Stem Cell Heart Repair

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Teacher's Guide

Recommended Grade Levels: 10 - 12 and up

Tips for using the site with students

Before using this activity in class (or at home), go through the activity once to make sure it works correctly on your computer(s). If the activity does not load after clicking the 'start' button, you may be asked to download the free Flash Player from Adobe.com. Please click yes, as this allows you to view the Edheads Stem Cell Heart Repair activity. If you are using school computers, you might need to contact your tech support team to download the Flash Player.
If you are using an iPad or other iDevice, our games will not play without downloading an app or browser. We recommend the Photon browser available at: https://itunes.apple.com/us/app/photon-flash-player-for-ipad/id430200224?mt=8.
Your computer(s) will need to have some sort of sound output. Either speakers or headphones will work well. The majority of this activity has voice audio. We highly recommend headphones or ear buds in a classroom setting. Students with hearing impairments can read the text at the bottom of the screen. If you are having difficulty hearing, check the audio settings on your computer.
We strongly recommend that students use a real mouse, as the touch pads on laptop computers are more difficult to use for this activity and slow students down significantly.
If the teacher would like students to fill out a worksheet while doing the activity, that can be printed here. The worksheet is NOT necessary to complete the activity, but is a way for students to show they have done the activity or for teachers to track student progress.
Students in the target grade-range will take approximately 25-30 minutes to complete the entire activity.
This activity is one of three available on the Edheads web site on stem cells. The first activity, Create a Stem Cell Line, is an introduction to stem cells, what they can do, and the vocabulary used by stem cell biologists. The second activity, Stem Cell Transplant, provides a current application of stem cells and introduces a new line of real, ongoing research using stem cells called MAPCs. This activity, Stem Cell Heart Repair, introduces two lines of new research to determine how best to use stem cells to repair the heart. These research projects are currently in clinical trials to be approved by the FDA. The three stem cell activities can be used together, individually or in combination as the teacher sees fit. If all three activities are done together, they are intended to provide an in-depth overview of what stem cells are, and how they might be used in human medicine now and in the future. The glossary contains words from all three activities.

Worksheet

The worksheet for this activity is optional. Teachers may choose to have their students do the worksheet as a means of ascertaining that the students have completed the activity. However, the worksheet is NOT required to complete the activity.

You can download the worksheet here.

Answers to the Worksheet

Normal ranges for cardiac tests

Ejection fraction: 50-70%, usually around 55%

Stress Test:

6 MWT (6 minute walk test): 500 meters

MLWHFQ (Minnesota Questionnaire) Score: 50 or more means patient is severely impacted, zero is no impact from heart failure, a change of 10 points or more means significant change in patient's life and health.

Patient 1

Patient 2

68 years old, male

Therapy: Stem cells were harvested via bone marrow aspiration and cleaned and concentrated stem cells were injected into heart.

71 years old, male

Therapy: Plasmids (genetic material) were injected in cells around the dead areas of the heart. These cells then began to produce SDF1, a signal that causes stem cells found naturally in the body to migrate to the damaged heart tissue.

Baseline data (before treatment)

Ejection fraction: 30%

Stress Test: positive (student should draw wave form)

6 MWT (6 minute walk test): 300 meters

MLWHFQ (Minnesota Questionnaire) Score: 50

Baseline data (before treatment)

Ejection fraction: 35%

Stress Test: positive (draw wave form)

6 MWT (6 minute walk test): 325 meters

MLWHFQ (Minnesota Questionnaire) Score: 58

One month after treatment

Notes on patient reaction to treatment:

Hurt hip, some pain from bone marrow aspiration, didn't like getting anesthesia twice.

One month after treatment

Notes on patient reaction to treatment:

No pain, worst comment was the waiting to leave

One month check up continued

Ejection fraction: 32%

Stress Test: (not performed at this time)

6 MWT (6 minute walk test): 320 meters

MLWHFQ (Minnesota Questionnaire) Score: 42

One month check up continued

Ejection fraction: 35%

Stress Test: (not performed at this time)

6 MWT (6 minute walk test): 338 meters

MLWHFQ (Minnesota Questionnaire) Score: 47

Two month check up

Ejection fraction: 34%

Stress Test: positive, but better resting perfusion

6 MWT (6 minute walk test): 328 meters

MLWHFQ (Minnesota Questionnaire) Score: 45

Two month check up

Ejection fraction: 37%

Stress Test: positive, but better resting perfusion

6 MWT (6 minute walk test): 353 meters

MLWHFQ (Minnesota Questionnaire) Score: 44

Four month check up

Ejection fraction: 36%

Stress Test: positive, but resting perfusion better

6 MWT (6 minute walk test): 340 meters

MLWHFQ (Minnesota Questionnaire) Score: 35

Four month check up

Ejection fraction: 40%

Stress Test: positive, but resting perfusion better

6 MWT (6 minute walk test): 380 meters

MLWHFQ (Minnesota Questionnaire) Score: 41

Additional notes on patient that might be pertinent to the study:

• How does the patient look?
• How are they moving and reacting differently?
• What are they saying that might indicate a change in health?

