Abstract
Injury to tissues is a major clinical challenge due to the limited regenerative capacity of endogenous cells. Stem cell therapy is evolving rapidly as an alternative for tissue regeneration. However, increasing evidence suggests that the regenerative ability of stem cells is mainly mediated by paracrine actions of secretome that are generally secreted by the cells. We aimed to systematically evaluate the efficacy of dental stem cell (DSC)-conditioned medium in in vivo animal models of various tissue defects. A total of 15 eligible studies was included by searching Pubmed, Scopus and Medline databases up to August 2017. The risk of bias was assessed using the Systematic Review Centre for Laboratory Animal Experimentation risk of bias tool. Of 15 studies, seven reported the therapeutic benefit of the conditioned medium on neurological diseases and three reported on joint/bone-related defects. Two interventions were on liver diseases, whereas the remaining three addressed myocardial infarction and reperfusion, lung injury and diabetes. Nine studies were performed using mouse models and the remaining six studies used rat models. The methodological quality of the studies was low, as most of the key elements required in reports of preclinical studies were not reported. The findings of this review suggested that conditioned medium from DSCs improved tissue regeneration and functional recovery. This current review strengthens the therapeutic benefit of cell-free product for tissue repair in animal models. A well-planned study utilizing validated outcome measures and long-term safety studies are required for possible translation to clinical trials.
Acknowledgment
The authors thank the Library Division of Universiti Putra Malaysia for providing access to the articles used in this review.
Conflict of interest statement: The authors declare no potential conflicts of interest.
References
Agacayak, S., Gulsun, B., Ucan, M.C., Karaoz, E., and Nergiz, Y. (2012). Effects of mesenchymal stem cells in critical size bone defect. Eur. Rev. Med. Pharmacol. Sci. 16, 679–686.Search in Google Scholar PubMed
Ahmed, N.E.M.B., Murakami, M., Hirose, Y., and Nakashima, M. (2016). Therapeutic potential of dental pulp stem cell secretome for Alzheimer’s disease treatment: an in vitro study. Stem Cells Int. 2016, 11.10.1155/2016/8102478Search in Google Scholar PubMed PubMed Central
Akyurekli, C., Le, Y., Richardson, R.B., Fergusson, D., Tay, J., and Allan, D.S. (2015). A systematic review of preclinical studies on the therapeutic potential of mesenchymal stromal cell-derived microvesicles. Stem Cell Rev. Rep. 11, 150–160.10.1007/s12015-014-9545-9Search in Google Scholar PubMed
Babaei, P., Soltani Tehrani, B., and Alizadeh, A. (2012). Transplanted bone marrow mesenchymal stem cells improve memory in rat models of Alzheimer’s disease. Stem Cells Int. 2012, 369417.10.1155/2012/369417Search in Google Scholar PubMed PubMed Central
Baraniak, P.R. and McDevitt, T.C. (2010). Stem cell paracrine actions and tissue regeneration. Regen. Med. 5, 121–143.10.2217/rme.09.74Search in Google Scholar PubMed PubMed Central
Bernardo, M.E. and Fibbe, W.E. (2012). Safety and efficacy of mesenchymal stromal cell therapy in autoimmune disorders. Ann. NY Acad. Sci. 1266, 107–117.10.1111/j.1749-6632.2012.06667.xSearch in Google Scholar PubMed
Camussi, G., Deregibus, M.C., and Cantaluppi, V. (2013). Role of stem-cell-derived microvesicles in the paracrine action of stem cells. Biochem. Soc. Trans. 41, 283–287.10.1042/BST20120192Search in Google Scholar PubMed
