stemcellres.com/article/10.1186/scrt111
Stem Cell Research & Therapy

Stem Cell Research & Therapy
* Volume 3
* Issue 3

Mesenchymal stem cell therapy for attenuation of scar formation during wound healing

Wesley M Jackson1,2, Leon J Nesti1,3 and Rocky S Tuan4*

* Corresponding author: Rocky S Tuan rst13@pitt.edu

Author Affiliations

1 Clinical and Experimental Orthopaedics Laboratory, Department of Surgery, Uniformed Services University, Bethesda, MD 20814, USA

2 The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA

3 Orthopaedic Research Group, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA

4 Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 450 Technology Drive, Room 221, Pittsburgh, PA 15219, USA

For all author emails, please log on.

Stem Cell Research & Therapy 2012, 3:20 doi:10.1186/scrt111

The electronic version of this article is the complete one and can be found online at: http://stemcellres.com/content/3/3/20

Published: 31 May 2012

© 2012 BioMed Central Ltd

Abstract

Scars are a consequence of cutaneous wound healing that can be both unsightly and detrimental to the function of the tissue. Scar tissue is generated by excessive deposition of extracellular matrix tissue by wound healing fibroblasts and myofibroblasts, and although it is inferior to the uninjured skin, it is able to restore integrity to the boundary between the body and its environment. Scarring is not a necessary process to repair the dermal tissues. Rather, scar tissue forms due to specific mechanisms that occur during the adult wound healing process and are modulated primarily by the inflammatory response at the site of injury. Adult tissue-derived mesenchymal stem cells, which participate in normal wound healing, are trophic mediators of tissue repair. These cells participate in attenuating inflammation in the wound and reprogramming the resident immune and wound healing cells to favor tissue regeneration and inhibit fibrotic tissue formation. As a result, these cells have been considered and tested as a likely candidate for a cellular therapy to promote scar-less wound healing. This review identifies specific mechanisms by which mesenchymal stem cells can limit tissue fibrosis and summarizes recent in vivo studies where these cells have been used successfully to limit scar formation.
Introduction

Adult human skin is limited in its ability to repair itself following injury that penetrates beyond the epidermis. The cutaneous wounding healing process results in the formation of a scar that is composed of excess extracellular matrix (ECM) in the place of the normal dermal tissue. Besides having a different visual appearance, which can be undesirable, the tissue in the vicinity of the scar does not function like the surrounding skin, as it does not contain many of the structures that are native to the dermis, including sebaceous glands, hair follicles and sensory nerve receptors [1]. The scar tissue is also limited to approximately 80% of the tensile strength of the surrounding skin [2] and results in a weak point that is susceptible to re-injury. However, scar formation is not required for cutaneous healing, as wound healing occurs in the absence of scarring throughout most of fetal development (reviewed in [3]). There has been considerable scientific effort to understand the mechanism of cutaneous scar formation with the goal of developing potential therapies to promote scar-less wound healing.

Despite the deleterious consequences of fibrosis and scar tissue formation, current treatments to promote scar-less wound healing are primarily limited to the standard principles of wound management. These include the use of topical antibiotics and sterile dressing in order to minimize the risk of infection to advance the wound healing process through the inflammatory phase and into the cellular proliferation and remodeling phases [1], where functional tissue regeneration can occur. Irrigation and debridement of the wound may be applied as necessary to remove foreign bodies and necrotic tissue that can promote tissue inflammation [4]. If the inflammatory phase is prolonged, the pro-inflammatory mediators will direct the wound healing cells, such as myofibroblasts and fibrocytes, in generating the non-functional, void-filling tissue that will result in the formation of a scar [5].

Mesenchymal stem cells (MSCs), which appear to be a native constituent of the wound bed [6], have emerged as an alternative to the standard pharmaceutical treatment modalities. These cells are important trophic mediators to promote tissue regeneration and can be readily derived from a variety of autologous or allogeneic adult tissues, as well as from commercial providers [7]. The versatility of these cells has made them an attractive candidate for clinical translation in a variety of therapeutic applications. In particular, MSCs may offer the means of recapitulating several mechanisms that are sufficient for inhibition of scar formation in skin wounds (Figure 1). This review will provide an overview of current research into cutaneous wound healing with an emphasis on specific mechanisms by which MSCs may enhance functional tissue regeneration.

thumbnailFigure 1. Mesenchymal stem cells can influence cutaneous regeneration by multiple distinct mechanisms acting on multiple cell types. HGF, hepatic growth factor; MSC, mesenchymal stem cell; RNS, reactive nitrogen species; ROS, reactive oxygen species.
Anti-scarring mechanisms of mesenchymal stem cells

MSCs are a broadly generalized cell type that can be found in a variety of adult tissues throughout the body and exhibit specific characteristics when cultured in vitro [8]. In particular, MSCs must be capable of robust ex vivo expansion and maintain the ability to differentiate into osteoblasts, adipocytes and chondrocytes. Many recent studies have also demonstrated that MSCs exhibit a number of trophic functions to enhance tissue regeneration, such as promoting angiogenesis and modulating the inflammatory response (reviewed in [9]). Originally harvested in the adherent fraction of cells in a bone marrow aspirate [10], MSCs have since been identified in a variety of other adult tissues, including adipose tissue [11,12], the marrow space of long bones [13,14], trabecular bone chips [15-17], periosteum [18,19], synovial fluid [20-22], periodontal ligament [23,24], palatine tonsil [25], parathyroid gland [26], fallopian tube [27] and traumatized muscle tissue [28,29]. MSCs have also been harvested from prenatal tissues that are lost as a result of development, such as umbilical cord [30,31], umbilical cord blood/Wharton’s Jelly [32,33] and primary tooth dental pulp [34,35]. There is a growing body of evidence to suggest that a substantial fraction of the cells exhibiting the in vitro characteristics of MSCs arise from vascular pericytes in vivo [36], suggesting that there is a common precursor cell type in a wide variety of adult and fetal tissues. Given their regenerative functions, availability and potential for cell banking [37], there is immense interest in developing cellular therapies based on autogenous or allogeneic MSCs.

