Islamic Perspective on Stem Cell

Prof.Dr.dr.H. Rusdi Lamsudin, SpS(K), M.Med.Sc

Dean Faculty of Medicine Indonesian Islamic University Yogyakarta

Outline
Introduction Definition stem cell Types of stem cells Sources of stem cells Current treatments Potential treatments Controversy over ethical implication Islamic perspective on stem cells

Introduction
A stem cell is a special kind of cell that has a unique capacity to renew itself and to give rise to specialized cell types

Researchers have for years looked for ways to use stem cells to replace cells and tissues that are damaged or diseased

Introduction
Research on stem cells is advancing knowledge about how an organism develops from a single cell and how healthy cells replace damaged cells in adult organisms Promising area of science is also leading scientists to investigate the possibility of cell-based therapies to treat disease-- regenerative or reparative medicine

Introduction
Stem cells are one of the most fascinating areas of biology today Like many expanding fields of scientific inquiry, research on stem cells raises scientific questions as rapidly as it degerates new discoveries

Outline
Introduction Definition stem cell Types of stem cells Sources of stem cells Current treatments Potential treatments Controversy over ethical implication Islamic perspective on stem cells

Stem cell
A cell from the embryo, fetus, or adult that has, under conditions, the ability to produce itself for a long period, or in the case of adult stem cells, throughout the life of the organism Can give rise to specialized cells make up the tissues and organs of the body

Outline
Introduction Definition stem cell Types of stem cells Sources of stem cells Current treatments Potential treatments Controversy over ethical implication Islamic perspective on stem cells

Types
Totipotent
A single totipotent stem cell can grow into an entire organism and even produce extra-embryonic tissues

Pluripotent
A single pluripotent stem cell has ability to give rise to types of cells that develop from the three germ layers (mesoderm, endoderm and ectoderm) from which all cells of the body arise.

Multipotent
Multipotent stem cell can only become one particular type of cells: e.g. blood cells, or bone cells

Outline
Introduction Definition stem cell Types of stem cells Sources of stem cells Current treatments Potential treatments Controversy over ethical implication Islamic perspective on stem cells

Sources of stem cells

Cord blood stem cells Adult stem cells Embryonic stem cells

Cord blood stem cells

Blood from the placenta and umbilical cord that are left over after birth is source of adult stem cells Since 1988 these cord blood stem cells have been used to treat;
Guthers disease Hunter syndrome Hurler syndrome Acute lymphocytic leukaemia And many more problems occuring mostly in children

Adult stem cells

Can be found in adult beings Undiffrentiated cells that produce daily provide certain specialized cells Ex: bone marrow stem cells are known to be able to transform into liver, nerve, muscle and kidney cells

What are Human Embryonic Stem Cells (HES cells)?

HES cells are stem cells derived from the inner cell mass of the blastocyst stage of a human embryo.

A stem cell is not specialized. That is, it can give rise to different kinds of tissue. A stem cell is self-renewing.

What are Human Embryonic Stem Cells (HES cells)?

They can be kept alive indefinitely in culture Embryonic stem cells are pluripotent. That is, they can differentiate into any kind of tissue in the human body. Unlike an embryo, they are not totipotent. That is, they are not capable of being implanted in a uterus and giving rise to a human being.

Outline
Introduction Definition stem cell Types of stem cells Sources of stem cells Current treatments Potential treatments Controversy over ethical implication Islamic perspective on stem cells

Current treatment
For more 30 years, bone morrow stem cells have been used to treat cancer patients which conditions as leukemia and lymphoma

Current treatment
During chemotherapy
Most growing cells are killed by cytotoxic agents These agents not only kill the leukemia or neoplastic cells, but also the stem cells needed to replace the killed cells as patient recovers If the stem cells are removed before chemotherapy, and then reinjected after treatment is terminated

Current treatrment
The stem cells in the bone morrow produce large amounts of red cells and white blood cells, to keep the body healthy and to help fight infections Adult stem cells have been successfully used to treat paralysis due to to spinal injuries, Parkinsons disease and other illness

Outline
Introduction Definition stem cell Types of stem cells Sources of stem cells Current treatments Potential treatments Controversy over ethical implication Islamic perspective on stem cells

Potential treatment
Cancerous tumors Apparently able to repair muscle damage after heart attacks - bone morrow stem cells Follicle stem cells may lead to successes in treating baldness through hair multiplication within three or four years

Potential treatment
Type 1 Juvenile diabetes could be cure with stem cells in the future. Autoimmune diseases and promise of stem cell-based therapies Rebuilding the nervous system with stem cells

Radiolabeled Designer Stem Cells

Donor DNA Extracted from egg cell
Polar body Donor egg's DNA Nucleus
** * * * ** * * * * ** * * * * * * * ** * ** * * * * * ** * ** * * * * * * * * * ** * * * * * * ** ** * * * * ** * ** * * ** * * ** * *

Organ specific stem cells are separated from cell culture and transfected with a reporter gene (*).