Cho, H.H., Jang, S., Lee, S.C., Jeong, H.S., Park, J.S., Han, J.Y., Lee, K.H., and Cho, Y.B. (2010). Effect of neural-induced mesenchymal stem cells and platelet-rich plasma on facial nerve regeneration in an acute nerve injury model. Laryngoscope 120, 907–913.10.1002/lary.20860Search in Google Scholar PubMed
Curley, G.F., Hayes, M., Ansari, B., Shaw, G., Ryan, A., Barry, F., O‘brien, T., O’Toole, D., and Laffey, J.G. (2012). Mesenchymal stem cells enhance recovery and repair following ventilator-induced lung injury in the rat. Thorax 67, 496–501.10.1136/thoraxjnl-2011-201059Search in Google Scholar PubMed
Fang, C., Yang, Y., Wang, Q., Yao, Y., Zhang, X., and He, X. (2013). Intraventricular injection of human dental pulp stem cells improves hypoxic-ischemic brain damage in neonatal rats. PloS One 8, e66748.10.1371/journal.pone.0066748Search in Google Scholar PubMed PubMed Central
Fujio, M., Xing, Z., Sharabi, N., Xue, Y., Yamamoto, A., Hibi, H., Ueda, M., Fristad, I., and Mustafa, K. (2017). Conditioned media from hypoxic-cultured human dental pulp cells promotes bone healing during distraction osteogenesis. J. Tissue Eng. Regen. Med. 11, 2116–2126.10.1002/term.2109Search in Google Scholar PubMed PubMed Central
Glenn, J.D. and Whartenby, K.A. (2014). Mesenchymal stem cells: emerging mechanisms of immunomodulation and therapy. World J. Stem Cells 6, 526.10.4252/wjsc.v6.i5.526Search in Google Scholar PubMed PubMed Central
Henderson, V.C., Kimmelman, J., Fergusson, D., Grimshaw, J.M., and Hackam, D.G. (2013). Threats to validity in the design and conduct of preclinical efficacy studies: a systematic review of guidelines for in vivo animal experiments. PLoS Med. 10, e1001489.10.1371/journal.pmed.1001489Search in Google Scholar PubMed PubMed Central
Herberts., C.A., Kwa, M. S., and Hermsen, H.P. (2011). Risk factors in the development of stem cell therapy. J. Transl. Med. 9, 29.10.1186/1479-5876-9-29Search in Google Scholar PubMed PubMed Central
Hirata, M., Ishigami, M., Matsushita, Y., Ito, T., Hattori, H., Hibi, H., Goto, H., Ueda, M., and Yamamoto, A. (2016). Multifaceted therapeutic benefits of factors derived from dental pulp stem cells for mouse liver fibrosis. Stem Cells Transl. Med. 5, 1416–1424.10.5966/sctm.2015-0353Search in Google Scholar PubMed PubMed Central
Hooijmans, C.R., Rovers, M.M., de Vries, R.B., Leenaars, M., Ritskes-Hoitinga, M., and Langendam, M.W. (2014). SYRCLE’s risk of bias tool for animal studies. BMC Med. Res. Methodol. 14, 43.10.1186/1471-2288-14-43Search in Google Scholar PubMed PubMed Central
Huang, S. and Fu, X. (2010). Naturally derived materials-based cell and drug delivery systems in skin regeneration. J. Control. Release 142, 149–159.10.1016/j.jconrel.2009.10.018Search in Google Scholar PubMed
Huang, G. J., Gronthos, S., and Shi, S. (2009). Mesenchymal stem cells derived from dental tissues vs. those from other sources: their biology and role in regenerative medicine. J. Dent. Res. 88, 792–806.10.1177/0022034509340867Search in Google Scholar PubMed PubMed Central
Inoue, T., Sugiyama, M., Hattori, H., Wakita, H., Wakabayashi, T., and Ueda, M. (2013). Stem cells from human exfoliated deciduous tooth-derived conditioned medium enhance recovery of focal cerebral ischemia in rats. Tissue Eng. Part A 19, 24–29.10.1089/ten.tea.2011.0385Search in Google Scholar PubMed
Ishikawa, J., Takahashi, N., Matsumoto, T., Yoshioka, Y., Yamamoto, N., Nishikawa, M., Hibi, H., Ishiguro, N., Ueda, M., Furukawa, K., et al. (2016). Factors secreted from dental pulp stem cells show multifaceted benefits for treating experimental rheumatoid arthritis. Bone 83, 210–219.10.1016/j.bone.2015.11.012Search in Google Scholar PubMed
