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11 August 2009

Stem cells – hope or hype?

Stem cell technology offers the promise of curing the incurable – but for the moment lives are being lost while the issue is mired in controversy.

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After 21 years of unsuccessful heart treatments, including several heart procedures, 68-year-old Coenie de Jongh was desperate. So when his cardiologist suggested a last-resort experimental therapy, it represented a literal life line.

Coenie, from Bloubergstrand near Cape Town, had his first heart attack at the young age of 40. A bypass operation followed and his condition improved, but seven years later Coenie’s health started deteriorating again. More operations and more intense treatment followed, but in 2002 his health took a real turn for the worse.

His condition was so bad he struggled to find a cardiologist who was willing to perform another bypass operation. The procedure was eventually done, but it wasn’t as successful as they’d hoped.

At that stage, Dr Andre Saaiman from Kuils River Hospital was conducting research involving the use of stem cells*. He was inspired by the work done by Prof Philippe Menasche from France, who had figured out a way to inject stem cells derived from skeletal muscle into failing hearts.

After getting ethical approval from Stellenbosch University, Dr Saaiman decided to try out the novel therapy on Coenie, who by then was extremely ill and confined to a wheelchair. In December 2004, he called Coenie in and took cells from his upper leg, which he then cultivated in a laboratory. A month later, he injected the cultivated stem cells into 40 areas of Coenie’s failing heart.

The results were little short of miraculous.

In less than two weeks, Coenie’s condition improved dramatically. “He was a different person,” Marlene, Coenie's wife, recalls.

"Before the operation, he had only 10 percent heart function; afterwards, his heart function shot up to almost 35 percent. It was amazing to see what he could do again. He started walking again, and could lead a relatively normal life."

Tragically, due to medical complications unrelated to the stem-cell transplant, Coenie passed away on 10 February 2008.

Even though stem-cell transplants are still experimental and research into this field is in its baby shoes, for Marlene and Coenie this procedure was a miracle.


Coenie de Jongh, here with his wife Marlene and grandchildren,
had experimental stem cell therapy that repaired his ailing heart.

Medical miracle –and controversy
Stem cells are one of the most exciting advances to have happened in medicine in the last few decades. Researchers are inspired by the prospect of curing the incurable, and many positive results are already being seen.

The use of stem cells, particularly those of the embryonic type, is, however, mired in controversy, thanks largely to the position adopted by conservative political and religious groupings. Former US President George W Bush firmly opposed stem-cell research during his term, arguing that working with cells ‘harvested’ from human embryos is tantamount to taking life.

This has had two spinoffs: the first is that the presidential vetoing of a number of stem-cell research bills has led to severe limitation on funds for the creation of new embryonic stem cell lines in the US. This, in turn, has greatly hampered the international research process.

The second issue is that the row has led to a global situation in which the potential use of stem cells is shrouded in excited confusion. This is alarming: even using stem cells in the current limited way, it’s calculated that one in every 200 people who reach the age of 70 will, at some point, develop a disease that could benefit from stem-cell transplantation. In other words, the concern about the ethics of stem cell technology could result in thousands upon thousands of unnecessary illnesses and deaths.

But while the debate is heated in the northern hemisphere, things are quiet at the southernmost tip of Africa – particularly with regard to research around the use of embryonic stem cells. According to Prof Michael Pepper, Extraordinary Professor in Immunology at the University of Pretoria's Faculty of Health Sciences, no basic research of note is currently being conducted here.

So what can be used?
Stuck in the middle of the international controversy are thousands of patients, many of whom anxiously await life-saving treatment.

While adult stem cells have been used for several decades in the treatment of disease – also in South Africa – the problem is that these cells aren’t as flexible as embryonic stem cells. They have fewer applications in the treatment of disease and they’re restricted to very specific tissues.

To compound the frustration, the use of adult stem cells is also quite limited. These cells have many important and wonderful applications (such as the way in which the technology was used to heal Coenie’s heart), but these are either in a legitimate experimental stage or are regarded as unethical, and aren’t accepted by the medical community as a routine form of therapy.

The South African government is in the process of producing regulations on stem cells, currently in draft form. “In the absence of regulations, doctors don’t have any local guidance at this stage, and have to rely on international standards and codes of practice,” Prof Pepper says.

While bone-marrow transplants are covered by the National Health Act, legislation that deals with human tissues, Section Eight, hasn’t been promulgated. In August 2009, the Financial Mail reported that, in its absence, researchers have to fall back on the Human Tissue Act of 1983. "This was published when many of the complex issues that require rules and guidelines were not yet part of the scientific landscape," Razina Munshi writes.

“This also means that we don’t have a legal framework in which to work,” Pepper adds.

At this stage, adult stem cells are used in bone-marrow transplants only. This is applied in the treatment of several diseases, but mainly in the treatment of cancer. These cells make it possible for patients to receive very high doses of chemotherapy and/or radiation therapy.

The way forward
Most experts agree that stem-cell technology holds enormous potential. We’re experiencing the benefits already. “The current reality is that close to 100 diseases can already be treated with bone-marrow transplants. Unfortunately, limited funds mean that it’s hugely underutilised,” Prof Pepper says.

A solution seems to be coming out of the alternative ways scientists are slowly finding to obtain embryonic cells. This could mean they might be able to circumvent any ethically controversial issues in future, paving the way to more research and, hopefully, more stem-cell-related treatment options.

In 2007, Japanese researchers managed to coax human and mouse skin cells into stem cells that are identical to those found in embryos – a discovery that has been hailed a major breakthrough. These results have also been replicated by scientists elsewhere. So, the future is looking bright.

Prof Pepper believes that the current excitement centred on curing a myriad of conditions is most certainly justifiable. Several potential uses of both adult and embryonic stem cells are currently being investigated, but are not yet a reality in a clinical sense – but he has no doubt that these applications will in the future become part of standard medical practice.

* Stem cells serve as a sort of repair system for the body – they are ‘immortal’ cells that can produce all the different cells in the body. Theoretically, they can divide and continue to divide, replenishing other damaged cells in your body for as long as you live. It’s hoped that scientists will one day succeed in replacing damaged genes or add new genes to stem cells in order to give them characteristics that can ultimately treat disease, according to the US National Institutes of Health.

[This is an edited version of an article by Health24's Carine Visagie as it appears in the launch issue of NETCARE magazine, May 2008. The online version was updated in August 2009.]

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