s Advocates gratefully voicing support for funding for CIRM on the 2020 ballot.”

The California Stem Cell Report welcomes comments and lengthier commentary from persons interested in the $3 billion stem cell agency. Please send them to djensen@californiastemcellreport.com.

Attacking Barriers to Stem Cell Cures: California to Put Official Stamp on New Strategy

Call it California’s $900-million road map to a stem cell cure. 

That’s what up for final action next week by the governing board of the state’s $3 billion stem cell agency, officially known as the California Institute for Regenerative Medicine (CIRM).

The plan includes a $105 million lure to entice Big Pharma and other possible investors to join the Golden State’s regenerative medicine bandwagon and create an “industrial stem cell therapeutic powerhouse.” 

Randy Mills, president of the California stem cell agency, and his team are calling for “attacks” on barriers to clinical development of therapies. That includes the FDA which Mills and company say “appears to be literally lobbying against the very therapeutic modality they are responsible for promoting.” (See here and here.)

The key part of the $105 million stem surge would bring together next year the state of California and private investors in a joint enterprise. Under the plan, the private investors would have the pick of the best research from CIRM that has not already attracted partners.

The agency would pony up $75 million with another $75 million coming from investors.

(Here are links to the CIRM description of the three components of the $105 million effort: here, here and here.)

The agenda for the Dec. 17 meeting in Los Angeles includes other matters, such as action on a clinical research applications for millions of dollars. The review summaries of those applications are not yet available online, but most of the additional supporting material for the meeting has been posted. That is a healthy change from some recent past meetings where backup information has been missing until much too late.

(The morning of Wednesday Dec. 9, the agency posted a note on the agenda saying the applications were no longer under consideration. Often that means that the proposals have been withdrawn because of negative recommendations from reviewers.)

Also on tap is a major change in the scoring of applications in non-clinical programs. Here is how the change is described by a CIRM memo:

“For non-Clinical Program applications, therefore, we propose to revert to our former scoring system (1 to 100) with two tiers: (Tier 1) average score of 85 or above, recommended for funding, if funds are available, and (Tier 2) average score of 84 or below, not recommended for funding. In  addition, for those programs for which only one application is expected to be funded, we propose to specify that the application that receives the highest average scientific score shall be deemed to be the GWG’s recommendation for funding.”

These changes would be in effect for the three rounds involved in the $105 million surge.

The board is also being asked to raise the cap on payments to patient advocate members of the board from $15,000 to $30,000 annually. The move would be retroactive to the beginning of this year. 

A CIRM memo said that demands on patient advocate directors have increased dramatically both in terms of the numbers of meetings and their role. The memo said that prior to Mills’ arrival at CIRM patient advocates were involved in only three or four review sessions a year. In 2015, those sessions have already risen to close to a dozen.

While next week’s meeting will be based in Los Angeles, remote, telephonic locations where the public can participate will be located at Stanford and UC San Diego. Specific addresses can be found on the agenda.

Faster Action Approved in California on Stem Cell Therapy for Parkinson's

To cheers and applause, directors of the $3 billion California stem cell agency this morning moved to speed action on a much-lobbied effort to fund research on a therapy for Parkinson's disease.

Randy Mills, president of the agency, said the action would mean that a request for applications would be posted within the next seven days instead of sometime next spring.

He spoke from the Sanford Consortium in La Jolla during a teleconference meeting with 18 locations. Parkinson's advocates at his site cheered and applauded the news.

A giddy Jenifer Raub, one of the leaders of the Summit4StemCells group, told agency directors,

"I feel like a kid at Christmas."

It was a feeling echoed by other members of the group, which had protested the delay at a CIRM board meeting in July and also earlier this month. About 17 were in attendance at Mills' location this morning.

The San Diego Parkinson's group is backing research by Jeanne Loring, head of stem cell research at the Scripps Institute in La Jolla. (See here and here.)

The unanimous vote by the board gave Mills more flexibility in scheduling upcoming rounds of awards involving basic and translational research. Loring's research fits in the translational area. The basic research round will now apparently be put off until next spring.

Parkinson's and the California Stem Cell Agency: Advocates Cite 'Overwhelming' Need to Air Unhappiness

The California stem cell agency has posted a letter online from Parkinson’s patient advocates that says that an emotional outpouring at a July stem cell meeting grew out of an “overwhelming” need to protest agency delays in funding research.

The letter was signed by Sherrie Gould and Jenifer Raub, leaders of Summit4StemCell, a San Diego group, and was sent to the agency's board. Gould and Raub wrote about the July 23 meeting of the board during which the patients protested after they learned that no funding for the research they were backing would be available until about 2017. (See here for full text of the protest.)

