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Cellular Donation and Stem Cell Research in the Islamic Countries

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Cellular Donation and Stem Cell Research in the Islamic Countries Hind Al Humaidan, MD, FRCPA Consultant Hematopathologist & Director, Blood Bank & Stem Cell Cord ... – PowerPoint PPT presentation

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Title: 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
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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
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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

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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
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