Genetic testing in the 21st century (8 March 2011)

[ Silence ]>>Dr. Harper: [Inaudible]
pleasure, pleasure, pleasure for me to be
here and to invited to give this lunch hour lecture. And I work at UCL just around
the corner, at UCL Center for Pre-Implantation Genetics
and Diagnosis, and I also work at the CRGH, which is the
Center for Reproductive and Genetics Health,
which is the IVF unit, the private IVF unit at, at
the Eastman Dental Hospital. And both of these departments
fall under the Institute for Women’s Health, which is a
quite new institute within UCL, and I also helped set up the, the ESHRA [phonetic] PGD
Consortium, which we set up in 1997, and I’ve been
chair of this for many years, and ESHRA is the
European Society for Human Reproduction
and Embryology. I’m going to show
you some of the data from the ESHRA PGD
Consortium during my talk. But I want my talks to
be quite controversial, and I want to give you
some food for thought. So this is what I’m
going to cover. I’m just going to give
you the very basics of in vitro fertilization. I wish I could give you a
whole lecture about that. There’s some really interesting
things that are happening, again, some quite
controversial things. I’ll touch on a very few of
those, but I’m just going to give you some basics,
and then just a little bit about where we are
currently with genetic testing and where we’re going to go in
the future, and then concentrate on what we do here at UCL,
which is pre-implantation, genetic diagnosis where
we’re testing embryos for genetic disease, and
then I’m going to finish off with some ethical thoughts
and also the future, and I hope to leave you
with some food for thought on maybe things that
you’d like to, to go read up a little
bit more on. So where did this all start? Well, it all started
in the 70’s. There were a number of
groups around the world that were trying to help
infertile couples have children. So what they wanted to do was
collect the eggs and the sperm and mix them in the laboratory,
so in vitro, to generate embryos and then transfer these
back to infertile patients and help them establish
a preg, pregnancy. It was actually, Bob Edwards
here along with Patrick Steptoe, but were the first who
actually were successful in getting a delivery,
and this was Louise Brown that was born in 1978. This is a picture
of her at the top with her, her, her own child. And we were all very pleased, everyone in the field
was pleased that Robert Edwards last year
was awarded the Nobel Prize. And this is something that probably affects
some of you in this room. It certainly affected me. This is a picture of
my son at the bottom. He was born by IVF. He’s, he’s eight now,
and I also have IVF twins that were born after
frozen embryos. So I’m sure some of you here are
also touched by these things. So how do we do IVF? Well, for IVF, we,
the basic procedure that we use is we stimulate the
woman to produce multiple eggs, and when we collect the eggs,
I’m, I’m sorry, the laser point. Oh, it does work. Someone said it didn’t work. It does work. Good. [laughs] This is the human
egg here, and you should just about see, but you will see
this in the next photos, there’s a membrane
surrounding the egg. It’s like a shell. We call it the zonapalusida
[phonetic]. It’s a special block
of protein coat, and these cells are
radiating in the cumulus cells which help nourish the
egg at the early stages. So we collect these eggs from
a woman, normally about eight or ten eggs, we mix it with
a prepared sample of sperm, and then we monitor
that in our laboratory and watch the development. Now, in the, in the 197, 1992,
the group in Brussels led by Palermo Van Sterticum,
they developed a technique to help male infertility. So if we have men with
very low sperm counts, or even with no sperm
in their ejaculate, but they are producing
sperm in the testes, which we can aspirate, we can
take these very low numbers of sperm, and we can do
this procedure called ICSI. And you’ll see here,
there’s the sperm there. It’s been injected. This is the zonaplusida. Here it’s being injected
through there. It’s being pierced into
the center of the egg. We’re sucking up some
of the cytoplasm here and then depositing,
and this here was done by [inaudible] at the CLGH. And this, this procedure is
used internationally now. Is, I don’t think there’s any
IVF unit that’s not doing ICSI for male infertility. And as you can see, it’s quite
a, quite an invasive procedure and quite different to nature. So I, I hope that’s probably the
first food for thought what we, what we’re actually doing
with this technology. But in the IVF lab,
we’ll monitor the embryo if it’s created by
