The State of Stem Cell Research

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The State ofStem Cell Research
Patrick D. McArthur, Ph.D.Department of
Biological SciencesOkaloosa Walton College
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Objectives

• Understand the scientific theories and processes
  between Embryonic (ES), Cloning, and Adult (AS)
  stem cell procedures
• Evaluate the current medical treatments
• Discern between Promises and Lies

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State of Affairs

• At an April 30, 2000 press conference, U.S.
  Senator Arlen Specter was asked by a reporter
  when life begins. Senator Specter replied, I
  havent found it helpful to get into the
  details.
• 2 Timothy 215 (KJV) Study to shew thyself
  approved unto God, a workman that needeth not be
  ashamed, rightly dividing the word of truth.

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The Scientific Method

• A strictly defined method
• Objective
• Constructs models to explain function
• Quantitative
• Compares observations against known principles
• A way of seeking principles of order in the
  natural world.
• Science is an organized and continually changing
  body of knowledge based upon observation,
  generalization, and experimentation.
• Science provides explanations for natural
  phenomena
• Science provides discoveries and technologies
  that improve life and society

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Derivation of Embryonic Stem Cells
Method patentedU.S. patent held by Univ.
Wisconsin
Purported Advantages1) Proliferate
indefinitely2) Form any tissue
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Evidence for Embryonic Stem Cell Pluripotency
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• Promises, Premises, and Published Data
• Claims for embryonic stem cells unsubstantiated
• Current and potential embryonic stem cell
  problems
• No current clinical treatments
• Few successes in animal models
• Difficulty in obtaining pure cultures in the dish
• Difficult to establish and maintain
• Problem of immune rejection
• Potential for tumor formation
• Genomic instability

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• Quotes from proponents of human embryonic stem
  cell research
• Rarely have specific growth factors or culture
  conditions led to establishment of cultures
  containing a single cell type. Furthermore,
  there is significant culture-to-culture
  variability in the development of a particular
  phenotype under identical growth factor
  conditions. The possibility arises that
  transplantation of differentiated human ES cell
  derivatives into human recipients may result in
  the formation of ES cell-derived tumors.
  Odorico JS, Kaufman DS, Thomson JA,
  Multilineage differentiation from human
  embryonic stem cell lines, Stem Cells 19,
  193-204 2001
• The work presented here shows that none of the
  eight growth factors tested directs a completely
  uniform and singular differentiation of
  cells.Schuldiner M et al. Effects of eight
  growth factors on the differentiation of cells
  derived from human embryonic stem cells Proc.
  Natl. Acad. Sci. USA 97, 11307-11312 Oct. 10,
  2000
• Transplanted ES cells spontaneously
  differentiate into any of a variety of
  ectodermal, endodermal and mesodermal cell
  typessometimes into a disorganized mass of
  neurons, cartilage and muscle sometimes into
  teratomas containing an eye, hair or even
  teeth.Robert P. Lanza, Jose B. Cibelli,
  Michael D. West Human therapeutic cloning
  Nature Medicine 5, 975-977 September 1999.
• Normally, if you take an embryonic stem cell, it
  will make all kinds of things, sort of
  willy-nilly," says Doug Melton. (Jacqueline
  S. Mitchell, Stem Cells 101, PBS Scientific
  American Frontiers, May 28th, 2002
  http//www.pbs.org/saf/1209/features/stemcell.htm)

