Potential of Adult Neural Stem Cells in Stroke Therapy
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Abstract:
Despite state-of-the-art therapy, clinical outcome after stroke remains poor, with many patients left permanently disabled and dependent on care. Stem cell therapy has evolved as a promising new therapeutic avenue for the treatment of stroke in experimental studies, and recent clinical trials have proven its feasibility and safety in patients. Replacement of damaged cells and restoration of function can be accomplished by transplantation of different cell types, such as embryonic, fetal or adult stem cells, human fetal tissue and genetically engineered cell lines. Adult neural stem cells offer the advantage of avoiding the ethical problems associated with embryonic or fetal stem cells and can be harvested as autologous grafts from the individual patients. Furthermore, stimulation of endogenous adult stem cell-mediated repair mechanisms in the brain might offer new avenues for stroke therapy without the necessity of transplantation. However, important scientific issues need to be addressed to advance our understanding of the molecular mechanisms underlying the critical steps in cell-based repair to allow the introduction of these experimental techniques into clinical practice. This review describes up-to-date experimental concepts using adult neural stem cells for the treatment of stroke.Keywords:
Stroke
Stem Cell Therapy
Cell therapy
Regenerative Medicine
Regenerative medicine aims to provide therapeutic treatment for disease or injury, and cell-based therapy is a newer therapeutic approach different from conventional medicine. Ethical issues that rose by the utilisation of human embryonic stem cells (hESC) and the limited capacity of adult stem cells, however, hinder the application of these stem cells in regenerative medicine. Recently, isolation and characterisation of c-kit positive cells from human amniotic fluid, which possess intermediate characteristics between hESCs and adult stem cells, provided a new approach towards realising their promise for fetal and adult regenerative medicine. Despite the number of studies that have been initiated to characterize their molecular signature, research on developing approaches to maintain and enhance their regenerative potential is urgently needed and must be developed.Thus, this review is focused on understanding their potential uses and factors influencing their pluripotent status in vitro.In short, this cell source could be an ideal cellular resource for pluripotent cells for potential applications in allogeneic cellular replacement therapies, fetal tissue engineering, pharmaceutical screening, and in disease modelling.
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Stem cell therapy is regarded as an innovative strategy to intervene in degenerative heart disease. The efficacy of stem cell therapy to regenerate ischemic myocardium has been limited by inadequate numbers of injected cells, unacceptable cell engraftment or long-term survival, and from restrictions associated with the method of delivery. In this review, we provide an overview of the literature emphasizing several strategies which enable improved results after cell therapy for ischemic heart disease. Enhanced cell therapy includes (a) combination of cell grafts either pre-co-cultured or co-injected cells, (b) transplantation of genetically modified cells, or (c) simultaneous administration of control released growth factors, (d) cell preconditioning, (e) use of adjunctive systemic therapy, or (f) repetitive cell therapy. Future studies should focus on the development of strategies for optimization of cell delivery, which will enable easy isolation of adequate cell volume and optimal functional results.
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Cell therapy is a key tool of regenerative medicine, but until the beginning of the last decade, products based on viable human cells were used primarily to repair damaged tissues and organs. Currently, the field of application of biomedical cell products has expanded significantly, but researchers still show considerable interest in the use of human cells in regenerative medicine. The stage of development of cell products varies significantly depending on the type of tissue and pathology, and ranges from preclinical and pilot clinical trials to authorised drugs with a long history of use. On the one hand, this may be attributed to methodological differences in the production and use of cell products, and on the other, to specific aspects of differentiation of cell types used in regenerative medicine, primarily mesenchymal stem cells. The aim of this study was to analyse current trends in the use of cell therapy in regenerative medicine and prospects for using available technologies. The paper summarises the main achievements in the use of cell therapy for regeneration of skin, bone and cartilage, nervous and cardiovascular systems. The key mechanisms of cell therapy effect are determined, on the one hand, by the differentiation potential of multipotent cells, and on the other, by the complex (immunomodulating, angiogenic, proliferative) action of the proteome expressed by the administered cells. The paper describes viable cell-based products currently authorised for each indication, and analyses the level of their clinical use. It might be promising to use directed cell differentiation technologies, as well as induced pluripotent cells in regenerative medicine.
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Cell therapy involves the transplantation of human cells to replace or repair the damaged tissues and modulate the mechanisms underlying disease initiation and progression in the body. Nowadays, many different types of cell-based therapy are developed and used to treat a variety of diseases. In the past decade, cell-free therapy has emerged as a novel approach in regenerative medicine after the discovery that the transplanted cells exerted their therapeutic effect mainly through the secretion of paracrine factors. More and more evidence showed that stem cell-derived secretome, i.e., growth factors, cytokines, and extracellular vesicles, can repair the injured tissues as effectively as the cells. This finding has spurred a new idea to employ secretome in regenerative medicine. Despite that, will cell-free therapy slowly replace cell therapy in the future? Or are these two modes of treatment still needed to address different diseases and conditions? This review provides an indepth discussion about the values of stem cells and secretome in regenerative medicine. In addition, the safety, efficacy, advantages, and disadvantages of using these two modes of treatment in regenerative medicine are also critically reviewed.
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