The link to the Aug. 2 letter is part of the agenda for this Thursday’s teleconference meeting of the directors of the $3 billion research effort. It said, 

“Our group at Summit4StemCell (has) been regularly attending the CIRM meetings for the past 18 months. Out of respect for Jeanne Loring PhD, we have typically shown up in ‘silent solidarity’ but this meeting was different and many of us had an opportunity to speak publicly about our project, our progress and our desperate need for funding.

“The outpouring on Thursday (July 23) was spontaneous and unexpected. We at Summit feel strongly that we communicate with all board members that our presence at any of the CIRM board meeting is not orchestrated by Jeanne Loring, Dr. Melissa Houser (of the Scripps Clinic) or anyone from the Loring lab.

“We are a passionate group of dedicated Californians that believe strongly in the probability of success of this research using pluripotent stem cell technology. Dr. Loring has always counseled respect and brevity. We believe she would prefer that we be the face of the issue and not the strident voice.

“When confronted with the possibility that there could be no help (or hope) for over a year, the need to speak and be heard was overwhelming. We sincerely believe that you and the board heard us and will do all you can to find an exception or some way to help.” 

The reference to Loring, who is head of the stem cell program at the Scripps Research Institute in La Jolla, has to do with the Summit group’s support of her research. It also seems to be linked to an anonymous comment filed on the California Stem Cell Report’s account of the July protest.

The writer indicated that Loring had submitted an application earlier that was scored unfavorably by the agency, based on a conversation that the writer had overheard at the Oakland meeting. In response, Loring said no such conversation took place. She said an earlier application in another round did not meet CIRM criteria and was withdrawn. The agency does not publicly comment on such grant review processes, which are conducted in secret. It also does not release the names of unsuccessful applicants. (See Loring's and the writer's complete comments at the end of this item.)

Summit4StemCell is also not happy with teleconference nature of this week’s meeting. Earlier this month, they said their voice was “diminished” because of the inability to speak to the governing board face-to-face.

The California Stem Cell Report item on the teleconference/Parkinson’s flap is the most widely read post this month, exceeding the readership of the item dealing with the agency’s announcement concerning its $32 million stem cell bank. 

Parkinson's Advocates Dismayed by California Stem Cell Agency Action

This is a Summit4stemcell video prepared following an emotional protest at the July meeting of the board of  the California stem cell agency.

Highlights

Lack of speed, openness protested

Agency cites cost issues

Patient-CIRM relationships unique

A group of Parkinson’s patients from San Diego is less than pleased today with a move by the $3 billion California stem cell agency that the group says will stall efforts to secure much-needed funding for a possible cure for the disease. 

The events this week follow an emotional protest at an agency board meeting in Oakland in July and highlight the often intense relationship between patient advocates and the stem cell agency – not to mention the pressure on the agency to move fast to find cures.

Anger and the Parkinson's symptoms of trembling and speech difficulties marked the protests. One patient advocate, Jenifer Raub of San Diego, said it was "outrageous" that an award round being discussed at the meeting would not provide funding until possibly 2017.

The patient advocate group, Summit4stemcell, had planned to address the stem cell agency board again at a Sept. 24 meeting scheduled to be held in San Diego. However, yesterday the group was told that the meeting would not be held in their city. Instead the session was being turned into a teleconference meeting and would be only about one hour long. Most in-person board meetings last much of the day.

Responding to questions from the California Stem Cell Report, Sherrie Gould, executive director of the Summit group and a nurse practitioner, said in an email,

Sherrie Gould, Scripps Health photo

“We are both confused and disappointed that this PUBLIC (Gould’s capitalization) meeting has been essentially cancelled.  We were prepared to talk with the ICOC (the agency board) and answer all questions about our patient advocacy movement (Summit4stemcells) and our research….

“Unless we can be present in front of the CIRM board, Summit's strong voice is diminished.  Being physically present in human form is always more effective than a teleconference. Delays, which we realize are a part of any government associated agency, are devastating to people suffering from the progressive symptoms of Parkinson's disease.” 

Jeanne Loring, head of the Scripps stem cell program in La Jolla, also voiced her displeasure in an email to Kevin McCormack, senior director of communications for the California Institute for Regenerative Medicine(CIRM), as the agency is formally known.

She wrote,

“CIRM has rather pulled the rug out from under the patient advocates. These meetings are supposed to be public, so how is the public going to participate if there is no access?…. I'm disappointed and the Parkinson's patients are exceedingly disappointed.  The Parkinson's group is trying to find out the resolution, if any, of the timing of the grant applications.”

