Subscribe to the BioNews newsletter for free

Login
Advanced Search

Search for
BioNews


Print Page Follow BioNews on Twitter BioNews RSS feed

Like the Progress Educational Trust on Facebook



King's College London - Health: More than a medical matter

Issue 648 (12 March 2012)

 

Welcome to BioNews by email, published by the Progress Educational Trust, providing you with news, comment and reviews on genetics, assisted conception, embryo/stem cell research and related areas.

Visit the BioNews website at www.bionews.org.uk where you can subscribe for free to receive BioNews by email in one of three formats, and search the archive of more than 6,000 articles.

 

 

CONTENTS

Comment

News Digest

Reviews


 



Crystal ball gazing: an interview with Professor Sir John Burn on genetics in 2012

12 March 2012

By Dr Rebecca Hill

Appeared in BioNews 648
Genome sequencing for all, the abuse of stored genetic data and red tape halting research are just some of the issues the NHS will have to deal with this year, according to Sir John Burn, professor of clinical genetics at the University of Newcastle, chair of the British Society for Human Genetics (BSHG).

As a finale to BioNews' crystal ball gazing series (see BioNews 642 and 640 for expert predictions in the fields of human embryonic stem cell and infertility research, respectively), I spoke to Sir John about what 2012 has in store for genomics and genetics. As he's also a member of the Human Genomics Strategy Group (HGSG), which released a report on the future of genetic medicine in the NHS in January, where better to start than there?

If, as the HGSG report noted, the NHS does need to take genomics more seriously, how can they go about it?

Genomics is such a big issue, it permeates every branch of medicine, in every corner of the land – so we need an integrated approach to wrestle with it. We want to link everyone's efforts together, encourage data sharing and break down the barriers between institutions. For that we need a strategic clinical network for genomics like there are for cancer and cardiovascular diseases. If we actually manage it, that would be a big breakthrough, and really raise the genomics flag.

Personalised medicine has attracted huge amounts of press lately – do you think we'll soon start seeing everyone having their genomes sequenced?

I was flying a lone flag when we were working on this part of the HGSG report, because it did have a theme of big genome science, but actually I don't think everyone having their genome sequenced and referenced is a practical way to run our health service.

Also, the minute you start trying to introduce it in a country with private sector dimensions people will get nervous about who knows what. Hundreds or thousands of healthcare workers could have access to the data. I think the security issue will introduce enough hot air for it not to happen – if nothing else it will be the perfect cover for a politician who doesn't want it!

What do you see as the better option?

Wherever possible, we should be looking for fast, cheap, near-patient tests relevant for that person's immediate needs, which is easier to introduce. My work is increasingly directed toward this: we're working on a handheld device designed to analyse DNA quickly to detect specific diseases in the field. So, for example it can be used in a GP's surgery - you just take a small blood sample, programme in the patient's data (age, sex, weight, and so on) and within a matter of minutes you know their warfarin [a blood thinning drug] sensitivity, and you base their prescription on that.

An issue you felt strongly about that was mentioned in the HGSG report was that of consent in clinical trials, why do you think that will pose problems as we move into the genomics era?

There needs to be a sense of urgency with genomics; we're on the cusp of generating unbelievable quantities of data which we've absolutely no idea what to do with. It's potentially going to cost us a fortune and we'll miss really useful clinical data because we can't see the wood for the trees.

The consenting process has evolved for giving people dangerous drugs or operating on them. It doesn't really fit when you're trying to work out how a million variants match up to 100,000 phenotypes in any combination - we simply don't have the resources to keep asking people if it's OK for us to use the information for this purpose or that purpose. People are bemused by these constant requests, they normally just ask 'Where do you want me to sign?'

And how do you see a way around that?

We want to put approved researchers in a position where they can harvest all the available data, analyse and cross reference it, and say 'We think this marker is predictive of this disease'. For that, we need a generic consent system that says it's OK to use samples taken within the context of the NHS for health research, as long they're anonymous and it won't hurt the person in question. I think we're pushing an open door there, we just need to present it in the right way.

You also work closely with the genetics specialty group, part of the National Institute for Health Research (NIHR), what do you think the big issues will be for them in 2012?

NIHR has had a major beneficial impact on clinical research. People are naturally apprehensive about funding for the life sciences but I expect it will continue to be protected. The big issue is squeezing some of the bureaucracy out. A drawback of funding in large scale organisations, like NIHR, is that the process sometimes strangles the outcome – so we're trying to make it easier for people in genetics to work together freely, as we used to. In projects involving rare diseases there are often more administrators involved than there are patients, this is hugely expensive and effectively kills the research.

The 'development arm' of our Genetics Specialty Group is the Collaborative Group for Genetics in Healthcare, and we've been lucky enough to get a programme grant from the Department of Health. So, with the support of the Secretary of State for Health, and now from the National Office for Clinical Research Infrastructure, we are working to develop a formal agreement to get a more efficient system for genetics research. Our idea is that this will allow any one of the 23 regional genetics centres, and their foundation trusts, to sign off non-interventional rare disease research on behalf of the whole network. We really hope this will be a forerunner of a major reduction in research bureaucracy when the promised Health Research Agency comes into being.

And in the field of genetics in general, what one thing do you think would make a big difference to the way research is carried out?

A genuine criticism of genetics is that we tend to look at the more traditional, single gene syndromes, rather than trying to address the economically important aspects of healthcare – perhaps because these diseases are seen to fall into another specialist's domain.

We need to ask ourselves what we're actually about – and that has to be alleviating suffering associated with any disease with a genetic component. We need to give them more attention, so we've got to enlist support of those with an interest in genetics who are involved in other specialities. We want them to be part of the genetics community, not set themselves up a separate entity.

