By: Susanne Rust and Kathleen Gallagher, Milwaukee Journal Sentinel

April 25, 2006, Milwaukee Journal Sentinel

Apr. 25--Madison -- Third of three parts

Susan Armacost and Ed Fallone are passionate about the morality of human embryonic stem cell research. They are also worlds apart.

Armacost, legislative director of Wisconsin Right to Life, says the destruction of embryos necessary to obtain the cells is murder. Her organization has added embryonic stem cell research to its traditional issues of abortion, euthanasia and assisted suicide.

Fallone, president of Wisconsin Stem Cell Now Inc., says it's wrong to put limits on research that many believe has the potential to cure diseases, including the juvenile diabetes that afflicts him, his father and his son. He formed his group to advocate for stem cell research in the state after President Bush was re-elected.

Here in Wisconsin -- the cradle of human embryonic stem cell research, with no laws promoting or restricting it -- the political and ethical conflicts on this issue are moving into the spotlight.

Human embryonic stem cells were first isolated in the lab of University of Wisconsin-Madison researcher James Thomson in 1998. Armed with critical patents and a planned research hub at UW that will encourage stem cell researchers from all walks of science to mingle with private industry, Wisconsin offers a hospitable environment for entrepreneurs in this field.

But whether human embryonic stem cell technology has a long-term future in the state depends on more than an agreement between science and industry. The deciding factor is a political consensus on what, if any, kind of embryonic stem cell research is morally and ethically acceptable -- a consensus that Armacost and Fallone each claim their side already has, citing different polls that say 70% of the public supports their respective positions.

Potential for cures

Complex diseases bring obstacles

One of the biggest unanswered questions in the debate over the morality of embryonic stem cell research -- and one that likely won't be answered soon -- concerns whether the cells will revolutionize medicine and provide the cures that some have predicted.

Talk to any of the researchers at UW-Madison and they'll tell you, with caution in their voices, that embryonic stem cells hold promise. But they'll quickly add that hurdles remain, and that the most powerful benefit derived from embryonic stem cells might not lie in their "cures" but in the ways we learn from them to understand and fight disease.

"There is tremendous potential for human embryonic stem cell-based transplantation therapies, but for most diseases, it will be very challenging to develop those therapies," said Thomson, the UW stem cell pioneer.

When people think of stem cells and their curative applications, they generally think in terms of organ regeneration or tissue replacement -- the transplantation-based therapies to which Thomson referred.

Because embryonic stem cells can develop into any tissue or cell type in the body, researchers have predicted that someday, if you were to have a defective body part -- such as a diseased heart -- your cardiologist could derive embryonic stem cells in a lab, insert them into your heart and build new, healthy replacement tissue.

But it's more complicated than that, Thomson said. Many of the diseases for which stem cells have been cited as possible cures are exquisitely complex and not entirely understood. Just plopping cells into an organ might not be the answer.

"We can already make heart cells from embryonic stem cells today, but the challenge will be to get them into the diseased heart in a way that the new heart cells survive, acquire a new blood supply and restore function," he said.

He thinks the first applications of embryonic stem cell research will involve drug development and testing.

"This will impact human medicine much faster than embryonic stem cell-based transplantation therapies, and could in the long run actually have a greater impact."

Researchers also believe embryonic stem cells will have a significant role in allowing researchers to model and investigate disease.

"Much of our ability to understand certain diseases is related to the fact that we have had limited or no access to the specific human cell types that are involved in the disease," he said.

For instance, Parkinson's disease results from the death of cells known as dopaminergic neurons. But these cells don't naturally divide, and, therefore, researchers can't culture them in laboratories.

"Human embryonic stem cells give researchers reliable access to these neurons for the first time, and it will now be possible to perform experiments to unravel why these neurons die in Parkinson's," Thomson said.

Although the cells might be used in transplantation-based therapies someday, "the knowledge we gain studying them may well lead to therapies that stop the progression of Parkinson's without the transplantation of cells," he said.

