Using stem cells in research

Interview with Novo Nordisk stem cell expert Ole Dragsbæk Madsen, Director of Research, Hagedorn Research Institute.

Why are stem cells important in the pharmaceutical research?

Stem cells have potential to cure very serious diseases. Tissue stem cells (adult stem cells) are already being used today to treat serious wounds from burns. It is possible to grow cells from undamaged parts of the human skin and obtain a thin layer of cellular tissue in the laboratory that can be transplanted to the burned parts of the skin. In this way wide areas of skin can be healed. Similarly, transplantation of bone marrow stem cells in cancer treatment allows much more aggressive use of radiation- and chemotherapy to eliminate cancer cells.

The future use of stem cells to cure serious chronic diseases is still to be proven, but could possibly be in practice within the next one or two decades. Other ideas are still in our imagination - like creating an organ for transplantation.

Which perspectives do you see using stem cells in the Novo Nordisk research?

Type I diabetes sometimes strikes very young people that are bound to treatment with insulin for the rest of their lives. Among the young patients and their relatives there is a strong belief in the possibilities of treatment with cell therapy based on the use of stem cells. The perspective of a cure based on stem cells requires that also immune tolerance of transplantation will be addressed. The use of embryonic stem cells offers the unique point of entry to provide both the cells or tissue to be replaced as well as potential immune-cells that can induce tolerance towards the replaced insulin producing cells.

In 2000, a team of researchers in Edmonton, Canada, succeeded in treating the first seven diabetes patients with cell therapy. They were injected fresh insulin producing cells from an organ donor and the cells were able to begin regulating the glucose level in the patients' blood. The cure is not without complications. The patients need to take medicine to avoid that the immune system attacks the transplanted cells. The medicine will raise their risk of getting infections and cancer.

What is your opinion on ethical dilemmas of using stem cells?

Some consider it unethical to deal with human embryonic stem cells in a laboratory. We make our decisions based on weighing the benefits to patients and society along with threats to our values and fundamental ethical principles - and importantly - we only want to use embryonic stem cells derived from surplus fertilised eggs from IVF-clinics that are anyway destined to destruction.

The use of human embryonic stem cells causes ethical dilemmas because the embryos from which they are derived hold the potiential for a human life and are in fact the very first stage of the process that leads to the newborn life.

Why are you engaged in the debate about the use of stem cells in research?

Embryonic stem cells are new in research and new to the public. As a scientist I find it important to communicate information on the issue to ensure an enlightened and informed debate rather than one based upon wrong assumptions.

I have attended meetings in religious communities and debated the use of stem cells. And it is my experience that communication makes people take a more nuanced point of view on the issue.

Furthermore, Novo Nordisk is committed to do research to find a cure for diabetes and at present stem cells is the most obvious way.

What risks do you see in the use of stem cells?

Embryonic stem cells have the potential to develop into the 220-240 different cell types constituting the human body. They cannot develop into a full human being like the blastocyst from which they are isolated.

The naïve and non-matured embryonic stem cells will form tumours (benign teratomas) when they are injected or transplanted. We have seen this in mice, where the effect is used to test the quality of the stem cells. Utmost precaution must be in place if cells generated from embryonic stem cells are to be injected or transplanted to patients and in the wrong hands this could cause reason for concern.

In some countries therapeutic cloning is allowed. This means that you are allowed to create an embryo identical to the donor of the chromosome material to gain compatible embryonic stem cells. This is not allowed in Denmark where Novo Nordisk stem cell research takes place. This method holds the potential for misuse, to clone a human being. Novo Nordisk has no interest in therapeutic cloning because type 1 diabetes is an autoimmune disease.

Which global guidelines would you like to see implemented?

In Denmark it has been legal to use embryonic stem cells since 2003. Novo Nordisk has been active in the debate prior to the legislation that led to the possibility of using eggs that are left over from artificial insemination. Of course the woman needs to give her consent to the use of her eggs.

When the scientists succeed in having developed cell lines that can be used for therapy, we have to be sure that high-level quality testing is in place to reduce the above mentioned potential of tumour development. At that point global guidelines are needed.

Research in stem cells is constantly refined and new unexpected possibilities are always turning up. Therefore, we need to follow the development very closely and use common sense in the ethical debate about the use of stem cells.

We will see situations where we need to make decisions even though the answers are not unequivocal. Scientists do not agree on the risks and benefits and it can be argued that using embryonic stem cells is some kind of organ donation.

We need to take into consideration and carefully evaluate the concerns others may have around the use of embryonic stem cells, as well as what should be done with unused and fertilised eggs.These and many more issues are taken into consideration when we frame our positions. It can be changed whenever new facts are brought to light. It is a dynamic process.