 

SOURCES & REFERENCES

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

11 March 2013 - by Professor John Galloway 
Perhaps fortuitously, I started to read Maxwell Mehlman's book at the same time as Roy Porter's 'A short history of madness'. It was then difficult not to muse on what Jonathan Swift might have made of 'transhumanising scientists'... [Read More]
11 February 2013 - by Dr Barbara Prainsack and Dr Daniela Steinberger 
The Swiss Academy of Medical Sciences' position paper on the 'Potential and Limits of "Individualised Medicine"' illustrates a concerning instance of public fear mongering based on factual mistakes and misinformation... [Read More]
17 September 2012 - by James Brooks 
The genetics community needs to work far more collaboratively if it is to meet the challenges of the genomic era, warns Professor Sir John Burn, one of the UK's leading genetics experts... [Read More]
03 September 2012 - by Sarah Norcross 
At the beginning of the year, BioNews genetics editor Dr Rebecca Hill (Beki) wrote the article 'Crystal ball gazing: an interview with Professor Sir John Burn on genetics in 2012'. Neither the esteemed Sir John our genetics editor predicted that Beki would be invited to apply for a position at Research Fortnight... [Read More]
26 March 2012 - by Dr Rebecca Hill 
Many bioscience graduates lack the practical skills that make them attractive to employers, according to a 2010 survey. In order to fill this skills gap, the Society of Biology launched a degree accreditation programme this week... [Read More]

06 February 2012 - by Dr Stuart Hogarth and Professor Paul Martin 
'Building on our inheritance: Genomic technology in healthcare' is the latest in a long line of reports that have sought to assess the potential of genomic medicine and to outline how policy can best support its development.... [Read More]
31 January 2012 - by Linda Wijlaars 
Genomic medicine will be at the forefront of the NHS, according to a report released last week by the Human Genomics Strategy Group (HGSG). The report highlights the UK's achievements in genomic technology to date and makes six recommendations to ensure future benefit of genomic innovation within the NHS... [Read More]
28 November 2011 - by Dr Rosie Morley 
An initiative has been launched to collect genetic data from NHS cancer patients in the hope of developing new, personalised treatments.... [Read More]
31 October 2011 - by Dr Rebecca Robey 
The NHS must take steps to prepare for a revolution in genetics-based medicine, according to a new report by the independent think tank, the Foundation for Genomics and Public Health (the PHG Foundation). The Foundation says that rapid advances in technology will soon make it possible for individuals to have their entire genome analysed affordably, and this will have a major impact on many aspects of healthcare... [Read More]



Hype, hope and heresy – or why it is bad to eggsaggerate

12 March 2012

By Professor Robin Lovell-Badge

Head of stem cell biology and developmental genetics, MRC National Institute for Medical Research, London, UK

Appeared in BioNews 648

Scientists have to be optimistic. How else to survive months or years of frustratingly slow progress in a difficult and often poorly rewarded profession?

But despite the frustrations, scientists retain a responsibility to present their work in a balanced way and not to give unrealistic or false hopes. Unfortunately, several stem cell researchers seem to disregard this all too frequently and the field is particularly prone to hype. It's a risky business – overhyping treatments that turn out not to work out in the clinic leaves patients disappointed and erodes trust in all stem cell research.

Recently, the newspapers were full of headlines about work from the lab of Professor Jonathan Tilly at Harvard. Tilly published a paper (1) reporting the discovery of stem cells in adult human ovaries that could be grown in large numbers in the lab (in vitro) and retain the ability to give rise to eggs (reported in BioNews 646).

For many years, the generally accepted view has been that women have a limited supply of eggs that are generated during embryonic development and are unable to make new ones after birth. Tilly's findings were therefore dramatic and, if true, very important. The cells they claim to have found were offered as a way to study egg cell (oocyte) development in the lab, to allow women to have children after cancer treatment, and as a solution to overcoming premature infertility – all laudable aims. It was also suggested that they could be used to prolong fertility beyond normal menopause – controversial, but an obvious possibility.

I am all for challenging dogma, but to do so requires robust evidence and carefully drawn conclusions. I feel that both were missing in this case.

The view that female mammals have a fixed number of oocytes around birth that cannot be replenished in later life is based on substantial data. For example, we can point to the clear reduction in oocyte numbers as females age, which parallels a decline in fertility. Secondly, scientists had long failed to identify any population of germ cells in the ovary that had not already entered meiosis.

But in 2004, Tilly claimed that there had to be a population of germ line stem cells in the ovaries of adult female mice that could go on to develop into oocytes (2). His reasoning was largely based on work counting oocytes at different postnatal stages, with Tilly concluding that there were insufficient oocytes to account for the normal reproductive lifespan of female mice. But counting oocytes is not as trivial as it sounds, and his analysis was dismissed by others (3).

A subsequent paper (4) suggesting that there were cells in the bloodstream able to colonise the ovary and give rise to oocytes was even more controversial and was disputed by other labs using hard data and robust theory (5).

Tilly changed tack and now claims that factors in the bloodstream can stimulate oocyte development within the ovaries, with the assumption that these new oocytes come from a stem cell population. Such claims were made without clear evidence. What was needed was an independent demonstration of the existence of such cells.

Dr Ji Wu and his team in Shanghai came closest to providing this. They reportedly isolated a subpopulation of cells from mouse ovaries with the ability grow in vitro (6). These cells gave rise to eggs, notably when reintroduced into mouse ovaries. The eggs could be fertilised and some were reported to develop into live-born mice after transfer to surrogate mothers.

However, aspects of this work were hard to understand. In particular, the team's isolation of their ovarian stem cells (OSCs) involved the use of an antibody against a protein (Ddx4) that functions within cells and is not, as far as anyone knows, expressed on the cell surface - despite that being essential for the method to work. The current paper by Tilly and colleagues starts with a more detailed look at the methods used by Wu, notably to see if they can be improved and extended to humans. They claim that they have achieved both these aims. However, there is still no understanding of how the antibody works and whether it really detects Ddx4.

In any case, using this antibody, Tilly identified at best a few hundred OSCs per mouse ovary. Less than one percent of these can be grown in culture, which means that the number of 'germ-line stem cells' per ovary was fewer than four! Their number could not be determined in human ovaries, but it seems they are equally rare.

So, the authors cannot see these cells in the mouse or human ovary, let alone demonstrate that they actually represent stem cells in vivo. Therefore, it is possible that it is the in vitro culture conditions that somehow convert rare ovarian cells into cells with germ-line properties. In other words, their OSCs, which are isolated in a way that is yet to make sense, could also be an in vitro artefact.

