Applications Of Stem Cells And Does Their Utility Outweigh The Ethical Issues They Raise?

Stem cells are believed by many to be the future of medicine and that they will be pivotal in the production of personalised treatment which will greatly increase the patient`s chance of survival. However there are others that argue that stem cells present significant ethical issues, which cause them to question the morality of these treatments and therefore whether the use of stem cells should be legal. What are Stem cells? Stem cells are unspecialised cells that have the capability of producing cells that are different to themselves while also "self-renewing". There are three different ways that stem cells can be classified: totipotent stem cells, which can differentiate into any cell in the human body and hence create an entire organism; pluripotent stem cells, which can differentiate into the vast majority of cells (often excluding placenta tissue); and multipotent stem cells which can differentiate into multiple types of cells. Currently stem cells are also categorised into 3 key types, which are dependent on how they are obtained and overlaps with their classification: Embryonic stem cells (ESCs) are created from the blastocyst which is a stage where the human embryo contains 8-10 cells. A sub division of ESCs are cells created by somatic cell nuclear transfer (SCNT cells) which is the laboratory process of removing the nucleus from an egg cell and replacing it with the nucleus of a body cell with desired genes; this cell will then replicate itself by mitosis to create multiple cells all with the desired genes. Tissue stem cells are the second group and are stem cells that are taken from the body`s tissue or blood, for example bone marrow. The final group is induced pluripotent stem cells (iPSCs or iPS cells) which are reverse-engineered body cells. The process involves removing any body cell from a live patient and adding 4 specific genes Oct3/4, Sox2, c-Myc and Klf4 (or adding Oct 3/4, Sox 2, Nanog, and LIN28), this effectively makes the cell act like an ESC and makes it pluripotent hence its name. Applications of Stem Cells Embryonic stem cells (ESCs) have a vast amount of potential, purely from their totipotency and their ability to have seemingly unlimited self-renewal. There are also less economic issues and possible mutation issues with producing ESCs, as they do not have to be reverse-engineered, meaning that there is currently a great amount of untapped potential with ESCs. Currently they are used for practical application stem cell research and there have been key insights into blindness, with clinical trials now occurring to attempt to cure age-related macular degeneration and also the eye disease Stargardt`s macular dystrophy. SCNT produced cells have the same potential as embryonic stem cells yet their main advantage over ESCs is that they can overcome immune rejection. This is due to the cell nucleus that is placed into the ovum (egg) cell, being taken from the patient and thus the cell cluster produced shares the same genetic coding as the patient, as such the applications are vast for SCNTs, however currently producing these cells has a very low yield rate. Tissue stem cells enclose the vast majority of known stem cells, and are also where most inroads into stem cell application have been made. However there is the distinct disadvantage that they are only multipotent and can only cure blood or tissue diseases. A key example is Cord Blood, which is produced from the umbilical cord postpartum, and is currently used to treat juvenile Leukaemia and Fanconi anaemia. It is useful to use Cord Blood as the cells originate from the child, due to the umbilical cord sharing the same DNA as the juvenile; hence the Cord Blood has a lower risk of rejection, or Graft-vs-Host Disease (GVHD). Mesenchymal stem cells (MSCs) also referred to as Multipotent Stromal cells, are key in regenerative medicine, as they can differentiate into cartilage and connective tissue. It is possible for MSCs to repair organs and tissues damaged by disease, trauma or age. They cannot be used to replace full organs, yet can be used to induce a paracrine trophic effect, whereby the MSCs release chemicals that bind to the tissue and alter how it works. A possible key application for MSCs is in treating pre-natal diseases such as Osteogenesis Imperfecta and Alport Syndrome, MSCs could reduce the number of still births as some diseases manifest in utero and they also act before any damage to tissue occurs. iPS cells are currently the least studied chain in terms of their application, yet theoretically they can offer the most of all stem cells with the least ethical issues. The main use for iPS cells at the moment is disease modelling and they can be used to study the development of a disease and hence aid in the production of medicine. This is likely to be used in fighting neurological based disorders such as dementia and also movement inhibiting diseases such as Spinal Muscular Atrophy. The main advantage with iPS cells is that they are not vulnerable to GVHD, due to them coming from the patient, hence it prevents further issues down the line and so is a key area of research, and will also be useful in creating personalised treatments. iPS cells have also been used to reproduce a beating heart, which uses the structure of a mouse heart "stripped" of its cells, that have been replaced with human iPS cells, which have been engineered into multipotent cardiovascular progenitor cells, stem cells which can differentiate into the 3 types of tissue in the heart. Although the beat is currently not strong or fast enough to support a human it is a promising insight into the potential of iPS cells. This technique is more likely to be used to create patches of muscle tissue to replace the individual areas that have been affected as this is less complex and is likely to have a higher success rate.