Izumoto-Akita, T., Tsunekawa, S., Yamamoto, A., Uenishi, E., Ishikawa, K., Ogata, H., Iida, A., Ikeniwa, M., Hosokawa, K., Niwa, Y., et al. (2015). Secreted factors from dental pulp stem cells improve glucose intolerance in streptozotocin-induced diabetic mice by increasing pancreatic β-cell function. BMJ Open Diab. Res. Care 3, e000128.10.1136/bmjdrc-2015-000128Search in Google Scholar PubMed PubMed Central
Kano, F., Matsubara, K., Ueda, M., Hibi, H., and Yamamoto, A. (2017). Secreted ectodomain of sialic acid-binding Ig-like lectin-9 and MCP-1 synergistically regenerate transected rat peripheral nerves by altering macrophage polarity. Stem Cells 35, 641–653.10.1002/stem.2534Search in Google Scholar PubMed
Kim, I.K., Kim, S.H., Choi, S.M., Youn, B.S., and Kim, H.S. (2016). Extracellular vesicles as drug delivery vehicles for rheumatoid arthritis. Curr. Stem Cell Res. Ther. 11, 329–342.10.2174/1574888X11666151203223251Search in Google Scholar PubMed
Koh, S.H., Kim, K.S., Choi, M.R., Jung, K.H., Park, K.S., Chai, Y.G., Roh, W., Hwang, S.J., Ko, H.J., Huh, Y.M., et al. (2008). Implantation of human umbilical cord-derived mesenchymal stem cells as a neuroprotective therapy for ischemic stroke in rats. Brain Res. 1229, 233–248.10.1016/j.brainres.2008.06.087Search in Google Scholar PubMed
Kumasaka, A., Kanazawa, K., Ohke, H., Miura, I., and Miura, Y. (2017). Post-ischemic intravenous administration of allogeneic dental pulp-derived neurosphere cells ameliorated outcomes of severe forebrain ischemia in rats. Neurocrit. Care 26, 133–142.10.1007/s12028-016-0304-4Search in Google Scholar PubMed
Kusindarta, D.L., Wihadmadyatami, H., Fibrianto, Y.H., Nugroho, W.S., Susetya, H., Musana, D.K., Wijayanto, H., Prihatna, S.A., and Wahyuni, A.E.T.H. (2016). Human umbilical mesenchymal stem cells conditioned medium promote primary wound healing regeneration. Vet. World. 9, 605–610.10.14202/vetworld.2016.605-610Search in Google Scholar PubMed PubMed Central
Ledesma-Martínez, E., Mendoza-Núñez, V.M., and Santiago-Osorio, E. (2016). Mesenchymal stem cells derived from dental pulp: a review. Stem Cells Int. 2016, 12.10.1155/2016/4709572Search in Google Scholar PubMed PubMed Central
Levy, Y.S., Bahat-Stroomza, M., Barzilay, R., Burshtein, A., Bulvik, S., Barhum, Y., Panet, H., Melamed, E., and Offen, D. (2008). Regenerative effect of neural-induced human mesenchymal stromal cells in rat models of Parkinson’s disease. Cytotherapy 10, 340–352.10.1080/14653240802021330Search in Google Scholar PubMed
Ma, H., Wu, Y., Zhang, W., Dai, Y., Li F., Xu, Y., Wang, Y., Tu, H., Li, W., and Zhang, X. (2013). The effect of mesenchymal stromal cells on doxorubicin-induced nephropathy in rats. Cytotherapy 15, 703–711.10.1016/j.jcyt.2013.02.002Search in Google Scholar PubMed
Matsubara, K., Matsushita, Y., Sakai, K., Kano, F., Kondo, M., Noda, M., Hashimoto, N., Imagama, S., Ishiguro, N., Suzumura, A., et al. (2015). Secreted ectodomain of sialic acid-binding Ig-like lectin-9 and monocyte chemoattractant protein-1 promote recovery after rat spinal cord injury by altering macrophage polarity. J. Neurosci. 35, 2452–2464.10.1523/JNEUROSCI.4088-14.2015Search in Google Scholar PubMed PubMed Central
Matsushita, Y., Ishigami, M., Matsubara, K., Kondo, M., Wakayama, H., Goto, H., Ueda, M., and Yamamoto, A. (2017). Multifaceted therapeutic benefits of factors derived from stem cells from human exfoliated deciduous teeth for acute liver failure in rats. J. Tissue Eng. Regen. Med. 11, 1888–1896.10.1002/term.2086Search in Google Scholar PubMed
