cellular donation and stem cell research in the islamic countries hind al humaidan, md, frcpa...
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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 Blood Bank
Department of Pathology and Laboratory Medicine
King Faisal Specialist Hospital & Research Centre
Riyadh, Kingdom of Saudi Arabia
Stem CellsStem 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
What are Stem Cells?What are Stem Cells?
The “Original” cells from which all 210 different kinds of cells that make the human body developed
ClassifiedClassified
Totipotent Cells
Pluripotent Cells
Multipotent and Progenitor Cells
Totipotent CellTotipotent Cell
Embryonic cells begin with the zygote until the 8 – cell morula stage.
Cannot self regenerate
Pluripotent CellPluripotent 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)”
Multipotent and Progenitor Multipotent and Progenitor CellsCells Descendants of developing embryo
inner cell mass
They are differentiated and developed into specific types of cells
Eventually make different body organs
Embryonic Stem CellsEmbryonic 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)
Embryonic Stem CellsEmbryonic Stem Cells
Demand human ESCs (hESCs)
More promising cure human disease
Human embryos created (IVF) specifically stem cell research
Embryonic Stem CellsEmbryonic Stem Cells
Embryonic Stem CellsEmbryonic Stem Cells
Embryos left over (IVF)
Use spontaneously aborted fetuses
Cloned embryos through somatic cell nuclear transfer (SCNT), therapeutic cloning
Benefits of Stem Cell Benefits of Stem Cell Research Research Best known successful Rx Leukemia &
many other hematologic disorders by:
BMT Umbilical Cord Blood Stem Cells
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.
Potential Benefits of Stem Cell Potential Benefits of Stem Cell ResearchResearch
Problems with Stem Cell-Based Problems with Stem Cell-Based TherapiesTherapies
Genetic Mutations
DNA Mutation
Tumorigenesis
Graft Rejection
Somatic Cell Nuclear Transfer Somatic Cell Nuclear Transfer (SCNT)(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.
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”
Somatic Cell Nuclear Transfer Somatic Cell Nuclear Transfer (SCNT)(SCNT)
Umbilical Cord Blood as Source of Stem Umbilical Cord Blood as Source of Stem CellsCells
UCB valuable source of hematopoietic stem cells
1988 first used Rx Fanconi’s anemia in a sibling
Less immunogenic
Cell dose 10% of adult BM
Does not raise ethical objection that is intrinsic use (hESCs)
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
Use of Adult Stem Cells in Use of Adult Stem Cells in TherapyTherapy
Will not provoke immune system rejection
Advantages of Adult Stem Advantages of Adult Stem CellsCells
Should not become cancerous
Use does not raise serious ethical or moral objections
Transdifferentiation limited compared to unlimited transdifferentiation potential pluripotent hESCs
Disadvantages of Adult Stem Disadvantages of Adult Stem CellsCells
ASCs are rare compared to abundant hESCs
ASCs hard to grow in vitro
hESCs holds the greatest promise
Ethical ConsiderationsEthical Considerations
Created greatest controversy
Use of human embryos?
Objections of many religious / ethical communities
Politics introduced an unprecedented extent form, legislation, presidential veto so far
ControversyControversy
Embryonic stem cell research brings into conflict two moral principles:
1. The duty to respect human life.
2. The duty to reduce human suffering.
Ethical ConsiderationsEthical 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
Ethical ConsiderationsEthical Considerations
Question revolves on determining moral status human embryo?
1. Fertilized egg (zygote) has full moral status
2. It becomes deserving protection at later stage. Moral status increases as the fertilized egg becomes more human like.
3. Embryo has no moral status at all, it is an organic material
Ethical ConsiderationsEthical Considerations
Ethical ConsiderationsEthical 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”
Ethical ConsiderationsEthical 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
Use of Human Embryos for Stem Cell Use of Human Embryos for Stem Cell ResearchResearch
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
Advocate asking couples undergoing IVF donate some fresh viable fertilized eggs.
Detailed comprehensive counseling should be provided and consent signed by couple.
Use of Human Embryos for Stem Cell Use of Human Embryos for Stem Cell ResearchResearch
Ethical Consideration with Ethical Consideration with SCNTSCNTMisconception 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
Ethical Consideration with Ethical Consideration with SCNTSCNT
Donated healthy women
Egg donation involves use hormones, invasive precedence to retrieve
Donors usually compensated
Would money be reason volunteering or pure altruism
Informed consent obtained
Ethical Consideration with Ethical Consideration with SCNTSCNT
Religion and Stem Cell Research Religion and Stem Cell Research IslamIslam
Islam is the submission to Allah’s will
Muslims believe that Islam controls their actions in material as well as spiritual matters
Islam is a way of life
Muslims in performing any act should permit it.
One has to fine Qur’anic verse on that matter or hadith (saying of Prophet Muhammad PBUH)
Or resort to opinion of Fuqah’a ( Islamic Legal Scholars) Whom use Ijtihad (independent judgment)
Religion and Stem Cell Research Religion and Stem Cell Research IslamIslam
When life starts
Ensoulment, the breathings of Allah’s rūh (spirit) into the fetus, differentiates biological life, which start at time of fertilization from human life.
Religion and Stem Cell Research Religion and Stem Cell Research IslamIslam
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.”
Religion and Stem Cell Research Religion and Stem Cell Research IslamIslam
-Sahih al-Bukhari.
All scholars agree that embryonic life is entitled to respect even before ensoulment but becomes more after.
Religion and Stem Cell Research Religion and Stem Cell Research IslamIslam
Four Islamic Principles ApplyFour 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.
Four Islamic Principles ApplyFour 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.
“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 League’s Islamic Jurisprudence Council Conference in December 2003 held in Mecca, issued Fatwa)
Religion and Stem Cell Research Religion and Stem Cell Research IslamIslam
Examples of Permissible Examples of Permissible SourcesSources
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
Example of Permissible Example of Permissible SourcesSources
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.
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
Religion and Stem Cell Research Religion and Stem Cell Research IslamIslam
The Islamic PositionThe Islamic Position
1. Principle Stem Cell research is acceptable due to its therapeutic potential
2. Fertilized eggs before implantation are not considered fully human because without implantation they cannot survive and develop into a human being
The Islamic PositionThe Islamic Position
3. 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.
4. Islamic scholars agree that creating human embryos for the sole purpose of research is prohibited.