islamic perspective on stem cell

Islamic Perspective on Stem Cell Islamic Perspective on Stem Cell Prof.Dr.dr.H. Rusdi Lamsudin, SpS(K), M.Med.ScProf.Dr.dr.H. Rusdi Lamsudin, SpS(K), M.Med.Sc

Dean Dean Faculty of MedicineFaculty of Medicine

Indonesian Islamic UniversityIndonesian Islamic UniversityYogyakartaYogyakarta

OutlineOutlineIntroductionIntroductionDefinition stem cellDefinition stem cellTypes of stem cellsTypes of stem cellsSources of stem cellsSources of stem cellsCurrent treatmentsCurrent treatmentsPotential treatmentsPotential treatmentsControversy over ethical implicationControversy over ethical implicationIslamic perspective on stem cells Islamic perspective on stem cells

IntroductionIntroductionA stem cell is a special kind of cell that has A stem cell is a special kind of cell that has a unique capacity to renew itself and to a unique capacity to renew itself and to give rise to specialized cell typesgive rise to specialized cell types

Researchers have for years looked for Researchers have for years looked for ways to use stem cells to replace cells and ways to use stem cells to replace cells and tissues that are damaged or diseasedtissues that are damaged or diseased

IntroductionIntroductionResearch on stem cells is advancing Research on stem cells is advancing knowledge about how an organism knowledge about how an organism develops from a single cell and how develops from a single cell and how healthy cells replace damaged cells in healthy cells replace damaged cells in adult organismsadult organisms

Promising area of science is also leading Promising area of science is also leading scientists to investigate the possibility of scientists to investigate the possibility of cell-based therapies to treat disease--cell-based therapies to treat disease-- regenerative or reparative medicineregenerative or reparative medicine

IntroductionIntroduction

Stem cells are one of the most Stem cells are one of the most fascinating areas of biology todayfascinating areas of biology today

Like many expanding fields of Like many expanding fields of scientific inquiry, research on stem scientific inquiry, research on stem cells raises scientific questions as cells raises scientific questions as rapidly as it degerates new rapidly as it degerates new discoveriesdiscoveries

Stem cellStem cellA cell from the embryo, fetus, or adult that A cell from the embryo, fetus, or adult that has, under conditions, the ability to has, under conditions, the ability to produce itself for a long period, or in the produce itself for a long period, or in the case of adult stem cells, throughout the case of adult stem cells, throughout the life of the organismlife of the organism

Can give rise to specialized cells make up Can give rise to specialized cells make up the tissues and organs of the bodythe tissues and organs of the body

TypesTypesTotipotentTotipotent– A single totipotent stem cell can grow into an entire A single totipotent stem cell can grow into an entire

organism and even produce extra-embryonic tissuesorganism and even produce extra-embryonic tissues

PluripotentPluripotent– A single pluripotent stem cell has ability to give rise to A single pluripotent stem cell has ability to give rise to

types of cells that develop from the three germ layers types of cells that develop from the three germ layers (mesoderm, endoderm and ectoderm) from which all (mesoderm, endoderm and ectoderm) from which all cells of the body arise. cells of the body arise.

Multipotent Multipotent – Multipotent stem cell can only become one particular Multipotent stem cell can only become one particular

type of cells: e.g. blood cells, or bone cellstype of cells: e.g. blood cells, or bone cells

Sources of stem cellsSources of stem cells

Cord blood stem cellsCord blood stem cells

Adult stem cellsAdult stem cells

Embryonic stem cellsEmbryonic stem cells

Cord blood stem cellsCord blood stem cellsBlood from the placenta and umbilical cord Blood from the placenta and umbilical cord that are left over after birth is source of that are left over after birth is source of adult stem cellsadult stem cells

Since 1988 these cord blood stem cells Since 1988 these cord blood stem cells have been used to treat;have been used to treat;

Guther’s diseaseGuther’s diseaseHunter syndromeHunter syndromeHurler syndromeHurler syndromeAcute lymphocytic leukaemiaAcute lymphocytic leukaemiaAnd many more problems occuring mostly in childrenAnd many more problems occuring mostly in children

Adult stem cellsAdult stem cells

Can be found in adult beingsCan be found in adult beings

Undiffrentiated cells that produce Undiffrentiated cells that produce daily provide certain specialized cellsdaily provide certain specialized cells

Ex: bone marrow stem cells are Ex: bone marrow stem cells are known to be able to transform into known to be able to transform into liver, nerve, muscle and kidney cellsliver, nerve, muscle and kidney cells

What are Human Embryonic What are Human Embryonic Stem Cells (HES cells)?Stem Cells (HES cells)?

