Bioethics in Daily Life

1. Bioethics in Daily Life Day 8 Prof. Connie J. Mulligan Department of Anthropology

2. This week Stem cells Definition of a stem cell Different types and uses of stem cells Status of stem cell research Current and potential applications of stem cells Reading http://en.wikipedia.org/wiki/Stem_cell - Wikipedia entry on stem cells http://learn.genetics.utah.edu/content/tech/stemcells/sctoday - Stem cell therapies today http://www.youtube.com/watch?v=HZWVj5mqJ1I&feature=channel – UM professor on stem cell research today http://www.allaboutpopularissues.org/pros-and-cons-of-stem-cell-research.htm - Simple and short explanation of the controversy over stem cells http://usliberals.about.com/od/stemcellresearch/i/StemCell1.htm - Political and legal status on stem cells http://learn.genetics.utah.edu/content/tech/stemcells/scissues/ - Questions to ponder (University of Utah Learn.Genetics site) Skim http://www.aaas.org/spp/sfrl/projects/stem/report.pdf - American Association for the Advancement of Science report on stem cell research (51 pages)Video Video - PBS documentary on stem cell research Oral presentations – Robots/personhood/personal identify

3. Next week – Spring breakIn two weeks – check website for readings • How to structure remainder of class • Oral presentations in two weeks on stem cells • Remember, must have one peer-reviewed article • Alternatives to oral presentations • More group presentations • Class debate • ???

4. The Science and Ethics of Stem Cell Research July 12, 2005 VaBIO Board of Trustees Presenter: Thomas F.Huff, Ph.D. Vice Provost for Life Sciences Virginia Commonwealth University Credit to VCU because I used a lot of slides from this presentation

5. What are stem cells ?

6. Stem Cells • Stem cells have three defining attributes: • The capacity for infinite growth • The capacity for self-duplication • The ability to differentiate into many many different cell types • There are about six classes of stem cells. We will discuss the two most important classes of stem cells: • Embryonic stem cells • Adult stem cells • Umbilical cord stem cells

8. Embryonic Stem Cells (ESC)

9. Embryonic Stem (ES) Cells • Derived from the inner cell mass of a blastocyst • A blastocyst is a hollow ball of cells formed 4-6 days after a human egg is fertilized. • ES cells are totipotent and can become any one of the 220 tissue cells in the body

10. Embryonic Stem Cells and Embryonic Stem Cell Lines • Cell lines are from one separated cell • The daughter cells are alike and grow indefinitely.

11. Video of extracting human embryonic stem cells and making a cell lineVideo of using stem cells to treat diabetes • http://www.sumanasinc.com/webcontent/animations/generalscience.html

12. VCU Life Sciences Survey

13. Adult Stem Cells

14. Adult Stem Cells • Many adult tissues have stem cells. • The most well studied are the blood stem cell (hematopoietic stem cell or HSC used in bone marrow transplants) and the neural stem cell • AS cells are pluripotent or multipotent and can become cells other than what they are, but not any of the 220 cell types in the human body • Recently, it was discovered that an adult stem cell from one tissue may act as a stem cell for another tissue, i.e. blood to neural

15. Evidence of Plasticity among Adult Stem Cells

16. Current Clinical Uses of Adult Stem Cells • Cancers—Lymphomas, multiple myeloma, leukemias, breast cancer, neuroblastoma, renal cell carcinoma, ovarian cancer • Autoimmune diseases—multiple sclerosis, systemic lupus, rheumatoid, arthritis, scleroderma, scleromyxedema, Crohn’s disease • Anemias (incl. sickle cell anemia) • Immunodeficiencies—including human gene therapy • Bone/cartilage deformities—children with osteogenesis imperfecta • Corneal scarring-generation of new corneas to restore sight • Stroke—neural cell implants in clinical trials • Repairing cardiac tissue after heart attack—bone marrow or muscle stem • cells from patient • Parkinson’s—retinal stem cells, patient’s own neural stem cells, injected • growth factors • Growth of new blood vessels—e.g., preventing gangrene • Gastrointestinal epithelia—regenerate damaged ulcerous tissue • Skin—grafts grown from hair follicle stem cells, after plucking a few hairs • from patient • Wound healing—bone marrow stem cells stimulated skin healing • Spinal cord injury—clinical trials currently in Portugal, Italy, S. Korea

