STEM CELL AND USAGE IN MEDICAL AESTHETICS
We tried to briefly explain a misused definition of Stem Cell Applications in applications that are popular recently as vitamin vaccine, blood vaccine, PRP, Sertap Erener’s stem cell application, youth vaccine among aesthetic applications. First of all, none of the applications mentioned above are stem cell applications. lets start.
What is Stem Cell?
Stem cells are functionally undifferentiated, that is, the main cells that form all tissues and organs in the human body, which are not fully matured to perform a special task in any organ or tissue of the body, have a complex structure, have unlimited division and self-renewal ability. In a short definition, stem cells are the beginning, that is, the precursor cells of the body.
When these cells divide, they can produce themselves or other tissue cell types. For example, stem cells in the skin can make more skin stem cells or differentiate into other skin cells, which we call melanocytes, which have their own unique function, such as making melanin, which gives skin its color. For stem cells to differentiate and turn into a specific cell, a stimulus must come.
Stem cells are also very young, rapidly dividing and very mobile. For example, when they are placed on the skin, they almost release energy to the skin, rejuvenate and activate the skin by dividing faster.
What are the characteristics of stem cells?
1. They can settle in a suitable growth environment by themselves or with a stimulus.
2. They have the ability to reproduce very quickly.
3. They can differentiate into other body tissue cells and provide the continuation of these cells.
4. They can ensure the continuity of cell communities as they renew themselves.
5. They have the potential to repair this tissue and make it functional following an injury to a part of the body.
Classification of Stem Cells
Stem cells can be classified according to their differentiation ability or the source from which they are obtained.
According to their differentiation abilities;
one- Totipotent Stem Cell: They have the ability to transform into all kinds of body cells with an unlimited number of differentiation abilities. Such cells are only found in embryos and turn into embryonic and placental cells.
2- Pluripotent Stem Cell:They are stem cells that can differentiate in a limited number, however, have the ability to form or repair many tissues in the organism.
3- Multipotent Stem Cell:They are stem cells that can form specialized cell groups.
4- Unipotent or progenitor Stem Cell: Stem cells that can form a single type of stem cell Cells that can differentiate in a single direction, for example, a stem cell obtained from the brain can only be transformed into a nerve cell
5- iPKH or exogenously induced pluripotent stem cell: iPKH has almost all the characteristics of embryonic stem cells, but they are not created from embryos. Therefore, there are no ethical problems associated with iPKH. Moreover, iPKH is derived from the patient’s own non-stem cell cell, which means that iPKH can be given to the patient without immune rejection, which is very important in stem cell transplants.
According to their source:
1-Embryonic Stem Cell: Embryonic stem cells develop in the “zygote” formed following the fertilization of the sperm and ovum. Within the 5th day, a hollow sphere called “blastocyte” with approximately 150 cells is formed. The blastocyst consists of cells like small sand grains and includes two types of cells; trophoblast and central cell cluster. The cluster of cells in the center come together to form the embryonic stem cell. Embryonic stem cells can also differentiate into all adult cell types. Stem cells in the period until the first 8 weeks of pregnancy are defined by this name.
2- Fatal Stem Cell; One of the potential sources of stem cells is early fetal tissue. The embryo takes the name “fetus” when it is approximately 7-8 weeks after fertilization.
3-Adult Stem Cell: . Adult stem cells are different from cells taken from the embryo and fetus and are found in tissues that develop in humans or animals after birth. Adult stem cells are cells found in many tissues. These include bone marrow, blood, cornea, retina, brain, skeletal muscle, liver, skin, gastrointestinal tract, and pancreas. However, the most suitable place from which these cells are obtained is the bone marrow, which is located in the center of some bones. In the bone marrow; There are different types of stem cells, including hematopoietic stem cells, endothelial stem cells and mesenchymal stem cells. blood of hematopoietic stem cells; It is known that endothelial stem cells form the vascular system (arteries and veins) and mesenchymal stem cells form bone, cartilage, muscle, fat and fibroblasts.
Adult stem cell sources other than bone marrow
Umbilical cord blood: Adult stem cells can also be obtained from sources such as the newborn’s umbilical cord. The umbilical cord is more easily accessible and a source of stem cells with a higher proliferation potential compared to similar adult tissues in the brain and bone marrow.
Baby tooth: Stem cells taken from umbilical cord blood or the fleshy structure under the baby tooth are younger stem cells than cells obtained from adults. These cells, which have the ability to proliferate more than many adult cells in culture, have the ability to form different tissues. Their potential in generating different cell types is being studied extensively.
Fat cells:Stem cells are obtained from the material obtained from fat tissues by liposuction.
With the success of bone marrow transplantation, the transplantation of stem cells came to the fore and its first applications were promising. Stem cells, which were first used only for bone marrow repair, have also been used for other organs and tissues of the body, although there are few applications. Stem cells of embryological origin were defined later, but applications with these cells were limited or banned in many countries, since moral problems could not be fully resolved. Currently, approximately 15,000 stem cell transplants are performed every year in the world. The majority of these are adult human-sourced applications.
Is Stem Cell Accepted as a Treatment Method Today? In Which Diseases Are Stem Cells Still Used?