The Summit group has raised $2 million to support Loring’s research and to match what CIRM might award for her effort.

Asked for comment today, McCormack said in an email,

“The reason we switched from an in-person to a teleconference board meeting is simple, the agenda for this meeting consisted of just a few items that could probably be handled in one hour. We can’t justify the cost of an in-person meeting in San Diego – which includes transportation for all those going there, plus hotel rooms, meals and the cost of the ballroom for the day - for one hour’s worth of business. As a state agency we are always mindful of how we spend our money so we made the change.” 

The next in-person meeting of the agency board is not scheduled until Dec. 17. But, in addition to the Sept. 24 meeting, two more teleconference meetings are scheduled between now and Dec. 17. Both are expected to be brief, routine approval of awards, if they are held at all.

Under the agency’s procedures and state law, members of the public can listen in and speak during teleconference meetings but only from the specific location from which an individual board member is participating.  

On the other hand, the in-person meetings offer an opportunity to speak face-to-face with all board members, chat with them informally during breaks and to converse directly with CIRM staff. The meetings have been an important tool for many patient advocate groups to press their cases. At times, however, their lengthy presentations have tried the patience of the agency.

The relationship between patient advocates and CIRM is notable. One of the unique features of the agency is the influence of patient advocates, particularly on its board.  Twelve sit on the 29-member panel and often play important roles. Sometimes they are the only way the board can approve awards because most of the other members have legal conflicts of interest and cannot vote.

David Higgins of San Diego is one of the patient advocate members of the board, which has a

David Higgins

specific slot for a Parkinson’s disease advocate. He was interviewed in July following the protest of the many-months delay in possible funding for Parkinson’s research. His remarks were recorded on a Summit-produced video(see at top of this item). Higgins, who is a scientist and has Parkinson's, said,

“It’s tough, it’s really tough, to be involved in the Parkinson’s community, especially to have Parkinson’s disease, and to watch things go in what seems like slow motion.”

Contacted today for additional comments, Higgins said,

“In my year at CIRM I have only encountered enthusiasm and support for patient advocacy - both from the staff as well as the board. Patient and patient advocate participation in the process is welcomed. CIRM is first and foremost about patients.”

Following the protests at the July meeting, CIRM President Randy Mills told the board he would see if there is anything he could do to speed funding. He said he would report back to the board later.

McCormack did not directly respond to a question today about whether recent, proposed changes in the award scheduling would have an impact on the Parkinson’s research.  He said only that the changes would provide more flexibility.

(The text of remarks by the various parties follow this item.)

Text of McCormack and Loring Emails on Stem Cell Board Meeting

Here is the text of the Sept. 9, 2015, email message to Sherrie Gould, executive director of Summit4stemcell, from Kevin McCormack, senior director of communications for the California stem cell agency, along with one from Jeanne Loring, head of the stem cell program at Scripps, to McCormack.  Loring sent her email to McCormack after she received a copy of his email to Gould.

The Gould-McCormack email comes first with the Loring-McCormack email following.

“Dear Sherrie
“I just wanted to let you know that there has been a change in plans for our September board meeting. As you know, it was originally scheduled to be held in San Diego, however, that has changed and it is now simply a telephonic meeting. The reason is that the agenda is going to be lighter than originally anticipated and it didn’t make sense to incur the cost of an in-person meeting for one hour’s worth of business. 

“I know you were planning to have many of the Parkinson’s group attend the meeting so I wanted to let you know so you can alert them to the change.
 “Our next in-person meeting will now be in Los Angeles on December 17th.
“Cheers,
“Kevin McCormack”

Loring’s email to McCormack:

“Hi Kevin:
 “Two in a row??  CIRM has rather pulled the rug out from under the patient advocates -these meetings are supposed to be public, so how is the public going to participate if there is no access?  Does CIRM have a plan to give access?  More importantly, is CIRM doing this to avoid having public access?
 “I'm disappointed and the Parkinson's patients are exceedingly disappointed.  The Parkinson's group is trying to find out the resolution, if any, of the timing of the grant applications.  Has anything been done in that regard yet?
 “In addition to the advocates, my students will be disappointed.  I always bring my interns and my CIRM fellows to the meetings so they can meet their benefactors.
 “Any plans for access to the public would be welcome.
 “Jeanne”

Text of McCormack's Response to Questions

Here is the text of remarks today from Kevin McCormack, senior director of communications for the California stem cell agency, concerning changes involving this month's governing board meeting. He made the comments in response to questions by the California Stem Cell Report.  One of the questions involved the agency's strategic plan, which was scheduled to be discussed at the meeting this month.

