Controversies regarding transplantation of mesenchymal stem cells

Table 3 Future directions in mesenchymal stem cell treatments

Aspect		MSC treatment
Personalized medicine	Patient-specific MSCs	One of the critical strategies in personalized medicine involves using patient-derived MSCs. These autologous MSCs are obtained from the patient's own tissues, such as bone marrow or adipose tissue. Using a patient's cells minimizes the risk of immune rejection, and treatment can be tailored to the individual's needs
	Genomic and molecular profiling	Advances in genomics and molecular profiling techniques enable the identification of specific markers or genetic characteristics that influence a patient's response to MSC therapy. This information can guide treatment decisions, allowing for the selection of the most appropriate MSC source and optimization of the therapeutic regimen
	Disease-specific approaches	Tailoring MSC therapies to the unique features of a particular disease is another aspect of personalized medicine. For example, MSCs can be engineered in cancer therapy to deliver anti-tumor agents or enhance immune responses, depending on the patient's cancer type and stage
	Dosage and timing optimization	Personalized medicine also extends to optimizing the dosage and timing of MSC treatments. Factors such as the severity of the condition, the patient's age, and comorbidities can all influence the treatment protocol, ensuring the best possible outcomes
Advanced delivery methods	Microencapsulation and biomaterials	Microencapsulation involves encapsulating MSCs within biocompatible materials or hydrogels. This protective environment shields MSCs from immune responses while providing a sustained release of therapeutic factors. This approach is encouraging for conditions like diabetes, where encapsulated MSCs can help regulate blood sugar levels
	Intravenous infusion techniques	Intravenous delivery of MSCs is a common method, but refinements in infusion techniques are being explored to maximize cell retention and tissue homing. Pre-conditioning or priming MSCs before infusion can enhance their migratory properties and tissue-specific targeting
	Nanoparticle-based carriers	Nanoparticles can serve as carriers for MSCs, protecting them during transit and improving their ability to reach target sites. These carriers can be loaded with therapeutic or imaging agents for tracking and treatment monitoring
	Direct injection and endoscopic delivery	For localized conditions, such as osteoarthritis or IBD, direct injection of MSCs into the affected area or endoscopic delivery methods are being refined to target tissues and minimize invasiveness precisely
	Exosome-mediated delivery	MSC-derived exosomes, tiny vesicles containing bioactive molecules, offer a cell-free approach to therapy. Exosomes can be isolated and administered to mediate therapeutic effects, making them a promising alternative to whole-cell therapy
Combining therapy	Immunomodulatory Combinations	Combining MSC therapy with immunomodulatory agents or immune checkpoint inhibitors can potentiate the immunosuppressive effects of MSCs, particularly in the context of autoimmune diseases or organ transplantation
	Gene editing and engineering	Genetic modification of MSCs allows for the precise manipulation of their properties. Engineered MSCs can be equipped with therapeutic genes or targeted for specific functions, such as enhancing tissue regeneration or tumor suppression
	Drug delivery systems	MSCs can serve as drug delivery vehicles, transporting therapeutic compounds directly to diseased tissues. This approach is particularly relevant in cancer therapy, where MSCs can deliver anti-cancer drugs to tumor sites
	Stem cell combinations	Combining different types of stem cells, such as iPSCs or neural stem cells, with MSCs can offer multi-pronged approaches to conditions like spinal cord injuries or neurodegenerative diseases
	Adjunct therapies	MSC transplantation can complement traditional treatments, such as surgery or radiation therapy. For example, MSCs can be used alongside surgical procedures in bone repair to accelerate healing and improve outcomes

MSC: Mesenchymal stem cell; IBD: Inflammatory bowel disease; iPSCs: Induced pluripotent stem cells.