Life after death: an activity to investigate the scientific, legal, & racial issues of the Henrietta lacks story.
Abstract: In this two-part activity, students examine living cervical cancer cells and chromosomes from a women named Henrietta Lacks who died over 60 years ago, but whose cancer cells continued to divide and grow even after her death. Students then debate the legal and bioethical issues surrounding the use of her cells. This laboratory activity reinforces important introductory biology concepts such as mitosis and cancer. Once the students have experimented with Henrietta Lacks's cells, they feel connected to her story and passionate about exploring the science, legal, and racial issues surrounding the use of her cells.

Key Words: Mitosis; cell division; cancer; HeLa; Henrietta Lacks; bioethics.
Article Type: Report
Subject: Cervical cancer (Genetic aspects)
Cancer (Genetic aspects)
Bioethics
Author: Baker, Stacy
Pub Date: 08/01/2011
Publication: Name: The American Biology Teacher Publisher: National Association of Biology Teachers Audience: Academic; Professional Format: Magazine/Journal Subject: Biological sciences; Education Copyright: COPYRIGHT 2011 National Association of Biology Teachers ISSN: 0002-7685
Issue: Date: August, 2011 Source Volume: 73 Source Issue: 6
Topic: Event Code: 980 Legal issues & crime Computer Subject: Company legal issue
Persons: Named Person: Lacks, Henrietta
Accession Number: 265291904
Full Text: Henrietta Lacks was a poor, African-American woman who died of cervical cancer in 1951 at the age of 31. Before she died, researchers at Johns Hopkins Hospital collected a sample of her cervical cancer cells and were stunned to discover that her cells had a never-before-seen ability to divide and grow outside of her body in culture. This allowed researchers to extensively study human cancer cells in the laboratory for the first time (see Gey et al., 1952). Sixty years after her death, her cells are still dividing. They've divided so many times that her cells could wrap three times around the earth. Research on her cells has led to the development of the polio vaccine, cloning, gene mapping, and in vitro fertilization (Skloot, 2010). Her cells were instrumental in the discovery of telomerase and of medicines used to treat cancer and Parkinsons disease (Moore, 2010). Despite the incredible contribution her cells have made to science, Henrietta Lacks never knew that her cells were taken for research purposes and her family wasn't informed until 25 years after her death (Skloot, 2010).

When researchers finally explained to the family how and why they were using Henriettas cells, they used words like "DNA" and "clones" technical language that the uneducated family didn't understand. Henrietta's daughter, Deborah, believed that scientists had made hundreds of clones of her mother. She lived in fear of one day bumping into a clone of her mother on the street. The family was terrified that every time researchers injected the Ebola virus into Lacks's cells, Henrietta was suffering pain. None of the researchers working on HeLa cells ever took the time to educate the family about what was really going (RadioLab, 2010).

The following laboratory activity and debate is an exciting way to bring scientific, legal, and racial issues into the classroom. It is suitable for a variety of age groups and classes and can be modified as needed to serve different student abilities and academic levels. I've used this investigation in 9th-grade Biology, AP Biology, and Research Seminar classes. My students often report learning a lot about how biology applies to the real-world through their work on this case.

"Observing the cancer cells was both educational and enlightening. Until recently, I was unaware of how simple cancer truly is. It is such a basic process and yet it destroys the lives of many." - a 9th-grade biology student

** Prerequisites

Before beginning the lab investigation with my students I give a brief lecture on why cancer is not contagious. I introduce the concept of major histocompatibility markers (MHC) on the surface of cells and how the immune system uses these markers to recognize self from nonself. This is so that students (and their parents) don't feel nervous about our use of living cancer cells in the lab. In addition, I cover mitosis before the lab and use the lab to reinforce the concepts students have already learned about the cell cycle.

Next, I discuss how cancer is uncontrolled cell division and how tumors are formed from a mass of rapidly diving cancerous cells. I describe the chromosomal differences between a normal diploid cell and a cancerous cell. Cancer cells are aneuploid; they have an incorrect number of chromosomes. HeLa cells have mutated so much in the past 60 years that they contain 82 chromosomes per cell (Macville et al., 1999). Because the cells are so different from normal human cervical cells and can survive and multiply outside the human body, some scientists have even proposed identifying the cells as a species, Helacyton gartleri (Van Valen & Maiorana, 1991).

Informing students how the HeLa cells were prepared prior to shipment will also help improve their understanding of mitosis. The cells are exposed to a colchicine, a plant-based toxin that inhibits microtubule function. Therefore, this toxin stops the cells in the middle of mitosis after the DNA has already been condensed into visible chromosomes.

** Pre-lab Setup

The HeLa cell cultures can be ordered from a National Institutes of Health-sponsored company called CellServ (http://www.cellserv.org; the author has no affiliation with this company), which sells a kit for $65 called "CSK4: Preparation of Human Chromosome Spreads." Although not identified as such on the website, the kit includes HeLa cells preserved in a fixative that must be used within 2 weeks if stored at 4[degrees]C or 4-6 weeks if stored at -20[degrees]C. There are enough materials for 30 students to do the experiment individually; however, I place my students in groups of two to four. This makes it possible to do the lab with up to 120 students.

