How stem cell transplant cures sickle cell disease

Prof. Godwin Nosakhare Bazuaye is a consultant hematologist and stem cell transplantologist. He is the Chief Medical Director, Igbinedion University Teaching Hospital Okada, Edo State, and also collaborating physician stem cell transplantologist to Celltek Healthcare Medical Center, the only stem cell transplant centre in the whole of sub-Saharan Africa. In this interview, he speaks on […]

Prof. Godwin Nosakhare Bazuaye is a consultant hematologist and stem cell transplantologist. He is the Chief Medical Director, Igbinedion University Teaching Hospital Okada, Edo State, and also collaborating physician stem cell transplantologist to Celltek Healthcare Medical Center, the only stem cell transplant centre in the whole of sub-Saharan Africa. In this interview, he speaks on how the centre is providing innovative treatments for sickle cell disease, the importance of quality genotype tests, and how government can improve access to care for sickle cell disease sufferers, among others.

What is the stickle cell disease?

It is a genetic disease that affects the haemoglobin (a protein in your red blood cells) and makes it lose the structure of being oval in shape, to look like a sickle, and that is why it is named sickle cell disease.

It is inherited from parents to offspring. So if both spouses have AS genotype, they have the chance of having a child with sickle cell disease.

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How important is genotype testing in preventing sickle cell disease?

Sickle cell is a disease that can be prevented, and that underscores the relevance of genotype screening.

I have advocated that genotype test be done properly. There are two types of problems in this, one is the fact that some people do not do a genotype test before marrying and having children, and the other problem is that those who are interested in doing it,  could get wrong results.

So, people should do quality and proper genotype screening and with that, we can avoid sickle cell disease.

About 3 per cent of Nigerians have sickle cell disease, and 25 per cent of the 200 million population are carriers of the sickle cell gene. So, we are advocating genotype screening which is actually the major way of eradicating the disease.

You pioneered the first successful stem cell transplant for the cure of sickle cell 2011. What is stem cell transplant or therapy and how does it help in curing sickle cell disease?

We pioneered it and since then we have done about 18 transplants for sickle cell disease patients.

Stem cell transplant is where we take stem cell from someone who has AA or AS genotype, and is a genetic match with the patient who is SS, then transplant it into the sickle cell patient and make it to grow and start producing the same cell of the donor.

We first of all destroy the genotype that produces the sickle cell disease in the patient, that is the first stage, and then, we collect the stem cell from the donor which is AA or AS, transplant into the bone marrow of the sufferer so that the genotype of the sufferer changes.

So if it is AA, the sickle cell patient will start producing AA and if it is AS, it will start producing AS. So that automatically changes the genotype of the patient from SS to AA or AS, and that brings a cure.

This means that once you are AA or AS, you would no longer have a crisis, and the only cure for sickle cell patients is stem cell transplant. The new treatment that is coming up now is called gene therapy which is still the manipulation of stem cell transplant.

With the breakthrough in stem cell transplant, how readily accessible and affordable is the therapy for sickle cell sufferers in Nigeria?

It is easily accessible. You know lots of people have left the country but rather than leaving the country, I have decided to stay back to render this service.

I am the only doctor doing stem cell transplant in Nigeria and so if I leave, it means it would not be accessible.

Now, affordability is the problem that makes accessibility a problem. Affordability is the biggest problem despite the fact that we are still the cheapest centre in the world where stem cell transplant is done.

The cost is still beyond the reach of most Nigerians because it is expensive. The average cost of stem cell transplant in Nigeria, on the average, is $30,000 and if you convert it to naira, you are requiring about N15 million.

In India, you still get it cheap but with flight tickets and accommodation, you still spend over $40,000 or $50,000. Ours is expensive because of power, we use diesel to power our generator due to epileptic power supply. We spend about N2 million on diesel to power our generators, pay electricity bills and we import drugs in dollars.

We started doing transplants for N3 million in 2011 and by 2017, we started doing it at about N10 million but now we can’t do that, because the dollar has gone up.

When we started in 2011, diesel was about N200 or less than that per litre. So these are the handicaps and why transplant in Nigeria today is high at N15 million, and how many Nigerians can afford that.

Our centre is a private sector that has no government inputs. We were doing it in government establishment but it didn’t work. We don’t have government support here, we don’t get waiver on the drugs we import, and the road leading to the only transplant centre in the whole of sub-Saharan Africa where we have visitors from all over the world is bad.

We have had the ambassador of Congo visit the centre, and transplant experts from America also visit the centre. So it would have been cheaper for Nigerians if we get waiver for all these things as well as government’s support.

At one time, I had a meeting with the wives of the 36 governors and I pleaded that if they can just afford one transplant for a sufferer a year, it would help in reducing the problem. We would have been doing 36 transplants in a year if they had agreed. Sickle cell disease sufferers are very poor.

Why did the one owned by government fail?

It failed due to the bureaucracy in government, we did three transplants at the University of Benin Teaching Hospital (UBTH) and they are all alive and well. But for the usual Nigeria factor, things are not working. In four years,  we did three transplants in government-owned hospital but within five years of private-sector collaboration, we have done almost 20.

The only way we can move the health sector forward is public private partnership (PPP) where private people can come in and have a stake and things would work.

You also pioneered the first automated red cell exchange for sickle cell in Nigeria in 2014. How has the programme expanded over the years?

The automated red cell exchange is what we do to alleviate the pain sickle cell patients go through. In a developed country, it is done three or four times a year for adult sickle cell sufferers to reduce their pain.

We have a yearly programme where we train nurses and doctors on the art of inferences and this is sponsored by Teromo, a company that produces inference machines; we train an average of 10 nurses and 10 doctors yearly in the art of red cell share and inferences.

Currently, with the number of doctors and nurses that I have trained, many centres in Nigeria now have inference units and are functioning well. When we started, only a few centres have machines and I trained a lot of Nigerians in the art of inferences.

What can the government do to improve access to innovative treatment like yours and other forms of care for sufferers?

Government should establish international transplant centres. It would become a centre of medical excellence and medical tourism. Many Nigerians go to India for these treatments. Nigeria is supposed to have a minimum of six transplant centres.

They can even start with one. We have been the only transplant centre since 2011 and the government has not deemed it fit to build one with international standards where we can have foreigners coming in for treatment.

So, I expect the government to collaborate with us in building an international transplant centre. In CellTeck, we have only two transplant rolls. We can only do two transplants at the same time, but where I was trained in Switzerland, they have over 30 rolls and they can be doing 30 stem cell transplants at the same time.

They can start with one transplant centre in each of the geopolitical zones, and I am available for the expertise and this will go a long way in helping sufferers.

Apart from sickle cell, we can also start doing bone marrow transplant for cancer patients. We have done four in our centre for Multiple myeloma which is cancer of the bone successfully. We have had patients from Ghana and Gambia coming for treatment.

Government can also give us soft loan. When the N500 billion earmarked for health sector improvement during COVID-19 was approved, I applied but I didn’t get it – the only stem cell transplant centre in sub-Saharan Africa didn’t get it.

In India, they give out soft loans to doctors at one per cent interest to set up big hospitals but here you take a loan at 20, 23 and 33 per cent and the final burden of this is sent back to the patients. And this doesn’t help.