Decisions, mind-bending decisons

The ABCs of Biotech for Christians - Twenty-second in a series - U is for Umbilical Cord Blood

In this biotech age many healthcare decisions must be made simply because knowledge has increased. (Dan 12:4) And though the professional guide whom you trust can fully explain your condition or that of your loved one and the available therapies, the heavy burden of decision-making is on you.

For example, the obstetrician who describes and refers for tests that a pregnant woman can take to determine whether her pre-born baby has Down Syndrome (DS), cannot advise the parents to select to abort the baby if anomalies are discovered— at least not in the USA. (In some other nations, DS children are weeded out before birth. Nearly 100% of unborn DS babies are aborted in Iceland, and Denmark is a close second with 96%.)

For most Christians this would not be an impossible decision. God would give grace to choose life and to love and enjoy the special child.

But what about choosing whether to reserve umbilical cord blood at the birth of a child? And, why would this be a hard decision? Cord blood has no embryonic stem cells.

The purpose of saving cord blood is to freeze it for future use:

“Cord blood is a rich source of blood stem cells. Stem cells are the building blocks of the blood and immune system. They have the ability to develop into other types of cells, so they can help repair tissues, organs, and blood vessels and can be used to treat a host of diseases. … Unlike the stem cells in bone marrow or peripheral blood, stem cells in cord blood are immature and haven't yet learned how to attack foreign substances. It's easier to match transplant patients with cord blood than with other sources of stem cells because the cord blood stem cells are less likely to reject the transfusion… Cord blood stem cells have been used successfully to treat more than 80 different diseases, including some cancers, blood disorders, and immune deficiencies. Among these are leukemia, aplastic anemia, Hodgkin's disease, and non-Hodgkin's lymphoma.
Cord blood transplants are also accepted as treatment for thalassemia and sickle cell anemia … and to treat rare metabolic disorders that would otherwise be fatal for infants, such as Krabbe disease and Sanfilippo syndrome … Children in clinical trials are being treated with their own cord blood for cerebral palsy …and for autism…” (ref)

The procedure is not hard. After clamping and cutting the cord, a needle is inserted into the umbilical vein on the part of the cord that is still attached to the placenta, and the blood drains into a collection bag in less than 10 minutes. The blood is then shipped to a cord blood bank where it is tested, processed and cryopreserved for long-term storage if it meets quality standards. (ibid) It can be reserved as a family resource or for the public good. Learn more about cord blood here.

Why would any Christian not do this, if not for personal use, for public donation? A simple answer is that not all hospitals or midwives offer this option. Cord blood collection services are only available in certain places. Realize, too, that an altruistic gift of cord blood will trade internationally for between $23,000 and $31,000/unit. 1

But if it is an option, a parent could still have concern whether it would be the best and right thing for the health of their baby.

The American College of Obstetrics and Gynecology (ACOG) recommends a delay of 30 to 60 seconds between delivery and cord clamping for healthy, full-term babies. It's believed that delayed clamping may be beneficial for newborns. Delayed clamping may affect the volume and quality of cells collected for donating or storing cord blood, however. (ibid, The Baby Center)

More thoroughly—

“Although clamping within a minute or less of delivery has become widely accepted as part of active management of the final stage of labor, there’s increasing concern among obstetricians that it deprives the baby of up to 60 percent of red blood cells and 30 percent of blood volume. For a full-term infant, allowing full placental flow gives the baby an additional 80 to 100 milliliters of blood. A series of clinical trials found that delayed clamping could reduce the risk of anemia, chronic lung disease, brain hemorrhage, sepsis, and eye disease in later life. While early clamping slams the brakes on hard and fast, ‘leaving the umbilical cord unclamped allows a period of transition between the fetal and adult circulations… thereby easing the newborn into extrauterine life.’” 2

But, to reiterate, if clamped too late, not enough stem cells are residual in the cord blood to make it valuable.

Thus, we see the dilemma that a parent must confront, desiring to do the right thing and to trust the professionals, yet having enough knowledge to doubt whether it is advisable, and not being sure.

As with all deep needs for wisdom, we pray for discernment and, if at all possible, to avoid last-minute decisions that may later haunt ones conscience and emotions. Expectant parents need our prayers.

It will help to memorize James 1:5 for those who need help with decision making.

1. Donna Dickenson, ME Medicine vs. WE Medicine, (Columbia University Press, 2013), 101.
2. Ibid, 99.

The Wild West in Biotech and Regenerative Medicine

The ABCs of Biotech for Christians - Nineteenth in a series - R is for Regenerative Medicine

Definitions come into play as we study Regenerative Medicine (RM). Which body parts can be regenerated? Can blood? Bone? Can skin, tissues, organs?

To regenerate is to cause a thing to come to life again. It was dead or nearly so, and a treatment revitalizes it to make it whole and functioning as it originally was.

Is the term “rejuvenate” the same as “regenerate”? It was not selected by the scientific community to describe their work in this medical frontier. Perhaps RM was chosen as the opposite of degenerative, which describes many conditions and diseases.