'Human lives on the line'

Opponent supports embryo adoption

Opponents of the research say too little has been shown in the eight years since the cells were first isolated to indicate the cells will yield any therapies. Justification for further research seems misguided, they say.

"My prediction is down the line, they're going to say, 'Whoops, this isn't working' -- they're willing to put human lives on the line for economic purposes, and we think that is abhorrent," said Armacost of Wisconsin Right to Life, the state's largest abortion-opposition group.

"Life at its very beginning is inherently valuable just because it exists," Armacost said. "If we start putting qualifications on that, then we're all in trouble."

There are two sources for embryonic stem cells: existing stem cell lines and frozen in vitro fertilized embryos, which are 4 or 5 days old. Most researchers work with cells from unused embryos that fertility clinics otherwise planned to destroy.

Armacost promotes embryo adoption instead of destroying unused embryos, but more couples choose to give their unused embryos to research (3%) than to adoptive parents (2%), according to a 2003 survey the American Society for Reproductive Medicine.

Adult vs. embryonic cells

Which would be more effective?

Armacost also asks: Why use embryos, when adult stem cells have already yielded several treatments for disease? Those include bone marrow transplants for cancer patients, pancreatic islet cells for diabetics and blood cells for people with leukemia.

Adult stem cells can be obtained from living adult tissue, in some cases with little technical difficulty. And cord cells, another type of non-embryonic stem cell, can be obtained from hospital delivery rooms, which would otherwise throw them away.

"If we're really serious about economic development, don't we want to go not just with ethical research, but with research that has proven to be effective?" asked Armacost, who said embryonic stem cell researchers are looking to profit economically from hype and promise without any certainty of success.

Armacost pointed to a tally kept on a Web site sponsored Do No Harm: The Coalition of Americans for Research Ethics. There have been 65 research treatments developed with adult stem cells and none with embryonic stem cells, it says.

Others say that's an unfair way to look at it, considering scientists began working with human embryonic stem cells only after Thomson first isolated them eight years ago, and they've been working with adult stem cells for decades.

In addition, adult stem cells have limitations, researchers say. Although embryonic stem cells can give rise to any of the cells in the body, adult stem cells are capable of becoming only a few kinds of cells. For instance, adult bone cells can become new bone cells, but they'd be useless for trying to repair a liver.

And adult stem cells haven't been found in every tissue type.

"To stop (embryonic) stem cell research now because there are no immediate applications would be like stopping work on transistors in 1947 when their main application was considered as a potential hearing aid," said Scott Stern, an associate professor of management and strategy at Northwestern University's Kellogg School of Management.

"Fund it all," Fallone said, "because who knows which avenue is going to lead to curing my son's disease. But don't close the door on embryonic stem cell research just because it keeps an important special interest group happy."

But there's also a concern that embryonic stem cell therapies could cause more harm than good.

According to Thomson, any cell grown in culture -- whether a stem cell or any other type -- will accumulate mutations over time. These mutations could cause cancer.

Therefore, researchers will have to be cautious about using these cells in a clinical setting, to avoid creating a disease that is worse than the one they are trying to cure, Thomson has said in speeches and interviews.

Growing embryos further

Statements called untrue

Armacost says Right to Life Wisconsin is concerned that without restrictions, scientists would be too tempted to use the embryos in horrific ways.

"We think the real goal is to use cloned human embryos and grow them further and further along in gestation -- if you're looking for organs, you need to grow those embryos further to transplant them or use them in research," she said.

Such conjectures are an example of the "misinformation campaign" special interest groups have waged on the state Legislature and citizens, said Andrew Cohn, a Wisconsin Alumni Research Foundation spokesman.

"They make statements that are totally untrue based on no facts and intended to damage the reputation of the most important scientists Wisconsin has produced," he said.

As new technology develops, and new discoveries are made, the debate could shift.

For instance, German researchers have shown that stem cells taken from mouse testicles behave like embryonic stem cells. That means, if similar research pans out in humans -- which is no means guaranteed -- some of these hot ethical issues may become moot.