Perhaps this doesn't strictly matter for the aims of the research, except subsequent data were also puzzling. For example, a piece of evidence the authors claim proves that they have oocytes forming spontaneously in culture, was the presence of cells with a 1n chromosomal DNA content. This would be typical of male germ cells that have undergone both meiotic divisions to produce haploid (when a cell only contains one set of chromosomes) sperm. However, during oocyte development, the second meiotic division does not occur until after fertilisation – there is no such thing as a haploid oocyte.

Tilly and colleagues claim to show that their human OSCs can also make fully grown oocytes (after being introduced into fragments of human ovary that are then grafted under the skin of mice). For 'ethical reasons' they did not test whether these oocytes could be fertilised or begin normal human embryo development. This means that their normality and potential remain unknown. They did show that the mouse oocytes could be fertilised but why did they not go on to ask (as Wu had done) if the resulting early embryos could give rise to healthy live-born animals?

The human OSCs were isolated from the ovaries of women of reproductive age, but the choice of donor was interesting. These were women who wanted to become men, and had undergone surgery to remove their ovaries as part of the sex-change process. It is usual for such individuals to live as men, usually for at least a year, before surgery can be undertaken, and during this time it is highly likely that they were given androgen (testosterone) hormone replacement therapy (HRT).

This HRT would have had a significant effect on their ovaries. It is hard to know whether this would have helped or hindered Tilly's experiments. Androgens can have powerful effects on cells, but relevant information was not included in the paper. Moreover, it was misleading to refer to them as normal ovaries. If a year of androgen treatment was necessary before OSCs could be derived, I doubt many women would want to proceed with this as a way to overcome infertility.

But even if all my worries about the data are unfounded, how are desperate or vulnerable patients expected to deal with the headlines? I am sure I was not alone in receiving e-mails, and I know there were calls to fertility clinics in London (I expect this was a common occurrence around the world).

How do we answer the patients' concerns? Are the techniques likely to be safe, when will they be available, and what type of patient is likely to be first to have their hopes realised? Where were the qualifying statements, and lists of the scientific issues still to be addressed? It would have been helpful if answers to some of these questions had been provided by the authors – if not in the paper then in accompanying press releases. And how do they expect to achieve societal acceptance of a technology that could have uses that rather stretch current reproductive boundaries? These include not just unlimited numbers of children for women of any age, as spelled out by some of the headlines, but germ line genetic engineering?

So who caused the hype? I suspect the authors of the paper contributed, but their employers, the journal that published it, and a largely unquestioning media did not help. There were some balanced pieces, notably that by Gretchen Vogel writing in Science (7), but too much coverage implied that fertility treatments were just around the corner. They are not. Even assuming the data are valid, the authors are a long way from testing safety and efficiency of OSC-derived oocytes. And in the UK at least, although the research is possible with a licence, it would require a change in primary legislation to permit their use for reproductive purposes, which in itself would take several years.

It is possible to be enthusiastic about a piece of science, but to do so in a qualified manner that respects the hopes and fears of patients. Hype should be avoided for everyone's sake.

 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

30 September 2013 - by Dr Gabrielle Samuel 
This event was designed to promote debate about how and when fertility research should be reported in the media, and to ask the question 'where does the responsibility lie to ensure that such reporting is not hyped?' And that it did... [Read More]
28 August 2012 - by James Brooks 
I'll brook no cynicism, the Olympics was the finest example of what makes Britain great. Which is to say: marketing, PR and all-around hype... [Read More]
16 July 2012 - by Daniel Malynn 
As a viewer I do not ask for much from a show; just to be a little informative, maybe some whimsical anecdote - I did not even get this from this short film. Instead, what I got was two and a half minutes of footage mostly of people opening doors and looking 'sciency' behind weird music.... [Read More]
16 April 2012 - by Rosemary Paxman 
The first human egg cells grown in the laboratory from stem cells could be fertilised later this year, scientists report... [Read More]

27 February 2012 - by Antony Blackburn-Starza 
Scientists in the USA have shown it may be possible to isolate egg-producing stem cells from women's ovaries.... [Read More]
20 April 2009 - by Dr Charlotte Maden 
New work in stem cell research has challenged the long-standing belief that women are born with all the eggs they will ever need. The results were published in the journal Nature Stem Cell, although the study was received with caution. The scientists at Shanghai Jiao Tong University... [Read More]
21 May 2007 - by Stuart Scott 
Hopes aroused by a controversial study suggesting that women may be able to produce new egg cells have been seemingly dashed. The 2005 paper, published in the journal Cell by researchers at Massachusetts General Hospital, fleetingly gave hope to infertile women when it suggested that egg production... [Read More]
16 June 2006 - by Dr Jess Buxton 
A new US study has cast serious doubt on controversial research that suggested bone marrow stem cells can produce new eggs in adult mice. Last year, a team based at Massachusetts General Hospital reported in the journal Cell that the eggs of mice rendered sterile could... [Read More]
03 October 2005 - by BioNews 
A US woman who became infertile after cancer treatment has stunned doctors by becoming pregnant naturally, following a transplant of ovarian tissue into her abdomen. Ann Dauer, from Canton, Ohio has now given birth to a healthy baby girl, named Sienna. Mrs Dauer had one of her ovaries removed and... [Read More]



Rat's vision restored with stem cell treatment

12 March 2012

By Dr Nadeem Shaikh

Appeared in BioNews 648

A potential stem cell therapy for glaucoma – a degenerative eye condition that can lead to blindness – has yielded positive results in animal tests. The treatment led to a 50 percent improvement in vision in rats with a model of the disease.

Glaucoma is a condition where pressure builds up in the eye, resulting in the death of retinal ganglion cells (RGCs) that normally form optic nerve fibres and help transmit information from the eye to the brain. It affects about 500,000 people in the UK, and 70 million people across the world. One in ten people with the disease go blind, often either because they were diagnosed too late or because their condition was too severe to be treated. In such cases, there is currently no way to reverse the blindness.

In this study, scientists at University College London, and Moorfields Eye Hospital, used adult stem cells called Müller glia cells. These rare cells, in this case isolated from corneas from organ donors, are multipotent, meaning they can develop into any type of eye cell. The scientists induced the Müller glia cells to develop into precursors to RGCs, then placed them in rats whose RGCs had been damaged in a way to simulate glaucoma. After four weeks the cells had not merged with the afflicted rat cell population but instead formed new bridges between undamaged sections. Under very low light conditions, the rats' vision had improved by 50 percent.