Ethical Issues The greatest amount of controversy concerning stem cell research is mainly due to the pro-life argument, whereby people believe that an embryo has a chance at life and it is its rights to receive this chance and as the production of ESCs requires the destruction of embryos, it is by default morally problematic. Hence the main ethical issues stem from the question of when life begins; this opposition has been intensified by falsified stem cell lines and the argument that donors are not properly informed prior to donation. The key groups against stem cells in the US are religious groups and anti-abortion groups; meanwhile in the UK the strongest opposition has originated from Catholics and the Society for the Protection of Unborn Children. Groups that are against ESCs are generally also against the use of SCNTs, objections are usually religion-based with claims of "playing God" and how the intentional creation of an embryo-like cell is unnatural and violates human dignity as well as undermining traditional, moral and cultural values. The pro-life and "playing God" arguments are the most extensively used in the fight against stem cells and have been adopted by the greatest number of groups. A further argument is that the creation of ESCs and SCNTs goes against the Hippocratic Oath and the general code of practice for medical professionals, referring to "Do not harm". The pro-life argument uses the foundation that no one life is more valuable than another, and as such destroying an embryo in an attempt to save a life is unethical and unjust. This is often accompanied by the factor that every individual should have the chance at life; this can be considered in both a religious and non-religious manner. Religious individuals argue that as God gave life only he can take it, non-believers reason that every living individual would not have had a chance at life if the embryo they had originated from had been destroyed. The claim that the creation of ESCs goes against the code of practice for doctors is a line of argument that is not as frequently presented as the other two, but it targets the fact that doctors should only perform actions that cannot harm an individual. Some also make the argument that as of yet, there has not been a human being that has benefited from the creation of ESCs. This is to combat the argument that many benefit from the harming of a single entity, if there have been no developments with the use of ESCs, then any arguments for their use and the destruction of an embryo is invalid. However there is a large amount of support for stem cell research as it is thought to hold the key for developing medical science and regenerative medicine without the risk of GVHD. Moreover the evidence supplied by the groups that oppose stem cells is often outdated and as such the arguments are left relatively unfound. This is especially true when referring to the ESCs and SCNTs, which are the main targets of these groups, for example in the argument there is repeated reference to destroying a life and taking away a chance at life. On the contrary the blastocysts used for research are obtained either from impregnated women that will abort anyway or are donated by females who have frozen their eggs for IVF, which has been successful and as such the eggs are no longer required. Hence the eggs or blastocysts used in research would not have a chance at life anyway and as such the use of these cells to possibly cure diseases is arguably more ethical than allowing them to be destroyed. A further counter argument often presented is that SCNTs are a distinct entity from embryos and as such their creation to be used in laboratory research is not ethically problematic, from the debate that they do not in fact have human rights. Although this counter argument is not perfect and there are still objections that the SCNT could become a life, it does decrease the number of objections, because it technically isn`t human, as the word is currently defined. When predicted uses of stem cells are included in this argument, it can be considered a one-sided judgement, as the possibilities are predicted to be almost infinite, and there are many unexplored avenues concerning stem cells, and the diseases they could treat. However this introduces the issue of uncertainty, currently it is impossible to truly judge the benefits that stem cells can bring. Despite this scientists still argue that even the lowest bound of uses that stem cells could have will improve the health and quality of life for a large number of people, which they believe justifies the use of stem cells. Conclusion Overall stem cells have a vast array of uses, with treatments of cancer, regenerative medicine and the study of degenerative diseases being the main fields. These applications will only exponentially increase in number in the coming years especially as this area of medicine is a rapidly advancing field, with fewer restrictions that slow the process of research, compared to the start of the 21st century. This is especially shown with the advancement with iPS cells, which were only first produced in 2006 yet have had a key role in disease modelling. In answer to whether their utility outweighs the ethical issues they pose, there will always be debate with medical professionals against conservative individuals. Nevertheless the sheer number of current uses for stems cells is enough to overshadow the ethical arguments especially when many of the arguments use questionable evidence, and the fact that the list of uses is ever increasing further proves the point that the utility of stem cells does outweigh the ethical issues posed.