Stem Cells Six Months Later

The medical, ethical and legal issues surrounding stem cell research mutate faster than the cells themselves.

This month the results of several stem cell studies were announced. At issue are not so much the anticipated benefits of using stem cells to treat certain diseases, but rather how the stem cells are obtained — whether from human embryos, less than 14 days old, or from adults.

“Early research says we’re going to be in this for a long time” said Dr. Michael Grodin, professor and director of the Law, Medicine, Ethics and Human Rights Program at Boston University’s School of Public Health. “There is an essential and immediate need to define our terms — to decide what it is, what it can be and who should decide what we should do.”

U.S. and international studies have already shown that stem cells can be used to treat a myriad of diseases, conditions and disabilities, including Parkinson’s, Alzheimer’s and Lou Gehrig’s diseases; spinal cord injur; stroke; burns; heart disease; diabetes, and rheumatoid arthritis. The National Institutes of Health (NIH) says that stem cells could be an infinitely renewable source of replacement cells and tissues.

But a fierce debate rages over how the cells are obtained.

Cells are the body’s building blocks. Stem cells are “primitive” cells that are undifferentiated — that is, they are not yet developed into specific cells, such as blood, muscle or bone.

Stem cells can be “gathered” primarily in two ways. Embryonic stem cells can be extracted from a four-day-old hollow sphere of cells called a blastocyst. These cells are valued because they are pluripotent; they can give rise to many types of cells that form an entire organism.

Stem cells can also be gathered from adult multipotent stem cells, which are cells that have further undergone specialization. These cells are committed to giving rise to cells that have a particular function.

The process for gathering adult stem cells is as risky and costly as vitro fertilization. Proponents of embryonic stem cell research argue that the pluripotent cells in a blastocyst are not all the types necessary for fetal development. The NIH says that if an inner cell mass cell (comprised of stem cells) were placed into a woman’s uterus, it would not develop into a fetus.

In dispute is which type of cells is more beneficial for the treatment of disease.

Last week, the Associated Press reported a study that argued embryonic stem cells are more genetically stable than adult stem cells. The study, which appeared in the Proceedings of the National Academy of Science, showed stem cells obtained from mice embryos had fewer mutations — and, therefore, a lower risk of rejection — than adult stem cells.

A Beth Israel Deaconess Medical Center animal study also announced this month shows the transplantation of embryonic stem cells can help repair injured heart muscle and improve cardiac function following heart attacks and the development of congestive heart failure.

While the National Academy of Science and Beth Israel studies promoted the use of embryonic stem cells, the March 7 New England Journal of Medicine ran a report that touted the versatility of adult stem cells.

The Journal study found evidence that adult stem cells circulating in the bloodstream can grow into new tissue in the liver, gut and skin. Although not definitive, this University of Texas study makes a case for the use of adult stem cells to treat disease.

“It seems difficult to deny that relieving widespread suffering is morally better than destroying embryos at no gain,” said Louis Guenin, who teaches ethics at Harvard Medical School and whose June 2001 article in Science magazine said using human embryos in scientific research is not only justifiable, but admirable.

“The perception changes when you look at cells in petri dishes,” said Dr. Jim Sujanen, a Boston radiologist. “People say, ‘Well, that’s not human.’ Well, if it’s not human, then why would you want to study it?”

Critics argue that harvesting embryos for research, even if the research is aimed at the treatment of disease, is a violation of the sanctity of human life.

Fearing “embryo farms,” the National Right to Life Committee launched a radio advertising campaign Feb. 25 in seven Utah cities urging Sen. Orrin Hatch (R-Utah) “to say no to embryo hatcheries.”

Many scientists and ethicists see one of the biggest challenges to the research “stemming” from the public’s misunderstanding of the research.

The Associated Press reported the President’s Council on Bioethics spent much of its Feb. 19 session debating the nomenclature of stem cell research, struggling to find names for the experiments and their derivatives.

But will stem cell research fulfill its promises?

“Sometimes I feel like the proponents of stem cell therapy are not being honest,” Sujanen said. “Cures for diseases are elusive. [Doctors] don’t really cure people; we make them better. We help them live longer and improve the quality of their lives.”

“Society equates any kind of physical or mental impairment with some kind of lesser personhood,” said Adrienne Asch, the Henry R. Luce Professor in Biology, Ethics and Politics of Human Reproduction at Wellesley College.

“We assume that all the person with a spinal cord injury wants to do is walk again. Yes, they might want that, but mostly they want to live normal lives. They want the ability to do normal things — to have jobs, lovers, families and go to restaurants,” Asch said.

Media attention to the stem cell debate reached a head last August when President Bush announced the federal government would only fund embryonic stem cell research already currently underway. Bush also named a president’s council to monitor stem cell research, to recommend appropriate guidelines and regulations and to consider all of the medical and ethical ramifications of biomedical innovation.

But the issues are still being argued in state and federal legislatures.

Actor Christopher Reeve, who was paralyzed from the neck down in a 1995 horse-riding accident, told the Senate Health Committee earlier this month that he was “deeply disturbed by unreasonable attempts to block scientific progress.” He asked lawmakers to support a bill, co-sponsored by Sen. Edward Kennedy (D-Mass.), which would allow funding for research on stem cells.

“The potential effects are enormous. It could touch every part of medicine. If we’re going to do it, the federal government and medical community should make sure it continues well,” Grodin said.

Financial resources, however, do not guarantee results. Billions of dollars and over 15 years of research have gone into the human genome project, for example, with no actual cures or treatments resulting from the studies.

In fact, the Associated Press reported last week that Larry Goldstein, a cell biologist at the University of California—San Diego, said it is unlikely the 78 cell colonies currently approved for federal funding will be enough to develop medical treatments.

No matter which side of the debate people fall on, almost everyone seems to agree it is impossible to know when proven, regulated treatments and drugs will be commercially available.