The Ethics Involved in Stem Cell Treatment

Definitions 

• Ethics: The branch of knowledge that deals with moral principles.
• Cellular differentiation: It is the process in which “less specialized cells” undergo maturation to become more specific in form and function. This is essentially when a cell changes from one specific type to another. It is most often differentiating into a more specialised cell. It occurs multiple times in the growth of multi-cellular organisms as cells within the zygote differentiate into tissues and then into complex organ systems each with their own cell types. Through the development of the foetus, humans also experience the differentiation of cells as we grow. For a zygote to further develop, the cells differentiate into another form suited to the next stage of growth.
• Somatic cell: Any cell that forms part of a biological body within a multicellular organism that is not a gamete, gametocyte, undifferentiated stem cell or germ cell.
• Regenerative medicine: It involves the treatment of damaged cells, aiming to either repair or replace the cells, or regenerate tissue or organs to restore normal bodily function.
• IVF embryos: IN VITRO FERTILISATION- this is essentially the fertilisation process in full occurring outside of the body. The sperm and eggs are combined in a lab, in vitro, outside of the body. The process involves the monitoring of a female’s ovulatory process, and the subsequent extraction of an ovum or ova, letting the sperm from a male fertilise the egg in an in a laboratory.
• IPSC: Induced pluripotent stem cells- these cells are obtained from skin cells or blood cells which have then been reprogrammed into an embryonic-like pluripotent state that allows the development of any human cell that is required for therapeutic or research purposes. They have been probed to become beta islet cells that treat diabetes, and blood cells to create new blood that is free from cancer cells. These cells were then implemented in the treatment that a leukaemia patient received. They have also been probed to form neurons to treat neurological disorders.
• SCNT technology: SOMATIC CELL NUCLEAR TRANSFER- It is a laboratory strategy that involves the creation of a viable embryo from a body or egg cell. The process involves the taking of an enucleated oocyte (egg cell) and implanting that cell into a donor nucleus from a somatic cell. In short, the nucleus from both a somatic cell and an egg cell is removed from the overall cell body, whilst the rest of the cells are then not needed.
• Haemorrhage: The leaking of blood from an injured blood vessel that has been damaged, often as a result of surgery.
• Neurosurgery: It is simply surgery carried out upon the nervous system, particularly the spinal cord and brain.

What is Stem Cell Research?

Stem cell research is the field of study that seeks to identify the uses of stem cells and further understand their potential in medicine. It studies the different properties of stem cells, seeking to gain knowledge on how stem cells work so that they can be implemented in the treatment of certain diseases and/or disorders. It is also known as regenerative medicine. It is for this reason that it is studied and investigated to promote the repair response in diseased, dysfunctional and damaged tissues. Instead of using donor organs, stem cells have the potential to play a major role in organ transplant surgeries, using the cells instead of organs.

Many severe medical conditions within humans occur due to the abnormal division of cells that then can have life-threatening implications for the patient. Understanding how stem cells work, and their potential functions can help scientists to understand why these conditions occur and possibly, hopefully, then provide suitable treatment possibilities.

It is so done, that the research obtained form the studies and experiments regarding stem cells, would form the foundation upon which new and ingenuitive treatments can be found for conditions such as diabetes and heart disease. The stem cells have the innate ability to divide easily and replace dead or damaged cells.

Currently, stem cells are largely implemented in the testing of drugs and their development. The stem cells used for this are called induced pluripotent stem cells which essentially have already undergone differentiation but have been reprogrammed by scientists using viruses to divide and take the form of any cell. When reprogrammed and forced to take on the role of another cell, these pluripotent cells now act as if undifferentiated cells.

This research then leads on to the process in which differentiated cells can be grown from these pluripotent stem cells to resemble cells that are undergoing treatment research, such as cancer cells. This allows scientists to test anti-cancer drugs.

In theory, stem cell research largely plays into the revolutionary concept of regenerative medicine. This approach to modern medicine seeks to provide better healthcare to patients by focusing on the cause of the disease and investigating means by which to regenerate, repair or replace the cells that are in question, affecting the quality of life. Because stem cells have the potential to repair cells or replace them, test drugs and treat severe medical conditions, stem cell research is done within numerous fields of a medical study.

The Ethics Involved in Stem Cell Treatment

Stem cell research and treatment in particular have always had controversial factors that add to the possible issues regarding the use of stem cells in the medical industry. The study of stem cells and their implementation in the treatment of severe medical conditions that very often are life-threatening or decrease a patient’s quality of life was first brought to the surface in the early 1900s. At that point in time, there was a very large opposition to the idea of stem cells due to where they were taken from which raised many ethical questions regarding the foundations of what it means to be humans. But the stem cell research we undertake today is far more advanced and complex to simply labelling ethics as the only grounds upon which to disagree with the use of stem cells as regenerative medicine. The potential risks, benefits and reality of stem cell treatment currently are so vast and complicated that ethics is only one part of a much larger medical investigation.

In short, the origin of the stem cells that have most commonly been used in the past is from an embryo. During the harvesting of the embryonic stem cells, the embryo is essentially destroyed. Historically, this hasn’t boded well for the support this treatment has received let alone the research. In its earlier stages, president George W. Bush had pro-life religious views that meant he would ban the funding of stem cell research in 2001. The bases on which the ban was founded was the controversy regarding when a human definitively becomes a human with every and all basic human rights. When does a person truly become privy to the rights of any fully functioning human being?