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Human Cloning
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Embryo Splitting
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Fertilization vs. Cloning (somatic cell nuclear
transfer)
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• Cloning is unsafe for the clone and the surrogate
  mother
• Our results indicate that even apparently healthy
  cloned animals can have gene expression
  abnormalities that are not severe enough to
  impede development to birth but that may cause
  subtle physiological abnormalities which could be
  difficult to detect. Humpherys D et al.
  Epigenetic instability in ES cells and cloned
  mice Science 293, 95-97 July 6, 2001
• Humpherys D et al. Abnormal gene expression in
  cloned mice derived from embryonic stem cell and
  cumulus cell nuclei Proc. Natl. Acad. Sci. USA
  99, 12889-12894 October 1, 2002
• A review of all the worlds cloned animals
  suggests that every one of them is genetically
  and physically defective. The widespread
  problems associated with clones has led to
  questions as to whether any clone was entirely
  normal, Ian Wilmut said. There is abundant
  evidence that cloning can and does go wrong and
  no justification for believing that this will not
  happen with humans. Gene defects emerge in all
  animal clones, Sunday Times of London, April 28,
  2002
• Dolly the sheep, first cloned mammal 1 live
  birth out of 277 cloned embryos (0.4)
• Cloned mice 5 live births out of 613 cloned
  embryos (0.8) 5 live births out of 314 cloned
  embryos implanted (1.6) (0.8 1 survived) 26
  live births out of 312 cloned embryos implanted
  (8.3) (4.2 13 survived)
• Cloned pigs 5 live births out of 72 cloned
  embryos implanted (7)
• Cloned goats 3 live births out of 85 cloned
  embryos implanted (3.5)
• Cloned cattle 30 live births out of 496 cloned
  embryos implanted (6) (4.8 24 survived)
• Cloned cat 1 live birth out of 188 cloned
  embryos (0.5) of 87 embryos implanted (1.1)
• Cloned gaur 1 live birth out of 692 cloned
  embryos (81 blastocysts) (0.1) (0 0 survived)
• Cloned rabbits 6 live births out of 1852 cloned
  embryos (0.3) (0.2 4 survived)
• Health risk for the surrogate motherlarge
  offspring syndrome

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Conceptualization of Therapeutic Cloning
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Human embryo cloning places women at risk To
treat 17 million Diabetes patients in the United
States Collecting 10 eggs/donor (ACT--71 eggs
from 7 donors) At generous 20 cloning efficiency
(to achieve blastocyst stage) At generous 10
efficiency at initiating ES cell culture Will
require minimum of 850 million eggs Will require
minimum 85 million women of childbearing age as
donors Health risksHigh-dose hormone therapy and
surgery to obtain eggs risks the donors health
and future reproductive success Commercial
exploitationdisadvantaged women in U.S. and
abroad
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Therapeutic Cloning Unsuccessful
Our results raise the provocative possibility
that even genetically matched cells derived by
therapeutic cloning may still face barriers to
effective transplantation for some
disorders. W.M. Rideout et al., Correction of a
genetic defect by nuclear transplantation and
combined cell and gene therapy, Cell Immediate
Early Publication, published online March 8, 2002
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ACT experiment with cloned cow tissues
Matching cloned tissues Not through use of
embryonic stem cells, but by gestation of clone
to fetal stage before tissue harvesting. Because
cloned cells were derived from early-stage
fetuses, this approach is not an example of
therapeutic cloning and would not be undertaken
in humans. (emphasis added) Robert Lanza et al.
Generation of histocompatible tissue using
nuclear transplantation, Nature Biotechnoology,
Advance Online Publication, June 3, 2002
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• Quotes regarding therapeutic cloning
• Moreover, because therapeutic cloning requires
  the creation and disaggregation ex utero of
  blastocyst stage embryos, this technique raises
  complex ethical questions.CRNT cell
  replacement through nuclear transfer, a.k.a.
  therapeutic cloning requires the deliberate
  creation and disaggregation of a human
  embryo.It is true that the techniques
  developed in CRNT cell replacement through
  nuclear transfer, a.k.a. therapeutic cloning
  research can prepare the way scientifically and
  technically for efforts at reproductive
  cloning.Robert P. Lanza, Arthur L. Caplan, Lee
  M. Silver, Jose B. Cibelli, Michael D. West,
  Ronald M. Green "The ethical validity of using
  nuclear transfer in human transplantation" The
  Journal of the American Medical Association 284,
  3175-3179 Dec 27, 2000.
• Thomas Okarma, chief executive officer, Geron
  Corporation says The odds favoring success are
  vanishingly small, and the costs are daunting.
  It would take thousands of human eggs on an
  assembly line to produce a custom therapy for a
  single person. The process is a nonstarter,
  commercially.(Denise Gellene, Clone Profit?
  Unlikely, Los Angeles Times, May 10, 2002)

