Current Stem Cell Research & Therapy - Volume 1, Issue 3, 2006

Autoimmune diseases affect approximately 6% of the population and are characterised by a pathogenic immune response that targets self-antigens. Well known diseases of this nature include type 1 diabetes, systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis. Treatment is often restricted to replacement therapy or immunosuppressive regimes and to date there are no cures. The strategy of utilising autologous or allogeneic haematopoietic stem cell transplantation to treat autoimmunity and induce immunological tolerance has been trailed with various levels of success. A major issue is disease relapse as the autoimmune response is reinitiated. Cells of the immune system originate from bone marrow and have a central role in the induction of immunological tolerance. The ability to isolate and genetically manipulate bone marrow haematopoietic stem cells therefore makes these cells a suitable vehicle for driving ectopic expression of defined autoantigens and induction of immunological tolerance.

The central thesis is that, while embryonic oocytes originate from extra-ovarian sources, those generated during fetal period and in postnatal life are derived from the ovarian surface epithelium (OSE). With the assistance of immune system-related cells, primitive granulosa and germ cells appear to originate from OSE stem cells in the fetal and adult human gonads. Fetal primary follicles are formed during the second trimester of intrauterine life, prior to the end of immune adaptation, possibly in order to be recognized as self and renewed later. With the onset of menarche, a periodical follicular renewal emerges to replace aging primary follicles and ensure that fresh eggs are always available during the prime reproductive period. The periodical follicular renewal ceases between 35-40 years of age, and the remaining primary follicles are utilized during the premenopausal period until exhausted. However, the persisting oocytes accumulate genetic alterations and may become unsuitable for ovulation and fertilization. Premature ovarian failure (POF) may result from premature termination of follicular renewal during adulthood, possibly due to the alteration of fetal follicular development during immune adaptation (idiopathic POF), or due to the alteration of the adult immune system by cytostatic chemotherapy. Factors responsible for the diminution of follicular renewal may be responsible for the aging of other tissues and the whole body in general. However, our recent research shows that OSE stem cells may produce new eggs in vitro, even when derived from ovaries lacking primary follicles. Consequently, their in vitro fertilization (IVF) and subsequent utilization of embryos for intrauterine implantation may represent a novel IVF approach for providing genetically related children to women with ovarian infertility, which is worthy of consideration and further exploration.

Hematopoietic stem cells (HSC) are characterized by their capacity of self-renewal, multi-lineage differentiation, and the ability to rescue lethally irradiated hosts. Both murine and human studies have attempted to characterize and purify HSC based on surface phenotypes, metabolic markers, in-vitro clonogenic and in-vivo competitive repopulation assays. The cell-fate of HSC is under intrinsic regulation by various transcription factors, including Hox and SCL genes, cyclin-dependent kinase inhibitors and telomerase, and extrinsic regulation by various signaling pathways involved in embryonic development, including the Notch, Wnt and bone morphogenetic proteins (BMP) pathways. Recent advances in genome research and gene profiling technologies have begun to unravel the regulatory mechanism of HSC by novel genes with hitherto unknown functions in hematopoiesis. The stem cell model of hematopoiesis has also shed light on the concepts of leukemic stem cells (LSC), which involves the presence of a rare population of cells that share the essential HSC attributes of self-renewing, replication and differentiation into progenies of leukemic blasts.

The first successful cord blood transplant was reported in 1989. In the last sixteen years, there has been a substantial increase in the use of cord blood as an alternative stem cell source for patients without matched related or unrelated bone marrow donors. Approximately 5000 cord blood transplants have been performed worldwide. Recently, the results in adult cord blood transplantation appear promising. In this review, the preclinical background, cord blood banking, and ethical issues will be briefly addressed. Outcome data for both pediatric and adult transplantation will be reviewed, with an emphasis on new strategies for adult cord blood transplantation. New indications for cord blood use outside of hematology/oncology will also be explored.

