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Aims: Bone marrow-derived mononuclear cell (BM-MNC) therapy may improve myocardial recovery in patients following acute myocardial infarction (AMI), though existing trial results are inconsistent., Methods and Results: Originally an open-label, multicentre Phase III trial, BAMI was designed to demonstrate the safety and efficacy of intracoronary infusion of BM-MNCs in reducing the time to all-cause mortality in patients with reduced left ventricular ejection fraction (LVEF, ≤45%) after primary angioplasty (PPCI) for ST-elevation AMI. Unexpectedly low recruitment means the trial no longer qualifies as a hypothesis-testing trial, but is instead an observational study with no definitive conclusions possible from statistical analysis. In total, 375 patients were recruited: 185 patients were randomized to the treatment arm (intracoronary infusion of BM-MNCs 2-8 days after PPCI) and 190 patients to the control arm (optimal medical therapy). All-cause mortality at 2 years was 3.26% [6 deaths; 95% confidence interval (CI): 1.48-7.12%] in the BM-MNC group and 3.82% (7 deaths; 95% CI: 1.84-7.84%) in the control group. Five patients (2.7%, 95% CI: 1.0-5.9%) in the BM-MNC group and 15 patients (8.1%, CI : 4.7-12.5%) in the control group were hospitalized for heart failure during 2 years of follow-up. Neither adverse events nor serious adverse events differed between the two groups. There were no patients hospitalized for stroke in the control group and 4 (2.2%) patients hospitalized for stroke in the BM-MNC group., Conclusions: Although BAMI is the largest trial of autologous cell-based therapy in the treatment of AMI, unexpectedly low recruitment and event rates preclude any meaningful group comparisons and interpretation of the observed results., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)

A central problem for the international governance of heritable germline gene editing is that there are important differences in attitudes and values as well as ethical and health care considerations around the world. These differences are reflected in a complicated and diverse regulatory landscape. Several publications have discussed whether reproductive uses would be legally permissible in individual countries and whether clinical applications could emerge in the context of regulatory gaps and gray areas. Systematic comparative studies that explore issues related to the governance of this technology from different national and international perspectives are needed to address the lack of knowledge in this area. In this research report, we contribute to filling this gap by presenting views of stakeholders in the United Kingdom on challenges to the governance of heritable genome editing. We present findings from a multistakeholder study conducted in the United Kingdom between October 2016 and January 2018 and funded by the Wellcome Trust. This research included interviews, literature analysis, and a workshop. We involved leading U.K. scientists, in vitro fertilization clinicians, and representatives from regulatory bodies, patient organizations, and other civil societal organizations, as well as fertility companies. Part one of this article explores stakeholder perceptions of possible global developments in heritable genome editing and associated risks and governance challenges. Part two presents a range of policy options that were generated during the workshop in relation to the challenges discussed in part one., (© 2019 The Hastings Center.)

Current European regulations hinder the compilation of the evidence that would be required to bring safe and effective autologous stem cell-based interventions (SCBIs) into standard clinical care. European agencies have expanded their regulations to cover all new SCBIs and research. They establish demanding conditions for cell retrieval, processing, and application. Drawing on empirical sociological findings from the implementation of the first phase III stem cell clinical trial in Europe, this article examines ethical problems effected by that policy, such as that the costs of bringing treatments to market means new autologous SCBIs may remain untested and that this plays in favor of the growing direct-to-consumer market, and that the research pathways in regenerative medicine and the role of clinician-scientists in developing new treatments are restricted, because the regulations are biased to enable specific SCBIs that are of interest to industry. This situation contradicts the moral and social concerns in favor of new treatments and patient interests, which the regulations supposedly safeguard. To align the aims and effects of policy better, European regulatory authorities should reconfigure their regulations to advance a fair and effective governance regime that allows pursuit of all promising SCBIs.

