Application Of Stem Cell In Surgery

Abstract

Stem cells are cells found in most multi-cellular organisms. The classical definition of stem cells requires that they possess two properties. The first one is self-renewal which is the ability to go through numerous cycles of cell division while maintaining the undifferentiated state. The second one is potency which is the capacity to differentiate into several specialized cell types. Because of these properties, stem cells are the basis of the new field of regenerative medicine. However, not all stem cells are alike and each type has its own ethics. There are many types of stem cells: adult stem cells (ASCs), embryonic stem (ES) cells, embryonic germ (EG) cells, and induced pluripotent stem (IPS) cells. ASCs are isolated from an adult body and have the potential for limited differentiation. ES cells are isolated from 5-day old embryos created by in vitro fertilization (IVF). ES cells are pluripotent, so have the best medical uses, and are relatively easy to isolate and grow in large numbers. ES cells can also be obtained in animals by cloning via somatic cell nuclear transfer (SCNT). IPS cells are adult cells (usually skin fibroblast cells) induced to de-differentiate into pluripotent cells using transcription factors. IPS cells do not destroy embryos to obtain them, but it is not yet proven whether they are truly as potent as ES cells. This rising debate has prompted authorities around the world to seek regulatory frameworks and highlighted the fact that stem cell research represents social and ethical challenge. Stem cells have the potential for almost unlimited applications when it comes to dealing with disease. Depending on the type of stem cell used, their regenerative abilities allow them to differentiate into any type of cell in the body. Our challenge is to control their growth to prevent cancer and to devise methods to ensure the correct differentiation pathway is taken. Most fields of stem cell research still need years of testing before trials can reach human patients and it will be years after that before the treatments become available to the general public. It is not an overstatement that the advances in stem cell biology will have a profound impact on the practice of surgery. The impact will likely be in specific areas that are currently in rapid evolution. These areas include but are not limited to, tissue engineering, cellular and organ transplantation, treatment of solid neoplasms, wound healing and fetal intervention. In Surgery, stem cells could be used in digestive surgery for treatment of liver diseases, short bowel syndrome, severe Crohn's disease refractory to other medical therapies, gastrointestinal motility disorders, esophageal disorders that need esophageal replacement. Stem cells have the potential for prevention of amputation of limbs in diabetes and critical limb ischemia by stimulation of angiogenesis. Another application is to use stem cells in reconstructive surgery, soft tissue replacement, and treatment of burns and skin ulcers, stem cells also could be used for repair of spinal cord injuries, repair of diseased myocardium and diseased heart valves. Stem cells may be used also in treatment of congenital anomalies in pediatric surgery, many urological disorders like urinary incontinence and erectile dysfunction and reconstruction after tumor resection. To conclude, the field of stem cell research is fraught with challenges. There are many issues related to the derivation, expansion, manipulation, characterization and testing of stem cells for efficacy, toxicity, disposition to tumor and cancer formation and immune responses that must be resolved before these cells or cells derived from them can be used to treat patients. It is important to realize that, few stem cells progeny are ready for safe and ethical use in treating human beings. Some believe that after few years, clinical researchers will be ready to transplant specialized stem cells or their offshoots into patients to replace cells that are diseased or carry deleterious mutations. Others argue that it will take much longer to achieve these goals, since considerably more information about the basic biology of human stem cells needs to be developed before they can be used more broadly to treat human beings safely.