How the end of Roe could hamstring medical research and the hunt for new treatments

Zandrea Ambrose is spending a lot of time making contingency plans these days.

The virologist at the University of Pittsburgh has dedicated her career to cracking how HIV hijacks the body’s cells and finding better drugs to stop that from happening. But much of her research relies on a powerful and increasingly controversial tool: fetal tissue.

“HIV only infects humans, so we need to use human cells to find better treatments and potentially a cure,” Ambrose said. “There just aren’t great alternatives for what we need.”

Other labs at her university have used fetal tissue obtained from elective abortions in their efforts to treat liver disease and understand how fetuses fight off infection. But continuing such research in Pennsylvania — and in many other red or purple states — is becoming increasingly fraught, and Ambrose is planning for the worst.

The Supreme Court’s decision last month overturning Roe v. Wade has intensified long-standing political pressures around fetal tissue research, which is already illegal in some states. And in Pennsylvania, days after the Supreme Court verdict, Republican members of the state House attached significant strings to their annual appropriations bill: If the University of Pittsburgh wants $151 million to help discount in-state student tuition, it must end all fetal tissue research. (Late on Wednesday, lawmakers agreed to move the university funding into a separate bill — but they plan to proceed with the effort to ban fetal tissue research.)

“I have a feeling that if it came down to supporting the few researchers here that still use fetal tissues versus getting millions from the state government, I think I might be a casualty of that political issue,” Ambrose said.

She worries the hostility and uncertainty swirling around her field will worsen now that Roe is no longer the law of the land. “I joke with colleagues about moving to Canada or another country where this isn’t an issue,” she said. “It’s a joke, but at the same time, if I’m not supported by the government to do my research here, maybe I do go to another country.”

Ambrose is not alone. “Researchers around the country are facing the same issue in lots of different fields,” she said. Grid reached out to over a dozen scientists who use fetal tissue to investigate topics as wide-ranging as skin infection and brain development. Most did not respond or declined to comment, with one researcher citing threats they’d received for speaking out in the past.

Several anti-abortion states already ban fetal tissue research, and experts expect that many more will rush to restrict this tool — which has helped generate vaccines, test new medicines and deepen basic understanding of human biology — with federal abortion protections gone. Just last week, lawmakers in Michigan passed a bill that would criminalize research using cells obtained from abortions, a measure the governor will likely veto.

“My fear is that this is going to embolden states to be more aggressive and start banning things without understanding the consequences,” said Kirstin Matthews, a science policy expert at Rice University. For now, federal funding of such research is safe under the Biden administration, but a Republican president could easily reinstate the Trump administration’s 2019 ban on fetal tissue research.

Ultimately, that uncertainty will have a cooling effect, Matthews said, and could drive more researchers like Ambrose away from one of the most powerful tools in biomedical science.

Why scientists use fetal tissue cells

Fetal tissue is so useful to scientists because of its shape-shifting ability.

“It has the materials for all the different organs,” said Larry Goldstein, a neurobiologist at the University of California, San Diego, School of Medicine. The immature state of fetal cells allows researchers to study how everything from eyes to intestines develops, and conversely how those tissues can degenerate and cause problems. Fetal tissue is helping scientists better understand developmental disorders, like Down syndrome. And it’s crucial for studying pathogens that don’t infect other species, like Zika and HIV.

Ambrose’s research relies on the cells that would become white blood cells, which are enriched in fetal liver tissue. In lab dishes, she can study how components of the immune system respond to HIV infection. Her lab also uses “humanized mice,” which develop humanlike immune systems because of fetal tissue implants. “This makes them infectable by HIV,” she said, allowing her to test drugs, vaccines and therapeutics.

Cell lines created from fetal tissue in the mid-20th century have helped develop or test some of the most groundbreaking vaccines, including those for measles, rabies, hepatitis A and chickenpox. Scientists also use fetal cells in transplantation research, since fetal tissue hasn’t developed the sorts of immunological markers present in adult cells that can trigger rejection.

“There’s nothing else like it out there,” said Alta Charo, a professor emerita of law and bioethics at the University of Wisconsin at Madison. “It has unique value because of the state of immaturity of the tissue.”

Fetal tissue used in research comes from elective abortions where the pregnant person consents to donating the materials. In states that allow it, researchers obtain those cells from local hospitals, clinics or tissue banks. Some degree of controversy has always surrounded fetal tissue research because of its connection to abortion, but for many years its value was largely recognized by politicians on both sides of the aisle, Charo said.

“It has a long history of bipartisan support because it can be separated from the debate around abortion itself,” she said. In 1993, Congress passed a law approving the use of fetal tissues for research and regulated the practice by barring people from being compensated beyond travel costs for donating tissue. Anti-abortion Republican senators like Bob Dole and Strom Thurmond were among the lawmakers who supported the legislation.

“But that dynamic has been changing, even pre post-Roe,” Charo said. Members of Congress who have supported this work in the past have started backing away from it, she said, “not on the merits of the issue, but because it’s become a symbol of your tribal affiliation with the side that opposed the right to abortion.”

In 2015, a series of misleadingly edited videos released by anti-abortion activists purported to show that Planned Parenthood was profiting from the sale of fetal tissue. Those claims were false, but the videos sparked outrage among Republican lawmakers and reportedly led some clinics to stop tissue donations because of harassment. Conservative antipathy came to a head in 2019 when the Trump administration barred all federal scientists from doing fetal tissue research and halted federal funding of grants that would involve it.

“When this just becomes a symbol, you’re sacrificing valuable research and condemning people now and in the future to diseases that they need not suffer from for the sake of a symbol,” Charo said. “I think that’s just wrong.”

Possible post-Roe fallout

At least five states, including Indiana, Ohio and Oklahoma, already ban fetal tissue research outright, while others restrict how it can be procured and used in research. Now that abortion is illegal, or will soon be so, in about half of states, there’s a good chance that fetal tissue available for research will become scarcer, since fewer surgical abortions will happen in those states. Whether that will impact ongoing research is unclear, both Charo and Goldstein said.

But with Roe gone, Charo suspects states will become bolder. “I think we’re likely to see states placing more limitations on the use of fetal tissue,” she said. “They could do this before; they didn’t have to overturn Roe, but I think we’re just going to see a lot of energy on the right to take advantage of this moment.”

More states might make fetal tissue research a central bargaining chip in funding fights, outlaw researchers from receiving fetal tissue in the mail or expand abortion laws to prohibit such research altogether, as lawmakers are trying to do in Michigan. “I’m concerned we might see states banning the use of cell lines that were created back in the ’60s and are still used to test vaccines and everyday products like Advil,” Matthews said.

Many of the labs that use fetal tissues are concentrated in blue states, where the research seems safe for the time being. “Researchers are going to gravitate toward states that have more permissible laws, like California,” Matthews said. But even states like California can’t guarantee that the National Institutes of Health — the main federal funder of biomedical research — won’t pull funding again if the country elects another Republican president.

“Without consistent funding, people may just migrate away from this research,” Matthews said. That, coupled with the kinds of personal threats such researchers get from anti-abortion advocates, “has a cooling effect,” she said.

Ambrose has watched the ranks of researchers who use fetal tissue research at her university dwindle as the field becomes more contentious, she said. “I don’t know if they’re finding alternatives or changing research entirely,” she said. She’s still unsure whether she’ll have to pivot too. “It’s really disappointing,” she said. Without this research, she said, “we’re just going to be slow helping people with diseases, whether they’re fetuses, children or older people.”

This article has been updated. Thanks to Lillian Barkley for copy editing.