is whole-ovary transplant a cure or risky gamble?
TRANSCRIPT
This week–
IN A transplant operation never
before performed in the west, a
woman has received a new ovary
donated by her sister. While the
surgeon responsible claims this
holds out hope for women without
functioning ovaries, others say
the procedure is dangerous and
unnecessary. The woman could have
got pregnant using a donor egg and
her husband’s sperm, and had any
premature menopause postponed by
hormone treatments, the critics say.
Sherman Silber removed an
ovary from Maeapple Chaney and
transplanted it into her sister,
Joy Lagos, at St Luke’s Hospital in
St Louis, Missouri, on 5 February. All
Lagos’s eggs had been destroyed
when she was given chemotherapy
treatment for cancer three years ago.
In 2002 surgeons at China’s
Zhejiang Medical Science University
reported a whole-ovary transplant
between sisters, though the
transplant was never documented in
the scientific literature and its long-
term success is not known. Since
2004, Silber has transferred grafts of
ovarian tissue between seven sets of
identical twins, resulting in at least
one live birth from the transplanted
graft (New Scientist, 23 October
2004, p 12). These grafts usually
only produce eggs and reproductive
hormones for a few years, Silber says.
He believes that transplanted
whole ovaries may be able to work
for as long as a woman’s own
ovaries, while transplanting a whole
ovary may also make it less likely to
be rejected than a graft, because it is
less prone to inflammation. This
could widen the range of possible
donors to at least include close
relatives, and not just twins, he says.
However, fertility specialists have
questioned Silber’s claims that the
ovary would be less likely to be
rejected than a graft and say it is too
soon to judge whether his latest
operation has been successful. “The
patient could reject the ovary at any
time. The ovary could clot next
week,” says Tommaso Falcone of
the obstetrics and gynaecology
department at the Cleveland Clinic in
Ohio. “We just don’t know the long-
term consequences.” Phil McKenna ●
Is whole-ovary
transplant a cure
or risky gamble?
INDONESIA has launched a high-
stakes bid to ensure it gets a
vaccine against pandemic flu. Last
week, David Heymann, the man
in charge of pandemic flu at
the World Health Organization,
revealed that Indonesia – current
epicentre of H5N1 flu outbreaks –
has refused to send WHO labs any
samples of H5N1 virus since the
start of the year. Its complaint:
the samples are used to make
commercial vaccines from which
the country will get nothing.
Indonesia’s challenge has
worried flu experts. Unless
Indonesian viruses are sequenced
abroad, scientists cannot track the
evolution of the virus in the very
country where an H5N1 pandemic
now seems most likely to emerge.
The WHO has been in talks with
the Indonesian government since
last November trying to settle the
dispute, and this week flu experts
will meet in Geneva to discuss the
issue further.
But the Indonesians may
have already found their own
solution: last week they signed an
agreement with US vaccine maker
Baxter, based near Chicago. A
Baxter spokesman refused to
divulge details, but reports
suggest that researchers will have
free access to Indonesian H5N1,
while Baxter will hold the sole
commercial rights – in return for
helping to build Indonesian
vaccine plants.
It is widely expected that
if a serious pandemic strikes,
countries with vaccine plants will
commandeer vaccine for their
own citizens. Indonesia’s move
seems calculated to ensure its
own supply.
It is not the only country
worried about missing out. “We
are sending out our virus to
rich countries to produce
vaccines,” Thai delegate Suwit
Wibulpolprasert told the WHO
executive board in December.
“And when the pandemic occurs,
they survive and we die.” He
said countries should share viral
samples only if they get any
resulting vaccines in return.
The roots of the crisis go back
decades. Every year countries
donate samples of ordinary flu to
the WHO so that manufacturers
can update vaccines. Developing
countries have previously given
away viruses for vaccines used
mainly in rich countries as “they
never had much demand for flu
vaccine”, says Heymann.
That changed with the threat
of a pandemic. Early last year
the Indonesian government
warned that it would share virus
samples for research but not for
commercial use. Such concerns
from Indonesia and other
countries with H5N1, such as
China, led the WHO to limit access
to its global database of H5N1
genetic sequences to a coterie of
15 labs.
After global protests from
scientists, Indonesia and other
countries agreed last August
to permit public access to their
sequences for research. Then in
January the Australian vaccine
manufacturer CSL, based in
Melbourne, announced it
had submitted for regulatory
approval an H5N1 vaccine based
on Indonesian H5N1 that it would
make for the Australian stockpile.
Indonesian health minister
Siti Fadilah Supari protested that
she had not given permission for
this, and that Indonesia would
seek legal action. CSL claims
it got the virus from the WHO
legitimately. “We have the virus,
we are getting sick, then they take
the virus from the WHO and make
[vaccine for] themselves,” says
Supari. Debora MacKenzie ●
8 | NewScientist | 17 February 2007 www.newscientist.com
“The hope is that transplanted
whole ovaries may be
able to work for as long as a
woman’s own ovaries”
–Time for some give as well as take–
Poor countries hold out for bird flu vaccine
SUPR
I/R
EUTE
RS