ICSI or by just nicks in the eggs and the sperm. We’ll then monitor the embryo. On day one, we hope
to see fertilization. This is a zygote. This is a, the male and
female [inaudible] here, and these structures here
are called the polar bodies. They’re excess from
the formation of the egg during myosis. And we’ll monitor the embryo
for the next few days. They’ll start to divide, and this is a two-cell human
embryo, and then a four cell. And then next day,
hopefully on day three, this is a really lovely
eight-cell embryo, and over the next few days, we
can still monitor the embryos, and they perform
blastocysts, and they will hatch from this zonaplausida, and
if they’re in the uterus, these are very good embryos,
and hopefully they’ll implant in the uterus and
lead to a pregnancy. As of these stages that in
IVF we normally transfer the embryos. We normally transfer
them either on day three or what’s becoming popular for certain patients
is blastocyst transfer. So let’s move onto
genetic testing. We’ve got the basics
of how we do IVF. Well, the molecules of, of life
of these, the DNA, and the DNA, as I’m sure you know, is
packed in chromosomes, and it’s formed by
this double helix. And the genetic code
is what we want to look at in genetic testing, and
the genetic code is made up of these basis, these G, C,
A, and T, which is shown here, and that’s what we’re
going to look at to see whether
there’s a genetic disease or any gene, other
genetic issue. So genetic disease is there can
be chromosome abnormalities. So these are quite
gross abnormalities where there’s maybe two
chromosomes of break, broken and swap around
their genetic material which is transforcations
[phonetic], or there could be other types
of inherited abnormalities with the chromosomes, or we
can be right down at the level of the gene, and there could
be errors, very small errors, even sometimes just one base
is wrong in the genetic code for a gene, and then we
can see that this leads, this can lead to a disease. And there’s three main
ways, well, actually, genetics has got much more
complicated in recent years, but there’s basically
three main ways that the single-gene disorders that just affect one
gene are transmitted. Recessive is where
both the parents have to have a faulty
gene to be at risk of transmitting that
to their child. So the child will only
have the disease if both of the genes are faulty, and that totally
knocks out the gene. You can get dominant
diseases where just one cup, one of the couple
carry the faulty gene, and these are often
late, onset diseases. So the person carrying
the gene may well get that disease later in life. And then exiting diseases
are carried by the mother. These are genes that are
abnormal on the x chromosome. They’re carried by the mother
and by females in the family, but they’re transmitted
to the males, and the males can be affected. So that’s sort of
genetic diseases. How we do, do, do we
do the genetic testing? And there’s, again,
many, many ways. I’m just going to show you the
main methods that have been used for genetic testing, and
many of these have been used in the human genome
mapping project. So if you want to
look at chromosomes, the gold standard
technique that has been around for decades
has been karyotyping, and this is where we band the
individual chromosomes and look at their banding pattern to see whether the chromosomes
are normal or abnormal, but these, this method
does not tell us anything about the genes. We can also use a technique
called fluorescent institute hybridization, which uses
little fluorescent pieces of DNA that bind to specific
chromosomes, and this is a fish image here. These will light up just
specific regions of chromosomes. Now, if we want to look at
genes, so if you want to look at a specific gene abnormality, the main technique has been
the [inaudible] chain reaction, and it’s like a molecular
photocopy. It will just copy the
sequence of a gene many, many times so then more
detailed analysis can be formed on that product to see what’s
happening with those genes. And something that’s
becoming very, very popular now is
actually sequencing. So this picture here is a
sequencing of a gene, of, of an area of a gene or even an
area of DNA that’s not coding for a gene, and you can see
here, here’s the basis, TTGTA, and these peaks are telling us
actually what base is present in what position in that
particular sequence. But what’s happening
in the future now, so you can actually see
this, there’s lots of dots, yellow dots on this
picture here, but they’re a new technology
that’s coming in now is the use of a rays or microchips, and
these arrays can tell us a lot of information about just even
one cell from an individual. And the two techniques of