HES cells are stem cells derived from HES cells are stem cells derived from the inner cell mass of the blastocyst the inner cell mass of the blastocyst stage of a human embryo.stage of a human embryo.

A stem cell is not specialized. That is, it A stem cell is not specialized. That is, it can give rise to different kinds of tissue.can give rise to different kinds of tissue.

A stem cell is self-renewing.A stem cell is self-renewing.

What are Human Embryonic What are Human Embryonic Stem Cells (HES cells)?Stem Cells (HES cells)?

They can be kept alive indefinitely in cultureThey can be kept alive indefinitely in culture

Embryonic stem cells are pluripotent. That Embryonic stem cells are pluripotent. That is, they can differentiate into any kind of is, they can differentiate into any kind of tissue in the human body.tissue in the human body.

Unlike an embryo, they are not totipotent. Unlike an embryo, they are not totipotent. That is, they are not capable of being That is, they are not capable of being implanted in a uterus and giving rise to a implanted in a uterus and giving rise to a human being.human being.

Current treatmentCurrent treatment

For more 30 years, bone morrow For more 30 years, bone morrow stem cells have been used to treat stem cells have been used to treat cancer patients which conditions as cancer patients which conditions as leukemia and lymphomaleukemia and lymphoma

Current treatmentCurrent treatmentDuring chemotherapyDuring chemotherapy– Most growing cells are killed by Most growing cells are killed by

cytotoxic agentscytotoxic agents– These agents not only kill the leukemia These agents not only kill the leukemia

or neoplastic cells, but also the stem or neoplastic cells, but also the stem cells needed to replace the killed cells cells needed to replace the killed cells as patient recoversas patient recovers

– If the stem cells are removed before If the stem cells are removed before chemotherapy, and then reinjected after chemotherapy, and then reinjected after treatment is terminatedtreatment is terminated

Current treatrmentCurrent treatrmentThe stem cells in the bone morrow The stem cells in the bone morrow produce large amounts of red cells and produce large amounts of red cells and white blood cells, to keep the body healthy white blood cells, to keep the body healthy and to help fight infectionsand to help fight infections

Adult stem cells have been successfully Adult stem cells have been successfully used to treat paralysis due to to spinal used to treat paralysis due to to spinal injuries, Parkinson’s disease and other injuries, Parkinson’s disease and other illnessillness

Potential treatmentPotential treatmentCancerous tumorsCancerous tumors

Apparently able to repair muscle damage Apparently able to repair muscle damage after heart attacks -after heart attacks - bone morrow stem bone morrow stem cellscells

Follicle stem cells may lead to successes Follicle stem cells may lead to successes in treating baldness through hair in treating baldness through hair multiplication within three or four yearsmultiplication within three or four years

Potential treatmentPotential treatment

Type 1 Juvenile diabetes could be cure Type 1 Juvenile diabetes could be cure with stem cells in the future.with stem cells in the future.

Autoimmune diseases and promise of Autoimmune diseases and promise of stem cell-based therapiesstem cell-based therapies

Rebuilding the nervous system with stem Rebuilding the nervous system with stem cellscells

Patient's DNA from skin cell injected into nucleus of Donor egg cell

Add growth stimulating compounds

Egg becomes a blastocyst with about 150 stem cells

Stem cells cultured with nutrient providing feeder cells

Polar body

Donor egg's DNA

Nucleus

Donor DNA Extracted from egg cell

Patient's DNAPatient's

Cell

Stem cellsFeeder cells

Injected Stem Cells

Radiolabeled Designer Stem Cells

Organ specific stem cells are separated from cell culture and transfected with a reporter gene (*).

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Stem cells are then injected into the recipeint.

