Stem cells, regenerative medicine, and Prometheus

The Lancet
Mar 03, 2018 Volume 391 Number 10123 p813-910

Stem cells, regenerative medicine, and Prometheus
The Lancet
Published: 03 March 2018
The possibility of regeneration fascinates us as much today as it did the ancient Greeks. In the story of Prometheus, an eagle was sent to peck his liver each day as punishment, while at night it regrew. Stem cells have a similar mythical character—part fact, part fantasy—that captures the imagination but also blurs reality. In today’s issue, we publish the Lancet Commission: Stem Cells and Regenerative Medicine (published online Oct 4, 2017) to assess advances in the field, including gene therapy, since our last Series on the topic in 2013, and how to plan future developments in a way that both promotes science and protects the public.

The commissioners emphasise the importance of well funded basic science that led to the insights and techniques that have made stem cell therapies possible. However, in-vitro findings have not always been replicated in humans. To improve translation, they suggest wider collaboration with clinician-scientists. The report notes that many regenerative therapies appeal to potentially vulnerable people, which raises concerns about ethics, safety (particularly for unregulated autologous cell use), and financial structures for development and marketing. At the same time, the enormous advantage of curative gene therapy for a disease like Duchenne muscular dystrophy, which can restore independence and reduce health-care costs, is clear. To guide practice, the Commissioners propose a social contract that emphasises best science, equitable funding, strong governance, and transparent engagement with patients and the public.

Prometheus was punished by Zeus for stealing fire and giving it to humans, which enabled civilisation. In other interpretations, Prometheus is associated with scientific enquiry. Since our previous Series, the spark of regenerative medicine has become a flame that offers vast potential benefits, such as limbal stem cells licensed for corneal repair. But dangers persist that are incompletely understood, and the best way to harness stem cells and genes to alleviate true clinical need is unclear. The Commission provides a welcome mechanism to move past the smoke of hype and cultivate the flame of hope.