Understanding Stem Cell Research

Last Editorial Review: 10/17/2004

WebMD Live Events Transcript

There has been a lot of discussion about embryonic stem cell research lately. Has the debate left you with questions about the medical potential for control and cures for diseases like Parkinson's, diabetes, and Alzheimer's? Pathologist Michael Shelanski, MD, PhD, joined us on Sept. 22, 2004, to discuss what he and other researchers might find down the stem cell path.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Shelanski. There has been a great deal of public discussion about stem cell research, but so much misinformation is floating around this subject. Can you give us a basic crash course on stem cell research?

SHELANSKI:
Stem cell research covers a very wide area, including stem cells on animals and research on stem cells from humans. A characteristic of a stem cell is that it is capable of giving rise over time to different types of cells; that is, it is a cell that has no characteristic of a kidney cell or a pancreas cell or a brain cell, but will, when put in the appropriate conditions, give rise to one or more of these types of cell.

The thing that makes stem cells different is that they are cells that have no defined characteristics and that you can cause to grow in number. So if you start with one stem cell and keep it as a stem cell, over time you can have 10 cells or 10,000 cells. Then by providing the proper signals to those cells you can turn all 10,000 cells into a nerve, a kidney, or pancreas cell.

From research in animals we can learn a great deal about the signals that are needed to do this, but the medical promise of the work lies in the possibility that you could use these cells in reparative or regenerative medicine; that is, you could take a heart that had a heart attack so part of it was dead or dying and you could then put the stem cells, in principle, into the heart to repair the heart. It would not be as good as new, but would be considerably less damaged. In humans you need to use human cells for this. You cannot put animal cells into humans because humans will reject the animal cells.

The debate that is going on in the public today is over, if you will, a sub-issue of "How do we obtain stem cells?" and it is confused by the fact that the term "stem cell" does not have one single meaning; they all share this multipotential ability, but many people, by "stem cells," mean the very primitive cells taken from an embryo. In fact, you can obtain stem cells from the human umbilical cord; you can obtain them from the adult brain (although no one has obtained them from the human brain, but in principle you could do it), and you can obtain stem cells from the blood.

Those people who object to stem cell research, for the most part, object to obtaining stem cells from human embryos. Many people who do not accept that work do not have a problem obtaining them from umbilical cord blood. The Catholic Church does not have a problem with stem cells obtained from umbilical cord blood. The issue comes that in working with embryonic stem cells is that you do sacrifice a very early embryo, and to some people that is completely acceptable, to some unacceptable, and the issue is not a scientific one. Other people might object to stem cells from blood or tissue, because in principle you could make an entire embryo from any stem cell, even an umbilical cord cell. Technologically it is difficult to do it, but theoretically it's possible.

"Nobody among responsible scientists is suggesting embryos be generated, be made, for the purpose of making embryonic stem cells."

Most scientists feel there is the possibility that they are different from other stem cells; they have greater potential, and if we do not investigate them we could miss the chance to proceed in curative or regenerative medicine, even though it's possible that a stem cell from a nonembryonic source might be able to do as well, but we do not know that. The limitation in access to embryonic stem cells is a bit like trying to fight a battle with one hand tied behind your back. You might find all the strength you need in one hand, but you might find the one hand won't do it.

Nobody among responsible scientists is suggesting embryos be generated, be made, for the purpose of making embryonic stem cells. The interest has been largely in using the large number of banked or frozen embryos from the various in vitro fertilization programs to make the cells, taking the view these will never be children or people; they will either be discarded or, less likely, kept indefinitely in a freezer.

Other people, including a small minority of scientists, either feel this use of an embryo for research is immoral to begin with or are afraid that this will encroach ultimately on the sanctity of life of children, late-term fetuses, and a whole scenario is postulated in which the child and fetus could be at risk, that we will not just stick to these excess embryos; we're going to want to encroach more on fetuses or generate more embryos for the purpose of medical therapy.

The big issue is this is not a scientific question; this is a religious and a national policy question, but not scientific. There's no scientific answer except to say if we do not do the research it's very possible important treatments for Parkinson's, diabetes, ALS, and heart attacks will not be developed, or that they will be developed but developed in other countries where either they will not be available to Americans, either because they start with embryonic cells, or if they are available, they will be at extremely high cost.

While the U.S. is doing little in stem cell research, other countries have made stem cell research a centerpiece of their research programs for the years to come. In the U.S., companies and universities that are not using government funds are also doing embryonic stem cell research, but most of the labs in the country have access to only a very limited number of cell lines. While I do not use any of these lines, there is some debate about how many of them are useful.

MODERATOR:
How many embryonic stem cell lines are available to scientists today? We hear conflicting reports. And why would variety be important to the research?

