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www.tncjournal.com
Policies and Regulations
Stem cell transplantation for nervous system disorders in Italy, European Union, and Ukraine: Clinical approach and governmental policies
Dario Siniscalco1 (), Nataliia Sych2 1 Department of Experimental Medicine, Second University of Naples, Napoli 80138, Italy 2 Clinical Department, Cell Therapy Center EmCell, Kiev 04073, Ukraine
ABSTRACT ARTICLE INFO Received: 8 November 2015
Revised: 31 November 2015
Accepted: 3 December 2015
© The authors 2015. This article
is published with open access
at www.TNCjournal.com
Several debates have been raised over the use of stem cells in the field of regenerative
medicine. Indeed, stem cell transplantation must follow strict rules. However, to date,
many differences exist among different Western and Eastern European countries. This
brief review summarizes the state‐of‐the‐art stem cell regulation in Italy, European
Union, and Ukraine.
KEYWORDS stem cells; regulation; cell transplantation; clinical trial
Citation Siniscalco D, Sych N. Stem cell transplantation for nervous system disorders in Italy, European Union, and
Ukraine: Clinical approach and governmental policies. Transl. Neurosci. Clin. 2015, 1(2): 125–127.
Stem cell transplantation offers promise in the field
of regenerative medicine. However, its application
must follow strict rules. Some differences exist
among Western and Eastern European countries. This
brief review summarizes the state‐of‐the‐art stem cell
regulation in European countries, such as Italy and
Ukraine.
In Italy, the research concerning stem cells is
regulated by the Italian Law 40 (February 19, 2004),
which outlines the standards of medically assisted
reproduction[1]. Accordingly, it prohibits “the creation
of human embryos for research, experimentation, or
purposes other than those intended by this law”
(Article 13). Indeed, Italian legislation recognizes
the embryo as a subject of rights from the moment
of the fertilization[2]. Of course, human cloning is
prohibited.
Nevertheless, adult stem cell research is possible.
After the mother has signed a written consent, it is
possible to donate fetal stem cells for research pur‐
poses. It is also conceivable to use human umbilical
cord‐derived stem cells. In this case, both parents
must provide consent. However, the cryopreservation
of stem cells is prohibited in Italy. Therefore, parents
must use foreign specialized clinical centers outside
Italy, i.e., in Switzerland or San Marino. In addition,
the decree of the President of the Council of Ministers
(November 21, 2001) has included in the basic
healthcare levels the collection, processing, control,
and distribution of blood components and transfusion
Corresponding author: Dario Siniscalco, E-mail: [email protected]
Translational Neuroscience and Clinics ISSN print edition: 2096-0441 ISSN electronic edition: 2096-0670
CN print edition: 10-1319/R CN electronic edition: 11-6030/R
DOI 10.18679/CN11-6030/R.2015.016 Vol. 1, No. 2, December 2015, pp 125–127
Dario Siniscalco and Nataliia Sych.: Cell transplantation in Italy, European Union, and Ukraine
www.tncjournal.com
126
services, as well as stem cell analysis and retrieval
from registers, in addition to domestic and foreign
cell banks[3]. Transplantation of hematopoietic stem
cells in humans is only allowed for blood‐derived
diseases. However, stem cell transplantation in humans
is prohibited in Italy. Until recently, the only way to
undergo a stem cell treatment was being offered one
by the Italian law Turco‐Fazio (Italian Ministerial Decree
05/12/2006), which authorized cell‐based therapies
only as compassionate use (the term compassionate use
indicates the access to experimental drug therapies,
outside of clinical trials, in patients with serious or
rare diseases or who are in danger of life, when, in
the opinion of the physician, there are no further
valid therapeutic alternatives)[4–5]. A great debate was
triggered by the Stamina case[6]. To avoid false hope
and expectations in the general population on the
use of mesenchymal stem cells, the Italian Parliament
updated the legislation regarding the regulation of
mesenchymalstem cell research with the Italian
Ministerial Decree #24 (March 25, 2013) and later
with the Italian Law 57 (May 23, 2013)[7–8]. However,
the scientific committee rejected the Stamina method
and the research has been stopped[9].