Patient's DNA from skin cell injected into nucleus of Donor egg cell Add growth stimulating compounds Egg becomes a blastocyst with about 150 stem cells Stem cells cultured with nutrient providing feeder cells

Patient's DNA

Patient's Cell

Stem cells are then injected into the recipeint.

Injected Stem Cells

Feeder cells

Stem cells

Radiolabeled probe targeting the reporter gene will be used to track these stem cells in the body
KT B

Outline
Introduction Definition stem cell Types of stem cells Sources of stem cells Current treatments Potential treatments Controversy over ethical implication Islamic perspective on stem cells

Controversy over ethical implication

One of the most heated ethical issues surrounding embryonic stem (ES) cell research is independent of reseach goal or outcome possibilities This ethical issue involves the status of human embryo

Controversy over ethical implication (the status of the human embryo)

Position #1
Embryos are human individuals and should not be used or destroyed for research purposes

Position #2
Embryos do not have the same status as fetus or a baby and can be uesd for research

Controversy over ethical implication (the status of the human embryo)

Position #3
Embryos should not be created for research, but can be used if they left over from in vitro fertilization (IVF) procedures

Position #4
Embryos are clusters of cells no different from other cells and can be created specifically for use in research

Controversy over ethical implication

US President George W Bush announced his executive decision on August 9, 2001, after consulting with scientists, scholars, bioethicists, religious leaders, doctors, researchers, members of Congress, [his] Cabinet, and [his] friends and reading heartfelt letters from many Americans, to prohibit the use of federal funding to work with embryonic cell lines created after that date.

Controversy over ethical implication

In April 2004, 206 members of Congress, including many moderate republicans, and some other prominent public figures signed a letter urging President Bush to relax the policy The 2004 Democratic presidential candidate, John Kerry, had promised to support all types of stem cells research if elected President

Organ Tissue replacement

Stem Cell Animal Organs
e.g., pig organ

Cadaver Organs
e.g., cornea

Living Donor
e.g., kidney

Artificial Organs

Fetal stem cells taken after child-birth death

Stem cells from your blood

Stem cells from your organ

Biological artificial organ

Mechanical artificial organ

Umbilical stem cells at your birth

Umbilical stem cells from others' birth

Stem cells Stem cells grown from prefrom a implanted discarded embryo aborted which is fetus to be discarded

Stem cells from a zygote modified in vitro and implanted for one month

Liver bioreactor with your stem cells

Liver bioreactor with stem cells not from you

Artificial heart

Religious perspectives
It is interesting to note that religions that have strong traditions of legal and religious law Judaism and Islam, support most forms of stem cell research Catholic Christian group have come out strongly against embryonic stem cell research as they view it as a form of abortion, which they see as murder

An Islamic Perspective on Stem Cells Research

References
1. A Muslim Perspective on Embryonic Stem-Cell research. IIIssues, Vol II, Number 3, August 29, 2001, Publish by the Islamic Institute, Washington DC 2. Muzzammii Siddiqi. An Islamic Perspective on Stem Cells Research. Article Ref:ICO202-404, february 27, 2002 3. Michele Weckerly. The Islamic View on Stem Cell Research 4. IMANAs Position on Organ Donation and Transplantation. Our Position The Position of Islamic Medical Association of North America on Issues of Medical Ethics. March, 26, 2005

An Islamic Perspective on Stem Cells Research

IIIssues, 2001
In an effort to formulate a policy position on embryonic stem cells research, and to ensure Muslim American participation in the debate of the ethical and scientific issue, the Islamic Institue convened a panel of expert, in cooperation with;
The Figh Council of North America (FCNA, North American council of Islamic jurisprudence) The Graduate School of Islamic and Social Science (GSISS) The International Institute of Islamic Thought (IIIT) The panel, consisting of medical doctors, scientist, and Islamic scholars

An Islamic Perspective on Stem Cells Research

IIIssues, 2001
Muslims have strongly rejected human cloning experimentation that contradicts Islamic legislation and prohibited in all its forms because it contradicts with Islam
Nevertheless, virtually all Muslim scholars see in-vitro fertilization (IVF) as a compassionate and humane scientific procedure to help infertile couples bear children. IVF, Islamic scholars emphasize, has to be performed under strict guidelines

An Islamic Perspective on Stem Cells Research

IIIssues, 2001
The Islamic Institute supports stem-cell research on these spare embryos from invitro fertilization (IVF)
Under the Islamic principle of the purposes and higher causes of the shariah (Islamic law), we believe it is a societal obligation to perform research on the extra embryos instead of discarding them

An Islamic Perspective on Stem Cells Research

IIIssues, 2001
None of the Islamic scholars on the panel, or those scholars that were subsequently consulted, felt the opinion was anyway contradictory to Islamic principles

An Islamic Perspective on Stem Cells Research

IIIssues, 2001
A majority of Muslim Americans support embryonic stem cell research according to a new poll conducted by the Islamic Institute. The Washington-based Islamic advocacy group also announced its support for research based on the recommendations of panel Islamic scholars, scientists, and medical doctors

An Islamic Perspective on Stem Cells Research

Dr. Muzammii Siddiqi, 2002
IVF is permissible in Islam First question Second question

An Islamic Perspective on Stem Cells Research

Dr. Muzammii Siddiqi, 2002
First question
Should an embryo, which is formed within a few days after an artificial fertilization and is not yet in the womb of its mother, be considered a human being, with all rights of human being?