"The reason we switched from an in-person to a teleconference Board meeting is simple, the agenda for this meeting consisted of just a few items that could probably be handled in one hour. We can’t justify the cost of an in-person meeting in San Diego – which includes transportation for all those going there, plus hotel rooms, meals and the cost of the ballroom for the day - for one hour’s worth of business. As a state agency we are always mindful of how we spend our money so we made the change.

 "The elimination of the dates in the Discovery and Translational programs is simply to give the CIRM Team more flexibility. As we say in the documents that will be presented to the Board – available on our website here https://www.cirm.ca.gov/sites/default/files/files/agenda/150905_Agenda_4_DTConcept%20Amendments%20--%20FINAL%20%2800256870xAEB03%29.pdf
  

"In  order  for  CIRM  to  operate  efficiently  and  to  respond  to  changing  circumstances  and  needs,  CIRM  must  be  nimble  and  flexible.   To  ensure  that  the  CIRM  team  has  the  ability  to  make  adjustments  to  the  program  schedule  to  meet  these  needs,  we  propose  to  eliminate  the  specificity in  the translation  and  Discovery  Program  concept  plans  regarding  the  schedule  for  the  submission  of  applications  in  response  to  program  announcements  issued  under these programs.”  (McCormack's boldface) 

"As for the Strategic Plan, we have already conducted extensive outreach, through both on-line surveys and in-person meetings, with Patient Advocates (including meetings in San Diego, Los Angeles and San Francisco), researchers, Board members and the public. We are now working on bringing all those thoughts and suggestions together in order to be able to present them to Board. 

"And the Board agenda will be posted ten days ahead of the meeting as usual." 

Arthritis, Alzheimer's, Healing: California Stem Cell Agency Urged to Help Elderly

Three California scientists are asking the state’s stem cell agency to come to the aid of tens of millions of elderly persons and provide $16 million to develop therapies to treat Alzheimer’s and arthritis and to speed skeletal healing in the elderly.

The researchers have asked the governing board of the $3 billion agency to overturn at its meeting tomorrow the rejection of the proposals by both scientific reviewers and the agency staff.  All of the potential therapies are close to moving into clinical trials.

Jill Helms, Stanford photo

One of the scientists, Jill Helms of Stanford, said in a letter to the board that her team is addressing healing issues -- “an unmet medical need in an under-served and often overlooked patient population, namely, the aged….Elderly patients are entitled to the same level of healthcare afforded to younger patients.”

The California Institute for Regenerative Medicine (CIRM), as the agency is formally known, has already pumped $7 million into Helms’ research. She is seeking another $7 million to advance the potential therapy closer to clinical trials.

The two other researchers are Daryll D’Lima of Scripps Health and David Schubert of Salk.

D’Lima is seeking $7.7 million to develop the first therapy that would alter the progression of osteoarthritis, which is the No. 1 cause of disability in the nation. Annually, arthritis has a more than $120 billion economic impact, which exceeds 2 percent of the gross domestic product.  D’Lima’s research has already received $3.1 million from CIRM.

Schubert has applied for $1.7 million for work on an Alzheimer’s therapy that he said was “highly effective at reversing the memory deficits” in mice. His proposal, he said, could move very quickly into clinical trials under new federal regulations.

The researchers’ rejected applications were scored at either at an average of 71 or 72 by the agency’s blue-ribbon scientific grant reviewers, who do their work behind closed doors. The reviewers approved five grants with scores ranging from 89 to 76. Two of the approved grants had the same median score of 75 as the three rejected grants.

During public sessions in the past, a number of board members have said that a few points difference on scores is not statistically significant.

In a memo to the board, Randy Mills, president of the agency, recommended rejection of the applications. He said the applicants could re-apply next summer under the agency’s new CIRM 2.0 program or possibly under the preclinical round that is now open.

Mills’ memo also includes the range of scores and summaries of reviewers' comments. The agency does not identify applicants by name until after the board acts and then only the winners. However, Helms' application is 08105; D’Lima’s is 08128, and Schubert’s is 08086. 

The CIRM board originally budgeted $40 million for the research to be approved tomorrow. Only five applications were okayed by reviewers for a total of $15.8 million.

Helms noted in her March 20 letter to the board that CIRM has been a big supporter of her research since 2009.  The agency has also considered her something of a bright light, using her on panels and presentations.

About the review of her application, she wrote,

“Reviewers had nothing negative to say about the proposed product, the preclinical data, the approach, the veracity of the indications, the MOA, the proposed plan of action, or the milestones.”

Helms said that Avalon Ventures is backing her research to the tune of $16 million, including creation of a new firm, Ankasa Regenerative Therapeutics of La Jolla, to push it forward.