Dr Astrid Limb of the UCL Institute of Ophthalmology, and leader of the research team, said: 'Although this research is still a long way from the clinic, it is a significant step towards our ultimate goal of finding a cure for glaucoma and other related conditions. We are optimistic that [...] we will be in a good position to start early-stage clinical trials on humans in around three to five years'.

Dr Rob Buckle, head of regenerative medicine at the Medical Research Council (MRC), which funded the research, said: 'Regenerative medicine is a key priority for the MRC and it's wonderful to see another example of how our significant investment in stem cell research in recent years is beginning to deliver results. Repair of the eye is an area that is now at the forefront of this field, and this study highlights a new route for delivering the promise of regenerative medicine to treat disabling conditions such as glaucoma'.

Other groups are also using stem cell technology to treat ocular diseases. The US company, Advanced Cell Technology, received the go-ahead earlier this year for a clinical trial to test a proposed stem cell therapy for advanced Stargardt disease – a leading cause of blindness in young people (reported in BioNews 642). That trial, which will be conducted in partnership with Moorfields Eye Hospital, will use human embryonic – rather than adult – stem cells.

 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

29 July 2013 - by Greg Ball 
Light-sensitive cells found in the retina have been grown from mouse embryonic stem cells (ESCs) and successfully transplanted into the eyes of visually impaired mice, restoring some vision... [Read More]
17 June 2013 - by Rhys Baker 
A 'non-invasive' method for delivering gene therapy into the eye has been developed by US researchers... [Read More]
18 February 2013 - by Maria Sheppard 
Twenty-four genes linked to short-sightedness have been identified by an international consortium of scientists... [Read More]
07 January 2013 - by Greg Ball 
Immune cells that can recognise and kill cancer cells have been grown from induced pluripotent stem cells (iPSCs)... [Read More]
28 May 2012 - by Ana Pallesen 
Two patients with corneal blindness have become the first people in the UK to have stem cells transplanted into their eyes in order to restore their sight... [Read More]

13 February 2012 - by Maria Botcharova 
Three women have reported a significant improvement in sight following gene therapy in both their eyes. Initially, they received the therapy in just one eye, but this latest study demonstrates the treatment was also successful in the other... [Read More]
06 February 2012 - by Ruth Retassie 
US company StemCells Inc have received Food and Drug Administration (FDA) authorisation to carry out clinical trials of their treatment for one of the leading causes of blindness in over 55-year-olds... [Read More]
31 January 2012 - by Dr Dusko Ilic and Dr Emma Stephenson 
Last week, Advanced Cell Technology (ACT) of Massachusetts, USA, made two important announcements regarding human embryonic stem (hES) cell-based therapies for the potential treatment of Stargardt's dystrophy and age-related macular degeneration, two devastating degenerative disease leading to blindness.... [Read More]
31 January 2012 - by Rosemary Paxman 
A clinical trial testing the safety of using human embryonic stem cell (hESC) in the treatment of progressive eye conditions has been carried out by researchers in the USA... [Read More]
21 March 2011 - by Dr Lux Fatimathas 
UK scientists have shown stem cells can be used to successfully stop glaucoma, an eye disorder, in rats. Stem cells were isolated from bone marrow and successfully grafted onto damaged nerves in the eye... [Read More]



Stem cell treatment counters kidney rejection in early trial

12 March 2012

By Dr Rebecca Robey

Appeared in BioNews 648

Stem cell therapy may remove the need for organ transplant recipients to have lifelong drug treatment to combat the risk of rejection, which would dramatically improve patients' quality of life.

A new therapy technique has been trialled in eight US kidney transplant patients and early results have been published in the journal Science Translational Medicine. One year after the transplant five of the patients managed to avoid taking the usual immunosuppressive medication and two patients were taking lower doses of these drugs than would normally be required. One patient developed viral sepsis – an occasional complication of organ transplantation – and had to have their new kidney removed again.

Dr Suzanne Ildstad, of the University of Louisville, who led the study, said: 'Immunosuppressive medications come with serious side effects with prolonged use including high blood pressure, diabetes, infection, heart disease and cancer, as well as direct damaging effects to the organ transplant. This new approach would potentially offer a better quality of life and fewer health risks for transplant recipients.'

The stem cell therapy effectively alters patients' immune systems, so that they do not recognise the transplanted kidneys as 'foreign' and reject them.

In the technique, the kidney donor is given medication to boost the number of bone marrow stem cells in their blood a month prior to the operation, and a blood donation is collected. The blood is processed to increase both the numbers of stem cells and another cell type the researchers called transplant 'facilitating cells', and frozen until needed.

The kidney recipient then undergoes radiation and chemotherapy to disable their own immune systems in a manner similar to treatment given to leukaemia patients prior to bone marrow transplants. The kidney is then transplanted and one day later the recipient receives a transplant of the stem cells and facilitating cells collected from the donor.

The transplant patient is then prescribed a usual regime of immunosuppressive drugs, but after six months is gradually weaned off them if the stem cell transplant has been successful.

Dr Tatsuo Kawai, a transplant surgeon at Harvard Medical School, who was not involved in the study, wrote a commentary on the new approach in the same journal. He lauded the results, but also said that it was hard to tell from the study how important the facilitating cells were, as there had been no control group where patients underwent the procedure without receiving these cells.

He also added that subjecting transplant patients to a treatment as harsh as radio- and chemotherapy should be carefully considered, especially as the current techniques for kidney transplantation are relatively safe and well understood.