array comparative genomic hybridization, or CGH. This is a method where you can
look at all of the chromosomes in a cell in, in one go, and
I’ll show you some images of that, and the other is a, a type of array called single
nuclear type polymorphism array, and this is a method where
we gain a huge amount of information from that
sample that we’re looking at. We, we, we look at the
chromosomes, but we also look at the genes, and we can find
out a lot of information. The trouble with these
[inaudible] arrays is at the moment, we really don’t
know how to interpret a lot of the information that we get. So it’s, it is being used,
brought in very slowly into the genetic
diagnosis arena, but what this information means,
we’re still trying to work out. So that’s the array CGH
and [inaudible] arrays. So when can we do it? If a couple have a child
or there, there’s an adult in the family that we think
has got a genetic problem, then we can take some of their
blood and do those genetic tests for the problem we think
they’ve got and see if we can find the genetic
reason for the abnormality. And if we find the genetic
abnormality in a family, we may decide to test the rest
of the family to try and see who else is at risk and, and
find out as much information as we can about the
genetics of that family. We would normally do a pedigree
analysis where we analyze as many of the family as we can. But there’s certain genetic
diseases that are specific or, or certainly very prevalent in
certain groups of, of patients and certain countries and
certain ethnic groups in, in different countries. So, for example, in Sardinia,
they have a, a, a huge issue with beta thalassemia,
which has pockets of, of problemed areas
throughout the world. And so in these populations
where there at very high risk of a specific genetic
disease, they may do screening where they screen the population
to find out if anyone’s at risk. But what’s happening more now is that there are certain
groups of, of cultures that are actually
testing before marriage. So those, I’ve heard that there
are several cultures that are, that do arranged marriages. They don’t just look at your
family and your income, etc., and your, whether you’ve been
to university, they also look at your genetic code and see
whether you’re carrying any genetic diseases. I’ve heard, heard this one,
three very different groups of, of, well, different countries where this is now become
quite common practice. So if this, if we’re
finding that the family or an individual is at risk of
transmitting a genetic disease, then the couple have to decide
what they would like to do, if they want to try and
have a, a family that’s free from this disease, and
the main techniques that are offered to them. There are several others,
but the main procedure that people would go through if
they want to have a family with, without that genetic
problem is an amniocentesis or a chorionic villus
sampling, and this is done where the person’s
already pregnant. So the woman’s pregnant. An amniocentesis, we take
a bit of the amniotic fluid that surrounds the
fetus and tests that, and chorionic villus sampling,
we take a bit of the placenta, and we do the genetic
testing on that. So the main problem with prenatal diagnosis is the
pregnancy’s already established. So if the couple feel that
this disease is very serious, and they, they do not want to
transmit this to their child, they have to decide if they want
to continue with the pregnancy, or whether they want to undergo
termination of pregnancy, and for any family,
this is a terrible, terrible decision
to have to be in. So this is why pre-implantation
genetic diagnosis, testing the embryo, the early
embryo before it actually implants, this is exactly why
this technique was developed. Now, pre-implantation
genetic diagnosis. Sorry, I meant to
turn the lights down. Anyway, but here,
[inaudible] [laughs]. [background noise] I
believe that’s not easy. No, I can’t do that. Maybe I can turn the lights
down, oh, they all turn on. It’s great. We are high tech. Sorry, this picture’s
a bit dark. So PGD was actually developed at the Harrisbooth
[phonetic] Hospital. So we’ve been very good
in the U.K. We’ve got the, the first IVF baby, which was
from [inaudible] in Cambridge and at the Hammersbooth Hospital
in 1988 with the first PGD baby, and I hope you can
just about see there. This is an, an old
picture of us in, in Israel at a conference
in the early 90’s. This is Alan Handiside,
who was the embryologist that was involved with the first
PGD, and Marilyn Monk is here, who was also one of the
pioneers that did a lot of the mouse work, and
this is Robert Winston. I think you all know
