Written by: Krystal, Chongqing Medical University
Expert review: Professor Li Jing, Affiliated Hospital of Jiangsu University
Stem cells have been widely used in the field of dermatology, and progress has been made. Recently, a review published in the Indian journal of dermatology summarized the research status of stem cell therapy in dermatology[1], arguing that the emergence of stem cell therapy provides a new strategy for the currently incurable diseases, and shows the application prospects of stem cells in pemphigus, systemic sclerosis, systemic lupus erythematosus, psoriasis, wound healing, hair loss, medical aesthetics and other fields related to dermatology.
Stem cells are undifferentiated cells present in different organ tissues, with three characteristics of self-renewal, differentiation and plasticity, in the process of injury, any one of the stem cells can differentiate to produce the entire cell lineage. As a result, stem cell therapy is used in the treatment of a variety of diseases, and advances have also been made in dermatology.
In the skin, stem cells are found in the inter-hair follicle epidermis, hair follicles, dermis and adipose tissue, helping to maintain the homeostasis of normal skin and repair and regeneration during injury. Based on their unique properties, stem cells have been used to treat systemic sclerosis, systemic lupus erythematosus, hair loss, psoriasis, wound healing, and even medical cosmetology.
1 Stem cells for psoriasis
Psoriasis, also known as psoriasis, is a chronic recurrent inflammatory disease that does not yet have a completely satisfactory treatment. Although considerable progress has been made in the exploration of the pathogenesis of psoriasis in recent years, the exact pathogenesis is not fully understood.
Currently, certain types of stem cell dysfunction may be the main cause of dysregulation of the inflammatory response to psoriasis. Patients with psoriasis have been found to achieve long-term remission after receiving stem cell therapy [3-5]. At the same time, cases of psoriasis acquired after receiving a bone marrow transplant from a psoriasis donor have also been reported. A large number of studies have confirmed that stem cells are involved in the pathogenesis of psoriasis, and their dysfunction may be the root cause of the dysregulation of the inflammatory response of psoriasis, so stem cells are considered an important potential treatment tool for psoriasis.
In our country, clinical trial applications for mesenchymal stem cell injections for psoriasis have been accepted. There are also a number of clinical studies of stem cells in the treatment of psoriasis in the world.
2 Stem cells to treat hair loss
Stem cell therapy has good application prospects in androgenic alopecia and alopecia areata. In recent years, there have also been research reports. The following is a literature report to explain the potential of stem cells to treat hair loss.
One study injected stem cells taken from body fat into the scalps of 20 alopecia areata patients, and all patients experienced significant hair growth over a three- to six-month follow-up [7].
Cultures of fatty stem cells are rich in growth factors such as vascular endothelial growth factor, hepatocyte growth factor, platelet-derived growth factor, and insulin-like growth factor, which can also be used to treat hair loss.
3 Clinical research of stem cells in aesthetic medicine
In recent years, the application of stem cells in plastic surgery has also become more and more common. In cosmetic plastic surgery, stem cells have been applied to soft tissue reconstruction and regeneration, skin rejuvenation, facial rejuvenation, scar improvement and anti-aging treatment.
Studies have found that adipose stem cells can activate fibroblasts and secrete a variety of growth factors, thereby producing antioxidant, pigment reduction and wound healing effects on the skin. Fibroblasts play a vital role in wound healing and in repairing damaged dermal components, and cultured autologous fibroblasts have broad application prospects in aesthetic medicine [9].
In 2021, the domestic "Chinese Journal of Aesthetic Plastic Surgery" published the "Expert Consensus on Research and Clinical Trials of Stem Cells in the Field of Plastic And Aesthetic Repair", which also emphasized the application of stem cell derivatives: the growth factors secreted by stem cells can improve the proliferation ability of the skin to promote the proliferation of fibroblasts in the dermis layer through various active factors, repair aging collagen fibers and elastic fibers, restore skin elasticity and reduce wrinkles.
4 Stem cells for systemic lupus erythematosus
Systemic lupus erythematosus is an autoimmune disease that affects the skin, serous membrane, joints, kidneys, and central nervous system. The therapeutic potential of mesenchymal stem cells in a variety of autoimmune diseases such as systemic lupus erythematosus has been explored, and its immunomodulatory and regenerative properties make it a new method for the treatment of systemic lupus erythematosus, which can lead to reduced disease progression, improved renal function, reduced autoantibody production, peripheral Treg upregulation, and Th1 and Th2-related cytokine balance reconstruction.
The first successful case report of autologous stem cell therapy for systemic lupus erythematosus was published in 1997, followed by a number of observational studies and clinical trials [Table 7].
In the mainland, Professor Sun Lingyun's team of Drum Tower Hospital of Nanjing University won the second prize of the National Technological Invention Award in 2019 for the "Key Technological Innovation and Clinical Application Research of Allogeneic Mesenchymal Stem Cells in the Treatment of Refractory Lupus Erythematosus".
The study has overcome the worldwide problem of lupus erythematosus treatment, and the team has carried out allogeneic mesenchymal stem cell treatment of refractory lupus erythematosus, which has been promoted to 35 units inside and outside the province.
Table 7 (from the literature [1]): Stem cell therapy for systemic lupus erythematosus
5 stem cells promote wound healing
Epidermal stem cells have the potential to regenerate the epidermis with appropriate stimulation and differentiate into various cell types and tissues. This property can be used to promote the healing of chronic unhealed wounds.
