HeLa, the VIP of cell lines

By  Gesa Junge, PhD

A month ago, The Immortal Life of Henrietta Lacks was released on HBO, an adaptation of Rebecca Skloot’s 2010 book of the same title. The book, and the movie, tell the story of Henrietta Lacks, the woman behind the first cell line ever generated, the famous HeLa cell line. From a biologist’s standpoint, this is a really unique thing, as we don’t usually know who is behind the cell lines we grow in the lab. Which, incidentally, is at the centre of the controversy around HeLa cells. HeLa was the first cell line ever made over 60 years ago and today a PubMed search for “HeLa” return 93274 search results.

Cell lines are an integral part to research in many fields, and these days there are probably thousands of cell lines. Usually, they are generated from patient samples which are immortalised and then can be grown in dishes, put under the microscope, frozen down, thawed and revived, have their DNA sequenced, their protein levels measured, be genetically modified, treated with drugs, and generally make biomedical research possible. As a general rule, work with cancer cell lines is an easy and cheap way to investigate biological concepts, test drugs and validate methods, mainly because cell lines are cheap compared to animal research, readily available, easy to grow, and there are few concerns around ethics and informed consent. This is because although they originate from patients, the cell lines are not considered living beings in the sense that they have feelings and lives and rights; they are for the most part considered research tools. This is an easy argument to make, as almost all cell lines are immortalised and therefore different from the original tissues patients donated, and most importantly they are anonymous, so that any data generated cannot be related back to the person.

But this is exactly what did not happen with HeLa cells. Henrietta Lack’s cells were taken without her knowledge nor consent after she was treated for cervical cancer at Johns Hopkins in 1951. At this point, nobody had managed to grow cells outside the human body, so when Henrietta Lack’s cells started to divide and grow, the researchers were excited, and yet nobody ever told her, or her family. Henrietta Lacks died of her cancer later that year, but her cells survived. For more on this, there is a great Radiolab episode that features interviews with the scientists, as well as Rebecca Skloot and Henrietta Lack’s youngest daughter Deborah Lacks Pullum.

In the 1970s, some researchers did reach out to the Lacks family, not because of ethical concerns or gratitude, but to request blood samples. This naturally led to confusion amongst family members around how Henrietta Lack’s cells could be alive, and be used in labs everywhere, even go to space, while Henrietta herself had been dead for twenty years. Nobody had told them, let alone explained the concept of cell lines to them.

The lack of consent and information are one side, but in addition to being an invaluable research tool, cell lines are also big business: The global market for cell lines development (which includes cell lines and the media they grow in, and other reagents) is worth around 3 billion dollars, and it’s growing fast. There are companies that specialise in making cell lines of certain genotypes that are sold for hundreds of dollars, and different cell types need different growth media and additives in order to grow. This adds a dimension of financial interest, and whether the family should share in the profit derived from research involving HeLa cells.

We have a lot to be grateful for to HeLa cells, and not just biomedical advances. The history of HeLa brought up a plethora of ethical issues around privacy, information, communication and consent that arguably were overdue for discussion. Innovation usually outruns ethics, but while nowadays informed consent is standard for all research involving humans, and patient data is anonymised (or at least pseudonomised and kept confidential), there were no such rules in 1951. There was also apparently no attempt to explain scientific concept and research to non-scientists.

And clearly we still have not fully grasped the issues at hand, as in 2013 researchers sequenced the HeLa cell genome – and published it. Again, without the family’s consent. The main argument in defence of publishing the HeLa genome was that the cell line was too different from the original cells to provide any information on Henrietta Lack’s living relatives. There may some truth in that; cell lines change a lot over time, but even after all these years there will still be information about Henrietta Lack’s and her family in there, and genetic information is still personal and should be kept private.

HeLa cells have gotten around to research labs around the world and even gone to space and on deep sea dives. And they are now even contaminating other cell lines (which could perhaps be interpreted as just karma). Sadly, the spotlight on Henrietta Lack’s life has sparked arguments amongst the family members around the use and distribution of profits and benefits from the book and movie, and the portrayal of Henrietta Lack’s in the story. Johns Hopkins say they have no rights to the cell line, and have not profited from them, and they have established symposiums, scholarships and awards in Henrietta Lack’s honour.

The NIH has established the HeLa Genome Data Access Working Group, which includes members of Henrietta Lack’s family. Any researcher wanting to use the HeLa cell genome in their research has to request the data from this committee, and explain their research plans, and any potential commercialisation. The data may only be used in biomedical research, not ancestry research, and no researcher is allowed to contact the Lacks family directly.