 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

28 January 2013 - by Michelle Downes 
In what is thought to be a first, stem cells have been used to generate human kidney tissue... [Read More]
30 July 2012 - by Greg Ball 
Adult stem cells extracted from liposuctioned fat have been used to grow new blood vessels, according to scientists presenting their work at a conference. The researchers hope that one day their technique could be used in vascular surgery... [Read More]
16 July 2012 - by Greg Ball 
Two UK newspapers have hailed a potential treatment for osteoarthritis using a patient's own stem cells although results from early studies in animals and patients are yet to be published... [Read More]
11 June 2012 - by Dr Maria Teresa Esposito 
Immune rejection, the body's defence mechanism, triggered in response to foreign tissues, is a huge problem for transplant operations. But why does a mother's immune system not reject the developing fetus? The answer may lie in modifications to genes that usually activate part of the immune response, according to scientists... [Read More]
11 June 2012 - by Greg Ball 
Stem cell research isn't a topic you'd expect to see in a comic book, particularly when the aim is to give a realistic insight into the subject, avoiding hype and sensationalism. But that's exactly what 'Hope Beyond Hype', a graphic novel telling the story of stem cell research from discovery to therapy, intends to do... [Read More]

10 October 2011 - by George Frodsham 
Scientists have found a new method of suppressing the automatic rejection of donated kidneys in transplant patients, by using the donor's stem cells. In a small trial carried out at Stanford University, California, eight out of 12 patients were able to stop taking anti-rejection drugs, which are usually a lifelong necessity, following this treatment.... [Read More]
18 April 2011 - by Dr Rosie Morley 
Scientists at Edinburgh University have grown kidney structures in the laboratory in a step they hope will lead to organs being grown for transplant patients from their own stem cells... [Read More]
22 March 2010 - by Dr Vivienne Raper 
A UK child has become the world's first to receive a full windpipe transplant using an organ built from his own stem cells... [Read More]
07 June 2009 - by Heidi Colleran 
A Chinese research team has brought the quest for a genetically modified pig, capable of providing viable organs for transplant patients, a step closer. Scientists at the Shanghai Institute of Biochemistry and Cell Biology (SIBCB) have succeeded in creating the first pig stem cells in the laboratory, the Journal of Molecular and Cell Biology reports. These cells could be used to create 'transgenic' pigs, which have been genetically altered so that their organs would not be rejected by the hum... [Read More]



Smokers and obese people denied IVF by some NHS trusts

12 March 2012

By Dr Rosie Morley

Appeared in BioNews 648

Nine NHS primary care trusts (PCTs) have introduced restrictions to IVF treatment for patients who smoke or are overweight.

Data obtained under the Freedom of Information act by Pulse, a magazine for GPs, indicate that 25 out of 91 PCTs have introduced new regulations related to smoking and weight since April 2011. In addition to IVF, there are also restrictions for patients wanting to undergo treatments such as hip and knee replacements and varicose veins.

Dr Clare Gerada, chair of the Royal College of General Practitioners, said that some of the restrictions, particularly for IVF, were 'dreadful'. She said: 'It's becoming the deserving and the undeserving. I think it's discriminatory and I find it astonishing. The Government should determine what should be applied universally'.

In Cornwall and Devon, couples must have quit smoking for six months before they are allowed IVF treatment. In addition, women may only be eligible for certain fertility drugs if they have a body mass index (BMI) of between 19 and 29.9 - a BMI below 18 is considered underweight, and above 30 is considered obese.

Dr Virginia Pearson, chairman of the NHS Peninsula Health Technology Commissioning Group said to BBC Cornwall: 'There is sound evidence that being significantly over or underweight can reduce fertility. Smoking may reduce fertility in women, while for men, there is a link between smoking and poorer quality of sperm. Smoking is also a risk to the baby, smoking exposes the unborn baby to the toxins in tobacco smoke, and can damage the placenta'.

Arguing against the restrictions, Dr Andy Sant, vice-chair of Devon Local Medical Council and a Plymouth clinician, said: 'Everybody has their own individual circumstances and it may be that often a six-month ban on smoking is unreasonable'.

 

SOURCES & REFERENCES
Pulse | 07 March 2012
 
BBC | 08 March 2012
 
Telegraph | 07 March 2012
 
Patients denied care 'if they fail NHS fat and fags test'
Metro | 06 March 2012
 
Pulse | 07 March 2012
 
Daily Mail | 07 March 2012
 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

03 September 2012 - by Cathy Holding 
Around one in three women who are entitled to receive IVF are being denied this right, according to a survey carried out by the National Infertility Awareness Campaign (NIAC)... [Read More]
28 May 2012 - by Mark Johnson 
From next year, local GP-led Clinical Commissioning Groups will take on the commissioning responsibilities of Primary Care Trusts, with the latter due to be abolished in April 2013. This now includes responsibility for commissioning fertility services such as IVF treatment... [Read More]
28 May 2012 - by Greg Ball 
The National Institute for Health and Clinical Excellence (NICE) has published a draft updated guideline on fertility that would see same-sex couples and women aged up to 42 eligible for fertility treatment on the NHS... [Read More]
30 April 2012 - by Annabel Christie 
Following the investigation of abortion clinics, fertility clinics should now improve their procedures so that there are no unwanted surprises if they are similarly inspected... [Read More]
19 March 2012 - by Sarah Guy 
Men who consume a diet rich in saturated fat - the type found in junk food - have lower sperm counts than men whose diets contain low levels of such fats, according to scientists... [Read More]

20 February 2012 - by Victoria Kay 
The UK's fertility watchdog, the Human Fertilisation and Embryology Authority (HFEA), has amassed cash reserves of around £3.4 million from charges to the clinics it licenses, prompting calls for the money to be given back to those seeking IVF treatment.... [Read More]
28 November 2011 - by Nicola Drury 
An increasing number of NHS clinics that provide assisted reproduction technologies (ART) are denying treatment to women who smoke or have a partner who smokes. But is it appropriate for any lifestyle factors to be used to deny state-funded treatment? And where should the line be drawn between medical 'advice' and 'restrictions'?... [Read More]
26 September 2011 - by Victoria Kay 
Doctors in Canada will consider a policy to withhold IVF to obese women at a national meeting of fertility experts this week.... [Read More]
15 August 2011 - by Susan Seenan 
Thirty years after the birth of the first IVF baby, you would expect the country that pioneered the technique to lead the world in providing access to fertility treatment. At the very least, the UK would guarantee fair and equitable access for eligible patients. But you would be wrong. Patients across the country are still fighting to get the treatment they deserve... [Read More]
11 July 2011 - by Kyrillos Georgiadis 
An Australian man is seeking to overturn a ruling barring him and his partner from accessing IVF on the grounds of his previous conviction in 2003 for having sex with a 16-year-old student while he was employed as a teacher's aide.... [Read More]



Israel: biological mother recognised as parent in landmark surrogacy decision

12 March 2012

By Ruth Retassie

Appeared in BioNews 648

A Tel Aviv Family Court judge has set a precedent by recognising a woman whose twins were born via a surrogate as the legal parent.

