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Whether she's chatting with a real estate agent in Palo Alto or talking with a cell biologist in Australia, says Renee A. Reijo Pera, "people recognize that what California has done is unique."
She's referring to the California Institute for Regenerative Medicine, a state agency created in 2004 by the passage of Proposition 71. CIRM will award $3 billion in grants for stem cell research during the next 10 years. Stanford already has received almost $26 million, more than any other single institution.
"The CIRM funding is important for the money, and also in terms of psychology," Reijo Pera says. "It feels like you're joining something bigger than yourself, and that's always attractive to scientists—that there's this statewide experiment to see if we can really make human embryonic stem cells into some sort of useful, novel therapeutic." She pauses, gazing out the window of her lab, which overlooks a beautiful rose garden and a flourishing vineyard beyond. "It's the same type of mentality people had in the race to the moon."
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HER WISH: Reijo Pera wants embryonic stem cell research depoliticized.
Steve Fisch Photography |
Reijo Pera, 47, a professor of obstetrics and gynecology, last spring was named director of human embryonic stem cell research and education for Stanford's Institute for Stem Cell Biology and Regenerative Medicine. Previously, she had worked for 10 years at the University of California-San Francisco, where she helped establish a human embryonic stem cell research center. Pera brought to the Farm her lab of 15 researchers, and a palpable sense of excitement.
"We've done big scientific projects that have to do with linear acceleration of particles, or putting spacecraft into space, but what's interesting is that we've never really explored our own origins, our own development," she notes. "This is a great exploration time that I refer to as 'the search within.'"
Reijo Pera draws a gamete on her wall whiteboard. "For anybody who spends two seconds thinking about it, the fact that an egg and a sperm fuse, and you get an embryo and a fetus and a child, is actually incredibly amazing." Human development, she explains, happens a cell or a tissue at a time, and there's an instruction manual, or plan, in the human genome that makes each of us unique. "We're not flies, or worms, or mice, or anything else," she says with emphasis. "We're very unique, and this really is a new day for understanding that complexity."
Stanford's institutes of medicine previously have been known for work with adult stem cells, largely thanks to the pioneering efforts of Irving L. Weissman, MD '65, who directs the umbrella Institute for Cancer and Stem Cell Biology and Medicine. With Reijo Pera's lab, the University expects to take a leading role among the handful of American institutions—Stanford, UCSF, Harvard and Columbia—doing research on embryonic stem cells. Specifically, Reijo Pera studies the information in human DNA that directs development of the embryo in the first 12 days, and her lab hopes to design new stem cell lines that can be used to treat disease.
"I'm in obstetrics and gynecology because a lack of information continues to hurt women," Reijo Pera says. "Women [who are infertile] are implanted with multiple embryos because we know nothing about what a good embryo is, and so we have to put in many, to bypass the lack of knowledge." Often, in vitro fertilization results in miscarriages, birth defects and fetal reduction. "The media always report 'five healthy quintuplets just born,' but mostly there are two born and three miscarried."
Reijo Pera describes herself as "quite a religious woman. I'm convinced that there is no inherent wrong in examining an embryo," she says. "And if you look at the people in my lab, there's really a sense of awe, almost of a spiritual nature, that this is not a slight undertaking."
Because her lab works with fertility-clinic embryos that would otherwise be discarded, Reijo Pera argues that "the actual ethical issue is whether to throw them away without using them, or to use them." The researchers in her group are "good people doing good research," she adds. "It would be a terrible thing to throw away embryos without learning anything."
More than 90 percent of embryonic stem cell biologists worldwide study mice as a so-called "model system," Reijo Pera says. But with high-profile universities now investing in human embryonic stem cell biology, she suggests that the research platform is changing in significant ways. "It's quite a difference in science, from a reductionist, 'Let's reduce everything to a basic plan,' to 'Let's embrace the complexity, let's understand ourselves.' And this has really only happened over the last five years."
The young scientists she is hiring today are "not content to think about model systems," Reijo Pera notes, "but want to tackle the big problems—where they come from, how we get a human from a sperm, how things are formed."
Progress in understanding human development would be greatly advanced, she says, "if we could get a certain honesty about the issues and a sense of clarity about what is really being done—and depoliticize it." Instead of mixing up embryonic stem cell research with right-to-life issues, Reijo Pera wishes critics would understand that there is "an absolute line" that is never crossed: embryos are never grown past 12 days. "It never happens—one, for ethical reasons, and, two, because it's impossible, because [the embryo] would have to be hooked up to the mother's blood system."
When President George W. Bush vetoed legislation in June that would have allowed federal funds for embryonic stem cell research, he argued that "promising new techniques" might allow scientists to derive stem cells from amniotic fluid or placentas, rather than from human embryos.
"I'm the most firm believer that there will be alternative ways to make cells," Reijo Pera says. "But at the end of the day, we are going to have to understand our own development. If you have no knowledge about early human development, you're always driving in the dark, with no ability to see where you're going." |
Clinical Trials Raise New Ethical Concerns
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FRONTIER MEDICINE: Scott cites patient safety issues. |
Four years ago, Chris Scott says, it was hard to find any scientists at the annual meeting of the International Society for Stem Cell Research who identified themselves as stem cell biologists. 'People would say, 'I'm a developmental biologist,' or, 'I'm a cell biologist,' but the field was still coalescing, trying to figure out what it was."
This year, sessions were overflowing with researchers eager to proselytize on behalf of stem cell biology. 'The reason is that it transcends so many areas of science—tissue engineering, transplant surgery, immunology, cell biology, genetics," Scott says. 'It touches every corner of biology."
A cell biologist by training, and author of Stem Cell Now (Penguin, 2006), Scott, MLA '05, directs the year-old program in stem cells and society that is part of Stanford's Center for Biomedical Ethics (SCBE). The program educates students, and the public, about stem cell research, hosts conferences and symposia, and consults with policy makers who want to know what's happening in the so-called ELSE issues—ethics, law, society and economics—surrounding that research.
Take medical tourism as an example. A desperate U.S. patient with a back injury travels to a Shanghai clinic, gets several injections of his own stem cells into his spinal cord, plus some physical therapy, and flies home. 'Trials may be carried out in unregulated environments, with no institutional oversight to ensure patient safety," Scott says. 'And some trials are simply 'one-offs.'"
Coming clinical trials in the United States are another 'area of concern" for Scott and his colleagues. 'Here in California, Geron will be the first penguin off the ice floe," he says. The pharmaceutical company plans to use stem cells derived from human embryos for patients who have spinal cord injuries, starting in early 2008. 'Much of the ethical debate has been centered on stem cell research, but now the ethics are turning to patients. The first human trials will be the kind of frontier medicine you can put in the same category as the first gene therapy trials."
The stem cell program coordinates several courses, including one that SCBE director David Magnus, PhD '93, teaches for all scientists receiving funding from the California Institute for Regenerative Medicine. 'He gives them a hard-core introduction to Immanuel Kant and John Stuart Mill, and arms them with philosophical arguments they can use in the public policy arena," Scott says. 'Then, when they are challenged, they can say, 'I do understand the radical Catholic position, but here's a rebuttal to that.'" |
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