Forum Bioethik INFO/ Human Genetics Alert
 

April 25, 2002

Contents
1.       Aborted cloned embryo could be a source of stem cells
2.       Spinning Stem Cells
3.       Genetic tests risk public "backlash"

1.
Wed, Apr 24 2002 8:37 PM AEST

ABC News

Aborted cloned embryo could be a source of stem cells

A cloned embryo, even one aborted in the early stages of its cellular
division, could be a source of stem cells, according to the work by British
researchers to appear tomorrow in the United States.

Researchers at the Wellcome Cancer Research Institute of Cambridge, in
Britain, showed a cluster of undifferentiated cells which results from an
aborted cloned frog embryo is reusable to produce muscle, bone or skin
tissue for another frog.

In an article published in the Proceedings of the National Academy of
Sciences (PNAS), the researchers explain that they isolated the nucleus of
frog cells carrying a protein made fluorescent in their DNA.

The researchers then injected the nucleus carrying the fluorescent marker
into the empty egg of another frog.

Researchers later extracted the cells stocks from embryos aborted after 24
hours of cellular division and grafted these cells on developing embryos
that had no marked cells.

The researchers discovered the cells with the fluorescent marker within the
fabric forming the muscle, bone and skin of the tadpole that grew from the
embryo.

The researchers said if a cloned embryo does not succeed in developing
beyond the first stage of cellular division, its DNA can nevertheless be
transmitted via its cells stocks established on a viable embryo.

"It may be that cells from nonviable cloned human embryos, which could not
survive independently, may be useful for research and therapeutic purposes,"
the researchers concluded.
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2.
Spinning Stem Cells
A damning reporting pattern.