The basic biology of wound healing has been extensively studied (reviewed in [1]), and MSCs are clearly capable of responding and modulating their function when exposed to the cells and biochemical factors that are characteristic of an injury environment. Human MSCs migrate preferentially to regions of inflammation [38] and express several chemokine receptors that are necessary to coordinate their homing ability [39]. Furthermore, MSCs have demonstrated chemotaxis toward a variety of wound healing cytokines in vitro, including platelet-derived growth factor, insulin-like growth factor-1, IL-8 and TNFα [40,41]. These data suggest that bone-marrow-derived MSCS or endogenous cells resembling MSCs, such as pericytes, are likely to migrate to and participate in the response to tissue injury.

There is ample evidence based on murine models of injury and disease to demonstrate that systemically administered allogeneic MSCs are capable of homing to and engrafting at the site of tissue damage [42,43]. Several recent studies have further quantified the extent of bone marrow-derived MSC involvement during wound healing. A chimeric mouse model was developed to evaluate MSCs by lethally irradiating female C57BL/6 mice, followed by replacement with fluorescently labeled MSCs from male BALB/c mice in the bone marrow [44]. These mice demonstrated gradual engraftment of the donor cells in the dermis as the bone marrow-derived MSCs participated in the process of dermal regeneration, and fluorescent cells in the regenerated tissue also exhibited markers of dermal fibroblasts. Furthermore, the number of green fluorescent protein-labeled cells in the dermis increased approximately 400% in regions that experienced cutaneous injury [45], suggesting that recruitment from the bone marrow occurred at the site of wound healing. As with other populations of marrow stromal cells, the mobilization of MSCs appears to be dependent on systemic levels of granulocyte-colony stimulating factor (G-CSF), and homing to the site of injury is dependent on local expression of stromal cell-derived factor (SDF)-1 [46]. Exogenous administration of either G-CSF or SDF-1 is sufficient to increase MSC recruitment to the site of injury and corresponds to enhanced wound healing at the sites of MSC recruitment.

One likely function of MSCs in the process of wound healing is to regulate the function of the leukocytes that have invaded the tissue in response to injury [47,48]. Once the MSCs enter the inflammatory environment, their immunomodulatory phenotype becomes activated by IFNγ, TNFα and IL-1β [49]. The ability of MSCs to regulate T-cell recruitment, proliferation and activity is well documented [49,50]. There is also evidence that MSCs are capable of suppressing the proliferation of B cells [51] and natural killer cells [52], thereby ameliorating the acute immune response to injury. By attenuating the function of these cell types, the MSCs would likely reduce the pro-fibrotic responses that can occur coincident with prolonged inflammation during wound healing [53,54]. However, a variety of other likely mechanisms by which MSCs could suppress fibrosis and the formation of scar tissue are discussed below.
Modulation of macrophage and T-cell function during wound healing

During the transition between the inflammatory and proliferation stages of wound healing, macrophages resident in the wound undergo a change in phenotype to an alternative activation (M2) state. IL-4 and IL-13 are the archetypical activators of the M2 phenotype [55], and there is evidence that IL-4 may be produced by mast cells that migrate from the margins into the wound bed during this stage of healing [56]. The precise alternative phenotype of the macrophages during cutaneous wound healing has not been fully defined, as the M1/M2 macrophage model varies somewhat between tissue types [57]. However, alternative macrophage activation is generally characterized by decreased expression of pro-inflammatory cytokines accompanied by an increase in anti-inflammatory signaling [57]. This shift in inflammatory modulation is accompanied by the expression of cytokines that promote tissue regeneration, such as heparin bound epidermal growth factor (HB-EGF), fibroblast growth factor (FGF)-2 and vascular endothelial growth factor (VEGF) [1]. HB-EGF signaling to keratinocytes provides additional stimulus to promote re-epithelialization and the formation of a new epidermal layer [58]. FGF-2 and VEGF promote the proliferation and migration of fibroblasts and endothelial cells into the fibrin clot [59].

The inflammatory environment of the wound activates the MSCs to initiate their immunomodulatory functions, including an increase in cyclooxygenase-2 activity and up-regulation of prostaglandin E2 (PGE2) expression [60], which has multiple fibroregulatory effects on the wound. In particular, PGE2 plays a necessary role in the immunoregulatory mechanism of the MSCs to inhibit the expression of IL-2 [61] and attenuate mitogenesis and proliferation of T cells in the wound [62]. PGE2 is also a co-factor in the transition from TH1 cells into TH2 cells [63], corresponding to a decrease in the expression of INFγ and up-regulation of IL-4 by the effector T cells [64]. The decreasing ratio of IFNγ relative to IL-4 in the wound promotes functions that are associated with the alternative activation of macrophages [65], which favor wound healing over inflammation and promote the activity of mesenchymal cells during the proliferation stage (reviewed in [55]).