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• Quotes regarding therapeutic cloning
• The poor availability of human oocytes, the
  low efficiency of the nuclear transfer procedure,
  and the long population-doubling time of human ES
  cells make it difficult to envision this
  therapeutic cloning becoming a routine clinical
  procedureOdorico JS, Kaufman DS, Thomson JA,
  Multilineage differentiation from human
  embryonic stem cell lines, Stem Cells 19,
  193-204 2001
• However, it is unlikely that large numbers of
  mature human oocytes would be available for the
  production of ES cells, particularly if hundreds
  are required to produce each ES line. The
  technical capability for nuclear transfer would
  also need to be widely available and this is
  unlikely. In addition, epigenetic remnants of
  the somatic cell used as the nuclear donor can
  cause major functional problems in development,
  which must remain a concern for ES cells derived
  by nuclear transfer. Although it is possible
  to customize ES cells by therapeutic cloning or
  cytoplasmic transfer, it would appear unlikely
  that these strategies will be used extensively
  for producing ES cells compatible for
  transplantation.(Alan O.Trounson, The
  derivation and potential use of human embryonic
  stem cells, Reproduction, Fertility, and
  Development 13, 523-532 2001)

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• Quotes regarding therapeutic cloning
• Robert Lanza, chief scientist at Advanced Cell
  Technology in Worcester, Mass., an ardent
  advocate for both embryonic stem cell studies and
  therapeutic cloning, agreed that in the course of
  the political debate, the need for cloning to
  overcome immune system rejection has been
  overstated. Its not all or nothing. You can
  move ahead.San Francisco Chronicle, Monday,
  March 18, 2002 Page E 1)
• John Gearhart of Johns Hopkins University
  also says that many scientists feel there are
  ways of getting around the rejection problem
  without the nuclear transfer paradigm.
  Constance Holden, Would cloning ban affect
  stem cells?, Science 293, 1025 Aug 10, 2001
• There is no question in my mind that the
  possibility exists that if you are doing an egg
  donor, and nuclear transfer into an egg, that
  there possibly exists that that cell -- that the
  embryonic stem cells derived from that could be
  rejected. Absolutely.Dr. John Gearhart
  transcript of the April 25, 2002 meeting of the
  Presidents Council on Bioethics p.47
  http//www.bioethics.gov/meetings/200204/0425.doc
  
• Dr. Irving Weissman, Stanford, told the
  President's Council on Bioethics on February 13,
  2002 that embryonic stem cells from cloned
  embryos would require immune suppression I
  should say that when you put the nucleus in from
  a somatic cell, the mitochondria still come from
  the host. He concluded, And in mouse studies it
  is clear that those genetic differences can lead
  to a mild but certainly effective transplant
  rejection and so immunosuppression, mild though
  it is, will be required for that.

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• Cloning Unnecessary and Obsolete--leading
  embryonic stem cell expert
• Alan Trounson, Australian embryonic stem cell
  expert and a leader in the field worldwide, says
  that stem cell research has advanced so rapidly
  in the past few months that therapeutic cloning
  is now unnecessary. My view is there are at
  least three or four other alternatives that are
  more attractive already, he said.Trounson
  abandoned his call for therapeutic cloning,
  saying scientific breakthroughs mean there is now
  no need for the controversial technique.Professor
  Trounson said therapeutic cloning faced
  logistical problems, and that other techniques
  were showing great promise and offered better
  options. I can't see why, then, you would
  argue for therapeutic cloning in the long term
  because it is so difficult to get eggs and you've
  got this issue of (destroying) embryos as
  well.Stem-cell cloning not needed, says
  scientist, The Age (Melbourne), pg. 2, July 29,
  2002Stem-cell research outpaces cloning, The
  Australian, pg. 3, July 29, 2002Therapeutic
  cloning no longer necessary expert, AAP
  Newsfeed, July 29, 2002

