Transcript PowerPoint Presentation - Morality of Stem Cells

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
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
What are Stem Cells?

The “Original” cells from which all 210 different kinds
of cells that make the human body developed
Classified

Totipotent Cells

Pluripotent Cells

Multipotent and Progenitor Cells
Totipotent Cell
Embryonic cells begin with the zygote until the 8 – cell
morula stage.


Cannot self regenerate
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)”
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
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)
Embryonic Stem Cells

Demand human ESCs (hESCs)

More promising cure human disease

Human embryos created (IVF)
specifically stem cell research
Embryonic Stem Cells
Embryonic Stem Cells

Embryos left over (IVF)

Use spontaneously aborted fetuses

Cloned embryos through somatic cell nuclear
transfer (SCNT), therapeutic cloning
Benefits of Stem Cell
Research

Best known successful Rx Leukemia & many
other hematologic disorders by:
BMT
Umbilical Cord Blood Stem Cells
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.
Problems with Stem Cell-Based
Therapies

Genetic Mutations

DNA Mutation

Tumorigenesis

Graft Rejection
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.
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”
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)
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
Advantages of Adult Stem
Cells

Will not provoke immune system rejection

Should not become cancerous

Use does not raise serious ethical or moral
objections
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
Ethical Considerations

hESCs holds the greatest promise

Created greatest controversy
Controversy

Use of human embryos?

Objections of many religious / ethical
communities

Politics introduced an unprecedented extent
form, legislation, presidential veto so far
Ethical Considerations

Embryonic stem cell research brings into
conflict two moral principles:
1.
The duty to respect human life.
2.The
duty to reduce human suffering.
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
Ethical Considerations

Question revolves on determining moral
status human embryo?
1.Fertilized
egg (zygote) has full moral status
2.It
becomes deserving protection at later stage.
Moral status increases as the fertilized egg
becomes more human like.
3.Embryo
material
has no moral status at all, it is an organic
Ethical Considerations

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

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
Use of Human Embryos for Stem Cell
Research

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

Advocate asking couples undergoing IVF
donate some fresh viable fertilized eggs.

Detailed comprehensive counseling should
be provided and consent signed by couple.
Ethical Consideration with SCNT

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

Donated healthy women

Egg donation involves use hormones,
invasive precedence to retrieve

Donors usually compensated
Ethical Consideration with SCNT

Would money be reason volunteering or
pure altruism

Informed consent obtained
Religion and Stem Cell Research Islam

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

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

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

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.”
-Sahih al-Bukhari.
Religion and Stem Cell Research
Islam

All scholars agree that embryonic life is
entitled to respect even before ensoulment
but becomes more after.
Four Islamic Principles Apply
1.
Islam always encourages men to
contemplate and explore new horizons.
2.
Prophet Mohammed ordered us to seek
cure for disease.
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.
Four Islamic Principles Apply
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”
-Sahih Muslim.
Religion and Stem Cell Research Islam
“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)
Examples of Permissible
Sources

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
Example of Permissible Sources

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.
Religion and Stem Cell Research Islam


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
The Islamic Position
1.
Principle Stem Cell research is
acceptable due to its therapeutic potential
2.
Fertilized eggs before implantation are
not considered fully human because
without implantation they cannot survive
and develop into a human being
The Islamic Position
3.
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.
4.
Islamic scholars agree that creating human
embryos for the sole purpose of research is
prohibited.