SHELANSKI:
When we carry things in the laboratory, things can change, things can be infected, taken from different stages of the embryo, they might divide more quickly or slowly, may be genetically different -- they are different because they come from different genetics. Except the point where the human stem cells come from identical twins, none of these are identical and you don't know which ones will be the best ones.

I do not recall the number, but the International Society of Stem Cell Research felt only 10 to 12 lines were available, and more like eight to 10 were useful. There are more lines available if you're not using federal money. The stem cell group at Harvard has 15 to 20 stem cell lines, but they cannot be used. They were derived from private funds and cannot be used for federal research. Those are owned by Harvard and there may be limitations on the uses to which these cells can be put outside the laboratory. You have to sign an agreement with Harvard to get these cells. At least six months ago the Harvard cell lines were for technical reasons not appropriate to put into humans.

MODERATOR:
That seems like a very small number of lines to base scientific inquiry on. So the federal restrictions could hamper exploration in this field?

SHELANSKI:
I think very seriously.

MODERATOR:
For what diseases do you see stem cell research holding the most promise?

SHELANSKI:
I see the stem cells holding promise in:

A wide variety of other diseases where the cells are unhealthy and could potentially be replaced by human stem cells that would be put into place then respond to the environment they are in. They would turn into heart or pancreas cells. We may have to help them by providing stimulating factors to make them become what we want.

"It's possible that what we learn from these cells will enable us to custom engineer new tissues to replace damaged tissues. That is far in the future."

MEMBER QUESTION:
Is there any hope that down the road it can also help people with COPD?

SHELANSKI:
There is a possibility, but I think it's a distant possibility. That represents a phase of regenerative, reparative medicine, which is still far in the future. It's possible that what we learn from these cells will enable us to custom engineer new tissues to replace damaged tissues. That is far in the future.

MEMBER QUESTION:
How long of a period of time will that be for those of us who have been type I for more than 35 years?

SHELANSKI:
The treatment of type I diabetes by what we will call "cell therapy" may not depend on stem cells. It is possible that pancreatic islet cells, which are the cells that produce insulin, can be transplanted and can grow in number to provide a possibility for treating type I diabetes. There have been some reports of success with this approach appearing. How many years before cell therapy is widely available? My guess would be at least 10 years.


MEMBER QUESTION:
Do we really need to harvest stem cells from embryos when skin cells and blood products have given such promising results?

SHELANSKI:
That is the hard question. We don't know what the limitations are on stem cells from the skin, from the blood, from umbilical cord blood. It is possible that these cells may be able to do everything that embryonic stem cells might be able to do. However, if we use these cells and we fail, we will not know whether we failed because of technical reasons or we failed because we really required an embryonic stem cell. Scientists would prefer to use all possible approaches -- that is embryonic stem cells and other stem cells.

MEMBER QUESTION:
I have been told that in England and Japan stem cell research is being tested for patients like me who have amyotrophic lateral sclerosis -- Lou Gehrig's disease. I have tried to research this online and I have been unsuccessful finding anything. Where can I find out more information?

SHELANSKI:
I have not heard of it being tested, and I know of no success in animals with stem cell treatment for the animals that have the human form of ALS. That does mean it is not being tried, but I don't know the results. I would suggest the ALS Society might be the best source of information.

MEMBER QUESTION:
Do you really think that stem cell therapy will someday cure multiple sclerosis?

SHELANSKI:
That is an area where there could be a great deal of promise for stem cell therapy. Would that be the cure? I do not know. It's possible to think stem cells could be put in and repair the damage to the nerve sheath in MS. It is also possible that the new cells would be attacked in the same way as the original cells were, but this would be one area of potential stem cell application.

"I remain committed to the belief that stem cells will eventually be useful in treating a variety of diseases."

MODERATOR:
We have several people inquiring about stem cell therapy to repair catastrophic nerve damage from trauma. Do you see this as a promising area of research?

SHELANSKI:
This has potential, especially as the therapies could be applied shortly after injury.

MODERATOR:
We are almost out of time, Dr. Shelanski. Before we wrap things up for today, do you have any final words for us?

SHELANSKI:
I remain committed to the belief that stem cells will eventually be useful in treating a variety of diseases, and that what we learn about stem cells will enable us to also develop new drug treatments to treat these same diseases.

Finally, we should remember there are also stem cells in adults, and as we understand how to make embryonic stem cells show their potential, we will probably also be able to use the knowledge that we have obtained to enable us to exploit the potential of adult stem cells in the brain and in other tissues.

MODERATOR:
Our thanks to Michael Shelanski, MD, PhD, for joining us. For more information, please check out the links on our web site for stem cell research and visit the condition centers for Parkinson's disease and other conditions that may benefit from this research.

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