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• THINGS TO CONSIDER
• Moral status of the human embryo
• Human being at one cell embryo, developmental
  continuum
• Whats in the dish? Person or property?
• Presence of human soul or personhood outside
  scope of sciencetheological/philosophical/societa
  l definition
• Commodification of human life (realized or
  potential)
• Scientific claims, scientific facts
• Potential medical benefits vs. patient suffering
• Alternatives (e.g., adult stem cells)
• Promises, Premises, and Published data(previous
  predictions of miracle cures, e.g., fetal tissue
  transplants)
• Public and Private
• Economics, Intellectual Property, Oversight,
  Public Policy
• Scientific Freedom, Status, and Stewardship
• Public perception, Access

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• Ethical Questions
• Unethical?
• to destroy human embryos
• to destroy human embryos for stem cells if there
  is a viable alternative
• to experiment with humans before work is verified
  in animals
• because embryonic stem cells pose significant
  risks
• Tumors
• Transplant rejection
• Instability in gene expression
• because it would divert limited funds to less
  promising research and potentially delay disease
  cures

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Questions regarding human cloning

• Any evidence that cloning is necessary or useful
  for medical treatments?
• Will cloning research divert resources and delay
  cures?
• Is banning only implantation unenforceable?
• Possible reproduction of living or deceased
  persons without knowledge or consent?
• Confusionkinship, parent-child identity,
  parental expectations?
• Creating a class of humans who exist only as
  means to achieve the ends of others?
• Risking health and exploitation of women?
• Leading to commodification, commercialization of
  human life?
• Gateway to genetic manipulation and control of
  human beings?

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In our judgment, the derivation of stem cells
from embryos remaining following infertility
treatments is justifiable only if no less morally
problematic alternatives are available for
advancing the research The claim that there
are alternatives to using stem cells derived from
embryos is not, at the present time 9/99,
supported scientifically. We recognize, however,
that this is a matter that must be revisited
continually as the demonstration of science
advances. Ethical Issues in Human Stem Cell
Research National Bioethics Advisory
Commission September, 1999 (emphasis added)
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Director, Program in NeuroscienceCentral
Michigan University 

• As a researcher, I am dismayed at the
  disinformation that is given to legislators by
  misguided critics of this legislation.  Please do
  not fall into the trap of believing that
  adult-derived stem cells are a viable alternative
  to using the undifferentiated blastocytes that
  the current legislation would allow.  This
  argument has been soundly refuted by leading
  scientists in my field, and is inconsistent with
  my own experience as a stem cell researcher.

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Scientific experts(the U.S. National
Institutes of Health, the U.S. National Academy
of Sciences, 80 Nobel Laureates) are not
necessarily unbiased arbiters
Some adult stem cells appear to have the
capability to differentiate into tissues other
than the ones from which they originated this is
referred to as plasticity. Reports of human or
mouse adult stem cells that demonstrate
plasticity and the cells they differentiate or
specialize into include 1) blood and bone marrow
(unpurified hematopoietic) stem cells
differentiate into the 3 major types of brain
cells (neurons, oligodendrocytes, and astrocytes)
ectoderm, skeletal muscle cells, cardiac muscle
cells mesoderm, and liver cells endoderm 2)
bone marrow (stromal) cells differentiate into
cardiac muscle cells, skeletal muscle cells, fat,
bone, and cartilage and 3) brain stem cells
differentiate into blood cells and skeletal
muscle cells. Ibid, Pg. ES-7 emphasis
added
There is no evidence of an adult stem cell that
is pluripotent. It has not been demonstrated that
one adult stem cell can be directed to develop
into any cell type of the body. That is, no adult
stem cell has been shown to be capable of
developing into cells from all three embryonic
germ layers. Stem Cells Scientific Progress and
Future Research Directions, National Institutes
of Health, June 2001 Pg. ES-6 (emphasis added)
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Adult Stem Cells More promising alternative for
treatments Able to generate virtually all adult
tissues Can multiply almost indefinitely,
providing numbers sufficient for clinical
treatments Proven success in laboratory
culture Proven success in animal models of
disease Proven success in current clinical
treatments Ability to home in on damage Avoid
problems with tumor formation Avoid problems with
transplant rejection Avoid ethical quandary
www.stemcellresearch.org
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Regenerative Medicine with Stem Cells
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Route Stem Cell The stem cell landscape depicted
here illustrates the emerging characteristics of
adult stem cells that include plasticity in cell
fate, diversity of origin, and a multiplicity of
tissue potentials. Stem cells (blue) are able to
enter diverse tissue compartments from the
bloodstream (the stem cell highway) via on
ramps and generate appropriate cell types in
response to homing signals or growth factors
depicted on billboards. In theory, all choices
are reversible.
from Blau HM, Brazelton TR, Weimann JM, The
evolving concept of a stem cell entity or
function?, Cell 105, 829-841, June 29, 2001
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Adult stem cells show pluripotent capacity Adult
stem cells from bone marrow can form all body
tissues--Jiang Y et al. Pluripotency of
mesenchymal stem cells derived from adult
marrow Nature 418, 41-49 4 July 2002
(published online 20 June 2002)Patients
receiving hematopoietic stem cell transplant
stem cells also formed liver, skin, digestive
tract.--Körbling MK et al. Hepatocytes and
epithelial cells of donor origin in recipients of
peripheral-blood stem cells New England Journal
of Medicine 346, 738-746 March 7, 2002A single
adult mouse bone marrow stem cell can form
functional marrow, blood cells, liver, lung,
gastrointestinal tract, skin, heart and skeletal
muscle.--Krause DS et al. Multi-Organ,
Multi-Lineage Engraftment by a Single Bone
Marrow-Derived Stem Cell Cell 105, 369-377 May
4, 2001Adult stem cells from brain can grow into
a wide variety of organsheart, lung, intestine,
kidney, liver, nervous system, muscle, and other
tissues. --Clarke et al. Generalized potential
of adult neural stem cells Science 288,
1660-1663, June 2, 2000. Adult stem cells can
multiply extensively, sufficient to treat
patients --Shi S et al. "Bone formation by human
postnatal bone marrow stromal stem cells is
enhanced by telomerase expression" Nature
Biotechnology 20, 587-591 June
2002--Neildez-Nguyen TMA et al. Human
erythroid cells produced ex vivo at large scale
differentiate into red blood cells in vivo
Nature Biotechnology 20, 467-472 May
2002--Antonchuk J et al. HOXB4-induced
expansion of adult hematopoietic stem cells ex
vivo Cell 109, 39-45 April 5, 2002
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Adult stem cells effective treating animal models
of disease StrokeAdult bone marrow stem cells or
umbilical cord blood stem cells, even delivered
intravenously to brain tissue which has suffered
stroke damage in rats, provide therapeutic
benefit after stroke. The cells appeared to
home to sites of damage.--Riess P et al.
Transplanted neural stem cells survive,
differentiate, and improve neurological motor
function after experimental traumatic brain
injury Neurosurgery 51 published online October
2002 doi10.1227/01.NEU.0000027826.68845.CF--Li
Y et al. Human marrow stromal cell therapy for
stroke in rat Neurology 59, 514-523 August
2002--Zhao L-R et al. Human bone marrow stem
cells exhibit neural phenotypes and ameliorate
neurological deficits after grafting into the
ischemic brain of rats, Experimental Neurology
174, 11-20 2002.--Chen J et al. Intravenous
administration of human umbilical cord blood
reduces behavioral deficits after stroke in
rats Stroke 32, 2682-2688 November 2001 Heart
DamageBone marrow stem cells injected into
heart, blood stream, or mobilized from the bone
marrow, repair damage after heart attack.--Toma
C et al. Human Mesenchymal Stem Cells
Differentiate to a Cardiomyocyte Phenotype in the
Adult Murine Heart Circulation. 105, 93-98 Jan
1/8, 2002--Orlic D et al., Mobilized bone
marrow cells repair the infarcted heart,
improving function and survival Proceedings of
the National Academy of Sciences USA 98,
10344-10349, August 28, 2001.--Jackson KA et
al. Regeneration of ischemic cardiac muscle and
vascular endothelium by adult stem cells
Journal of Clinical Investigation 107, 1395-1402
June 2001--Orlic D et al. Bone marrow cells
regenerate infarcted myocardium Nature 410,
701-705 April 5, 2001
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Adult Stem Cells Several labsadult stem cells
capable of re-growth and reconnection in spinal
cord injury, allowing functional recovery. They
"promote functional recovery of paraplegic adult
rats and long-distance motor axon regeneration in
their completely transected severed spinal
cords," and showed "dramatic functional
improvement and anatomical repair" (Ramon-Cueto
et al. 2000). Transplanted adult stem cells
or stimulation of existing cells achieved
re-growth of neurons and re-myelination
(sheathing) of neurons.Hofstetter CP et al.,
Marrow stromal cells form guiding strands in the
injured spinal cord and promote recovery, Proc