PGE2 expression results in other indirect fibroregulatory effects by interacting with immune cells that are resident in the wound. In response to PGE2, T cells [66] and macrophages [60] become reprogrammed and begin to express higher levels of IL-10, an important anti-inflammatory cytokine with multiple functions to limit or attenuate the inflammatory mechanism of immune cells [67]. IL-10 is a powerful inhibitor of neutrophil invasion into the wound and prevents further oxidative tissue damage from their release of reactive oxygen species (ROS) [68]. IL-10 may also have direct effects on fibrosis by down-regulating the expression of transforming growth factor (TGF)β1 in macrophages and T cells [67], and reprogramming wound fibroblasts to favor ECM remodeling by up-regulating the expression of matrix metalloproteinases (MMPs) and down-regulating the expression of collagens [69]. IL-10 also prevents excessive collagen deposition by attenuating the expression of pro-inflammatory cytokines in the wound, such as IL-6 and IL-8 [70]. As a result of these mechanisms, expression of IL-10 contributes to a resolution of the inflammatory stage and acceleration of the wound into the proliferation stage [71]. The role of IL-10 in fibroregulation has been verified by demonstrating that scar-less wound healing can be abrogated in fetal mice by knocking out IL-10 [70], and then over-expression of IL-10 in post-natal skin generates a permissive environment where wound healing is more likely to occur with the absence of scar formation [72].
Neutralization of reactive oxygen species in the wound

MSCs substantially up-regulate the expression of inducible nitric oxide synthase in response to their interaction with T cells in a pro-inflammatory environment. Nitric oxide is complementary to PGE2 for the inhibition of T-cell proliferation [73], but there is evidence that it has other, more direct mechanisms to prevent the formation of scar tissue. ROS secreted by neutrophils, including super-oxide, hydrogen peroxide and alkyl peroxides, are highly cytotoxic compounds used to achieve wound sterility, but these ROS are also intensifiers of collagen deposition [74]. Prolonged ROS exposure during wound healing leads to enhanced fibrogenesis and accumulation of fibrotic tissues through a mechanism involving membrane lipid oxidation and induction of TGFβ1 [75]. Nitric oxide produced by MSCs in the wound can scavenge ROS to produce reactive nitrogen species, such as peroxynitrite [76]. Although these reaction products are also oxidative and cytotoxic, they react more slowly than their associated ROS [77] and prevent oxidative damage to DNA and membrane lipids [76]. A recent study has demonstrated that inducible nitric oxide synthase expression is sufficient to alter the ROS/RNS balance to prevent the formation of fibrotic tissues [78].
Mesenchymal stem cells produce anti-fibrotic factors

MSCs secrete a variety of cytokines and growth factors that have anti-fibrotic properties, including hepatocyte growth factor (HGF), IL-10 and adrenomedullin [79-81]. The anti-fibrotic properties of IL-10 have been described earlier in this paper. HGF has also been shown to attenuate fibrosis and scar formation through a variety of mechanisms. Fibroblasts respond to HGF by down-regulating their expression of TGFβ1 [82], collagen type I [83] and collagen type III [82], as HGF receptor binding antagonizes downstream signaling cascades [83] and promotes the nuclear exclusion of SMAD 3, the transcription factor associated with many pro-fibrotic genes [84]. HGF also stimulates the up-regulation of MMP-1, MMP-3 and MMP-13 expression in fibroblasts [85], thereby promoting the turnover of the ECM. In addition to fibroregulation of fibroblast function, HGF promotes keratinocyte migration, proliferation [86], and up-regulates their expression of VEGF-A [87]. Therefore, the expression of HGF contributes to the generation of a high-quality, well-vascularized granulation tissue and enhanced re-epithelialization of the wound [86].

There is also evidence for an additional anti-fibrotic mechanism of HGF by contributing to the inhibition of myofibroblast differentiation. Although contraction may facilitate re -epithelialization by narrowing the wound margin for alignment of ECM components [1], this process does not necessarily require fully differentiated myofibroblasts. Fetal wound healing occurs in the near absence of myofibroblasts [88]. Furthermore, during oral epithelial wound healing, which is characterized by high levels of HGF and keratinocyte growth factor, rapid wound contraction occurs in the absence of robust myofibroblast commitment and yields less scar tissue compared to cutaneous wound healing [89]. TGFβ1 is a potent driver of myofibroblast differentiation, and high levels of TGFβ1, which is often related to a prolonged acute inflammatory response, can lead to over-contraction, formation of tight collagen bundles and excessive matrix deposition with the visual appearance of a scar. In diseases caused by excessive fibrosis, HGF appears to resist the differentiation of fibroblasts into myofibroblasts [90], thereby limiting the pro-fibrotic functions that are characteristic of these cells.
Mesenchymal stem cells enhance dermal fibroblast function

During the proliferation stage of wound healing, dermal fibroblasts from the wound margin proliferate and migrate into the wound, generate granulation tissue, and begin to remodel the wound matrix to generate new dermal tissue. However, there are additional sources of fibroblasts that may be recruited to participate in these wound repair processes, as is warranted by the extent of the injury. In response to elevated levels of TGFβ1, endothelial cells from damaged blood vessels may be encouraged to undergo epithelial-to-mesenchymal transition (EMT) and become wound healing myofibroblasts [91]. Fibrocytes may also be recruited into the wound due to prolonged inflammatory response or when the wound matrix cannot be rapidly converted into granulation tissue [92], and the fibrocytes rapidly differentiate into myofibroblasts in the presence of TGFβ1 and T cells [93]. Although these generic wound-healing fibroblasts may be needed to restore integrity of the skin after some types of injury, they produce excessive amounts of ECM compared to dermal fibroblasts, and they are more likely to yield a tissue with the visual appearance of a scar [94]. MSCs resident in the wound can inhibit EMT by producing HGF [95] and PGE2 [96], and they can resist myofibroblastic differentiation as described in the previous section. MSCs also produce paracrine factors that promote specific wound healing functions of dermal fibroblasts [97]. These combined mechanisms enable MSCs to regulate the cells populating the wound to favor resident wound healing cells to produce an ECM that more closely resembles the surrounding dermal tissue.
Mesenchymal stem cells promote angiogenesis and vascular stability