Processes involving conversion of mature adult cells into undifferentiated cells have tremendous therapeutic potential in treating a variety of malignant and non-malignant disorders, including degenerative diseases. This can be achieved in autologous or allogeneic settings, by replacing either defective cells or regenerating those that are in deficit through reprogramming more commited cells into stem cells. The concept behind reprogramming differentiated cells to a stem cell state is to enable the switching of development towards the required cell lineage that is capable of correcting the underlying cellular dysfunction. The techniques by which differentiated cells can reverse their development, become pluripotent stem cells and transdifferentiate to give rise to new tissue or an entire organism are currently under intense investigation. Examples of reprogramming differentiation in mature adult cells include nuclear reprogramming of more commited cells using the cytoplasm of empty oocytes obtained from a variety of animal species, or cell surface contact of differentiated cells through receptor ligand interaction. Such ligands include monoclonal antibodies, cytokines or synthetic chemical compounds. Despite controversies surrounding such techniques, the concept behind identification and design/screening of biological or pharmacological compounds to enable re-switching of cell fate in-vivo or ex-vivo is paramount for current drug therapies to be able to target more specifically cellular dysfunction at the tissue/organ level. Herein, this review discusses current research in cellular reprogramming and its potential application in regenerative medicine.

To achieve the goals of engineering large complex tissues, and possibly internal organs, vascularization of the regenerating tissue is essential. To maintain the initial volume after implantation of regenerated tissue, improved vascularization is considered to be important. Recent advances in understanding the process of blood vessel growth has offered significant tools for the neovascularization of bioengineered tissues and therapeutic angiogenesis. Several angiogenic growth factors including vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and hepatocyte growth factor (HGF) were used for vascularization of ischemic tissues. Other approaches such as prevascularization of the scaffold, prior to cell seeding, and incorporation of endothelial cells in the bioengineered tissue showed encouraging results. In this article, we will review recent advances in angiogenic growth factors, and discuss the role of these growth factors and endothelial cells in therapeutic angiogenesis and tissue engineering.

The progressive increase in life expectancy within the last century has led to the appearance of novel health related problems, some of those within the musculoskeletal field. Among the latter, one can find diseases such as osteoporosis, rheumatoid arthritis and bone cancer, just to mention some of the most relevant. Other related problems are those that arise from serious injuries, often leading to non-recoverable critical size defects. The therapies currently used to treat this type of diseases/injuries are based on the use of pharmaceutical agents, auto/allotransplant and synthetic materials. However, such solutions present a number of inconveniences and therefore, there is a constant search for novel therapeutic solutions. The appearance of a novel field of science called Tissue engineering brought some hope for the solution of the above mentioned problems. In this field, it is believed that by combining a 3D porous template - scaffold - with an adequate cell population, with osteo or chondrogenic potential, it will be possible to develop bone and cartilage tissue equivalents that when implanted in vivo, could lead to the total regeneration of the affected area. This ideal cell population should have a series of properties, namely a high osteo and chondrogenic potential and at the same time, should be easily expandable and maintained in cultures for long periods of time. Due to its natural and intrinsic properties, stem cells are one of the best available cell types. However, after this sentence, the readers may ask, “Which Stem Cells?”. During the last 10/15 years, the scientific community witnessed and reported the appearance of several sources of stem cells with both osteo and chondrogenic potential. Therefore, the present review intends to make an overview of data reported on different sources of adult stem cells (bone marrow, periosteum, adipose tissue, skeletal muscle and umbilical cord) for bone and cartilage regenerative medicine, namely those focusing on the differentiation potential of the latter as well as in vivo proof of concept of their applicability. Simultaneously novel aspects of adult stem cells biotechnology such as their immunogenic characteristics and cell expansion methodologies will also be put forward. The present review also points out on issues such as the bone and cartilage regenerative market, and gives a brief description on bone and cartilage bone biology, so the readers can have a true idea of the current state of the art, and how adult stem cells can be an added value to this field.

Mesenchymal stem cells (MSCs) have been isolated not only from bone marrow, but also from many other tissues such as adipose tissue, skeletal muscle, liver, brain and pancreas. Because MSC were found to have the ability to differentiate into cells of multiple organs and systems such as bone, fat, cartilage, muscle, neurons, hepatocytes and insulin-producing cells, MSCs have generated a great deal of interest for their potential use in regenerative medicine and tissue engineering. Furthermore, given the ease of their isolation and their extensive expansion rate and differentiation potential, mesenchymal stem cells are among the first stem cell types that have a great potential to be introduced in the clinic. Finally, mesenchymal stem cells seem to be not only hypoimmunogenic and thus be suitable for allogeneic transplantation, but they are also able to produce immunosuppression upon transplantation. In this review we summarize the latest research in the use of mesenchymal stem cells in transplantation for generalized diseases, local implantation for local tissue defects, and as a vehicle for genes in gene therapy protocols.