Radiolabeled probe targeting the reporter gene will be used to track these

stem cells in the body

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Controversy over ethical implicationControversy over ethical implication

One of the most heated ethical issues One of the most heated ethical issues surrounding embryonic stem (ES) cell surrounding embryonic stem (ES) cell research is independent of reseach goal or research is independent of reseach goal or outcome possibilitiesoutcome possibilities

This ethical issue involves the status of This ethical issue involves the status of human embryohuman embryo

Controversy over ethical implicationControversy over ethical implication(the status of the human embryo)(the status of the human embryo)

Position #1Position #1Embryos are human individuals and should not be Embryos are human individuals and should not be used or destroyed for research purposesused or destroyed for research purposes

Position #2Position #2Embryos do not have the same status as fetus or a Embryos do not have the same status as fetus or a baby and can be uesd for research baby and can be uesd for research

Controversy over ethical implicationControversy over ethical implication(the status of the human embryo)(the status of the human embryo)

Position #3Position #3Embryos should not be created for research, but can Embryos should not be created for research, but can be used if they left over from in vitro fertilization (IVF) be used if they left over from in vitro fertilization (IVF) proceduresprocedures

Position #4Position #4Embryos are clusters of cells no different from other Embryos are clusters of cells no different from other cells and can be created specifically for use in cells and can be created specifically for use in researchresearch


US President George W Bush announced US President George W Bush announced his executive decision on August 9, 2001, his executive decision on August 9, 2001, after consulting with “scientists, scholars, after consulting with “scientists, scholars, bioethicists, religious leaders, doctors, bioethicists, religious leaders, doctors, researchers, members of Congress, [his] researchers, members of Congress, [his] Cabinet, and [his] friends” and “reading Cabinet, and [his] friends” and “reading “heartfelt letters from many Americans”, “heartfelt letters from many Americans”, to prohibit the use of federal funding to to prohibit the use of federal funding to work with embryonic cell lines created work with embryonic cell lines created after that date.after that date.


In April 2004, 206 members of Congress, In April 2004, 206 members of Congress, including many moderate republicans, and including many moderate republicans, and some other prominent public figures some other prominent public figures signed a letter urging President Bush to signed a letter urging President Bush to relax the policyrelax the policy

The 2004 Democratic presidential The 2004 Democratic presidential candidate, John Kerry, had promised to candidate, John Kerry, had promised to support all types of stem cells research if support all types of stem cells research if elected Presidentelected President

Organ Tissue replacement

Fetal stem cells taken

after child-birth

death

Stem cells from your

blood

Stem cells from your

organ

Animal Organs

e.g., pig organ

Cadaver Organs

e.g., cornea

Stem Cell

Umbilical stem cells

at your birth

Umbilical stem cells

from others' birth

Stem cells grown from a

discarded aborted

fetus

Stem cells from pre-implanted embryo which is

to be discarded

Artificial Organs

Mechanical artificial

organ

Biological artificial

organ

Stem cells from a zygote

modified in vitro

and implanted

for one month

Liver bioreactor with your stem cells

Liver bioreactor with stem cells not from you

Artificial heart

Living Donor

e.g., kidney

Religious perspectivesReligious perspectivesIt is interesting to note that religions that It is interesting to note that religions that have strong traditions of legal and have strong traditions of legal and religious lawreligious law

Judaism and Islam, support most forms of Judaism and Islam, support most forms of stem cell research stem cell research

Catholic Christian group have come out Catholic Christian group have come out strongly against embryonic stem cell strongly against embryonic stem cell research as they view it as a form of research as they view it as a form of abortion, which they see as murderabortion, which they see as murder

An Islamic Perspective on Stem An Islamic Perspective on Stem Cells ResearchCells Research

ReferencesReferences1.1. A Muslim Perspective on Embryonic Stem-Cell A Muslim Perspective on Embryonic Stem-Cell

research. IIIssues, Vol II, Number 3, August 29, research. IIIssues, Vol II, Number 3, August 29, 2001, Publish by the 2001, Publish by the Islamic InstituteIslamic Institute, , Washington DCWashington DC

2.2. Muzzammii SiddiqiMuzzammii Siddiqi. An Islamic Perspective on . An Islamic Perspective on Stem Cells Research. Article Ref:ICO202-404, Stem Cells Research. Article Ref:ICO202-404, february 27, 2002february 27, 2002

