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Thiry L, Clément JP, Haag R, Kennedy TE, Stifani S. Optimization of Long-Term Human iPSC-Derived Spinal Motor Neuron Culture Using a Dendritic Polyglycerol Amine-Based Substrate. ASN Neuro 2022; 14:17590914211073381. [PMID: 35023784 PMCID: PMC8784909 DOI: 10.1177/17590914211073381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Human induced pluripotent stem cells (hiPSCs) derived from healthy and diseased individuals can give rise to many cell types, facilitating the study of mechanisms of development, human disease modeling, and early drug target validation. In this context, experimental model systems based on hiPSC-derived motor neurons (MNs) have been used to study MN diseases such as spinal muscular atrophy and amyotrophic lateral sclerosis. Modeling MN disease using hiPSC-based approaches requires culture conditions that can recapitulate in a dish the events underlying differentiation, maturation, aging, and death of MNs. Current hiPSC-derived MN-based applications are often hampered by limitations in our ability to monitor MN morphology, survival, and other functional properties over a prolonged timeframe, underscoring the need for improved long-term culture conditions. Here we describe a cytocompatible dendritic polyglycerol amine (dPGA) substrate-based method for prolonged culture of hiPSC-derived MNs. We provide evidence that MNs cultured on dPGA-coated dishes are more amenable to long-term study of cell viability, molecular identity, and spontaneous network electrophysiological activity. The present study has the potential to improve hiPSC-based studies of human MN biology and disease.We describe the use of a new coating substrate providing improved conditions for long-term cultures of human iPSC-derived motor neurons, thus allowing evaluation of cell viability, molecular identity, spontaneous network electrophysiological activity, and single-cell RNA sequencing of mature motor neurons.
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Affiliation(s)
- Louise Thiry
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
| | - Jean-Pierre Clément
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
| | - Rainer Haag
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Berlin, Germany
| | - Timothy E Kennedy
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
| | - Stefano Stifani
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
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2
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Perugini V, Santin M. A Substrate-Mimicking Basement Membrane Drives the Organization of Human Mesenchymal Stromal Cells and Endothelial Cells Into Perivascular Niche-Like Structures. Front Cell Dev Biol 2021; 9:701842. [PMID: 34650967 PMCID: PMC8507467 DOI: 10.3389/fcell.2021.701842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/10/2021] [Indexed: 12/23/2022] Open
Abstract
Extracellular matrix-derived products (e.g. Matrigel) are widely used for in vitro cell cultures both as two-dimensional (2D) substrates and as three-dimensional (3D) encapsulation gels because of their ability to control cell phenotypes through biospecific cues. However, batch-to-batch variations, poor stability, cumbersome handling, and the relatively high costs strictly limit their use. Recently, a new substrate known as PhenoDrive-Y has been used as 2D coating of tissue culture plastic showing to direct the bone marrow mesenchymal stromal cells (MSCs) toward the formation of 3D spheroids. When organized into 3D spheroids, the MSCs expressed levels of pluripotency markers and of paracrine angiogenic activity higher than those of the MSCs adhering as fibroblast-like colonies on tissue culture plastic. The formation of the spheroids was attributed to the properties of this biomaterial that resemble the main features of the basement membrane by mimicking the mesh structure of collagen IV and by presenting the cells with orderly spaced laminin bioligands. In this study, PhenoDrive-Y was compared to Matrigel for its ability to drive the formation of perivascular stem cell niche-like structures in 2D co-culture conditions of human endothelial cells and adult bone marrow MSCs. Morphological analyses demonstrated that, when compared to Matrigel, PhenoDrive-Y led endothelial cells to sprout into a more consolidated tubular network and that the MSCs nestled as compact spheroids above the anastomotic areas of this network resemble more closely the histological features of the perivascular stem cell niche. A study of the expressions of relevant markers led to the identification of the pathways linking the PhenoDrive-Y biomimicking properties to the acquired histological features, demonstrating the enhanced levels of stemness, renewal potential, predisposition to migration, and paracrine activities of the MSCs.
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Affiliation(s)
- Valeria Perugini
- Centre for Regenerative Medicine and Devices, School of Applied Sciences, University of Brighton, Brighton, United Kingdom
| | - Matteo Santin
- Centre for Regenerative Medicine and Devices, School of Applied Sciences, University of Brighton, Brighton, United Kingdom
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3
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Abdollahiyan P, Oroojalian F, Baradaran B, de la Guardia M, Mokhtarzadeh A. Advanced mechanotherapy: Biotensegrity for governing metastatic tumor cell fate via modulating the extracellular matrix. J Control Release 2021; 335:596-618. [PMID: 34097925 DOI: 10.1016/j.jconrel.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/19/2022]
Abstract
Mechano-transduction is the procedure of mechanical stimulus translation via cells, among substrate shear flow, topography, and stiffness into a biochemical answer. TAZ and YAP are transcriptional coactivators which are recognized as relay proteins that promote mechano-transduction within the Hippo pathway. With regard to healthy cells in homeostasis, mechano-transduction regularly restricts proliferation, and TAZ and YAP are totally inactive. During cancer development a YAP/TAZ - stimulating positive response loop is formed between the growing tumor and the stiffening ECM. As tumor developments, local stromal and cancerous cells take advantage of mechanotransduction to enhance proliferation, induce their migratory into remote tissues, and promote chemotherapeutic resistance. As a newly progresses paradigm, nanoparticle-conjunctions (such as magnetic nanoparticles, and graphene derivatives nanoparticles) hold significant promises for remote regulation of cells and their relevant events at molecular scale. Despite outstanding developments in employing nanoparticles for drug targeting studies, the role of nanoparticles on cellular behaviors (proliferation, migration, and differentiation) has still required more evaluations in the field of mechanotherapy. In this paper, the in-depth contribution of mechano-transduction is discussed during tumor progression, and how these consequences can be evaluated in vitro.