Angiogenesis is a necessary process during the proliferation phase of wound healing to provide the fibroblasts with sufficient nutrient supply for the production of a provisional granulation matrix [98]. Failure to generate an adequate microvascular network leads to deficiencies in wound closure and may develop into a chronic non-healing wound. Equally important is the need to stabilize the provisional vessels as the tissue remodels and to form a permanent vascular network. In addition to macrophages and fibroblasts, MSCs produce basic FGF and VEGF-A, which provide powerful mitogenic cues to promote proliferation, migration and differentiation of microvascular endothelial cells [99,100]. MSCs also express paracrine factors to promote vascular stability and vasoprotection [101,102], including adreno-medullin [103]. It has been hypothesized that these functions are unique to MSCs due to their possible perivascular origin, and they are able to exploit these functions to recreate their perivascular niche as the process of vasculature remodeling is concluded [104]. Enhancement of vascular formation by bone-marrow-derived MSCs has been demonstrated in vitro [105] and to facilitate the development of long-lasting functional vasculature as perivascular progenitor cells [106].
Mesenchymal stem cells differentiate into dermal cell types

MSCs are typically characterized based on their ability to differentiate into osteoblasts, adipocytes and chondrocytes in vitro. It is likely that MSCs in the wound environment may assume a phenotype that resembles that of the resident dermal fibroblasts or myoblasts, and this differentiation process has been recapitulated in vitro [107]. More interesting and relevant is recent evidence demonstrating that MSCs may trans-differentiate to epidermal cells, keratinocytes and microvascular endothelial cells under defined conditions in vitro [39,108,109]. Finally, MSCs may also trans-differentiate into keratinocytes under conditions that allow them to interact with native epidermal cells [110]. These studies suggest that MSCs could participate directly in the structural regeneration of dermal and epidermal tissues, thus representing an additional mechanism by which the MSCs may promote cutaneous wound healing.
Conclusions and future perspectives

In this review, we have highlighted many recent scientific findings that illustrate the cellular mechanism by which MSCs participate in and enhance the process of wound healing with the potential to minimize the formation of scar tissue. Although it is unlikely that MSCs can replicate the mechanisms of scar-less wound healing that occur in fetal dermal tissues, they may still re-initiate or promote some of the processes that characterize fetal wound healing. There is also emerging evidence that MSC phenotype can be polarized by inflammatory environments, and suggests a paradigm for MSC function mirroring similar behavior in T cells and macrophages [111]. These studies indicate that MSCs respond to inflammatory cytokines by modulating the expression levels of Toll-like receptors, thereby attenuating the immunosuppressive biochemical signaling that is typical of MSC populations [112]. A better understanding of how MSCs interact with and regulate the resident immune cells in the wound will facilitate their clinical translation for wound healing applications.

In a recent review [113], we have summarized the recent pre-clinical and clinical studies designed to evaluate MSCs as a cell therapy to improve wound healing, and a summary of these studies is provided in Table 1. Based on a variety of small and large animal studies, a growing body of evidence suggests that MSCs provide significant benefit during dermal wound healing, as they can (1) accelerate the rate of wound closure and re-epithelialization, (2) improve the quality and strength of the regenerated tissue, (3) recover wound healing pathologies that might otherwise result in a chronic, non-healing wound, and (4) minimize the visual appearance of scar tissue. In spite of these encouraging pre-clinical findings, there are currently only four active clinical trials pertaining to the treatment of dermal wounds with MSCs [114]. This is evidence of several substantial barriers that still exist that limit the clinical translation of MSCs, including a scalable cell-sourcing platform, a means of cell delivery (reviewed in [115]), and a predictable regulatory framework. In this review, we have brought attention to the promise of MSCs as a therapy to improve cutaneous wound healing and the need for new technologies to overcome these barriers and enable the clinical use of MSCs in wound healing applications.

Table 1. In vivo outcomes of wound healing augmented by mesenchymal stem cell therapy
Abbreviations

ECM: extracellular matrix; FGF: fibroblast growth factor; G-CSF: granulocyte-colony stimulating factor; HB-EGF: heparin bound epidermal growth factor; HGF: hepatocyte growth factor; IFN: interferon; IL: interleukin; MMP: matrix metalloproteinase; MSC: mesenchymal stem cell; PGE2: prostaglandin E2; RNS: reactive nitrogen species; ROS: reactive oxygen species; SDF: stromal cell-derived factor; TGF: transforming growth factor; TNF: tumor necrosis factor; VEGF: vascular endothelial growth factor.
Competing interests

