26th September 2003
Fact finding missions, we in Leinster House refer to them as, but there are those outside who prefer to call them "junkets". So here, to keep you up to date is a report of my latest fact finding mission/junket on behalf of the Oireachtas Joint Committee on Health and Children.
The Medical Research Council and the Biotechnology and Biological Sciences Council of the United Kingdom held a two day meeting in London entitled "Stem Cells - Shaping the Future". The U.K. Department of Trade and Industry was involved as well and I attended representing our committee. A senior civil servant went with me and we looked at the packed tight agenda with some concern, wondering how it could all be fitted into two days.
Well, it was and it was well organised and very useful. To begin with most of what I know about stem cells concerned embryonic stem cells or cells produced for cloning. They are but a small part of the scene. Work is being carried out on adult and foetal stem cells in many areas and while embryonic cells have the advantage of being pluripotent ethical issues make many unwilling to work with them. Indeed, because of this and because of the concerns about cloning a push appears to have been given to the work on adult and foetal cells.
Adult myoblasts of autologous origin to repair heart tissue are being used following myocardial infraction. Professor John Martin of University College, London (who confessed to having studied philosophy before he studied medicine) proposes to carry out a double blind trial on 100 patients without doing any work on primates first, so confident is he of the usefulness of the treatment. The myoblasts are put down a catheter in the relevant coronary artery nearest the damaged tissue. I felt rather concerned about the control group because these people will have a catheter introduced into a coronary artery without receiving any treatment and it can hardly be described as a procedure without risk.
Anders Haegerstrand, the CEO of Neuronova, a stem cell company presented a paper entitled "Harnessing the potential of adult neural stem cells". This involved putting neurogenic cells into the lateral ventricles for the treatment of Parkinsons' disease. I had thought that only embryonic cells could be used for this treatment but apparently this is not so. Another surprise was to hear that spontaneous neurogenesis occurs in the substantia nigra after injury. Growth factor helps increase the number of neurons that develop and apparently "improves their behaviour". This, and I hope I'm reporting correctly, means getting them to migrate to the damaged brain tissue and repair it. Astrocytes can develop too - amazing! It made putting hepatocytes into the portal vein to treat diabetes seem very simple.
There were several discussions on the use of bone marrow stroma cells and adipose tissue cells, would you believe, which could make cartilage. (And a great deal of other sorts of tissue with it, as a sceptic told me during a coffee break. The researcher who had produced the paper had not pointed out this fact but we have to make allowances for enthusiasm).
Bone marrow stroma cells are also being used to bridge severed spinal cord in the mouse but the work using embryonic cells of the mouse on mouse spinal cord is the most advanced. Like many others, I have concerns about the use of embryonic tissue and do not feel work on human embryonic tissue will be carried out here probably as much for legal as ethical reasons.
But what is going to happen if this work is very successful and patients here begin to demand it? It will be a very difficult debate if, let us say, in ten years time it can be shown that a young man who suffers a spinal injury playing rugby leading to paralysis could be restored to health by embryonic stem cell treatment. It may be a long way away but Christopher Reeve injured in a riding accident is looking forward to it.
Professor Ian Wilmot of the Roslin Institute and of "Dolly the sheep" fame spoke on nucleus replacement in research and therapy. During the discussion on nucleus replacement we heard about work carried out in Shanghai in which the nucleus is removed from a rabbit oocyte and replaced by a human cell nucleus which is then stimulated to divide. This means that human genetic material is being put into an animal cell. A lay member of the audience asked, I think tongue in cheek, if rabbit mitochondria had any influence on the proceedings.
We became much more down to earth when the Department of Trade and Industry were to the fore. The area where money could really be made apparently is treating alopecia in the United States. Proverbial lip licking went on as the possibilities of implanting hair follicle stem cells rather than conventional transplants were considered.
Having worked for so long with varicose ulcers I was very interested in the work using adult fibroblasts for wound healing, chronic and acute and in burns. A company called Intercytex has developed products called Protoderm and Protoskin and are apparently getting good results, although the products have a short shelf life.
We were told it is very hard to get City funds for any projects which take more than five years from initial research and development to producing revenue, a hard task, indeed. Also, concern was expressed by many as to who would work on "Orphan drugs" which might be very efficacious for rare diseases. Motor neurone disease and the muscular dystrophies were mentioned as conditions which could be helped but were not so common as to be considered good for investment.
Wasn't this a brave new world I entered, three stories subterranean, down a spiral staircase around a lift in a most claustrophobic room with 500 other mortals? When I got back to Leinster House I found EU Directive COM (2003) 340 on my desk. To fulfil this we must bring in legislation on setting standards of quality and safety for the donation, procurement, testing, processing, storage and distribution of human tissues and cells. The brave new world is here and we must all get involved in shaping it - it is the future.
Senator Mary Henry, MD