who, what he looks like. So he’s, he’s there, and he was
the clinical person involved. That’s me actually. This is Mark Hughes who’s
also been very involved. He, he, he’s from the U.S.,
and he came to the Hammersmith in the early 90’s,
and he was involved with diagnosing the first
PGD for cystic fibrosis. So now this has spread
throughout the world, and there’s many, many centers
that, that do this procedure. So how do we do it? There’s two stages. The couple have to
go through IVF. We get the embryos in our lab,
and we’re going to take out some of the cells from the
embryo, and then we’re going to do our single-cell diagnosis. And there’s three stages
that we can take cells. I mentioned when I showed you
the zygote those polar bodies. There’s two polar bodies that
are formed during formation of the egg, during
ugenesis [phonetic], and these can be taken out, both
of these in polar b, biopsy, they can be taken out, and
from them we can determine a reflection of what
the chromosomes and the genes are
within the egg. So this will only tell us
about the mother’s genes and the mother’s chromosomes. It will not tell
us anything else about the actual
embryo’s chromosomes because then we’ll have
the paternal contribution. The majority of centers
have done this procedure, which is called cleavage
stage biopsy, and this is how we
originally did PGD, and it’s still the most common
procedure today, and I’m going to show you a video of
how we take these cells from the embryo. But now a lot of
people are doing it at the blastocyst stage, at
about day five of development. You can take these trifectodom
[phonetic] cells which are going to go up and make the placenta. It doesn’t actually affect the
inner cell mass which will go and make the, the fetus, but
you can take these and find out about the genes
of the embryo. So this is a, a short video
showing you embryo biopsy, and the first stage
there was making a hole in the zonapalusida [inaudible]. So here’s the [inaudible],
you can just about see that around the outside, and
we need to make this hole so that we can gain access, and
this prepack here is just going to gently aspirate one of
these cells from the embryo. A trifectodom biopsy
is very similar. We’re just going to take from the trifectodom
cells from the embryo. So once we’ve got our single
cell, then we can apply the, the diagnosis to that. [ Background Noise ]>>Dr. Harper: So for PGD,
we use the same techniques that are used in
genetic testing. We can use PCR to look at
mutations in specific genes. We can use fish to look at
chromosomes, and we can also, more recently, are
using these arrays. This array comparative
genetic [inaudible] and these single nuclear
type polymorphism arrays, and I haven’t got time,
unfortunately, to tell you more about them, but if you visit
this paper that I wrote with Gary Hartan last year,
we’ve written a review on the current use
of arrays in PGD. So this is some of
the data from ESHRA. In ESHRA, we collect data every
year, and we publish this data, and you can find these, these
papers are in Open Access, and you can get these on
the ESHRA [inaudible], the ESHRA website,
the PGD Consortium, but the most common diseases
that are diagnosed are those that are very serious diseases
and those that are very, very common in, in the
general population. Something I’m going to bring
in, in is testing for things that are not so important
and not so life threatening. In the U.K., we are very lucky. We are governed by the
Human Fertilization Em, Embryology Authority. Hopefully still in
the future, their, their future is a little
bit bleak at the moment because they’re merging
with another big group, but at the moment, the HFEA
regulates all the diagnoses that we do. So to do a genetic
diagnosis, we have to, by PGD, we have to have permission
from the HFEA, and if you’re interested in
what is and what is not allowed at the moment, if you
go to the HFEA website, it will list everything
that they’ve licensed. All the diseases that
are licensed for by PGD. And there have been some
controversial ones on there that have been actually
slightly taken out of content. There was one that said that,
that they’ve licensed a PGD for a squint, and it’s
not actually a squint, it’s actually a much
more involved disease, and also diseases do vary
in different families. As I said, genetics is not
that, that easy anymore. It’s, things that
get very complicated. And this is, so what we’ve done in our own center using this
array CGH, Siobhan Sanguta is in charge of all our
diagnoses, and this was one of our Ph.D. students,
Famina Mamus, who has taken single cells and
applied these on this array, and from this, we
can look at all of the chromosomes
