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The Stem Cell Controversy

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1 The Stem Cell Controversy
Robbie Majzner, Legislative Advocacy

2 Quick Review: What are the characteristics of a stem cell?
1) POTENCY The ability to differentiate into any type of cell in response to cell signaling Pluripotency: This is why stem cells have the potential to "cure any disease" 2) SELF RENEWAL The stem cell can divide over and over and remain in this undifferentiated state. This is why you hear a lot about stem cell "lines." 3) CONTROVERSY No matter what, they seem to cause controversy

3 Types of Stem Cells: Somatic/Adult
Cells that come from human sources that have some measure of multipotency (usually less so than embryonic, but can be made pluripotent) Sources include bone marrow, cord blood, teeth (--> hepatocytes), neural cells, skin, and more Used in bone marrow transplant (allogenic or autologous), tendon/ligament injury in horses, and in 2008, used to regenerate a section trachea that was transplanted into a woman Used to be without controversy but have now stepped into the limelight

4 Embryonic Stem Cells Derived from Embryos, thus the controversy of when life begins Harvested from embryos at the blastocyst (day 5) stage PLURIPOTENT Express transcription factors that suppress differentiation  Cells that survive growth/harvesting process can become pluripotent stem cell lines

5 Embryonic Stem Cell Uses
FANTASY Spinal Cord Regeneration Traumatic Brain Injury SC+ Cloning = New livers for everyone, no risk of rejection Extra limbs New islet cells in DM1 Post MI, heart remodeling  Replacing SN cells in Parkinson's REALITY  A single Phase 1 trial of injecting stem cells into spinal columns of patients with acute spinal cord injury approved in 2009, but held due to safety concerns until July 2010

6 Induced Pluripotent Stem Cells
In 2006, researchers in Japan successfully inducted mouse somatic cells to become pluripotent stem cells pluripotency depends on transcription factors retroviruses used for introduction of these TF's First successfully performed in human cells by same group at University of Wisconsin who first isolated hESC in 2007 and the same group in Japan in 2007 Possible problems with this cell is retrovirus that randomly inserts could interrupt tumor suppressor genes Current research focusing on using protein only induction Promising field as avoids the controversy of embryonic SC

7 The History of Embryonic Stem Cell Politics & Research
1981: First Embryonic Stem Cells are isolated from mice (Camridge, UK and UCSF)  1995: Accomplished in Primate (Rhesus Monkey) in Wisconsin 1995: NIH Human Embryo Research Panel recommends federal government fund research using BOTH embryos left over from IVF  and on embryos created for experimentation Bill Clinton, citing ethical concerns, seeks middle ground and by executive order to HHS/NIH declines to fund research on embryos created for experimentation

8 Divided Government, Republicans Chime in...
Newt Gingrich Jay Dickey (AK)

9 The Dickey Amendment, 1995 Despite Clinton's opinion, Congress intervened and passed the Dickey Ammendment "banning stem-cell research" Passed as a Rider on other legislation, every year since 1997, prohibits HHS/NIH funding for: (1) the creation of a human embryo or embryos for research purposes;  or 2) research in which a human embryo or embryos are destroyed, discarded, or knowingly subjected to risk of injury or death... Illegal for government to fund, but not for private citizens to carry out research (some European countries ban all)

10 Research Continues...(privately)
In '98, two groups w/private funding successfully harvested HUMAN EMBRYONIC STEM CELLS (Hopkins, U. Wisconsin) Brought to limelight, so Clinton reconsiders his position  In 1999, the president's National Bioethics Advisory Commission again recommended that hESC harvested from embryos discarded after IVF treatments eligible for federal funding but Dickey stands in his way

11 Legal Cover Chief Counsel for the Department of Health and Human Services Harriet Rabb (now at Columbia Center for Bioethics) writes a legal opinion in 1999 that changes the Clinton Administration opinion and determines US policy for 10+ year Government cannot fund any destruction of embryos but can fund the research once the stem cells are created Creative work around accepted by Clinton Administration but called "Legal Sophistry" by Republicans at the time

12 Clinton and NIH Setup to start funding in 2000/2001, but....

13 The Bush administration puts a hold on all NIH funding in January 2001...
Tommy Thompson, the new head of Health and Human Services, instructs the NIH to suspend the reviewing of all grants involving hESC President Bush took seven months to issue his decision regarding stem cell research in a TV speech that was supposed to be one of the biggest decisions of his term

14 The Bush Stem Cell Decision, 8/9/01
Similar to Clinton's decision, the NIH could fund research on stem cells after they were created (no funding embryo destruction) Unlike Clinton's decision, these funds could only support research on already established stem cell lines where The derivation process was initiated prior 8/9/01 must have been derived from embryo that was created for reproductive purposes & was no longer needed. Informed consent must have been obtained  Seen as a compromise by much of the media, but heavily criticized by liberals and the scientific community