Daryll D'Lima, Scripps photo

In his March 19 letter, D’Lima said his research has demonstrated “very convincing proof" that his possible therapy was “very successful in repairing osteochondral defects (a major factor leading to osteoarthritis)." 

Schubert said in his letter that “there are currently no drugs that halt (Alzheimer’s) progression so the potential benefits of moving CAD- 

031(the name of the treatment) into human trials are enormous."

David Schubert, Salk photo

Schubert’s letter was dated March 16 but was only posted on CIRM Web site within the last two days as were the other letters(dated March 19 and

March 20). The delay in posting makes it difficult for patient advocates to attend the board meeting tomorrow to express directly to the board their opinions about the proposals.

The D’Lima and Schubert applications also involve organizations that do not have seats on the agency’s governing board. D’Lima’s is the only award to Scripps Health. Schubert works at Salk which has not had a representative on the CIRM board since 2011. Salk has received $50 million from the agency.

About 88 percent of the funds that the CIRM board has awarded have gone to institutions with ties to persons who have been members of the board.

(Editor's note: An earlier version of this item said that Helms had received $11 million from the agency, based on information on the CIRM Web site. She said, however, the correct figure is $7 million.)

$100 Billion Stem/Genomics Plan: Borrowing on an International Scale

Bob Klein at UC San Diego last week
Bradley Fikes/San Diego U-T photo

More details are emerging on the $100 billion, international stem cell/genomics research proposal being offered up by Bob Klein, the first chairman of California’s stem cell agency.

Klein’s plan was discussed in a piece by Bradley Fikes of the San Diego U-T, the only daily newspaper in California’s second largest city. The article yesterday also carried videos of Klein pitching his plan.

Klein, a real estate investment banker, cited California’s $3 billion stem cell agency as an example to be emulated internationally. It operates on money that the state borrows (bonds), which roughly doubles the cost of the research because of the interest expense.

He said an international research organization could be supported by bonds which are backed by pledges from 15 countries, including the United States.

Fikes quoted Klein, who left the California agency three years ago, as saying,

"Because the borrowing is so much cheaper than anything a country can do, from the surplus funds we raise, which are about 35 percent to 40 percent more than most countries can raise from the same amount of money, we can have an international pool, where we can collaborate and compete through peer review." 

Fikes continued,

“Klein pointed to the International Finance Facility for Immunization as an international public-private partnership as a financial model. Using long-term government pledges as collateral, the agency can raise capital as needed from the bond markets.” 

Neither the Fikes piece nor an earlier article from the San Diego Daily Transcript carried any indication that Klein’s proposal had the support of major research organizations or governmental agencies.  

Neither article also carried any reference to Klein’s earlier proposal for another $5 billion bond issue to continue the operations of the California stem cell agency, which will run out of money in 2020 based on current spending rates.

Klein and U.S. Rep. Scott Peters, D-San Diego, shared an appearance at a cancer conference last week at UC San Diego. Both extolled the power of using patient advocates as the leading edge of lobbying for research funds.

Fikes wrote,

“Peters…said scientists must broaden their political base beyond their traditional bastions if they wish to become more influential. Patient advocates are key.

"'When we're fighting for NIH funding, a lot of the voices for that come from people who are in universities and in areas of science, and a fairly narrow political spectrum,’ Peters said. ‘Frankly, they tend to be people from Boston, and San Francisco and San Diego, who don't always vote the same way that people from West Texas, or Kansas or rural Wisconsin vote. So patient advocates provide a huge imput for folks from all across the country."

“Klein recounted an example of how that coalition succeeded in keeping diabetes research money flowing in 2002 when that funding was threatened with interruption. He said the bill, which required unanimous consent, got through the House with the support of then-House Speaker Denny Hastert, an Illinois Republican, who had a staff member with Type 1 diabetes."

Fikes continued,

"'Oklahoma is not a hotbed of scientific support, but through a weekend effort, JDRF (Juvenile Diabetes Research Foundation) was able to get 25,000 emails generated,' Klein said. ‘But more importantly, the patient advocates working as informed advocates with the scientists from the Type 1 research and clinical areas got to enough chairmen of the boards and board members and CEOS of major corporations in Oklahoma that they shut down the switchboards of Sen. Nickles' offices in Oklahoma and Washington D.C. with calls.’"

“Nickles released his hold on the bill.

"'We had unanimous consent of the U.S. Senate, two hours before the end of the special session, because scientists informed and teamed up with patient advocates ... ' Klein said."