Assessment and discussion

For an assessment tool, teachers may want to have students put their names on the Worksheets and turn them in. These should indicate if students completed the assigned activity.

A quick 12 question quiz can be found here.

Answers to the quiz questions can be found here.

After students use the site, additional in class discussion questions (which can also act as assessment tools) can be asked or assignments made:

If these two lines of research make it through clinical trials and are approved by the FDA (Food and Drug Administration), what other applications do you see for this knowledge? (This is to get students thinking about the future and applying knowledge in new ways.) This type of stem cell therapy might be used for burn patients, to increase the amount of skin that will grow back; to limit scarring in cosmetic surgery or repair of facial skin after an accident; and eventually might even be used to re-grow digits or limbs lost in accidents.

How does heart disease develop and progress? What are the steps from first symptoms up through congestive heart failure? (The answer can be found online or in a good anatomy text book.).

Where was the heart damaged in these two patients? Are there locations in the heart where damage would not be so bad (not create as many symptoms)? What locations in the heart would be the worst places to have damage? These two patients' left ventricles were damaged and it is this chamber of the heart that pumps blood to the rest of the body. It is pretty much the worst place to have damage. Damage to the atria would be less serious, but obviously, any damage to the heart could be life threatening.

Describe the difference between a heart attack and cardiac arrest (the ventricles stop altogether or go into fibrillation – a rapid, uncoordinated fluttering of the ventricle that does not pump blood out of the heart). A heart attack or myocardial infarction is blood not reaching a relatively small part of the heart muscle itself. This is usually due to a blockage in one of the arteries that feeds blood to the heart muscle. A small section of the heart dies, as a result of lack of blood flow. During cardiac arrest, blow flow to the entire body, including the brain, stops. Therefore, cardiac arrest is a much more serious problem than a heart attack, although a heart attack can be fatal, as well.
What aspects of your students' lives would change if they had stage three congestive heart failure? Remember, at this stage, walking for six minutes is not possible without resting several times. Could they get from one class to another with congestive heart failure? Could they get to their busses on time or get from the bus to their home? What other aspects of their lives would be limited by this condition?
List all the careers you think might be involved with these lines of research from start to finish, even those not specifically mentioned in the activity.
Minnesota Living with Heart Failure Questionnaire – If you would like to look up this test and discuss the questions asked and what they mean to patients, the original can be found at: http://www.license.umn.edu/Products/Minnesota-Living-With-Heart-Failure-Questionnaire__Z94019.aspx You do have to register and download the questionnaire, but it is free to educators.
Have your students write a report describing which treatment they would recommend to the FDA. Include sections that describe the methods used in the research, comparisons of the base line data and final results, what the results were and why one particular method was recommended over the other. The medical community is looking primarily at the SDF1 study as being the most cost effective and viable, because it has many other potential uses (not just heart repair) and is easier on the patient (no invasive bone marrow aspiration or second anesthesia) and easier on the hospital (no five hour wait between aspiration and catheterization). Your students should explore these issues in their paper.

Ohio Science Standards – Benchmarks and Indicators

Grade 10:

Life Sciences

Historical Perspectives and Scientific Revolutions

Describe advances in life sciences that have important long-lasting effects on science and society (e.g., biological evolution, germ theory, biotechnology and discovering germs).
Analyze and investigate emerging scientific issues (e.g., genetically modified food, stem cell research, genetic research and cloning).

Science and Technology

Understanding Technology

Cite examples of ways that scientific inquiry is driven by the desire to understand the natural world and how technology is driven by the need to meet human needs and solve human problems.
Describe examples of scientific advances and emerging technologies and how they may impact society.

Scientific Inquiry

Doing Scientific Inquiry

Research and apply appropriate safety precautions when designing and conducting scientific investigations (e.g. OSHA, MSDS, eyewash, goggles and ventilation).
Present scientific findings using clear language, accurate data, appropriate graphs, tables, maps and available technology.
Draw conclusions from inquiries based on scientific knowledge and principles, the use of logic and evidence (data) from investigations.

Scientific Ways of Knowing

Science and Society

Investigate how the knowledge, skills and interests learned in science classes apply to the careers students plan to pursue.

Grade 11:

Scientific Inquiry

Doing Scientific Inquiry

Evaluate assumptions that have been used in reaching scientific conclusions.
Design and carry out scientific inquiry (investigation), communicate and critique results through peer review.
Summarize data and construct a reasonable argument based on those data and other known information.

Scientific Ways of Knowing

Science and Society

Explain that the decision to develop a new technology is influenced by societal opinions and demands and by cost benefit considerations.
Research the role of science and technology in careers that students plan to pursue.

National Science Standards for Grades 10-12

Science as Inquiry:

Abilities necessary to do scientific inquiry
Understandings about scientific inquiry

Life Science:

The cell