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The ethics of using stem cells for enhancement

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On October 9, 2014, the Centre for the Commercialization of Regenerative Medicine (CCRM) held a Café Scientifique called Bigger, Better, Faster, Stronger — Are Stem Cells the Answer? at the Hard Rock Café in Toronto, sponsored by the Canadian Institutes of Health Research. Three experts discussed the ethics and likelihood of using stem cells to enhance human performance.

Stem cell therapies are an exciting reality, helping many people recover from life-threatening diseases and debilitating chronic conditions. Worldwide, more than 350,000 patients have been treated with living cell products. Currently, scientists are looking for ways to use stem cells to treat a wide range of disease conditions, such as Parkinson’s disease, multiple sclerosis, rheumatoid arthritis, heart disease, liver disease and diabetes.

While the venue was perhaps an odd setting for a discussion about stem cell applications, moderator Dr. Peter Zandstra noted that it was fitting to be meeting less than a kilometre away from where two Canadians, Dr. James Till and Dr. Ernest McCulloch first discovered transplantable stem cells. Dr. Zandstra is Chief Scientific Officer for CCRM, Professor at the University of Toronto’s Institute of Biomaterials and Biomedical Engineering and Canada Research Chair in Stem Cell Bioengineering.

The first speaker was Dr. Paul Zehr, a neuroscientist, professor and director of the biomedical research centre at the University of Victoria, and author of the book Becoming Batman: The Possibility of a Superhero. He discussed the concept of a continuum, how at one end of the scale we have stem cell treatments that can cure disease and help restore performance to ‘normal,’ and at the other end of the spectrum in the future, we could potentially use stem cell treatments to boost performance from normal to extremely high levels seen in Olympic athletes and sports heroes. He highlighted the key questions we should be asking as science moves along this continuum:

  • Which situations should qualify for biomedical enhancements?
  • Who decides the rules?
  • What is the ‘acceptable’ range of human performance?
  • Who gets access?
  • Should we allow biomedical shortcuts or continue to require athletes to train for many years to reach their optimal potential?

Richard Pound, one of Canada’s most recognized figures in international sport, founding president of the World Anti-Doping Agency and former Secretary and President of the International Olympic Committee spoke next. He discussed how organized sport is a form of social conduct governed by rules agreed to by participants and how sport is intended to be humanistic, where the outcome is determined on skill attained through practice and training. Those who do not agree with the rules are not obligated to participate in sports. One of the key rules is to not use banned substances and methods codified in the World Anti-Doping Code. Adherence to the Code prevents unfair advantage in competition and safeguards athletes from health risks.

For example, take erythropoietin, or EPO as it’s commonly known. Originally developed as a therapeutic treatment to stimulate red blood cell production in patients with chronic kidney disease or undergoing cancer treatments, elite athletes have used it as a way to increase red blood cell counts above average, to boost performance by increasing the amount of oxygen reaching muscle tissue. EPO carries significant health risks because it thickens the blood, and its use has led to some deaths by cardiac arrest.

Pound said that the WADA has been aware of gene therapy and genetic manipulation since shortly after the organization was formed in 1999 and that there is already a rule in place about genetic manipulation. He says that so far though, emerging science in stem cell technology is not currently a major concern in sports. Evidence to date shows that stem cell treatments may assist in recovery from injury, but not always full recovery. Pound said that the hype is outpacing the action, so there is no need yet to amend the list of banned substances and methods to prohibit medical applications of stem cells.

If stem cell treatments do become a method for gaining unfair advantage in organized sport in the future, one the key issues will be finding a reliable screening test. Athletes cannot be disqualified on suspicion, but how will it be possible to target the exact tissue to find out if a stem cell therapy was used? WADA’s Gene Doping Panel will continue to tap into the literature and follow the buzz to see if a reliable test for gene doping can be found.

The third speaker, Dr. Bartha Knoppers, discussed the human right to attain the highest state of health, the ethical questions raised by the context of “attain” and that we must take into account the importance of the United Nations Convention on the Rights of the Child. She is a lawyer, ethics expert and professor at McGill University, holds the Canada Research Chair in Law and Medicine, and has also served on WADA’s International Ethics Committee.

