Quel futur pour les cellules-souches mésenchymateuses dans les affections ostéoarticulaires ?

Abstract

Regenerative medicine using mesenchymal stem cells (MSC) is developped in several musculoskeletal diseases. The concentration of bone marrow or adipose tissue has been the most common therapeutic method used. The large variability of the cell-productions, however, could be a limitation. Recent biological research concerning MSC has unearthed several new aspects. Firstly, a heterogeneity of the MSC was found following the tissue origin and/or the patient's. Then, the characterisation of MSC was improved by using new combinations of cellular membrane markers. Another important step was the discovery of the paracrine activity of MSC. The MSCs are able to produce a lot of growth factors and cytokines, a production of extra cellular vesicles like exosomes arising an intercellular signaling. MSCs were found to have not only a proliferation and differentiation performance to restore the damages of time, but also immunomodulation and anti-inflammation activities. The field of cell-based therapy with MSC is enlarged with newer and more promising methods than bone marrow concentrate. Expansion culture methods of MSC have been developped, as in vitro differentiation in osteoblasts and chondrocytes or cell manipulations by transfection to produce induced pluripotent stem cells or super MSCs able to produce more growth factors or cytokines, or to modify the membrane signaling for improving MSC homing. The translation of these biological developments in human therapy is the key for the MSC future. After pre-clinical tests to verify the safety, controlled trials are needed to define the true place of this regenerative medicine.