2023-09-13 16:54:30
Dr. Jaime Millás Mur, expert in Bioethics and professor at the Faculty of Human Medicine of the University of Piura, addresses the diversity of functions and applications of these cells in current medicine and the associated ethical dilemmas.
By Gabriela Hernandez. September 13, 2023. Published in Mail, September 12, 2023.
Advances in stem cell research offer hope in the treatment and possible cure of various diseases. A study published in the New England Journal of Medicine highlights the use of genetically modified stem cells to treat sickle cell anemia, a condition that primarily affects African Americans. Additionally, stem cell therapies are being explored to reduce the toxicity of chemotherapy in cancer treatment and protect the heart, as Stem Cell Reports reported.
The report also mentions the case of a woman who was freed from HIV through an umbilical cord stem cell transplant. What applications have been proven through scientific experiments? What advances has medicine achieved in the treatment of diseases with stem cells?
What are Stem cells?
They are a type of cells discovered relatively recently. They have two properties: a great generative capacity, which can give rise to many cells; and, an enormous capacity for differentiation. That is, specialization. They can have an asymmetric division: a stem cell divides and gives rise to another stem cell and a new cell that is already beginning a differentiation process towards a specific tissue.
How many types of stem cells are there?
There are different types, depending on the fabric. At first, they were thought to be solely from the bone marrow; and, in fact, the first experiments, worldwide, were done with the bone marrow of mice. Later, embryonic ones have come, because they are taken from the embryo… Depending on their potential, they also have different names. Those that are in embryos are called pluripotent, because they can give rise to any of the three embryonic layers. Instead, there may be totipotent cells; the only one that has been shown to be of this type is the zygote: the mother cell of all mothers. Also, there are multipotent cells, which can give rise to different cells from the same layer (they can be from the blood), or unipotent cells if they generate a single cell line.
What is the most common application of stem cells in medicine?
They have been used for some time now, mainly for their regenerative capacity. Here, we can think of blood stem cells, which are used to cure certain cancers, such as leukemia, lymphomas or myelomas. This is already widely experienced and is precisely due to this regenerative capacity of stem cells. There are people who can undergo radiotherapy and lose all those cells, but if they have been preserved, they can then be reintroduced and their blood system regenerated.
Are they applied to the treatment of other diseases?
Also, stem cells have two other very important capacities such as their anti-inflammatory and immunomodulatory capacity. They can reduce tissue inflammation. For example, Dr. García Olmo in Spain has invented the first biological medicine with stem cells from adipose tissue. It is already being manufactured industrially and will be used to treat Crohn’s syndrome, which causes perianal fistulas (and great suffering in patients who have it). With this medicine, they can be cured. There are also a few other established therapies, such as corneal limbal stem cell transplantation to repair ulcers or mesenchymal cell therapy to treat graft-versus-host disease in children. And a little more.
There is talk of stem cell therapy to treat Alzheimer’s and other degenerative diseases, what advances are there in this regard?
Stem cells and the reprogramming technique give promising hope in the research and treatment of neurological diseases, including Alzheimer’s. This technique, developed in 2006 by Yamanaka, allows the creation of iPS cells (induced pluripotent stem cells), which can become neurons with the genome of patients affected by Alzheimer’s. This provides an experimental model to better understand the disease and test new drugs. In addition, it helps reproduce the biological and biochemical phenomena involved in neurological diseases, allowing advances in the understanding and treatment of pathologies such as Alzheimer’s, amyotrophic lateral sclerosis and many others.
For both Alzheimer’s and any other neurodegenerative disease, such as Parkinson’s, or autoimmune diseases such as diabetes, there are still no guaranteed therapies; But, there are very interesting clinical trials, they are already underway. There is a lot of hope with stem cells because of their regenerative capacity.
What ethical dilemmas arise from the medical application of stem cells?
From the beginning, there have been quite a few ethical dilemmas regarding its use. I might say that, if somatic stem cells are used, that is, from the human body in general, there is no problem because nothing is being done that goes once morest ethics. However, if embryonic stem cells are used, there is an ethical dilemma that is very negative, because the embryo is being killed: these cells are removed from the internal part of it, causing its death. We are facing the elimination of an incipient human life, which begins with the fertilization of the egg.
Are there experiments to overcome dilemmas like this?
There is a type of cells discovered in 2006 by Shinya Yamanaka, who was a recent Nobel Prize winner. This is very interesting because it is something like science fiction. The cellular clock is being turned back or delayed to bring the cells to a quasi-embryonic phase. So, all these properties of “embryonic stem” cells are also possessed by these IPS (Induced pluripotent stem cells). With these, Japan is working hard. There are therapies that are already starting to work. If this works, there would no longer be a need to use embryonic cells. However, these IPS might also be misused to produce gametes and carry out some type of human cloning.
In the case of the use of somatic stem cells, clinical trials must verify their safety and effectiveness, in accordance with bioethics in research.
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