There are numerous views regarding this question. Some people believed that a human is called as such from the moment of conception and so the destruction of the embryo is, in the literal meaning, murder. Others argued that a person first and foremost has the same moral status as any other as soon as the foetus develops into an embryo. Some said that the birth of a child signifies its right to basic human rights when it takes its first breath. All of which meant that the destruction of an embryo was morally wrong and thus prevented stem cell research from being carried out in full due to the failure to communally identify when a person is truly a human.

But at the same time, those who supported the use of stem cells in treatment and research argued that the scientists received consent from the male and female whose eggs and sperm were concerned in the production of the embryo. It is also true that fertilised eggs created during in-vitro fertilization are in any case discarded and so might as well be used for the benefit of suffering patients.

Today, it is not only embryonic stem cells that are used in stem cell treatments. By 2006 induced pluripotent stem cells had been discovered and used in research. But, the conception of iPSCs in treatment also raises the question of whether human cloning is ethical or not. Because iPSCs can potentially create a clone of a donor embryo, there is a whole other basis upon which ethics now comes into play. Cloning has not yet been carried out. Some countries even have legislations that prevent it. But now we must consider whether a clone has the same rights to a naturally produced child or not.

Stem cell research extends across many fields and involves many factors. Logistically, there are more than just embryonic stem cells that exist with the potential to provide revolutionary treatment methods. The ethical complications are concerned with the degree to which stem cell research and treatment can extend before it becomes morally unethical or wrong.

The potential risks involved with the treatment of the patient

Stem cell treatment has potential risks for patients undergoing treatment procedures, particularly those who are engaging in trials or investigating treatments.

One of those potential risks or concerns is whether the use of stem cells can cause tumours. The great potential that embryonic stem cells possess is their ability to form any type of cell within the body. When implanted into an animal, there have been cases in which the cells do form tumours called teratomas because of this ability. They often consist of many cells including hair cells and possibly many other tissues. It is for this reason that the embryonic cells are matured into highly purified adult cells before they are implanted into humans. This has proved to be effective but the potential for something to go wrong is still a risk.

Just as there is a risk with any form of implantation, there is the risk of immune rejection. These cells do have the potential to be recognized by the immune system as foreign, in which case your immune system will then reject the cells just as it would any other potentially dangerous organ. In transplants such as the kidney, liver and heart, the patient must be on immune suppressive drugs for the entirety of their lives. This prevents the immune system from destroying these organs. It is the same in the case of stem cell transplants. To prevent the rejection of the cells the patient will have to be on the same form of the drug. The added risk with these drugs is that they don’t just suppress the immune system when it concerns foreign cells, the immune system is also suppressed when it comes to identifying and destroying pathogens or foreign objects within the body that do present very real dangers to the patient’s liver health. The drugs may then allow the transplant to be effective, but it also means that the person is at a higher risk of infection from external pathogens due to a weakened immune system.

The likelihood that the immune system will reject the cells depends on the origin of said cells. Stem cells isolated from IVF embryos will have a genetic make-up that could very likely be identified as foreign and thus be rejected as it will not match that of the patient’s genetic make-up. However, stem cells generated from iPS and SCNT technology have a genetic make-up that will match that of the patient and is thus less likely to be rejected by the person's immune system. But some have said that even if there is a perfect match, it is not entirely unlikely for the body to reject the cells. This is the case in cancer cells which have the same genetic make-up as the patient, but the immune system will often destroy tumours early on when possible.

Furthermore, the majority of the risks of stem cell transplantation include tumour formation, inappropriate stem cell migration, immune rejection or transplanted cells, haemorrhage during neurosurgery and postoperative infection.

Patients undergoing stem cell treatment or transplants can experience complications when the stem cells migrate from the graft site to inappropriate regions of the brain. Undifferentiated neural stem cells are very likely to migrate to undesirable areas with the brain from the graft site. This is done through the white matter tracts. There have been enough cases in which the neural stem cells have migrated to lesions within the brain to suggest that this is a recurring potential risk. The migration of these cells could possibly cause abnormal brain function, especially due to the abundance of the migration. Even if a low percentage of cells migrate from the graft site to other areas of the brain, the potential effects that it could have on the patient are very likely to be harmful. The clinical symptoms that are predicted to arise with the migration are grey matter heterotopias and temporal lobe epilepsy. Grey matter heterotopias is a collection of normal neurons or astrocytes in unusual parts of the brain such as the subependymal region of the lateral ventricles and the white matter below the cortex that is as a result of migrating cells during cortical development. Because they have anomalous activity and limited maturity, the occurrence of seizures may be prevalent. Medically refractory temporal lobe epilepsy is thought to be caused by neurogenesis and subsequent migration of ectopic granule cells to the hilus which can cause excitatory synaptic inputs that lead to clinical symptoms of seizures.

It is estimated that 3% of stereotactic neurosurgery used in the transplantation of FVM tissue is associated with the risk of intracerebral haemorrhage and postoperative infection. During the procedure, it is possible for the instrument used to injure blood vessels which make the possibility of a haemorrhage likely. This can then lead to occurring stroke-like syndrome, sensory loss or weakness. Any infection is a possibility when human error means that an instrument is not properly sterilised. However, haemorrhages and infection during neurosurgery are not risks able to be prevented. It is the brain anatomy and postoperative care that determines these risks and the likelihood to occur in the patient.

It is also possible for infected cells to be transplanted from FVM tissue. Different screenings can be carried out to identify the possible pathogens that could appear in these tissues, but it then needs to be done often and thoroughly. Handling of the stem cells could also result in infectious agents being transplanted in the stem cells. It is a danger for the patient, who is at risk if the screenings are not done often, or if human error prevails and mistakes are made.