An Islamic Perspective on Stem Cells Research

Dr. Muzammii Siddiqi, 2002
Answer First question
Muslim jurists have made a clear distinction between the early stages of pregnancy (first 40 days) and its later stages It is mentioned that if someone attacks a pregnant woman and aborts her baby in the early stages of her pregnancy, that persons punishment will be less than that of the person who does that during full pregnancy . And if he kills the child after the birth, then he is liable to be punish for homicide

An Islamic Perspective on Stem Cells Research

Dr. Muzammii Siddiqi, 2002 Second Question
Whether according to the Shariah it is acceptable to destroy an embryo for shake of research, even if this research can potentially cure many otherwise fatal disease?

An Islamic Perspective on Stem Cells Research

Dr. Muzammii Siddiqi, 2002
Answer Second Question
That the embryo in this stage is not human. It is not in its natural environment, the womb If it is not placed in the womb it will not survive and it will not become a human being So there is nothing wrong in doing this research, especially this research has potential to cure disease

An Islamic Perspective on Stem Cells Research

Dr. Muzammii Siddiqi, 2002
Recommnedation #1 Recommendation #2 Recommendation #3

An Islamic Perspective on Stem Cells Research

Dr. Muzammii Siddiqi, 2002
Recommnedation #1
It is claimed by experts in the field that the research on stem cell has potential to relieve human disease and suffering If this the case then it is not only allowed but it is obligatory (fard kifayah) to pursue this research

An Islamic Perspective on Stem Cells Research

Dr. Muzammii Siddiqi, 2002
Recommendation #2
The use of embryonic stem cell should be very heavily limited. Only allow isolation of stem cells from frozen embryos that were created for the purpose of in vitro fertilization and would otherwise have destroyed Obtain full consent from the donors Provide safequards against monetary compensation to embryo donors and against the creation of embryos in excess of what is required for in vitro fertilization

An Islamic Perspective on Stem Cells Research

Dr. Muzammii Siddiqi, 2002
Recommendation #3
Perhaps research using stem cells derived from adults will eventually prove to be most promising We should encourage further research on the use of adult stem cells, to the point where ir will be unnecessary to use embryos for this purpose Specifically, we should find better ways to isolate existing stem cells in the human body

An Islamic Perspective on Stem Cells Research

Michele Weckerly

To analyze Islams stance towards stem cell research, the status of embryo must be determined In Chapter 23 (Al Muminuun), verse 12-14, the Quran teaches:
We created (khalaqna) man of an extraction of clay, then we sent him, a drop in a safe lodging, then We created of the drop a clot, then We created of the clot a tissue, then We created of the tissue bones, the We covered the bones in flesh; thereafter We produced it as another creatur. So blessed be God, then the best of creators (khaliqin)!

An Islamic Perspective on Stem Cells Research

Michele Weckerly
Allah passage has been interpreted to indicate that a fetus is is perceived as human life, only later on the biological development because of the Qurans use of the words thereafter We produced his as another creature. Addtionally, many scholars indicate that ensoulment of the fetus does not occur until the end of the fourth month of pregnancy (120 days),

An Islamic Perspective on Stem Cells Research

Michele Weckerly
However, tradition states:
Each of you possesses his own formation within his mothers womb, first as a drop of matter for forty days, then as a blood clot for forty days, and then the angel is sent to breathe life into him

An Islamic Perspective on Stem Cells Research

Michele Weckerly
Additionally, the Shariah makes a distinction between actual life and potential life, determining that actual life should be afforded more protection than potential life. Under most interpretations of Islamic law, the embryo is not considered a person and the use of it for stem cell research does not violate Islamic law.
Also, under this same line of analysis, stem cells from aborted fetuses would also be permitted if the abortion was performed before the fourth month of pregnancy

An Islamic Perspective on Stem Cells Research

IMANAs Position on Organ Donation and Transplantation. Our Position The Position of Islamic Medical Association of North America on Issues of Medical Ethics. March, 26, 2005
Transplantation in general, both giving and receiving organs, is allowed for this the purpose of saving life This has be done under the following guidelines:

An Islamic Perspective on Stem Cells Research

The guidelines
1. The medical need has to be defined 2. The possible benefit to the patient has to be defined 3. Consent from the donor as well as recipient must be obtained 4. No finacial incentive to the donor or his relatives for giving his organs (a voluntary gift may be permitted)

An Islamic Perspective on Stem Cells Research

5. Any permanent harm to the donor must be avoided 6. May not transplant sex organs (testicles, ovaries or) which violate the sanctity of marriage 7. There should be no sale of organs by any party 8. There should be cost to family of the donor for removing the organ 9. Cadaver donation is permitted but only if specifically mention in that persons will or in driving license

The guidelines