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Stem cells in gynecology
The document discusses the role of stem cells in gynecology, outlining their characteristics, challenges in research, and potential applications in treating conditions such as infertility and urogenital disorders. It highlights the ethical concerns surrounding embryonic stem cell research and presents amniotic fluid stem cells as a promising alternative, though results in clinical studies remain inconclusive. Ultimately, while stem cell applications are a possibility, they are still primarily in the research phase and not yet established as proven treatments.
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Stem cells in gynecology
- 1. Stem cells inGynecology Fact or fiction ??????
- 2. Basic criteria ofstem cells 1. Self-renews 2. Differentiates Progenitor cell Stem cell Stem cell
- 3. 3/2/2015 Dr. HariomYadav Types Princeton University
- 4. Multipotent hematopoietic Stem cell (hemocytoblast) Commonmyeloid progenitor Common Lymphoid progenitor Small lymphocyte B lymphocyte T lymphocyte Natural killer cell (Large granular Lymphocyte) Plasma cell Monocyte Macrophage EosinophilBasophil Thrombocyte Megakaryocyte Erythrocyte Mast cell Mayeloblast Neutrophil
- 5. 3/2/2015 Dr. HariomYadav
- 7. Challenges to EmbryonicStem Cell Research • Ethical considerations
- 8. 3/2/2015 Not only ethics •The use of mouse “feeder” cells to grow ESC could result in problems due to xenotransplantation (complicating FDA requirements for clinical use).
- 9. 3/2/2015 Moreover • Recently, abnormalitiesin chromosome number and structure were found in three human ESC lines.
- 10. 3/2/2015 Dr. HariomYadav
- 11. Other available sources •Placenta • Amniotic membranes • Abortus itself • ?? Quantity
- 12. Human MSCs DeclineWith Age: 1 10,000 1 100,000 1 250,000 1 400,000 1 2,000,000 MSCsperMarrowCells Newborn Teen 30 Age (Years) 50 80
- 13. Here comes theimportance of A.F stem cells • amniotic fluid stem cells (AFSCs) provide a novel source : • their primitive stage, • low immunogenicity • easy accessibility.
- 14. The question is:Fact or Fiction!!! • urogenital tract • intrauterine stem cell transplantation • Infertility
- 15. Urogenital tract disorders •Urinary incontinence • Bladder reconstruction • Pelvic floor
- 16. U.I • stem cellinjection for sphincteric muscle regeneration is the subject of research in a number of centers • Both animal and human studies have been conducted • Results are conflicting • Unresolved question : ??transient or permanent
- 17. Bladder reconstruction (entero–cystoplasty) •A tissue–engineered and urothelial–lined bladder provides a functional barrier against urine exposure • could help to overcome most of the serious complications associated with conventional entero–cystoplasty. • Still under trial • Results are disappointing
- 18. Pelvic prolapse • Theidea is to generate new muscle which can perform in an integrated manner with the existing organs • Avoid mesh complications (erosions and extrusion) • Needs to be tested
- 19. intrauterine stem celltransplantation (IUSCT) • for monogenic diseases • to correct a genetic disorder early in the evolution of disease through the engraftment of normal functional stem cells
- 20. Quantity needed ismuch less • fetal size offers a distinct advantage over the several–fold larger neonate • Avoid the need of postnatal bone marrow transplantation
- 21. Real model • hfMSChave been collected from the liver of fetus for intrauterine transplantation targeting osteogenesis imperfect (Mattar et al, 2012)
- 22. IUSCT applications • β–thalassaemiaand sickle cell anaemia, muscular dystrophies • successful treatment has only been achieved in a very few fetuses
- 23. How it wasdone? • Ultrasound or fetoscopy guided fetal liver biopsies • first trimester • with very low rate of abortion (8%) • Others used Amniotic fluid if significant quantity of stem cells can be derived????
- 24. The major questionis : • Can this be a complete cure?!!! • Days will tell.
- 25. What about infertility:In POF? • AFSCs were transplanted into the ovaries of mice with POF six weeks post induction using chemotherapeutic drugs. • the transplanted AFSCs did not differentiate into germ line cells in vivo.
- 26. Stem cells typesReferences Stem cells and germ cells markers Chemotherapy Morphologically of ovary after stem cells transplanted Hormone or cytokines profile changes Tracking of stem cells Bone marrow transplantation Lee et al.43 / / / BMP15, FMR1, FSHR, INHA, AMH, NOBOX, FOXO3, EIF2B, FIGLA and GDF9 Reactivate host oogenesis; not generate oocytes CD44 +/CD105 + human amniotic fluid mesenchymal stem cells Liu et al.73 CD29, CD44, CD73, CD90, CD105 and CD166 Intraperitoneal injection of cyclophosphamide / / / Adipose-derived stem cells Sun et al.63 / Intraperitoneal injection of cyclophosphamide Follicle number , ovulation number and apoptotic GCs¯ HGF , VEGF, PGF and TGF-β Not participate in follicle regeneration Umbilical cord mesenchymal stem cells Wang et al.64 CD29, CD44,CD90 and CD105 Intraperitoneal injection of cyclophosphamide Apoptosis of GC¯, number of folliclesand oocyte containing follicles E2 Not develop into follicles Human amniotic fluid cells Lai et al.72 Intraperitoneal injection of cyclophosphamide and busulphan Oocytes at all stages AMH and FSHR Differentiated into GCs; not germ cell
- 27. Summary of results •No evidence of differentiation into oocytes • But risk of developing GC tumour is potential (Botman , 2014) • So till now, use of stem cells for POF in human is not valid
- 28. What about maleinfertility? • studies have reported differentiation of mouse and human germ cells from pluripotent stem cells (PSCs) in vitro, • However, differentiation of human germ cells from SCs in vivo has not been reported
- 29.
- 30. Beware • Testicular teratomahas been reported after SC injection in azoospermic man
- 31. human trials? • OnlyTwo clinical trials are registered in human • Unfortunately both from the Middle East (Egypt & Jordan) • Patients accepted such treatments and were eager to take part because they have no other choice (RBMonline, 2014)
- 32. Patients asks: Isthere any hope?? • Using the patient miserable condition is not ethical • Taking money from patients in context of clinical research is not ethical
- 33. Conclusion • It isnot fiction • But far from being Fact
- 34. • Its useshould stay within research rather than practice Keep in Mind