Cellular Donation and Stem Cell Research in the Islamic Countries

1
Cellular Donation and Stem Cell Research in the
Islamic Countries 

• Hind Al Humaidan, MD, FRCPA
• Consultant Hematopathologist Director, Blood
  Bank Stem Cell Cord Blood Bank
• Department of Pathology and Laboratory Medicine
• King Faisal Specialist Hospital Research Centre
• Riyadh, Kingdom of Saudi Arabia

2
Stem Cells

• Stem Cell Research is relatively new field of
  Medicine
• It has a great promise
• Led to confrontation established religious
  moral values
• Generated heated debate regarding the boundaries
  of scientific research that it should not cross

3
What are Stem Cells?

• The Original cells from which all 210 different
  kinds of cells that make the human body developed

4
Classified

• Totipotent Cells
• Pluripotent Cells
• Multipotent and Progenitor Cells

5
Totipotent Cell

• Embryonic cells begin with the zygote until the
  8 cell morula stage.
• Cannot self regenerate

6
Pluripotent Cell

• Capacity to transform into all three primary germ
  layers
• endoderm
• mesoderm
• ectoderm
• Self renew
• Cells inner cell mass blastocyst called
• Embryonic Stem Cells (ESCs)

7
(No Transcript)
8
Multipotent and Progenitor Cells

• Descendants of developing embryo inner cell mass
• They are differentiated and developed into
  specific types of cells
• Eventually make different body organs

9
Embryonic Stem Cells

• Most on-going research has been utilizing
  embryonic stem cells
• Embryonic inner cell mass, kept growing in tissue
  culture
• Most studies murine (ESCs)

10
Embryonic Stem Cells

• Demand human ESCs (hESCs)
• More promising cure human disease
• Human embryos created (IVF) specifically stem
  cell research

11
Embryonic Stem Cells
12
Embryonic Stem Cells

• Embryos left over (IVF)
• Use spontaneously aborted fetuses
• Cloned embryos through somatic cell nuclear
  transfer (SCNT), therapeutic cloning

13
Benefits of Stem Cell Research

• Best known successful Rx Leukemia many other
  hematologic disorders by
• BMT
• Umbilical Cord Blood Stem Cells

14
Potential Benefits of Stem Cell Research

• Real promise development
• Regenerative Medicine
• Human tissues organs used replace damaged
  tissues / organs, recover lost function
• Progenitor cell developed can differentiate
  myocardial cells, neurons pancreatic cell, etc.

15
(No Transcript)
16
Problems with Stem Cell-Based Therapies

• Genetic Mutations
• DNA Mutation
• Tumorigenesis
• Graft Rejection

17
Somatic Cell Nuclear Transfer (SCNT)

• Somatic Cell obtained from individual
• Human Oocyte obtained egg donor
• Oocyte enucleated then fused with biopsied cell,
  transferring nucleus to a new cell induced to
  develop embryo
• 
  Therapeutic Cloning.

18
Somatic Cell Nuclear Transfer (SCNT)

• Blastocyst forms
• Inner cell mass isolated
• Cultivated produce ESCs
• Differentiate into various cell types
• eventually producing tissue used as an
  autologous tissue graft original person somatic
  cell obtained

19
(No Transcript)
20
Umbilical Cord Blood as Source of Stem Cells

• UCB valuable source of hematopoietic stem cells
• 1988 first used Rx Fanconis anemia in a sibling
• Less immunogenic
• Cell dose 10 of adult BM
• Does not raise ethical objection that is
  intrinsic use (hESCs)

21
Use of Adult Stem Cells in Therapy

• Few stem cells found in many adult tissues
• Hematopoietic stem cells (BM) coaxed
  differentiate neural, myogenic hepatic cell
  types
• Neural skeletal muscle cells coaxed developed
  hematopoitic cells.
• Mesenchymal stem cell develop adipocytic,
  chandrocytic or osteocytic lineages

22
Advantages of Adult Stem Cells

• Will not provoke immune system rejection

• Should not become cancerous

• Use does not raise serious ethical or moral
  objections

23
Disadvantages of Adult Stem Cells

• Transdifferentiation limited compared to
  unlimited transdifferentiation potential
  pluripotent hESCs

• ASCs are rare compared to abundant hESCs

• ASCs hard to grow in vitro

24
Ethical Considerations

• hESCs holds the greatest promise

• Created greatest controversy

!!!
25
Controversy

• Use of human embryos?
• Objections of many religious / ethical
  communities
• Politics introduced an unprecedented extent
  form, legislation, presidential veto so far

26
Ethical Considerations

• Embryonic stem cell research brings into
  conflict two moral principles
• The duty to respect human life.
• The duty to reduce human suffering.

