Review article: Biomedical intelligence
Vol. 141 No. 0506 (2011)
Disease modelling using pluripotent stem cells: making sense of disease from bench to bedside
Summary
New advances in human stem cell biology now permit the derivation of disease-specific induced pluripotent (iPS) stem cell lines, so-called “disease-in-a-dish” (DIAD) models. This is a promising approach for the study of disease phenotypes at the cellular and molecular level, both because such human cell lines may produce more faithful experimental models of disease than can be produced using non-human organisms, and because reprogrammed cell lines can provide a virtually infinite supply of cells without requiring additional tissue donation. However, expectations placed on this emerging technology privilege the laboratory over the clinic as the site for making sense of disease, thereby distracting from the socially embedded meanings of disease and reorienting how the goals of medicine are imagined. Here we identify and review the implications of this area of research for clinical approaches to disease. We argue that there is a central place for the larger medical community and patients in the very construction of experimental research programs and the expectations placed thereon. By attending to the constellation of social factors that inform understanding, treatments and experiences of disease, DIAD projects can be more effectively placed in the service of clinical goals, in both their research design and in the forms of innovation they claim to anticipate.
Stem cells are increasingly considered to be at a forefront of medicine. Billions of Euros have been raised by both private and public institutions to battle disease and improve healthcare. Fundamentally immature, stem cells represent a plastic substrate for modern molecular bioengineering to generate therapeutics for diseased and injured patients [1, 2]. Research involving these plastic cells lies at the nexus of molecular research and clinical application. In this article, we discuss and anticipate emerging issues for clinical medicine that will likely unfold as this research progresses.
References
- Daley GQ, Scadden DT. Prospects for stem cell-based therapy. Cell. 2008;132(4):544–8.
- Saha K, Jaenisch R. Technical challenges in using human induced pluripotent stem cells to model disease. Cell Stem Cell. 2009;5(6):584–95.
- Rossant J. Stem cells and early lineage development. Cell. 2008;132(4):527–31.
- Takahashi K, Yamanaka S. Induction of pluripotent stem cells from mouse embryonic and adult fibroblast cultures by defined factors. Cell. 2006;126(4):663–76.
- Park IH, Arora N, Huo H, Maherali N, Ahfeldt T, Shimamura A, et al. Disease-specific induced pluripotent stem cells. Cell. 2008;134(5):877–86.
- Carvajal-Vergara X, Sevilla A, D’Souza SL, Ang Y-S, Schaniel C, Lee D-F, et al. Patient-specific induced pluripotent stem-cell-derived models of LEOPARD syndrome. Nature. 2010;10;465(7299):808–12.
- Johnson C. Stem cells allow drug trials in a dish. South San Francisco, CA: KGO-TV; 2009.
- CIRM. Stem Cells Accelerating Basic Research. Available from: http://www.cirm.ca.gov/StemCellBasics_BasicResearch.
- Kim K, Doi A, Wen B, Ng K, Zhao R, Cahan P, et al. Epigenetic memory in induced pluripotent stem cells. Nature. 2010;467(7313):285–90.
- Hanna JH, Saha K, Jaenisch R. Pluripotency and Cellular Reprogramming: Facts, Hypotheses, Unresolved Issues. Cell 2010;143(4):508-25. doi:10.1016/j.cell.2010.10.008.
- Caulfield T, Scott C, Hyun I, Lovell-Badge R, Kato K, Zarzeczny A. Stem cell research policy and iPS cells. Nat Methods. 2010;7(1):28–33.
- Simon BM, Murdoch CE, Scott CT. Pluripotent patents make prime time: an analysis of the emerging landscape. Nature Biotechnology. 2010;28(6):557–9.
- Zarzeczny A, Scott C, Hyun I, Bennett J, Chandler J, Chargé S, et al. iPS cells: mapping the policy issues. Cell. 2009;139(6):1032–7.
- Hippocrates. Of The Epidemics: Kessinger Publishing; 2004.
- Kleinman A. The illness narratives: suffering, healing, and the human condition: Basic Books; 1989.
- Rosenberg CE. The tyranny of diagnosis: specific entities and individual experience. The Milbank Quarterly 2002;80(2):237–60.
- Hacking I. The social construction of what?: Harvard University Press; 1999.
- Epstein S. Impure Science: AIDS, Activism, and the Politics of Knowledge: University of CaliforniaPress; 1996.
- Epstein S. Inclusion: The Politics of Difference in Medical Research: University Of Chicago Press; 2009.
- Feudtner JC. Bittersweet: diabetes, insulin, and the transformation of illness: UNC Press; 2003.
- Marks HM. The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900–1990: Cambridge University Press; 2000.
- Weisz G. Divide and Conquer: A Comparative History of Medical Specialization: Oxford University Press, USA; 2005.
- Rosenberg CE. Framing Disease: Studies in Cultural History: Rutgers University Press; 1992.
- Foucault M. The Birth of the Clinic: An Archaeology of Medical Perception: Vintage; 1994.
- Jewson ND. The Disappearance of the Sick-Man from Medical Cosmology, 1770–1870. Sociology. 1976;10(2):225–44.
- Ackerknecht EH. Medicine at the Paris Hospital, 1794–1848. Baltimore: Johns Hopkins Press; 1967.
- Albury WR. Corvisart and Broussais: Human Individuality and Medical Dominance. Constructing Paris Medicine. Amsterdam: Editions Rodopi B. V.; 1998. p. 221–50.
- Weisz G. The Medical Mandarins: the French Academy of Medicine in the nineteenth and early twentieth centuries: Oxford University Press US; 1995.
- Callon M, Rabeharisoa V. The Growing Engagement of Emergent Concerned Groups in Political and Economic Life: Lessons from the French Association of Neuromuscular Disease Patients. Science, Technology & Human Values. 2008;33(2):230–261.