The authors declare that they have no competing interests.
Acknowledgements

Supported in part by the National Institutes of Health Intramural Research Program (Z01 AR41131) and from the Commonwealth of Pennsylvania Department of Health. Additional support provided by the Department of Defense Military Amputee Research Program at the Walter Reed Army Medical Center (Department of the Army, Grant No. PO5-A011), the Peer-reviewed Orthopedic Research Program (Department of the Army, Grants No. W81XWH-10-2-0084 and W81XWH-10-2-0085), and the Defense Medical Research Development Program (Department of the Army, Grant No. D10_I_AR_J8_981), for which the U.S. Army Medical Research Acquisition Activity 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. The views expressed in this manuscript are those of the authors alone and do not represent the views, policies or official positions of, nor should any official endorsement be inferred on the part of, the United States Government, the United States Army, the Uniformed Services University of the Health Sciences (USU), or the Department of Defense. Nor do they represent those of the National Institutes of Health or the Department of Health and Human Services. Figure one was produced using Sevier Medical Art.
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Tomado de Panorama Diario
La principal característica de las células madre es su capacidad de transformarse en células específicas de cualquier órgano del cuerpo, regenerando la zona en la que son implantadas.
Consciente de esta propiedad, y pensando en la gran cantidad de adultos mayores con heridas crónicas de tipo vascular (que demoran mucho tiempo en sanar debido a la mala circulación venosa) o pacientes con grandes quemaduras, expertos de la U. Católica diseñaron un spray de células madre extraídas de grasa humana para mejorar la cicatrización de este tipo de heridas crónicas y agudas.
El innovador producto podría comenzar sus pruebas en humanos antes de fin de año, después que múltiples estudios anteriores ya demostraran la efectividad de las células madre en la regeneración de piel.
Para obtener estas células madre, los investigadores recurrieron a la grasa extraída de liposucciones, sustancia rica en este tipo de células. Una vez en el laboratorio, son aisladas, cultivadas, expandidas y formuladas (preparadas) junto a excipientes y sustancias que las mantienen vivas, para luego ser aplicadas con un atomizador de nube fina.
La gracia de la aplicación de estas células directamente sobre la herida con un atomizador, es que así no se interviene directamente la lesión.
Aunque en algún momento se evaluó usar una pomada, finalmente se decidió el spray que es más fácil de aplicar, genera una entrega más homogénea y como no se toca la herida, es menos doloroso para el paciente
El objetivo de la terapia es lograr un buena cicatrización en el menor tiempo posible. “Estamos hablando de grandes heridas, algunas que demoran un año o más en curar y que durante todo ese tiempo están expuestas a infecciones”, dice Roberto Ebensperger, académico de la Facultad de Química de la UC, quien dirige la investigación, un proyecto Fondef, apoyado por el laboratorio Recalcine.
“Creamos un spray para tratar grandes heridas, como las úlceras vasculares, las que se producen por insuficiencia venosa, que hacen llagas muy grandes, sobre todo en las piernas”, explica el investigador. Estas heridas se presentan principalmente en adultos mayores con diabetes e hipertensión, enfermedades que dificultan la cicatrización. También están consideradas heridas producidas por mordeduras de animales y grandes quemados.
Para Andrés Valdivieso, director Médico del Centro Avanzado de Tratamiento de Heridas (Cath), que también participa en el estudio, estas heridas son un problema para la calidad de vida de los enfermos. “Son pacientes que por diabetes o insuficiencia venosa ven comprometida gran parte de sus extremidades inferiores. Heridas que se infectan, no cierran y dificultan hábitos como el baño diario y los traslados. A veces, deben dejar de trabajar”, indica. Incluso, en casos extremos, terminan en amputación.
Duración de las células
Una de las principales preocupaciones de los expertos fue mantener las células vivas el mayor tiempo. “Tuvimos que demostrar que durante todo el proceso de administración -desde que salen del frasco, pasan por el atomizador y llegan a la piel- no se destruyen”, explica Ebensperger. “Estamos hablando de células vivas, no de una molécula de alta durabilidad. Cuando las tienes en laboratorio, se mantienen en condiciones especiales de temperatura, sobreviviendo largos período. En el spray, en cambio, están en suspensión”.
¿Cómo lo hacen? Por ahora es confidencial, se excusa el experto, pues están patentando el proceso. Sí adelanta que en pruebas, las células madre tienen 100% de vida útil a las 72 horas de envasadas.
Este plazo permite que el spray llegue a clínicas en regiones, evitando que el paciente viaje a sus curaciones.
Pasado ese período, se reduce la cantidad de células vivas. Diez días después de ser envasadas, sólo sobrevive entre el 30 y el 40%.
Aunque el spray puede ser aplicado en cualquier persona, no está considerado su aplicación domiciliaria, debido a que como se trata de heridas grandes, se debe velar por las condiciones de asepsia del lugar de la curación. Además, dada la complejidad de las heridas, se requiere la evaluación constante de un experto.
Por ahora, la investigación es evaluada por el comité de ética de la universidad y los expertos esperan los resultados de un nuevo proyecto Fondef para iniciar los estudios en al menos 16 personas antes de fin de año, aunque por ahora no hay plazo para iniciar su comercialización.

En: Noticias #

El implante de células iPS modificadas de un paciente con Huntington consigue repoblar la zona cerebral dañada en ratones enfermos. Se trata de un primer paso para la terapia celular.

El grupo de Lisa Ellerby, del Instituto Buck para la Investigación sobre Envejecimiento, en California, ha corregido una mutación genética responsable de la enfermedad de Huntington con células iPS procedentes de un paciente con dicha dolencia. Los investigadores han recogido iPS del enfermo, las han manipulado genéticamente y han generado células neuronales que han trasplantado en ratones con Huntington. Han podido observar que se han desarrollado neuronas sanas en el área cerebral afectada por dicha neurodegeneración. Los resultados del trabajo se publican en el último número de Cell Stem Cell (doi: 10.1016/j.stem.2012.04.026).

Ellerby ha indicado que “haber podido modificar células iPS de pacientes con Huntington es un paso importante para poder emplear estas células en el tratamiento de la neurodegeneración. La corrección genética puede resolver los signos de la enfermedad en estas células, que no serán susceptibles de muerte celular y la función de su mitocondria es normal”.

Repoblación
Las células alteradas han sido capaces de repoblar el área cerebral de los ratones afectados con Huntington, por lo que el siguiente paso será saber cuál es el trasplante correcto de estas células para ver si los ratones enfermos consiguen mejorar su función.

Para Ellerby, estos estudios son necesarios para poder implantar células específicas en pacientes para la terapia que consiste en eliminar la mutación que provoca la neurodegeneración.

En el trabajo se ha corregido la mutación reemplazando la repetición de un trinucelótido expandido con una repetición de recombinación homóloga.