from a single cell. So these are the chromosomes
listed here, 1 to 22 plus x and y, and anything
within this line is normal, anything above the line there’s
an extra copy of the chromosome, and so this one’s
actually trisomy 10, there’s an extra copy of chromosome 10 in
this single cell. And in this cell here, you might
see there’s several chromosomes below the line and
several above the line. This is a, a very,
very abnormal cell. Now, I just want to briefly
mention a slight tangent to PGD, and that’s that this
technology has been used for a slightly different aim. Rather than patients
with, inherit, specific inherited disorders,
the technology’s being used as something that’s being
called pre-implantation genetic screening, or PGS, and this
is using the techniques that we look at the
chromosomes, not specific genes, but just looking at the
chromosomes, and using this in our IVF patients, so
these are infertile patients, to help embryo selection. We certainly know that
as women age, the, the chromosomes are more
likely to be abnormal. There’s an increase
in Down’s syndrome, etc. So this technique has
really been used to try and improve delivery
rates in these couples and help identify abnormal
embryos, but, unfortunately, there’s no evidence
at the moment to show that this does improve delivery
rates, and there’s been a lot of press about this because
there’s people say, oh, we can get a 70 percent
pregnancy rate using this technology, but, unfortunately,
there is no data at the moment to show that this procedure
does help delivery rates. But I wanted to explain that to
you because this is a summary of our data, and we did the
last publication last year. There’s another due
out this year. These are the years of our data
collection, and this is PGS. You see PGS, this genetic,
or chromosome analysis for infertile patients
actually counts for more than all the PGD’s put together. So we separate the
genetic disease into sexing [inaudible] disease,
chromosome abnormalities, and monogenetical
single-gene abnormalities, but I want to point out
here now social sexing. And this is a controversial
use, and I’m going to come back to that
in a moment. So if the issues around PGD have
been not that we’re using it to help couples that are at risk of serious genetic abnormality
have a, a, a normal child, but that we’re designing babies. That we’re not designing
anything. If we’re designing babies,
we’d be doing gene therapy and moving the genes around
and changing everything. We are selecting the embryos
that those, those patients have, and putting back embryos that
are free from a genetic disease. We are selecting, but
we’re not designing. But this headline here
is “Babies Created to Save Their Brother.” And the, probably the most
famous case of this is, there’s a famous
basketball player called, called Carlos Boozer, and he had
a child here that was affected by sickle cell disease,
and this is a very, very serious disease of, of
the blood, and the only way that he could cure this child
was by having some stem cells or some cord blood
from a matched donor, and the best matched
donor is a sibling. So what they did is they went
through PGD, and this was with Mark Hughes in the
U.S.A. They went through PGD. They made sure that the embryos
that they were going to pick for transfer did not
have sickle cell disease. So that was number one. They did PGD for sickle cell
disease, but they also made sure that they had embryos
that were tissue matched for the already existing child,
and they were very lucky. They these twins,
twins delivered. They took the cord blood
after delivery of these twins, and they used the cord blood
cells to cure sickle cell in this child, and as a
result, Carlos has donated a lot of money to help PGD,
especially in Africa for couples that are having sickle
cell disease. Now, I just wanted to show you. Some of you may have read the
book “My Sister’s Keeper,” or you might have
seen this movie, and this is exactly
the same situation. This is a, a family that are
going [music] through PGD ->>Most babies are accidents.>>Oh, how did you know that?>>Not me. [background noise]
I was engineered. Born to save my sister’s life.>>Dr. Harper: Oops. Sorry. So that child, as
they sit there, she was born to save her sister’s life,
and the child actually in the movie that’s already
existing has actually leukemia, and they went through
PGD in this story to use the cord blood,
but then that didn’t work, and the book’s very
different to the film. I won’t say anymore,
but I just want to show you how Hollywood
shows this. So going back to sex selection,
some couples feel that, well, certainly in the Western
world, I think, I think we look at everything as a commodity,