17. Video – Growing a mouse or pig heart from adult stem cells • http://www.youtube.com/watch?v=j9hEFUpTVPA&feature=related

18. Umbilical Cord Stem Cells

19. Umbilical cord stem cells • Umbilical cord is a rich source of stem cells • Must plan ahead to store umbilical cord • Stem cells can be used by infant, mother or father • More distant the relationship, the more likely it is that the stem cells will be rejected by the immune system

20. Conclusions of the NIH Study on Stem Cells • “During the next several years, it will be important to compare embryonic stem cells and adult stem cells in terms of their ability to proliferate, differentiate, survive and function after transplant and avoid immune rejection”

21. Stem Cells and Regenerative Medicine With stem cell therapy (embryonic or adult), there is enormous promise of treating diseases previously thought to be unmanageable Valid and Invalid Controversy The question is not whether or not to use stem cells. The question is whether to use adult or embryonic stem cells.

22. VCU Life Sciences Survey 2005http://www.vcu.edu/lifesci/centers/cen_lse_surveys.html • Fifth Annual VCU Life Sciences Survey • Conducted by VCU Center for Public Policy • National Telephone Survey of 1002 Randomly-Selected U. S. Adults • Data Collected September 14 through 29, 2005 • Margin of Error ± 3% at 95% Confidence Level • A majority of Americans—58%—strongly or somewhat favor embryonic stem cell research, up from 53% in the 2004 survey and 47% in the 2003 survey. • Greatest promise: • Embryonic stem cells – 14% • Adult stem cells – 7% • Other sources (umbilical cord blood) – 37% • Continued strong resistance to human coning

23. Top 5 Reasons Why People Favor Embryonic Stem Cell Research • To prevent and cure disease (25%) • To help people with disease (13%) • It saves/prolongs life (9%) • The potential/benefits (9%) • Research/benefits to science (6%)

24. Top 5 Reasons Why People Oppose Embryonic Stem Cell Research • It’s part of a living person (19%) • Just think it’s wrong/immoral/pro-life (16%) • Against God/religion (11%) • It’s from an embryo (10%) • We have no business going to that extent (4%)

25. How do you get an embryonic stem cell?

26. How do you get an embryonic stem cell? • From an embryo made for IVF that will not be used • Allowed with federal funding, not allowed under Bush • From an embryo made expressly for stem cells • Not allowed with federal funding • From somatic cell nuclear transfer (SCNT) technology (Day 6 – therapeutic cloning) • Allowed with federal funding

27. Video – Obama ends ban on federal funding for stem cell research • http://www.youtube.com/watch?v=63Uqp9VcCq4&feature=fvw

28. Latest research • What if you could get embryonic stem cells and establish a cell line without damaging blastocyst, i.e. without killing the embryo? • Human embryonic stem cell lines derived from single blastomeres. • Klimanskaya I, et al, Nature. 2006 Nov 23;444(7118):481-5. Korf 2000

29. PBS documentary on stem cell research • http://www.youtube.com/watch_popup?v=GWiNC0WLxs8

30. Discussion • Did the documentary change any of your thoughts about stem cell research?

31. Discussion • What do you think about the fact that different religions have different beliefs on when life starts? Does it make sense to have laws that privilege Christian beliefs over other religions?

32. Discussion • Does it matter how the embryonic stem cells are derived, i.e. is there a difference between getting ES cells from an embryo vs SCNT cells?

33. Discussion • Some people who oppose embryonic stem cell research for religious reasons say that suffering is part of the human experience and that eliminating suffering, especially if it involves killing something, is not the correct goal