Reprogramming a patient's own skin cells to replace cells in the brain that are progressively lost during Parkinson's disease has been shown to be technically feasible, reports a team of investigators from McLean Hospital and Massachusetts General Hospital in the most recent issue of the New England Journal of Medicine .
"Because the cells come from the patient, they are readily available and can be reprogrammed in such a way that they are not rejected on implantation. This represents a milestone in 'personalized medicine' for Parkinson's," says senior author Kwang-Soo Kim .
The researchers reprogrammed a 69-year-old patient's skin cells to induced pluripotent stem cells and then differentiated them. The patient reports an improvement in his quality of life. Routine activities, such as tying his shoes, walking with an improved stride, and speaking with a clearer voice, have become possible again.
It's only data from a single patient, but it is good news. However, the experiment raises a number of ethical issues, an article in STAT points out .
First of all, the patient, Dr George Lopez, helped to fund the research. He is a former doctor and the founder of a successful medical equipment company. He also paid for the legal work needed to get FDA approval.
Scientific integrity. When a patient funds research leading to a clinical trial, "scientists can be incentivized to make decisions that are optimized for the patient-funder and not the science," said bioethicist Jonathan Kimmelman of McGill University.
Informed consent. While Lopez is a doctor who understands the risks, it is possible that his financial stake might have distorted his judgement.
Suborning researchers. "We want to believe that science advances where it's most promising. There is something deeply inequitable about a wealthy individual commandeering research resources," one bioethicist told Stat.
Secrecy. The experiment was published 32 months after Lopez had his first surgery. "That seems like an awfully long time," said bioethicist Alison Bateman-House of New York University's Grossman School of Medicine. "It's OK to wait until you have more data before disclosing results, but at least give us something in real time. You have an ethical responsibility to disclose what you've done, such as in a paper presented at a medical meeting."