O Materials Needed

Set-up is minimal and takes about 10 minutes.

CellServ Kit #4 (CSK4) includes:

Teacher will need to supply:

** Safety Precautions

Students should wear aprons, goggles, and gloves during the lab. The stains used in the kit can permanently stain clothing. Although not identified as such in the kit, Stain 1 is Hema 3 (Solution 1) and Stain 2 is Hema 3 (Solution 2). These stains may cause minor irritation of the skin and digestive tract. Both are safe for use in a high school laboratory.

Part 1: Preparation of Chromosome Spreads (45-minute class period)

The success of the lab depends on proper technique. The first step is to splatter 6-8 drops of the HeLa cell suspension onto a microscope slide from various heights and angles. The students must drop the cells from a significant height onto the microscope slides (see Figure 1). This ensures that the cells will burst open and the chromosomes spill out. It's also really important to let the slide air dry completely after dropping the cells onto the slide and before the first stain is used. To aid in the drying process as well as smear the cells over the surface of the slide, students should blow gently on the slide for a few seconds.

The next step is to dip the slide for several seconds into Stain 1 three times and then dip the slide for several seconds into Stain 2 three times. After completing the staining process, the student should rinse the slide carefully with distilled water and then let it air dry completely. Once the slide is completely dry, a drop of Permount should be added to it and a coverslip placed on top. The slide is now ready for observation.

Part 2: Observation of the HeLa Cells (45-minute class period)

A wonderful advantage of this lab is that once the slides have been prepared with Permount, they typically last several days to weeks and do not have to be examined immediately. When students begin to examine the slides (Figure 2), I instruct them on how to properly search the slide for HeLa cells and chromosomes. The students will be looking for purple-colored cells that appear to have tiny X's (chromosomes) bursting out of the cell. It is helpful to show students pictures of what the cells look like with the short lens objective and with the long lens objective (see Figure 3).

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

[FIGURE 3 OMITTED]

The students will find that some cells have remained intact and do not have any chromosomes outside them. In other cases, chromosomes are not directly near a cell and may have spread farther away from it. Whenever one student group finds an excellent sample, I have other groups look at it so that they know what to look for on their own slide. The images presented here are actual student results from one of my 9th-grade classes.

In analyzing their results, the students must draw and describe the appearance of the chromosomes and count the number of chromosomes found outside the cells. Then they submit a group paper summarizing what they learned from viewing the cells and how the HeLa cells are different from normal, diploid cells.

Part 3: Debate

In the 6 years I've performed this activity with students, the debate has always been very exciting for students. The first 5 years were a bit difficult because so little information was readily available about Henrietta Lacks. The recent release of the New York Times bestselling book, The Immortal Life of Henrietta Lacks by Rebecca Skloot, has led to an explosion of media regarding her story. A simple Google search will yield an extensive amount of information for students to research. This new information has made the debate even more exciting for my students and makes it easier for teachers to reproduce this activity in their own classroom.

Before beginning this year's debate, I had the students listen to the WNYC RadioLab segment, "Henrietta's Tumor" (RadioLab, 2010). The segment is very powerful as it includes interviews with Henrietta's daughter, Deborah, who was deeply affected by the use of her mother's cells. As the students listen to the radio segment, I encourage them not to take a side at this point and to just write down their observations.

The class is then split into two teams. One team represents the Lacks family (the Prosecution) and the other team represents Johns Hopkins Hospital (the Defense). The Prosecution and the Defense are each made up of lawyers and witnesses. I let the students determine who their witnesses should be on the basis of the evidence they collect. The Prosecution normally uses family members as witnesses, and the Defense normally uses Dr. Gey (the researcher who first discovered the immortality of HeLa cells).

The purpose of the debate is to determine whether Johns Hopkins Hospital should be forced to compensate the Lacks family for their role in distributing Henrietta Lacks's cells without her consent. At first glance, this case may seem cut and dried. During the time the cells were taken, there were no laws regarding the use of a person's cells (and there are none today either). However, there are still many powerful arguments that each team can make to support its case (see Table 1), and each year my students are able to passionately defend both sides of the argument.

** Background Research

After splitting the class into teams, I give the students two full class periods in the computer lab to conduct research. Initially, I don't give the students any assistance on where to begin their research, other than to assist them with evaluating the credibility of their sources. I do this in order to empower the students to make their own discoveries. If a team appears to be stuck and isn't sure how to collect data or what questions they should ask, I give the whole class some prompts, such as: What are patient/doctor rights? Have there been any recent legal cases regarding the use of human cells? How did the Lacks family find out about the use of Henrietta's cells?

The students' use of credible sources when collecting research is very important. During the debate, if a team doesn't know how to respond to a particular argument, they can ask the other team to state their source of the information. If the other team cites a noncredible source or can't cite a source at all, I (as the judge) will permanently erase that evidence from the record. The students really love using this tactic, and it reinforces the need for them to use credible sources.