California Stem Cell Agency Director Prieto Defends Agency in Trounson Affair

One of the long-standing directors of the $3 billion California stem cell agency has taken issue with an item earlier today headlined “Fallout From the Trounson Affair: A Taint on the California Stem Cell Agency.”

In an email, Francisco Prieto, a Sacramento physician, said, among other things, that it is “grossly unfair” to say that none of the media coverage and other reaction in the matter reflects well the agency. Prieto, who has served as a CIRM director since 2004, said “the agency had nothing to do with it.”

The item this morning discussed reaction to the news earlier this month that the agency’s former president, Alan Trounson, was appointed to the board of StemCells, Inc., which is the recipient of $19.4 million in funding from the stem cell agency. Concerned about a conflict of interest, the agency has announced a “full review” of all StemCells, Inc., activities. Trounson was appointed seven days after he left the agency.

The item also contained a comment from scientist Jeanne Loring of Scripps that said that the Trounson Affair detracts from the value of CIRM’s good work.

Here is the text of Prieto’s comment, the essence of which is certain to be shared by many CIRM board members,

“I think Jeanne Loring is right: CIRM has been a remarkable driver of this research, and it would be a shame if the actions of Dr. Trounson and StemCells Inc. (What were they thinking?) obscures this.  I think it is grossly unfair to say that ‘none of this reflects well on the agency,’ when the agency had nothing to do with it.  Most of us on the board – and the staff, I think it’s safe to say – felt blindsided by this.  I was gratified to see Randy Mills’ prompt and appropriate response to this, and I expect we’ll hear more from him on the subject.  I think it’s a bit disingenuous of Michael Hiltzik (of the Los Angeles Times) to say that ‘so many members had to recuse themselves that only nine were left to vote,’ when the new voting procedures (that prohibited members from grant-receiving institutions from discussing or voting on those grants) were a direct response to the reform recommendations in the IOM report, and were lauded by most at the time. I don’t think that included Mr. Hiltzik, who I believe has never had anything good to say about the agency or its work. I’m curious whether that will change as stem cell treatments we’ve funded actually start moving into clinical trials, but I won’t hold my breath.”

The California Stem Cell Report has great respect for Prieto and the other 28 members of the agency’s board and its staff.

However, there is no escaping the impact of the news and the resultant commentary, which will be around virtually forever, embedded in every Internet search that is performed about the stem cell agency. Today, for example, a Google search on the term “California stem cell agency” turned up eight hits on the first page of search returns. Five dealt with the Trounson Affair.

Moreover, conflict of interest concerns were aired very early on in CIRM’s history, dating back to 2004, before the ballot proposal creating the agency was even approved by voters. Revolving door issues also came up years ago, including in 2007 when Richard Murphy, a former member of the board, was hired as interim president at a salary of $300,000 for six months work. The Little Hoover Commission mentioned the issue briefly in its 88-page report in 2009.

Additionally, given that financing of the agency was limited to 10 years, revolving door problems were always likely to surface. It was an issue that could have been dealt with by the board years ago, avoiding the situation with Trounson today. Revolving door restrictions could have and should have been part of his conditions of employment.

The IOM’s recommendations for dealing with conflict-of-interest problems at the agency were far-reaching. The steps taken by the agency do little to comply with the IOM recommendations.  The strange case of having only nine out of 29 members eligible to vote is not all that uncommon. Indeed, the agency has worked hard to keep its 12 patient advocate members in attendance at board meetings because sometimes they are the only ones who can vote without legal conflicts-of-interest.

The situation with Trounson is certainly unpleasant.  Whether board members think the reaction is unfair is not the main point. It is up to them to take action to respond to those public concerns and ensure that the agency’s integrity is reinforced and that its work is not impugned by conflicts of interest, real or perceived.

Patient Advocate Reed Defends Klein Donation to Stem Cell Agency

The California Stem Cell Report today received the following email from Don Reed, a patient advocate, who has long been involved in California stem cell agency affairs. Reed is vice president of public policy for Americans for Cures Foundation, a position he has held for some years. Americans for Cures is the personal lobbying organization created by Robert Klein, former chairman of the California stem cell agency. Reed said his opinions below are his own and may or may not reflect those of the foundation.

“I must take issue with your entry, 'Robert Klein Gives $21,630 to the California Stem Cell Agency,' May 05, 2013.

“When Bob Klein donated $21,630 to the California stem cell program (to allow scientists to attend a research conference in Japan) he was doing exactly what he always does: advancing research to ease suffering and save lives.  The scientists needed a way to attend a top-level conference. Believing in the benefits of researchers sharing thoughts, Bob paid for their trip.

“Unfortunately, your article appears to imply corrupt motivations.

