Cellular Donation and Stem Cell Research in the Islamic Countries

1. Cellular Donation and Stem Cell Research in the Islamic Countries Hind Al Humaidan, MD, FRCPA Consultant Hematopathologist & Director, Blood Bank & Stem Cell Cord Blood Bank Department of Pathology and Laboratory Medicine King Faisal Specialist Hospital & Research Centre Riyadh, Kingdom of Saudi Arabia

2. Stem Cells • Stem Cell Research is relatively new field of Medicine • It has a great promise • Led to confrontation established religious & moral values • Generated heated debate regarding the boundaries of scientific research that it should not cross

3. The “Original” cells from which all 210 different kinds of cells that make the human body developed What are Stem Cells?

4. Classified • Totipotent Cells • Pluripotent Cells • Multipotent and Progenitor Cells

5. Totipotent Cell • Embryonic cells begin with the zygote until the 8 – cell morula stage. • Cannot self regenerate

6. Pluripotent Cell • Capacity to transform into all three primary germ layers: endoderm mesoderm ectoderm • Self renew • Cells inner cell mass blastocyst called • “Embryonic Stem Cells (ESCs)”

8. Multipotent and Progenitor Cells • Descendants of developing embryo inner cell mass • They are differentiated and developed into specific types of cells • Eventually make different body organs

9. Embryonic Stem Cells • Most on-going research has been utilizing embryonic stem cells • Embryonic inner cell mass, kept growing in tissue culture • Most studies murine (ESCs)

10. Embryonic Stem Cells • Demand human ESCs (hESCs) • More promising cure human disease • Human embryos created (IVF) specifically stem cell research

11. Embryonic Stem Cells

12. Embryonic Stem Cells • Embryos left over (IVF) • Use spontaneously aborted fetuses • Cloned embryos through somatic cell nuclear transfer (SCNT), therapeutic cloning

13. Benefits of Stem Cell Research • Best known successful Rx Leukemia & many other hematologic disorders by: BMT Umbilical Cord Blood Stem Cells

14. Potential Benefits of Stem Cell Research • Real promise development “ Regenerative Medicine” • Human tissues organs used replace damaged tissues / organs, recover lost function • Progenitor cell developed can differentiate myocardial cells, neurons pancreatic cell, etc.

16. Problems with Stem Cell-Based Therapies • Genetic Mutations • DNA Mutation • Tumorigenesis • Graft Rejection

17. Somatic Cell Nuclear Transfer (SCNT) • Somatic Cell obtained from individual • Human Oocyte obtained egg donor • Oocyte enucleated then fused with biopsied cell, transferring nucleus to a new cell induced to develop embryo Therapeutic Cloning.

18. Somatic Cell Nuclear Transfer (SCNT) • Blastocyst forms • Inner cell mass isolated • Cultivated produce ESCs • Differentiate into various cell types “eventually producing tissue used as an autologous tissue graft original person somatic cell obtained”

20. Umbilical Cord Blood as Source of Stem Cells • UCB valuable source of hematopoietic stem cells • 1988 first used Rx Fanconi’s anemia in a sibling • Less immunogenic • Cell dose 10% of adult BM • Does not raise ethical objection that is intrinsic use (hESCs)

21. Use of Adult Stem Cells in Therapy • Few stem cells found in many adult tissues • Hematopoietic stem cells (BM) coaxed differentiate neural, myogenic & hepatic cell types • Neural & skeletal muscle cells coaxed developed hematopoitic cells. • Mesenchymal stem cell develop adipocytic, chandrocytic or osteocytic lineages

22. Advantages of Adult Stem Cells • Will not provoke immune system rejection • Should not become cancerous • Use does not raise serious ethical or moral objections

23. Disadvantages of Adult Stem Cells • Transdifferentiation limited compared to unlimited transdifferentiation potential pluripotent hESCs • ASCs are rare compared to abundant hESCs • ASCs hard to grow in vitro

24. Ethical Considerations • hESCs holds the greatest promise • Created greatest controversy !!!

25. Controversy • Use of human embryos? • Objections of many religious / ethical communities • Politics introduced an unprecedented extent form, legislation, presidential veto so far

26. Ethical Considerations • Embryonic stem cell research brings into conflict two moral principles: • The duty to respect human life. • The duty to reduce human suffering.

