Stem cells have been the backbone of regenerative medicine. Their healing potential lies in their plasticity, that is, their ability to transform into different cells. In addition to plasticity, they also secrete growth factors that stimulate the inherent healing abilities of a tissue. They also regulate the vascularization process and immune responses. Their immunomodulation effects prevent infections while also suppressing inflammation. They have gained an edge, especially for diseases that are not curable by conventional drugs. These drugs only provide short-term relief from the symptoms of the diseases and slow their worsening. However, stem cell-induced regeneration can effectively reduce and even eliminate the disease. Several groundbreaking projects have scaled stem cell therapeutics from labs to clinics. So, let’s embark on this fascinating journey of stem cells and their application in regenerative therapies.
Reflecting on The Past: Where It All Began (Regenerative Medicine)
The journey began in the early 18th century with the identification of stem cells. In the late 70s, infusion of bone marrow stem cells successfully treated an otherwise incurable genetic disorder. Till now, the research suggested that stem cells can transform into a restricted set of cells belonging to a tissue. However, a milestone was achieved when they also exhibited the ability to form cells of any tissue based on their environment. In fact, bone marrow mobilizes its stem cells to the damaged tissue for reparative purposes. The findings drove regenerative medicine into a new age of therapeutics. Soon, studies proved the presence of stem cells in every tissue for tissue healing purposes.
Sources of Stem Cells
The discovery of tissue-resident stem cells urged the exploration of different sources of stem cells. In-depth analysis narrowed down three sources from which to extract stem cells effectively.
Bone Marrow: It was the first identified source of stem cells. It comprises two different kinds of stem cells- hematopoietic and mesenchymal. The extraction procedure involves inserting a syringe into the iliac crest, aspirating the fluid, and isolating stem cells.
Embryo: Stem cells present in the embryo can form any kind of cells in the body. Although its differentiation potential exceeds that of any other stem cell, the application of embryonic stem cells has ethical and legal implications. Moreover, embryonic stem cells were found to cause teratoma. Such considerations prohibit their extraction and use in clinical settings.
Umbilical Cord: Stem cells found in umbilical cord blood have differentiation potential second to that of embryonic stem cells. Since it is discarded after birth, it has become a cost-effective option. Additionally, a non-invasive and painless extraction procedure with the ability to extract large amounts of stem cells renders it the most popular source.
Adipose Tissue: The discovery of adipose tissue as a stem cell source marked the beginning of the 21st century. Adipose tissue is known for its lipid storage. The differentiation potential of adipose tissue stem cells is in close proximity to that of bone marrow stem cells. Its abundance in the body and the location in the subcutaneous region have made the extraction procedure relatively easy, minimally invasive, and less painful.
Even with the optimization of sources and their corresponding extraction procedure, obtaining stem cells with higher purity and yield is difficult. It requires stringent handling practices and environmental conditions. Some of the best stem cell research labs in India can deliver on the quality of stem cells in a cost-effective manner.
Living The Present: Where We Are
The easy availability of stem cells has made their clinical applications a reality. An extensive list of diseases that had no cure previously could now be treated with stem cells. A few of them have been described below.
Cardiovascular disorder: cardiovascular diseases like ischemic stroke, myocardial infarction, arrhythmias, and cardiomyopathy are the leading causes of mortality. Cholesterol deposition in artery walls results in hardening of the arteries and the obstruction of blood flow. A shortage of blood in the heart damages its tissue. Current treatment modalities focus on lowering cholesterol levels, insertion of stents, and bypass surgeries. But the tissue damage still remains. Stem cell treatment is beneficial in such cases. Joshua M. Hare and his team reported a 4-fold decrease in arrhythmia events in patients receiving stem cell treatment along with improvements in cardiac function.
Neurological disorder: Disorders such as Amyotrophic lateral sclerosis, Multiple Sclerosis, Alzheimer’s disease, Autism, and Parkinson’s disease are a few examples where the nervous system is adversely impacted. The nerve function gradually diminishes due to reasons such as damage to nerves, nerve degeneration, and impaired neural development. Patients face difficulty in movement and decline in cognitive functions, rendering daily tasks challenging to perform. Therapeutic drugs, in combination with certain rehabilitation therapies, provide little comfort. Stem cell therapy is more effective as it promotes tissue healing and development, thus restoring the original neural function.
Diabetes: According to IDF estimates, every 1 in 10 adults suffers from diabetes. The high blood glucose levels in diabetes subsequently endanger multiple organs like the liver, cardiovascular system, kidneys, eyes, etc., while also increasing the chances of limb amputation. Patients receive insulin injections to control blood glucose levels. But the lifelong dependence on drugs, the need to alter the lifestyle, and the potential injury to other tissues linger. A clinical study at Karolinska University Hospital, Sweden, showed that patients undergoing stem cell transplantation had lower diminishing levels of insulin dependency, thus proving the gradual restoration of pancreas function and stem cell efficacy.
Liver dysfunction: Liver failure due to viral infection, fatty liver, alcohol, autoimmune disorder, etc., claims 2 million lives every year. Current therapeutics have limited impact, and late-stage disease often requires liver transplants. Stem cell therapy repairs the damaged liver and controls the immune system to prevent further damage. Andy Peng Ziang and Zhi-Liang Gao conducted a clinical trial to analyze the stem cell healing potential of Hepatitis B-induced chronic liver failure. The data showed 73.2% survival in patients undergoing allogeneic stem cell transplant owing to better liver function as compared to 55.6% survival in the ones injected with conventional treatment.
Musculoskeletal disorders: Damage to bone and its surrounding tissue in osteoarthritis, rheumatoid arthritis, accidental injuries, and osteoporosis causes pain and difficulty in walking. Drugs only work on pain management. Surgical replacement of damaged parts is the last resort in many cases. However, the regenerative potential of stem cells can rescue these individuals. Alberto Gobi and his colleagues demonstrated that stem cell infusion significantly improved the pain score and knee injury along with restoration to nearly normal tissue.
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Predicting The Future: Where We Might Go
The potential of stem cells has endless possibilities. For decades, signaling cues that drive stem cells have been decoded. The information has now aided in growing organs in labs. Several organs, such as the brain, spinal cord, heart, blood vessels, and lungs, have been engineered in labs, albeit in their primitive forms. 3D bioprinting has accelerated these efforts. These lab-grown organs mimic the functionality of the real organs. They can provide key insights into organ development and mechanisms of disease. In the later stages of organ failure, organ transplantation remains the only viable option. However, finding a matching donor is a challenging task. The next generation of stem cell-based regenerative medicine will witness the creation of whole organs in labs and their use in transplantation.
Conclusion
The promise of stem cells in disease and development was made a century ago. After numerous advancements, stem cell research labs are now delivering that promise to our doorstep. Numerous diseases have found enormous success with stem cell therapy. The patients have found sustainable relief from the disease with stem cell-based therapies, and their quality of life has drastically improved. But the adventure does not end here. The evolving regenerative medicine field confirms that stem cell potential has not been fully explored. And much more still remains to be unravelled in the coming time.
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