Stem Cells Application in Thoracic Surgery: Current Perspective and Future Directions

Our plain-English summary of Stem Cells Application in Thoracic Surgery: Current Perspective and Future Directions, by F. Petrella, L. Spaggiari (Advances in Experimental Medicine and Biology, 2018).

The study

• Authors: F. Petrella, L. Spaggiari
• Journal: Advances in Experimental Medicine and Biology
• Published: 2018;1089:143-147
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Two main fields of clinical applications of stem cells in thoracic surgery have been explored: (a) regenerative medicine, that is a branch of translational research in tissue engineering and molecular biology dealing with the replacement, engineering or regeneration of cells, tissues and organs to restore normal function; (b) drug loading and delivery, that is an emerging field proposing stem cells as vectors to deliver anti-cancer agents for targeted therapies.Bronchopleural fistula is a pathological connection between the bronchus and the pleural cavity that may develop after lung resection, thus causing pleural empyema due to colonization by resident airway bacteria; stem cells and regenerative medicine approach can effectively contribute to impaired bronchial healing, thus preventive a septic and ventilator catastrophe.In the field of thoracic oncology, MSC are probably one of the best choice for anticancer drug delivery, emerging as potential experimental approach to malignant mesothelioma treatment.The goal of this review is to focus on clinical applications of stem cell technologies in thoracic surgery, emphasizing regenerative medicine aspects as well as drug loading and delivery in thoracic oncology.

In plain English

This short review by two thoracic surgeons in Milan, Italy, described how stem cells, mainly mesenchymal stromal cells (MSC), have been used or tested in thoracic surgery. It reported no new research and did not mention asbestos. It covered two areas. The first was repairing bronchopleural fistula, an abnormal connection between an airway (bronchus) and the pleural cavity, the space around the lung, that can follow lung surgery. The authors described their own earlier animal work. They also described a case they had reported in which a fistula after right extrapleural pneumonectomy was closed using the patient's own bone marrow MSC, placed through a bronchoscope. Other teams reported similar results. The second area was using MSC to carry cancer drugs to malignant pleural mesothelioma. The authors described their earlier laboratory finding that bone marrow MSC loaded with paclitaxel inhibited growth of mesothelioma cells in vitro. They said further studies and in vivo testing were needed. The authors concluded that the field was promising but that several drawbacks still exist. They warned against sensational, anecdotal or enthusiastic reports.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review; the article contains no original studies with human participants or animals
• Who was studied: No study population; a review of published work on clinical uses of stem cells in thoracic surgery, by authors at the European Institute of Oncology and University of Milan, Italy
• Main results:
  • The review stated that bronchopleural fistula after lung resection for lung cancer occurs in 1% to 4% of cases, with mortality of 12.5% to 71.2%. This is background, not a finding of this article.
  • The authors described their earlier report of a single case in which a bronchopleural fistula after right extrapleural pneumonectomy was closed by bronchoscopic transplantation of the patient's own bone marrow derived MSC. That report followed earlier work in a large animal model.
  • The review noted that other teams later reported similar results using adipose derived MSC, platelet rich plasma and an MSC seeded matrix graft.
  • The review described malignant pleural mesothelioma as resistant to chemotherapy, with a response rate of 20% of treated patients, and said there are no effective second-line treatments.
  • The authors described their earlier laboratory finding that bone marrow MSC loaded with paclitaxel inhibited in vitro growth of malignant pleural mesothelioma cells.
• The authors' conclusion: The authors concluded that applying stem cell technologies to thoracic surgery is intriguing and promising. They said that several drawbacks remain and should be emphasized before preclinical findings are moved into clinical practice. They also warned against sensational, anecdotal or enthusiastic reports.
• Limitations the authors state:
  • The authors stated that their paclitaxel-loaded MSC results against mesothelioma cells are preliminary and in vitro only, and that further studies and in vivo testing are needed.
  • The authors stated that it remains unsettled whether MSC interacting with the tumor environment suppresses tumor growth or instead favors it.

Topics

Medical terms in this study, explained in our Lexicon: STEM, Thoracic Surgery, Bronchus, Pleural Cavity, Empyema, Malignant Mesothelioma.

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