and people really want to have a boy and a girl. That seems to be
the perfect family. I have three boys, and I
can’t imagine having a girl in my family [laughs], and
people keep saying to me, are you going to try for a girl? No, I’m not going
to try for a girl. But this is how so many think. Perfect family, a
boy and a girl. Oh, they’re so lucky. They’ve got a boy and a girl,
and it’s supposedly banned in all European countries,
but certainly if you do this, and you [inaudible] PGS it
does also determine the sex, and I know many patients
that have actually come to us and said that they’ve had
sex selection in a number of European countries. So it’s much more
widespread than reported, and it certainly is
legal in some countries. It’s legal in Australia,
and it’s legal in the U.S., and it’s being done a
lot in the Middle East, for example, in Jordan. They have a very
active PGD program, and they’re mainly
selecting boys. It’s something like 98 percent
I’ve been told were selecting boys, and this is the trouble. In the developing world,
many cultures do want boys. I’ve been told by a number
of Indian obstetricians that in the labor wards in,
in India, if it’s a boy, everyone’s dancing
in the corridor. If it’s a girl, everyone’s
very quiet. And I’ve been told
that a number of times, and I think people should
had a read of this book “The First Century
After Beatrice.” Excellent book where a
pill’s developed where, when the woman takes this
pill she only has boys, and the problem, the
international problem that develops in this is
from the developing world. There can be no, not enough
women to support the population. Robert Winston once said on TV his sperm can fertilize
the whole of the U.K., which I, did make me slightly worried. [laughter] But he’s right. He is right. If, if, in a population,
to sustain the population, you only need a couple of men. They produce millions of sperm. It takes nine months for
a woman to have a child, and just briefly would like
to show you this video, [crosstalk] would you
trust these guys ->>I’m Daddy Clay ->>And I’m Daddy Brand. Whether or not they’re
willing to admit it, many of the expected parents
out there, for whatever reason, have a preference
– boy or girl ->>And there are a lot
of wives’ tales out there about what you can do
to make a boy or a girl.>>Dr. Harper: I, I find
that a bit worrying. I found that very easily on
the Internet, and I’d just like to take that a
little bit further. Someone said I shouldn’t show
this because I might get sued. But if we look at Victoria
Beckham, there was a number of articles about
what she should do to have a girl or a boy. She made it very clear
that she wanted a girl. They, as she didn’t mention PGD, they said she should eat more
cheese, delay motherhood, get stressed at work, or look
at the time to conception. They didn’t mention
PGD, and then, of course, she’s got three boys. I don’t know why
she wants to go, I’ve heard she wanted a girl. [inaudible] [laughs] I
think she, she wanted a girl for various reasons, but this,
obviously, then confirmed that she was carrying a baby
girl, and they were living in the U.S. at the time. So I don’t know whether
they did go through PGD. I always felt like [inaudible]
well, if you really want one, you should go through PGD. So there’s a number
of ethical concerns. It’s to save the siblings, the
tissue matching I mentioned, sex selection, but the issue around PGD has always been
the non-life threatening, who decides, and these
[inaudible] arrays, this is going to be a problem
because this will be a situation where we can test
for almost anything. And this is an article that
came out I think in January where pre-conception tests
allowed prospective parents to screen for flawed DNA, could
eliminate childhood diseases, and it says here,
“Will be available in British fertility
clinics within months.” Well, I don’t know,
I don’t know exactly. We didn’t really say
what was going on there, but it’s not available yet. So is this designer baby
no longer fashionable? Well, let’s look at
some food for thought. We’ve got frozen eggs here, fre, freezing of human eggs now
is, is very successful. The, I think I believe in
the U.S., they’re going around campuses and telling all
the girls to freeze their eggs so they can delay motherhood. We’ve, we will, I’m
sure, have super eggs. For, for many years, we’ve
been able to go to a sperm bank in the U.S.A. and buy Nobel
Prize winners’ sperm [laughter] if you want to do that. We’ve got Dolly the sheep here. I’m going to [inaudible], just very briefly mention
stem cells as I finish off. Another book to revisit,
“Brave New World.” Are we that far away,
and I’m going to finish off showing you
