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Mesenchymal stem cells by definition can be described as multipotent progenitor, self renewing cells with multiple avenues having potential to differentiate into the cell types of mesodermal origin such as osteocytes, adipocytes and chrondrocytes.
They are usually isolated from bone marrow and in some cases also isolated from other tissues such as placenta, adipose tissue, amniotic fluid and umbilical cord blood.
For all kinds of Celluar therapy mesenchymal stem cells have been considered to be gold standard as they are easily available and also because of the fact that they can be easily expanded.The unique characteristic of their multipotency has been used in tissue repair and regenerative medicine. Their therapeutic potential is also huge as the secretion of their soluble factors can be used to induce immunomodulatry environment. There is huge interest in Msenchymal stem cells application and it has become the stem cell of choice for regenerative medication one of the reasons being partly to the ease with which it can be isolated from tissues and the way it works in wide range of diseases.
The mesenchymal stem cells have been used in the treatment of bone disorders for example they have been uses in osteogenesis imperfecta and hypophosphatasia.
The patients in Pediatric age group go for allogrnic hematopoeric stem cells transplantation. After that the transplanted bone marrow cells are engrafted and generated as functional osteoblasts leading to normal progenesis of bone growth.
It is also successfully used in the treatment of cardiovascular diseases. Owing to its regenerative and immunomodulatory properties it is considered as an ideal candidate for repair and regeneration of cardiovascular tissues. Based on the properties of modulation of immune responses by mesenchymal stem cell it is also highly effective in treatment of autoimmune diseases. Due to its regenerative capacity it is also highly effective in treatment of liver diseases such as cirrhosis of liver. Mesenchymal stem cells are genetically modified to express various anti cancer genes. Mesenchymal stem cells play a significant role in making path breaking treatment protocols in diseases that lack real time effective treatment at present with all modern amenities.
It has made breakthrough in graft versus host diseases and cardiovascular diseases due to complexities associated with such disorders.
The specific role of mesenchymal stem cells are yet to be ascertained by completing clinical trials in myocardial infarction, stroke, liver cirrhosis, amyotrophic lateral sclerosis and graft versus host disease.The main pathways for therapeutic mechanisms of mesenchymal stem cells are –
Mesenchymal stem cells based regenerative approaches are increasingly in demand specially in musculoskeletal disorders. It is a matter of time when therapies of non life threatening diseases will start showing improved outcomes compared to standard treatment protocols will these MSCs be able to prove long term cost effectiveness and their name in therapeutic regimen of all standard protocols. One particular area of interest concerning me was cardiovascular diseases as it is commonly found and yet again difficult to treat at times even with best effort in best places for threatment. Even after significant improvements in surgical and medical fields heart diseases and heart failure continue to show very high morbidity and mortality in most cases.
Owing to its regenerative and immunomodulatory properties it has been the choice of many experiments and studies in candidate shaving cardiovascular disorders.
The results after using engrafts having shown tremendous results in improvement of cardiac function. In addition to autologous mesenschymal stem cells even allogenic MSCs has shown encouraging results. Allogenic MSCs were used to improve left ventricular ejection fraction and to lower the incidences of arrhythmias.In view of the study conducted with both autologous and allogenic variety of MSCs it can be easily said that it will be the main stay of treatment protocols in regard to cardiac therapy in both acute and chronic case with cardiovascular disorders.
Initially with the stem cell therapy whether it’s allogeneic stem cell or autologous stem cells the thought process primarily was that it will lead to cardio genesis that the cells will actually go into the heart and grafted into the heart and become an actively contractile cardiac tissue but from the tagging studies we have learned over the years that these cells are actually there for a relatively short time and then this sort of migrate away. SO new therapies started coming up, new hypothesis, one of them suggested that maybe most of the effect is because of neovasculogenesis which is related to the VEGF and another neohormonal secretion per se but the concept is much broader and that the two theories which are out there one is that the predominant effect is paracrine effect which is related to immunomodulatory or anti-inflammatory and other effects that are beneficial. And then there are some suggestion also that maybe these secretions also activate their resident progenitor stem cells within the hearts. So there are lots of theories out there but the most favored theory right now is that these are paracrine effect based on all the immunomodulatory and anti-inflammatory substances, which are secreted by theses cells.
If the theory that the paracrine is the primary property through which the stem cells have the beneficial effect then obviously as it stands to reason that the higher the amount of paracrine secretions, neurohormonal secretion are there with the cells, the better it is and there is basic science literature that suggests that these mesenchymal stem cells which are grown under hypoxic condition the so-called ischemia tolerance cells that they had a higher capacity to secrete paracrine factors and therefore theoretically, atleast, have a better chance of being beneficial.
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