Harmonized regulation of research with human stem cells in Europe has shaped innovation in regenerative medicine. Findings from a Phase III academic clinical trial of an autologous cell procedure illustrate the obstacles that a multinational trial faces. A typology of the obstacles encountered, may help other teams embarking upon trials. The findings throw light on the situation of clinician-scientists in clinical innovation, as the expertise to run scientific trials is very complex. The innovation route of clinical translation takes insufficient account of the interdependencies between multiple social and cultural factors from outside the laboratory and the clinic. For ethical reasons, however, academic and business routes to stem cell treatments ought to be enabled by the regulators. Suggestions arise, how academics can prepare for trials, that academic research needs better institutional support and that new models of medical innovation may need to be developed for regenerative medicine.

Clinical applications of biomedical research rely on specialist knowledge provided by professionals who straddle research and therapy, and possess both medical and scientific expertise. To date, this professional group remains under-explored in sociology. Our article presents a case study of clinician-scientists working in stem cell research for heart repair in the UK and Germany who are engaged in double-blind randomised clinical trials using patients' own stem cells. The analysis draws on sociological and medical literature, interviews and ethnographic fieldwork to analyse the experiences and self-rationalisations of a small number of clinician-scientists and the ways in which these professionals portray, explain and justify their role in the wider clinical research environment. We examine our participants' views on the clinical trials they conduct, the challenges they encounter and the ways through which they negotiate a complex disciplinary terrain, and argue that the recent clinical implementation of stem cell research brings clinician-scientists to the fore and provides a renewed platform for their professional legitimisation. The article helps increase our understanding of how randomised clinical trials are involved in consolidating the individual status of actors and the collective standing of clinician-scientists as leaders of change in translational medicine., (© 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.)

Translation from the laboratory to the clinic is one of the key problems of stem cell research. One reason for this is that stem cell science is ethically charged and therefore its successful therapeutic application would support its social legitimacy and further funding. We discuss translation both theoretically and with reference to an example, namely efforts regarding the creation of cardiomyocytes from embryonic stem cell lines with the aim to regenerate a patient's myocardium post trauma. Using this case we explain the facts that need to be established scientifically and the subsequent steps that need to be taken in order to develop and implement clinical application. We also discuss aspects of current scientific development related to the moral charge of the research, in particular emerging methods aimed at the derivation of pluripotent cells, such as the hybridization of human DNA and animal egg cells, or the genetic modification of adult somatic cell nuclei in culture to induce pluripotency.

This paper aims to show that references to genes and genomes are counterproductive in legal and political understandings of what it is to be human and a unique individual. To support this claim, I will give a brief overview of the many incompatible meanings the term 'identity' has gathered in reference to genes or genome in the contexts of biology and family ancestry, personal identity, species identity. One finds various and incompatible understandings of these expressions. While genetics is usually considered to deliver definitive knowledge about history and the future, genomics seems to work with more complicated relations between DNA, inheritance and phenotype. In genomics, 'identity' is no longer about identification and status markers but about individualization. Regulatory and legal documents project from traits to genomes, implying that individuality is at least represented, if not created, in a unique genome. Boundaries between humans and other animals, between different 'kinds' of humans, and between all individual humans are re-established via reference to the chemical matter of DNA. My analysis will show how this trend is a reactionary response to modern understandings of identities as social products and that it ignores new biomedical understandings of human bodies.

This article aims to show how the traditions of ethical reasoning and policy-making shape stem cell research in Britain. To do so I give a detailed account of the earlier developments of regulations on embryo research and the specific scientific advances made in Britain. The subsequent regulation of stem cell research was largely predetermined by those structures and the different and partly opposing orientations of a utilitarian approach to policies on biomedicine. The setting up of the first stem cell bank and the directing of public funding into not only bioethical but also sociological guidance of the development of the new science field are aspects of the particular British way of supporting stem cell research. However, there is also an ongoing philosophical and juridical debate on the possible erosion of fundamental values caused by incremental regulatory weakening. Although I am highly sympathetic to the critical position that there is a need for a metaphysical anchor to secure individual human rights, one has to admit that the British mode of handling the inevitable ethical problems we face with biomedical progress is rather successful in terms of securing some of the basic needs and values of a modern democratic society.