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Prop 71: Stem Cell Hype and Hope

Prop 71: Stem Cell Hype and Hope. Richard Deem, Scientists Against Proposition 71 (www.NoOn71.us). Topics. What are stem cells Stem cell types Human cloning What’s wrong with Proposition 71 Problems Deceptive Claims Cures or hype? ESC/cloning problems Ethical questions.

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Prop 71: Stem Cell Hype and Hope

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  1. Prop 71: Stem Cell Hype and Hope Richard Deem,Scientists Against Proposition 71 (www.NoOn71.us)

  2. Topics • What are stem cells • Stem cell types • Human cloning • What’s wrong with Proposition 71 • Problems • Deceptive Claims • Cures or hype? • ESC/cloning problems • Ethical questions

  3. Stem Cell – Definition A cell that has the ability to continuously divide and differentiate (develop) into various other kind(s) of cells/tissues

  4. Kinds of Stem Cells Totipotent Pluripotent Multipotent

  5. Sources of Stem Cells Embryonic Fetal stem cells Umbilical cordstem cells Placenta derivedstem cells Adult stem cells

  6. Day 2 2-cell embryo Day 3-4 Multi-cell embryo Day 1 Fertilized egg Day 5-6 Blastocyst Day 11-14 Tissue Differentiation Stages of Embryogenesis

  7. Isolate inner cell mass (destroys embryo) Outer cells (forms placenta) Inner cells (forms fetus) Culture cells Day 5-6 Blastocyst “Special sauce”(largely unknown) Liver Heart repaired Kidney Heart muscle Derivation and Use of Embryonic Stem Cell Lines

  8. “CC” Carbon Copy History of Somatic Cell Nuclear Transfer (Cloning) • 1996 – Dolly, the sheep cloned • 1998 – Mice cloned • 1998 – Cows cloned • 2000 – Pigs cloned • 2001 – Cat cloned • 2002 – Rabbits cloned • 2003 – Mule cloned • 2004 – Bull serial-cloned

  9. Human Embryo Cloning • 2001 – First cloned human embryos (only to six cell stage) created by Advanced Cell Technology (USA) • 2004* – First human cloned blastocyst created and a cell line established (Korea) *Hwang, W.S., et al. 2004. Evidence of a Pluripotent Human Embryonic Stem Cell Line Derived from a Cloned Blastocyst. Science 303: 1669-1674.

  10. Neural Retinal Bone Cartilage Epithelial Cloned ESC Differentiate Into Different Tissue Types

  11. Cloned Embryonic Stem Cells – Advantages/Problems • Advantages • No rejection, “Perfect match” • Problems • Extremely expensive (>$200,000/patient) • Only 0.6% (1 out of 176) oocytes survived to become a cell line (required 16 egg donors to produce one cell line) • “Further improvements in SCNT protocols and in vitro culture systems are needed before contemplating the use of this technique for cell therapy.” • Cloning damages DNA (virtually all cloned mammals suffer genetic damage)

  12. What’s Wrong With Prop 71? • Fiscal problems • Political appointments • Informed consent modifications • Provision for backroom meetings • Exploitation of women for eggs • Limits funding to ESC and cloning • Deceptive claims • Deceptive list of potentially curable diseases

  13. Research 30% Interest50% Indirect 12.5% Facilities 5% Administrative 3% Prop 71 Adds $6 Billion to the California Deficit $

  14. Research 59% Administrative 6% Facilities 10% Indirect 25% Prop 71 $3 Billion Bonds $ • 6% of bond costs will be spent on administration • By comparison, the 2005 NIH budget commits 4% to administration Administrative 6%

  15. Research 59% Administrative 6% Facilities 10% Indirect 25% Prop 71 $3 Billion Bonds $ • 25% of bond costs will be spent on indirect costs (goes to institution) • For a $4 million grant, company or institution gets $1 million Indirect 25%

  16. Research 59% Facilities 10% Administrative 6% Indirect 25% Prop 71 $3 Billion Bonds $ • 10% of bond costs will be spent on real estate and facilities construction • This is pure pork barrel politics, since investigators already have labs

