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WE ARE NOT THERE YET
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Stem Cell Research From a Local Perspective
By Linda F. Jarrett
Few topics can jump-start a conversation among friends or strangers like “Stem Cell Research.” Do
you want it? Why? Why not? Can you explain it?
Terms like “embryonic stem cells” and “somatic cell nuclear transfer” boggle the layman’s mind and often lead to misinformation.
To try to define the controversy, embryonic stem cells (ESC) are unspecialized cells that have the potential of developing into any cell in the body, giving rise to the hope that they could be used in finding a cure for such conditions as Parkinson’s Disease, diabetes, spinal cord injuries, Alzheimer’s, heart disease, and a host of others.
Adult stem cells, on the other hand, taken from the blood or organs of healthy adults, do not show the adaptability of ESCs and are
limited in that they will only turn into a certain number of cell types specified for a more
limited array of diseases.
In August 2001, President George W. Bush limited federal funding for stem-cell research to 60 existing stem cell lines. However, only 21 were actually available for research and those 12 lines, grown on mouse cell cultures, stand a great chance of not being applicable to human therapeutics.
Missouri legislators are contemplating a bill that would criminalize a procedure, called “somatic cell nuclear transfer (SCNT),” early stage stem cells. Scientists and physicians from around the state are lobbying against this bill, while some religious leaders and social conservatives are voicing their support.
 Dr. Steven Teitelbaum, Wilma & Rosewell Messing Professor, Department of Pathology at Washington University. |
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Dr. Steven Teitelbaum, Department of Pathology at Washington University, explains that SCNT has nothing to do either with abortion or with a sperm fertilizing an egg. “One takes an egg from a woman, removes the DNA. Then removes the nucleus. The empty egg serves as a factory. You give the egg a little shock, and under the right conditions, it will start dividing.
“From day five it forms a structure called a blastocyst,” Teitelbaum says. “This blastocyst, although it looks the same, is different than one formed from sexual reproduction, because there are important embryonic genes that are not turned on by SCNT. Then, we take the embryonic stem cells from the inside of the blastocyst and we put those in a dish in the laboratory where they grow, and we can make huge numbers of these cells.”
“We believe the body will view these cells as the body’s own and not reject them,” he adds. “But, the important point is that we are not there yet.”
Donn Rubin, executive director of the Coalition for Plant and Life Sciences says this is not a dispute between scientists. “There is no real debate in the medical community about the promise of SCNT. For example, 60 Nobel Prize winners support SCNT. There is no comparable list of opponents.”
Along with, according to a survey by Market Strategies, Missourians favor the research with a greater than 2 to 1 margin, he adds.
“Sometimes this is framed as a competition between adult stem cells or ESCs,” Rubin says. “But this is a battle against disease. The more people learn about this issue, the more supportive they are of assuring the ability in our State to pursue the research in early stem cells and assure the right of physicians and patients to have access to the treatments and cures that would come from this research.
“Unfortunately,” Rubin says. “The legislation proposed this session would both restrict the ability to conduct research and restrict the ability of patients in Missouri to access cures.”
Teitelbaum says those opposing ESC research make two arguments. “First, that the use of ESCs from SCNT is destructive of a human life-they equate the blastocyst form to a human life, and that’s an argument you have to put within your own ethical framework. This pinpoint size ball of cells has not been formed by a sperm fertilizing an egg.
“The other argument is that adult stem cell research offers an alternative form of
therapy,” he says. “But they don’t have the ability to differentiate as much as ESCs. So, my bias is that while adult stem cells may be useful, ESC’s hold more promise.”
Teitelbaum, whose field of research is bone disease, participated in the first cure of a fatal childhood disease with adult stem cells 25 years ago. The patient was a 3-1/2 month-old girl with osteopetrosis, a condition that usually kills in the first years of life. “Her brother was genetically a match with her, so we gave her a bone marrow transplant and it took. She just graduated from college and it’s the best thing I’ve ever done in my life.
“This was using adult stem cells in the bone marrow, and it will work once in 10 times,” he says. “But, I want to tell parents it will work nine times of 10, and we think SCNT in which the patient has its own DNA is more likely to be effective.”
| Dr. Gerard Magill, director and department chair of the Center for Health Care Ethics at Saint Louis University |
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Dr. Gerard Magill, director and department chair of the Center for Health Care Ethics at Saint Louis University says this debate is the most “outstanding” he has known in the past 30 years. Politicians on this issue, he says, “have the headache of a lifetime and it’s a tough cookie for them. Dolly The Sheep was created by SCNT in 1997 and major breakthroughs weren’t predicted for 15 to 20 years. Now, eight years later, here we are.”
“But, the most important thing that I believe has to be said,” Magill says, “is that this dilemma between science and ethics has to be resolved by our politicians. That’s why we elected them. They don’t want this, but by golly it’s sitting there smiling in front of them”
The options for the politicians are many, Magill says. “They can ignore it, but that’s absurd. They can outlaw everything to do with this research. They’re not going to do that either. Or they can approve everything. They’re not going to do that. So, it’s all about nuance. The question is how do we get ethical consensus on a deeply divided issue.
