Saturday, November 15, 2008

Stem Cells 101: Adult, Embryonic, and Exploitation

With the recent coverage of President-elect Obama's intent on reversing President Bush's executive order that limited the majority of embryonic stem cell research from receiving federal tax dollars, I thought it was a good time to review the political history, discuss the terminology and basic information regarding stem cells.

In terms of a bit of history, President Clinton was the first president who could have permitted federal funding on embryonic stem cell research, but he did not. President Bush was the first to allow federal funds to be used on a limited amount of embryos for embryonic stem cell research, embryos which had already been destroyed and stem cell lines created from those embryos

Most people, including myself until recently, do not know the difference between embryonic and adult (or somatic) stem cells. Taking a step back, all stem cells are unique since they repair damage organs and rebuild vital tissues in our bodies. They do this by multiplying and transforming into new healthy cells - this is the "regenerative" aspect of stem cell medicine.

Embryonic stem cells are pluripotent, which means they can be grown in the lab and become any type of cell, and they have the potential to divide an unlimited number of times. Adult stem cells are multipotent, meaning for example, that a bone stem cell could be grown in the lab to make more bone skin cells, or a blood stem cell could be grown in the lab to make blood stem cells, so they are limited in their flexibility compared with embryonic stem cells. However advances have shown that adult stem cells have been able to be coaxed into forming different stem cells therefore may have more pluripotent stem cell capabilities like embryonic stem cells.

Embryonic stem cells to date have had limited success in animal tests and has yet to produce a single viable treatment in humans. For that matter, they have not yet been safe enough to enter into any human clinical trials. One difficulty is because of their pluripotency, they become disorganized and produce teratomas (tumors) that lead to cancer. Also because embryonic stem cells come from another human, there is the risk of immune rejection.

Adult stem cells, which include umbilical cord blood stem cells, have provided benefits in over 70 diseases based on peer-reviewed published reports. From helping people with brain cancer, diabetes, spinal cord injury, heart disease, Parkinson's, sickle cell anemia, lupus and others. An adult stem cell treatment recently cured a man with multiple sclerosis and he has been MS free for 5 years now. The advantage of adult stem cells is that they do not form teratomas, and often the stem cells used to treat the patient are their own, therefore avoiding any immune rejection issues, and there is no big money involved.

Why make this last statement? Because what is unknown from most conversations is that embryonic stem cells is driven by money as much as it is driven to find cures. In 2004, Proposition 71 in California allocated $3 billion for embryonic stem cell research and cloning, which helped fuel new companies within this space, but both startups and larger companies are involved in this chase for a golden egg.

Curiously, another unknown in this debate is the need for human eggs for this embryonic and cloning research. Most eggs are donated by IVF (in vitro fertilization) patients, but a growing source are young healthy women. How are these young women enticed to donate their eggs? Money. Ads are placed on college campuses stating $50,000 or $100,000 for egg donations. This is why feminist organizations have voiced a great concern that women will be sought out has embryo farms. Alarmist?

Just consider that sometimes 100 eggs are necessary to obtain one embryonic stem cell line. If a cure is ever discovered through embryonic stem cells, imagine how many eggs it would take to cure 100,000 people. 10,000,000 eggs. Let's simplify it and say 10 eggs. 1,000,000 eggs. 1.5 million Americans have Parkinson's disease, so to "cure" them it would take 15 million eggs. All from IVF? Of course not. Young women in America. If feminist and other organizations wise up, which they will, where do you think the embryonic stem cell industry will look? Third world countries? Of course. Kenya? India? Peru? There have already been two cases of exploitation of women for eggs. First, in South Korea, during the Dr. Hwang fraudulent cloning research scandal, and then in Eastern Europe, where the European Parliament found their young women were being exploited for eggs and issued the, “European Parliament Resolution on the Trade in Human Egg Cells.”

This is not a pro-life or pro-choice issue. This is a very serious women's health issue. Another fact that most people don't know is that to extract eggs for IVF and embryonic stem cell research Ovarian Hyperstimulation is used. This stimulates a woman's body to release more eggs than a normal ovulation cycle would allow. 5, 10 or greater. A result of putting a woman's ovary into hyperdrive can be Overian Hyperstimulation Syndrome (OHSS). The changes can even cause death. Ask former Stanford University student, Calla Papademas, about this. After answering an egg donor ad for money, the process caused a stroke, brain damage and left her infertile.

Regardless of your support for embryonic stem cell research or not, we should all seek a minimum of:

1. Providing adequate informed consent. There is none present at this time. Women donating their eggs don't know about the risks. We can’t tell them the risks because, we don't even know the risks involved since there hasn't been any meaningful short or long term studies on the effects of this practice. In addition conflicts of interest within the IVF and scientific community have hindered efforts to protect young women egg donors. They need eggs, and lots of eggs, so it is in their interest to claim the safety of egg donation and down-play any risks.

2. Creation of a national egg donor registry. This is needed at a bare minimum, to begin tracking and monitoring women undergoing ovarian stimulation. Similar to the current organ donation registry, which tracks and monitors all organ donors, egg donors deserve the same type of follow-up.

What's unfortunate is that the battle for embryonic stem cell search was led by big money. Most of the state propositions that passed were misleading because they did not discuss the serious women's health issues involved. Also they stated that human cloning would not be involved, which 90% of Americans are against. It was a twisting of words since cloning is used in the process to create embryonic stem cells from cloned human embryos. Using cloned embryos is key to avoiding the immune rejection problems. Ask medical experts such Stanford University's Dr. William Hurlbut, or others outside of the IVF and embryonic stem cell industry. Last, if you notice the wording on some of the propositions, they discuss the success of "stem cell" treatments. As stated earlier, the only successes have been with adult stem cells, which are not under religious controversy, so this was another unethical twisting of facts.

There is a new promise that could eliminate the religious controversy and women's health issues. In 2006, Shinya Yamanaka at Kyoto University in Japan generated the first induced pluripotent stem cells (ISP). They have the promise of embryonic stem cells without all the baggage. In 2007, James Thomson, who interestingly discovered embryonic stem cells, and colleagues at University of Wisconsin - Madison (Go Badgers!) and Shinya Yamanaka and colleagues at Kyoto University in Japan both produced the first human induced pluripotent stem cells. Basically they took adult cells and returned them to an early state similar to embryonic stem cells. It's also interesting to hear the scientists, backed by large funding sources, who previously said that the only focus should be on embryonic stem cell research are now saying to seek all solutions.

If these issues concern you, at a minimum tell people about the women's health issues around embryonic stem cell research. If you want to do more, push for adequate informed consent and a national egg donor registry. Also you can learn more from the Center of Bioethics and Culture here.

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