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2012 Marek Vácha There is a growing gulf between what medicine can do and what the health service can afford. Richard Gardner, chair of the Royal Society´s.

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Presentation on theme: "2012 Marek Vácha There is a growing gulf between what medicine can do and what the health service can afford. Richard Gardner, chair of the Royal Society´s."— Presentation transcript:

1 2012 Marek Vácha There is a growing gulf between what medicine can do and what the health service can afford. Richard Gardner, chair of the Royal Society´s working group on stem cells and therapeutical cloning

2 Embryonic Stem Cells ES cells that have proliferated in cell culture for 6 or more months without differentiating, and which have pluripotent and appear genetically normal, are referred to as an embryonic stem cell line.

3  each of early blastomeres (2,4,8 cell stage) is thought to be able to form an entire embryo, including the trophoblast  isolated ICM cells probably cannot form the trophoblast cells

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5  1975 The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research issued its report and recommendations for research on the human fetus  no federal monies should be used for IVF of human eggs until a special Ethics Advisory Board reviewed the ethical issues  1994 NIH established the Human Embryo Research Panel  some areas of human embryo research be acceptable for federal funding, including research on embryos created expressly for the purposes of research  however, president Clinton directed NIH not to allocate resources to "support the creation of human embryos for research purposes"  tough his directives said nothing about reseach involving spare embryos

6  1994  Congress stopped the enterprise dead in its tracks by enacting an amendment to the omnibus appropriations bills that prohibited NIH from using federal funds for any and all research on human embryos.  1998  NIH attorneys ruled that the prohibiting law actually permitted federal funding of research on the embryonic stem cell lines, provided that the researchers were not themselves responsible for the acts of embryo destruction needed to produce them.

7  2000  After a study by the National Bioethics Advisory Commission supported such research, and after the NIH developed guidelines for it, President Clinton authorized such funding  august 2001  The federal government would agree to fund embryonic stem cell research only on already existing stem cell lines, but there would be any further destruction of human embryos

8  August 2000: scientists could apply for federal funding only for research utilizing 78 existing stem cell lines.  the true number of available and suitable lines appears to be closer to twenty than the higher number.  President Bush agreed to finance embryonic stem cell research, but limited federally financed research to 21 cell lines already in existence by  Kass, L.R., (2002) Life, Liberty and the Defense of Dignity. Encounter Books, New York, London. p

9  the restriction do not hamper the use of private funds for the other lines, only federal funds  09/03/2009 president Obama releases federal funds   23/08/2010 A federal district judge blocked President Obama’s 2009 executive order that expanded embryonic stem cell research, saying it violated a ban on federal money being used to destroy embryos.

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11  With the case back in his court, Judge Lamberth ruled that the administration’s policy violated the clear language of the Dickey-Wicker Amendment, a law passed annually by Congress that bans federal financing for any “research in which a human embryo or embryos are destroyed, discarded or knowingly subjected to risk of injury or death.”  The Obama administration said that its rules abided by the Dickey-Wicker Amendment because the federal money would be used only once the embryonic stem cells were created but would not finance the process by which embryos were destroyed. The judge disagreed, writing that embryonic stem cell research “necessarily depends upon the destruction of a human embryo.” 

12  the appellate court said that because the law is written in the present tense, “it does not extend to past actions.”  Judge Karen LeCraft Henderson, the dissenter in Friday’s appeals court ruling, wrote that her colleagues “perform linguistic jujitsu” to arrive at their conclusion.  The plain language of the law bans financing for all research that follows the destruction of embryos, she wrote, and it is meaningless to try to separate the process of destruction from the use of the stem cells that result from that destruction. 

13 Embryonic Stem Cells  were firstly isolated from mice in1981.  Human Embryonic Stem Cells were firstly isolated in 1998 by  James Thomson (Wisconsin university funded by Geron corporation).  Dr. John Gearhart of Johns Hopkins University James A. Thomson says he thought “long and hard” before doing stem cell research.

14 James A. Thomson (2007)  His laboratory was one of two that reported a new way to turn ordinary human skin cells into what appear to be embryonic stem cells without ever using a human embryo.  The fact is, Dr. Thomson said in an interview, he had ethical concerns about embryonic research from the outset, even though he knew that such research offered insights into human development and the potential for powerful new treatments for disease.  “If human embryonic stem cell research does not make you at least a little bit uncomfortable, you have not thought about it enough,” he said. “I thought long and hard about whether I would do it.”

