Global trends in clinical trials involving pluripotent stem cells: A systematic multi-database analysis

Background: Pluripotent stem cells (PSCs) hold great potential for novel therapeutic approaches to regenerate or replace functionally impaired tissues. Since the introduction of the induced pluripotent stem cell technology in 2006, the number of scientific publications on this topic has constantly been increasing. However, so far no therapy based on PSCs has found its way into routine clinical use. Methods: In this study, we examined research trends related to clinical trials involving PSCs based on data obtained from ClinicalTrial.gov, the ICTRP database from the World Health Organization, as well as from a search of all individual databases that are included in the ICTRP using a multistep search algorithm. Results: 131 studies could be classified as clinical trials involving PSCs and were included into further analyses. The magnitude of these studies (77.1%) was observational, which implies that no cells were transplanted into patients, and only a minority of studies (22.9%) had an interventional character. The number of clinical trials involving induced pluripotent stem cells (iPSCs, 74.8%) was substantially higher than the one involving embryonic stem cells (ESCs, 25.2%). However, the picture changes when focusing on interventional studies, where in the majority (73.3%) of cases ESCs were used. Interestingly, the study duration was significantly shorter for interventional versus observational trials (p=0.002). When focusing on the geographical study regions, it became obvious that the greatest part of all observational trials was performed in the USA (41.6%) and in France (16.8%), while the magnitude of interventional studies was performed in Asian countries (China 36.7%, Japan 13.3%, South Korea 10.0%) and in the field of ophthalmology. Conclusions: These results indicate that only a limited number of trials were focusing on the actual transplantation of PSCs into patients in a rather narrow field of diagnoses. The majority of interventional trials involving PSCs took place in Asian countries and in the field of ophthalmology. The future will tell us, if the iPSC technology will ultimately overcome the current challenges and will finally make its way into routine clinical use.