Natl Acad Sci USA 99, 2199-2204 Feb 19, 2002M.
Sasaki et al., "Transplantation of an acutely
isolated bone marrow fraction repairs
demyelinated adult rat spinal cord axons," Glia
35, 26-34 July 2001A. Ramon-Cueto et al.,
"Functional recovery of paraplegic rats and motor
axon regeneration in their spinal cords by
olfactory ensheathing glia," Neuron 25, 425-435
Feb 2000.M.S. Ramer et al. "Functional
regeneration of sensory axons into the adult
spinal cord," Nature 403, 312-316 Jan 20, 2000.
Shihabuddin et al. "Adult spinal cord stem
cells generate neurons after transplantation in
the adult dentate gyrus," J Neurosci 20,
8727-8735 Dec 2000.Barnett et al.
"Identification of a human olfactory ensheathing
cell that can effect transplant-mediated
remyelination of demyelinated CNS axons," Brain
123, 1581-1588, Aug 2000A. Ramon-Cueto et al.,
"Long-distance axonal regeneration in the
transected adult rat spinal cord is promoted by
olfactory ensheathing glial transplants, J
Neurosci 18, 3803-3815 May 15, 1998
Spinal Cord Injury
Embryonic Stem Cells McDonald et al. showed some
functional improvement in rats with spinal cord
injury, slightly better than no treatment alone.
Liu et al. and Brüstle et al. showed that ES
cells could form protective myelin sheaths around
nerves in rats with spinal cord injury, but they
did not show or test for any functional recovery
of the animals.J.W. McDonald et al.,
"Transplanted embryonic stem cells survive,
differentiate and promote recovery in injured rat
spinal cord," Nature Medicine 12, 1410-1412, Dec
1999S. Liu et al., "Embryonic stem cells
differentiate into oligodendrocytes and myelinate
in culture and after spinal cord
transplantation," Proc. Natl. Acad. Sci. USA 97,
6126-6131 May 23, 2000O. Brüstle et al.,
"Embryonic Stem Cell-Derived Glial Precursers A
Source of Myelinating Transplants," Science 285,
754-756, July 30, 1999
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Diabetes
Adult Stem Cells Scientists retrained immune
cells to reverse diabetes in mice. The
autoimmunity that was previously directed against
insulin-secreting cells was reversed, and adult
stem cells in the mice formed insulin-secreting
cells. The treatment was thus able to effect an
apparent cure of established Type 1 diabetes in
the diabetic mouse.S. Ryu et al. "Reversal
of established autoimmune diabetes by restoration
of endogenous ß cell function, J. Clin. Invest.
108, 63-72 July 2001Liver or pancreatic adult
stem cells grown in culture formed
insulin-secreting islets. When injected into
diabetic mice, the mice survived without further
need of insulin injections.Abraham et al.
Insulinotropic hormone glucagon-like peptide-1
differentiation of human pancreatic islet-derived
progenitor cells into insulin-producing cells
Endocrinology 143, 3152-3161 Aug 2002Yang L
et al. In vitro trans-differentiation of adult
hepatic stem cells into pancreatic endocrine
hormone-producing cells Proceedings of the
National Academy of Sciences USA, Online Early
Edition 10.1073/pnas.122210699 June 4, 2002
Peck A et al. Use of in vitrogenerated, stem
cellderived islets to cure type 1 diabetes. How
close are we? Ann. N.Y. Acad. Sci. 958, 59-68
2002.V.K. Ramiya et al. "Reversal of
insulin-dependent diabetes using islets generated
in vitro from pancreatic stem cells," Nature
Medicine 6, 278-282, March 2000.
Embryonic Stem Cells Researchers reported the
conversion of mouse embryonic stem cells into
insulin producing pancreatic islet cells. The
mouse embryonic stem cells secreted only 1/50th
the normal amount of insulin, and diabetic mice
implanted with the cells still died.N. Lumelsky
et al. "Differentiation of embryonic stem cells
to insulin-secreting structures similar to
pancreatic islets," Science 292, 1389-1394 May
18, 2001
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Parkinsons Disease
Adult Stem Cells
Embryonic Stem Cells
Injection of growth protein into brains of
Parkinsons rats caused their neural stem cells
to grow, migrate to damage, and begin to replace
missing nerve cells. 80 of rats showed a
benefit, with no tumor formation.J. Fallon et
al. "In vivo induction of massive
proliferation,directed migration, and
differentiation of neural cells in the adult
mammalian brain," Proc. Natl. Acad. Sci. USA 97,
14686-14691 December 19, 2000 A Chicago Rush
Hospital team identified the signal to turn brain
stem cells into dopamine neurons, and grafted the
cells into brains of Parkinsons rats,
effectively curing the rats severe Parkinson
symptoms.Experimental Biology meeting, New
Orleans, April 2002 An Emory University group
implanted retinal cells into brains of advanced
Parkinsons patients, improving their motor
function by 50.American Academy of Neurology
conference, Denver, April 18, 2002 Using the
patients own adult neural stem cells, a group at
Los Angeles Cedars-Sinai Medical Center reports a
total reversal of symptoms in the first
Parkinsons patient treated.American Association
of Neurological Surgeons meeting, April 8, 2002
NIH researchers used gene engineering to enrich
mouse ES cells for dopamine neurons. Injected
into Parkinsons rats gave some benefit up to 8
weeks after injection.J-H Kim et al. Dopamine
neurons derived from embryonic stem cells
function in an animal model of Parkinsons
disease Nature 418, 50-56 July 4, 2002
(published online June 20, 2002) Parkinsons rats
injected with embryonic stem cells showed a
modest benefit for just over 50 of the rats, but
one-fifth (20) of the rats died of brain tumors
caused by the embryonic stem cells.L.M.
Bjorklund et al. "Embryonic stem cells develop
into functional dopaminergic neurons after
transplantation in a Parkinson rat model, Proc.
Natl. Acad. Sci.USA 99, 2344-2349 Feb 19, 2002
(published online Jan 8, 2002)
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• Current Clinical Uses of Adult Stem Cells
• CancersLymphomas, multiple myeloma, leukemias,
  breast cancer, neuroblastoma, renal cell
  carcinoma, ovarian cancer
• Autoimmune diseasesmultiple sclerosis, systemic
  lupus, rheumatoid arthritis, scleroderma,
  scleromyxedema, Crohns disease
• Anemias (incl. sickle cell anemia)
• Immunodeficienciesincluding first successful
  human gene therapy
• Bone/cartilage deformitieschildren with
  osteogenesis imperfecta
• Corneal scarring-generation of new corneas to
  restore sight
• Strokeneural cell implants in clinical trials
• Repairing cardiac tissue after heart attackbone
  marrow or muscle stem cells from patient
• Parkinsonsretinal stem cells or patients own
  neural stem cells
• Growth of new blood vesselse.g., preventing
  gangrene
• Gastrointestinal epitheliaregenerate damaged
  ulcerous tissue
• Skingrafts grown from hair follicle stem cells,
  after plucking a few hairs from patient

