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Will Cell Reprogramming Resolve the Embryonic Stem Cell Controversy? A Narrative Review

Carl Power, PhD; and John E.J. Rasko, MBBS, PhD
[+] Article, Author, and Disclosure Information

From the Centenary Institute, University of Sydney, and the Royal Prince Alfred Hospital, Sydney, Australia.

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1697.

Requests for Single Reprints: John E.J. Rasko, MBBS, PhD, Centenary Institute, Locked Bag 6, Newtown NSW 2042, Australia; e-mail, j.rasko@cenint.org.

Current Author Addresses: Drs. Power and Rasko: Centenary Institute, Locked Bag 6, Newtown NSW 2042, Australia.

Author Contributions: Conception and design: C. Power, J.E.J. Rasko

Drafting of the article: C. Power, J.E.J. Rasko.

Critical revision of the article for important intellectual content: C. Power, J.E.J. Rasko.

Final approval of the article: C. Power, J.E.J. Rasko.

Ann Intern Med. 2011;155(2):114-121. doi:10.7326/0003-4819-155-2-201107190-00007
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In the past few years, relatively straightforward laboratory techniques have been developed to reprogram normal body cells to enter an embryonic stem cell–like state. Not only do these induced pluripotent stem cells hold great medical promise—perhaps greater than that of embryonic stem cells—but they also have escaped the ethical controversy in which the latter is mired.

This article examines how cell reprogramming is likely to transform regenerative and reproductive medicine and highlights some of the medical, moral, and political hurdles that it faces. It also argues that induced pluripotent stem cells are more ethically problematic than most people believe and that cell reprogramming will not solve the stem cell controversy but complicate it further.


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Figure 1.
Derivation and medical use of iPS cells.

Somatic cells can be reprogrammed into iPS cells and then differentiated into the desired functional cell type. If necessary, genetic defects may be corrected with gene therapy. Cells derived in this manner may have various uses, including autologous and allogeneic cell transplantation, in vitro disease modeling, drug screening, and regeneration research. Figures were produced using Servier Medical Art, available at www.servier.com. iPS cells = induced pluripotent stem cells.

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Figure 2.
Possible reproductive use of iPS cell–derived gametes.

Cell reprogramming may one day be used in IVF clinics to produce artificial gametes, including male-derived ova and female-derived sperm. This figure shows the reproductive options that this technology could open for male IVF donors. Artificial sperm could be used for heterosexual fertilization, whereas artificial ova could enable same-sex fertilization and self-fertilization. Figures were produced using Servier Medical Art, available at www.servier.com. iPS cells = induced pluripotent stem cells; IVF = in vitro fertilization.

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