15 Morningside Road, Edinburgh EH10 4DP, Tel: 0131 447 6394 or 0774 298 4459
15 March 2005
Organisers: Progress Educational Trust
Venue: London
SCHB participant: Dr. Neville Cobbe
The PET Annual Conference held on 15th November 2005 was entitled "Putting stem cells into practice". This was advertised as focusing on the ethical, legal and social issues raised by embryonic and adult stem cell research, although relatively little discussion was actually directed towards adult stem cell research itself. The various presentations were organised into three sessions, of which the first provided an overview from the perspective of scientists engaged in research with embryos or embryonic stem cells, the second session dealt with funding for such research and its regulation and the final session closed with presentations focusing on possible future issues in stem cell research. Perhaps the most beneficial aspect of the whole conference was the generous amount of time allocated for questions and discussion, with one hour devoted to this purpose after each of the three sessions.
The first session was chaired by Professor Alison Murdoch (Newcastle Fertility Centre at Life) and opened with a highly informative and superbly balanced presentation by Dr Stephen Minger (King's College London), providing an introductory overview of stem cells in general. Dr Minger pointed to the controversy and debate regarding whether stem cells from bone marrow might be pluripotent (capable of differentiating into all cell types of a mature organism), as well as the loss of potency of many adult stem cell populations after expansion. However, he merely mentioned that various different labs had experienced difficulties replicating each other's findings, due to a host of potential variables, leaving open whether such adult stem cells might be truly pluripotent or just exceptionally diverse with regard to their differentiation potential. He also pointed to differences between individual cell lines or the ability to produce tissues for various mouse and human embryonic stem cells, particularly with regard to generating insulin producing cells. The proliferative capacity of adult stem cells was also highlighted, describing how roughly three million blood cells are made every second and how a stroke induces a huge burst of neurogenesis with migration of neurons to the site of damage (antidepressants seemingly inducing similar effects). Lastly, he described how it typically takes six months of hard work to produce just one embryonic stem cell line for research, thereby rendering utterly unfeasible any hopes of using cloning by nuclear transfer to generate patient-matched stem cells. Instead, he emphasized the importance of creating banks of stem cells corresponding to various immunologically compatible groups.
Dr Minger's excellent presentation was followed by a reasonably balanced talk from Professor Peter Braude (King's College London), discussing how one might source human eggs and embryos for stem cell research. The problems associated with sourcing eggs for research were made in reference to the incidence of ovarian hyperstimulation syndrome following hormonal treatment. Professor Braude pointed out problems associated with mosaicism in embryos, such that the biopsy of cells for PGD may yield a diagnosis that is not necessarily representative of the whole embryo. Consequently, many perfectly good and presumably viable embryos may be rejected based on unrepresentative or unreliable information. He discussed the possibility of routinely attempting culture of embryos to the blastocyst stage (day 5) before deciding whether "surplus" embryos should be cryopreserved or donated for research, rather than making such decisions sometime before the third day post-fertilisation. After his presentation, Professor Alison Murdoch commented how the funding opportunities for stem cell researchprovided new opportunities for the IVF field. I then asked Professor Braude (along with other panel members for the first session) what ethical issues might be associated with obtaining eggs for research from a woman receiving IVF treatment when her intended male partner was unable to produce sperm. Professor Braude's immediate response was that one would really have to ask what's going wrong in such a clinic. Professor Murdoch offered no further comment at this point.
The last talk in the initial session was given by Professor Sir Martin Evans (University of Cardiff) and dealt with the question of whether or not one should attempt to develop engineered "alternatives" to embryos for stem cell research. This dealt with suggestions such as generation of embryonic stem cell following "altered nuclear transfer", as proposed by Dr William Hurlbut of Stanford University. Although most of Professor Evans' presentation seemed rambling, disjointed and not particularly informative, he nevertheless made it clear that he felt that biological engineering should not replace rational resolution of ethical debate.
After lunch, the second session was entitled "Securing stem cell research for the future" and was chaired by Phil Willis MP, who had recently been appointed as Chair of the House of Commons Science and Technology Committee. This session began with a presentation by Charles Kessler of the European Commission, describing EU support for stem cell research against the backdrop of an uneven panorama of funding in Europe. Among other initiatives, he emphasized the availability of funding for fundamental research on differentiation, including the "Allostem" project focusing on bone marrow and the "Eurocord" initiative for haematopoietic stem cell therapy using umbilical cord blood. He also described the "Euro Stem Cell Project", an "integrated project" with a four year duration based in Edinburgh, that includes research in 18-20 countries. Although the derivation of embryonic stem cells from "surplus" embryos is eligible for EU funding, the creation of embryos specifically for research is not and the funding emphasis was described as being placed on many different sources of stem cells, in order to gather evidence on their comparative potential.
Mr Kessler's talk was followed by a presentation from Dr Simon Best (BioIndustry Association), discussing funding for stem cell research in the USA and the rest of the world. Dr Best pointed out that most funding for research with either adult or embryonic stem cells in the USA comes from private sources. This was exemplified by the funding available in California through Proposition 71, with bonds raising three billion dollars to be spent on research over ten years (despite fiscal challenges based on the question of investment returns for taxpayers). Dr Best also described how Australian embryonic stem cell researchers were looking elsewhere for funding (such as Singapore), whilst billions had been invested in the work of Woo-Suk Hwang's huge team as he was considered to be a subject of national pride.
The last presentation of the second session was given by Suzi Leather (Human Fertilisation and Embryology Authority), pointing out how scientific progress may ultimately be hampered by a lack of attention to public concerns, yet questioning how much weight should be given to different views. Ms Leather opined that the system of regulation in the UK was good but permissive but warned that public opinion on embryo research "is delicately balanced between optimism and fear". She presented the results of a public attitude study, showing that opinions towards embryo research (including stem cell developments) are finely balanced, with people saying that effective regulation is key to maintaining confidence in the sector. She warned that experience elsewhere had shown that if the public fail to be convinced that researchers are acting appropriately and with proper scrutiny, then the broadly supportive consensus for research could break down. She pointed out that although public support exists, it is not unconditional and one cannot build a consensus without public confidence in a particular area, making it very difficult to sustain progress subsequently. As Ms Leather began by pointing out that the Human Fertilisation and Embryology Authority is a relatively small body, I openly asked her whether she felt it was adequately resourced to keep pace with diverse scientific developments and inform or engage with the general public. However, she emphatically denied any possible suggestion to the contrary and pointed out that engagement with public opinion should not necessarily be done in such a way as to determine policy.
The final session was entitled "Future issues in stem cell research" and began with a presentation by Anna Smajdor (Imperial College London) that discussed ethical issues associated with the potential use of gametes from stem cells. Without providing any critical commentary on any of the current scientific limitations, she raised the possibilities of male couples, women past the menopause, infertile couples and even celibate individuals producing their own children. She argued that the government has failed to address all the possibilities such technology might open up, suggesting that what really disturbs some observers is the idea of using stem-cell sperm or eggs to make children for those not directly facing infertility problems. However, she asked "if we can overcome biology, why not?" and insisted that there was no reason why same sex couples, post-menopausal women and single men might not be permitted to have their own genetically related offspring, should this prove to be technically possible. Ms Smajdor suggested that the acceptability of such technology and its use might be compared to the acceptance of IVF, which provoked a huge outcry when it was first used.
The final talk was given by Professor Jan Helge Solbakk (University of Oslo) and dealt with perceived inconsistencies in the public policy decisions of various nations regarding embryonic stem cell research. He began by describing how Norway had one of the strictest policies regarding embryo research yet had a tradition of importing therapies or sending patients overseas. He then argued that such countries forbidding embryonic stem cell research should have a moral duty to export their "spare" embryos to facilitate research abroad. Even those who disagreed profoundly with his ethical conclusions nevertheless conceded that much of his reasoning seemed logical. However, this depended on an unaddressed presupposition that only embryonic stem cells would lead to therapies for all or most conditions, which is currently far from the case.