Mita, T., Furukawa-Hibi, Y., Takeuchi, H., Hattori, H., Yamada, K., Hibi, H., Ueda, M., and Yamamoto, A. (2015). Conditioned medium from the stem cells of human dental pulp improves cognitive function in a mouse model of Alzheimer’s disease. Behav. Brain Res. 293, 189–197.10.1016/j.bbr.2015.07.043Search in Google Scholar PubMed
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and Group, T.P. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 6, e1000097.10.1371/journal.pmed.1000097Search in Google Scholar PubMed PubMed Central
Morad, G., Kheiri, L., and Khojasteh, A. (2013). Dental pulp stem cells for in vivo bone regeneration: a systematic review of literature. Arch. Oral Biol. 58, 1818–1827.10.1016/j.archoralbio.2013.08.011Search in Google Scholar PubMed
Nagata, M., Iwasaki, K., Akazawa, K., Komaki, M., Yokoyama, N., Izumi, Y., and Morita, I. (2017). Conditioned medium from periodontal ligament stem cells enhances periodontal regeneration. Tissue Eng. Part A 23, 367–377.10.1089/ten.tea.2016.0274Search in Google Scholar PubMed PubMed Central
Park, J.H., Kim, D.Y., Sung, I.Y., Choi, G.H., Jeon, M.H., Kim, K.K., and Jeon, S.R. (2012). Long-term results of spinal cord injury therapy using mesenchymal stem cells derived from bone marrow in humans. Neurosurgery 70, 1238–1247.10.1227/NEU.0b013e31824387f9Search in Google Scholar PubMed
Pawitan, J.A. (2014). Prospect of stem cell conditioned medium in regenerative medicine. BioMed. Res. Int. 2014, e965849.10.1155/2014/965849Search in Google Scholar PubMed PubMed Central
Peng, W., Xing, Z., Yang, J., Wang, Y., Wang, W., and Huang, W. (2014). The efficacy of erythropoietin in treating experimental traumatic brain injury: a systematic review of controlled trials in animal models. J. Neurosurg. 121, 653–664.10.3171/2014.6.JNS132577Search in Google Scholar PubMed
Pimentel-Coelho, P.M. and Mendez-Otero, R. (2010). Cell therapy for neonatal hypoxic-ischemic encephalopathy. Stem Cells Dev. 19, 299–310.10.1089/scd.2009.0403Search in Google Scholar PubMed
Risbud, M. (2000). Tissue engineering: implications in the treatment of organ and tissue defects. Biogerontology 2, 117–125.10.1023/A:1011585117310Search in Google Scholar
Sakai, K., Yamamoto, A., Matsubara, K., Nakamura, S., Naruse, M., Yamagata, M., Sakamoto, K., Tauchi, R., Wakao, N., Imagama, S., et al. (2012). Human dental pulp-derived stem cells promote locomotor recovery after complete transection of the rat spinal cord by multiple neuro-regenerative mechanisms. J. Clin. Invest. 122, 80–90.10.1172/JCI59251Search in Google Scholar PubMed PubMed Central
Sato, M., Uchida, K., Nakajima, H., Miyazaki, T., Guerrero, A.R., Watanabe, S., Roberts, S., and Baba, H. (2012). Direct transplantation of mesenchymal stem cells into the knee joints of Hartley strain guinea pigs with spontaneous osteoarthritis. Arthritis Res. Ther. 14, R31.10.1186/ar3735Search in Google Scholar PubMed PubMed Central
Shimojima, C., Takeuchi, H., Jin, S., Parajuli, B., Hattori, H., Suzumura, A., Hibi, H., Ueda, M., and Yamamoto, A. (2016). Conditioned medium from the stem cells of human exfoliated deciduous teeth ameliorates experimental autoimmune encephalomyelitis. J. Immunol. 196, 4164–4171.10.4049/jimmunol.1501457Search in Google Scholar PubMed