  17. Who Supports and Funds Prop 71? $

  18. Institute Run by Political Appointments • Citizen's Oversight Committee appointed by state politicians: • Governor, Lieutenant Governor • Treasurer, Controller • Speaker of the Assembly • President Pro Tem of the Senate. • Consists of UC bureaucrats, members of disease advocacy groups

  19. Prop 71 Will Change Informed Consent Procedures • Studies involving human subjects must inform patients about medical procedures to prevent abuse of patient rights • Proposition 71 initially requires grant recipients to comply with federal regulations • However, the proposition allows for “modifications to adapt to the mission and objectives of the Institute.” (ARTICLE 1. 125281.06 (1))

  20. Prop 71 Exempts Institute From “Open Meeting" Laws • Closed meetings to hand out patents and profits • 125281.05 (d) Public Meeting Laws(3) …In addition, the ICOC may conduct closed sessions when it meets to consider or discuss:(B) Matters involving confidential intellectual property or work product, whether patentable or not, including, but not limited to, any formula, plan, pattern, process, tool, mechanism, compound, procedure, production data, or compilation of information…

  21. Prop 71 Will Exploit Poor Women for Their Eggs • Thousands of egg donors will be required to produce the eggs required for human cloning. • Poor women and college students will likely donate eggs to earn quick cash. • However, the procedure to obtain these eggs uses powerful, dangerous drugs that have already resulted in the deaths and hospitalization of hundreds of women.

  22. Prop 71 Research Limited to Human Embryo Cloning and Destruction • According to the legal text: “In this regard, other research categories funded by the National Institute of Health shall not be funded by the Institute.” • Funding of research that does not destroy human embryos must be approved by a 2/3 vote of the Scientific and Medical Research Funding Working Group

  23. Why Do They Hide the Real Nature of Research Funded?

  24. Prop 71 Deceptive Claims • Royalties to the state • Sales tax will cover bond interest • Stem cell research is banned • Cures require use of embryonic cell lines • 400,000 embryos will be discarded anyway • Bush policy is based on ideology and not science

  25. Prop 71 will Provide Patent and Royalty Revenues to the State? • Proposition 71 does not require that one single penny of the patent and royalty revenues that might result from future research be returned to California taxpayers. • The “Institute” established by Proposition 71 may, at its discretion, have taxpayers pay 100% of the costs, and award venture capitalists with 100% of the profits.

  26. Sales Tax Generated by Prop 71 Will to Cover Bond Interest? “The supporters’ own economic study shows that in the following nine years, when annual debt service on the bonds soars to more than $170 million, the putative tax gains will cover only 11% to 19% of that sum.” Michael Hiltzik, Los Angeles Times, 8/23/04

  27. Prop 71 Claim: Human ESC Research is Banned • “Some of the most pioneering cures and treatments are right at our fingertips, but because of the stem cell ban, they remain beyond our reach.” John Kerry False • Human embryonic stem cell research for any purpose is allowed using private funds • Embryonic stem cell research is funded by the NIH for 22 available human lines created before 8/9/01

  28. Prop 71 Claim: Only Embryonic Cells Are Pluripotent • Cells from the umbilical cords of newborns are pluripotent • Researchers have shown the ability of these cells to grow bone, cartilage, hematopoietic (blood), neural (brain, spinal cord, nerves), liver and heart tissue. Reference: Kögler, G. et al. 2004. A New Human Somatic Stem Cell from Placental Cord Blood with Intrinsic Pluripotent Differentiation Potential. Journal of Experimental Medicine 200: 123-135.

  29. 400,000 Embryos are Going to Be Discarded Anyway • 88.2% are being held for family building (i.e., babies) • 2.2% are slated to be discarded • 2.8% are designated for research • Of these 11,000 embryos, optimistically, only 275 cell lines would be expected to established

  30. John Kerry Says George Bush Has “politicized science” • “While the Bush administration has politicized science, Kerry will put America back on the path of scientific excellence with a commitment to scientific research based on fact – not ideology.”

  31. Prop 71: Diseases Claimed to be Treatable by ESC

  32. Prop 71: Adult Stem Cells in Therapy of Cystic Fibrosis • Successes have occurred using adult stem cells (not funded by this proposition) to generate new lung cells • Human cloning would be ineffective for this genetic disease. Reference: H. Spencer and A. Jaffe. 2004. The potential for stem cell therapy in cystic fibrosis. J. R. Soc. Med. 97 (Suppl. 44):52–56.

  33. Prop 71: Treatment of Spinal Cord Injuries • Both embryonic and adult stem cells (bone marrow, skin, and umbilical cord derived) have shown promise in treatment of spinal cord injuries. References: Oliver Brüstle, et. al. 1999. Embryonic Stem Cell-Derived Glial Precursors: A Source of Myelinating Transplants. Science 285: 754-756. Ankeny DP, McTigue DM, Jakeman LB. 2004. Bone marrow transplants provide tissue protection and directional guidance for axons after contusive spinal cord injury in rats. Exp. Neurol. 190:17-31. Li HJ, et. al. 2004. Transplantation of human umbilical cord stem cells improves neurological function recovery after spinal cord injury in rats. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 26:38-42.

  34. Prop 71: Embryonic Stem Cells as a Cure for Alzheimer’s Disease? • “I think the chance of doing repairs to Alzheimer's brains by putting in stem cells is small.”Michael Shelanski, Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Columbia University Medical Center) • “To start with, people need a fairy tale.” Ronald D.G. McKay, National Institute of Neurological Disorders and Stroke Reference: Rick Weiss. Stem Cells An Unlikely Therapy for Alzheimer's. Washington Post Thursday, June 10, 2004; Page A03

  35. Pancreas Prop 71: Embryonic Stem Cells as Treatment for Diabetes? • Proponents cite studies in which cultured mouse embryonic stem cells produced insulin • However, these cells were not beta cells (of neurological derivation) and insulin secretion was very low and not glucose dependent Reference: S. Sipione et al. 2004. Insulin expressing cells from differentiated embryonic stem cells are not beta cells. Diabetologia 47: 499-508.

  36. Prop 71: Adult Stem Cells in Treatment of Multiple Sclerosis • Adult stem cells (bone marrow or endogenous neural stem cells), but not embryonic stem cells have been used in numerous studies (including some preliminary clinical trials) to treat multiple sclerosis. References: Fassas A, Kimiskidis VK. 2004. Autologous hemopoietic stem cell transplantation in the treatment of multiple sclerosis: rationale and clinical experience. J. Neurol. Sci. 15:53-58. Muraro PA, Cassiani Ingoni R, Martin R. 2003. Hematopoietic stem cell transplantation for multiple sclerosis: current status and future challenges. Curr. Opin. Neurol. 16:299-305.

  37. Prop 71: Treatment of Amyotrophic Lateral Sclerosis • Mouse model showed that cord blood stem cells are beneficial in reversing spinal cord injury, even when infused 5 days after injury. • A 2004 review of scientific literature indicated that adult stem cell treatments showed promise for treatment of ALS. References: Garbuzova-Davis, Svitlana, et al. 2003. Intravenous Administration of Human Umbilical Cord Blood Cells in a Mouse Model of Amyotrophic Lateral Sclerosis: Distribution, Migration, and Differentiation. Journal of Hematotherapy and Stem Cell Research 12: 255–270. Silani V, Cova L, Corbo M, Ciammola A, Polli E. 2004. Stem-cell therapy for amyotrophic lateral sclerosis. Lancet 364:200-2.

  38. Both Adult and Embryonic Stem Cells Treat Myocardial Infarction • Rat embryonic stem cells were used in rat model of myocardial infarction to improve ventricular function and repair damaged heart tissue • Mesenchymal stem cells (MSCs) when introduced into the infarcted heart, prevented deleterious remodeling and improved recovery References: Hodgson DM, et. al. 2004. Stable benefit of embryonic stem cell therapy in myocardial infarction. Am. J. Physiol. Heart Circ. Physiol. 287:H471-H479.Pittenger MF, Martin BJ. 2004. Mesenchymal stem cells and their potential as cardiac therapeutics. Circ. Res. 95:9-20.

  39. Prop 71: Treatment of Cancer? • Cancer is caused by cells of the body multiplying uncontrollably due to genetic mutation or viral infection, in some cases. • Stem cells would not be useful in therapy. This wide spectrum of diseases was added simply because there are a lot of people who have been affected who might vote for the initiative.

