By Joel A. Moskowitz, MD

Like its subject matter, stem cell research is in its pre-infancy. There needs to be much more development before we can begin to grasp its potential, a panel of experts has told a forum at the Salk Institute for Biological Studies in La Jolla, California 

Evan Y. Snyder M.D., a research pediatrician and neurobiologist with the neighboring Burnham Institute, which specializes in the basic biological sciences, explained Tuesday, Jan. 18, that embryonic stem cells are "akin to packets of life building tissue" 

Not only can they differentiate themselves to replace damaged cells, they can also morph into related cells, which support and interact with the replaced cells. For example, the brain contains several different types of cells, each with their special function. Prior thinking was that the undifferentiated primitive embryonic stem cell could, with laboratory techniques, repair one particular cell line, which was diseased or genetically defective. 

Paraphrasing Hillary Clinton, Dr. Snyder said, "it takes a village of cells" to rejuvenate destroyed tissues. In other words, these same embryonic stem cells placed into a Petri dish, encouraged biochemically, are a source of repair by becoming this complex of harmoniously necessary cells. These events promise a wondrous outcome "."If not cure, at least relief," offered this  panelist.

"We try to pretend we are nature by manipulating these tissue cultures," voiced Snyder enthusiastically. "We have to learn how these  early cells are programmed" what is within their inborn property that  carries on to adulthood  function."

"Nervous cells tissue has a plasticity, a capacity for change and repair, about which we are just becoming aware," he explained. A child whose brain has suffered a stroke has the capacity to heal. This suggests that early in our lives, our cells have a yet- to- be- understood self-repair mechanism.

Besides solving the mystery of how stem cells once introduced into the body know how to go
where they are needed, many other questions remain: "Is it better to take cells from an embryo or from, as an example,  adult nervous tissue and teach it to become a fixer cell" posed Dr.
Snyder. Which would work better? The questions facing those who  study stem cells are "Talmudic in their complexity" according to this pediatric researcher.

Concerns about ownership of  government-funded research prompted the inclusion on the panel of Cathryn Campbell J.D. PhD, partner of an international law firm with  specialization in Intellectual Property .

She described the parameters by which a discovery is permitted, for a time, to be a "legal
monopoly," a patent. While some are quick to see profit schemes of private biotechnology firms, Dr. Campbell exclaims academic centers can and do benefit. She illustrated with the example that a  cooperative venture of Stanford and the University of California at San Francisco earned many millions of dollars from royalties in the licensing of a mutually owned biologic product. 

The third panelist, Charles Stevens, M.D., PhD, professor of neurobiology at the Salk Institute, joined in asserting that tight controls attend all peer-monitored and reviewed biological
research.

Dr. Stevens described how his 40-year-old dermatologist daughter who has lupus, an autoimmune disease, received a treatment, which deliberately killed the troublesome cells but preserved her stem cells. Sadly, these same  stem cells, which gave her temporary respite, were tainted by an  inborn genetic defect and her lupus returned. Stem cell treatment remains problematic was his message.

For those suffering from a devastating illness such as Parkinsonism, basic science investigation of these biologically early cells (stem cells from which other more mature cells may be derived) may not yield  immediate or near-future remedies. The history of medical discovery indicates that serendipity plus keen observation is a winning  combination. Examples are the discovery of insulin and penicillin.

Mastering the complexities of cell life through stem cell research promises that one day we can alleviate the suffering of millions. The panelists envisaged California becoming a "mini National Institutes of Health." Research alliances will form with other institutions even abroad. Dr Benjamin Reubinoff of Hadassah Hospital in Jerusalem  is coming to San Diego next week, reported Dr. Snyder. The agenda is  to effect cooperation between researchers in Israel and California in the field of stem cell investigations.

Under the recently adopted California ballot measure known as Proposition. 71, the new California Institute for Regenerative Medicine has  been established to monitor these evolving 'miracles'. There is to be a Citizens Oversight Committee. The California Research and Cures
Coalition's newly named President Nicole Friedland indicated that the comments and discussions from four California forums held up and down the state would be made available to the Citizens Oversight Committee.

California has taken the lead in publicly funding research on stem cells from both embryos and adults. The growth of this bioscientific, ethical and legal adventure offers  hope. Itself the best medicine.