Although Israeli law allows for legal parenthood status arising from surrogacy agreements made in Israel no law covers parents who use overseas surrogates. In this case the children were born in Georgia and previously the mother would have had to apply for adoption to be recognised as the parent.

Following this ruling, mothers of children delivered by surrogate mothers will only need to complete a DNA test to confirm that the baby is theirs. This route to legal parenthood was previously only available to the father.

Overseas surrogates are commonly used by prospective Israeli parents to save money and time. According to the Haaretz newspaper, this was true for the couple in the current case. They had trouble in the past with a difficult pregnancy and decided to use IVF and a surrogate in Tbilisi, Georgia.

The couple asked for approval early on for a joint DNA test to confirm their legal parent status but the Israeli state prosecutor's office requested they withdraw their application and undergo a paternity test which would allow the twins to be brought to Israel. The mother could then adopt the children.

But as Georgian law accepts the biological mother as the legal parent of children carried by a surrogate, the parents were able to obtain birth certificates for the twins which showed them as the parents.

Had they hidden their use of a surrogate mother, the couple would have been able to register the twins without a problem on the grounds of having valid overseas birth certificates. They decided, however, to wait for the court's decision.

Ultimately Judge Shifra Glick was clear in her ruling. 'That a biological mother must adopt her natural children', she said, 'is intolerable and defies common sense'.

According to The Jerusalem Post, she added that while Israel has no laws about overseas surrogacy, the current laws should not act against Israeli citizens who use it.

After the decision was announced, the father said: 'It's wonderful that justice was finally served, after fighting for so many months. We are very happy, but we still have to wait for the Interior Ministry – we hope it doesn't delay the DNA test'.

 

SOURCES & REFERENCES
Jerusalem Post | 07 March 2012
 
Haaretz | 07 March 2012
 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

27 January 2014 - by Ari Haque 
Supporters of the parents of 65 babies born to surrogate mothers in Thailand have gathered outside the home of Israeli interior minister Gideon Sa'ar to protest the Israeli Government's refusal to accord citizenship to the children... [Read More]
16 December 2013 - by María Victoria Rivas Llanos 
The Israeli Health Minister, Yael German, has announced the introduction of a new measure to allow unmarried and homosexual men and women access to surrogacy services in the country... [Read More]
27 August 2013 - by Ayesha Ahmad 
A court in Israel has rejected a lesbian couple's request to undergo a surrogacy procedure in the country.... [Read More]
07 May 2013 - by Natalie Gamble 
The Human Fertilisation and Embryology Authority (HFEA) voted on 20 March 2013 to update the guidance it gives to UK fertility clinics on surrogacy. It is a welcome decision that will mean better support for the growing numbers of families created through surrogacy in the UK.... [Read More]
28 January 2013 - by Nina Chohan 
An Irish couple has brought a legal challenge against the State for refusing to remove the surrogate mother from their children's birth certificates and to register the genetic mother as a legal parent... [Read More]

05 March 2012 - by James Brooks 
The Court of Appeal in Rennes, France, has upheld an earlier decision to accord civil status – similar to nationality – to twins carried by a surrogate mother in India for a French couple... [Read More]
05 March 2012 - by Fiona Duffy 
The long-awaited guidelines for Irish couples who have children born abroad through surrogacy, issued on 21 February, have all but avoided some of the most fundamental legal issues surrounding surrogacy... [Read More]
05 March 2012 - by Daniel Malynn 
Hosted by 7 Bedford Row chambers, this intellectually stimulating event highlighted the uncertainty and lack of consensus around surrogacy law. However, such was the emphasis on surrogacy the event title was never formally answered. Yet I nevertheless came away with the feeling that some key issues in surrogacy, applicable to the wider agenda of assisted reproduction, were thoroughly explored. Moreover, it established some momentum to press for law reform in the area.... [Read More]
12 December 2011 - by Dr Ruth Shidlo 
Living in Israel, where gamete donor anonymity still rules supreme, I confess I envy the UK's clear focus on the welfare of the donor conceived child and the evolution of the legal rights of offspring... [Read More]
15 August 2011 - by Ayesha Ahmad 
An Israeli court has granted permission for a family to extract and freeze eggs from their deceased daughter's ovaries... [Read More]



Cancer complexity causes concern for personalised medicine

12 March 2012

By Maren Urner

Appeared in BioNews 648

A single tumour can have many different genetic mutations at various locations, cancer researchers have found. In a study, two thirds of the specific genetic faults identified in tumours were not repeated in the same tumour.

'This adds another layer of complexity', said lead author Professor Charles Swanton, from Cancer Research UK's London Research Institute.

In what was the first genome-wide analysis of the genetic variations within one tumour, the British team studied the tumours of four kidney cancer patients treated at London's Royal Marsden Hospital. They took samples from various regions in both the advanced tumours in the kidneys, as well as from tumours in other organs after the cancer had spread.

'We used every possible genomics technique available. Even then we were only scratching the surface', Professor Swanton said.

Cancer drugs are often targeted at specific mutations of cancer cells identified via a biopsy, and often this analysis relies on a single biopsy.

The findings, published in the New England Journal of Medicine, underline the difficulty of treating cancer based on one biopsy. The team even found genetic signatures associated with both good and poor prognoses in different parts of the same tumour.

To understand the genetic diversity they saw, the researchers examined the evolutionary history of the mutations, a bit like a family tree. The results showed some common mutations in the 'trunk' of the tree that were present in a number of samples.

This emphasises the importance of early treatment – both in terms of targeting these common mutations and in diagnosing cancer before it spreads. Furthermore, the later the tumour cells are treated, the higher the chances that drug-resistant mutations could develop.