Stem cells have been isolated at all stages of development from the early developing embryo to the post-reproductive adult organism. However, the fetal environment is unique as it is the only time in ontogeny that there is migration of stem cells in large numbers into different organ compartments. While fetal neural and haemopoietic stem cells (HSC) have been well characterised, only recently have mesenchymal stem cells from the human fetus been isolated and evaluated. Our group have characterised in human fetal blood, liver and bone marrow a population of non-haemopoietic, non-endothelial cells with an immunophenotype similar to adult bone marrow-derived mesenchymal stem cells (MSC). These cells, human fetal mesenchymal stem cells (hfMSC), are true multipotent stem cells with greater selfrenewal and differentiation capacity than their adult counterparts. They circulate in first trimester fetal blood and have been found to traffic into the maternal circulation, engrafting in bone marrow, where they remain microchimeric for decades after pregnancy. Though fetal microchimerism has been implicated in the pathogenesis of autoimmune disease, the biological role of hfMSC microchimerism is unknown. Potential downstream applications of hfMSC include their use as a target cell for non-invasive pre-natal diagnosis from maternal blood, and for fetal cellular and gene therapy. Using hfMSC in fetal therapy offers the theoretical advantages of avoidance of immune rejection, increased engraftment, and treatment before disease pathology sets in. Aside from allogeneic hfMSC in utero transplantation, the use of autologous hfMSC has been brought a step forward with the development of early blood sampling techniques, efficient viral transduction and clonal expansion. Work is ongoing to determine hfMSC fate post-transplantation in murine models of genetic disease. In this review we will examine what is known about hfMSC biology, as well as discussing areas for future research. The implications of hfMSC trafficking in pregnancy will be explored and the potential clinical applications of hfMSC in prenatal diagnosis and fetal therapy discussed.

Recruitment of neural stem cells (NSCs) represents an elegant strategy for replacing adult central nervous system (CNS) cells lost to injury or disease. However, except in the rostral migratory stream to the olfactory bulb, the adult CNS harbors a relatively non permissive environment for motility of neural stem cells. This opens the possibility of therapeutic enhancement of NSC motility towards sites of CNS injury or disease. The Epidermal Growth Factor Receptor (EGFR) is involved in the activation of a number of downstream pathways that regulate the phenotype of progenitor cells. Activated EGFR tyrosine kinase activity enhances NSC migration, proliferation, and survival. However, EGFR signaling is also known to play a role in the most malignant and highly invasive of human tumors, glioblastoma multiforme (GBM). Recent evidence supports the theory that GBM derives from a ‘cancer stem cell’ and that EGFR signals are commonly altered in these precursor cells. This article will review the role of EGFR signaling as it relates to neural stem cell motility and invasion. The duality of altered EGFR signaling in neural progenitor cells is discussed and opportunities for enhancing the recruitment of adult progenitors, and consequences of altering EGFR signaling in progenitor cells will be highlighted.

The proteome of a cell is a molecular fingerprint directly relating to the gene expression snapshot profile at a certain point of time or developmental stage. Monitoring the expansion and the differentiation state of stem cells by proteomic means seems therefore a very attractive method for diagnostic as well as for therapeutic purposes. We have investigated the protein expression patterns of umbilical cord blood-derived CD34+/AC133+ cells in order to obtain a most comprehensive view of the stem cell proteome. For this purpose, we have applied 2-D gel electrophoresis and 2-D chromatography for most efficient protein/peptide separation and characterisation. The proteins were identified after tryptic digestion by nano-HPLC coupled directly to an ion trap mass spectrometer. An extensive bioinformatic analysis of the protein obtained revealed a dynamic stem cell proteome. This means that the heterogeneity of protein expression patterns obtained from different stem cell preparations refers to a limited set of stem cell-specific house keeping proteins as well as to a large number of proteins which depend on (marginal) stimuli from the environment. Since those are difficult to standardise, snapshot views of the stem cell proteome reflect not only stem cell-intrinsic metabolism but also the strong influence of the sample history on protein expression patterns.