3.3. Michele WeckerlyMichele Weckerly. The Islamic View on Stem Cell . The Islamic View on Stem Cell ResearchResearch

4.4. IMANA’s Position on Organ Donation and IMANA’s Position on Organ Donation and Transplantation. “Our Position” The Position of Transplantation. “Our Position” The Position of Islamic Medical Association of North AmericaIslamic Medical Association of North America on Issues of Medical Ethics. March, 26, 2005on Issues of Medical Ethics. March, 26, 2005


IIIssues, 2001IIIssues, 2001In an effort to formulate a policy position on In an effort to formulate a policy position on embryonic stem cells research, and to ensure embryonic stem cells research, and to ensure Muslim American participation in the debate of the Muslim American participation in the debate of the ethical and scientific issue, the Islamic Institue ethical and scientific issue, the Islamic Institue convened a panel of expert, in cooperation with;convened a panel of expert, in cooperation with;

The Figh Council of North America (FCNA, North The Figh Council of North America (FCNA, North American council of Islamic jurisprudence)American council of Islamic jurisprudence)

The Graduate School of Islamic and Social Science The Graduate School of Islamic and Social Science (GSISS)(GSISS)

The International Institute of Islamic Thought (IIIT)The International Institute of Islamic Thought (IIIT)

The panel, consisting of medical doctors, scientist, The panel, consisting of medical doctors, scientist, and Islamic scholarsand Islamic scholars


IIIssues, 2001IIIssues, 2001Muslims have strongly rejected human Muslims have strongly rejected human cloning experimentation that “contradicts cloning experimentation that “contradicts Islamic legislation and prohibited in all its Islamic legislation and prohibited in all its forms because it contradicts with Islam” forms because it contradicts with Islam”

Nevertheless, virtually all Muslim scholars Nevertheless, virtually all Muslim scholars see in-vitro fertilization (IVF) as a see in-vitro fertilization (IVF) as a compassionate and humane scientific compassionate and humane scientific procedure to help infertile couples bear procedure to help infertile couples bear children. IVF, Islamic scholars emphasize, children. IVF, Islamic scholars emphasize, has to be performed under strict guidelineshas to be performed under strict guidelines


IIIssues, 2001IIIssues, 2001The Islamic Institute supports stem-cell The Islamic Institute supports stem-cell research on these spare embryos from in-research on these spare embryos from in-vitro fertilization (IVF)vitro fertilization (IVF)

Under the Islamic principle of the Under the Islamic principle of the “purposes and higher causes of the shariah “purposes and higher causes of the shariah (Islamic law)”, we believe it is a societal (Islamic law)”, we believe it is a societal obligation to perform research on the extra obligation to perform research on the extra embryos instead of discarding themembryos instead of discarding them


IIIssues, 2001IIIssues, 2001

None of the Islamic scholars on the panel, None of the Islamic scholars on the panel, or those scholars that were subsequently or those scholars that were subsequently consulted, felt the opinion was anyway consulted, felt the opinion was anyway contradictory to Islamic principlescontradictory to Islamic principles


IIIssues, 2001IIIssues, 2001

A majority of Muslim Americans support A majority of Muslim Americans support embryonic stem cell research according to embryonic stem cell research according to a new poll conducted by the Islamic a new poll conducted by the Islamic Institute. Institute. The Washington-based Islamic advocacy The Washington-based Islamic advocacy group also announced its support for group also announced its support for research based on the recommendations of research based on the recommendations of panel Islamic scholars, scientists, and panel Islamic scholars, scientists, and medical doctorsmedical doctors


Dr. Muzammii Siddiqi, 2002Dr. Muzammii Siddiqi, 2002– IVF is permissible in IslamIVF is permissible in Islam– First questionFirst question– Second questionSecond question


Dr. Muzammii Siddiqi, 2002Dr. Muzammii Siddiqi, 2002– First questionFirst question

Should an embryo, which is formed within Should an embryo, which is formed within a few days after an artificial fertilization a few days after an artificial fertilization and is not yet in the womb of its mother, and is not yet in the womb of its mother, be considered a human being, with all be considered a human being, with all rights of human being?rights of human being?