a clip from “Gattaca,” but let’s look now
at the celebrities. So here you’ve got Elton John. They were refused adoption, but
they could use the technologies that we’re looking at. So here’s some famous
couples that have adopted. They’re accessory, their child
[inaudible] that they want from the particular
ethnic group to, to add to their, their brood. Most people wouldn’t do
that, but, obviously, that’s something they do, and
where are we going from that. Where going from, to egg
donation and also to surrogacy, and you may have been
aware, just read the title. “Another Day, Another
47-Year-Old Celebrity Pregnant with Twins.” And this is a website about egg
donation, and it lists a number of famous people there. Ob, obviously, of very
advanced maternal age. So they probably wouldn’t be
getting pregnant naturally, and then surrogacy as well. Well, Elton John would have
to have had an egg donor and someone to carry
his child, but, again, some other famous people
have done this recently. We’ve got here Nicole Kidman. I don’t know why she had
surrogacy, and there, there’s also a number
of other people. Sarah Jessica Par,
Parker, etc. And something that brings me onto, another
book that we should revisit – Margaret Atwood “The
Handmaid’s Tale.” This was a situation
where in the, in the not-too-distant
future something had happened which affected fertility,
and the rich people, then, took a young fertile
woman into their home, and she was their egg and,
egg donor and their surrogate, and she carried the child for
the family, and, unfortunately, I think that’s already here. So I think there really wasn’t
the not-too-distant future. So stem cells. There are two types
of stem cells. There’s embryonic stem
cells which we have to get from the inner cell
mass of the embryo. There’s induced pluriopotent
stem cells which we can get from an, an already existing
adult, and the view is that we can use these stem cells to make all the tissues
and repair ourself. So if I need a new heart
tissue, I could take some of my skin stem, stem cells, and
make them then different shape, into heart tissue, and then
use that for my treatment. Very expensive if we were
trying to do this on the NHS. I don’t know how [inaudible]
is going to cope with this, but the embryonic stem cells, the problem here
is tissue matching. We can’t just take stem cells from an embryo and
use that for me. It’s not going to
tissue matched. I would actually reject it. But let’s just before
we go onto cloning look at some more frivolous
use of stem cells. So, anyway, there’s always,
there’s always one, isn’t there? [Laughter] So let’s,
let’s look at cloning. Now, cloning [inaudible]
falls into two parts – therapeutic and reproductive. Basically, they’re
the same things. We take some of my skin,
we take an egg, and this, this is one of the rate
limiting steps here. We need to get eggs from people. We take out the nucleus
from the egg, and we put one of my skin cell nuclei
in there, and we zap it, and hopefully we’d
make a blastocyst. If we’re going to want some
heart, cardiac tissue for me, we can take that
blastocyst, make stem cells, and then make my cardiac tissue, and help my condition
that I’ve got. So that’s what therapeutic
cloning is. Again, not sure the NHS
would do this for everyone that needed some new heart
tissue, and at the moment, as far as we’re aware,
we haven’t got to this stage in the human. If we decide to take
this blastocyst, instead of making stem cells,
we put that back in someone, maybe even myself, then
that’s reproductive cloning. There’s a number of people
that have claimed to do this. That’s certainly how
Dolly the sheep happened. This blastocyst here with our
own cells in was transferred, and, and she was delivered, and it’s been done
in numerous species. It is only a matter of time. Mary Warnock came to
UCL a few years ago, and she said this will not be
done in our lifetime, and I, I personally don’t agree. I think this definitely will. They’ll be some crazy person who
will do this in our lifetime, and I’ll show you, again, Hollywood’s interpretation
of this. [background noise]>>You’re clones. You’re copies of people
out here in the world.>>What?>>Clones.>>What?>>Copies of, what are
you talking about ->>Why?>>Some hag trophy wife needs
new skin for a facelift, or one of them gets sick, and
they need a new part, they, they take it from you.>>Dr. Harper: You
need to see the film. [laughter] I’ll stop there. So, where are we going
to be in the future? Now, I think, there’s
two companies that say they’ll sequence
your genetic code. They’ve got a lot
of press about this. I know some people at Tufts
Medical College in Boston, and the dean of the
