A brave, new laboratory world: the future of stem cells and lab medicine

by Anthony S. Kurec

The clinical laboratory is entering a new age. It is on the edge of a new era in how it will assist direct healthcare providers in diagnosing and treating patients. More importantly, it might help prevent many devastating diseases and injuries as well as other maladies not yet identified.

This new era involves the use of stem-cell technology and its potential ability to provide a means by which cells differentiate, replicate, and develop into specific cells that would replace abnormal cells and result in the growth of normal, healthy tissues.

Functionally, there are three types of human stem cells:

* Totipotential stem cells are seen in the first few hours after an egg is fertilized and can develop into any human cell type, including those needed for development of an embryo into a fetus. This is the most versatile type of stem cell.

* Pluripotential stem cells are present several days after fertilization and can also develop into any cell type but cannot develop into a fetus.

* Multipotential stem cells are derived from pluripotential stem cells and can be found in adults. These cells can only form specific types of cells to form tissues. For example, bone-marrow stem cells are limited in the types of cells produced [i.e., all blood cell types (leukocytes, erythrocytes, megakaryocytes), bone, cartilage, and fat cells]. These undifferentiated cells must be programmed to develop into specific tissue cell types, such as leukocytes found in the blood, neurons in the brain, epithelial cells of the skin, or cardiac cells from the heart.

The full potential of how these cells can be used is under investigation around the world. Stem-cell research is, however, facing significant controversy in the United States due to moral and ethical issues. This has resulted in limited federal dollars available for certain types of research.

Yet, it is thought that with more research, stem-cell technology will alter how healthcare providers will treat or even prevent various diseases in the very near future. Studies are currently taking place to determine how to use stem-cell technology to cure diseases treated with highly toxic drugs. Much of the research has focused on four types of stem-cell therapy:

* Embryonic stem-cell (ESC) therapy is based on the use of totipotential stem cells derived from embryonic tissues and is the source of much of the controversy in the United States.

* Fetal stem-cell (FSC) therapy is based on the use of pluripotential stem cells obtained from aborted human fetuses usually less then three months old and is also the subject of concern for many religious and conservative groups.

* Cord stem-cell (CSC) therapy utilizes stem cells retrieved from umbilical cord blood at the birth of full-term infants. CSCs are readily available, easily obtained, and have become a commercial entity for entrepreneurs offering a "stem-cell banking" service to parents who want to protect their newborn against potential life-threatening situations. Recent studies have revealed that cord blood may also be a source for a small number of embryonic-like stem cells. There use would likely bypass some of the ethical issues surrounding stem-cell research.

* Adult blood stem-cell (ASC) therapy is based on the use of multipotential stem cells most often recovered from bone marrow. ASCs are also obtained from liposuction treatments or fat-derived stem cells, which may be used in the treatment of certain cancers such as leukemia.

How stem cells might be used in research, treatment, and prevention is open to the imagination at this time.

As laboratory scientists, we know that, when studying diseases, we need an animal "model" that most closely reflects the deficiencies seen in the human counterpart. Stem cells will provide that mechanism at the cellular level. But we will have to create whole new sections of the laboratory to obtain, culture, and isolate these stem cells.

In the near future, we will develop a higher level of technological expertise to study heart disease, Parkinson's, diabetes, spinal cord injuries, liver disease, muscular dystrophy, autoimmune diseases, and many, many others. We will also develop new techniques to grow and replace skin tissue, broken bones, and even breast tissue. One of the most exciting new research projects from MD Anderson Cancer Center involves programming stem cells to act as "smart bombs" by delivering engineered genes to destroy cancer cells. Another involves using stem cells to address infertility problems.

This new technology will not only improve the quality of life but will also reduce healthcare costs. For example, just over $1 trillion is spent each year to treat the 90 million Americans suffering from chronic diseases. By eliminating many of these diseases, we can markedly reduce these costs.

Efforts from stem-cell research will provide the modalities needed to treat many diseases, the impact of which will have profound effects on the clinical laboratory. In fact, it will change how laboratory medicine is practiced, providing laboratory scientists with new opportunities to use their skills in a way that will be cutting-edge and that will give them a larger role in the management of patient care.

Anthony S. Kurec, H(ASCP)DLM, is an administrator for University Pathologists Laboratories, Department of Pathology, State University of New York (SUNY) Upstate Medical University in Syracuse, NY. He is a clinical associate professor in the College of Health Professions at SUNY and is past president of the Clinical Laboratory Management Association (CLMA).

Photographs by and through the courtesy of Daniel Anderson, PhD, Research Associate, Chemical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA.

References

1. American Cell Therapy Research Foundation. 2004 annual report. Available at: http://www.stemcellresearchfoundation.org/. Accessed August 23, 2005.

2. American Academy of Pediatrics Work Group on Cord Blood Banking. Cord blood banking for potential future transplantation: subject review. Peds. July 1999; 104(1): 116-118.

3. Centers for Disease Control and Prevention. Chronic disease overview: June 6, 2005. Available at: http://www.cdc.gov/nccdphp/overview.htm. Accessed August 23, 2005.

4. Ertelt S. Adult stem cell research more useful than embryonic stem cells. Lifenews.com. May 24, 2005. Available at: http://www.lifenews.com/bio984.html. Accessed August 23, 2005.

5. National Institutes of Health. Stem cell information. Available at: http://stemcells.nih.gov/index.asp. Accessed August 23, 2005.

6. Goodchild S. Grow-your-own breast implants on the way. New Zealand Herald. March 28, 2005. Available at: http://www.nzherald.co.nz/index.cfm?c_id=1&ObjectlD=10117337. Accessed August 23, 2005.

7. Mayo Clinic. Stem cells: medicine's new frontier. Available at: http://www.mayoclinic.com/invoke.cfm?id=ga00012. Accessed August 23, 2005.

By Anthony S. Kurec, H(ASCP)DLM