“'A seemingly innocuous…gift…generated a wave of special favors for (Klein) that stretched out to include a gold mining multimillionaire from Canada.'.
A 'wave of special favors?'  The article states that 'Klein wanted to meet with the six science officers…'  and to get their impressions on the conference.

“Is that not natural? First, would it not be helpful to hear from the scientists if the trip was worth the time and expense? Second, Bob Klein works in real estate, a full-time job. He does not have the scientist’s automatic involvement to keep him up to speed on everything new in regenerative research. But he wants to know the latest: what is working, what is not. He is always eager for a chance to speak one-on-one with an expert.

“He met with a Canadian millionaire? Why is this shocking? The millionaire supports stem cell research; so does Bob. California is working closely with Canada on several projects; they pay their scientists, we pay ours; more bang for the buck. If there is a person with the resources and will to advance Canadian research, it is natural that Bob would want to develop a deeper interest in the shared research.

“And why should Klein be criticized for supporting a research project attempting to alleviate Alzheimer’s? He saw his own mother die of the disease, after losing the ability  to recognize her own son.  I am familiar with that particular Alzheimer’s project, and it had some amazing results, restoring memory to laboratory rats. This was a water maze test, and the rats recovered the memory of a pathway out of the water, which they had forgotten. To the best of my knowledge, no one else in the world had achieved memory return, and the project deserved the most serious consideration.  Yes, the board of directors voted against the Grants Working Group; it is not only their right but their responsibility to exercise judgment, and not merely be a rubber stamp for the GWG.

“There is also the matter of free speech. Anybody else in California can come to the meetings of the program and voice their opinion—why should Klein be denied the right to voice his opinion?

“Bob Klein owns no stem cell stock, no biomedical enterprises. Financially, supporting stem cell research has cost him a great deal. This is the man who led the fight to build the California stem cell program, donating roughly six million dollars, taking out loans on his house to help finance Proposition 71. And, for six years (without salary) he worked full-time as Chair of the Board of the oversight committee. Physically and emotionally, it has been an exhausting decade for him. He has not profited in any way, except to see the advancement of research for cure.

“Passing a $3 billion stem cell program in the midst of a recession was like relocating Mount Everest—seemingly impossible, but he did it anyway. He moved the mountain. Thousands of people helped, but one man made it possible. Without Bob Klein, California would not have the greatest stem cell program in the world: challenging diseases considered incurable since the dawn of time. That he should continue to support it, with his dollars, time, energy and creativity, is commendable.

“Sometimes a good deed is just that: no sinister motivations, no secret agendas-- just a positive action which benefits all.”  

Loring on Patient Advocates and Their Role at the California Stem Cell Agency

The following statement by stem cell researcher Jeanne Loring was read at the January 23, 2013, meeting of the governing board of the California stem cell agency. Loring is director of the Center for Regenerative Medicine at the Scripps Research Institute in La Jolla, CA.

“I am sorry that I cannot attend this important meeting of the ICOC. I'm in Toronto reviewing stem cell grants for Japan and Canada. I've asked (patient advocate) Don Reed to read my statement.

“I am a California stem cell scientist whose research is funded by the NIH, private foundations, and CIRM. I am the director of one of CIRM's shared laboratories, which has provided formal training in research and ethics to hundreds of young stem cell scientists. My CIRM funding supports the stem cell genomics research that is the main focus of the lab. We have also been funded by CIRM to investigate stem cell therapies for Alzheimer disease and multiple sclerosis. I have leveraged CIRM grant support to obtain funding for studies of autism through the NIH, and for Parkinson's disease from a private foundation.

“The IOM report recommended a number of changes in CIRM's policies. One of these recommendations is of especially great concern to me: the suggestion that patient advocates should have much less influence in CIRM's decisions about what research should be funded.

“Patient advocates are extremely valuable to us researchers. Most of us stem cell researchers had never met a patient advocate- and perhaps not even a patient- before CIRM was founded. In my 20 years of being funded by the NIH, the funding agency never once suggested that I should talk to people who have the disease, or have relatives with a disease that I was receiving funding to study.

“With my first CIRM grant, I started meeting patient advocates, and now I can't imagine pursuing a disease-related research project without them. I've learned a great deal from the advocates on the ICOC, and I greatly enjoy talking with them. They are wonderful sources of knowledge: Jeff Sheehy taught me about HIV/AIDS and patient activism, I learned about Parkinson's disease from Joan Samuelson, autism from John Shestack, and David Serrano-Sewell, Diane Winoker have educated me about MS and ALS.

