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Last summer, President Bush made "stem cells" a household term. Now, Cleveland researchers and activists wrestle
with what public funding and new awareness mean for the city's medical and biotech communities.
r
by Christopher Johnston
I
n spacious biomedical research lab-
a Gerson oversees cell and gene therapy In what many pundits labeled a
I oratory at University Hospitals of
Cleveland's Ireland Cancer Center,
Stanton Gerson, M.D., directs more than
research at University Hospitals and the
Case Western Reserve University School
of Medicine. His research focuses on
shrewd political compromise, President
George W. Bush allowed funding from
the National Institutes of Health for
II
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a dozen physicians and scientists. Each stem cells derived from bone marrow for research on the approximately 64
day, they marshal the tools of their trade transplants - hematopoietic stem cells, colonies of existing embryo cells. Obvi-
to test the elastic capacity of stem cells - which become blood and bone marrow ously wrestling with the decision (one
the body's primitive building blocks - cells, and mesenchymal stem cells, which that displeased many of his more conser-
for developing a variety of organ tissues. become bone, cartilage, tendon, muscle vative supporters), Bush acknowledged
After drawing samples from a tis- and other connective tissues in the body. the enticing potential embryonic stem
sue-culture incubator, one researcher Though microscopic in size, stem cell research holds for possible medical
peers into a confocal microscope to cells are the centerpiece of research that treatments to replenish diseased organs,
track intracellular proteins; another many anticipate will lead to revolution- but said he did not want taxpayer dollars
employs customized laser equipment to ary breakthroughs in human tissue and supporting further destruction of
scan the surface of individual cells for organ regeneration. They gained main- human embryos.
special biological markers. Through a stream attention last summer during the The August decision opened new
series of sophisticated procedures, Ger- heated debate over whether federal doors for medical research and unlocked
son's lab can find stem cells, determine funding should be used to finance the the possibility of future business oppor-
what sort of tissue they match, separate study of stem cells harvested from tunities in the biotech sector. Gerson
and grow them, human embryos. cautions, however, that Bush's decision is
CLEVELAND 139

2. Healtb Care Guide
just the first step in what will undoubt- cer Center. "I don't use that word has been guiding for nearly Ij years. "I
edly be a daunting journey filled with lightly, because that's what science is all spent a lot of time and energy starting
moral and ethical questions that, in about: discovering things that we really that company," Caplan says. "I can't, at
many cases, will have to be answered for don't understand and, frankly, this is the moment, see doing that again."
the first time. one of them." Nevertheless, with the right business,
In addition to the pubiic-relations political and financial support, Caplan
quandary, Gerson estimates at least a says he believes that Cleveland could
decade of work will be required to f'''' leveland has already seen the promise generate a substantial portion of its
understand the rules of how embryonic '''''" of stem-cell research as a source of biotech industry from enterprises built
stem cells function before that can even spin-off business for the biotechnology around stem-cell research.
be translated into clinical applications - sector. Recognized as one of the premier "Whether it's for stem-cell or gene
rules that have already been established stem-cell researchers in Cleveland, therapy, there's all kinds of technologies
for the mature and umbilical stem cells Arnold Caplan, Ph.D., professor ofbiol- sitting at CWRU," he notes, adding that
over the past 20 to 30 years. In light of ogy and director of the Skeletal Research the university is greatly committed to the
the recent decision freeing federal fund- Center at CWRU, launched a Cleveland translation of basic science into
ing, however, Gerson says his research company 10 years ago based on his lab's entrepreneurial activity. "What we're
group may incorporate embryonic stem work in developing the technology for lacking is efficient and suitable invest-
cells into its current studies. That process isolating adult mesenchymal stem cells ment and people who are going to follow
is a protracted one. Gerson will submit a from bone marrow. The firm, Osiris those technologies up the ladder."
grant proposal to 1 IH in the next six to Therapeutics, moved to Baltimore several The Cleveland Clinic Foundation has
nine months. It will take another 12 to years later, citing that area as a stronger also spun off some of its discoveries into
15 months before a decision is made. location for biotechnology ventures. commercial ventures, according to
The government will then disburse the Osiris continues to LIsethe technology George F. Muschler, M.D., director of the
NIH research money. license from CWRU to develop products bone biology laboratory in the Clinic's
"Embryonic stem-cell research is in a that will affect orthopedics, as well as department of biomedical engineering.