How the Flintstones can Help the Jetsons: History Lessons for Modern Medicine

By Lori Bystrom, PhD

Many of us look forward to a future of convenience with magical gadgets and miracle cures, perhaps something akin to the lifestyle of the cartoon characters on The Jetsons. The show’s optimistic portrayal of the future depicts our fascination with modern technology – an interest that stems not only from our desire for new and improved modes of transportation and communication, but also from our desire for new and better medicine.

 

The future of medicine may seem promising, but understanding the past may be vital for making medical dreams come true. Just as the stone-age characters from The Flinstones are capable of helping the futuristic characters of The Jetsons fix their time machine (see The Jetsons Meet The Flinstones clip from 1:00 to 1:17), so too can our long-departed ancestors help us in ways that will benefit us in the future (perhaps in less barbaric ways than hitting something with a club). In other words, medical advancements, although conventionally based on research using modern technology, can also be derived from medical information of the ancient past.

 

Nowhere is this better exemplified than in the recent discovery of a plant-based eye infection remedy found in a 1,000 year old medical text. This finding was recently presented at the British Society for General Microbiology Annual Conference by researchers at the University of Nottingham in England and Texas Tech University in the United States. They found that the 9th century Anglo-Saxon book, known as Bald’s Leechbook, contained a remedy for an eye infection that consisted of a mixture of garlic, onion or leeks, wine, and bile (from cow’s stomach) that was boiled and fermented in a brass vessel. Amazingly, the recreation of this ancient remedy proved to be effective against the resilient methicillin-resistant Staphylococcus aureus (MRSA), both in vitro and on wounds. In fact, it was found to be more effective than one of the antibiotics (vancomycin) currently used to treat the modern day superbug (see this article). Although clinical trials need to be conducted to confirm the beneficial effects of this medicinal preparation, this is an extraordinary start for a potential drug.

 

Should we be surprised that some of these ancient remedies actually have therapeutic value? Back in the day, when clinical trials did not exist and ethical practices were not necessarily enforced, there was probably a great deal of trial and error as people tried medicines on each other. The only medicines that were recorded were probably those that worked, while ineffective treatments may or may not have been noted. Interestingly, some of the traditional medicines may have been inspired by how animals treated their ailments (an area of study known as zoopharmacognosy). There also may have been minimal repercussions for failed treatments (no lawsuits?), and therefore maybe more freedom for finding medical cures. Moreover, if a treatment was found to be effective nobody probably had to wait for approval from any organization such as the Food and Drug Administration (FDA).

 

Regardless of what happened in the past, it is apparent there are valuable lessons we can learn from our ancestors. For instance, the ancient practice of fecal transplantation is now gaining acceptance in modern medicine. As far back as the 4th century, Ge Hong, a traditional Chinese medicine doctor, used fecal material to treat his patients with food poisoning or severe diarrhea. Just recently, the FDA approved the use of fecal transplants for specific gastrointestinal problems. The use of leeches for the treatment of venous congestion, among other ailments, is another example of modern medicine embracing old technology (see this article). There are numerous conventional medications that also have roots in the distant past (e.g. aspirin). Any book on the history of medicine will provide more information on this subject matter.

 

All of these examples suggest that medical research is limited if it turns a blind eye to the past. Moreover, the medical community needs to address the polar opposite views on traditional/natural medicines: those that think all natural products/traditional remedies are safe and those that think all traditional medicines/natural therapies are inherently bad. What it really comes down to is what is effective and not what resonates better to different patients or doctors. More scientific research needs to assess whether these treatments are safe and effective, while identifying those that may be snake oil. The journalist and information designer, David McCandless, beautifully illustrates some of these differences on his website.

 

Modern medicine should keep an open mind while researchers continue to investigate ancient remedies and screen out the good from the bad. It is appropriate that a small division of the National Institute of Health, known formerly as the National Center for Complementary and Alternative Medicine, was renamed as the National Center for Complementary and Integrative Health. Unconventional or traditional medicines that are effective are not the ‘alternative’, but perhaps the best option or one that can be integrated with other medical treatments.

 

As we move forward in medicine, we might want to keep digging up the past so we are prepared to combat new diseases and improve current treatments. The future of medicine may just need, as George Jetson puts it nicely, “a little stone-age technology.”