Stem cells of the bone marrow, including hematopoietic stem cells (HSC), mesenchymal stem cells (MSC) and hepatic progenitors were reported to give rise to hepatocytes by both transdifferentiation and cellular fusion. Transdifferentiation was observed without liver damage although significant numbers of stem cell derived hepatocytes were not described. Cellular fusion was demonstrated in the presence of a proliferation stimulus in conjunction with impaired intrinsic liver regeneration capacity. Here, we review potential therapeutic applications of stem cell derived hepatocytes depending on how they emerge. Stem cells turning into hepatocytes by transdifferentiation introduce new functioning liver cells into a diseased organ, which can support intrinsic liver regeneration or bridge the time gap until a definitive treatment is available. When cellular fusion is the mechanism behind stem cell plasticity, however, no new cells emerge in the first place, whereas new genetic material is introduced. The fusion cell thereby acquires a selective advantage over resident hepatocytes allowing for extensive proliferation and liver repopulation. Therefore genetic deficiencies might be the predominant target for cell fusion therapies. We conclude that transdifferentiation and cellular fusion might be powerful tools for the therapy of liver diseases in the future and we propose the introduction of artificial cell fusion as well as stem cell differentiation as therapeutic options.

Nearly 80% of patients with Hodgkin's disease (HD) are cured with chemotherapy with or without radiotherapy. However, in patients with primary refractory or relapsed disease, high-dose therapy (HDT) and autologous or peripheral-blood stem-cell transplantation (ASCT or PBSCT) represents the best curative option. Several prognostic factors to identify patients at high risk for relapse or progression have been analyzed. However, in almost all analyzed series, disease status before high-dose chemotherapy with PBSC support remains the most important factor predicting the outcome of these patients. Nonetheless, the benefit of cytoreduction before HDT has yet to be fully determined and efforts to identify the best active regimen, combining therapeutic activity and CD34+ stem-cell mobilizing potential, represent a challenging issue for these patients. Furthermore new approaches like myeloablative and non-myeloablative allogeneic transplants have been assessed to improve long-term in such patients. In this review we analyzed the results of the most important salvage chemotherapy combinations as well as allogeneic transplantations to clarify the optimal treatment options for patients with resistant/relapsing HD.

Transplantation of insulin-producing cells offers a promising therapy to treat diabetes. However, due to the limited number of donor islet cells available, researchers are looking for different sources of pancreatic islet progenitor or stem cells. A stem cell with extensive proliferative ability may provide a valuable source of islet progenitor cells. Several studies have demonstrated that a progenitor/stem-cell population can be expanded in vitro to generate large numbers of islet progenitor cells. However, efficient and directed differentiation of these cells to an endocrine pancreatic lineage has been difficult to achieve. We discuss here various pancreatic islet stem cells that we and others have obtained from embryonic, fetal or adult human tissues. We review the progress that has been achieved with pancreatic islet progenitor cell differentiation in the last 2 decades and discuss how close we are to translate this research to the clinics.

The article published in “CURRENT STEM CELL RESEARCH & THERAPY” 2006 Vol. 1(1), authored byDr. H. Shibicharvarthy Kannan and Min Wu has exactly the same data at some places which was published byDr. I.P. Neuringer and Dr. S.H. Randell in “RESPIRATORY RESEARCH” 2004 Vol. 5(6). Due to oversight on the part of the author, the aforementioned article was published incorrectly. Table 1 employed datafrom a review article by I.P. Neuringer and S.H. Randell (Respiratory Research 2004, 5:6). While this review was cited in ourarticle and a statement was made in the text that Table 1 was an adaptation of Table 1 in the article by Neuringer and Randell,we did not specifically indicate this in the Table sub text. We would like to make the following addition to the sub text ofTable 1: Table 1 is adapted from Table 1 of the review article by I.P. Neuringer and S.H. Randell (Respiratory Research 2004,5:6), incorporating more recent data.