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Stem cells: hope and fear | David Scadden

Uncertain futures

By David Scadden
November 14, 2010

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YOUR GRANDPARENTS were good to you. They supported the health research framework that put polio out of business and made childhood leukemia a curable disease. Now the duty is ours. We are the architects of the health fears our children will confront.

Our prospects? The code that makes a human human has been unraveled. That code depends upon cells to provide life, and we have the most potent of all cells — stem cells — in hand. They are the stuff from which every other cell is made and may even have a satanic side in making the cells of cancer. If we think rebuilding tissues damaged by disease or trauma and doing better with cancer are things we would like to do for our children, it takes only a heartbeat to conclude stem cells should be part of the plan. Private philanthropy has set the spark for work such as this, but it is federal support that fuels long-term deep research. Federal support for one important aspect of stem cell work, human embryonic stem (ES) cells, is again in question.

Two scientists have been given standing by Judge Royce Lamberth, claiming harm by having to compete with human embryonic stem cell researchers for grants. This will enable a ruling that could derail any federal support for this vital research, an outcome worse than any the field has yet experienced. The legislative action that could provide a way forward seems highly unlikely in the current climate.

Should we care? Does human ES cell research really matter, particularly now that we have the ability to make ES-like cells from any one of us by cellular re-programming? (Cellular reprogramming is a process by which mature cells can erase their mature status and revert to something like ES cells.)

Personally, I’ve invested my career in adult stem cells. Yet I regard embryonic stem cells as essential. They are a very distinct cell state, and studying them has unleashed a treasure trove of important information. If embryonic cells were not available for study, no one would have known how to begin to assess the possibility of cellular reprogramming, much less how to accomplish it. The notion that cells can be reprogrammed has rocked the firmament. It opens the door on thinking about cells as units that can be redirected in their function, not unlike components in microelectronics: highly adaptable to applications we can only begin to now imagine.

The advances are not just conceptual. A reprogramming factor has now been sufficiently studied that just last week, it was shown to convert cells known as fibroblasts into blood cells. The clinical implications of a ready-made source of blood are easy to imagine. Granted, this is several steps away from embryonic stem cell work, but judging which finding will lead to important next-generation work is simply not possible. Taking a key component in the discovery process off the table now seems like nothing short of self-hindrance.

Self-hindrance is not the mode with which the rest of the world is approaching stem cell science, and it has consequences. That the United States has been attractive to the world’s scientific talent is in no small part because our government has invested courageously in big challenges. The new pattern — of fitful stops and starts in support for an area with potential to change medicine — puts us more in the ranks of the feckless than the fearless. Shutting down federal support for embryonic stem cell work will cost us in scientific information. But what may hurt more is the loss of talent.

Young stem-cell scientists can’t help but feel acute uncertainty in the current context, and they have options in other countries and other fields. They will drive stem cell science and shape its impact. Their loss would cost us all. While it isn’t possible to foresee how an individual judge will rule, it is possible to see that this legal limbo and the ping-pong-like history of the field will wear thin on those making career-defining choices.

If we want to fulfill our forebears’ legacy of knocking out diseases, we need to get stem cell science on solid ground. Clear policy and private philanthropic action enabling stem cell science to move ahead is an investment worthy of those who walked this path before us.

David Scadden, a hematologist and oncologist, directs the Center for Regenerative Medicine at the Massachusetts General Hospital and co-directs the Harvard Stem Cell Institute.