Friday, July 22, 2011

Where Is Stem Cell Research in Arthritis Heading?

Much of the excitement arising from the use of stem cells (SC) technology for treatment of arthritis, in fact, for the treatment of many medical diseases, has focused on the ability of embryonic SC. These cells, derived from fetuses can self-renew indefinitely and are also able to differentiate into any cell type. This last property is known as "pluripotency".

Unfortunately there are disadvantages to the embryonic SC. This includes a range of ethical and political issues. Moreover, their use in the armies of adults can be problematic as the host, no doubt, will mount a graft-versus ... body's immune system mounts an attack on stem cell graft. This means that a patient receiving embryonic SC s may have to undergo chronic immunosuppressive medication.

More recently, scientists have conducted experiments to somehow get around these problems.

A breakthrough study by a team of scientists at Kyoto University led by Dr. Shinya Yamanaka, was published in the journal Cell in 2006.

What they showed was that by injecting a set of genes in adult mouse cells could reprogram cells and turn them into a pluripotent state. These cells are called induced pluripotent SC.

What made this discovery so exciting is that it avoids all the ethical problems with embryonic stem cells. He also introduced the idea that any cell could be reprogrammed into a pluripotent cell that could differentiate-it, any other type of cell tissue. For those of us interested in regeneration of cartilage, this study has been opening his eyes.

This led to experiments in diseased cells remained pluripotent ... making it easier to study disease models in the laboratory.

In addition, it became apparent that the cells could become a different kind of tissue cells without becoming a pluripotent stem cell by direct gene transfer. This procedure is called "transdifferentiation".

However, the idea of ​​induced pluripotency has continued to excite researchers. What has emerged is that although there are drawbacks. The first is the oldest of a cell, the harder it is to induce the cells to a pluripotent state. And even when it does, the cell still retains vestiges of its former self which means that it is probably easier for a pluripotent cell-induced skin into a skin cell of what is to become a cell cartilage.

The other danger is about the possibility of developing cancer as a result of genetic manipulation of cells leading to mutations. In other words, cell multiplication can continue unchecked. This is also known as cancer.

To date, however, breeds that are most useful are the breeds present in autologous all adults and is found abundantly in areas such as bone marrow and adipose fat.

An excellent review article on this subject was written by the power and Rasko (Power C, Rasko JEJ cell reprogramming will resolve the controversy of embryonic stem cells a narrative review Annals Int Med 2011; 155 :.?.. 114-121) . It's a bit technical, but still a great read.

In our center, we still feel that autologous stem cells, the patient's own stem cells, hold the greatest promise for cartilage repair. There is no danger of rejection nor is there any concern about uncontrolled growth.



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