Scientists have shed light on a common bleeding disorder by growing and analysing stem cells from patients' blood to discover the cause of the disease in individual patients.
The technique may enable doctors to prescribe more effective treatments according to the defects identified in patients' cells.
In future, this approach could go much further: these same cells could be grown, manipulated, and applied as treatments for diseases of the heart, blood and circulation, including heart attacks and haemophilia.
The study focused on von Willebrand disease (vWD), which is estimated to affect 1 in 100 people and can cause excessive, sometimes life-threatening bleeding. vWD is caused by a deficiency of von Willebrand factor (vWF), a blood component involved in making blood clot. vWF is produced by endothelial cells, which line the inside of every blood vessel in our body. Unfortunately, they are difficult to study because taking biopsies from patients is invasive and unpleasant.
A group led by Dr Anna Randi at the National Heart and Lung Institute, Imperial College London used a new approach to investigate the disease. Dr Richard Starke, a British Heart Foundation Intermediate Fellow and lead author of the study, took routine blood samples from eight patients with vWD, extracted stem cells called endothelial progenitor cells, and grew them in the lab to yield large numbers of endothelial cells.
By testing these cells, they were able to analyse each patient's disease in unprecedented detail. In some patients, the scientists found new types of defect, which may enable them to recommend improved treatments. Professor Mike Laffan, a collaborator in the study and in charge of patients with VWD at Hammersmith Hospital in West London, is looking to apply these findings to reduce severe bleeding in these patients.
Dr Randi believes that endothelial progenitor cells could become an invaluable resource for testing new drugs for vWD and other diseases. "We will be able to test the effects of a range of compounds in the patients' own cells, before giving the drugs to the patients themselves," she said.
This approach could have impact far beyond vWD. Endothelial cells derived from blood could also be isolated and reinjected into someone recovering from a heart attack, to help them grow new blood vessels and repair the injured heart tissue. Dr Starke says this approach avoids the main problem with transplant therapies, in which the immune system tries to destroy the foreign material. "The patients would receive their own cells, so they wouldn't face the problems of rejection," he said.
Work is well underway towards achieving this goal, but blood-derived endothelial cells are only now being explored. "There are already many studies where patients have been injected with stem cells to see whether damage to the heart could be repaired, and there are some promising results," says Dr Randi. "The door is open to such treatments, and our studies are a step towards identifying the right cells to use."
The group's previous research has already thrown up pointers for potential new treatments. Aside from producing vWF to form clots, endothelial cells are responsible for forming new blood vessels. In their last paper, the group showed that vWF is actually needed to build healthy blood vessels. Some patients with vWD suffer severe bleeding from the gut because defects in vWF cause their blood vessels to develop abnormally. "There are drugs already being used in other diseases which target abnormal blood vessel, that could be useful to stop bleeding in some vWD patients," says Randi. "Nobody would have thought of using them to treat vWD, but by testing them on the patient's own endothelial cells , in the laboratory, we can find out if these drugs work before giving them to the patient."
Scientists are now interested in the possibility of using endothelial cells as a treatment in themselves. For instance, haemophilia, the hereditary bleeding disorder which affected Queen Victoria's family, might one day be treated by taking these cells from a patient and replacing the gene that causes the disease, then putting them back into the patient.
Funding for the study came from the British Heart Foundation, the Medical Research Council and the National Institute for Health Research Imperial Biomedical Research Centre.
For further information please contact:
Research Media Officer
Imperial College London
Tel: +44(0)20 7594 2198
Out of hours duty press officer: +44(0)7803 886 248
Notes to editors
1. Reference: RD Starke et al. 'Cellular and molecular basis of Von Willebrand Disease: studies on blood outgrowth endothelial cells.' Blood April 4, 2013 vol. 121 no. 14 2773-2784 doi: 10.1182/blood-2012-06-435727 http://bloodjournal.
2. About Imperial College London
Consistently rated amongst the world's best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research that attracts 14,000 students and 6,000 staff of the highest international quality. Innovative research at the College explores the interface between science, medicine, engineering and business, delivering practical solutions that improve quality of life and the environment - underpinned by a dynamic enterprise culture.
Since its foundation in 1907, Imperial's contributions to society have included the discovery of penicillin, the development of holography and the foundations of fibre optics. This commitment to the application of research for the benefit of all continues today, with current focuses including interdisciplinary collaborations to improve global health, tackle climate change, develop sustainable sources of energy and address security challenges.
In 2007, Imperial College London and Imperial College Healthcare NHS Trust formed the UK's first Academic Health Science Centre. This unique partnership aims to improve the quality of life of patients and populations by taking new discoveries and translating them into new therapies as quickly as possible.
3. Imperial College Healthcare NHS Trust
Imperial College Healthcare NHS Trust comprises Charing Cross, Hammersmith, Queen Charlotte's & Chelsea, St Mary's and Western Eye hospitals. With more than one million patient contacts each year, it is one of the largest acute Trusts in the country and, in partnership with Imperial College London, is the UK's first Academic Health Science Centre (AHSC). It has an annual turnover of around £950 million.
Imperial College Healthcare is one of eleven NIHR Biomedical Research Centres. This designation is given to the most outstanding NHS and university research partnerships in the country; leaders in scientific translation and early adopters of new insights in technologies, techniques and treatments for improving health. Imperial College Healthcare has some of the lowest mortality rates in the country according to the Dr Foster Guide - an annual, independent report published 2011.
4. About the British Heart Foundation
The British Heart Foundation (BHF) is the nation's heart charity, dedicated to saving lives through pioneering research, patient care, campaigning for change and by providing vital information. But we urgently need help. We rely on donations of time and money to continue our life-saving work. Because together we can beat heart disease. For more information visit bhf.org.uk/pressoffice.
5. About the Medical Research Council
Over the past century, the Medical Research Council has been at the forefront of scientific discovery to improve human health. Founded in 1913 to tackle tuberculosis, the MRC now invests taxpayers' money in some of the best medical research in the world across every area of health. Twenty-nine MRC-funded researchers have won Nobel prizes in a wide range of disciplines, and MRC scientists have been behind such diverse discoveries as vitamins, the structure of DNA and the link between smoking and cancer, as well as achievements such as pioneering the use of randomised controlled trials, the invention of MRI scanning, and the development of a group of antibodies used in the making of some of the most successful drugs ever developed.
Today, MRC-funded scientists tackle some of the greatest health problems facing humanity in the 21st century, from the rising tide of chronic diseases associated with ageing to the threats posed by rapidly mutating micro-organisms. http://www.
6. About the NIHR
The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world-class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. http://www.
7. About NIHR Biomedical Research Centres
NIHR Biomedical Research Centres support research across a wide range of disease areas. These Centres are the most outstanding NHS/University research partnerships in the country; leaders in scientific translation and early adopters of new insights in technologies, techniques and treatments for improving health. To ensure they are able to succeed, the NIHR BRCs receive substantial levels of sustained funding. NIHR BRC funding supports the NHS infrastructure to create an environment where scientific endeavour can thrive, attracting the foremost talent and producing world-class outputs.