discovery stage now," explains Gerson, treat cancer and other diseases, but Also a member of the Clinic's depart-
who is the chief of the division of hema- Caplan is back in Cleveland. He left ment of orthopedic surgery, Muschler's
tological oncology and associate director Osiris near the end of the '90s to concen- research focuses on understanding the
for clinical research for the Ireland Can- trate on his center's research, which he adult stem-cell population present in
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140 DECEMBER 200i

3. human bone marrow that is an area on which many are
contributes to bone forma- pinning their hopes for help
tion. His department has in regenerating damaged
already developed a nerve and brain cells.
patent-license agreement "The regenerative poten-
and a partnership with tial with stem cells is enor-
Dupuy Orthopedics, a mous because there isn't a
Johnson & Johnson com- drug conceivable that would
pany, to improve the way restore function after any
bone-grafting procedures neurodegenerative condi-
are performed in the oper- tion;' he says.
ating room. Herrup cautions that peo-
Muschler says there are ple need to separate the
still plenty of opportunities short-term promise from the
to develop new applications long-term research necessary
and potentially even new before any of it might
businesses in Cleveland become a reality.
pertaining to cartilage, ten- "If you ask, 'Can my Aunt
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don, ligament and muscle 'J,!,'I
Josie, who's now in the early
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regeneration and improved stages of Alzheimer's disease,
methods for bone-marrow look to the stem-cell commu-
transplantation that relate nity for help?' the answer is
to the technologies his lab clearly no," he states. "Can
is exploring. her daughter? The answer is a
"Existing biotech C0111- very possible yes:'
panies in Cleveland should David Geldmacher, M.D.,
have greater opportunities clinical director of the Uni-
I
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to serve as partners and
participate in these devel-
oping niches for their
products associated with
versity Memory Aging Cen-
ter, concurs with his colleague
that the recent events pertain-
ing to stem-cell research
"
E
ro
"
"
i ~' - "
I cellular therapy applica- -.'. should not elevate it to "silver
I, tions," he notes. bullet" status. The research
I, UH's Gerson says he trail is going to be a long one.
I
sees potential for technol- Drs. Stanton Gerson (left), Stephen Haynesworth and Orner Koc study While he prefers not to com-
i~
ogy-transfer opportunities mature stem cells at University Hospitals of Cleveland. Gerson, who oversees ment on the president's deci-
from embryonic stem-cell the research, says working with embryonic stem cells may be the next step. sion, Geldmacher does agree
research, but remarks that that all stem-cell experimen-
it may take a while to reach the commer- professor of neuroscience at CWRU's tation contributes significantly to
cialization level, since all of the current School of Medicine, is confident that as Alzheimer's research - even if it only
research efforts still represent early scien- discoveries in the nascent stem-cell field comes in the form of collateral knowl-
tific and medical initiatives and not yet advance, there will be substantial pres- edge about cell functioning that enhances
therapeutic initiatives. He adds that dra- sure to extend the amount oflines avail- our understanding of how to maintain
matic medical results will likely first be able, allowing the research to proceed brain-cell health.
seen from the study of mature stem cells. further. "As an example, while the knowledge
"Currently, we are able to take bone- "As a scientist, [Bush's decision] was a we've gained from AIDS research doesn't
marrow stem cells and turn them into very disappointing decision, because if always directly help the person who has
bone-marrow cells in patients or turn you take it at face value, there's not much AlDS today, it has vastly improved our
them into brain, lung and liver tissues in there to work with," Herrup says. "But if knowledge about immune function and
the laboratory;' explains Gerson. "None you take a step back and look at it in the ways of manipulating it," offers Geld-
of that has been accomplished yet with political context in which this decision macher, who conducts experimental drug
embryonic cells, so it's still very early in was made and all that Bush had to juggle, trials to slow the progression of
the research for that area." it was a very carefully crafted move." Alzheimer's or improve the mental abili-
In his role, Herrup oversees an active ties of people with the disease, He adds
research program that includes a $2 mil- that Parkinson's disease, because it is a
T here is hope that revised federal
guidelines down the road will expe-
lion annual NIH grant to operate the
Alzheimer's Disease Research Center.
simpler system than Alzheimer's, attack-
ing a relatively restricted portion of the
dite advances in embryonic stem-cell Although he is not involved in stem-cell brain as opposed to multiple areas
research. Karl Herrup, Ph.D., director of research (his primary focus is studying throughout the brain, is likely to be an
the University Memory and Aging Center early neurological development and late earlier successful target for stem-cell
at University Hospitals of Cleveland, and neurodegenerative diseases) he knows it treatment.
