Stem cell surgery disputeComment on this story
Cape Town - The doctor who performed groundbreaking stem-cell transplants on a quadriplegic patient has been slammed by two professional bodies.
Tommie Prins, 32, from Milnerton, told the Cape Argus last week he was “honoured” to be the first known patient to receive the transplant in South Africa.
He had been paralysed while on a holiday on the Garden Route six years ago, when he plunged into the ocean, hit a sandbank and broke his neck.
Now, since operations at Melomed Private Hospital by Franschhoek-based neurosurgeon Adriaan Liebenberg on October 10 and 24, an extraordinary recovery had begun.
“I am very optimistic. Every day there are new muscle groups which wake up. We can see flexes in muscles which wouldn’t move before,” he said.
But on Monday, two professional organisations expressed concern.
Robert Dunn, a professor of orthopaedic surgery at UCT and head of orthopaedic surgery and orthopaedic spinal services at Groote Schuur Hospital, said in a statement to the Cape Argus: “These patients are extremely vulnerable and desperate for any improvement in their functional state.
“It is up to the doctor to protect them and act in their interest. In the case of stem cells in spinal cord injury, there is only animal model evidence of any benefit. This procedure is nowhere near the level that it should be used in humans outside of a strictly controlled scientific trial.”
Dunn said there were also recognised risks of implanting stem cells, including immune rejection and tumour development issues.
“It is also offering false hope at this point,” he charged. “In my opinion, the procedure should not be performed on current evidence.”
Asked about Prins’s apparent optimism, he said: “It is unfortunately false expectation. He is desperate and will believe anything, possible ignoring all risks, in the hope of functional improvement. We see this every day in our Acute Spine Injury Unit.
“Even if the stem cells were to initiate ‘new nerve’ growth it’s likely to be chaotic and non-functional. In addition it takes months to years for the nerves to reach their target, growing at 1mm a day. After 18 months or so, the muscle motor endplates (receptors) die and (should) the nerve reach them, they are unlikely to respond to stimulation in any event.”
Asked if patients should have the option of electing to have such transplants even if there are no scientifically proved benefits, Dunn said: “Only in a scientific study based on a probability of improvement from successful animal studies. There is no place for ad hoc, uncontrolled experimental surgery with wild claims and no evidence.”
The Cape Argus learnt on Monday that a number of South Africans had travelled to countries such as Brazil and India to have the operations.
But Dunn said: “We would discourage this based on the fact that there is no conclusive evidence of benefit in humans. One is never sure what is being injected as this can vary from animal stem cells to human. In addition there is risk of immune response and neurological deterioration, infection and tumour growth.
“These patients often make huge financial sacrifices to try this sort of intervention, with no chance of improvement.
These funds would be better spent on their supportive care.”
Sameer Nadvi, president of the Society of Neurosurgeons of South Africa, said the society was in complete agreement with Professor Dunn. “At present there is no scientific evidence that stem-cell therapy improves outcome in patients with spinal cord injury. In view of the vulnerability of patients, the costs involved and the ethical and legal issues around stem-cell therapy, we urge caution.”
Dr Liebenberg responds:
“I am not aware that Professor Dunn has any experience in embryonic stem-cell work. There is a wealth of literature to support the treatment. There are a multitude of animal models and… several human trials as well. Embryonic stem-cell derived cells have been implanted in human patients… in the US. The embryonic stem cells used in the US are non-autologous and therefore have another person’s DNA…There has been legislation in other countries that [has] hampered use of autologous embryonic stem cells but this has now changed in several countries. There is no law against use of autologous embryonic stem cells in South Africa. There is no risk of immune rejection as Professor Dunn claims as the cells we use in our technique are autologous.
“I do not believe we are offering false hope. I would not have performed the procedure if I did not believe there was a chance of improvement. The patient has the legal right to self-determination. This is a novel procedure with no other known treatment, there has been no prejudice against the patient [who] gave full informed consent [and who] had a full understanding of the potential risks and benefits… as did his family. We spent months in consultation with them and presented our findings to them in detail in helping them to make an informed decision.
“This operation is the culmination of seven years of laboratory work, animal studies, cadaveric studies and exhaustive research of international literature results. We are hoping the work we have done will prove conclusively that this kind of work MUST continue.”