In the past week I received a note from Kerri McCusker (SL: Kerri Macchi) about a project completed for the Serious Games and Virtual Worlds Team, University of Ulster in Northern Ireland. Second Lives sets out to demonstrate a more recent approach to dealing with Crohn’s disease: autologous stem cell transplant.

You can view the Second Life aspect for yourself, or the video below explains the project in its entirety. I’ve also appended a section of the in-world notecard explaining the stem cell transplant history in some detail.

It’s yet another example of simulation as a useful adjunct for wider learning experiences. The level of complexity of this simulation is more at the patient education level rather than as a health professional training mechanism, but with further evolution it could obviously achieve both aims. I certainly learned a lot more about newer treatment options for Crohn’s disease. Anyone who’s been involved in the care of an individual with the disease knows that anything that improves health outcomes is a highly desirable thing.

Appendix: Sample of information provided by Second Lives Clinic

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Welcome to Second Lives Medical Clinic.
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This virtual clinic is a showcase of the process of the autologous stem cell transplant in Crohn’s disease.

Cellular therapy with stem cells is revolutionizing the focus of treatment of many serious diseases. Replacing the cells of damaged tissue with other new cells from the same patient is already a reality. This is the basis of cellular therapy and regenerative medicine, the latest great advance in biomedicine. In this line, Hospital Clínic, Barcelona is leading the world in the application of an innovative cellular therapy that uses stem cells to treat Crohn’s disease, a chronic genetic disease that affects 1% of the population in Spain and which has considerable impact on the quality of life of the patients. The procedure is based on an autologous bone-marrow transplant (when patients receive a transplant of their own stem cells) and now constitutes a treatment option to cure an intestinal disease that sometimes does not successfully respond to drugs and requires highly complex surgery that does not provide a cure.

Hospital Clínic, Barcelona is one of the few hospitals in the world to apply this new therapeutic option for patients with Crohn’s disease, and it does so with the guarantee of success experienced in the US and Italy, where the technique has been tested with excellent results: in an average follow-up period of 6 years, 80% of transplant patients are in a phase of total remission of the disease and the remaining 20% have shown considerable improvement following the transplant, and are now responding favorably to drugs. Dr. Julián Panés and Dr. Elena Ricart over the Gastroenterology Department of Hospital Clínic, Barcelona are the driving force behind this therapy in Spain and began to implement regenerative cellular therapy in patients with Crohn’s disease in August 2008. To date, a total of 6 patients are benefiting from this new treatment. The transplant requires several weeks of admission to hospital before patients receive their own cells. The procedure is the same as that carried out in bone-morrow transplants to cure leukemia or myeloma.

Autologous Stem-Cell Transplant: Phases of the Procedure

When the case is detected (that does not respond to drugs or surgery), the patient undergoes an autologous stem-cell transplant, which is a bone-morrow transplant in which the immune system is reset to prevent it from attacking the intestinal flora. The process lasts approximately 2 months and consists of 6 phases:
1. Initial Chemotherapy (Cyclophosphamide + G-CSF). In this initial phase, the reduction of the number of leukocytes (immune-system cells) in the blood is induced in the patient.

2. Migration of Stem-Cells to the Blood. Following the previous immunosuppression, the organism reacts by releasing stem cells from the bone marrow into the blood; these are the cells which will later be used for the transplant.

3. Collection of Stem Cells by means of Apheresis. Apheresis is a technique that separates components of the blood. Here, the stem cells that previously migrated from the bone marrow are separated.

4. Cryopreservation of Stem Cells. When the stem cells have been collected by apheresis, they are frozen and preserved until ready for transplant.

5. Second Chemotherapy. In this phase, total leukopenia is induced; that is, the immune system is left devoid of leukocytes, ready to be reset with the stem-cell transplant.

6. Autologous Stem-Cell Transplant. The patient receives the transplant by means of transfusion with his or her own stem cells. The immune system is reset, leading to remission or reduction of the abnormal inflammatory process of Crohn’s disease.