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Chapter 20 : Medical Biotechnology in Society

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Medical Biotechnology in Society, Page 1 of 2

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Abstract:

This chapter provides relevant scientific and historical information relating to genetic testing and human embryonic stem (hES) cell therapies and describes some of the societal issues surrounding them. The risks of invasive diagnostic tests that require physicians to remove tissue samples are obvious, as are those based on X rays and injected dyes, radioactive molecules, or other imaging agents. Greater availability of gene-based diagnostic tests, made possible by the Human Genome Project (HGP), carries with it the same problems shared by all diagnostic tests. Genetic information differs from clinical measures because sometimes genes shed light on future health problems. The results of genetic tests might allow physicians to predict the possible appearance of cardiovascular or lung disease in the absence of any clinical symptoms. Using factual information and specific language in discussions of complex technical issues is always important; both become even more essential if the topic elicits strong emotional feelings about moral issues. Human embryonic cells have the potential to treat a variety of serious diseases, but some people find the derivation of embryonic cell lines to be ethically troubling. Government policies influence the direction of scientific research through funding, laws, and policies that encourage some types of research and restrict others. By directing the course of scientific inquiry, governments determine which medical advances occur.

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20

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Figures

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Figure 20.1

Diagnostic sensitivity and specificity and disease prevalence. The probability of receiving an inaccurate diagnosis is affected by the specificity and sensitivity of the diagnostic test and the prevalence of the disease being diagnosed. () Tests with higher specificity give fewer false positives, and tests with higher sensitivity give fewer false negatives. In both cases shown, 20% of the population had the disease. () The probability of inaccurately diagnosing a disease is related to the prevalence of the disease in the population being screened. Note the significant decrease in the number of false positives as disease prevalence increases, even though the sensitivity and specificity of the test do not change. This explains why disease prevalence affects a physician's decision to use diagnostic tests.

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
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Image of Figure 20.2
Figure 20.2

Genetic diagnostics. Physicians have used karyotyping to identify major chromosomal alterations for many decades. The sequence information provided by the HGP greatly amplifies the diagnostic power of karyotyping, because DNA probes, tagged with fluorescent tags, can be used to identify changes in single genes. In this case, some chromosomal changes that cannot be visualized with standard staining techniques are revealed. These cancerous cells have many numerical and structural chromosome abnormalities, including aneuploidy (changes in chromosome number) and deletions and translocations (multicolored chromosomes). Note that the chromosomal changes differ in the two types of cancer. () Normal. () Bladder cancer. () Brain cancer. (Micrographs courtesy of H. Padilla-Nash and T. Ried, National Cancer Institute, NIH.)

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
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Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
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Figure 20.3

Genes and observable traits. A single gene affects many traits, and any one trait results from the actions of many genes.

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
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Image of Figure 20.4
Figure 20.4

Genetic testing.The microarray test shown focused on a gene known to be associated with cancer. As you can see, there are other differences between the two genomes, but researchers know very little about how other genetic differences might affect the propensity to develop cancer. (Photograph courtesy of Jason Lang, National Cancer Institute, NIH.)

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
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Figure 20.5

Prenatal testing. Amniocentesis and chorionic villus sampling are prenatal tests for genetic and biochemical defects. In both procedures, fetal cells are withdrawn from the mother's uterus, cultured, and tested. Amniocentesis uses fetal cells that are floating in the amniotic fluid. Chorionic villus sampling removes a small piece of tissue from the placenta.

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
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Figure 20.6

Early embryonic development. The schematic representation depicts human embryonic development from blastocyst to gastrulation. Five days after fertilization, the blastocyst begins to implant into the wall of the uterus. By day 14, gastrulation has occurred, implantation is complete, and the pluripotent cells of the ICM have already differentiated into ectoderm, mesoderm, and endoderm. Therefore, they are no longer pluripotent. The trophoblast cells differentiate into placental tissues.

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
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Figure 20.7

IVF. After fertilizing a number of eggs in petri dishes, the clinicians nurture the fertilized egg through the first 5 days until it becomes a blastocyst. At that point, the embryo must be either implanted or frozen to survive. (A) Human sperm on the surface of the egg. (B) Day 2—four cells. (C) Day 3—eight cells. (D) Day 5—blastocyst. (Photographs courtesy of D. Waddell, Center for Microscopy and Microanalysis, University of Queensland, Brisbane, Australia [A], and Michael Vernon, West Virginia University Center of Reproductive Medicine, Morgantown, W. Va. [B to D].)

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
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Figure 20.8

Creating hES cell lines. Virtually all hES cell lines were derived from frozen blastocysts from IVF clinics that were being discarded with the parents' permission. The first successful attempts to establish hES cell lines from ICM (in 1998 to 2001) relied on a layer of mouse cells to support the human cells. As a result, the early lines are unsuitable for therapeutic uses because of possible contamination with mammalian viruses.

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
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Image of Figure 20.9
Figure 20.9

SCNT. The nucleus is removed from the egg on the left. A nucleus from a somatic cell is injected on the right. Note the small tear in the egg membrane and the tiny nucleus between the membrane and the cytoplasm. A nucleus is also visible in the pipette. (Photographs courtesy of Roslin Institute, Edinburgh, United Kingdom.)

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
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Image of Figure 20.10
Figure 20.10

Adult stem cells. () Some organs maintain a population of stem cells to replenish the cell types found in that organ. () For example, bone marrow stem cells can give rise to any of the cell types found in blood: red blood cells, various types of white blood cells, and platelets. Not all organs have a resident population of stem cells. Adult stem cells are multipotent but not pluripotent. Recent research indicates that adult stem cells may have more developmental flexibility than previously thought. (Photograph courtesy of NIH.)

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
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References

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Tables

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Table 20.1

Disease screening in asymptomatic populations

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
Generic image for table
Table 20.2

Possible outcomes of a diagnostic test

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
Generic image for table
Table 20.3

Genetic tests

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20
Generic image for table
Table 20.4

Neonatal screening for genetic disorders

Citation: Kreuzer H, Massey A. 2005. Medical Biotechnology in Society, p 509-534. In Biology and Biotechnology. ASM Press, Washington, DC. doi: 10.1128/9781555816094.ch20

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