Introduction

Procuring fetal tissue for research and treatment has recently become politically controversial in the United States. The result has been to obscure professional responsibility in this matter, which has been a disservice to the medical community and the patients who can and do benefit from resulting medical advances. In this commentary we explain why the use of fetal tissue for research and treatment should not be controversial but, instead, viewed as a professionally responsible success story.

A brief history of fetal tissue research and treatment

The 1954 Nobel Prize in Physiology or Medicine was awarded to John Enders, Thomas Weller, and Frederick Robbins for the discovery of the ability of poliomyelitis viruses to grow in cultures of various types of tissue. Although great progress had been made in fighting bacterial infections in the prior decades, viruses were difficult to cultivate. Preventive or therapeutic agents were therefore mostly unattainable. Although animal models are informative for many diseases, viruses are often species specific, so nonhuman studies were often not informative. As early as the 1930s, Olitsky et al had attempted to grow poliovirus in cultures of chick, mouse, monkey, and human embryo cells. Only the human brain tissue from embryos that were the product of induced abortion was successful as a host. This line of research was continued by Enders et al who found that the virus could be grown in cells from numerous embryonic tissue types in addition to neurons. Ultimately, these advances in human embryo-derived viral culture advanced the field and led to the ability to cultivate varicella, measles, and numerous other viruses. This research was instrumental in the ability to produce viruses to study and develop vaccines. Without such research, the polio vaccine and other vaccines may not have been developed or may have been delayed by decades.

Although the teratogenicity of congenital rubella was known since the 1940s, progress in understanding the disease and developing vaccines only came later, when research was undertaken on embryonic and fetal tissue from patients who opted for termination because of acquisition of rubella in pregnancy. The tissue from those aborted embryos and fetuses was used both to purify virus and to understand viral host reactions. Research using cadaveric fetal tissue led to the development of the rubella vaccine and the subsequent elimination of congenital rubella in the Americas, thereby decreasing the need for induced abortion due to congenital rubella.

More recently, fetal tissue became a cornerstone of some of the most promising therapies for Parkinson disease and other difficult-to-treat adult conditions. More than 100 patients with Parkinson disease have received cells transplanted from the midbrain of aborted embryos. Initial studies indicated that the patients most likely to benefit were young, had early-stage disease, and had large numbers of cells of fetal origin integrated. Those studies were used to help design a new trial of 150 patients in Europe. Although there is hope that pluripotent stem cells may provide an alternative in the future, “right now the fetal cell is the gold standard we need to match.”

Cadaveric fetal tissue benefits scientific research across many fields, including physicians and scientists who may not even realize its contribution to their work. The HEK293 cell line originated from the kidney cells of an aborted embryo. Due to the ease of transfection, and the subsequent ease of production and purification of human proteins, they have become ubiquitous in research. A PubMed search for “HEK293” reveals >28,000 articles. Studies in the American Journal of Obstetrics and Gynecology in areas as diverse as preeclampsia, fetal drug exposure, and placental gene transfer also utilized this cell line. The cell line can be purchased from repositories. Protein production can also be outsourced to companies that maintain these cell lines and will transfect and purify the protein of interest. These cells have been used in the development and production of therapeutics.

A brief history of fetal tissue research and treatment

The 1954 Nobel Prize in Physiology or Medicine was awarded to John Enders, Thomas Weller, and Frederick Robbins for the discovery of the ability of poliomyelitis viruses to grow in cultures of various types of tissue. Although great progress had been made in fighting bacterial infections in the prior decades, viruses were difficult to cultivate. Preventive or therapeutic agents were therefore mostly unattainable. Although animal models are informative for many diseases, viruses are often species specific, so nonhuman studies were often not informative. As early as the 1930s, Olitsky et al had attempted to grow poliovirus in cultures of chick, mouse, monkey, and human embryo cells. Only the human brain tissue from embryos that were the product of induced abortion was successful as a host. This line of research was continued by Enders et al who found that the virus could be grown in cells from numerous embryonic tissue types in addition to neurons. Ultimately, these advances in human embryo-derived viral culture advanced the field and led to the ability to cultivate varicella, measles, and numerous other viruses. This research was instrumental in the ability to produce viruses to study and develop vaccines. Without such research, the polio vaccine and other vaccines may not have been developed or may have been delayed by decades.

Although the teratogenicity of congenital rubella was known since the 1940s, progress in understanding the disease and developing vaccines only came later, when research was undertaken on embryonic and fetal tissue from patients who opted for termination because of acquisition of rubella in pregnancy. The tissue from those aborted embryos and fetuses was used both to purify virus and to understand viral host reactions. Research using cadaveric fetal tissue led to the development of the rubella vaccine and the subsequent elimination of congenital rubella in the Americas, thereby decreasing the need for induced abortion due to congenital rubella.

More recently, fetal tissue became a cornerstone of some of the most promising therapies for Parkinson disease and other difficult-to-treat adult conditions. More than 100 patients with Parkinson disease have received cells transplanted from the midbrain of aborted embryos. Initial studies indicated that the patients most likely to benefit were young, had early-stage disease, and had large numbers of cells of fetal origin integrated. Those studies were used to help design a new trial of 150 patients in Europe. Although there is hope that pluripotent stem cells may provide an alternative in the future, “right now the fetal cell is the gold standard we need to match.”

Cadaveric fetal tissue benefits scientific research across many fields, including physicians and scientists who may not even realize its contribution to their work. The HEK293 cell line originated from the kidney cells of an aborted embryo. Due to the ease of transfection, and the subsequent ease of production and purification of human proteins, they have become ubiquitous in research. A PubMed search for “HEK293” reveals >28,000 articles. Studies in the American Journal of Obstetrics and Gynecology in areas as diverse as preeclampsia, fetal drug exposure, and placental gene transfer also utilized this cell line. The cell line can be purchased from repositories. Protein production can also be outsourced to companies that maintain these cell lines and will transfect and purify the protein of interest. These cells have been used in the development and production of therapeutics.