“We are a Catholic Jesuit institution and with a mission that Saint Louis University has to uphold,” Magill says. “Our mission identity would not go to war with the official Catholic teaching on these very basic issues of human life, but that does not mean we can’t use our best reasoning skills and our most scientific research to try to find ways where can get middle ground.”
Magill gave two issues to find this middle ground. One is putting more effort into adult stem cell and cord blood research. The other is one of the major developments that might possibly be an answer.
He told of an article recently published where scientists claimed they were able to harvest ESCs from the stage called the “morula,” which precedes the blastocyst.
“They remove a little cell from the morule, culture it and it grows into an ESC,” he says. “It could never become an embryo, and when you remove that cell from the human embryo, it just grows another one. So you see how we might be able to solve this tremendous debate between science and ethics by
scientists making breakthroughs.”
But, Magill says, if this process is criminalized, the development is stopped and, hence, any breakthroughs. “If what you create by that process of SCNT can never become a human embryo that could be implanted into a woman’s womb, then perhaps it may not be human life from the beginning. What is being generated is a reproduction of cells, not the beginning of human life.”
In November 2004, California passed Proposition 71, which provides three billion dollars in state funding. This has prompted fears in other states that they could lose biotechnology companies and investments to California. Massachusetts, New Jersey, Illinois and Wisconsin are considering spending millions on stem cell research. Missouri, however, is among those, including Kansas, considering a ban on any ESC research.
Rubin, Magill and Teitelbaum believe that passage of this bill would have severe
adverse economic ramifications for the State as well, especially in the terms of biotech industry coming to Missouri.
“Our medical school is ranked number two in the country,” Teitelbaum says. “For us to remain competitive, and the way a university remains great is by recruiting great faculty and great students. I fear that we will not be great in 10 years.”
He quoted from an article published in
the Providence (Rhode Island) Journal Sept. 22, 2004. “If you’re a big company looking for a place to put your biotech research park, would you rather go to Missouri where lawmakers want to make your life’s work a felony, or California, where the state is
strewing dollars in your path?”
Rubin agrees. “With such a ban passing, one will see, over time, a decline of our great medical centers. The best and brightest want to be where the cutting edge research is. If our legislature and our State send a signal that we are not welcoming to scientists and, in fact, want to criminalize their work, we will no longer attract the best and brightest, many of whom want to make their home here and end up treating you and me. We’re fortunate to have some of the top medical care providers in the world right here, and that will decline if SCNT research is criminalized.”
“We are in the Midwest and humble people but, by golly, we are big players,” Magill adds. “If this is criminalized, it will have a devastating effect on research in Missouri and, secondly, it will have a piggy-backing effect on business and investment.”
Jerry Feldhouse, director of the Building and Trades Council also weighs in on this issue. “ESC research is vital to the economic stability and growth to this region. It would create thousands of jobs, not only construction, but permanent jobs for our unions. If we lost this to other states, it would be a huge loss to Missouri.”
Rose Windmiller, director or state and location relations for Washington University says, “Creating an environment that is not conducive to medical research, which is what the passage of any kind of anti-stem cell legislation would do, does a couple of things. It signals to investors in the biomedical fields that we’re not an attractive place to invest money, and to researchers who often bring grant money that their research may be criminalized if they do stem cell research.”
Jobs in this field require an educated work force and pay accordingly. The people attracted to Missouri would not only establish the State as a leader in biomedical research, but it would stimulate the entire economy.
Magill sums it up. “Science and ethics are joined at the hip on this issue and trying to figure out this conundrum requires the utmost subtlety and nuance. This is asking for your intelligence, not a sledgehammer approach.”
Cord Blood-Another Option?
Many of those opposed to ESC research say that more research needs to be done on cord blood and that much of what cord blood could offer is still unknown.
The St. Louis Cord Blood Bank, affiliated with Saint Louis University Hospital and Cardinal Glennon Hospital, is the second largest umbilical cord bank in the world, collecting from 32 area hospitals and over 400 obstetricians. Cord blood is processed, frozen, and then stored until selected for a transplant procedure.
Cord bank director Dr. Michael Creer, professor of pathology and pediatrics at
Saint Louis University Hospital, says that the stem cells contained within cord blood are used to treat leukemia, congenital disorders of bone marrow functions and a variety of inherited metabolic diseases. These diseases are caused by the patient’s cells inability to make a certain enzyme.
“We’re salvaging a product that would otherwise be discarded,” Creer said. “And derive something that’s as useful as bone marrow from a living person.”
The Cord Blood Bank also collects adult peripheral blood. The donor is given a medication that stimulates the bone marrow to push out immature cells into the peripheral blood. After five days, the donor goes to a collection center where the blood is taken, the white cells removed, and the plasma returned to the donor.
Creer says, “The white cells we collect are stem cell products. These products, whether bone marrow, peripheral blood or cord blood could contain these cells with the capability of providing us with the same treatment as ESC. The problem is we don’t know how to find them and we can’t unless we study true ESCs. If we don’t support stem cell research, then continuing to use these other products will be like trying to find a needle in a haystack. The intermediate step we can take is research; there is no other way.” |
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