27
Ethical Considerations

• The dilemma whether we as society agree which
  two principles ought to be given precedence?
• Agree there is time in development of embryo that
  it cannot be considered human worthy full
  protection accorded fetus or live born infant

28
Ethical Considerations

• Question revolves on determining moral status
  human embryo?
• Fertilized egg (zygote) has full moral status
• It becomes deserving protection at later stage.
  Moral status increases as the fertilized egg
  becomes more human like.
• Embryo has no moral status at all, it is an
  organic material

29
Ethical Considerations

• Opinion I
• The human embryo is a potential person from the
  time of fertilization
• Opinion II
• Fertilized egg is potential person but there are
  degrees of value of life depending on stage

30
Ethical Considerations

• Opinion III
• Fertilized human eggs with embryos are
  merely parts of other peoples bodies
• For being to be destroyed it should have
  interest that is defeated.
• Interest means beliefs, desires, expectations,
  aims and purposes

31
Use of Human Embryos for Stem Cell Research

• Available source surplus fertilized eggs
  produced during course IVF procedures.
• Fresh better that frozen
• Frozen 10 can form blastocyts
• IVF fertilized eggs for PGD source

32
Use of Human Embryos for Stem Cell Research

• Advocate asking couples undergoing IVF donate
  some fresh viable fertilized eggs.
• Detailed comprehensive counseling should be
  provided and consent signed by couple.

33
Ethical Consideration with SCNT

• Misconception of SCNT is reproductive cloning
• First step along a slippery slope would conclude
  with reproductive cloning
• Embryos produced SCNT have little potential
  developing to being born alive

34
Ethical Consideration with SCNT

• Donated healthy women
• Egg donation involves use hormones, invasive
  precedence to retrieve
• Donors usually compensated

35
Ethical Consideration with SCNT

• Would money be reason volunteering or pure
  altruism
• Informed consent obtained

36
Religion and Stem Cell Research Islam

• Islam is the submission to Allahs will
• Muslims believe that Islam controls their actions
  in material as well as spiritual matters
• Islam is a way of life

37
Religion and Stem Cell Research Islam

• Muslims in performing any act should permit it.
• One has to fine Quranic verse on that matter or
  hadith (saying of Prophet Muhammad PBUH)
• Or resort to opinion of Fuqaha ( Islamic Legal
  Scholars) Whom use Ijtihad (independent judgment)

38
Religion and Stem Cell Research Islam
???

• When life starts
• Ensoulment, the breathings of Allahs ruh
  (spirit) into the fetus, differentiates
  biological life, which start at time of
  fertilization from human life.

39
Religion and Stem Cell Research Islam

• Ensoulment occurs at 40 or 120 days
• Each one of you is collected as a sperm (nutfa)
  in the womb of his mother for 40 days, and then
  turns into a clot (alaqa) for an equal period of
  40 days and turns into a piece of flesh (mudga)
  for a similar period of 40 days and then God
  sends an angel and order him to write
  things,i.e., his provision, his age, and whether
  he will be of the wretched or the blessed in the
  hereafter. Then the soul is breathed into him.

-Sahih al-Bukhari.
40
Religion and Stem Cell Research Islam

• All scholars agree that embryonic life is
  entitled to respect even before ensoulment but
  becomes more after.

41
Four Islamic Principles Apply

1. Islam always encourages men to contemplate and
   explore new horizons.
2. Prophet Mohammed ordered us to seek cure for
   disease.

He said Allah did not create a disease without
creating a cure for it except senility, so sons
of Adam seek cures but do not use haram
(forbidden things)
-Sunan Abi Dawud.
42
Four Islamic Principles Apply

• 3. All actions are in principle permissible as
  long as they are not categorically prohibited.
• 4. In matters in which other invocations are
  silent the concept of maslaha (public interest)
  applies.
• Where the welfare of people resides,
  there resides that statute of God

-Sahih Muslim.
43
Religion and Stem Cell Research Islam

• It is permissible to acquire, grow and use stem
  cell for therapy or scientific research as long
  as the cells sources are permissible.
• (The Muslim World Leagues Islamic Jurisprudence
  Council Conference in December 2003 held in
  Mecca, issued Fatwa)

44
Examples of Permissible Sources

• Adults who consent as long as it does not
  inflict harm on them
• Children whose guardians consent for a legal
  benefit without inflicting harm
• Placenta or umbilical cord blood with the
  permission of the parents

45
Example of Permissible Sources

• Spontaneously aborted embryos or those aborted
  for a legally acceptable cause with the
  permission of parents.
• Excess fertilized eggs produced during course of
  IVF and donated by parents with assurance that
  they are not to be used to produced illegal
  pregnancy.

46
Religion and Stem Cell Research Islam

• It is forbidden to obtain or use stem cells if
  its source is forbidden.
• Examples
• Fetuses intentionally aborted without a legal
  medical reason
• Intentional fertilization between donated ovum
  sperm
• Therapeutic cloning

47
The Islamic Position

• Principle Stem Cell research is acceptable due to
  its therapeutic potential
• Fertilized eggs before implantation are not
  considered fully human because without
  implantation they cannot survive and develop into
  a human being

48
The Islamic Position

• The surplus embryos produced during IVF cannot be
  donated to other couples, instead should be
  destroyed or left to die if not used by the
  couple. Their Use for stem cell research is then
  acceptable at a minimum and may even be preferred
  to their destruction.
• Islamic scholars agree that creating human
  embryos for the sole purpose of research is
  prohibited.

49
(No Transcript)