 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

04 March 2013 - by Reuben Harwood 
Losing genes that help stabilise a cells DNA may explain why some cancers are resistant to treatment, say scientists... [Read More]
05 November 2012 - by Professor Donna Dickenson 
The soaring promises made by personalised medicine advocates are probably loftier than in any other medical or scientific realm today. Francis Collins, former co-director of the Human Genome Project, wrote: 'We are on the leading edge of a true revolution in medicine, one that promises to transform the traditional "one size fits all" approach into a much more powerful strategy'... [Read More]
08 May 2012 - by Cait McDonagh 
A gene that usually prevents excessive cell growth may be switched off in aggressive pancreatic cancers, scientists have reported... [Read More]
19 March 2012 - by Suzanne Elvidge 
Personalised medicine doesn't get much more personal than this. For more than two years, researchers at the Stanford University School of Medicine have been focusing on one person's genetic profile – that of their colleague and fellow geneticist, Dr Michael Snyder... [Read More]

31 January 2012 - by Linda Wijlaars 
Genomic medicine will be at the forefront of the NHS, according to a report released last week by the Human Genomics Strategy Group (HGSG). The report highlights the UK's achievements in genomic technology to date and makes six recommendations to ensure future benefit of genomic innovation within the NHS... [Read More]
12 December 2011 - by Mehmet Fidanboylu 
The National Institutes of Health (NIH) in the US has demonstrated its intent to make personalised medicine a reality by outlining plans for projects set to cost almost half a billion US dollars... [Read More]
28 November 2011 - by Dr Rosie Morley 
An initiative has been launched to collect genetic data from NHS cancer patients in the hope of developing new, personalised treatments.... [Read More]
14 November 2011 - by Dr Louisa Petchey 
A new genetic test that will help to tailor drugs to cancer patients' individual tumours has been successfully trialled in the US... [Read More]
03 May 2011 - by Mehmet Fidanboylu 
Two US studies have demonstrated how whole-genome screening can help improve cancer treatment and diagnosis. The researchers claim to have taken a major step towards using this type of screening to help predict patients' responses to different treatments based on their genetics... [Read More]



Intense exercise can alter your DNA

12 March 2012

By Dr Zara Mahmoud

Appeared in BioNews 648

A bout of intense exercise can change the way your genes are regulated, scientists have shown. These changes led to an increase in enzymes that are involved in energy production.

Looking at muscle samples taken from healthy volunteers before and after exercise, the team found altered patterns of methylation, a process where certain DNA bases are altered to 'mask' them from the machinery in the cell that produces proteins. This is quite unusual in itself, because it was thought that methylation in adult cells, like muscle cells, is irreversible.

'Our muscles are really plastic', says study leader Professor Julian Zierath, of the Karolinska Institute in Stockholm, Sweden. 'We often say, "you are what you eat". Well, muscle adapts to what you do. If you don't use it, you lose it, and this is one of the mechanisms that allows that to happen'.

Methlylation, which is used to slow down or turn off gene production at specific times, is most commonly found in genes that produce proteins known as transcription factors. These proteins control the expression of a number of other genes in the cell.

Using tissue biopsies taken from the thigh muscles of 14 volunteers, who did not exercise frequently, before and 20 minutes after intense exercise, the researchers found a partial demethylation of three genes. These genes are involved in regulating other genes linked to energy generation from sugar.

Further studies with a sub-group of volunteers established a link between levels of demethylation and exercise - volunteers who exercised the hardest had the greatest levels of demethylation.

'It's one of the first studies that really proves that DNA methylation can affect things in a very short timeframe', says Dr Marloes Dekker Nitert, who studies these kinds of genetic changes at Lund University in Sweden.

Though very distinct, the effects of exercise on methylation were temporary. A similar analysis 48 hours after volunteers had finished a three-week exercise program found that DNA methylation had returned to pre-exercise levels.

The exact mechanism of DNA demethylation remains unclear. However, a parallel study exposing rat muscles cells to caffeine showed a similar pattern of demethylation.

Professor Zierath suggests there is a link between calcium concentrations and demethylation triggers: 'Caffeine releases calcium into the muscle tissue and it sort of mimics a contracting muscle'.

The study offers new evidence that external factors, such as exercise, can alter gene expression, indicating it is more flexible than once thought. In the long run it is hoped this will help us better adapt to changes in our environment.

 

SOURCES & REFERENCES
Nature News | 06 March 2012
 
Cell Metabolism | 07 March 2012
 
NHS Choices: Behind the Headlines | 07 March 2012
 
The Scientist | 06 March 2012
 
Cell Press press release | 06 March 2012
 
Time | 07 March 2012
 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

06 June 2012 - by Victoria Kay 
Scientists have developed a way of crafting DNA into complex shapes such as letters of the alphabet, symbols and even smiley faces. The nanotechnology may one day be able to create customised DNA structures that can carry therapeutic drugs to specific sites in the human body without triggering an immune response... [Read More]

07 November 2011 - by Marianne Neary 
When it comes to our weight, there is no need to wallow in the gene pool. Scientists have found that physical activity lessens the link between genes and obesity... [Read More]
24 October 2011 - by Luciana Strait 
An unnamed Premier League football club has had DNA tests carried out on its players to determine which of them may be susceptible to injury. The tests were carried out by leading molecular geneticist and assistant professor at Yale University School of Medicine Dr Marios Kambouris, who was told neither the name of the club nor the identities of the players... [Read More]
04 July 2011 - by Marianne Neary 
Scientists have linked a so-called ‘lean gene’ to an increased likelihood of developing heart disease and type II diabetes.... [Read More]
26 April 2010 - by Dr Charlotte Maden 
The obesity-related gene FTO also plays a role in loss of brain tissue, according to a US study published in the Proceedings of the National Academy of Sciences last week... [Read More]



TV Review: Postcode Lottery

12 March 2012

By Cathy Holding

Appeared in BioNews 648

Postcode Lottery

BBC1, Thursday 8 March 2012

Presented by Dominic Littlewood

'Postcode Lottery', BBC1, Thursday 8 March 2012


BBC1's 8 March episode of 'Postcode Lottery', presented by Dominic Littlewood, featured Sarah and Levi Johnson, a couple living in Portsmouth who want to have IVF on the NHS.