En este caso de recombinación se ha cambiado una de las moléculas de ADN alteradas por otra sana para poder corregir la mutación de la enfermedad.
julio 1/2012 (Diario Médico)

Ningzhe Zhang, Gary Scott, Daniel Montoro, Tobias Wittkop, Sean Mooney, Simon Melov, et. al. Genetic Correction of Huntington’s Disease Phenotypes in Induced Pluripotent Stem Cells. Cell Stem Cell, publicado junio 28/2012.
La editora recomienda:

Induced Pluripotent Stem Cells from Patients with Huntington’s Disease Show CAG-Repeat-Expansion-Associated Phenotypes

En: Noticias #

Investigadores japoneses aportan nuevas evidencias de la función inmunológica de los folículos capilares, que actúan como portales para dirigir las células de Langerhans hacia la epidermis.

Las células de Langerhans están asociadas a los folículos capilares, pero las razones de esta conexión no están demasiado claras. Un estudio que se publica en la edición en línea de Nature Immunology (DOI: 10.1038/ni.2353)aporta nuevos datos. Keisuke Nagao, de la Universidad de Keio, en Tokio, y su equipo han comprobado que los folículos pilosos actúan como portales para el reclutamiento de células de Langerhans hacia la epidermis.

Los folículos pilosos funcionan como reservorios de diversos tipos de células madre de la epidermis, y en esta capa es donde se distribuyen las células de Langerhans formando una densa red y se autorrenuevan en condiciones normales. Sin embargo, cuando surgen situaciones de estrés, la repoblación se lleva a cabo con células procedentes de la médula ósea.

Inflamación
En este sentido, los investigadores han constatado que, ante estímulos inflamatorios o de estrés, distintas regiones del folículo piloso secretan quimiocinas, que son capaces de dirigir la migración de los progenitores de células de Langerhans hacia la epidermis. Más concretamente, han apreciado que existen distintas subpoblaciones de queratinocitos que promueven o inhiben la repoblación con células de Langerhans a través de diferencias en la producción de quimiocinas.

Por otro lado, han visto que los precursores de células de Langerhans no pueden ser introducidos en la piel de ratones o humanos alopécicos, lo que demuestra que los folículos pilosos son los portales de dichas células.

De ahí que los individuos que padecen liquen plano pilar -enfermedad autoinmune que conduce a la destrucción de los folículos capilares- carezcan de células de Langerhans en su piel.
junio 25/2012 (Diario Médico)

Keisuke Nagao, Tetsuro Kobayashi, Kazuyo Moro, Manabu Ohyama, Takeya Adachi, Daniela Y Kitashima, et. al. Stress-induced production of chemokines by hair follicles regulates the trafficking of dendritic cells in skin. Nature Immunology, publicado junio 24/2012.

En: Noticias #

Científicos canadienses de la Universidad de Columbia han comprobado desde 2003 y luego de sucesivas pruebas con ratones que la implantación de células madre en las personas calvas puede ayudar a hacer crecer el pelo. Se trata de una terapia innovadora.
Los resultados del hallazgo fueron presentados el viernes en Barcelona y, aseguran los expertos que han sido muy eficaces para el tratamiento de la calvicie común o también llamada alopecia androgénica. Sucede que las células madre permite la regeneración de tejidos permitiendo el crecimiento de cabello en aquellas zonas donde no hay tal regeneración.

El investigador canadiense implantó en la calva de diecinueve hombres las células madres de ellos mismos extraídas de su nuca, una zona hormonalmente privilegiada en la que siempre hay vello. En esta prueba se logró una regeneración máxima de la zona sin pelo del 19% y una media de la muestra fue del 6%.

A futuro y para mejorar los porcentajes, el doctor McElwee anunció la realización de nuevas pruebas. Centros de Barcelona podrían estar involucrados.

Para el investigador de la Universitat de Barcelona (UB) Ramon Grimalt, presidente del Grupo Español de Tricología, los resultados, aunque puedan parecer bajos, son “muy esperanzadores” para tratar eficazmente la calvicie.

La técnica de implantación de células madres, que apenas tiene efectos secundarios, podría suponer un giro definitivo ya que, a diferencia de los otros, este tratamiento ataca el problema de raíz.

Además, se ha observado en ratones a los que se les practicó el implante de células madre que el pelo no dejó de crecer hasta que fallecieron.

El problema de la alopecia androgénica no es que el cabello caiga, sino que se hace tan fino que acaba por desaparecer a raíz de un proceso hormonal en el que actúan un conjunto de genes y factores ambientales que la ciencia está investigando.

Sin embargo, cuando se observa que el pelo cae es porque las células madre continúan trabajando para regenerar el tejido, por lo que el cabello volverá a aparecer.

Por: Celina Abud Tomado de DocSalud.com
Médicos del instituto FLENI y el CEMIC, junto a seis hospitales de Brasil, realizarán el primer ensayo clínico con células madre en pacientes que hayan sufrido un accidente cerebro vascular isquémico (ACV). Para el estudio, los centros participantes planean reclutar a 140 pacientes a los que se les trasplantarán las partículas, extraídas de sus propias médulas óseas.

Este protocolo es el primero de Neurología en haber sido autorizado por el INCUCAI (Instituto Nacional Central Único Coordinador de Ablación e Implante) para el uso de células madre en humanos. Arrancará dentro de tres meses y pretenderá obtener los primeros resultados para 2015. Precisamente, buscará determinar si el uso de las partículas es efectivo para tratar las secuelas de un ACV, también conocido como stroke o ataque cerebral.

“Investigaciones previas en animales y estudios inciados en pocos voluntarios, más una buena base teórica, muestran que las células madre podrían ser una opción para tratar las secuelas de un ataque cerebral”, dijo a DocSalud.com el doctor Sebastián Ameriso, líder de la investigación y Jefe del Departamento de Neurología Vascular de FLENI.

Este es el primer ensayo argentino que evaluará la técnica. Pero tampoco existen investigaciones internacionales que hayan arrojado resultados concluyentes. Según detalló el neurólogo, apenas si hubo trabajos preliminares en grupos de no más de 20 pacientes en países como Brasil o el Reino Unido.