“Professional research scientists are competitive by nature- a conversation between scientists is often constrained by our secrecy- we need to publish, or perish. But advocates have no such constraints, which makes ICOC meetings more enjoyable and informative than many scientific meetings.

“Patient advocacy has made me a better scientist. Advocacy makes CIRM-funded research breathtakingly relevant and uniquely powerful to change the course of medicine.”

Patient Advocate Reed Defends Patient Advocates on Stem Cell Board

Patient advocate Don Reed, declaring that the Institute of Medicine's (IOM) 17-month study of the $3 billion California stem cell agency is "grossly misguided," this weekend nonetheless said the agency took "the high road" in its response to the study's recommendation.

Reed, of Fremont, Ca., was particularly incensed about the IOM's recommendations concerning patient advocates on the board. The IOM said that none of the board members, including patient advocates, should vote on grant applications secretly in grant review groups. The IOM said their votes should be recorded in public at full board meetings. Other patient advocates would still have seats on the grant review group, under the IOM recommendations. But they would not also be members of the governing board.

The IOM also said that CIRM should also revise its conflict of interest standards to regulate personal conflicts of interest, such as those involving particular diseases and patient advocates. Some members of the CIRM governing board bristled at the recommendation, and the board did not act on it last week.

Last Wednesday, the CIRM board acted to permit board members who are patient advocates to continue to participate in the closed door grant review sessions, but not vote on the grants at that stage. Previously patient advocates had two cuts at applications, one in the grant review group and one at the public board meeting.

Writing on the Daily Kos blog, Reed also said that no real conflicts of interest currently exist on the board, although 90 percent of the $1.7 billion that has awarded has gone to institutions tied to board members.

CIRM Board Member Cites Valuable Role of Patient Advocates

Jeff Sheehy, a patient advocate member of the governing board of the California stem cell agency, last month said the Institute of Medicine was recommending what amounted to "defenestration" of the 10 patient advocate members on the board.

Following a staff presentation this morning on the scientific progress of the agency, Sheehy took the opportunity to point out that several of the programs highlighted were only underway because of efforts patient advocates or appeals by rejected applicants.

Sheehy, who is vice chairman of the CIRM grant review group, said "programmatic" reasons advanced by patient adovocates led to the group's approval of two of the programs. Two more of the highlighted awards were rejected by grant reviewers but only approved by the full board after the applicants appealed using the agency's extraordinary petition process.

The IOM has recommended that the petitions be eliminated because of the threat they pose to the scientific peer review process. It has also recommended that the board not vote on individual grants -- only a slate approved by reviewers. The IOM additionally has recommended major changes in the role of patient advocates on the board.

Diane Winokur, Veteran ALS Patient Advocate, Named to California Stem Cell Agency Board

Longtime ALS patient advocate Diane Winokur of San Francisco, who has lost two sons to the disease, has been appointed to the governing board of the $3 billion California stem cell agency.

She fills the vacancy left by David Serrano Sewell, who resigned from the 29-member panel earlier this year after serving since the agency's inception. CIRM has 10 patient advocates on its board.

Diane Winokur
Photo -- Legal Momentum

Winokur is well-known in ALS circles. She sat for five years on the governing board of the national ALS advocacy group and currently serves on the board for the California state group, the Golden West chapter. She also served for six years on the board of trustees for the Sanford- Burnham Institute in La Jolla, which has received $37 million from the stem cell agency. She left Sanford in 2011.

Last summer Winokur appeared before the CIRM board to successfully seek approval of an $18 million ALS grant that was rejected by the agency's reviewers. Researcher Clive Svendsen of Cedars-Sinai in Los Angeles appealed the denial to the full board and was supported in emotional testimony by other patient advocates as well, including persons with the affliction.(See here for video of some of the testimony.)

The agency has awarded about $30.6 million, including the Svendsen grant, for research directly related to ALS.

Golden West issued a press release Nov. 21, lauding the Winokur appointment by California Lt. Gov. Gavin Newsom. The release quoted Lucie Bruijn, chief scientist of The ALS Association, as saying,

"Her contributions have been invaluable and she will be a tremendous asset in moving the ALS research field forward through CIRM funding."

The stem cell agency posted a blog item on Winokur's appointment in addition to a press release. CIRM Chairman J.T. Thomas said,

“Her knowledge, expertise and leadership will be a tremendous addition to the ICOC (the stem cell agency governing board) and help guide us in our work.”

Patient advocate Don Reed of Fremont, Ca., described Winokur in a 2008 blog item as “small, elegant, full of energy, an exclamation point of a person.”

(Editor's note: Based on information from CIRM and Golden West, an earlier version of this item incorrectly stated that Winokur is a current member of the Sanford-Burnham board.