Ethical and policy issues relating to progenitor-cell-based strategies for prevention of atherosclerosis.

OBJECTIVE: To examine important ethical and societal issues relating to the use of progenitor-cell-based strategies for disease prevention, particularly atherosclerosis. BACKGROUND: Several nascent lines of evidence suggest the feasibility of using progenitor cells to reverse the health consequence of atherosclerosis. Such potential uses of progenitor cells are scientifically exciting, yet they raise important ethical and societal issues. METHOD: The Working Group on Ethics of Progenitor Cell-based Strategies for Disease Prevention met to discuss the relevant issues. Several drafts of a report were then circulated to the entire Working Group for comments until a consensus was reached. RESULTS: Scientific evidence suggests the appropriateness of using progenitor-cell-based strategies for some rare conditions involving atherosclerosis, but additional preclinical data are needed for other, more prevalent conditions before human trials begin. All such trials raise a set of ethical issues, especially since trials aimed at prevention rather than treatment may involve persons who do not yet have disease but will be exposed to the risks of interventions. In addition, enrolment in prevention trials may be hazardous and harmful if participants erroneously believe experimental interventions will necessarily prevent disease. Finally, given the high prevalence of atherosclerosis, there are some important public policy implications of taking such an approach to prevention, including the sources of progenitor cells for such interventions as well as the allocation of health resources. CONCLUSION: Potential uses of progenitor-cell-based strategies for preventing atherosclerosis must be considered in the context of a range of social and ethical issues.

Pathophysiology of plaque instability: insights at the genomic level.

Atherosclerosis and plaque rupture represent complex "traits" of unknown cause that involve multiple genes and their variants. Novel genomic technologies provide us with the tools that will allow for the identification of groupings of genes that determine either susceptibility or resistance relative to the development of atherosclerosis and its thromboembolic complications. This information may, in turn, lead to a clearer understanding of the cause and risk for atherosclerosis. Diagnostic tools, as well as preventive and therapeutic strategies, will be derived from such heightened understanding of the disease process. With this chapter, we have presented the current state of knowledge of atherosclerosis genomics.