Category:	Science and Technology
Domain:	Biology and Biotechnology
Keywords:	Biotechnology & genetics - embryonic stem cells, developmental biology, regenerative medicine, therapeutics, disease, ethics, cloning
Outlook:	Stem cell research is likely to lead to a new kind of cell-based medicine that regenerates the body, but practical and ethical challenges mean safe and effective treatments may be decades away.
Summary Analysis:	Stem cells are undifferentiated cells that have the potential to develop into other more specialized cells. Stem cells are found in adults in the bone marrow, but also in embryos. While adult stems cells have been used to treat disease for several decades in bone marrow transplants, it is the progress in embryonic stem cell research that has been the source of great therapeutic hope, ethical and legal controversy, and international competition. Unlike adult stem cells, embryonic stem cells have the potential to become any other kind of cell, which is the key to the intense interest. Novel therapeutic treatments could potentially be applied to every system in the human body. Possibilities include replacing malfunctioning liver cells or even growing entire livers to replace diseased ones, therapies for Parkinson's and Alzheimer's diseases, spinal cord injury, stroke, cancer, burns, cardiovascular disease, diabetes, osteoarthritis, and rheumatoid arthritis. Interest in developmental biology, health and disease, medical economics, and national pride are all driving forward this relatively new research area. The technical challenges of acquiring and working with embryonic stem cells in a laboratory environment are significant but nevertheless, important breakthroughs are beginning to occur and progress in research practices in the next 5 to 10 years is possible. Practical applications of embryonic stem cell research however are likely to be decades away. Much more biological knowledge is needed before an embryonic stem cell can be guided and controlled into developing into just the right specialised, viable, and stable cell. The economic potential however is leading to immediate investment by biotechnology companies. Because the research relies on using tissue from aborted fetuses, this research raises a number of moral, religious and political concerns about the sanctity of embryos and the use of fetal cells, as well as an uneasiness about cloning and hybridisation of species. A complicated set of rules, guidelines and practices has developed across nations, leaving considerable room for individual countries to respond to the views and concerns of their population. As a result of this lack of consensus, advances in stem cell research are most likely to be made in geographic areas with less restrictive legislation. Currently, China has the most permissive environment for research with little opposition, while the UK is a Western leader, with a strong scientific research pool and a relatively supportive public. The US restricts the flow of federal money for research but places no bans on private, state, or local government funding and American opinion fluctuates but on average is evenly divided over the issue of federal funding for stem cell research.

