Grow Your Own Heart.

(28 Feb ’10)

            After anti-biotics, this is THE breakthrough in medical science. In the past so many years, all Nobel Prizes for medicine have gone to those who have done research in cytology or cell-related studies.

You’ve read or heard about stem cells, those magical things from which you can grow in a glass jar, a living replica of yourself, more than a twin (which has its own set of genes), a clone (which has your exact combination). I attended an ‘open forum’ arranged by the Indian Council for Medical Research in which top notch scientists explained what all this was about.

It’s still experimental, so if anyone promises to cure you yet of any disease using stem cells, don’t believe it hundred percent. Yes, those who are desperate, paralyzed due to injury or with a failed organ or end stage dreaded disease are going to try anything at all. But it’s good to be informed, nevertheless, for at present, it is hype versus hope. What is it all about?

The female ‘egg’ or ova is potentially able to become any tissue, organ, or even a full person. It’s a single cell. The moment it gets fertilized and starts to multiply, there are several such cells which can potentially become any tissue, organ, etc. These cells keep multiplying rapidly and at different stages are known by strange names like blastula, gastrula and, much later, foetus. Sometime during these stages, the cells become ‘specialized’. Their future functions are defined. Either they will become skin and bone (ectoderm) or nerves, brain, muscle (mesoderm) or stomach, liver, etc (endoderm). Once their roles are known, they have a fixed life cycle, they will fulfill their duties and die, to be replaced by others. So if one has to grow cells to do what we want, we have to catch ‘em ‘young’. That is, at a stage when they are still not ‘specialized’ or ‘defined’.

As of now, we can’t make these cells in factories, we can only ‘harvest’ them from placenta, embryos, women. Take out the nucleus from a stem cell, put in one from a patient’s kidney or heart-muscle, and voila, you can place that cell inside the patient and it’ll grow into that particular organ. Magic? Yes, but it’s more complicated than it sounds.

There are many parents who want to store/freeze their children’s placenta cells so that at a future date they may be useful in the treatment of disease. It’s an expensive proposition, but those who have Crohn’s disease or are on dialysis would do anything to spare their offspring the agony. (There are parents who have stored ‘spare’ embryos, too). We need to think: for how long can/will these cells (or embryos) stay ‘live’ and, if they are thawed after a couple of years, how effective will their use be? If they are not used at all, these ‘banks’ will overflow: how then will they be destroyed? Can they be destroyed without the consent of those whom they belonged to? So many ethical questions arise.

If someone offers ‘treatment’ by stem cell use (and presently other than bone-marrow transplants it isn’t the standard of care in anything else), please ASK a zillion questions. What cells are being used? Is the treatment investigational? Is the person or institution licenced? How many people were ‘treated’ thus before you and what was the response? Is anyone willing to give in writing the risks, specially the long term ones? What are the costs and what do the costs include? Remember, a single success story told to you, or even four or eleven such aren’t proof. Of safety or of cure. 

There are already companies which are selling processed stem cells (like one would sell drugs or any medicinal products) for skin and some other ailments. They are useful for bad burn cases, for example, or patients who have got paralyzed because of a damaged spinal cord. Stem cell therapy will benefit organ-failure patients, those with ulcerative colitis, Alzheimer’s disease, diabetes, etc.

There are several legal, ethical, religious issues yet to be debated. In-vitro fertilization or IVF is already helping so many couples to have children. It’s been around for years, and is still being debated. In a country like India, we have to be very careful about vulnerable patients: the poor, women, children, prisoners, the very old. They should not be exploited for research in the name of science or progress. Voluntary consent, voluntary informed consent is very important before anyone participates in any research activity.

I appreciate the ICMR’s initiative to have public consultations (like the one I attended) in four regions of the country. It has given rise to many questions in my mind. I’m spreading the word so that it can set off the thinking, questioning process in others, too.

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