Participarán de este protocolo 20 expertos de todos los centros, incluidos también el equipo del CEMIC (Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”), liderado por la doctora Marina Romano, Coordinadora de Enfermedades Cerebrovasculares de la Institución.

Los destinatarios

Para el protocolo, se reclutarán a personas “que sufrieron un ACV isquémico en forma muy reciente, precisamente entre las seis horas y los siete días”, es decir, “la forma aguda” de esta afección, indicó el experto para luego agregar que se incluirá a pacientes de todas las edades, a partir de los 18 años.

Existen dos tipo de strokes. En primer lugar, están los isquémicos, que “representan el 80% del total de estos episodios, tanto en Argentina como en el mundo”, confirmó Ameriso. Estos son los que se producen por trombosis, embolia o “taponamiento” de alguna arteria.

Por otra parte están los hemorrágicos, que ocurren con menor frecuencia. Son causados por la rotura de un vaso sanguíneo, suponen un riesgo mayor de mortalidad y no son candidatos para este estudio.

El accidente cerebrovascular isquémico agudo es una de las principales causas de morbi-mortalidad en el mundo y en la región y el primer motivo de discapacidad a nivel global. En el país se calcula que se producen 481 ACVs por cada 100.000 habitantes.

El procedimiento, paso por paso

El protocolo de investigación involucra principalmente cuatro disciplinas médicas: neurología; neurocirugía endovascular; hematología y anatomía patológica. Además contempla técnicos para los postoperatorios y radiólogos encargados de realizar el diagnóstico por imágenes.

“El neurólogo es el ‘director de orquesta’ de la investigación ya que es el que detecta el ACV y administra el tratamiento”, indicó Ameriso. La segunda intervención la realiza el hematólogo al ejecutar la punción de la médula ósea del propio paciente, un proceso de rutina para estos especialistas.

En tercer lugar el hematólogo junto con el anátomo patólogo preparan las células para insertárselas al voluntario. Por último, este procedimiento lo realiza el neurocirujano endovascular, “quien coloca un catéter para trasportarlas, que va desde la ingle hasta las arterias del cerebro donde el paciente sufrió el ACV”, indicó el experto de FLENI.

“Si bien se espera tener los primeros resultados dentro de dos años, se empezará a evaluar a los pacientes a partir de los tres meses del trasplante. El pronóstico y la evolución son individuales y pueden variar en cada caso”, agregó.

La investigación requerirá una inversión total de $ 2.400.000 aportados por el MINCyT, la Fundación Pérez Companc y la Fundación FLENI. Se realizará en el marco del Programa Binacional de Terapia Celular (PROBITEC), que tiene por objetivo realizar proyectos a cargo de investigadores argentinos y brasileños, en el campo de la terapia celular, los aspectos de conocimiento básico, investigación pre-clínica y clínica.

“Este es el primer ensayo que evaluará la eficacia y la seguridad del trasplante autólogo de células madre en pacientes con ACV en el país. Pero cabe aclarar que de ninguna manera se trata de una cura”, puntualizó Ameriso, en relación a la oferta de tratamientos de este tipo para distintas lesiones, en su mayoría en fase experimental.

El experto lamentó que algunas instituciones los ofrezcan con “promesas irrealizables de curación”, a pesar de que muchas de las prácticas ofrecidas no posee efectos terapéuticos comprobados ni siquiera en animales.

El presente y el futuro las terapias celulares

Existen solo dos de éstos tratamientos aprobados por los organismos de control debido a su eficacia terapéutica y seguridad: el transplante alogénico de células madre de médula ósea, sangre periférica y cordón umbilical; y el autotrasplante de células madre de médula ósea y sangre periférica para tratar enfermedades curables con trasplante de células progenitoras hematopoyéticas.

Son aquellos destinados a enfermedades que se curan con trasplante de médula ósea. Fuera de éstos, no existe evidencia clínica reproducible y contundente, ni tratamientos que hayan demostrado la eficacia del autotransplante de células madre para mejorar o curar enfermedades altamente discapacitantes como diabetes, Parkinson y Alzheimer, entre otras.

Sin embargo estas células se diferencian de otras por no ser “especializadas” y poder adaptarse a distintas áreas del cuerpo, además de ser capaces de renovarse ilimitadamente. Por eso surge la necesidad de generar ensayos clínicos para determinar si pueden ser usadas para curar enfermedades para las que hay pocos recursos terapéuticos.

Un laboratorio público bonaerense llevará adelante una experiencia con células madre de donante cadavérico para regenerar la piel en personas que sufrieron quemaduras graves. El procedimiento ya fue autorizado por el Ministerio de Salud