By Wesley J. Smith

National review
he pattern in the media reportage about stem cells is growing very
wearisome. When a research advance occurs with embryonic stem cells, the
media usually give the story the brass-band treatment. However, when
researchers announce even greater success using adult stem cells, the media
reportage is generally about as intense and excited as a stifled yawn.
As a consequence, many people in this country continue to believe that
embryonic stem cells offer the greatest promise for developing new medical
treatments using the body's cells  known as regenerative medicine  while
in actuality, adult and alternative sources of stem cells have demonstrated
much brighter prospects. This misperception has societal consequences,
distorting the political debate over human cloning and embryonic-stem-cell
research (ESCR) and perhaps even affecting levels of public and private
research funding of embryonic and adult stem-cell therapies.
This media pattern was again in evidence in the reporting of two very
important research breakthroughs announced within the last two weeks. Unless
you made a point of looking for these stories  as I do in my work  you
might have missed them. Patients with Parkinson's disease and multiple
sclerosis received significant medical benefit using experimental
adult-stem-cell regenerative medical protocols. These are benefits that
supporters of embryonic-stem-cell treatments have yet to produce widely in
animal experiments. Yet adult stem cells are now beginning to ameliorate
suffering in human beings.
Celebrity Parkinson's disease victims such as Michael J. Fox and Michael
Kinsley regularly tout ESCR as the best hope for a cure of their disease.
Indeed, the Washington Post recently published a Kinsley rant on the subject
in which the editor and former Crossfire co-host denounced opponents of
human cloning as interfering with his hope for a cure. Yet as loudly as Fox
and Kinsley promote ESCR in the media or before legislative committees, both
have remained strangely silent about the most remarkable Parkinson's
stem-cell experiment yet attempted: one in which researchers treated
Parkinson's with the patient's own adult stem cells.
Here's the story, in case you missed it: A man in his mid-50s had been
diagnosed with Parkinson's at age 49. The disease grew progressively,
leading to tremors and rigidity in the patient's right arm. Traditional drug
therapy did not help.
Stem cells were harvested from the patient's brain using a routine brain
biopsy procedure. They were cultured and expanded to several million cells.
About 20 percent of these matured into dopamine-secreting neurons. In March
1999, the cells were injected into the patient's brain.
Three months after the procedure, the man's motor skills had improved by 37
percent and there was an increase in dopamine production of 55.6 percent.
One year after the procedure, the patient's overall Unified Parkinson's
Disease Rating Scale had improved by 83 percent  this at a time when he was
not taking any other Parkinson's medication!
That is an astonishing, remarkable success, one that you would have thought
would set off blazing headlines and lead stories on the nightly news. Had
the treatment been achieved with embryonic stem cells, undoubtedly the
newspapers would have screamed loudly enough to be heard. Unfortunately,
reportage about the Parkinson's success story was strangely muted. True, the
Washington Post ran an inside-the-paper story and there were some wire
service reports. But the all-important New York Times  the one news outlet
that drives television and cable news  did not report on it at all. Nor did
a search of the Los Angeles Times website yield any stories about the
experiment.
Human multiple-sclerosis patients have now also benefited from
adult-stem-cell regenerative medicine. A study conducted by the Washington
Medical Center in Seattle involved 26 rapidly deteriorating MS patients.
First, physicians stimulated stem cells from the patients' bone marrow to
enter the bloodstream. They then harvested the stem cells and gave the
patients strong chemotherapy to destroy their immune systems. (MS is an
autoimmune disorder in which the patient's body attacks the protective
sheaths that surround bundles of nerves.) Finally, the researchers
reintroduced the stem cells into the patients, hoping they would rebuild
healthy immune systems and ameliorate the MS symptoms.
It worked. Of the 26 patients, 20 stabilized and six improved. Three
patients experienced severe infections and one died.
That is a very positive advance offering great hope. But rather than making
headlines, the test got less attention than successful animal studies using
embryonic cells. The Los Angeles Times ran a brief bylined description,
while the New York Times and Washington Post only published wire reports.
Once again, the media's almost grudging coverage prevented society at large
from becoming acutely aware of how exciting adult-cell regenerative medicine
is fast becoming.
Meanwhile in Canada, younger MS patients whose diseases were not as far
advanced as those in the Washington study have shown even greater benefit
from the same procedure. Six months after the first patient was treated, she
was found to have no evidence of the disease on MRI scans. Three other
patients have also received successful adult-stem-cell grafts with no
current evidence of active disease.
It's still too early to tell whether the Canadian patients have achieved
permanent remission or a cure, but there can be no question that the
research is significant. Yet the story was only publicized in Canada's Globe
and Mail and in reports on Canadian television. American outlets did not
mention the experiments at all.
These Parkinson's and MS studies offer phenomenal evidence of the tremendous
potential adult cell regenerative medicine offers. At the same time, the
unspectacular coverage these breakthroughs received highlights the odd lack
of interest in adult stem-cell research exhibited by most mainstream media
outlets. Nor are these stories the only adult-stem-cell successes to have
gotten the media cold shoulder.
It's worth recapping just a few of the other advances made in adult-cell
therapies and research in the last two years, all of which were
significantly underplayed in the media:
Israeli doctors inserted a paraplegic patient's own white blood cells into
her severed spinal cord, after which she regained bladder control and the
ability to wiggle her toes and move her legs. (I only saw reporting on this
case in the Globe and Mail, June 15, 2001.)
Immune systems destroyed by cancer were restored in children using stem
cells from umbilical-cord blood. (There was a good story in the April 16,
2001 Time, but other than that I saw no reporting.)
At Harvard University, mice with Type I diabetes were completely cured of
their disease. The experiment was so successful that human trials are now
planned. (This was reported in the July 19, 2001, Harvard University
Gazette, but I saw no coverage at all in the mainstream press.)
Diabetic mice treated with adult stem cells achieved full insulin production
and all lived. This is in contrast to an experiment in which embryonic stem
cells injected into diabetic mice achieved a 3 percent insulin production
rate and all the mice died. (According to the May 2001 STATS, published by
the Statistical Assessment Service, the embryo experiment made big news
while the media ignored the adult cell experiment.)
How many humans have been treated by embryonic stem cells? Zero. Indeed,
before human trials can even be safely undertaken researchers will have to
overcome two serious difficulties that stand between patients and
embryonic-cell regenerative medicine: 1) ES cells cause tumors, and 2) ES
cells may be rejected by the immune system. Surmounting these difficulties 
if they can be surmounted at all  will take a very long time and much
expense. There is no risk of rejection with adult cells, by contrast,
because they come from the patients' own bodies. Nor, at least so far, does
adult-stem-cell therapy appear to cause tumors. This puts adult therapies
years ahead of the game.
The media continue to imply that embryos hold the key to the future. But
increasingly, it looks as if our own body cells offer the quickest and best
hope for regenerative medicine. The time has come for the public to insist
that the media stop acting as if adult stem cells are the "wrong" kind of
stem cells, and report to the American people fully and fairly the
remarkable advances continually being made in adult regenerative medicine.
 Mr. Smith is the author of Culture of Death: The Assault on Medical Ethics
in America
<http://www.amazon.com/exec/obidos/ASIN/189355449X/qid=1019503591/sr=12-1/10
2-9931137-5358526/nationalreviewon> . His next book will be A Consumer's
Guide to Brave New World, a discussion of the business, science, and
morality of human cloning.
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3.