Sugimura-Wakayama, Y., Katagiri, W., Osugi, M., Kawai, T., Ogata, K., Sakaguchi, K., and Hibi, H. (2015). Peripheral nerve regeneration by secretomes of stem cells from human exfoliated deciduous teeth. Stem Cells Dev. 24, 2687–2699.10.1089/scd.2015.0104Search in Google Scholar PubMed PubMed Central
Timmers, L., Lim, S.K., Hoefer, I.E., Arslan, F., Lai, R.C., van Oorschot, A.A., Goumans, M.J., Strijder, C., Sze, S.K., Choo, A., et al. (2011). Human mesenchymal stem cell-conditioned medium improves cardiac function following myocardial infarction. Stem Cell Res. 6, 206–214.10.1016/j.scr.2011.01.001Search in Google Scholar PubMed
Tsai, M.J., Tsai, S.K., Hu, B.R., Liou, D.Y., Huang, S.L., Huang, M.C., Huang, W.C., Cheng, H., and Huang, S.S. (2014). Recovery of neurological function of ischemic stroke by application of conditioned medium of bone marrow mesenchymal stem cells derived from normal and cerebral ischemia rats. J. Biomed. Sci. 21, 5.10.1186/1423-0127-21-5Search in Google Scholar PubMed PubMed Central
Tu, Y., Lineaweaver, W.C., Chen, Z., Hu, J., Mullins, F., and Zhang, F. (2017). Surgical decompression in the treatment of diabetic peripheral neuropathy: a systematic review and Meta-analysis. J. Reconstr. Microsurg. 33, 151–157.10.1055/s-0036-1594300Search in Google Scholar PubMed
Vishnubhatla, I., Corteling, R., Stevanato, L., Hicks, C., and Sinden, J. (2014). The development of stem cell-derived exosomes as a cell-free regenerative medicine. J. Circ. Biomark. 3, 2.10.5772/58597Search in Google Scholar
Wakayama, H., Hashimoto, N., Matsushita, Y., Matsubara, K., Yamamoto, N., Hasegawa, Y., Ueda, M., and Yamamoto, A. (2015). Factors secreted from dental pulp stem cells show multifaceted benefits for treating acute lung injury in mice. Cytotherapy 17, 1119–1129.10.1016/j.jcyt.2015.04.009Search in Google Scholar PubMed
Wang, J., Ding, F., Gu, Y., Liu, J., and Gu, X. (2009). Bone marrow mesenchymal stem cells promote cell proliferation and neurotrophic function of Schwann cells in vitro and in vivo. Brain Res. 1262, 7–15.10.1016/j.brainres.2009.01.056Search in Google Scholar PubMed
Wang, Z., Peng, W., Zhang, C., Sheng, C., Huang, W., Wang, Y., and Fan, R. (2015). Effects of stem cell transplantation on cognitive decline in animal models of Alzheimer’s disease: a systematic review and meta-analysis. Sci. Rep. 5, 12134.10.1038/srep12134Search in Google Scholar PubMed PubMed Central
Xin, H., Li, Y., Liu, Z., Wang, X., Shang, X., Cui, Y., Zhang Z.G., and Chopp, M. (2013a). MiR-133b promotes neural plasticity and functional recovery after treatment of stroke with multipotent mesenchymal stromal cells in rats via transfer of exosome-enriched extracellular particles. Stem Cells 31, 2737–2746.10.1002/stem.1409Search in Google Scholar PubMed PubMed Central
Xin, L.Z., Govindasamy, V., Musa, S., and Kasim, N.H. (2013b). Dental stem cells as an alternative source for cardiac regeneration. Med Hypotheses 81, 704–706.10.1016/j.mehy.2013.07.032Search in Google Scholar PubMed
Yamagata, M., Yamamoto, A., Kako, E., Kaneko, N., Matsubara, K., Sakai, K., Sawamoto, K., and Ueda, M. (2013). Human dental pulp-derived stem cells protect against hypoxic-ischemic brain injury in neonatal mice. Stroke 44, 551–554.10.1161/STROKEAHA.112.676759Search in Google Scholar PubMed
Yamaguchi, S., Shibata, R., Yamamoto, N., Nishikawa, M., Hibi, H., Tanigawa, T., Ueda, M., Murohara, T., and Yamamoto, A. (2015). Dental pulp-derived stem cell conditioned medium reduces cardiac injury following ischemia-reperfusion. Sci. Rep. 5, 16295.10.1038/srep16295Search in Google Scholar PubMed PubMed Central
