When Adrienne Shapiro’s daughter Marissa was diagnosed with sickle cell disease, the doctors said that she would not live till her first birthday. However, when Marissa managed to live past that benchmark, it did not mean the end of Adrienne’s worries. In fact, it was the beginning of many painful years of blood transfusions and immunological disorders. When an improperly matched blood transfusion caused a severe reaction leading to the removal of Marissa’s gall bladder and temporary kidney failure, she was unable to receive further blood transfusions.

However, luckily for Marissa a project sponsored by the California Institute for Regenerative Medicine (CIRM), headed by Don Kohn, MD at UCLA, was starting a clinical trial. The objective of the project was ‘to remove bone marrow from the patient and fix the genetic defect in the blood-forming stem cells. Then those cells can be reintroduced into the patient to create a new, healthy blood system. The success of this clinical trial has given hope to Adrienne that with the help regenerative medicine her daughter will be able to lead a healthy and pain-free life.

The Stem Cell & Regenerative Medicine Center at the University of Wisconsin-Madison describes ‘Regenerative Medicine’ as ‘a new scientific and medical discipline focused on harnessing the power of stem cells and the body’s own regenerative capabilities to restore function to damaged cells, tissues and organs.’

Stem cells that are found in the umbilical cord blood of newborn children have the ability to renew and regenerate themselves. A stem cell, through the process of mitosis, can divide itself to either become a specialised cell like a brain cell or muscle cell or remain a stem cell. They are also able to repair internal damage caused by any type of disease, disorder or trauma. Stem cell transplantation, stem cell grafting and regenerative medicine are some of the ways in which stem cells are used to cure disorders and illnesses.

Regenerative medicine includes a wide range of scientific disciplines, such as biochemistry, genetics, molecular biology and immunology. Scientists from these fields have been conducting research and studies in this domain and have identified three methods of using regenerative medicine. They are cellular therapies, tissue engineering and medical devices and artificial organs.

Cellular Therapies

In this method, cellular materials, in most cases adult stem cells, are extracted and stored and then injected into the site of injury, tissue damage or disease. These cells, thereafter, repair the damaged cells or regenerate new cells to replace the damaged ones.

Tissue Engineering

This method is related to the field of biomaterials development and utilises a combination of functioning tissues, cells and scaffolds to engineer a fully functioning organ which is then implanted into the body of the receiver in place of a damaged organ or tissue.

Medical Devices and Artificial Organs

When a body organ fails, the most common method of treatment is to replace it with a donor organ. Donor organs are not easily available and can pose as a hindrance in such cases. Even if a donor is available, he or she may need to take immunosuppressant drugs before the transplant and these drugs have been known to cause side-effects. In such circumstances, medical devices that imitate the function of the failed organ can be used, instead of transplantation.  An example of one such device is the ventricular assist device (VAD) that is used in place of heart transplants.

Since regenerative medicine deals with the use of stem cells, it occasionally requires embryonic stem cells for research purposes. This use of embryonic stem cells can often give rise to questions regarding ethics and legality. The laws and regulations concerning regenerative medicine are different in different countries. Creation of human embryos for research is only legally permitted in three countries. The majority of the countries only allow extraction of cells from surplus IVF embryos. A recent study, related to human embryonic stem cells (hECS) research policy, was conducted which revealed that the UK, Sweden and Belgium were very permissive in authorising the creation of human embryos for research, whereas, Luxembourg, Austria, Poland and Ireland had no laws regarding hECS. The legislations regarding hESC in most other countries range from being mildly restrictive to very restrictive.

Regenerative medicine is the future of modern medical treatments. Scientists are conducting clinical trials and studies every day to further enhance and improve in this area of medicine.

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How effective are stem cells in regenerating organs, tissues and cells? The prognosis is good, and the implications for patients are enormous.

Regenerative medicine is fast gaining popularity globally, where consistent research is being conducted into the field. Broadly, regenerative medicine is a field of research in molecular biology which studies engineering or renewing human cells, organs or tissues[1]. Regenerative medicine is applicable in the restoration of damaged organs and tissues, once usual medical intervention has been done and cannot be continued further.

This implies that regenerative medical techniques can help grow cells, tissues and organs in laboratory conditions, and ready them for transplant later. The basic building blocks for the procedure would be derived from the patient himself – this also solves the problem of transplant rejection. There is also no need to look for a transplant donor.

Stem cells and regenerative medicine

The clinical therapies in regenerative medicine may involve the use of stem cells. These could be injected via directed differentiation cell therapies, or via immunomodulation therapy, or even via tissue engineering. This last in vitro procedure is still in the trial stages.

The direct implication of regenerative medicine is that patients with irreversible tissue or organ damage may be able to heal themselves with a regenerated tissue or organ. In this context, pluripotent stem cells are being studied and used in clinical trials that involve treating renewing damaged muscles and skin in burn accident victims, and congestive heart disease.[2]

Pluripotent stem cells can help regenerate any of the cell types present in the human body, while embryonic stem cells are able to regenerate an organism. One of the stem cell treatments being researched in regenerative medicine involves extracting a few stem cells from the body and renewing them in a large batch. Once a sufficiently large quantity of stem cells has been regenerated, it is injected into the patient. Doctors hope this method will help the in vitro regeneration process much faster.[3]

Bone marrow is a rich source of adult stem cells. It contains the cells that give rise to blood and even bone, fat and cartilage. Regenerative medicine doctors are investigating the full range of bone marrow use in re-growing cells, organs and tissues.

[1] ‘Regenerative medicine’, Wikipedia

[2] Gorman, Christine, ‘What’s Next for Stem Cells and Regenerative Medicine?’, Scientific American magazine, March 2013

[3] Dr Mahendra Rao, Director, Centre for Regenerative Medicine, National Institutes of Health, Bethesda, in an interview to Scientific American magazine, March 2013

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