More MS news articles for Aug 2001

Problems, promise of fetal tissue

Federally Funded Projects Seek Cures Using Cells from Abortions

http://www0.mercurycenter.com/premium/scitech/docs/fetus07.htm

Published Tuesday, Aug. 7, 2001, in the San Jose Mercury News
BY LISA M. KRIEGER
Mercury News

They are medicine's silent donors, surrendering their tissue so that others may someday live.

They do so without fuss, fanfare or celebrity-studded fundraisers. Their gifts are anonymous, generating none of the gratitude or recognition awarded other contributors.

They are human fetuses. While their potential lives have ended, the research they make possible is being conducted in laboratories around the country.

Medical research using aborted fetuses is a legal -- and well-hidden -- field of scientific inquiry, with 135 federally funded research projects now under way. While a national debate goes on over federal funding for stem cell research, the National Institutes of Health is quietly spending $21.1 million this year to support fetal tissue research, up from $20.5 million last year.

That money is going toward everything from the search for a cure for Parkinson's disease to understanding the mysteries of how the body heals. The research is tinged with all the emotional and ethical concerns that arise from the fight over abortion. But scientists say its promise makes it invaluable.

"Research on human embryos is important because you simply can't learn these kinds of things on adult tissue," said Jeffrey Kahn of the University of Minnesota Center for Biomedical Ethics in Minneapolis. "Without U.S. government funding, you won't learn it as quickly, if at all. We can learn from our failures and successes."

Fifteen years ago, fetal tissue research generated much of the same debate as is now being heard about embryonic stem cell research. The two both rely on the same source: unborn, potential people. Stem cells are extracted from organisms not yet a week old; embryonic or fetal tissue is taken several weeks later.

While fetal tissue research may be morally objectionable to many, it is legally different because it uses embryos that are already dead. Some stem cell research uses frozen zygotes that might otherwise be brought to life.

Then, as now, opponents argued that the research involved destruction of human life; supporters responded that tissue had vast therapeutic potential. Anti-abortion pressure led to a five-year ban on fetal research, lifted in 1993.

Since the ban was lifted, studies have yielded promising leads but no miracle cures.

It was research using 18- to 24-week-old fetuses that has helped doctors at the University of California-San Francisco solve the mystery of wound healing without scarring.

Scientists have transplanted tissue from aborted fetuses during experiments aimed at treating people with Parkinson's disease, insulin-dependent diabetes, Alzheimer's disease, multiple sclerosis, spinal-cord injuries and certain inherited blood disorders.

Early in life

Several key human genes shut off by the time a baby is born, making fetal research the only way to watch them in action. Fetal tissue is also superior for transplantation because it avoids some of the rejection problems of adult tissue, proponents say.

Research is thought to hold the greatest potential when cells are extracted long before the time when they mature into well-defined tissue. That's why there is such excitement over the use of stem cells, extracted from tiny 1- to 7-day-old zygotes. Embryos from an abortion clinic were the source of stem cells isolated in 1998 by Dr. John Gearhart of Johns Hopkins University. The hope is that these cells can be nudged into becoming any of the body's 200 or more tissues.

"The embryonic stem cell work is, in some ways, the next step beyond the fetal tissue work -- getting cells that are still younger, earlier in the development process, and more flexible in order to create the new tissues of medical value," said Henry Greely, associate professor of law at Stanford University's Center for Biomedical Ethics.

But the moral implication of research using cells from embryos troubles many people -- no matter what stage of the developmental process they are extracted.

"They're using these babies as someone would use a salvage yard of automobiles. It's barbaric," said Troy Newman, director of Operation Rescue West in Sacramento.

An unborn fetus is not offered the same protections as other humans, he said. "On the other hand, they want to harvest this preborn child for all its humanity, because it is human."

In the late 1980s and early 1990s, both embryo research and stem cell research were banned. Then, President Clinton lifted the ban on fetal tissue research.

"There were parallel policies," said bioethicist Kahn of the University of Minnesota. "Then they parted ways."

Collecting tissue

Federal support of embryo research has ensured that it is monitored and that donors provide informed consent.

But unlike research involving other human tissues, the collection and distribution of fetal tissue are informal and unstructured. Several non-profit organizations are in charge of procurement.

Few laws specifically regulate procedures involving the procurement and distribution of fetal tissue. On two issues, however, the law is quite explicit:

First, compensation for tissue donation is expressly prohibited.

Second, women donating such tissue must consciously agree to its use in research by signing a consent form. Because the women have already decided to abort when they check a box on a form offering the fetal tissue for research, the research offers no inducement for abortion.

Under a law enacted in 1993, researchers can pay for the cost of procuring and shipping fetal tissue. However, buying or selling fetal tissue for a profit is strictly forbidden.

But unlike drugs or medical devices, which are regulated by the Food and Drug Administration, fetal-tissue transplantation and research are procedures that are regulated only by each hospital's research ethics committees.

No national guidelines are in place for obtaining, testing, processing, freezing, and storing fetal tissue. Nor are there legal controls that specifically ensure the safety and suitability of tissue.

The procurement procedure begins with a consent form being signed by the woman having the abortion. Not all American women getting abortions are approached -- it is more commonly offered at abortion sites affiliated with research institutions.

Most donated tissues are sent to the NIH-supported Central Laboratory for Human Embryology at the University of Washington, which supplies embryos and fetuses of gestational ages between 40 days and term to medical researchers throughout the country and Canada. They do not collect living tissue from late-term abortions, or from abortions known as "intact dilation and evacuation," in which the fetus is partially extracted and its brain suctioned out before the fetus is entirely removed from the womb.

International clinics are another source of aborted fetuses, with more than 35 million legal abortions performed each year worldwide.

For instance, embryos aged 5 to 14 weeks are provided by the University of Zagreb Medical School in Croatia to NIH-based developmental biologists studying bone and cartilage growth. Moscow's International Institute of Biological Medicine has supplied fetal tissue for use in American transplantations.

In some instances, the needed tissue from these embryos is extracted and cooled in a suspension of saline and glucose until needed; in others, it is sliced and preserved in paraffin.

Ethical objections

Special ethical concerns have been raised about the use of fetal tissue from elective abortion. Symbolically, say critics, it sanctions abortion.

Unlike other tissue donors, fetuses are unable to give their consent, say critics. Fetal research raises similar ethical questions as the use of neurological research data from victims of the Holocaust or information gathered by the Japanese about human hypothermia by torturing Chinese prisoners, they say.

"Twenty years from now, we're going to look back and say, `My God, what did we allow? What did we do?' " said Newman, director of Operation Rescue West.

And claims of therapeutic potential have been exaggerated by the medical community, they say.

Even if a therapy works, they ask, is it acceptable to use it if requires thousands of abortions a year to sustain an adequate level of tissue? Does the United States want to depend on abortion as a means of curing people?

Scientific promise

Proponents of research say it doesn't sanction abortion any more than taking a donated organ from a suicide or murder victim makes suicide or murder acceptable.

Doctors at Yale University, the University of Colorado and other prominent medical centers report in major scientific journals that fetal tissue, while still preliminary, shows promise of curing severe disorders and chronic diseases.

The many abortions performed each year in the United States should not occur in vain, they add. Proponents also note that the termination of pregnancy is legal -- and that early fetuses have no constitutional right to protection by the law.

"As long as people have the right to choose abortion, then it becomes moot what happens next," said bioethicist Kahn of the University of Minnesota.

So society has a choice, they say: Should the tissue be discarded or put to good use?

"All this work with growing new tissue is very exciting, very promising -- and very speculative," said Greely. "But as with all basic research, its ultimate value is unknown."