Dr. Muzammii Siddiqi, 2002Dr. Muzammii Siddiqi, 2002– Answer First questionAnswer First question

Muslim jurists have made a clear distinction Muslim jurists have made a clear distinction between the early stages of pregnancy (between the early stages of pregnancy (first 40 first 40 daysdays) and its later stages) and its later stages

It is mentioned that if someone attacks a pregnant It is mentioned that if someone attacks a pregnant woman and aborts her baby in the early stages of woman and aborts her baby in the early stages of her pregnancy, that person’s punishment will be her pregnancy, that person’s punishment will be less than that of the person who does that during less than that of the person who does that during full pregnancy . And if he kills the child after the full pregnancy . And if he kills the child after the birth, then he is liable to be punish for homicidebirth, then he is liable to be punish for homicide


Dr. Muzammii Siddiqi, 2002Dr. Muzammii Siddiqi, 2002

Second QuestionSecond QuestionWhether according to the Shari’ah it is Whether according to the Shari’ah it is acceptable to destroy an embryo for shake acceptable to destroy an embryo for shake of research, even if this research can of research, even if this research can potentially cure many otherwise fatal potentially cure many otherwise fatal disease?disease?


Dr. Muzammii Siddiqi, 2002Dr. Muzammii Siddiqi, 2002Answer Second QuestionAnswer Second Question

That the embryo in this stage is not human. That the embryo in this stage is not human.

It is not in its natural environment, the wombIt is not in its natural environment, the womb

If it is not placed in the womb it will not If it is not placed in the womb it will not survive and it will not become a human beingsurvive and it will not become a human being

So there is nothing wrong in doing this So there is nothing wrong in doing this research, especially this research has research, especially this research has potential to cure diseasepotential to cure disease


Dr. Muzammii Siddiqi, 2002Dr. Muzammii Siddiqi, 2002– Recommnedation #1Recommnedation #1– Recommendation #2Recommendation #2– Recommendation #3Recommendation #3


Dr. Muzammii Siddiqi, 2002Dr. Muzammii Siddiqi, 2002– Recommnedation #1Recommnedation #1

It is claimed by experts in the field that the It is claimed by experts in the field that the research on stem cell has potential to research on stem cell has potential to relieve human disease and sufferingrelieve human disease and suffering

If this the case then it is not only allowed If this the case then it is not only allowed but it is obligatory (fard kifayah) to pursue but it is obligatory (fard kifayah) to pursue this researchthis research


Dr. Muzammii Siddiqi, 2002Dr. Muzammii Siddiqi, 2002– Recommendation #2Recommendation #2

The use of embryonic stem cell should be very The use of embryonic stem cell should be very heavily limited. heavily limited. Only allow isolation of stem cells from frozen Only allow isolation of stem cells from frozen embryos that were created for the purpose of in embryos that were created for the purpose of in vitro fertilization and would otherwise have vitro fertilization and would otherwise have destroyeddestroyedObtain full consent from the donorsObtain full consent from the donorsProvide safequards against monetary compensation Provide safequards against monetary compensation to embryo donors and against the creation of to embryo donors and against the creation of embryos in excess of what is required for in vitro embryos in excess of what is required for in vitro fertilizationfertilization


Dr. Muzammii Siddiqi, 2002Dr. Muzammii Siddiqi, 2002– Recommendation #3Recommendation #3

Perhaps research using stem cells derived Perhaps research using stem cells derived from adults will eventually prove to be from adults will eventually prove to be most promisingmost promisingWe should encourage further research on We should encourage further research on the use of adult stem cells, to the point the use of adult stem cells, to the point where ir will be unnecessary to use where ir will be unnecessary to use embryos for this purposeembryos for this purposeSpecifically, we should find better ways to Specifically, we should find better ways to isolate existing stem cells in the human isolate existing stem cells in the human bodybody


Michele WeckerlyMichele Weckerly– To analyze Islam’s stance towards stem cell To analyze Islam’s stance towards stem cell

research, the status of embryo must be research, the status of embryo must be determineddetermined

