Life, Ethics & Independence IV – Stem Cells

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In my fourth look at contentious public policy issues, I’m addressing something that’s a bit more technical than the other ones. It’s likely to be one of the more important medicine-related issues over the next decade or two, but still highly controversial – embryonic stem cell research and therapy.

What are stems cells?

Stem cells are cells from which all of the body’s tissues and organs originate from. I suppose you could describe them as “seeds” of sorts. They have the ability to change (differentiate) into many different tissues during human development, while some specific stem cells retain this ability through into adulthood.They were first cultured (in mice) by Cardiff University Chancellor Sir Martin Evans (who won an unrelated joint Nobel Prize for Medicine in 2007) and Prof. Matthew Kaufman when they were both working at Cambridge University.

The science of human stem cells

There are many different “levels”of ability to change into different tissues, called “potency”.

  • Totipotency – The ability to change into all cells of the body.
  • Pleuripotency – The ability to change into any of the three main layers that form all of the bodies main tissues during embryogenesis.
  • Multipotency – The ability to change into a fixed line of mature adult cells.

There are others too, but they’re not as important for this exercise.

Immediately following fertilisation, human zygotes are totipotent. That makes sense, because everything has to be formed from scratch.

After around eight days, the zygote changes into a blastocyst – a ball of outer cells, and a mass of inner cells. That inner cell mass (embryoblast) will become the developing embryo, and eventually, the foetus. The embryoblast cells are pluripotent, forming the three layers of the embryo, which I’ve covered before when discussing abortion (ectoderm, mesoderm, endoderm).

Once these embryoblast cells are removed and grown in culture, they’re termed embryonic stem cells.

Eventually, the embryo/foetus will mature right through to birth and onwards, losing this pleuripotent ability because it’s no longer needed as the foetus has fully formed.

Some stem cells though retain a multipotency through into adulthood. These are called adult stem cells and all of us have them. The most obvious example would be fat (adipose) stem cells – which aren’t exactly desirable! – and stem cells found in bone marrow (haemopoetic stem cells).

Why are stem cells prized in medicine?

That’s fairly obvious. As I’ve said, embryonic stem cells (ES cells) have the ability to change into the three main layers that form all of the bodies main tissues. If you could harvest ES cells, and “direct” them in culture to forming specific tissues you could, theoretically, provide replacements for any damaged or diseased tissue in the body. Or, you could use ES cells as a therapy to restore some functions that have been lost through disease.

Adult stem cells are already used to treat various diseases. The most obvious example would be treating leukaemia via a bone marrow donation. The adult stem cells in the donated bone marrow replace white blood cell (leukocyte) stem cells lost to cancer – enabling a recipient to begin producing their own healthy leukocytes again. There’s ongoing research that suggests that bone marrow stem cells could be used to create liver and muscle cells too. Some types of adult stem cells have also been used in Canada to restore a man’s eyesight.

Unfortunately, there are plenty of tissues in the body that don’t have an adult stem cell equivalent. It’s these tissues where ES cells would prove useful, as you can “grow” new tissue. This could provide potential treatments for diseases and conditions like:

  • Parkinson’s Disease
  • Alzheimer’s Disease
  • Dementia
  • Multiple Sclerosis
  • Serious neurological damage as the result of trauma
  • “Degenerative” musculo-skeletal diseases like motor neurone disease, Huntington’s disease and muscular dystrophy

Why is embryonic stem cell research controversial?

You have to get those embryonic stem cells from somewhere. That somewhere being….human embryos.Many of the arguments here significantly overlap with those in the abortion debate. By maturing an embryo just long enough to remove embryoblasts and culture them it would, in effect, be an abortion.All of the religious and moral arguments against abortion apply here too – regardless of the “utility” of using ES cells in medical treatment. It could be interpreted as denying one life “a life” whilst prolonging another life whose time has come. The moral question is – would humanity have a right to interfere at such a fundamental level like that?

There’s also the delicate issue of getting embryos in the first place. That somewhere would probably be IVF clinics.IVF clinics usually fertilise several eggs at once for back ups, to be used for research or for training etc. Many of those fertilised embryos are routinely destroyed as part of the process, as the law says embryos can’t be stored for longer than five years.It’s these embryos – there are estimated to be at least 1 million in the UK alone – which would likely become the “resource” for ES cell therapy. That could be interpreted as turning human embryos – perhaps human eggs too – into some sort of commodity. That’s quite an uncomfortable place to be, regardless of your thoughts on that.

The Catholic Church alone would be having kittens. However, you could twist that into making sure embryos aren’t wasted by putting them to good use in the first place via stem cell therapy and research.

Is ES cell therapy viable? Are there alternatives?