Stem cells are not yet used as a disease treatment method in the world. Stem cell transplantation applications, which are frequently announced in communication tools, are mostly performed for tissue ‘repair’. For example; In diabetes, if the pancreatic tissue does not work and cannot produce insulin, to ensure that the pancreas produces insulin, even if it is insufficient, by stem cell transplantation, or if some cells of the brain and spinal cord are not working, to regenerate the nerve cells more or less with the help of stem cells. The aim is to repair the bone marrow with the help of stem cells, not to treat the blood cancer in this way, in blood cancer and some anemia diseases in which the bone marrow functions inadequately. Here, the following question can be raised: Isn’t this method also a form of treatment? Theoretically, the answer to this question is yes, but today, scientific medical disciplines do not accept this non-standardized form of treatment provided for diseases in which stem cells are used, as an established method.
Today, stem cells are mostly used in blood diseases. The most well-known of these are the conditions in which the bone marrow does not work, caused by blood cancer and hereditary anemia. A very high rate of success is achieved with stem cell applications in repairing the bone marrow destruction caused by these diseases and enabling them to produce blood again. In addition, it is still used both experimentally and clinically for pancreas in diabetes, kidney failure, spinal cord injuries, various degenerative diseases of the brain such as Parkinson’s and Alzheimer’s, strokes, retinal diseases of the eye, immune system diseases, and some heart and vascular failure diseases. as work continues. Despite some promising developments, no definite success has yet been achieved in these diseases. Regeneration or functionalization of an organ (such as the bladder) or tissue (such as the retina of the eye) using stem cells, which is frequently covered in the press, is currently carried out on small experimental animals in the laboratory environment, it has no application in humans. In our country, very recently, stem cell transplantation treatments have been started to be applied in a limited number of paralyzed patients with spinal cord damage who have suitable criteria for treatment. The results of these studies will be reported in the coming years. Recent studies have shown that stem cells obtained from blood can transform into fat, muscle, vascular endothelium (inner wall), liver, cartilage, bone and nerve cells under appropriate conditions in the laboratory.
What is the Legal Dimension of Stem Cell Applications in Our Country?
In our country, both clinical and research applications have been made with stem cells for many years, but the necessary legal regulations have not been put forward yet. In 2006, the Stem Cell Advisory Board was established under the Ministry of Health. The Stem Cell Working Group was established in 2004 within the Turkish Academy of Sciences (TÜBA) in order to keep up to date with scientific developments and knowledge, and to provide national and international standardization in the research and applications of stem cells.
Should Cord Blood Be Stored?
Cord blood is a good source to obtain stem cells. Blood taken at birth can be stored ready for use for a very long time at minus 196°C. Stem cells obtained from cord blood do not have the ability to differentiate as much as embryological stem cells. Unlike stem cells derived from bone marrow or blood, cord blood is currently only used for the person it belongs to, but theoretically, it can be used for other people if the tissue is compatible. The use of cord blood is very limited today. According to statistics, one out of every three thousand people needs their own cord blood. Experts do not recommend storing cord blood. In our country, some private institutions provide cord blood bank services, but these institutions have not yet become official.
What is Embryological (Early Fetal Stage) Stem Cell Application?
Embryological stem cells are cells obtained in the early stage of the fetus shortly after fertilization occurs. These cells can only be obtained from embryos created by artificial insemination in in vitro fertilization, from those who have excess requirements or as a result of miscarriage after unintended pregnancy. Embryological stem cells have unlimited differentiation potential (totipotent) compared to stem cells obtained from adults. these types of cells have the ability to repair damage in any organ, while those of the adult type show more limited differentiation (pluripotent and unipotent). Currently, embryological stem cell studies are prohibited in our country and in many countries. There is no such limitation in the UK and Belgium, while certain restrictions have been introduced in Germany.
What Are the Known Side Effects of Stem Cell Therapy Today?
It has been reported that new tumors may occur, especially in studies with (embryological) stem cells obtained from the embryo, which is the first stage of the fetus. It is not known what potential risks the cells produced in the presence of serum, chemicals and media used in research pose to human health. There is a 2% risk of death in autologous stem cell transplants and 9% in allogeneic stem cell transplants.
Is there a stem cell use in aesthetic applications?
Today, among the aesthetic applications, the real stem cell application is the one obtained from the adipose tissue. In recent studies, it has been determined that there are 5 times more stem cells than bone marrow in adipose tissue. The adipose tissue taken from the patient by liposuction is separated from the fat cells in the young stem cells in the laboratory with the help of a system. This is a process that takes 2.5-3 hours. After separating the stem cells, they are collected and mixed with a small amount of PRP and adipose tissue and injected into the areas intended for aesthetics. The decrease in skin adipose tissue, muscle tissue and bone tissue, which are the aesthetic problems of aging, is replaced with this application. These stem cells make and revitalize the tissue cells to which they are applied in the skin and under the skin.
For this purpose, liposuction is performed under local anesthesia in a small area in the abdomen or hip region, in such a way that 40-200 cc of adipose tissue is removed. They are then centrifuged. Stem cells are separated from adipose tissue.
Then, 50-100 cc blood is taken from the patient and PRP rich in platelets and growth factor is obtained. Then, stem cells and PRP are combined so that stem cells are activated. This activation is around 50%. This mixture is passed through IPL and activation reaches up to 90%. The most recently obtained activated stem cells can be administered to the patient from the vein to the skin.
PRP, which is the popular process of recent times, is not a stem cell application. PRP is the passing of the blood taken from the patient in a centrifuge and the separation of tissue repair and regeneration cells, which we call thrombocyte, and applying them back to the patient.
Sertap Erener’s own skin is removed and fibroblasts are multiplied from the skin and applied back to the skin. It is not stem cell therapy.