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Live Patients vs. Dead Mice German researchers
successfully used patients own adult bone marrow
stem cells to repair heart muscle damaged by
heart attack. Ten heart-attack patients
received their own adult stem cells through a
special catheter into their heart, a procedure
where the patient can be awake and talk during
treatment. Three months later, the patients
treated with their bone marrow stem cells showed
significant decreases in the areas of heart
damage, and damaged areas were significantly
smaller than in patients that did not receive
stem cells. Hearts of treated patients were also
functioning better than hearts of patients who
did not receive stem cells. The authors note
that their approach represents a novel and
effective therapeutic procedure for repair of
damaged heart muscle, and For this method of
therapy, no ethical problems exist, and no side
effects were observed at any point of
time.Strauer B.E. et al. Repair of infarcted
myocardium by autologous intracoronary
mononuclear bone marrow cell transplantation in
humans Circulation 106 published online before
print September 3, 2002, 10.1161/01.CIR.0000034046
.87607.1C  Heart cells derived from embryonic
stem cells had a tendency to develop irregular
beating rhythms. The scientists found that
heart cells derived from mouse embryonic stem
cells had easily inducible triggered arrhythmias
abnormal beating rhythms and noted that
transplant of such cells into an already damaged
heart could actually promote abnormal heartbeat.
Based on their results with embryonic stem cells,
the authors note These findings suggest that
cells with restricted developmental potential may
be more suitable. Adult stem cells are
considered to have more restricted developmental
potential.Zhang Y.M. et al. Stem cell-derived
cardiomyocytes demonstrate arrhythmic potential
Circulation 106, 1294-1299 September 3, 2002.
(published online before print August 12, 2002,
doi10.1161/01.CIR.0000027585.05868.67)
45