At the moment, the use of ES cells in medical therapies is in its earliest clinical trials, so it’s still some way away from being a mainstream medical treatment.
It’s also not without its problems. ES cells, by and large, don’t have any real medical application for a simple reason – they’re (technically speaking) cancerous. It’s hypothesised that some types of cancer could be caused by stem cells that haven’t been “switched off” due to damaged/mutated “switch off” genes. There are also, AFAIK, problems in trying to direct ES cells to differentiate into something useful.

The main benefit of using ES cells over adult stem cells is that they have the ability to change into a wider range of cells and tissues. However, there’s a (highly experimental) prospect of induced pleuripotent cells. That means adult cells – usually skin – which are “reprogrammed” to have the same ability to change into things (pluripotency) as an embryonic stem cell. So it’ll have the benefits, without the controversial need to use a human embryo.

There’s hardly any controversy at all surrounding adult stem cell research, which even has the support of many religious groups. There’s a very real prospect that many diseases pinpointed for treatment by ES cells could one day be treated by alternatives, rendering the use of ES cells in medicine obsolete. That’s how science works, but the research needs to be done in the first place.

The politics of stem cell research and therapy

Most of the controversy here – especially in the US – surrounds state funding for ES cell research, for obvious reasons. Any financial help given towards “destroying” embryos is going to push buttons as it’s effectively state-sanctioned abortion (sort of).

At the moment, the US Government (via the National Institutes of Health) spends around $147million (~£90million) on human ES cell research, and a total of around $1.5billion on general stem cell research. Funding rules have been relaxed by President Obama, after being tightened under George W. Bush. There are also individual state programmes – in particular California – and private investment on top of this, so it’s quite a money intensive area of research.

That puts Wales’ £150million Sêr Cymru and Welsh Life Sciences Fund – however welcome they both are – into perspective. But I think even a relatively modest sum like £10million towards human stem cell research would probably go a long way.

However, as I pointed out, due to improvements in the use of adult stem cells, there might be valid scientific reasons not to fund it too. But I’m not sure cutting funding on this would be the right thing to do, especially for more complicated diseases like Parkinson’s and Alzheimer’s.

In terms of the wider social and health impacts, it would be a game changer, with the prospect of completely transforming medicine. You would no longer need transplants. You could grow replacement organs and tissues from pluripotent stem cells, that would be biologically compatible with the recipient, making rejection unlikely. That would include parts of the body where transplants aren’t currently an option – brain tissues and nerves for instance.All of that would no doubt rapidly improve quality of life, perhaps healthy life spans as well. That will have its own impact because if we all live longer, healthier lives, we’re probably going to want to work longer, there’ll be more people to feed, clothe and house. Some of us might even be more willing to engage in risky behaviours if we’ll know we can “engineer” a new organ relatively easily.

There are also, perhaps perfectly valid concerns, that a more permissive stance in an area like ES cells could open the door to different experiments on human embryos, perhaps delving into genetically engineered humans, “designer babies” and even – under the wrong political regime – things like eugenics. That’s a slippery slope fallacy though. With the right regulations and oversight, it should be fine.

Oh, and you better believe this will end up being a rich man’s/woman’s toy. In an age where people in some parts of the world still die of completely preventable diseases, the richer nations will put money into research that could extend our healthy lives.

Stem cell policy and Independence

It’s unclear if this area of science policy is devolved or not, but I suspect it isn’t.

This is one area of policy I believe the UK has largely got spot on already. Creating human embryonic stem cell lines is legal, and Newcastle University is one of Europe’s leading research centres in this area of science. China actually has some of the most liberal laws on this, because they generally place no (cultural/religious) value on the embryo.

However, creating embryonic stem cell lines remains illegal in a few European countries like Germany, Austria and France.

I don’t think there’s any need for a major shift in policy at a Welsh level, whether via devolution or independence. Should we go as far as the Chinese? Probably not, as it’s worth keeping a slight leash on any area of scientific research.

Changes could include better guidance and funding with regard all types of stem cell research and therapies, as well as perhaps extending the limit for storing human embryos beyond five years (if they would still be useful beyond that point).

The wider question is – how much money should/could Wales put into this area? Should we try to attract private sector investment and involvement in experiments on human embryos? Should we instead concentrate on adult stem cell research and traditional tissue engineering and develop a speciality there?

Developing a niche specialism in tissue engineering – with or without ES cells – could have big spin offs for the Welsh economy if it resulted in new tools or scientific techniques being developed and properly patented. Cardiff University is already home to a specialist tissue engineering research institute, as well as another research institute investigating links between cancer and stem cells.

Maybe there are “miracle cures” in ES cells, maybe they’ll be overtaken by some other innovation. We should probably pursue both avenues, but this issue is likely to shape regenerative medicine over the next decade or two and Wales should stake its claim by building on its university foundations, and by developing solid life science policy from the Welsh Government and Assembly.

Independence, or control over this area of science, might give us a lot more options there.