Title: Cellular Donation and Stem Cell Research in the Islamic Countries
1Cellular 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
2Stem 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
3What are Stem Cells?
- The Original cells from which all 210 different
kinds of cells that make the human body developed
4Classified
- Totipotent Cells
- Pluripotent Cells
- Multipotent and Progenitor Cells
5Totipotent Cell
- Embryonic cells begin with the zygote until the
8 cell morula stage. - Cannot self regenerate
6Pluripotent 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)
8Multipotent 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
9Embryonic 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)
10Embryonic Stem Cells
- Demand human ESCs (hESCs)
- More promising cure human disease
- Human embryos created (IVF) specifically stem
cell research
11Embryonic Stem Cells
12Embryonic Stem Cells
- Embryos left over (IVF)
- Use spontaneously aborted fetuses
- Cloned embryos through somatic cell nuclear
transfer (SCNT), therapeutic cloning
13Benefits of Stem Cell Research
- Best known successful Rx Leukemia many other
hematologic disorders by - BMT
- Umbilical Cord Blood Stem Cells
14Potential 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)
16Problems with Stem Cell-Based Therapies
- Genetic Mutations
- DNA Mutation
- Tumorigenesis
- Graft Rejection
17Somatic 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.
18Somatic 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)
20Umbilical 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)
21Use 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
22Advantages of Adult Stem Cells
- Will not provoke immune system rejection
- Should not become cancerous
- Use does not raise serious ethical or moral
objections
23Disadvantages 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
24Ethical Considerations
- hESCs holds the greatest promise
- Created greatest controversy
!!!
25Controversy
- Use of human embryos?
- Objections of many religious / ethical
communities - Politics introduced an unprecedented extent
form, legislation, presidential veto so far
26Ethical Considerations
- Embryonic stem cell research brings into
conflict two moral principles - The duty to respect human life.
- The duty to reduce human suffering.
27Ethical 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
28Ethical 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
29Ethical 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
30Ethical 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
31Use 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
32Use 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.
33Ethical 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
34Ethical Consideration with SCNT
- Donated healthy women
- Egg donation involves use hormones, invasive
precedence to retrieve - Donors usually compensated
35Ethical Consideration with SCNT
- Would money be reason volunteering or pure
altruism - Informed consent obtained
36Religion 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
37Religion 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)
38Religion 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.
39Religion 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.
40Religion and Stem Cell Research Islam
- All scholars agree that embryonic life is
entitled to respect even before ensoulment but
becomes more after.
41Four Islamic Principles Apply
- Islam always encourages men to contemplate and
explore new horizons. - 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.
42Four 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.
43Religion 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)
44Examples 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
45Example 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.
46Religion 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
47The 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
48The 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)