142 DECEMBER 2001

4. +
Rimas Iasinevicius, executive director research," Jasinevicius says. "Rather, we moral argument," declares Mary Colling-
of the Cleveland Area Alzheimer's Asso- try to enlighten not only our legislators, wood, director of the Pro Life Office at
ciation, says his organization supports but the general public about the overall the Catholic Diocese of Cleveland.
any research that holds significant importance of research." Adamant in the position that human
promise in combating Alzheimer's, The life begins at the moment of conception,
urgency for effective treatments grows Collingwood, the Roman Catholic
every day: Currently, approximately 4 o discussion of the president's deci- Church and other right-to-life groups do
million Americans suffer from the dis- N sion and the early phases of embry- not allow any wiggle room in interpreta-
ease, and that number is expected to onic stem-cell research can be broached tion of the topic. It does not matter that
increase by 50 percent over the next eight without acknowledging the gorilla in the the cells were originally created in a petri
years as the population continues to age. laboratory closet: the moral and ethical dish for in vitro fertilization - which
"We try not to get hung up in the implications of using human embryos. they also oppose - or for the express
debate with regards to stem-cell "The president does not have a proper purpose of research and were not
extracted from a uterus.
"The cells that researchers are now
allowed to use were created for the pur-
poses of research," Collingwood says. "So
they were created to be destroyed, and
that does not respect human life or the
dignity of human life."
She points out, however, that Pope
John Paul II is a strong advocate for con-
tinued research with umbilical-cord and
mature stem cells. The pope has stated
that using embryonic stem cells is unnec-
essary, especially since the research done
in private labs or in other parts of the
world to date has not yet delivered on the
hopes that were promised early in the
process. Still, even if it had, Collingwood
says, the end does not justify the means
in the eyes of the Catholic Church.
For his part, Gerson disagrees with
the church's interpretation of when life
begins, saying that these cells are for bio-
logical experimentation and only repre-
sent the creation of human life when
implantation occurs in the uterus. Even
so, he firmly believes public discussion of
such moral and ethical issues should
stand at the center of this early phase of
embryonic stem-cell research, since citi-
zens need to express their concerns and
acquire a clearer understanding of the
UHHS Laurelwood's specialized mental health and chemical complex process.
dependency programs provide expert, compassionate, high- "It's not the scientist's right to pre-
empt societal discussion from taking
quality care to children, adolescents, adults and older adults,
place," Gerson says.
enabling them to regain health and wholeness. Some physicians, such as the Clinic's
Muschler, praise President Bush's restric-
University Hospitals tions as necessary at this point in the
HealthSystem research, to quell perceptions that labs
might wantonly generate human
Laurelwood Hospital embryos, then destroy them and produce
stem cells for profit.
& Counseling Centers
"The decision responsibly walks the
440-953-3000 balance between respecting human life
and not being indiscriminate about the
process of using human cells in this way,"
he says. "But at the same time, it's not so
restrictive that it prevents what poten-
144 DECEMBER 2001

5. tially are very valuable life-changing
therapies from becoming available."
Some physicians are a shade less
accommodating.
Robert Friedland, M.D., for example,
finds the right-to-life argument reason-
able, and says those who support it should
simply not get involved with in vitro fertil-
; ization or embryonic stem-cell research.
But others should be left to pursue the
budding research to its fullest extent.
The number one cause of adult disabilityin America is
, Thus, the pure scientist in him is not over-
i
STROKE. joyed by the president's restrictions.
II CLEVELAND HEARING & SPEECH CENTER'S(CHSC) "Bush's decision is limiting an area
i with enormous potential for the treat-
certified speech-language pathologists can help
! ment of brain disorders," Friedland says.
improve impaired functions of conversation.
"He's not being realistic in implying that
CHSC offers individual and group therapy, survivor support the existing stem-cell repositories will be
:1 adequate for the purposes of research."
groups, and family education and guidance
A professor of neurology, radiology
to help create an environment for recovery. and psychiatry for the CWRU medical
school and University Hospitals, Fried-
For more information on how CHSCcan land is currently investigating
help you or yourfamily, call 216.231.8787 Alzheimer's disease in a group of Israeli
Arabs in which researchers have
observed a high incidence of the disease.
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Gerson claims the president's restric-
tions are legitimate and prudent. Even
though they will hinder researchers, they
will also force the NIH to devise impor-
tant precedents to control research into
You 'If think you're in determining what these cells are and
how they function, as well as create over-
8(/1/ ~ ~rvt 3fUV. sight, safety and ethical guidelines. Ger-
son adds that when that groundwork is
Your smile u/ill show you're in completed and the medical payoff
potential becomes more clearly articu-
?;~~ lated, perhaps the federal government
will see fit to approve additional stem-
~eni£lt~ cell lines for research.
"Scientists will just have to work a lit-
tle bit harder to establish the rationale
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'46 DEe EM B E R 200 1