15 The Stem Cell Lines Initially thought to be 77 cell lines available world wide (from labs in US, S. Korea, India, Sweden, Israel, and more) Turned out there were only 21 available Some cell lines were contaminated, others had genetic mutations! Criticized as not genetically diverse Put a lot of money/power in the hands of those that owned these lines Engendered controversy throughout the Bush presidency and became a big issue in the 2006 and 2008 elections

16 During Bush, the states speak out...
Several states put their own money into stem cell research 2004: NJ legislators pass a state budget that includes $9.5 million for a newly chartered Stem Cell Institute of New Jersey 2004: California Proposition 17 authorizes the state to spend $3 billion on embryonic stem-cell research over 10 years, making it a larger funder than the federal govt.  Efforts also in IL, FL, CT, Iowa and others

17 Congress considers relaxing the restrictions...
After initial victory in 2004, there was significant weakening of the Republicans and Conservatives in congress Stem Cell research a hot button issue in '06/'08 campaigns State funding as well as celebrities like Christopher Reeve helped bring this issue to the forefront of the media  2005 poll, 70% Americans favored loosening the Bush restrictions (including >50% of conservatives)

18 But Bush sticks to his guns...
President Bush used his first ever veto in July 2006 to veto a bill that would have increased federal funding for other stem cell lines Bush vetoed only 12 bills in his 2 terms as opposed to 44 for Bush 41 in 1 term and 37 for Clinton in 2 terms Of those 12 bills, only 7 did not become law 3 of those 7 bills were for increased stem cell funding

19 Democratic Takeover/Obama '09
Obama campaigned promising to increase Federal Funding for Stem Cell Research In his first 100 days, Obama reversed the Bush restrictions, but also signed an appropriations bill extending the Dickey Amendment, thus returning policy to that under the end of the Clinton Administration In the years between Clinton and Obama, many other stem cell lines were created by private industry, total now ?75 Obama did not legalize government funding of the creation of new hESC lines

20 Sherley v Sebelius, August 2010
James L. Sherley and Theresa Deisher, two Adult Stem Cell researchers, brought suit in federal court against HHS to protest the funding of hESC research over aSC research They maintain that original intent of the Dickey Amendment was to prohibit all research on destroyed human embryos U.S. District Judge Royce Lamberth (DC Appelate) issued a preliminary injunction on funding hESC research If one...piece of research of an ESC research project results in the destruction of an embryo, the entire project is precluded from receiving federal funding This was a temporary injunction, case not yet decided

21 The plaintiffs and their backing
The two scientists were represented by The Alliance Defense Fund: "a servant organization that provides the resources that will keep the door open for the spread of the Gospel through the legal defense of religious freedom, the sanctity of life, marriage  and the family." Sherley was formerly at MIT; when denied tenure, he went on a hunger strike and claimed racial bias: “When I say ‘embryoism,’ I mean discriminating against human embryos, just like there is discrimination against people of different culture and races,” he said."

22 NIH/HHS Response Initially the NIH said they would stop all further funding of projects until the lawsuit was resolved but current grantees could continue research Appeal to Judge Lamberth for a stay of the injunction was rejected One week later, an appeal to the DC Court of Appeals granted an administrative stay of this injunction, returning federal funding to the initial Obama policy Now the court is hearing full arguments in Sherley v Sebelius before determining policy

23 Future Options... Unclear how this case will be decided
Plantiffs, who claim, irreperable harm not clearly damaged by this policy Policy may not violate law, was accepted by both Republican and Democratic administrations If government loses, would likely mean a stop to all federal funding of hESC research Appeal to US Supreme Court Legislative option to repeal or not renew the Dickey Amendment State by State funding

24 Get Involved Embryonic Stem cells, while they have little practical application today, have the potential to help cure and understand many congenital and acquired diseases. AAP Statement:   Research using human embryos and pluripotent stem cells is of sufficient scientific important that the NIH should fund it and...federal oversight is morally preferable to the currently unregulated private sector approach. Write your senators and congressmen to repeal the Dickey Amendment Be an advocate for scientific research in your own states,  state pressure changes the action of the Federal govt

25 Possible Compromises... Repealing Dickey would allow for funding of destruction of embryos by the federal government, which may not be universally acceptable...Other possibilities: Ammend the Dickey Ammendment to reflect the Clinton/Bush/Obama understanding Induced Pluripotent Stem Cells Return to Bush era policy with a renewal of the date after which we can use the stem cell lines to incorporate more lines

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