medical school decided that all the staff run
their blood through this, which was not a good idea. They found some things
they didn’t want to find, some late onset issues
within some of their staff. And all you have to do
for $199, it was at $499, [laughter] you get your kit,
you, you give them some saliva, and then they send
you this information. There’s a couple of points,
just want to point out here. Learn from your DNA. You’ll find out about baldness,
your muscle performance, and your risk for 99 diseases. Now, I apologize to all of those
in the audience with red hair, but I just thought
that this was something that we should have a look at. You can also check
your susceptibility to transmitting hair color,
and, of course, they’re looking at red versus non-red hair. So I apologize for that, but
have a look at that website. That’s, again, food for thought. There is just, it’s just scary, it’s very scary, but
that can be done. And the final video
I want to show you, [background noise] well,
this is very loud so I ->>[Inaudible] What can
it [inaudible] the ability to perfect the physical
and mental characteristics of every unborn child? [ Crosstalk ]>>In the not-too-distant
future, our DNA will determine
everything about us. [ Music ]>>A minute drop of blood [ Music ]>>Saliva, or a single hair
determines where you can work, who you should marry, what
you’re capable of achieving.>>Dr. Harper: So,
certainly, the technology to do that is actually almost here. Hopefully, we won’t all
reproduce, be reproducing by PGD and selecting the most fit
embryos, but certainly, the technology is
here to do that. So I’d just like to thank you. This is our team, some past and
present members of our team. My son was convinced
this morning that this was a picture of him. I said, “Sorry, it’s
not a picture of him.” But, which baby would
you choose? [inaudible] Thank you. [ Applause ]>>Thank you for a wide ranging
and fascinating [inaudible]. We’ve got about three
minutes for questions. We, we need three days, I think. [laughter]>>Dr. Harper: I will
be outside as well if anyone has any
other questions. [background talk] Louis. Louis.>>Louis: [inaudible]
You haven’t spoken about genetic manipulation ->>Dr. Harper: No. [laughter] No. That’s another lecture,
Louis, that’s another lecture. As I was saying,
that’s not what, that’s what we’re not doing ->>Louis: OK.>>Dr. Harper: Hopefully
not yet.>>Anybody else with a question?>>Dr. Harper: There’s
someone at the back.>>As of a couple of
years ago, it’s illegal to prefer an embryo
likely to develop a, a disease over one that isn’t. That’s very easy when you
only know about one disease at a time through PGD. Bit more difficult when the
embryo that’s most genetically healthy and the one that’s more
morphologically healthy are different, how’s
it going to work or what are the consequences if we’re doing [inaudible]
embryo testing, and you know multiple things
about several embryos, and you can’t pick one that’s
less healthy than the other?>>Dr. Harper: It’s,
it’s a mindfield. It’s a total, total mindfield. These [inaudible] arrays are
going to tell us so much. I mean, even in prenatal
diagnosis now when they’ve got a, an
amniocentesis or a CVS, and they, they’re using
these [inaudible], they don’t know how
to, we don’t know how to interpret the
information we’ve got now. There’s so much information. Sometimes the fetus looks like it’s got a really
serious abnormality. We test the parents and find out
that they’ve got the same thing. We just don’t know enough about
the genetic code at the moment. So it will take several years to really understand the
information that we get, but when we do understand
it, how we choose one over the other is going
to be very [inaudible]. That’s why I’m glad at the
moment we’ve got the HFEA. So I don’t want them to go away because I don’t know
what we’re going to do. It’s, it’s, it’s going
to be a mindfield. There’s no answer to that. It’s going to be tricky. There was one question here. [background talk] Alright. Yes. Yes. So we’re lucky
we’ve got the HFEA. [laughs] They’re our buffer. You know, in, in other
countries, they don’t have that, and the, it’s, it’s
going to be complicated.>>Well, the, the,
the admiration of the world actually is ->>Dr. Harper: [crosstalk] Yeah. No, they are, they are ->>It’s absurd that anyone
would want to abolish it.>>Dr. Harper: Yes.>>Anybody got any
other questions? [background talk]>>Dr. Harper: Hopefully
there’s some food for thought [inaudible]. [laughs] I guess some books
and websites will [inaudible] ->>On everyone’s behalf,
then, let me thank Dr. Harper for giving us a very
stimulating lecture. [ Applause ]

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