– In Chapter 23 (Al Mu’minuun), verse 12-14, In Chapter 23 (Al Mu’minuun), verse 12-14, the Qur’an teaches:the Qur’an teaches:

We created (khalaqna) man of an extraction of clay, We created (khalaqna) man of an extraction of clay, then we sent him, a drop in a safe lodging, then then we sent him, a drop in a safe lodging, then We created of the drop a clot, then We created of We created of the drop a clot, then We created of the clot a tissue, then We created of the tissue the clot a tissue, then We created of the tissue bones, the We covered the bones in flesh; bones, the We covered the bones in flesh; thereafter We produced it as another creatur. So thereafter We produced it as another creatur. So blessed be God, then the best of creators (khaliqin)!blessed be God, then the best of creators (khaliqin)!


Michele WeckerlyMichele Weckerly– Allah passage has been interpreted to Allah passage has been interpreted to

indicate that a fetus is is perceived as indicate that a fetus is is perceived as human life, only later on the biological human life, only later on the biological development because of the Qur’ans development because of the Qur’ans use of the words “thereafter We use of the words “thereafter We produced his as another creature. produced his as another creature. Addtionally, many scholars indicate Addtionally, many scholars indicate that ensoulment of the fetus does not that ensoulment of the fetus does not occur until the end of the fourth month occur until the end of the fourth month of pregnancy (120 days), of pregnancy (120 days),


Michele WeckerlyMichele Weckerly– However, tradition states:However, tradition states:

Each of you possesses his own formation Each of you possesses his own formation within his mother’s womb, first as a drop of within his mother’s womb, first as a drop of matter for forty days, then as a blood clot matter for forty days, then as a blood clot for forty days, and then the angel is sent to for forty days, and then the angel is sent to breathe life into himbreathe life into him


Michele WeckerlyMichele Weckerly– Additionally, the Shari’ah makes a distinction between Additionally, the Shari’ah makes a distinction between

actual life and potential life, determining that actual actual life and potential life, determining that actual life should be afforded more protection than potential life should be afforded more protection than potential life.life.

– Under most interpretations of Islamic law, the embryo Under most interpretations of Islamic law, the embryo is not considered a person and the use of it for stem is not considered a person and the use of it for stem cell research does not violate Islamic law.cell research does not violate Islamic law.

– Also, under this same line of analysis, stem cells from Also, under this same line of analysis, stem cells from aborted fetuses would also be permitted if the aborted fetuses would also be permitted if the abortion was performed before the fourth month of abortion was performed before the fourth month of pregnancypregnancy


IMANA’s Position on Organ Donation and IMANA’s Position on Organ Donation and Transplantation. “Our Position” The Transplantation. “Our Position” The Position of Islamic Medical Association of Position of Islamic Medical Association of North America on Issues of Medical Ethics. North America on Issues of Medical Ethics. March, 26, 2005March, 26, 2005– Transplantation in general, both giving and Transplantation in general, both giving and

receiving organs, is allowed for this the purpose receiving organs, is allowed for this the purpose of saving lifeof saving life

– This has be done under the following guidelines:This has be done under the following guidelines:


The guidelinesThe guidelines1.1. The medical need has to be definedThe medical need has to be defined

2.2. The possible benefit to the patient has The possible benefit to the patient has to be definedto be defined

3.3. Consent from the donor as well as Consent from the donor as well as recipient must be obtainedrecipient must be obtained

4.4. No finacial incentive to the donor or his No finacial incentive to the donor or his relatives for giving his organs (a relatives for giving his organs (a voluntary gift may be permitted)voluntary gift may be permitted)


The guidelinesThe guidelines5. Any permanent harm to the donor must be 5. Any permanent harm to the donor must be

avoidedavoided6. May not transplant sex organs (testicles, 6. May not transplant sex organs (testicles,

ovaries or) which violate the sanctity of ovaries or) which violate the sanctity of marriagemarriage

7. There should be no sale of organs by any 7. There should be no sale of organs by any partyparty

8. There should be cost to family of the donor for 8. There should be cost to family of the donor for removing the organremoving the organ

9. Cadaver donation is permitted but only if 9. Cadaver donation is permitted but only if specifically mention in that person’s will or in specifically mention in that person’s will or in driving licensedriving license

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