27. Ethical Considerations • The dilemma whether we as society agree which two principles ought to be given precedence? • Agree there is time in development of embryo that it cannot be considered “human” worthy “full” protection accorded fetus or live born infant

28. Ethical Considerations • Question revolves on determining moral status human embryo? • Fertilized egg (zygote) has full moral status • It becomes deserving protection at later stage. Moral status increases as the fertilized egg becomes more human like. • Embryo has no moral status at all, it is an organic material

29. Opinion I “The human embryo is a potential person from the time of fertilization” Opinion II “Fertilized egg is potential person but there are degrees of value of life depending on stage” Ethical Considerations

30. Opinion III “Fertilized human eggs with embryos are merely parts of other peoples bodies” For “being” to be destroyed it should have interest that is defeated. Interest means beliefs, desires, expectations, aims and purposes Ethical Considerations

31. Available source surplus fertilized eggs produced during course IVF procedures. Fresh better that frozen “Frozen 10% can form blastocyts” IVF fertilized eggs for “PGD” source Use of Human Embryos for Stem Cell Research

32. Advocate asking couples undergoing IVF donate some fresh viable fertilized eggs. Detailed comprehensive counseling should be provided and consent signed by couple. Use of Human Embryos for Stem Cell Research

33. Misconception of SCNT is reproductive cloning First step along a slippery slope would conclude with reproductive cloning Embryos produced SCNT have little potential developing to being born alive Ethical Consideration with SCNT

34. Donated healthy women Egg donation involves use hormones, invasive precedence to retrieve Donors usually compensated Ethical Consideration with SCNT

35. Ethical Consideration with SCNT • Would money be reason volunteering or pure altruism • Informed consent obtained

36. Islam is the submission to Allah’s will Muslims believe that Islam controls their actions in material as well as spiritual matters Islam is a way of life Religion and Stem Cell Research Islam

37. Muslims in performing any act should permit it. One has to fine Qur’anic verse on that matter or hadith (saying of Prophet Muhammad PBUH) Or resort to opinion of Fuqah’a ( Islamic Legal Scholars) Whom use Ijtihad (independent judgment) Religion and Stem Cell Research Islam

38. When life starts Ensoulment, the breathings of Allah’s rūh (spirit) into the fetus, differentiates biological life, which start at time of fertilization from human life. Religion and Stem Cell Research Islam ???

39. Ensoulment occurs at 40 or 120 days “Each one of you is collected as a sperm (nutfa) in the womb of his mother for 40 days, and then turns into a clot (alaqa) for an equal period of 40 days and turns into a piece of flesh (mudga) for a similar period of 40 days and then God sends an angel and order him to write things,i.e., his provision, his age, and whether he will be of the wretched or the blessed in the hereafter. Then the soul is breathed into him.” Religion and Stem Cell Research Islam -Sahih al-Bukhari.

40. Religion and Stem Cell Research Islam • All scholars agree that embryonic life is entitled to respect even before ensoulment but becomes more after.

41. Islam always encourages men to contemplate and explore new horizons. Prophet Mohammed ordered us to seek cure for disease. Four Islamic Principles Apply He said “ Allah did not create a disease without creating a cure for it except senility, so sons of Adam seek cures but do not use haram (forbidden things)” -Sunan Abi Dawud.

42. 3. All actions are in principle permissible as long as they are not categorically prohibited. 4. In matters in which other invocations are silent the concept of maslaha (public interest) applies. “Where the welfare of people resides, there resides that statute of God” Four Islamic Principles Apply -Sahih Muslim.

43. “It is permissible to acquire, grow and use stem cell for therapy or scientific research as long as the cells sources are permissible.” (The Muslim World League’s Islamic Jurisprudence Council Conference in December 2003 held in Mecca, issued Fatwa) Religion and Stem Cell Research Islam

44. Adults who consent as long as it does not inflict harm on them Children whose guardians consent for a legal benefit without inflicting harm Placenta or umbilical cord blood with the permission of the parents Examples of Permissible Sources

45. Spontaneously aborted embryos or those aborted for a legally acceptable cause with the permission of parents. Excess fertilized eggs produced during course of IVF and donated by parents with assurance that they are not to be used to produced illegal pregnancy. Example of Permissible Sources

46. It is forbidden to obtain or use stem cells if its source is forbidden. Examples: Fetuses intentionally aborted without a legal medical reason Intentional fertilization between donated ovum & sperm Therapeutic cloning Religion and Stem Cell Research Islam

47. Principle Stem Cell research is acceptable due to its therapeutic potential Fertilized eggs before implantation are not considered fully human because without implantation they cannot survive and develop into a human being The Islamic Position

48. The Islamic Position • The surplus embryos produced during IVF cannot be donated to other couples, instead should be destroyed or left to die if not used by the couple. Their Use for stem cell research is then acceptable at a minimum and may even be preferred to their destruction. • Islamic scholars agree that creating human embryos for the sole purpose of research is prohibited.