** Structure of the Debate

The debate should take between one and two class periods to complete. In order to make the debate really fun for students, I attempt to act like a typical judge in a court room. The students must "all rise" as the judge enters the room. Students who misbehave or get off-task are held in "contempt of court" and given a warning. I use a gavel to request "order in the court." However, in order to maintain a constantly flowing debate, I do not allow "objections" to interrupt a team's statements.

Each group must prepare a 2-minute opening position statement. After the opening statements have been read, the Prosecution is given the opportunity to make a single argument in favor of their case. The Defense is then given the chance to respond. The argument continues until neither group can add any new detail to the argument or I declare the argument over (I do this when the teams begin to repeat their statements). Then, the Defense is given the opportunity to make a single argument in favor of their case and the Prosecution responds to that argument.

After both the Prosecution and Defense have had several opportunities to present arguments, each team is given 15 minutes to form a final, 2-minute closing statement. I inform the teams that the closing statements should be modified from the original statements to include new detail that was discussed during the debate.

** Conclusion

I base my judge's decision on the quality and quantity of evidence presented, the team's ability to counter arguments made by the other team, and the strength of the opening and closing statements. I don't base the ruling on how I think an actual judge would rule if this were a real case. Therefore, the final ruling may change from class to class. A video, written transcript, court ruling, and grading rubric for an actual student debate is available at (http://bit.ly/HeLaNABT [case sensitive]).

"I learned quite a bit about bioethics and how people have different standings on different issues." - a 9th-grade biology student

DOI: 10.1525/abt.2011.73.6.6h

** Acknowledgments

My thanks to Michael Kunst for taking the images of my students' microscope slides.

References

Gey, CO., Coffman, W.D. & Kubicek, M.T. (1952). Tissue culture studies of the proliferative capacity of cervical carcinoma and normal epithelium. Cancer Research, 12, 264-265.

Macville, M., Schrock, E., Padilla-Nash, H., Keck, C., Ghadimi, B., Zimonjic, D. & others. (1999). Comprehensive and definitive molecular cytogenetic characterization of hela cells by spectral karyotyping. Cancer Research, 59, 141-150.

Moore, J.M. (2010). [Review of] The Immortal Life of Henrietta Lacks by Rebecca Skloot. American Biology Teacher, 72, 585-587.

RadioLab. (2010). Henrietta's tumor. [Radio program.] New York, NY: WNYC. Available at http://www.radiolab.org/2010/may/17/henriettas-tumor/.

Skloot, R. (2010). The Immortal Life of Henrietta Lacks. New York, NY: Crown.

Van Valen, L.M. & Maiorana, V.C. (1991). HeLa, a new microbial species. Evolutionary Theory & Review, 10, 71-74.

STACY BAKER is a biology teacher at Staten Island Academy, 715 Todt Hill Road, Staten Island, NY 10304; e-mail: extremebiology@gmail.com.
HeLa cells
   Stain 1 & 2
   Permount


Microscope slides
   Plastic pipettes
   Staining jars
   Gloves and lab coats/aprons
   Compound, light microscope (minimum 400x objective)
   Immersion oil (optional)


Table 1. Arguments that students commonly use in the debate.

Lacks Family (Prosecution)            Johns Hopkins Hospital (Defense)
Henrietta Lacks (HL) never gave      In 1980, the Supreme Court of
consent for the collection of        California ruled in the case
her cells for research. John         of John Moore vs. Regents of the
Hopkins (JH) violated the due        University of California that
Process clause of the 14th           patients have no rights to
Amendment by collecting and          tissues after they leave the
indefinitely storing the cells       body.
without her consent

JH violated the search-and-          There are no established laws
seizure clause of the Fourth         protecting a patient from the
Amendment by removing cells          nonconsensual use of their cells.
from HL's body after she died.

The family can't even afford         The family's inability to afford
basic health insurance, even         health insurance is not the fault
though their mother's cells          of JH.
have to led to millions of
dollars in profit.

JH profited from the use of          JH never profited financially from
HL's cells. Dr. Gey appeared on      the sale of HL's cells. If people
television, published papers,        were allowed to sue for the use of
and became famous from the           their cells, which is a
use of her cells.                    well-established practice in
                                     research medical research would
                                     grind to a halt.

HeLa cells were named after the      JH did not release HL's name
first two letters of HL's first      in order to maintain patient
and last name, which                 privacy.
acknowledges her connection
to the cells.

JH acknowledged the connection       HL's cells have mutated so
of HeLa cells to the Lacks           greatly as to be considered
family when they asked family        a separate species and they
members for DNA samples              do not belong to the Lacks
25 years after HL's death.           Family.

The Lacks family tried               JH had no legal requirement
contacting JH numerous times to      to inform the Lacks family
find out what was going on with      as to how HL's cells were
HL's cells, but they were            being used.
Repeatedly ignored.

The Lacks family questions the       The use of HeLa cells has led to
spiritual and ethical                development of new research
repercussions of researchers         methods, medicines, and tests that
manipulating their mother's          have benefited all members of
cells (e.g., injecting HeLa          society, which justifies their
cells into unwilling prisoners;      use.
infecting HeLa cells with Ebola).
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