Mesenchymal stem cells play an important role in all processes of wound healing. Mesenchymal stem cells promote cell migration, angiogenesis, epithelialization and granulation tissue formation, thereby accelerating wound closure.
In addition, mesenchymal stem cells help reduce scarring by promoting cell regeneration to repair wounds rather than forming fibrous tissue. Using a special fibrin spray system, the researchers successfully applied human mesenchymal stem cells to unhealed and acute wounds [6].
6 stem cells for pemphigus
Pemphigus is a serious skin disease, a disease caused by a disorder of the autoimmune system, and the clinical feature is that the patient's skin and mucous membranes are blistered. Current first-line treatment for pemphigus is corticosteroids and other immunosuppressants, but some patients are intolerant.
Studies have shown that transplanted stem cells can repopulate the immune system and reduce the number of autoreactive immune cells, which helps restore immune balance [2] and can be used in the treatment of pemphigus. Successful cases of hematopoietic stem cells for refractory pemphigus have been established, and large-scale multicenter studies and longer follow-up times are still needed to confirm the results in the future [Table 5].
Table 5 (from the literature [1]): Stem cell therapy for pemphigus
7 Stem cells for systemic sclerosis
Systemic sclerosis, also known as scleroderma, is an autoimmune disease that affects the whole body and is characterized by localized or diffuse skin thickening and fibrosis. In recent years, stem cells have been used in the treatment of systemic sclerosis.
The goal of stem cell therapy is to non-specifically suppress autoreactive T cells and B cells through high-dose immunosuppression and to rebuild a tolerant immune system by reinjection. Three randomized controlled trials have shown that autologous stem cell therapy is an effective, safe and feasible method for the treatment of systemic sclerosis in the United States, the International Scleroderma Trial of Autodermacidism, the Sclerophosphamide or TransplantAtion Study.
Stem cell therapy is more effective than traditional immunosuppressive therapy and is currently the only strategy to improve long-term survival, prevent organ deterioration, improve skin and lung function, and improve the overall quality of life of patients.
brief summary:
In dermatology, stem cell therapy has been tried in several refractory conditions with some success. However, there are still many difficulties to be solved in the future, such as how to standardize stem cell preparations, how to carry out large-scale verification, and so on. The emergence of stem cell therapy has made it possible to cure diseases that were previously considered incurable, and it is believed that further research in the future will bring more possibilities for stem cell therapy.
bibliography:
[1] Khandpur, S., Gupta, S., & Gunaabalaji, D. R. (2021). Stem cell therapy in dermatology. Indian journal of dermatology, venereology and leprology, 87(6), 753–767. https://doi.org/10.25259/IJDVL_19_20
[2] Vanikar, A. V., Trivedi, H. L., Patel, R. D., Kanodia, K. V., Modi, P. R., & Shah, V. R. (2012). Allogenic hematopoietic stem cell transplantation in pemphigus vulgaris: a single-center experience. Indian journal of dermatology, 57(1), 9–11. https://doi.org/10.4103/0019-5154.92667
[3] Owczarczyk-Saczonek, A., Krajewska-W odarczyk, M., Kruszewska, A., Placek, W., Maksymowicz, W., & Wojtkiewicz, J. (2017). Stem Cells as Potential Candidates for Psoriasis Cell-Replacement Therapy. International journal of molecular sciences, 18(10), 2182. https://doi.org/10.3390/ijms18102182
[4] Chen, W., Ren, G., Zuo, K., & Huang, X. (2018). Complete remission of both immunoglobulin light chain amyloidosis and psoriasis after autologous hematopoietic stem cell transplantation: A case report. Medicine, 97(50), e13589. https://doi.org/10.1097/MD.0000000000013589
[5] Kaffenberger, B. H., Wong, H. K., Jarjour, W., & Andritsos, L. A. (2013). Remission of psoriasis after allogeneic, but not autologous, hematopoietic stem-cell transplantation. Journal of the American Academy of Dermatology, 68(3), 489–492. https://doi.org/10.1016/j.jaad.2012.08.021
[6] Otero-Vi as, M., & Falanga, V. (2016). Mesenchymal Stem Cells in Chronic Wounds: The Spectrum from Basic to Advanced Therapy. Advances in wound care, 5(4), 149–163. https://doi.org/10.1089/wound.2015.0627
[7] Anderi, R., Makdissy, N., Azar, A., Rizk, F., & Hamade, A. (2018). Cellular therapy with human autologous adipose-derived adult cells of stromal vascular fraction for alopecia areata. Stem cell research & therapy, 9(1), 141. https://doi.org/10.1186/s13287-018-0889-y
[8] Schatton, T., Murphy, G. F., Frank, N. Y., Yamaura, K., Waaga-Gasser, A. M., Gasser, M., Zhan, Q., Jordan, S., Duncan, L. M., Weishaupt, C., Fuhlbrigge, R. C., Kupper, T. S., Sayegh, M. H., & Frank, M. H. (2008). Identification of cells initiating human melanomas. Nature, 451(7176), 345–349. https://doi.org/10.1038/nature06489
[9] Kim, W. S., Park, B. S., Park, S. H., Kim, H. K., & Sung, J. H. (2009). Antiwrinkle effect of adipose-derived stem cell: activation of dermal fibroblast by secretory factors. Journal of dermatological science, 53(2), 96–102. https://doi.org/10.1016/j.jdermsci.2008.08.007