	Implications:	Potential to overcome limitations of pharmaceutical (molecular-based) treatments More informed theories of carcinogenesis as well as refined use of pharmaceuticals Relocation of scientific labor and expertise in the next decade to the least restrictive and best funded environments, such as South Korea, China, and the UK Increase in demand for training of doctorates in stem cell research Increase in property rights litigation as more therapies are developed and commercialised
	Early Indicators:	Development of dedicated research institutions at universities, such as the Harvard Stem Cell Institute (which has raised $30 million from foundations and private donors and is creating its own stem cell lines) and the Cambridge Stem Cell Institute (which has raised £16.5 million and plans to raise a further £33.5 million over the next five years to further its mission to 'deliver therapies in regenerative medicine at the earliest possible date') Geron's intention to apply for FDA permission to conduct clinical trials of cells for a spinal therapy Stem Cell Science's work on developing a treatment for Batten disease, a fatal brain disease Public support of research by celebrities such as Michael J. Fox, Nancy Reagan, and Christopher Reeve in hopes of treatments for Parkinson's disease, Alzheimer's disease, and spinal injury The South Korean government's issuance in February 2005 of a postage stamp in honor of Dr. Hwang Woo Suk, a pioneer of embryonic stem cell research, and its allocation of $43 million to build Dr. Suk a stem cell research centre. As of Summer 2006, Hwang Woo Suk is on trial for faking research findings and fraud. Passage in November 2004 of a California bill allocating $3 billion over 10 years to stem cell research
	What to Watch:	Stem cell researchers become concentrated at centres focused on biomedical applications. An international statement is issued on the ethics and practices of stem cell research encouraging a more permissive research environment. The number of viable embryonic stem cell lines routinely used in research increases rapidly. Large clinical trials testing treatments for incurable degenerative diseases are initiated.
	Parallels/Precedents:	Treatment of leukemia with transplantations of adult stem cells from bone marrow Widespread use of chemotherapy for cancer treatment
	Enablers/Drivers:	Technical improvements in handling and culturing of embryonic stem cells Continuing lack of alternative therapies for fatal diseases Resolution of ethical debates about the cloning and use of human embryonic stem cells and standardisation of regulations Increased government funding driven by international competition Greater investments from venture capitalists who are currently waiting for resolution of legal, regulatory, and medical issues
	Leaders:	Regions: US, UK, China, South Korea Institutions: Harvard Stem Cell Institute, Harvard University (research on and creation of stem cell lines) Cambridge Stem Cell Institute, Cambridge University (work to develop cell-based therapies) [link] Seoul National University, South Korea (Hwang Woo Suk's pioneering embryonic stem cell research -- but see "Stem Cells: Miracle Postponed?", below) University of Toronto, Department of Medical Genetics and Microbiology ES International (providing stem cell research products; owner of 6 of the US federally approved human embryonic stem cell lines) Geron (planning to conduct clinical trials of cells for a spinal therapy) Advanced Cell Technology (ACT) Holdings (work on cloning) Stem Cell Sciences, Inc. (work on developing a treatment for Batten disease) Australian Stem Cell Centre, Monash University, Melbourne, Australia [link] Stem Cell Research Centre, Beijing University National University of Singapore [link] "Stem Cell Research Project." Swedish Research Council Centre for Stem Biology, University of Sheffield [link] UK Stem Cell Bank [link] Roslin Institute [link] Institute for Stem Cell Research, Edinburgh [link]
	Figures:
	Sources:	"The Future of Stem Cells." Financial Times and Scientific American Special Report. July 2005 (pages A1-A35). "California Institute of Regenerative Medicine" California Institute of Regenerative Medicine. [link] U.S. National Institutes of Health. "Stem Cell Information" [link] Blackburn, E., and J. Rowley. "Reason as Our Guide." PLoS Biol 2, no. 4 (2004): E116. Stolberg, Sheryl Gay. "House Approves a Stem Cell Research Bill Opposed by Bush." New York Times, 25 May 2005. [link] Odelberg, S. J. "Unraveling the Molecular Basis for Regenerative Cellular Plasticity." PLoS Biol 2, no. 8 (2004): E232. Kolata, Gina. "South Koreans Streamline Cloning of Human Embryos." New York Times, 19 May 2005. [link] "International Society for Stem Cell Research" International Society for Stem Cell Research. [link] Paarlberg, Robert. "The Great Stem Cell Race." Foreign Policy, May/Jun2005, Issue 148. Gilliand, D. Gary, and Tom Fagan. "Do Stem Cells Cause Cancer?" Newsweek Special Edition Summer 2005, 20. "The Stem-Cell Also-Ran: America." BusinessWeek Online 27 May 2005. [link] "UK to Head Stem Cell Research." UK Trade and Investment Research News. [link] Audio Broadcast on "The World." [link] "Bush besieged over Stem Cell Research." August 6 2005. New Scientist [link] "Stem Cells: Miracle Postponed?" March 11 2006. New Scientist [link] Stem Cell Mission to China, Singapore and Korea, DTI GlobalWatch Mission, September 2004 [link] International Stem Cell Forum [link] "UK Stem Cell Initiative: Report and Recommendations.", Department of Health, 2005 (includes assessment of stem cell research around the world)

	At A Glance:	When:	21-50 years +
		Where:	Global
		How Fast:	Years
		Likelihood:	Medium-Low
		Impact:	Medium-Low
		Controversy:	Medium

Related Outlooks: