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Bioethic information and analysis newsletter

Following Letter

N°77 - May 2006

What is most intimate to life than life itself, the story of our first and last moments? This life we received, we can transmit it. And then, one day, this life will go by, our life and the one of those we love …

Today, science enables to give life as well as death. But how do not be wrong? Until where can we go with the control of life, at its beginning and at its end? Here is the stake of the BIOethics Manual for Young People: to train to this immense responsibility, in order not to improvise in an emergency situation.

7 chapters to understand

The Manual deals with the essential bioethics themes: the story of a small human being, abortion, prenatal diagnosis, medically assisted reproduction, preimplantation diagnosis, stem cells and cloning and finally euthanasia. A clear definition, the methods used, the French legislation, the ethic questions and the thoughts as well as accounts are presented for each of these themes.

The ethical stakes

The BIOethics Manual for Young People puts in full perspective the reality of the biological acts and their ethical implications and begins by « removing the doctoring » of words. This way, when a woman is proposed an embryonic reduction or a preimplantation diagnosis, what do they talk about? What is a « designer baby » or a nuclear transfer? What are the consequences of these new possibilities the medicine offers us in the field of life sciences?

If the medical assistance for reproduction enables some sterile couples having a baby, it also generates in France the conception of a stock of more than 120,000 frozen embryos commonly named supernumerary because they do not correspond anymore to a parental project. They can be destroyed or be subject to experiments... This is the way everything begins and that the frontier of ethics pushes back constantly.

To understand before acting

To decide to think, to train before to be faced with urgent decisions which leave no more time to stand back. How many young people today are faced with abortion and decide urgently, subject to the pressure of relatives and time limits to respect, without realizing the consequences of their act all their life long? Can we talk about a free choice? After an unfavourable even uncertain prenatal diagnosis, how many women do attest of the pressure of the medical profession to resort to so-called «therapeutic» abortion and had it without realizing what was happening? Towards which society does this policy of systematic screening for abnormalities and handicap? It is urgent to think about it.

A immense responsibility

The law often is after the technique, pressed for the scientists to authorize in the law what is enabled by the technique. Is it ethical for all that? What does the power of life and death on somebody mean because the law authorizes it? Which freedom are we talking about? And which future does a society enable us where the female model intends to build its identity by killing its children and where does scheduled murder of oldest and more injured people appear as a heights of compassion?

The purpose of this BIOethics Manual for Young People is to discover the immense responsibility of men and women faced with the transmission of life, to think before being faced with these terrifying questions, to improve knowledge by helping everybody to perceive its own mission.

1 - Manuel BIOéthique des Jeunes (in french) by Jérôme Lejeune Foundation: freely available on request at fjl@fondationlejeune.org or 31 rue Galande, 75005 Paris – 00 33 +1 55 42 55 15.

Taking stock of regenerative therapies using stem cells in 2006 ¹

Regenerative therapy using stem cells holds great hope for millions of patients with degenerative diseases or injuries. Repair of damaged organs or tissues using stem cells could address the needs of the patient.

Beyond the emotion caused by the false hopes, it is imperative that a complete review of the scientific results and promises clarifies the debate.

Stem cell characteristics

A stem cell has two chief characteristics: it continues to proliferate so that a pool of cells is always available and it responds to appropriate signals by differentiating into one or several specialized cell types. The sources of human stem cells are varied: they can come from early embryos (from 5-7 day post-conception), foetal tissue, blood and umbilical cord matrix, placental tissues and from most of body tissues. Adult stem cells come from post-natal sources. The plasticity of a stem cell, in other words its ability to form differentiated cell types ranges from unipotent (able to form only one differentiated type), to multipotent (able to form multiple cell types), to pluripotent (able to form most of all tissues of the adult body) to totipotent (able to form all postnatal or extraembryonic tissues, potentially able to regenerate a complete new embryo).

