Cellular Donation and Stem Cell Research in the Islamic Countries Hind Al Humaidan, MD, FRCPA Consultant Hematopathologist & Director, Blood Bank & Stem

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)


Demand human ESCs (hESCs)

More promising cure human disease

Human embryos created (IVF) specifically stem cell research



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.


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


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



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”


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)


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.


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.”


-Sahih al-Bukhari.

All scholars agree that embryonic life is entitled to respect even before ensoulment but becomes more after.


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)


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


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.

Documents

Cellular Donation and Stem Cell Research in the Islamic Countries Hind Al Humaidan, MD, FRCPA Consultant Hematopathologist & Director, Blood Bank & Stem