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My Lords, the scientific community, all those with degenerative diseases and those concerned about the ethics of different aspects of research should be grateful to the noble Lord, Lord Patel, for instigating this important debate.
"Stem cells" is an umbrella term, often used far too broadly, inappropriately and with little understanding. Fantasy has fuelled scaremongering and the finger has been pointed inappropriately at researchers carrying out high-quality research. Meanwhile, vulnerable patients in desperate situations travel abroad for expensive treatments, where they are effectively robbed in undergoing non-evidence-based interventions, some of which may be harmful. That is a desperate situation for those patients and demonstrates the lack of understanding in the public domain about stem cells.
The science is developing and has huge potential, particularly to halt the progression of slowly degenerative diseases. Haematology pioneered this with haemopoetic stem cell research, which has now been translated into routine bone marrow transplants. Using cord stem cells has resulted in more than 2,500 patients receiving bone marrow transplants and doing well as a result. All that gets little publicity now. Cardiology, too, has started to enter the realm of stem cell research. Such research is in its early days. An editorial in the New England Journal of Medicine summed it up very well. It states:
"Recent randomized studies of cell therapy for heart disease represent a milestone in this rapidly developing field while serving as a cogent reminder that many important clinical and fundamental questions have yet to be addressed. We should guard against both premature declaration of victory and premature abandonment of a promising therapeutic strategy. The ultimate success ... is likely to depend on continued and effective coordination of rigorous basic and clinical investigations".
Stem cells, sometimes called progenitor cells, are pluripotent. Immaturity gives the ability to differentiate into different cell lines; hence the appeal of embryonic cells, but the ethical dilemmas abound. I shall confine my remarks to cord blood stem cells and even adult stem cells as they have also been shown to be able to differentiate into tissues such as cartilage, bone, adipose tissue and muscle. Normal adult tissue seems to have a few stem cells present which are responsible for ongoing tissue repair and protection from injury. Many of these are present in normal bone marrow and can be harvested for transplantation. Some are present in the liver and can regenerate, but a few also appear to be present in other tissues as well such as cardiac muscle. These nursemaid cells have an important role and warrant research as well.
It is difficult to know just what we are dealing with when people talk about stem cell research in scientific papers. The immature cell has poorly developed surface markers making it difficult to identify accurately. The only way really to know that a cell is pluripotent is to culture it on different media and see it differentiate. The lack of cell surface markers makes comparison of one research project with another difficult at present. CD34 cells are haemopoetic stem cells that are now relatively easily identified using cytofluorometric analysis, which basically gives the cell a coloured marker. Then you can extract the cell and know what you are dealing with. Those are the ones used in bone marrow transplant.
Intra-coronary and intra-muscular injection of stem cells is promising in cardiology but it is interesting to note that the benefits are marginal and short-lived because these cells die off quite quickly. An important development in the UK is the establishment of cord blood donation through the National Blood Service Banking Centre. Cord blood contains relatively immature cells that would otherwise be discarded. Interestingly, Virgin has entered this area with combined private/public banking whereby 20 per cent of the sample is cryopreserved for that family and 80 per cent donated for public use. It costs the parents about £1,500 but this does not cover the cost of collection in the delivery suite. The National Blood Service's three collection centres in Barnet, Northwick Park and Luton and Dunstable now have a 40 per cent ethnic minority mix of these cells for transplant. These are also very important cells for research.
These are expensive developments. They are within the framework of the NHS and deserve to be supported. They will cost—it will be many years before we get financial return—but we have an important start here in the UK. Even US Republican senators are seeing the value of such research. If research is encouraged, high-quality groups will develop. If not, poorly conducted research using non-vigorous methods will continue. It will only discredit this important area and result in patients continuing to seek quack cures abroad being robbed under false claims. We must support research. We must streamline the regulation of it. We must make sure that the monitoring is done by an expert central body of people who really understand the science, not people who are unduly cautious. That is the only way high-quality research will continue for the benefit of our country.