It is at the center of the latest scientific controversy in Spain. His claim to use human embryonic stem cells to fight diabetes has been denied by the government. Bernat Soria receives VERY in his laboratory in Alicante to talk about his scientific project: “I am convinced – he says – that in Spain the use of embryonic stem cells will eventually be approved, although two or three years late”.
–And what will that mean?
-Well, once again, we will miss the train.
–But Spanish patients will also benefit from these advances, whether they are made in Spain or not.
-Well, it should be seen. The current situation of work on human embryonic stem cells is one of legalities. If there were a rule that made them illegal, prohibited them directly, the consequences derived from these findings would also be illegal.
–That doesn’t seem to be the case …
-Not. In the end it will be legalized, but late and we will have to pay more for those advances. Those who are not capable of developing technology have to pay for what others develop. And in this case it is possible that it is technology made by Spaniards, but outside of Spain and that, therefore, Spaniards will have to pay.
–What state is your research currently in?
-In one of the lines of the laboratory we use mouse embryonic stem cells. In the last two years we have published a group of works in which we show that it is possible to go from a pluripotential embryonic cell to a cell that produces insulin. With these cells we can cure diabetes in mice. At this time we have several protocols in which 100% of cells that produce insulin are achieved quite systematically and in concentrations that are between 5 and 10% of normal. We are far from the solution, but we have taken an important step.
-And these data can be reproduced in humans?
-Of course. It is precisely for this reason that we have achieved successful protocols in mice, that is why we are thinking of transferring the work to similar, but human cells.
–And that’s where the project stops …
-Yes, for that work we had funding from the Juvenile Diabetes Foundation of about 600,000 euros. But once our first problems appear in Spain, the project is definitively canceled and we make the decision to take it abroad.
–Once you move your laboratory to another country, what path will your research take to achieve a market therapy for diabetes?
-In a period of 3 to 5 years we could have cells that produce insulin and release it in a regulated way. If all this is done according to the controls that the US FDA requires for cell therapy, we would have a material that would be similar to beta cells from donors and transplants could be done. The steps to be taken would be the same as in the rest of the therapies. In this way, we could start doing trials as long as the risk derived from this proposal is lower than the life risk of the patient himself. The first group of candidates has to be people whose life risk is very high.
–What advantages will the use of embryonic stem cells have compared to other therapies such as transplantation of islets from adult or cadaver donors or molecular therapies against diabetes?
-When what fails is a molecule, the patient can be given another molecule to compensate for the lack. But in the case of diseases such as diabetes, Parkinson’s or other neurodegenerative diseases, what fails us is a type of cells that has disappeared, in this case, insulin-producing cells. Therefore, they must be replaced. All other treatments are merely palliative.
–But donor cells can be transplanted. Why go to an embryo?
-In transplants we are always limited by the number of donors. In the case of diabetes, even in Spain, which is number one in the world in organ donation, we could have about 1,300 pancreas a year. This realistically means about 200 transplants. But in our country we have 100,000 type 1 diabetics and more than 2 million type 2 diabetics. We will never have enough organs for a donor transplant: we have to be able to make cells in vitro.
–It can be done, but not only with embryonic cells, also with adult cells …
-Stem cells can come from embryos, fetuses or adults. The great difference between one and the other is that the capacity for expansion and differentiation of the embryonic ones is not those of the adult. For this reason, certain advances that have been achieved with embryos have not been achieved with the other types.
–Where would you get the embryonic stem cells from?
-Of the 35,000 one to two week old embryos obtained in Spain as leftovers from in vitro fertilization processes.
–And those extra embryos couldn’t be re-implanted in infertile women?
-The freezing process is not safe. We spend all day freezing and thawing cells and we know that it is very difficult for them to acquire the vitality that they previously had. It is estimated that 15 percent of embryos that are frozen could be “pulled out” again. As a doctor, I believe that the possibility of miscarriage or, worse, malformations is so high that implanting embryos frozen more than 5 years ago would be unethical. The remaining 85 percent have already died. That is to say, when one speaks of “leaving the embryos alone” a big mistake is made: in reality, being frozen they are dying little by little. The legislative paralysis in this regard, which consists of doing nothing with them, is already doing something: it is letting them die. According to some people, this alternative is more ethical than allowing cells to serve to save patients …
–With 35,000 embryos there would be enough or would it be necessary to resort to therapeutic cloning?
-They would be enough, but they will be cells that will promote allogeneic transplants, that is, transplants from foreign donors with the compatibility risks that this produces. The only way to have an autologous transplant is therapeutic cloning, unless much progress is made in immunosuppression to avoid rejection problems.
–Have you been pressured to change your research?
-I’ve just been forbidden.
-¿Has anyone suggested to you that it would be better for you to use adult cells?
-I have received many verbal communications and I have been told that I cannot continue doing my job. But nothing in writing.
–Verbal communications, at what level?
-From the Ministry of Health in which I am informed what is the interpretation that this Ministry makes of the current legislation.
–Is there any difference between the treatment you receive from the Government of the nation and the one that the Valencian Autonomous Government gives you?
-Yes. The Valencian Autonomous Community is clearly more progressive on these issues.
–Who should set the limits to this type of research?
-Any investigation must have the limit indicated in the ethics committees. Science does not advance at the stroke of the Penal Code.
–And who forms those committees?
-Experts in ethics, lawyers, doctors and lay people, street people …
–Do you understand that there are citizens who are willing to suffer from diabetes for life, even to die, rather than to renounce their ethical principles that make them disgust the use of embryos because they consider them human beings?
-I understand that this exists, but I don’t know anyone. It is not the same to give an opinion on ethics when suffering from the disease …
–Some associations for the disabled in the US have asked not to work with human embryos because they do not feel desperate enough to renounce their religious beliefs in search of a cure …
-Well, I respect it. But let’s think about other cases … In the parents of a child with diabetes, who know that their child is going to be diabetic all his life, that he can go into a coma or die, that he is going to have a very difficult adolescence because adolescents are They rebel against the world and, in that case, they will rebel against their illness … Those parents build their ethics in another way, no doubt.
–But you cannot assure those parents that the use of embryonic cells can cure their child …
-Not yet, although if we don’t investigate with them, we won’t know.
– Is there a scientific consensus on the use of these cells?
-Science does not work based on consensus, but with laboratory data. Even so, there is almost unanimity when it comes to justifying the use of stem cells.
– And the citizen consensus seems difficult because it is a matter of religious beliefs.
-It is much more complex. But we have some examples, such as the legislation on abortion, in which the Law is not restrictive and achieves high doses of agreement.
– What is a human embryo for you?
-A group of cells that implanted and nested in the uterus can end up being a human being. He is not a human being, nor is he a potential human being because if he is not in the womb or receives epigenetic factors, he will not develop. But it is a group of cells that deserves special status. It is not like any other group of cells. There must be laws that regulate what can be done with them. But not because they are already human, but because they could be.
If I thought that this group of cells is a human being, I would never be able to investigate with them.
Jorge Mayor
This interview was published in April 2002, in number 251 of VERY Interesting.