• FEDERAL LEGISLATION
• HHS Appropriations language (since 1996)SEC.
  510. (a) None of the funds made available in
  this Act may be used for (1) the creation of a
  human embryo or embryos for research purposes or
  (2) research in which a human embryo or embryos
  are destroyed, discarded, or knowingly subjected
  to risk of injury or death greater than that
  allowed for research on fetuses in utero under 45
  CFR 46.208(a)(2) and section 498(b) of the Public
  Health Service Act (42 U.S.C. 289g(b)).(b) For
  purposes of this section, the term human embryo
  or embryos includes any organism, not protected
  as a human subject under 45 CFR 46 as of the date
  of the enactment of this Act, that is derived by
  fertilization, parthenogenesis, cloning, or any
  other means from one or more human gametes or
  human diploid cells.

46

• FEDERAL LEGISLATION
• Stem Cell Research Act (HR2059
  S723)(McDermott Specter)(allow Federal funds
  for derivation and use of human embryonic stem
  cells)
• Responsible Stem Cell Research Act (HR2096
  S1349)(Chris Smith Ensign Brownback)(increase
  funding of adult stem cell research, start stem
  cell bank)
• Human Cloning Prohibition Act of 2002
  (S2439)(Specter, Feinstein, Kennedy, Harkin,
  Hatch) (prohibit reproductive cloning
  (implantation), allow therapeutic cloning)
• Human Cloning Prohibition Act (S2076)(Dorgan)(pr
  ohibit reproductive cloning (live birth), allow
  therapeutic cloning)
• Human Cloning Prohibition Act (HR2505
  S1899)(Weldon Stupak Brownback
  Landrieu)(prohibit all human cloning)(Passed
  House 7/31/2001 265-162)Supported by President
  Bush

47

• EXECUTIVE ORDERS
• BushFederal funding for research on (78)
  existing human embryonic stem cell lines, derived
  before Aug. 9, 2001No Federal funds for embryo
  destruction
• Supports total ban on human cloning

48

• STATE LEGISLATION
• 3 StatesTotal Ban on all human cloningMichigan,
  Virginia, Iowa
• 9 StatesBan on destructive embryo researchLA,
  ME, MA, MI, MN, ND, PA, RI, SD(in most cases
  would prohibit research on cloned embryos)
• Most states debating legislation regarding human
  cloning, embryo research

49

• What does it mean to be human?
• Person or property?
• To whom do we choose to assign value?
• Who will benefit? Who will decide?

50

• The Future?
• Stem Cells
• Cloning
• Creation of embryos for research
• Patenting of human life forms
• Germline Genetic Engineering
• Chimerism
• Cybernetics and Nanotechnology