Current status & Rationale
Current Status
stem-cell therapy could fundamentally change medicine, almost all treatments being developed are still in an experimental stage or under clinical trial, except for a few orthopaedic and cosmetic indications.
Autologous stem cells are most accepted as of now because of having advantages in terms of immune compatibility, lack of, and ethical issues.
Two major lines of investigation have emerged –one advocating stem cell enrichment only and the other doing expansion with or without differentiating these endogenous stem cells.
Enrichment has the advantage of fresh cells along with a cocktail of numerous different types of supportive cells and growth factors necessary for promoting cell growth.
The culture of stem cells increases the number but there are concerns about induction of mutations, changes in the behaviour of cells, etc.
Avoid the use of Cryo preserved cells as much as possible as on thawing viability is lost up to 25 %. Their death further increases during transportation. The biological behaviour also deteriorates. The ideal is fresh expanded /cultured cells directly from Lab.
Allogenic cells (not from the Patient’s own tissue) need more safety studies before clinical use
Rationale of use
Several published studies have documented the positive clinical effect of delivering autologous (patient’s own) bone marrow and adipose tissue-derived stromal cells.
Our own results of pilot-human studies are very encouraging.
Based on these available data, we are currently offering a safe and similar therapeutic approach to a small group of patients with various orthopaedic, cosmetic, neurodegenerative, Cardiac, Renal, hepatic, and metabolic (Diabetes) disorders.
Mechanism of Action
Stem cells help by secreting growth factors which help in new blood vessels formation (Neoangiogenesis) This leads to more blood supply hence better repair
Secrete lot of growth factors (of paracrine effect). It modulates the Locoregional Milieun hence Promoting self-repair of residing tissue cells. this also activates the dormant endogenous stem cells
Few stem cells may also get Engrafted and Differentiate into component cell types and integrate with the target tissue
Hype
Clinical stem cell application should be done as a clinical trial in a few patients in those conditions where scientific evidence in literature is available. It should be followed by a placebo-controlled clinical trial on more Patients. ANY CENTRE CLAIMING OF DOING HUNDREDS OF CASES IN A PARTICULAR DISEASE IS NONSENSE.
Stem cell research and therapy should not be hyped but presented as a possible hope. The field needs time to grow and mature before stem cells can be turned into clinical and other applications. It will happen, but not right away.
Many hospitals and centres have overstated their stem-cell treatments with very bold claims.
Don’t be carried away with Testimonials as they can be generated Fake. Understand the Science and if willing kindly participate in it as an experiment.
1. Quantity of cells being injected.
2. Type of cells: Stem cells are identified by markers. E.g. haematopoietic (CD34 +ve) or mesenchymal (Cd 34 –Ve, CD 105 +ve)
It would be very ideal for a centre to provide a sample of the cells for cross verification.
3. Route of administration: should be as Direct as possible.
Intralesional or into the feeding artery of the organ involved
High dose and multiple administrations are needed if administering Intravenous as
the majority of these cells get trapped in the lungs and hence will not reach the target organ.
Good cell isolation protocol
A good protocol of minimal manipulation is essential for stem cell isolation
1. cells should not leave their biological environment.
2. Should not lose adult pluripotent stem cells like VSELS
3. Should also keep functional characteristics of stem cells intact.
4. Should be rich in growth factors necessary for stem cells to home at the lesion.
5. Should not adversely affect in terms of cell aging changes in the genome, chromatin structure, create mutations or activate oncogenes
6. Should yield CFU (a way of assessment of functional efficacy)
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India 263153
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