Stem Cells and Medical Innovation: An Ongoing Medical Debate

Image Credits: Desert Spine And Sports Physicians 

Article Authors: Gordon Slater| Tandose Sambo 

Stem cells are a little like blank slates that are yet to take on a specific task. If you rewind the clock on any of your body’s tissues, its cells will become less specialised, until you’re left with a cell with a lot of potential to become nearly anything.

MIKE MCRAE

Introduction 

We live in some unprecedented times that are enabling a multitude of medical innovations to reach the forefront of our attention. With technologies ranging from medical robotics, to gene editing to stem cells, there are many advances that have to be carefully assessed before they can be allowed to enter mainstream medical utilization. 

Stem cell technology is one of the medical blessings that the medical industry has had to carefully discuss from various perspectives, particularly that of the ethical perspective. With biotechnology advancing as it has, many policy and ethical issues have had to be discussed as increasing knowledge on the applications of stem cells is understood. The stem cell research and the rest of the medical community have identified a few significant issues that are worth discussing. 

With every discovery there’s an aligning policy, and bioethics is one of those areas that is specifically designed to address the issues that are centered around concerns of stem cell research and the therapies that will be incorporated with their utilization. From the bench top to the clinical application, we have to be careful in the applications of stem cell therapies. One of the sensitive issues involves the utilization of human embryonic stem cells, and with the discovery of additional stem cells within the body, the utilization becomes less sensitive, but concerns about translation to clinical trials poses additional concerns to be  discussed below. While healing mechanisms remain largely unknown, it seems that elucidating the healing path ways are the least of our worries in the discovery pipeline. 

Stem Cell Research 

Stem Cell Research is a varied topic that spans a variety of types of stem cells that are generated across the human lifecycle. Stem cell researchers have identified a multitude of applications for stem cell therapies. These applications include[1]: 

  1. seeking new sources of highly multipotent stem cells and methods of perpetuating them; 
  2. creating induced pluripotent stem cell (iPSC) lines to study genetic disorders or explore pharmacogenomics; 
  3. conducting animal or early-phase human studies of experimental stem cell interventions; 
  4. or working with stem cells and biomaterials to develop organoids and other products for use in regenerative medicine. 

There is rapid evolution in the stem cell research activities outlined above, and they are just the tip of the iceberg. Stem Cell researchers are well aware of the potential that they possess, and with great responsibility is the need for the researchers to understand the ethical impacts and how they will impact the wider population.  

Modern design involves the incorporation of ethical research from the start of the exercise. During the early phases of R and D, as the preclinical research is being conducted, researchers should start asking themselves questions about the ethical nature of their activities. If any potential issues can be identified from the beginning, then the appropriate actions can then be taken to fix or eliminate the issues. Prevention in all activities, is better than a downstream cure. Critical questions that researchers can ask include: 

  1. What is the scientific value of my research? 
  2. What is the social value of my research? 
  3. How can the research process be designed to ensure that the experiments are properly conducted and repeatable? 
  4. How can we educate the public on our findings? 
  5. What are the associated risks at each stage of the research process? 

Until full mechanistic details of the operations of the various types of stem cells within the body are understood, the research process will pose both harm and potential benefits to the society. Knowing the odds of each possibility will be the key to ensuring that justification of each phase of the exercise can be quantified and validated. 

Scientific research is a standardized methodology that is proven by experimental data. With the appropriate data, it will be possible for medical researchers to translate their experiments across each stage of the research process. From lab scale, to animal trials to human subjects, it will then be justifiable in the research exercise. 

Within human trials, it will be important to select and recruit appropriate patient-subjects. Having controls in place, will make the data collection more representative of the sample population understudy. Robust planning and design will result in successful trials and suitable approval by the relevant authorities such as the US Food and Drug Administration(FDA). 

Critical Areas of Clarity In Stem Cell Research 

Stem Cell Research is actually a very broad topic. The reason for this is the fact that the body generates different types of stem cells. The type of stem cells understudy include: embryonic stem cells and other types of multipotent stem cells that are generated by adult stem cells. Sources of stem cells in the body include: 

-amniotic fluid 

-umbilical cord blood

-adipose tissue

-urine 

-additional body sources such as the bone marrow 

Clarifying exactly which type of stem cell is being utilized in the treatment of a particular condition will be key. The body’s reaction to each type of stem cell will differ, and the efficacy will not be the same in each subject. The public’s perception when they hear stem cells may be different from what the researcher is perceiving, and it will be important for the clarity to be identified in any scientific discussion. 

Establishment of Stem Cell Research Oversight Committees 

Human embryonic stem cell research is one of those areas of medical research that is embroiled in controversy, as their harvesting involves the destruction of an embryo. As new applications of stem cell research are being conducted, so too will these additional areas generate their own associated risks. Fortunately for these additional cells, they will be sourced from live humans, but the risks of utilization will have to be contended with. For this reason, it will be important for overarching bodies to oversee the activities of researchers in the realm, and enable appropriate legislation and standardization of their applications. 

Agencies such as the National Academy of Sciences (NAS) have actually started to develop guidelines for both institutions and researchers who are studying stem cell research, particularly for areas such as Human Embryonic Stem Cell Research. The National Institutes of Health has also facilitated guidelines in the realms of: 

-Human Pluripotent Stem Cells 

-Donors of Biomaterials

-Embryo Generations 

-Animal-Human Chimeras (Chimeras are organisms that are composed of cells from two or more sources) 

As overarching bodies remain in existence, the research community will have a means to be accountable to the wider community. 

Conclusions

As biotechnology evolves, there are simultaneous innovation potentials and ethical risks that medical researchers will have to face. Stem Cell Research, as a multi-faceted research topic has generated a multitude of questions from both ethical bodies and the general public. Researchers must ensure that they are asking critical questions in their research practices and ensuring that what they produce is for the greater good of all. Where researchers fall off, there will be regulatory bodies on hand to ensure that they are abiding to their commitments. 

Reference Article: 

[1] PubMed: Ethical Issues In Stem Cell Research and Therapy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4097842/

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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