Yang, D., Wang, W., Li, L., Peng, Y., Chen, P., Huang, H., Guo, Y., Xia, X., Wang, Y., Wang, H., et al. (2013). The relative contribution of paracine effect versus direct differentiation on adipose-derived stem cell transplantation mediated cardiac repair. PLoS One 8, e59020.10.1371/journal.pone.0059020Search in Google Scholar PubMed PubMed Central
Yang, X., Zhu, T.Y., Wen, L.C., Cao, Y.P., Liu, C., Cui, Y.P., Meng, Z.C., and Liu, H. (2015). Intraarticular injection of allogenic mesenchymal stem cells has a protective role for the osteoarthritis. Chin. Med. J. 128, 2516.10.4103/0366-6999.164981Search in Google Scholar PubMed PubMed Central
Yoshikawa, T., Mitsuno, H., Nonaka, I., Sen, Y., Kawanishi, K., Inada, Y., Takakura, Y., Okuchi, K., and Nonomura, A. (2008). Wound therapy by marrow mesenchymal cell transplantation. Plast. Reconstr. Surg. 121, 860–877.10.1097/01.prs.0000299922.96006.24Search in Google Scholar PubMed
Zhang, W., Liu, X.C., Yang, L., Zhu, D.L., Zhang, Y.D., Chen, Y., and Zhang, H.Y. (2013). Wharton’s jelly-derived mesenchymal stem cells promote myocardial regeneration and cardiac repair after miniswine acute myocardial infarction. Coron. Artery Dis. 24, 549–558.10.1097/MCA.0b013e3283640f00Search in Google Scholar PubMed
Zirak Javanmard, M., Asgari, D., Karimipour, M., Atabaki, F., Farjah, G., and Niakani, A. (2015). Mesenchymal stem cells inhibit proteoglycan degeneration in a rat model of osteoarthritis. Gene Cell Tissue 2, e31011.10.17795/gct-31011Search in Google Scholar
©2018 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Accelerated aging and aging process in the brain
- Recent studies on cellular and molecular mechanisms in Alzheimer’s disease: focus on epigenetic factors and histone deacetylase
- The neurophysiology of working memory development: from childhood to adolescence and young adulthood
- Mothering under the influence: how perinatal drugs of abuse alter the mother-infant interaction
- The natural history of subependymal giant cell astrocytomas in tuberous sclerosis complex: a review
- Why do herpes simplex encephalitis and semantic dementia show a different pattern of semantic impairment in spite of their main common involvement within the anterior temporal lobes?
- Regenerative potential of secretome from dental stem cells: a systematic review of preclinical studies
- Understanding the controversial drug targets in epilepsy and pharmacoresistant epilepsy
- Population-based differences in immune system response contribute to an increased risk of schizophrenia in African migrants?
Articles in the same Issue
- Frontmatter
- Accelerated aging and aging process in the brain
- Recent studies on cellular and molecular mechanisms in Alzheimer’s disease: focus on epigenetic factors and histone deacetylase
- The neurophysiology of working memory development: from childhood to adolescence and young adulthood
- Mothering under the influence: how perinatal drugs of abuse alter the mother-infant interaction
- The natural history of subependymal giant cell astrocytomas in tuberous sclerosis complex: a review
- Why do herpes simplex encephalitis and semantic dementia show a different pattern of semantic impairment in spite of their main common involvement within the anterior temporal lobes?
- Regenerative potential of secretome from dental stem cells: a systematic review of preclinical studies
- Understanding the controversial drug targets in epilepsy and pharmacoresistant epilepsy
- Population-based differences in immune system response contribute to an increased risk of schizophrenia in African migrants?