After six unsuccessful years of trying to conceive naturally, they discovered, to their dismay, they fall foul of the strict qualifying criteria set by their local PCT. Sarah is now too old (over 35) and too overweight [BMI (body mass index) above 30], and her partner Levi has a child from a previous relationship – all three are no-gos for a couple wanting IVF on the NHS in this area.

Sarah has polycystic ovaries, endometriosis and fibrosis, and was told by her fertility consultant that nothing more could be done for her – unless she had £5000 for private IVF treatment. 'That was the end of anybody doing anything for us', she said.

The couple described their situation as 'devastating' and 'heart-breaking'. Levi said it was impossible to imagine the pain Sarah felt after having been told, as he put it, 'you can't have children, that's it, go away'.

The fact IVF was pioneered in this country featured prominently in the programme. 'How is it', demanded Littlewood, 'that in a nation of medical miracles and bouncing babies, thousands more women are being denied access to this potentially life-changing treatment?'

However, he quoted statistics saying that there had been 12,714 IVF births in 2009, and that over 45,000 more women in the UK received IVF treatment in 2010. To me, this figure is astonishing – and suggests quite a lot of women are actually successfully gaining access to IVF on the NHS.

According to the programme, the National Institute for Health and Clinical Excellence recommendations for couples seeking IVF treatment on the NHS are three free cycles of treatment to women between the ages of 23 and 39. However, each PCT is allowed to set their own criteria based on the likelihood of a woman conceiving by IVF.

As the programme title suggests, the focus was on the differences in PCT criteria according to postcode. For example, women in Portsmouth must be under 35, whereas in Brighton they can be up to 39. In the Midlands, most PCTs have a maximum age policy for the male partner. Finally, according to the programme, NHS Surrey only offer IVF at the age of 39 – 'not a year younger, not a year older!' says Littlewood. (However, as reported in BioNews 633, as of April 2012, IVF on the NHS will be reinstated in Surrey).

The number of children from previous relationships also differs depending on area: in Portsmouth it's zero; in Bolton one partner is allowed one child; and in Hackney you are allowed four children from previous relationships, as long as you have none with your current partner.

For me, the main issue this programme raised was the arbitrary variations that people get caught up in because of different criteria set by individual PCTs.

Furthermore, I felt the programme was trying to imply that every couple should be given the chance to try IVF because of its miraculous, life-changing abilities. But IVF is only miraculous and life-changing if it works.

While the success rate for IVF (25 percent) was given by Littlewood, along with the acknowledgement that this 'falls sharply over the age of 35', he buried these statistics in an attack on NHS Surrey for only offering IVF at the age of 39.

So IVF is, in itself, very much a lottery. But if you don't play then you can't win.

Meanwhile, Sarah and Levi both appear to believe bureaucracy is the only thing standing in the way of a pregnancy.

In her closing comment she said: 'There is somebody out there who can help us, and so I'll just keep fighting – until eventually I get my child'.

And indeed she is fighting, in March 2011, Sarah started an online petition calling for IVF criteria to be made uniform across the UK. She aims to reach a thousand signatures before presenting it to Downing Street (1).

Levi summed up their feelings: 'Just one child, it's not a lot to ask for, is it?'

 

SOURCES & REFERENCES
Go Petition | 14 March 2011
 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

10 December 2012 - by Ari Haque 
A couple who was refused fertility treatment on the NHS for being 'too old' has said it intends to challenge the decision in the courts, arguing that the decision amounts to age discrimination.... [Read More]
02 July 2012 - by Louisa Ghevaert 
The inconsistent and inadequate provision of IVF treatment on the NHS is an unacceptable way to treat the one in seven UK couples (3.5 million people) currently affected by infertility... [Read More]
30 April 2012 - by Annabel Christie 
Following the investigation of abortion clinics, fertility clinics should now improve their procedures so that there are no unwanted surprises if they are similarly inspected... [Read More]

14 November 2011 - by Kimberley Bryon-Dodd 
NHS Surrey will reinstate free IVF treatment on 1 April 2012, following a year's suspension to cut costs... [Read More]
15 August 2011 - by Susan Seenan 
Thirty years after the birth of the first IVF baby, you would expect the country that pioneered the technique to lead the world in providing access to fertility treatment. At the very least, the UK would guarantee fair and equitable access for eligible patients. But you would be wrong. Patients across the country are still fighting to get the treatment they deserve... [Read More]
08 August 2011 - by Dr Anna Smajdor 
In 2007, the world's media reported - with various degrees of shock and disapproval - on a Big Brother-style TV programme being created in Holland. This was Big Brother with a bizarre twist: instead of a cash prize and a moment of minor celebrity, the winner would get ... a kidney. Fast forward to 2011. A similar media outcry has been provoked by the announcement by fertility charity To Hatch of a lottery where the prize is - not cash; not a kidney, but... fertility treatment... [Read More]
13 June 2011 - by Gareth Johnson MP 
IVF is one of Britain's greatest inventions. Professor Robert Edwards received the Nobel Prize for Medicine for his pioneering work developing this fertility treatment and - in the last week - it has been announced that he will be knighted in the Queen's Birthday Honours list. The result of Professor Edward's work was Louise Brown, the world's first so-called 'test tube' baby. Britain, more than any other country, should be championing the use of IVF treatment... [Read More]
28 February 2011 - by Ayesha Ahmad 
A survey by Pulse, a weekly magazine aimed at General Practitioners (GPs), has revealed that 31 percent of GPs report that their patients are facing restrictions in IVF treatment following the latest cost-saving measures... [Read More]

 

Published by the Progress Educational Trust
RISK ASSESSMENT:
BREAST CANCER, PREDICTION AND SCREENING
FREE public event in central London, 6.30pm on Thursday 8 May 2014 - find out more HERE

DataLabel Supplying Printed Labels To The UK For Over 15 Years

ANNIVERSARY APPEAL
Please donate HERE, so that the Progress Educational Trust can continue throughout 2014 (and beyond) while keeping BioNews FREE for you to read

The Progress Educational Trust was shortlisted for the Charity Times Awards 2011

Advertise your products and services HERE - click for further details

Good Fundraising Code

Become a Friend of PET HERE, and give the Progress Educational Trust a regular donation