  40. Prop 71: Embryonic Stem Cells as Treatment for Parkinson’s? • Only 50% of rats experienced improvement of symptoms • 25% of rats developed brain tumors and died • Who wants to signup for the first clinical trial? Reference: Bjorklund, L. M., R. Sanchez-Pernaute, et al. 2002. Embryonic stem cells develop into functional dopaminergic neurons after transplantation in a Parkinson rat model. Proceedings of the National Academy of Sciences 99: 2344-2349.

  41. Prop 71: Treatment of Mental Health Diseases? • Since the cause of most mental health diseases is unknown, it is not known whether stem cells could be useful in therapy. • However, since many people suffer from these diseases, it was added to garner additional support for the proposition.

  42. Prop 71: Embryonic Stem Cells as a Cure for HIV/AIDS? • AIDS is caused by an infectious virus (HIV) that attacks the immune system • Stem cell treatments could improve the function of the immune system, but the effect would be temporary until the new stem cells became infected themselves • Adult (not embryonic) stem cells would be the preferred treatment

  43. Adult Stem Cell Success:Liver Cells from Bone Marrow • Multipotent adult progenitor cells have been shown to differentiate into functional, hepatocyte-like (liver) cells. Reference: Schwartz, R. E., et al. 2002. Multipotent adult progenitor cells from bone marrow differentiate into functional hepatocyte-like cells. Journal of Clinical Investigation 109: 1291-1302.

  44. Adult Stem Cell Success: Cord Blood Stem Cells and Stroke • When umbilical cord-derived stem cells were given intravenously along with the drug mannitol, which can penetrate the brain's protective blood-brain barrier, stroke size was reduced by 40 percent. Reference: Cesar V. Borlongan, et al. 2004. Central Nervous System Entry of Peripherally Injected Umbilical Cord Blood Cells Is Not Required for Neuroprotection in Stroke. Stroke 35:2385.

  45. Adult Stem Cell Success:New Jaw Bone • Man’s jaw bone was removed due to cancer • Replacement jaw bone was grown for 7 weeks in his back muscles using his own adult stem cells enclosed in a titanium frame with cow-derived bone mineral blocks and human bone growth factor Reference: Rookmaaker MB, Verhaar MC, Van Zonneveld AJ, Rabelink TJ. 2004. Progenitor cells in the kidney: Biology and therapeutic perspectives. Kidney Int. 66:518-22.

  46. Adult Stem Cell Success: Kidney Stem Cells • Stem cells have been demonstrated in the kidneys • Adult stem cells can dedifferentiate into progenitors • Stem cells from alternate sources can be differentiated into kidney cells Reference: Rookmaaker MB, Verhaar MC, Van Zonneveld AJ, Rabelink TJ. 2004. Progenitor cells in the kidney: Biology and therapeutic perspectives. Kidney Int. 66:518-22.

  47. Adult Stem Cell Success: Stem Cells for Hearing Loss • Stem cells in the adult inner ear are capable of differentiating into hair cells Reference: Li H, Corrales CE, Edge A, Heller S. 2004. Stem cells as therapy for hearing loss. Trends Mol Med. 10:309-15.

  48. Adult Stem Cell Success: Corneas From Adult MSC • Adult stem cells taken from patients were grown in culture before transplantation onto the damaged eyes. Sixteen of the 20 patients had improved vision. Reference: Schwab, IR et al. 2000. Successful transplantation of bioengineered tissue replacements in patients with ocular surface disease. Cornea 19: 421-426.

  49. Adult Stem Cell Success: Treatment of Retinitis Pigmentosa • An injection of adult stem cells saved the sight of mice who would otherwise have gone blind. • Such treatment could be used for a group of eye diseases called retinitis pigmentosa, in which cells in the retina break down over time, causing gradual loss of vision and sometimes blindness. Reference: Otani A., et al. 2004. Rescue of retinal degeneration by intravitreally injected adult bone marrow–derived lineage-negative hematopoietic stem cells. J. Clin. Invest., 114. 765 - 774.

  50. Adult Stem Cells Work as Well as Embryonic Stem Cells • Both adult mesenchymal stem cells and embryonic stem cells produced teeth in mice Reference: Ohazama A, Modino SA, Miletich I, Sharpe PT. 2004. Stem-cell-based tissue engineering of murine teeth. J. Dent. Res. 83:518-522.

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