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Promises and Challenges of Stem Cell Research for Regenerative Medicine

Carl Power, PhD; and John E.J. Rasko, MBBS, PhD
[+] Article and Author Information

From the Centenary Institute, University of Sydney, and the Royal Prince Alfred Hospital, Sydney, Australia.


Acknowledgment: The authors thank Cure The Future (Cell and Gene Trust) and the Brocher Foundation for support. The figures were produced using Servier Medical Art (www.servier.com).

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1370.

Requests for Single Reprints: John E.J. Rasko, MBBS, PhD, Centenary Institute, Locked Bag 6, Newtown, New South Wales 2042, Australia; e-mail, j.rasko@cenint.org.

Current Author Addresses: Drs. Power and Rasko: Centenary Institute, Locked Bag 6, Newtown, New South Wales 2042, Australia.

Author Contributions: Conception and design: C. Power, J.E.J. Rasko.

Drafting of the article: C. Power, J.E.J. Rasko.

Critical revision of the article for important intellectual content: C. Power, J.E.J. Rasko.

Final approval of the article: C. Power, J.E.J. Rasko.

Obtaining of funding: J.E.J. Rasko.

Collection and assembly of data: C. Power, J.E.J. Rasko.


Ann Intern Med. 2011;155(10):706-713. doi:10.7326/0003-4819-155-10-201111150-00010
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In recent years, stem cells have generated increasing excitement, with frequent claims that they are revolutionizing medicine. For those not directly involved in stem cell research, however, it can be difficult to separate fact from fiction or realistic expectation from wishful thinking. This article aims to provide internists with a clear and concise introduction to the field. While recounting some scientific and medical milestones, the authors discuss the 3 main varieties of stem cells—adult, embryonic, and induced pluripotent—comparing their advantages and disadvantages for clinical medicine. The authors have sought to avoid the moral and political debates surrounding stem cell research, focusing instead on scientific and medical issues.

Figures

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Figure 1.
Derivation and differentiation of human stem cells for cell-based therapies.

ES = embryonic stem; iPS = induced pluripotent stem; SC = stem cell. A. ES cells are usually derived from the inner cell mass of a blastocyst. B. iPS cells are produced by in vitro reprogramming of adult cells so that they enter an ES cell–like state. Both ES and iPS cells are pluripotent—they can be differentiated into a wide range of specialized cell types via multipotent intermediate cells. C. Adult SCs can be collected from a variety of sources, including bone marrow, peripheral blood, adipose tissue, and neural tissue. They are generally believed to be multipotent, or able to generate specialized cell types belonging to the organ from which they were derived. ES = embryonic stem; iPS = induced pluripotent stem; SC = stem cell.

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Figure 2.
Modeling diseases with iPS cells.

Cells can be obtained from a patient with almost any disease, reprogrammed to a pluripotent state, expanded in vitro, and differentiated into a cell type that expresses features of the disease. Such disease models “in a dish” can be used to test new drugs and gene therapies. Induced pluripotent stem cells derived from healthy donors can also assist in the development of new drugs by offering an unlimited supply of heart, liver, and neural cells for toxicology testing. iPS = induced pluripotent stem.

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Neurological improvement after omental transplantation in the cervical cord in a 4-year-old girl
Posted on November 20, 2011
Hernando, Rafael, Neurosurgeon
Clinica Santa Monica,Lima-Peru
Conflict of Interest: None Declared

TO EDITOR.I read the article by Power and Rasko (1) about stem cells: 1)adult, 2)embryonic and 3)induced pluripotent. I wish to comment that recently we have transplanted omental tissue on the injured cervical cord (C3)in a 4-year-old girl without respiratory automatism and tetraplegia, caused by a bullet in August 9,2010.The patient was connected to a fan during 11 months. An omental transplantation was performed in July 15,2011.During the surgery we found :1) moderate peridural fibrosis; 2)severe fibrosis in the posterior surface of the cervical cord between C2 and C3;3) small intramedullar cyst in the left cervical cord,4)cervical cord reduced to 70% and 3 cm of height.On this residual cervical cord a segment of omentum was placed(2-4)Two days after surgery,she began with respiratory automatism. Ten days later,she presented sensory in her hands and voluntary movement occasionally in the right limbs. At present, four months after surgery,she can walk with help of orthopedic devices. In conclusion, based in our experience wide with omental transplantation in the spinal cord(2,3) and medulla oblonagata(4),we conclude that neurons and/or axons in the ischemic zones and ischemic penumbra can improve if circulation is restituted through the omentum,and later on, because of neuronal and axonal regeneration,as well as of neurogenesis (4,5).

REFERENCES

1-Power C,Rasko JEJ:Promises and challenges of stem cells research for regenerative medicine. Ann Intern Med 2011;155:706-713

2-Rafael H,Malpica A,Ruiz C,Moromizato P,Malo J,Espinoza E,et al.Paraplejia traumatica cronica.Diagnostico y tratamiento(parte 2).Mundo Medico (Mex) 1991;18(204):11-19.

3-Rafael H.Omental transplantation for cervical degenerative disease.J Neurosurg:Spine 2010;13:139-140

4.-Rafael H,Mego R. Transplante de epiplon para isquemia en la medula espinal y oblongada.Rev Argent Neuroc 2011;25(2):85-89.

5.-Garcia-Gomez I,Goldsmith HS,Angulo J,Prados A,Lopez-Hervas P,Cuevas B,et al.Angiogenic capacity of human omental stem cells.Neurol Res 2005;27(8):807-811.

Conflict of Interest:

None declared

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