El Ministerio de Salud bonaerense autorizó a un laboratorio a trabajar con células madre de donante cadavérico para regenerar la piel en personas que sufrieron quemaduras graves, en lo que constituye el primer ensayo clínico de este tipo en el mundo. El procedimiento estará a cargo del Servicio de Ingeniería Tisular, Medicina Regenerativa y Terapias Celulares del Centro Unico de Ablación e Implantes de la provincia de Buenos Aires (Cucaiba), dependiente de la cartera sanitaria.
Eduardo Mansilla, responsable del laboratorio del Cucaiba, quien se capacitó en la Universidad de Harvard y se dedica desde hace 20 años a la investigación de la regeneración de piel humana para personas con grandes quemaduras, señaló a Página/12 que “el procedimiento se inicia cuando a un cadáver se le extraen las células madre mesenquimales de la médula ósea. Tras la obtención de la muestra, éstas se cultivan en el laboratorio por unos 21 días para que sean capaces de convertirse en piel, y así quedar disponibles para aquel paciente que lo requiera”.
“Se saca el tejido muerto y se aplican las células con un spray de fibrina”, indicó el referente del Cucaiba. “La fibrina es un polímero, propio del ser humano, que actúa en el sistema de coagulación normal de la sangre. Forma una matriz biológica en donde las células pueden adherirse, crecer y multiplicarse”, agregó.
También explicó que “los grandes quemados no dan tiempo y hay que tratarlos rápidamente porque si no mueren”. “Si bien en muchos casos el equipo médico de cada centro de salud trabaja con la piel del propio paciente para regenerar la misma en las zonas afectadas por quemaduras, aquí la novedad que se presenta es que trabajaremos con la piel del banco de cadáver.”
De esta manera, el uso de células madre mesenquimales de donante cadavérico –presentes en todas las personas– “posibilita tenerlas preparadas de antemano y emplearlas no bien el paciente llega al hospital con quemaduras extremas y profundas”, añadió Mansilla a este diario.
Por otra parte, el responsable del laboratorio indicó que hace ocho años empezaron a trabajar en la técnica. Primero en modelos in vitro y luego en animales, descubrió que tenía una célula que poseía “plasticidad no inmunogénica”. “No generaba rechazo en el receptor y podía ser de una persona fallecida, no ya del propio quemado, lo que constituía una ventaja enorme porque nos permitía tenerlas preparadas de antemano”, sostuvo.
Por su parte, el ministro de Salud bonaerense, Alejandro Collia, afirmó que la técnica constituye “uno de los tres ensayos clínicos con células madre aprobados por el Ministerio de Salud de la Nación a través del Incucai la semana pasada”. “Si bien hay una gran expectativa porque son ensayos que de funcionar marcarán un hito en la historia de la medicina, hay que ser muy prudentes y advertir que aún están en fase de prueba, deben demostrar seguridad y eficacia”, agregó.
“El ensayo clínico está en marcha. En breve, comenzaremos a trabajar con los cirujanos plásticos del Hospital General José de San Martín de La Plata y del Instituto de Quemados, de la ciudad de Buenos Aires. Llevará al menos dos años recolectar todos los datos para certificar esta iniciativa pionera en el mundo que podrá salvar la vida de muchos pacientes con quemaduras severas”, explicó Mansilla.
El Ministerio de Salud bonaerense afirmó que “de funcionar, la nueva técnica presenta ventajas significativas en comparación con las que se venían utilizando hasta ahora, como el cultivo de queratinositos: células de la piel que se extraen del propio paciente y se cultivan hasta que alcanzan la dimensión necesaria para cubrir la zona quemada”.
“Cuando un quemado grave llega al hospital los cirujanos deben compensarlo y sacarle la piel muerta por acción del fuego. Quedará con los músculos al desnudo. Ahí llega el momento de aplicar las células cultivadas que crearán la nueva piel”, informaron fuentes de la cartera sanitaria.
La piel, el órgano más extenso del cuerpo humano, es una suerte de escudo protector de todo el organismo. Contiene sustancias capaces de matar bacterias, proteger al cuerpo de los rayos solares y regular la temperatura corporal, entre otras funciones indispensables para la vida.
Informe: Sabrina Améndola.
Tomado de Doc.Salud

En: General #

Una niña de diez años se ha convertido en el primer paciente del mundo a la que se implanta una vena bioartificial, fabricada en el laboratorio a partir de sus propias células madre. La niña, operada hace un año en el Hospital Universitario Shalgresnska de Gotemburgo (Suecia), necesitaba un bypass para solucionar una obstrucción en la vena porta, entre sus intestinos y el hígado. En lugar de utilizar una vena propia que hubiera deteriorado más su circulación, los médicos optaron por utilizar el vaso sanguíneo de un cadáver. Para evitar que generara rechazo, eliminaron todas las células que recordaran su origen y lo repoblaron con las células madre de la niña. De esta forma, crearon un vaso sanguíneo bioartificial totalmente compatible con la paciente.

Un año después del trasplante, en la revista «The Lancet» se cuentan los detalles del proceso y la buena evolución de la pequeña que sigue sin tratamiento inmunosupresor. No tuvo complicaciones tras la cirugía, el flujo sanguíneo se restauró sin complicaciones y ahora ha ganado peso y hasta participa en actividades deportivas.

Por primera vez
Otros grupos de investigación ya habían creado vasos sanguíneos y otros órganos bioartificiales, como los corazones del equipo del Hospital Gregorio Marañón de Madrid. Pero es la primera vez que un vaso sanguíneo de laboratorio se implanta en un paciente real.

La niña padecía una enfermedad poco frecuente llamada púrpura trombocitopénica y tenía una obstrucción en la vena porta hepática, el vaso que lleva al hígado la sangre procedente del bazo y de los intestinos. Su obstrucción causa hemorragias y puede provocar la aparición de varices en el esófago.

Una vía experimental
El tratamiento clásico hubiera consistido en hacer un bypass con otra vena propia, una nueva ruta para que la sangre fluyera sin dificultad al hígado sorteando la obstrucción, aunque en el caso de la niña sueca fue imposible encontrar un vaso viable de 9 centímetros, por eso optaron por la vía experimental. El vaso sanguíneo del donante fue repoblado con células madre extraídas de la médula ósea de la niña.

Este caso abre una vía esperanzadora para casos como el de esta niña y numerosos pacientes que necesitan cirugías de bypass, como los enfermos de corazón o los enfermos con diálisis. Prescindir de una vena genera problemas añadidos en los enfermos y, hasta el momento, ninguna alternativa artificial ha sido tan eficaz como las venas humanas. La fabricación de venas bioartificiales pondría fin a este problema. Aún queda, como recuerda el editorial que acompaña al artículo, probar su eficacia en un ensayo clínico.