Embryonic stem cells

Mouse embryonic stem (ES) cells were first grown in culture in 1981, but human ES cells were not successfully cultured until 1998. Isolation of embryonic stem cells requires the disaggregation of the early embryo, hence the ethical debate regarding these cells. These stem cells, considered the archetypal pluripotent stem cell, they are capable to form any type of tissues, have to face many scientific hurdles to overcome before they might be used clinically, specifically tumour formation and immune rejection. In order to overcome potential rejection of ES cells,  various solutions have been proposed, including establishing “banks” of ES cell lines to match potential recipients, but we do not know the number of stem cells needed to match all the patients (undoubtedly from 250 to 10 000 lines). Therapeutic cloning has been hailed as a potential panacea for overcoming immune rejection. But, and this, despite the fraudulent claim from Korean researchers, at this point no human cloning have been successful; In a previous experiment in mice, the cells from cloned embryos were rejected by the genetically matched host.

Adult stem cells

Recent researches showed remarkable flexibility of adult stem cells. Evidence was presented that a single adult bone marrow stem cell could contribute not only to marrow and blood but also to formation of liver, lung, digestive tract, skin, heart, and muscle². Several examples now exist of some adult stem cells with pluripotent flexibility, including cells from bone marrow, peripheral blood, the inner ear, umbilical cord blood, nasal mucosa, amniotic fluid, and the placental amniotic membrane. Many of these published studies also document that these particular pluripotent adult stem cells can multiply in culture for extensive periods of time while still retaining their ability to differentiate and providing sufficient numbers of cells for clinical treatments.

There have been numerous reports of the effectiveness of adult stem cells in treating animal models of disease.

In some experiments, the cells showed a “homing” ability to the site of tissue damage. For spinal cord injury, adult stem cells have promoted neuronal growth and therapeutic benefit in rodent models.

In animal models of Parkinson’s disease, adult stem cells have shown effectiveness at stimulating dopamine secretion and decreasing behavioural symptoms. One patient received a transplant of his own neural stem cells, resulting in decreasing the symptoms of Parkinson’s disease. Regarding diabetes, several examples now exist showing generation of insulin-secreting cells from adult stem cells, including the liver, bone marrow, and pancreas.

Adult stem cells have also been used in bone repair protocols.

Repair of cardiac damage in patients has also moved to the clinical trials stage, with several reports of early success in repair of infarct damage.

Even if the mechanism for these regenerative results is still unclear, the flexibility and the enormous potential of adult stem cells are now shown.

1 - Current Science of Regenerative Medicine with Stem Cells, David A. Prentice, Journal of Investigative Medicine, vol. 54 number 1, January 2006.

2 - Multi-organ, multi-lineage engraftment by a single bone marrow-derived stem cell, Krause DS, Theise ND, Collector MI et al. Cell 2001 ; 105 ; 369-77.

Europe: vote against the funding for research on embryos and cloning

The Committee on Legal Affairs of the European Parliament opposed any European funding for research on embryo by a decision adopted on 5 May 2006 with 16 votes (Poland, Germany, Austria…) against 6 and 3 abstentions¹.

Recalling that “Member States should not be forced to indirectly co-finance, by their financial contribution to the budget of the European Union, research activities which are prohibited in their country because of fundamental and essential ethical objections”, the Committee also mentions that “following the Hwang’s affair in South Korea, it is more important than ever to interpret the principle of subsidiarity in a very strict way”.

Excluded financing

The following research activities cannot be subject of financing according to the 7^th framework-program: Research activity aimed at human cloning for reproductive purposes, to modify the genetic heritage of human beings, to create human embryos solely for the purpose of research or for the purpose of stem cell procurement, and research activity using the cells from such embryos; research activities which destroy human embryos or using human embryonic stem cells.

Researches to be promoted

The Community must give priority to research projects enabling to replace controversial technologies on an ethical level by research on adult stem cells and umbilical stem cells, the resolution of fertility problems without creating supernumerary embryos and genetic trials linked with the therapy.

1 - Proposal of Decision of the European Parliament and of the Council concerning the 7^th framework-programme of the European Community research, technological development and demonstration activities, adopted by the Committee on Legal Affairs on 5 May 2006.