Tracing the origin of a heart attack in patients of cardiac failure and then treating them using stem cells is all in the day's work for Dr Sandeep Seth, lead researcher and additional professor, department of cardiology at the All India Institute of Medical Sciences (AIIMS).
For end-stage heart-disease patients, this therapy ensures the stem cells reach the desired target.
"It involves injecting labelled stem cells coated with radio-active technetium intravenously into the patient. This technique helps us find out the exact location of myocardial infarction under a SPECT imaging," says Dr Seth.
If the scan shows that enough cells haven't concentrated in the desired area, they inject more to achieve results.
Worldwide, this research is showing promise only in two other centres in Germany and South Korea.
"Both these centres are using still higher radio-substances in their tests," says Dr Seth.This can be given to all patients of heart failure, where all other therapies have failed.
"At least 10% of all cardiac patients have end-stage cardiac disease. Since we are a referral centre, we mostly get very critical patients and our results have shown a lot of promise," says Seth.
Stem cells, the building blocks of the body, have an established role in treatment of cancer therapies, especially bone cancers. Using these "naïve" or "pre-mature" stem cells extracted from bone marrow, hair follicles or eyes into dead or diseased areas is already showing results but researchers say it'll take some more time before they can be certified as established therapies.
"Stem cells have shown a lot of promise in treatment of chemical burns in eyes, vitiligo or white patches in skin, chronic ulcers, strokes (brain), multiple sclerosis, Parkinson's disease, bones and heart," says Dr Sujata Mohanty, head of stem cell facility at AIIMS.
"There's still a lot more systemic study and scientific research needed on a large patient base before the department of biotechnology accepts it as standard therapy," she says.
"But, nevertheless, it is a therapy for the future, as people are living much longer and degenerative diseases are on a constant rise," she said.
Blindness and chemical burns
Mohammad Ikram, 26, who owns a small business of repairing and selling second-hand electronic items, suffered severe eye burns after a packet of lime (chuna) - used widely in betel-leaf preparations across India - burst when he was trying to open it with his mouth.
"I thought it was a harmless powder as we ate it wrapped in betel leaf. But the spilt powder left me blinded in both eyes," said Ikram.
"My marriage was called off and I became home-bound. When six months of treatment in a government hospital failed to show results, a friend took me to AIIMS, where doctors told me about stem cell therapy. I opted for it and today I can see again," says Ikram, who is about to get married now.
"We take a 2mm graft rich in stem cells from the cornea of the patient and expand it in the lab till it is about 12mm. Then we transplant it. This improves vision by replenishing the occular surface of eye enough for a patient to see comfortably," says Dr Radhika Tandon, professor of ophthalmology in the RP Centre at AIIMS, who has treated over 100 cases of stem cell therapy in eyes.
"Using stem cells to repair a cornea with chemical burns has been in use for a decade now as there is no other treatment. But till a couple of years ago, we would take a 12mm graft from a cadaver and implant it. Now we take a much smaller graft from the patient's own eye and harvest it in the laboratory. Since it is autologous (from patient's own cells) recovery is better," she says.
A lot of research using stem cells is underway in the treatment of retinal diseases at the ophthalmology department under Dr Atul Kumar.
Although the successes are in nascent stages, positive results are seen in patients with degenerative retina disorder (night blindness), retinitis pigmentosa and age related macular degeneration.
Double-blinded trials - where both the doctor or the patient do not know if stem cells are actually being injected - on 75 heart patients have been completed at AIIMS and the results are being analysed.
"We had started the programme in 2004 under Dr P Venugopal. Stem cells were extracted from the chest bone at the time of opening up the heart for bypass and was put in the dead parts of the arteries after processing it. The therapy showed positive results, so we tried it non-surgically by extracting cells from the hip bone and then injecting them in failing hearts," says Dr Sandeep Seth, associate professor, department of cardiology at AIIMS.
Stem cells, however, work only as reparative agents and help the heart muscle gain strength as new cells are generated. No new muscle mass form.
"These therapies so far only help repair conditions where all other therapies have failed. Since this is the last hope, patients often agree for stem cells," he says.