Genetic tests risk public "backlash"

23 April 2002 18:00 GMT
by Bea Perks, BioMedNet News <mailto:news.feedback@biomednet.com>

A growing disparity between the volume of genetic data available and its
clinical usefulness, coupled with difficulties in interpreting test results,
could generate a "substantial degree of misunderstanding" about the value of
molecular diagnostics, warns a leading US geneticist.
Hyping a future that fails to deliver could prompt a "backlash" from the
public, according to Stephen Chanock, principal investigator at the NIH
National Cancer Institute in Bethesda. "Our analysis is extremely
rudimentary compared with the amount of data that we have," he told
BioMedNet News today.
"Before we go overboard in predicting imminent progress or even the
attainment of a medical utopia based on the recent advances in genomics," he
noted, "we must acknowledge that we are not yet sufficiently equipped with
the knowledge to make sense of the enormous opportunities that lie ahead."
Further, he adds, management of the switch in mind-set from the enduring
notion of "one gene, one disorder" to an appreciation of the
poorly-understood risk factors involved in complex genetic disease will need
to be very carefully controlled.
"This could generate a substantial degree of misunderstanding," warned
Chanock, "even a backlash against all of molecular diagnostics."
A new framework needs to be defined in which to address the ethical and
economic issues raised by the field, he says.
The advent of analyses based on single nucleotide polymorphisms (SNPs) or
cDNA microarrays, for example, allows for the detection of vast numbers of
genes at once, he says, but it is not practicable to discuss each gene
individually with every patient. The system of informed consent will have to
be modified, he adds.
"Right now, whenever you do any test, you have to explain that particular
test in great detail," he noted. "Now, suppose we get into the SNPs world,
you'd say 'we need to do these 97 different tests and we're going to look at
that profile; the first one that we're going to do is ..., the second one is
...' How are you possibly going to be able to convey that information?"

Chanock questions whether even the physician will understand each of those
genes. Will the fine print still say, as it does on NIH consent forms, that
the patient must fully understand each of the 97 tests?
"I don't think that that's wrong, but the question now is how do you
superimpose that tremendous amount of information? It has to undergo
substantial transformation, or else it's like tying a Monty-Pythonesque
16-ton weight to our feet; we won't be able to swim."
Chanock presents his views in the June issue of Trends in Molecular Medicine
<http://journals.bmn.com/journals/list/latest?jcode=mmt> , a special issue
dedicated to molecular diagnostics.
A second contributor contemplates the rapid growth and potential of the
field.
"In the molecular pathology laboratory I directed, we signed out five test
results in 1991," recalled Daniel Farkas, now director of clinical
diagnostics at Motorola Life Sciences in Pasadena. "By the time I left seven
years later, we were signing out nearly 15,000 per year and the rate of
increase continues at 15-20% per year."
Some reference laboratories are now signing out 1,800 molecularly-based
cystic fibrosis tests per week, he adds.
Such tests facilitate the upstream search for diagnostics, vaccines, and
therapeutics, says Farkas. As more is learned of the molecular basis of
inherited, somatic, and infectious disease, "molecular diagnostics begins to
play a key role in patient management," he added.
"If one accepts these premises, then it is only a matter of time before
molecular diagnostics becomes normalized into the mainstream diagnostic
pathology laboratory," he noted. "In time, molecular diagnostics will be
broadly applicable in laboratory medicine and test volumes will rival those
of established specialities like hematology and clinical chemistry."
Molecular diagnostics will move towards automated readouts of real-time PCR
detectors downloaded to laboratory information systems, he predicts.
"Testing for minimal residual neoplastic disease will increase. Panels for
multiple drug-resistant pathogens will be developed, used and exploited to
control outbreaks," he suggested.
"My guess is that all of these predictions will ring true by 2010, perhaps
sooner," concluded Farkas.

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