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17 James A. Thomson (2007)  Now with the new technique, which involves adding just four genes to ordinary adult skin cells, it will not be long, he says, before the stem cell wars are a distant memory. “A decade from now, this will be just a funny historical footnote,” Dr. Thomson said in the interview.  ef=slogin

18 Classification  (ESC)Human embryonic stem cells,  Embryonic Stem Cell (ESC) Therapy - theoretically involves the use of cells extracted from a five day old in vitro fertilized embryo (in this embryo there is approximately 100 cells, ICM is 30 of them). ESCs have been scientifically substantiated to be pluripotent for all cell types.  (FSC)Human embryonic germ cells,  Fetal Stem Cell (FSC) therapy involves the use of human fetuses aborted between 1 and 3 months. Tissue with imbedded stem cells is scraped from the liver, neural or gonadal ridges. Commercial providers of these potentially pluripotent cell types do not scientifically classify the cell populations.  (ASC)Human Adult stem cells,  ASC are undifferentiated, found among differentiated cell types in a tissue or organ. ASC can renew themselves, and can differentiate to yield the major specialized cell types of the tissue or organ. Their primary role in a living organism is to maintain and repair the tissue in which they are found. There are approximately 20 types of ASC in the human body.

19 iPS  = induced pluripotent stem cells  by addition of four human human genes to human skin cells they can be reprogrammed back to the state of stem cells from an early embryo, with the abuility to develop into every cell type in the body

20 iPS  iPS thus promise to provide a source of immunologically compatible tissues for treating patients currently suffering from incurable genetic diseases such as Alzheimer´s disease, without encountering the ethical objections raised by using ESC from human embryos or cybrids

21  „In the long-term the scientific view is that it will be possible to re-programme adult stem cells with the full potential of embryonic cells but without the morally contestable need to create an embryo.“  Liam Donaldson, the Chief Medical Officer in the UK

22 Classification  totipotent cells  pluripotent stem cells  pluripotent = "capable of becoming many things"  multipotent stem cells  progenitor (=unipotent) stem cells  can produce only one cell type

23 ASC

24 Embryonic Stem Cells

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26 Possible Sources of Embryonic Stem Cells  Surplus embryos  Embryos made exclusively in order to receive ESC  SCNT = Therapeutic Cloning

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28 Dr. Woo Suk Hwang  24/ Dr. Hwang is forced to to step down  female researchers in his own lab had supplied eggs for his research.  two key scientific papers in 2005, both published in Science Magazine, were found to have been fabricated. August 2005 Snuppy, an Afghan hound was cloned by Dr. Hwang

29 Dr. Hwang  Dr Hwang was in March fired from his professorship at Seoul National University (SNU) and in May was charged with fraud and embezzlement. Dr Hwang had received millions of dollars' worth of funds from the state and private foundations for his research.  The downfall of Dr Hwang came as a big shock to Koreans, who had taken great pride in what appeared to be the pioneering work of the stem cell researchers at Seoul National University.  Dr Hwang at one point had 15,000 hard-core fans, who belonged to a "I love HWS" online community.

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31 Definition of Human Embryo  A human embryo is a discrete entity that has arisen from either:  (i) the first mitotic division when fertilization of a human oocyte by a human sperm is complete or  (ii) any other process that initiates organized development of a biological entity with a human nuclear genome or altered human nuclear genome that has the potential to develop up to, or beyond, the stage at which the primitivestreak appears,  and has not yet reached 8 weeks of development since the first mitotic division.

32 Arguments for obtaining Embryonic Stem Cells from embryos  The prospects are beyond our scope  Only 30-50% zygote implants. If Mother Nature is so prodigal, we may not to bother with embryos.  individual is „in-dividium“, non-divisible.  Human embryo is nothing than cluster of cells  if we approved abortions, there is no discussion about status of embryos  utilitarianism: we have to consider the ethical calculation, gains and losts: happy and healthy patient/destroyed embryo

33 Arguments for obtaining Embryonic Stem Cells from embryos  If abortions are legal, protection of embryos is inproportionate, inadequate  ES cells are not embryos. These cells are no more totipotent. If we already have these lines, they are cells, not embryos.  individuum is etymologically indivisible  MZ twins could arise until the end of the second week. Until this time we cannot speak about individuum

34 Arguments for obtaining Embryonic Stem Cells from embryos  Argument of utilitarianism: on the one side of the ethical scale is healthy happy patient, on the other side of the scale embryo which can not feel neither pain, nor pleasure

35 Arguments against obtainig Human Embryonic Stem Cells  Embryo is not, embryos are. Every embryo has a unique genetic design  An Embryo has a potentiality to become an adult human person, so we must treat an embryo as a person.  every embryo has two living beings, parents  Aristotle: four „causes“  Immanuel Kant:  the problem of freedom  difference between cost/value and dignity

