Cell Banking for Future Autologous Cell Therapies Seems Pointless

I'll start here by pointing out the most useful application for cryopreservation of cells and tissues: it greatly reduces the cost of logistics in transplant medicine. When you need to coordinate people and cells and places on timescales of a few days, weeks, or months, the ability to confidently put the cells into safe storage for short period of time changes the whole tenor of the affair. Just look at the organ transplant field, for example, which is defined by the fact that this storage cannot yet be achieved. Organ transplantation is enormously expensive not just because the donor pool is limited, but also because organs cannot be kept alive and useful for very long outside the body. When the state of reversible tissue crypopreservation advances to permit reliable vitrification and restoration of whole organs, the whole field of transplantation will change dramatically. That change in logistics has already taken place for applications involving cells, such as fertility biotechnology, but long enough ago that most of us probably don't appreciate the magnitude of the difference between before and after.

A recent startup, Forever Labs, is aiming at an application of cell cryopreservation that I think is much less useful. This is the practice of banking cells, particularly stem cells, in the hope of using them in cell therapies in the more distant future, decades away. The theory here is that you are banking today's less damaged cells, and because they are less damaged they will be more helpful in medical applications than the worn set of cells you'll possess twenty years and a lot more damage down the line:

Forever Labs preserves young stem cells to prevent your older self from aging

Forever Labs, a startup in Y Combinator's latest batch, is preserving adult stem cells with the aim to help you live longer and healthier. Stem cells have the potential to become any type of cell needed in the body. It's very helpful to have younger stem cells from your own body on hand should you ever need some type of medical intervention, like a bone marrow transplant as the risk of rejection is greatly reduced when the cells are yours. The founder spent the last 15 years studying stem cells. What he found is that not only do we have less of them the older we get, but they also lose their function as we age. So, he and his co-founders started looking at how to bank them while they were young.

The founder banked his cells two years ago at the age of 38. So, while he is biologically now age 40, his cells remain the age in which they were harvested - or as he calls it, "stem cell time travel." Stem cell banking isn't new. In fact, a lot of parents are now opting to store their baby's stem cells through cord blood banking. But that's for newborns. For adults, it's not so common, and there's a lot of snake oil out there.

The process involves using a patented device to collect the cells. Forever Labs can then grow and bank your cells for $2,500, plus another $250 for storage per year (or a flat fee of $7,000 for life). The startup is FDA-approved to bank these cells and is offering the service in seven states. What it does not have FDA approval for is the modification of those cells for rejuvenation therapy. The founders refer to what the company is doing as longevity as a service, with the goal being to eventually take your banked cells and modify them to reverse the biological clock. But that may take a few years. There are hundreds of clinical trials looking at stem cell uses right now. Forever Labs has also proposed its own clinical trial to take your stem cells and give them to your older cells.

To me banking cells for future cell therapy sounds pointless. It is, in effect, a bet against progress in applied cell biotechnology - and given the revolutionary pace of advancement in all areas of biotechnology, this appears a poor wager from where I stand. Is it to be imagined that two decades from now it will not be possible to engineer youthful or sufficiently-youthful-like cells from old skin samples? The process of producing induced pluripotent stem cells is already known to be capable of reverting a number of aspects of aged cells, such as mitochondrial issues. Tinkering with epigenetic markers, such as those that differ between cells from old and young tissues, is a going concern: gene therapy of all sorts will explode in size and capability over the decades ahead. Age-related metabolic waste inside cells can be diluted through replication. Correcting stochastic mutations in cell samples is in principle as straightforward as picking out different cell lineages and comparing their genomes to find the root genome prior to those mutations, and then applying CRISPR. Today that's a feasible lab project given some funding. Twenty years from now colleges will be running that as an afternoon lesson on the student's personal lab desk machines in CellBio 201. In the absolute worst case, use somatic cell nuclear transfer to put patient DNA into a pristine cell, and establish a new line that way.

Progress isn't all that we should consider here, however. Suppose that the cell banking wager pays off, and biotechnology somehow magically fails to advance meaningfully over the next two decades. Lucky you, now the beneficiary of younger, less damaged cells that can be used for cell therapy. But with the technology of cell therapies as they stand now or next year, what can you really do with those cells? The answer is nothing that is more than somewhat beneficial, meaning the present panoply of more reliably effective stem cell transplants and cell therapies. All of those potential uses, so far as can be seen to date, are more or less as effective when employing the cells of an old individual. So far the only signs that young cells would be significantly better occur in cases where those cells are taken from individuals shortly after birth, or before. But even there, this is a question of cell signaling and cell state, something that researchers are hotly engaged in deciphering even now: just how likely is it that they will have failed to replicate these mechanisms a few decades from now?

So it seems to me that the only way in which banking your stem cells makes sense is if biotechnology progresses extremely selectively: a complete failure to understand and control cell state any more effectively than today, coupled with radical strides in the capabilities of cell therapies. Since the latter strongly depends on the former, I'd say that this future isn't going to come to pass. Therefore it really doesn't make much sense to bank cells for future therapeutic use based on the idea that relative levels of age-related cell damage will make a significant difference.