Currently, and according to the European Union
(EU) legislation, the only way to undergo stem cell
transplantation is by being enrolled in a clinical trial,
in agreement with the Clinical Trials Directive[10]. The
EU provides legislation (Tissues and Cells Directive
2004/23/EC and Commission Directive EU 2015/566)
about quality and safety of cells and tissues for human
applications[11–12]. However, the final decision on their
use relies on the single member state. Each member
state’s legislation often shows different or divergent
positions reflecting the cultural, ethical, and religious
views on the issue[13]. For example, Germany and Italy
adopt a more restrictive approach, as they prohibit
or severely restrict the use of embryonic stem cells
(in Italy it is possible to use only imported already
existing embryonic stem cell lines), whereas Belgium,
the Czech Republic, Finland, Israel, Portugal, Spain,
Sweden, and the United Kingdom authorize the use
of this type of stem cells. Research on embryonic stem
cells is permitted in Denmark, France, Hungary, the
Netherlands, Norway, and Switzerland, but therapeutic
cloning is not. Otherwise, the UK, Belgium, Spain,
and Sweden have legalized therapeutic cloning of
embryos[13].
On the other hand, in Ukraine, an Eastern Europe
republic that is not a member state of the EU, stem cell
treatment is legal and is regulated by the Ukrainian
legislation[14]. The treatment with umbilical cord blood,
bone marrow, and fetal stem cells is permitted on
Ukrainian territory. However, patients must sign an
informed consent prior to each treatment. In the case of
underage patients, informed consent must be given
by both parents. Bio‐banks for human cord blood
exist in Ukraine, as well as for other cells and tissues.
All of these facilities undergo a specific regulation,
i.e., molecular biology laboratories must be equipped
with specialized PCR equipment capable of detecting
pathogenic biological agents of the hazard groups 1–4
in every biological material. The staff at these bio‐
banks must have competent medical and/or biological
education, and the director must have a higher medical
or biological education, as required by the Ukrainian
Ministry of Health.
For the medical staff acting as such, the corresponding
qualification requirements have been established
by the following guidelines: article #78 Health Care,
approved and implemented by the decree #117 at
the Ukrainian Ministry of Health (March 29, 2002).
Requirements to qualifications among the medical
staff are defined by the decree #359 at the Ministry of
Health of Ukraine (December 19, 1997) about advanced
medical training of doctors registered at the Ministry of
Justice of Ukraine (January 14, 1998) with the reference
#14/2454, and decree #742 at the Ministry of Health
of Ukraine (November 23, 2007) about certification of
junior medical specialists, registered by the Ministry
of Justice of Ukraine (December 12, 2007) with the
reference #1368/14635.
In conclusion stem cell therapy has recently
acquired impulse to its emerging development which
is connected with establishing the new characteristic
features of stem cells. Many differences still perxist
among different Western and Eastern European
countries. In the countries of the European Union
licensing and other permissions for clinical use of the
high technology therapeutic methods including gene
Transl. Neurosci. Clin.
www.tncjournal.com
127
engineering, stem cell therapy and treatment using
somatic cells have been regulated by the standards of
European Medical Association and the statement of
Directive 2001/83/EU I Regulation (EU) #1394/2007 on
advanced‐therapy medicinal product(ATMP).
Consequently, Committee for Medicinal Products
for Human Use (СНМР) establishes the requirements
for application for the suggested treatment method
registration and issuing the corresponding licenses and
restrictions, in particular: the Directive 2001/20/EU of
04/04/2001 concerning clinical trials and the Directive
2005/28/EU of 08/04/2005 on application of such a
method in clinical practice.
Legislative and regulatory frameworks which
remain in force in Ukraine stipulate the requirements
on license provisions and are not complying with
complex standards on АТМР in the European Union.
However, the above licensing regulations permit
experimental studies and clinical application of pre‐
parations including stem cells such as: bone marrow
stem cells, autologous stem cells, adipose‐derived and
fetal stem cells.
Conflict of interests
The authors have no financial interest to disclose
regarding the article.
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