36 Aristotle ccausa materialis ccausa formalis ccausa efficiens ccausa finalis

37 ccausa materialis: „cluster of atoms“, „cluster of cells“, „C,H,O,N,“ etc. ccausa formalis – form of living matter is a soul ccausa efficiens „where from I came?“ ccausa finalis „what is goal of my life?“

38 „Cluster of cells“ Five day old embryo is composed from150 – 200 cells, adult human from cells

39 Germany  The German Parliament established the 2002 Stem Cell Act, which allows the import of hESCs for high- ranking research objectives.  These must be evaluated by the Robert Koch Institute, a federal institute in Berlin, and its central ethics committee for stem-cell research (http://www.rki.de).  Moreover, only hESC lines produced from surplus embryos from in vitro fertilization (IVF) before 1 January 2002 can be legally imported. This key date was chosen to ensure that no hESC lines are directly produced for German research; in other words, that no human embryos are destroyed 'on German order'

40 Regulation of Research in EU  Germany: prohibition to destroy embryos for obtaining hES. Allowance to work with hES if the lines were created before 01/  22/ this import and usage was shifted to 01/

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42  Ms. Best said her nine embryos “have the potential to become beautiful people.”  The thought of giving them up for research “conjures all sorts of horrors, from Frankenstein to the Holocaust,” she said, adding that destroying them would be preferable.  Her teenage daughter favors letting another couple adopt the embryos, but, Ms. Best said, she would worry too much about “what kind of parents they were with, what kind of life they had.”

43 „Solutions that typically are not offered“  Smaller numbers of patients wished for solutions that typically are not offered.  Among them were holding a small ceremony during the thawing and disposal of the embryos, or  having them placed in the woman’s body at a time in her cycle when she would probably not become pregnant, so that they would die naturally.

44  Some people pay storage fees for years and years.  Others stop paying and disappear, leaving the clinic to decide whether to maintain the embryos free or to get rid of them.  “They would rather have you pull the trigger on the embryos,” Dr. Sauer said. “It’s like, ‘I don’t want another baby, but I don’t have it in me; I have too much guilt to tell you what to do, to have them discarded.’ ”

45 SCNT  this technique is too elaborate, and hence too expensive for routine use  technique might be more properly called „research cloning“

46 Reproductive and Therapeutic Cloning

47 Human Embryo Luis Santamaría, U.A.M., Spain  Human embryos are not:  some other type of animal organism, like a pre- human entity  neither are they a part of an organism, like a heart, a kidney, or a skin cells  nor again are they a disorganized aggregate, a mere clump of cells awaiting some magical transformations  rather, a human embryo is a whole living member of the species Homo sapiens in the earliest of his or her natural development

48 Embryo science, Embryo technology, Embryo ethics Luis Santamaría, U.A.M., Spain  Embryo science  tells us what the embryos are and when they begin  Embryo technologies  represent the abilities of researchers to do things to or with embryos  they can make embryos in lab, by IVF or by cloning  they can keep embryos alive in the lab whether in culture, or indefinitely by freezing  they can destroy these embryos

49 Embryo science, Embryo technology, Embryo ethics Luis Santamaría, U.A.M., Spain  Embryo ethics  are such manipulation morally right?  it is not uncommon to hear embryo researchers claim that only science should have a say what science does, and that ethics, religion and politics have no business in the concerns of science  it is true that moral philosophy cannot say what embryo is nor has anything to say about what can be done with an embryo

50 Geoffrey Chu, 2003  Rasko correctly asserts that certain medical research is unethical and unjustifiable (i.e. Nazi experiments) and should always be prohibited, regardless of significant potential gains.  Accepting this premise renders utilitarian arguments in favour of ESC research irrelevant if the human embryo is considered to be an individual human being.  Utilitarian arguments have serious limitations because the eventual outcome of benefits and harms is initially uncertain and may remain unclear for a substantial period − decades or longer. 

51 Geoffrey Chu, 2003  In the early phases of this continuum, we casually redefine 'human' to suit our personal agendas. (…) Emergence of the embryonic streak on day 14 is another unfortunate arbitrary definition of who is human.  Those who have lost part of their cortex from a stroke or Alzheimer's Disease are no less human than they were beforehand.  RETRY=0

52 Cybrids  applications have been made by three teams of UK researchers to the HFEA for licences to use rabbit, cow and goat eggs to create cytoplasmatic hybrid embryos, so-called cybrids  the proposal, which has found widespread support in the bioscience community, was the subject of a public consultation exercise, which resulted in the HFEA giving „in principle“ approval for the use of the technique in 2007

53 Cybrids

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