Frontier is a good word to help us appreciate the work in the labs and clinics of doctors and researchers of RM. Like the pioneers and gold diggers of past generations who set forth to find a better life in the American west, so today this new field beckons those who want to see new horizons in healthcare and healing.

Blood

A healthy person’s blood will replace itself. That is regeneration. After donating a pint of blood, plasma is replaced within about 24 hours and the red cells in four to six weeks. But the person with leukemia (for example), a cancer that harms the body’s ability to make healthy blood cells, needs RM.

An article this year describes conversion of leukemia cells into iPSCs ((see previous post) for study of how they cause cancer. RM is also at work to try to convert skin cells into the type of stem cell (hematopoietic) that could regenerate the blood.

Bone marrow transplant with its many drawbacks is a last resort, but RM is working on a way to make it work without chemotherapy or radiotherapy. Currently, a bone marrow transplant, also called a blood stem cell transplant, can cure some cases of leukemia and some other blood or immune disorders.

Bone

The human body will regenerate a full bone within 10 years, but what if you break a bone or lose bone through osteoporosis? Can TERM (Tissue Engineering and Regenerative Medicine) help? Or, what if a disease or the process of aging destroys the cartilage in your body so that your joints have no cushioning?

This video describes the structure of bone and the below describes how RM is bringing relief to people with degenerative bone disease using stem cells derived from the patient’s own bone marrow. It’s less invasive than joint replacement.

The video was produced by a major medical clinic, but these therapies are offered by doctors locally in metro areas. However, as stated by the doctor, the procedure does not actually regenerate cartilage, though this is under study.

Japan is a leader in bone tissue RM. However, the most I have been able to determine from research on the internet is that RM is rejuvenating bone health, but so far, not regenerating tissues. This is why there is such a demand for pluripotent stem cells in medical research. More on that in the next post.

Skin

Regrowth of skin is critical for burn victims and others with severe wounds. Much progress is being made by RM for these needs. Whereas “autologous” skin (from “skin banks” that preserve skin from corpses for use by burn victims) provided some help, today there are skin substitutes that combine a person’s own (autologous) skin with dermal scaffolds (invented coverings to provide a way for skin to heal). These have been proven to close wounds in burns over more than 90% of total body surface, but they do not repair vascular and lymphatic networks, hair follicles, and other aspects that skin normally has. Use of stem cells to engineer such improvements is underway… “skin substitutes constructed from a combination of stem cells and biomaterials remain a promising solution for the future”. A clinical trial now accepting participants is here.

Tissues and Organs

For these, wonderful but not dramatic progress has been made in RM. This excerptM/a> describes the state of the art:

Currently, tissue engineering plays a relatively small role in patient treatment.  Supplemental bladders, small arteries, skin grafts, cartilage, and even a full trachea have been implanted in patients, but the procedures are still experimental and very costly. While more complex organ tissues like heart, lung, and liver tissue have been successfully recreated in the lab, they are a long way from being fully reproducible and ready to implant into a patient. These tissues, however, can be quite useful in research, especially in drug development. Using functioning human tissue to help screen medication candidates could speed up development and provide key tools for facilitating personalized medicine while saving money and reducing the number of animals used for research.

This same article goes on to describe how regenerating a new kidney from a patient’s own cells may not be far off based on successful experimentation on rats that used a donor organ to scaffold growth of new tissue that was able to perform like a kidney. The next step would be to try this procedure in humans.

Taking a procedue from a lab dish to an animal and then to a human is known as translational medicine. Step by step, processes are developed with the ultimate goal of improving the health of humans.

Did you know that scientific researchers believe the major obstacle to their progress comes from the religious community?

People like me are not opposed to progress and I applaud researchers who sincerely desire to better the human condition through improving our health prospects. But using body parts from people who are not yet dead, or from aborted fetuses, with the insistence that —they were already dead anyway, so what difference does it make— is not a Christian concept.

Progress in RM should not need to depend on destruction of human life. The bright future circles its wagons on adult stem cells. In the next post we will revisit the Stem Cell controversies.

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A SistersSite eBook

Flesh and Bone and The Protestant Conscience is an e-book on Amazon.com. It is 99¢ and in the Amazon lending library as well. The book description follows.

Would you let your conscience be your guide?

Does God care if the skin and bone of the dead are passed along to the living for medical uses? Is organ donation OK with God? Should you sign a Living Will?

Did you know that dead organ donors are often anesthetized before their organs are removed? Do you know the current definition of death? The conscience cannot function without facts.

As we ponder the ethics of in vitro fertilization, stem cell research and man-made chimeras, our thoughts trail off. How then should we live? (Ez 33:10)

How should a Christian think about euthanasia by starvation when doctors and the state attorney general all agree it is time to withhold feeding from a brain injured patient? Some things are family matters, but someday it may be our family.

Here is a small book to help you think about whether you want to sign your driver's license, donate a kidney, cremate your loved one, and many other practical questions that may arise in the course of your healthcare decisions or watch over others.

It offers a special focus on the doctrine of the Resurrection that is related to such decisions. Sunday School classes and Bible Study groups could use this book to facilitate discussion about the issues covered.