Abstract
With uncertainty and the possibility of serious risks, stem cell based therapies should be introduced to clinical practice only after clinical trials demonstrate their efficacy and safety. The ethical issues related to current stem cell based therapies are examined based upon ethical principles. For the ethical conduct of clinical trials using stem cells, the guidelines for all clinical research should be followed. Because of highly innovative nature of such trials, special attention must be paid to rigorous scientific and ethics review in comparison of currently available treatments, assurance of voluntary informed consent and publication of findings of the clinical trial including negative results and adverse effects. International guidelines and Korean regulations are surveyed for justifiable medical use of unproven stem cell-based interventions. Key features include application of such innovative intervention only to a very small number of seriously ill patients, following a written protocol, approval from an ethics committee, informed consent, safety monitoring, follow-up data collection to evaluate effectiveness and adverse effects and transition to a formal clinical trial in a timely fashion after experiencing a few patients.
References
1. The National Academies. Stem Cells and the Future of Regenerative Medicine. 2002. Washington DC: National Academy Press;75.
2. Derubeis A, Pennesi G, Cancedda R. Battler A, Jonathan Leor J, editors. Stem cell and gene-based therapy: Frontiers in regenerative medicine. Mesenchymal stem cells: Where can you find them? How can you use them? 2006. London: Springer;159–168.
3. Nelson B. A superficial success. Nature Reports Stem Cells. 2009. 01. 15. Published online: 15 January 2009. doi:10.1038/stemcells.2008.163.
6. Lau D, Ogbogu U, Taylor B, Stafinski T, Menon D, Caulfield T. Stem cell clinics online: the direct-to-consumer portrayal of stem cell medicine. Cell Stem Cell. 2008. 3:591–594.
7. Kiatpongsan S, Sipp D. Offshore stem cell treatments. Nature Reports Stem Cells. Published online: 3 December 2008. doi:10.1038/stemcells.2008.151.
9. Dobkin BH, Curt A, Guest J. Cellular transplants in China: observational study from the largest human experiment in chronic spinal cord injury. Neurorehabil Neural Repair. 2006. 20:5–13.
10. Enserink M. Biomedicine. Selling the stem cell dream. Science. 2006. 313:160–163.
11. Halme DG, Kessler DA. FDA Regulation of Stem-Cell-Based Therapies. N Engl J Med. 2006. 355:1730–1735.
12. Tsubouchi M, Matsui S, Bannob Y, Kurokawa K, Koji Kawakami K. Overview of the clinical application of regenerative medicine products in Japan. Health Policy. 2008. doi: 10.1016/j.healthpol.2008.02.011.
13. Guidelines on clinical research using human stem cells. 2006.7.3. Japan: Ministry of Health Labor and Welfare;
http://www.mhlw.go.jp/bunya/kenkou/iryousaisei01/pdf/01.pdf.
14. Turkmen OH, Arda B. Ethical and legal aspects of stem cell practices in Turkey: where are we? J Med Ethics. 2008. 34:833–837.
15. Nelson B. Stem cell researchers face down stem cell tourism. Nature Reports Stem Cells. Published online: 5 June 2008. doi: 10.1038/stemcells.2008.89.
16. Baker M. Stem cell society condemns unproven treatments. Nature Reports Stem Cells. Published online: 26 June 2008. doi:10.1038/stemcells.2008.98.
17. Scott C. What stem cell therapy can learn from gene therapy. Nature Reports Stem Cells. Published online: 4 September 2008. doi:10.1038/stemcells.2008.123.
18. Dawson L, Bateman-House AS, Mueller Agnew D, Bok H, Brock DW, Chakravarti A, Greene M, King PA, O'Brien SJ, Sachs DH, Schill KE, Siegel A, Solter D, Suter SM, Verfaillie CM, Walters LB, Gearhart JD, Faden RR. Safety issues in cell-based intervention trials. Fertil Steril. 2003. 80:1077–1085.
19. Mathews DJ, Sugarman J, Bok H, Blass DM, Coyle JT, Duggan P, Finkel J, Greely HT, Hillis A, Hoke A, Johnson R, Johnston M, Kahn J, Kerr D, Kurtzberg J, Liao SM, McDonald JW, McKhann G, Nelson KB, Rao M, Regenberg A, Siegel AW, Smith K, Solter D, Song H, Vescovi A, Young W, Gearhart JD, Faden R. Cell-based interventions for neurologic conditions: ethical challenges for early human trials. Neurology. 2008. 71:288–293.
20. Jacobson PD, Parmet WE. A new era of unapproved drugs: the case of Abigail Alliance v Von Eschenbach. JAMA. 2007. 297:205–208.
21. Lo B, Kriegstein A, Grady D. Clinical trials in stem cell transplantation: guidelines for scientific and ethical review. Clin Trials. 2008. 5:517–522.
22. Scott CT. Does stem cell therapy contain too many unknowns to move into human clinical trials? Nature Reports Stem Cells. Published online: 18 December 2008. doi:10.1038/stemcells.158.
23. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 2008. 6th ed. London: Oxford University Press;99–287.
24. Scott CT. Weighing risks and rewards en route to the clinic. Nature Reports Stem Cells. Published online: 18 December 2008. doi:10.1038/stemcells.2008.158.
25. International Society for Stem Cell Research. Guidelines for the Clinical Translation of Stem Cells. December 3, 2008. http://www.isscr.org/clinical_trans.
29. Kim OJ, Choi EK. Ethics of conflict of interest in biomedical research. J Korean Bioethics Assos. 2006. 7:29–52.
30. Steinbrook R. Financial conflicts of interest and the Food and Drug Administration's Advisory Committees. N Engl J Med. 2005. 353:116–118.
32. Rosenfeld JV, Gillett GR. Ethics, stem cells and spinal cord repair. Med J Aust. 2004. 180:637–639.
33. World Medical Association, Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. http://www.wma.net/e/policy/b3.htm.
34. Korean Food and Drug Administration. KFDA Guidance No. 2008-32. Guidelines on approval of clinical trial applications. 2008. 06. 18.
35. Korean Food and Drug Administration. KFDA Guidance No. 2008-78. Guidelines on review and approval of biologicals. 2008. 12. 08.
36. Korean Food and Drug Administration. Divsion of Biologicals. Document No. 12038. Letter to the clinical trial institutes regarding employment of the system of the approval for the emergency use. 2006. 05. 08.