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IPS Stem Cells: New Ethical Quandaries

Sally Lehrman

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When scientists learned how to turn back the clock in a young skin cell, to bring it back to an early-stage cell that could become any other type in the body, both they and ethicists rejoiced. The reprogrammed cell was pluripotent, much like an embryonic stem cell. Maybe even better, it also might be prompted to jump from one cell type to another.

One day, these induced pluripotent stem cells -- iPS cells for short -- might be able to correct any number of life-threatening and disabling conditions. Much sooner, these cells will almost certainly serve as extremely useful models for studying disease.

The researchers used viruses to deliver three to four new genes into the cell nucleus. And with the new information, the skin cells reprogrammed themselves. They behaved almost exactly like embryonic stem cells, which are derived from fertilized eggs. But with these reprogrammed cells, people thought, there would be no moral and political controversy. No embryo would be destroyed.

Recently, new studies have taken the work a step further. Researchers used synthetic RNA instead of viruses to get new instructions into the cell nucleus. This sped up the process and lessened the possibility of side effects such as cancer when the cells finally become a treatment for patients. (They're called RNA-induced pluripotent cells.)

But as researchers and ethicists take a closer look at these iPS cells, they are realizing that the issues posed are as thorny as ever. In fact, the issues may be even more urgent because the new techniques are so much easier and cheaper. The concerns fall into three main areas.

First, the possibility of human cloning from one person's skin cells or human reproduction from cells made into sperm and egg. The possibility is far-off, but real. Scientists already have reported progress that could lead to either. One could become a parent at any age, using tissue from someone either living or dead.

More immediate concerns have to do with control of the original tissue donation and the purposes to which it is applied.

For instance, privacy. Because of the desire to use these cells to study or treat diseases such as Parkinson's, juvenile diabetes or Alzheimer's, it will be important to know the donor's health history. The donor's personal information and health history must always be linked to the cells. It may be impossible to maintain donor privacy.

Another is ethical norms. Bedrock ethical norms of consent and withdrawal may no longer be feasible. Let's say I donate tissue but don't want it used for studies that combine human and animal cells. Should I have the right to approve each new use? How will that be managed and tracked?

What if I simply have a change of heart? My cells will be growing in labs all over the world. Is it fair for me to be able to ask for them to be destroyed? Is it even possible?

Finally, money. New concerns may arise about equitable treatment of the donor. In this brave new world, in which your skin cells may turn into expensive treatments, pharmaceutical testing tools, or models to study disease, should you get to share in the profit? Should you have a say in the commercial products that your cells ultimately produce?

These questions are becoming more urgent as the science advances. Recently the first human safety trial using human embryonic stem cells began. How do you see the ethics unfolding as scientists advance this technology and begin to apply it to real problems?

Note: Geron Corp. began the first-ever human study of human embryonic stem cells to treat disease in early October 2010. It is a small test for safety in patients with a recent spinal cord injury. Scientists believe that iPS cells may not fully replace the embryonic kind, and most certainly adult stem cells cannot. They are simply not as flexible. But iPS are seen as extremely similar to embryonic stem cells. Of the federal monies awarded to the three types of stem cell research during this fiscal year, embryonic stem cell research has received about one quarter, or $131 million.

Award-winning science journalist Sally Lehrman is the Knight Ridder San Jose Mercury News Endowed Chair in Journalism and the Public Interest at Santa Clara University.

November 2010

November 1, 2010

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