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. 2020 Aug 19;2020(8):CD013202. doi: 10.1002/14651858.CD013202.pub2

1. Types of regenerative cells.

Cell type Source Rationale Mechanism of action Preclinical/clinical results References
MSC Human umbilical cord tissue/blood; rodent/human bone marrow Safe and feasible in phase 1 RCT for bronchopulmonary dysplasia
  • Low immunogenicity (low MHC II), easily obtainable, rapid expansion

  • Autologous/allogeneic administration

  • Paracrine release of trophic factors

  • Paracrine release of IGF‐1, EGF, VEGF, BDNF

  • Immunomodulatory: regulate T‐cell, B‐cell function, and production of inflammatory cytokines

  • Mitochondrial transfer

  • Nerve fibre remyelination and axonal regeneration

  • Improve behavioural/motor tests

  • Enhance neural cell proliferation, survival, function

  • Decrease infarct size

Ahn 2016; Boshuizen 2018; Chopp 2002; Hsu 2016; Islam 2012; Liu 2010; Murphy 2013; Park 2016
MNC Human umbilical cord blood
  • Readily collected and large supply in cord blood with high plasticity

  • Safe and feasible in phase 1 RCT for hypoxic‐ischaemic encephalopathy

  • Low immunogenicity (minimal HLA matching)

  • Paracrine release of trophic factors

  • Autologous/allogeneic administration

  • Increase expression of BDNF, NGF, VEGF, GDNF

  • Activation of pro‐survival Akt pathway

  • Decrease TNF‐α and increase IL‐10 gene expression

  • Reduce CD4+ T cell infiltration

  • Regulate hedgehog signalling

  • Decrease neuronal apoptosis, astrogliosis, inflammation

  • Improve oligodendrocyte survival

  • Induce axonal growth

  • Improve neurobehavioral outcome

Aridas 2016; Cotton 2014; Fan 2005; McDonald 2018; Pimentel‐Coelho 2012; Rowe 2010; Wang 2013
OPC Rodent/human embryonic stem cell; human NSC derivation
  • Differentiate into oligodendrocytes (cells highly susceptible to hypoxic‐ischaemic injury)

  • Remyelinate injured axons

  • Diffuse biodistribution along white matter tracts and differentiate into myelin‐sheath‐producing oligodendrocytes

  • Promote myelin sheath formation, NSC proliferation, and inhibit apoptosis

  • Motor recovery following CNS injury

Chen 2015; Gopagondanahalli 2016; Kim 2018; Manley 2017; Niimi 2018; Xu 2015
NSC Human fetal striatum; human ESC; human iPSC
  • Differentiate into cells necessary for brain repair, including: neurons, astrocytes, and oligodendrocytes

  • Paracrine release of trophic factors

  • Low immunogenicity and tumorigenicity

  • Immunomodulation

  • Paracrine secretion of BDNF, VEGF, and EGF

  • Attenuate NF‐κB signalling

  • Upregulate glutamate transport

  • Stimulate survival and migration of endogenous NSCs and neurons

  • Reduce inflammation and reactive oxygen species production

  • Improve axonal growth, motor function, decreased infarct size

Daadi 2016; Huang 2018; Ji 2015; Mine 2013
HSC Umbilical cord blood
  • Paracrine release of neurotrophic factors

  • Multipotent capacity and ability to transdifferentiate into neuronal cells

  • Autologous/allogeneic administration

  • Reduce microglial cells and T lymphocytes

  • Secrete VEGF, HGF, IGF‐1

  • Decrease infarct size and maintains cerebral blood flow

  • Enhance axonal growth

  • Ameliorate neuronal apoptosis and post‐ischaemic inflammation

Schwarting 2008; Tsuji 2014; Verina 2013
EPC Human umbilical vein; human umbilical cord blood; human adipose stem cell; human iPSC
  • Umbilical‐cord‐derived EPCs have higher regenerative potential than adult bone marrow‐derived EPCs

  • Endothelial cell protection, repair, angiogenesis

  • Low immunogenicity

  • Paracrine release of regenerative factors

  • Autologous administration

  • Anti‐inflammatory effects: reduce CD4+ infiltration to the brain

  • Activation of PI3/Akt pathway

  • Axonal growth: BDNF secretion

  • Angiogenesis: VEGF, IGF‐1 secretion

  • Improve cognitive and motor function

  • Inhibit neuronal apoptosis

  • Stimulate blood vessel formation and reduce infarct size

Grandvuillemin 2017; Kidani 2016; McDonald 2018; Nabetani 2018; Wang 2016; Wu 2013
iPSC Skin fibroblasts, umbilical cord tissue, amniotic tissue
  • Autologous administration

  • Differentiation into multiple neural lineage cells

  • Low immunogenicity

  • Differentiate into functional neural cells (electrophysiological properties)

  • Decrease infiltration of MPO+ neutrophils and CD11b+ microglia

  • VEGF expression and organelle transfer

  • Improve survival and sensorimotor function

  • Establish axonal connections

  • Inhibit inflammation, neural apoptosis, and glial scar formation

Cai 2010; Hsu 2016; Oki 2012; Pluchino 2013; Qin 2015; Tornero 2013

BDNF: brain‐derived neurotrophic factor; CNS: central nervous system; ESC: embryonic stem cell; EGF: epidermal growth factor; GDNF: glial cell‐line derived neurotrophic factor; HGF: hepatocyte growth factor; HLA: human leukocyte antigen; HSC: haematopoietic stem cells; IGF‐1: insulin‐like growth factor 1; iPSC: inducible pluripotent stem cells; IL: interleukin; MHC: major histocompatibility complex; MSC: mesenchymal stem cell; MNC: mononuclear cells; NF‐κB: nuclear factor kappa beta; NGF: nerve growth factor; NSC: neural stem cells; OPC: oligodendrocyte progenitor cells; RCT: randomised controlled trial; TNF: tumour necrosis factor; VEGF: vascular endothelial growth factor.