She cautioned that the danger of well-intended abuse could arise if parental manipulation takes on a whole new meaning and stem cell treatments are used for performance enhancement in sports. She advocated that we will need an oversight framework to safeguard children as the science of stem cells progresses and interest in performance enhancement applications grows. The key questions we need to answer are: Are the interventions in the best interests of the children? Are the interventions medically required or for performance enhancement? Who decides what the best interests of children should be?

While this Café Scientifique did not provide answers, it was an interesting discussion of the important ethical considerations for the future applications of stem cells. In the concluding Q&A session, a bright woman asked,”Who gets access to these enhancements in a society that’s becoming increasingly stratified?” As Dr. Alfred Lanning says to Will Smith’s Detective Spooner character in the fictional movie, I Robot, “That, Detective, is the right question.”

Epigenetics – Ending the Nature versus Nurture Debate

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Is it nature or nurture? That was the theme of a recent Café Scientifique in Toronto, hosted by the Canadian Institutes of Health Research (CIHR). Three experts talked about the field of epigenetics and how the ‘nature or nurture’ debate is a futile argument.

Genetic research in the laboratory

 

Recent spectacular advances in genetic research may make you think scientists are on the brink of solving the whole puzzle about what makes us human. Today supercomputers can sequence billions of DNA molecules at once. The cost to sequence an entire genome now stands at about $2,000-4,000, significantly lower than the cost of several hundred million dollars in 2001 when the Human Genome Project was just beginning.

Researchers recently sequenced an entire family’s genome and learned that the son does not carry a gene that increases the risk for developing dangerous blood clots in the future yet the daughter does. By running the daughter’s genetic information through a drug database, her optimal treatment for the future, should she need one, is already identified.

In the near future, we could all have our genomes sequenced and that information could become a standard part of our personal health records.  But will having our DNA on our smartphone tell us what our destiny is?

Not by a long shot.

Our genome contains the entire record of our selves. But it is the epigenome that tells the genes whether to switch on or off, by adding or removing chemical tags.

“This is really very novel, to think that our DNA is sitting around in our early life, waiting to get experience, and because of that experience, more protein or less protein is being made. We now understand the biological mechanism for how that happens,” said Marla B. Sokolowski, PhD, FRSC, Canada Research Chair in Genetics and Behavioural Neurology and Professor and Academic Director at the University of Toronto.

“Think of DNA as books in a library. That library is not particularly useful until you read those books. So the DNA is sitting there in the cells but when there is an experience that that individual has, then that DNA can be read. It can be opened up and then the gene can be expressed. In the case of epigenetics, there are proteins that interact with the DNA that determine if it can be read or not. So if a child grows up in a very stressful environment, the genes that are important for coping with stress get wrapped up in those proteins and so they cannot be expressed. And that’s what is meant by epigenetics,” said Dr. Sokolowski.

Dr. Sokolowski discussed the groundbreaking rat studies by Michael Meaney, Moshe Syzf and Gustavo Turecki, Ph.D’99 at McGill, showing that when a mother rat licks her babies, a gene that decreases the number of stress hormones that get released gets turned on.

Dr. Sokolowski spoke about her current CIHR funded study about mother-infant interactions, which seeks to find how those interactions vary depending on whether the mother had a history of abuse. Everyone has one of two forms of a gene that controls how much serotonin, the major chemical responsible for regulating mood and emotion, is transported from one place to another in the brain. But that gene may not always be expressed if epigenetic tags have been added from abusive experiences.

Dr. Rosanna Weksberg spoke about how environmental factors can impact on how genes are expressed as early as when new life is first implanted. She cited the case where Danish mothers who were 0-10 weeks pregnant during a famine delivered very low birth weight babies that even 60 years later carried different growth factor marks on their genes compared to those who were not affected by the famine. Dr. Weksberg is Staff Physician with Clinical and Metabolic Genetics at The Hospital for Sick Children and Professor, Pediatrics and Molecular Genetics at the University of Toronto.

Dr. Albert Wong talked about his research which hopes to find potential drug treatments that could help prevent the expression of strong, inherited susceptibilities for schizophrenia and depression, by acting on the epigenome. Dr. Wong is Research Scientist, Neuroscience Division at the Center for Addiction and Mental Health (CAMH) and Associate Professor, Psychiatry and Pharmacology at the University of Toronto.

So, is it nature or nurture? The answer is ‘both,’ right down to our genes.