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Affiliation(s)
| | - Fatemeh Oroojalian
- Department of Advanced Sciences and Technologies in Medicine, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran; Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran.
| | - Behzad Baradaran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Miguel de la Guardia
- Department of Analytical Chemistry, University of Valencia, Dr. Moliner 50, 46100 Burjassot, Valencia, Spain
| | - Ahad Mokhtarzadeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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4
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Yazdian Kashani S, Keshavarz Moraveji M, Bonakdar S. Computational and experimental studies of a cell-imprinted-based integrated microfluidic device for biomedical applications. Sci Rep 2021; 11:12130. [PMID: 34108580 PMCID: PMC8190060 DOI: 10.1038/s41598-021-91616-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023] Open
Abstract
It has been proved that cell-imprinted substrates molded from template cells can be used for the re-culture of that cell while preserving its normal behavior or to differentiate the cultured stem cells into the template cell. In this study, a microfluidic device was presented to modify the previous irregular cell-imprinted substrate and increase imprinting efficiency by regular and objective cell culture. First, a cell-imprinted substrate from template cells was prepared using a microfluidic chip in a regular pattern. Another microfluidic chip with the same pattern was then aligned on the cell-imprinted substrate to create a chondrocyte-imprinted-based integrated microfluidic device. Computational fluid dynamics (CFD) simulations were used to obtain suitable conditions for injecting cells into the microfluidic chip before performing experimental evaluations. In this simulation, the effect of input flow rate, number per unit volume, and size of injected cells in two different chip sizes were examined on exerted shear stress and cell trajectories. This numerical simulation was first validated with experiments with cell lines. Finally, chondrocyte was used as template cell to evaluate the chondrogenic differentiation of adipose-derived mesenchymal stem cells (ADSCs) in the chondrocyte-imprinted-based integrated microfluidic device. ADSCs were positioned precisely on the chondrocyte patterns, and without using any chemical growth factor, their fibroblast-like morphology was modified to the spherical morphology of chondrocytes after 14 days of culture. Both immunostaining and gene expression analysis showed improvement in chondrogenic differentiation compared to traditional imprinting methods. This study demonstrated the effectiveness of cell-imprinted-based integrated microfluidic devices for biomedical applications.
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Affiliation(s)
- Sepideh Yazdian Kashani
- Department of Chemical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, 1591634311, Iran
| | - Mostafa Keshavarz Moraveji
- Department of Chemical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, 1591634311, Iran.
| | - Shahin Bonakdar
- National Cell Bank Department, Pasteur Institute of Iran, P.O. Box 13169-43551, Tehran, Iran.
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5
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Yazdian Kashani S, Keshavarz Moraveji M, Taghipoor M, Kowsari-Esfahan R, Hosseini AA, Montazeri L, Dehghan MM, Gholami H, Farzad-Mohajeri S, Mehrjoo M, Majidi M, Renaud P, Bonakdar S. An integrated microfluidic device for stem cell differentiation based on cell-imprinted substrate designed for cartilage regeneration in a rabbit model. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 121:111794. [PMID: 33579444 DOI: 10.1016/j.msec.2020.111794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/30/2020] [Accepted: 12/02/2020] [Indexed: 01/12/2023]
Abstract
Separating cells from the body and cultivating them in vitro will alter the function of cells. Therefore, for optimal cell culture in the laboratory, conditions similar to those of their natural growth should be provided. In previous studies, it has been shown that the use of cellular shape at the culture surface can regulate cellular function. In this work, the efficiency of the imprinting method increased by using microfluidic chip design and fabrication. In this method, first, a cell-imprinted substrate of chondrocytes was made using a microfluidic chip. Afterwards, stem cells were cultured on a cell-imprinted substrate using a second microfluidic chip aligned with the substrate. Therefore, stem cells were precisely placed on the chondrocyte patterns on the substrate and their fibroblast-like morphology was changed to chondrocyte's spherical morphology after 14-days culture in the chip without using any chemical growth factor. After chondrogenic differentiation and in vitro assessments (real-time PCR and immunocytotoxicity), differentiated stem cells were transferred on a collagen-hyaluronic acid scaffold and transplanted in articular cartilage defect of the rabbit. After 6 months, the post-transplantation analysis showed that the articular cartilage defect had been successfully regenerated in differentiated stem cell groups in comparison with the controls. In conclusion, this study showed the potency of the imprinting method for inducing chondrogenicity in stem cells, which can be used in clinical trials due to the safety of the procedure.
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Affiliation(s)
- Sepideh Yazdian Kashani
- Department of Chemical Engineering, Amirkabir University of Technology (Tehran Polytechnic), 1591634311 Tehran, Iran
| | - Mostafa Keshavarz Moraveji
- Department of Chemical Engineering, Amirkabir University of Technology (Tehran Polytechnic), 1591634311 Tehran, Iran.
| | - Mojtaba Taghipoor
- School of Mechanical Engineering, Sharif University of Technology, 11155-9567 Tehran, Iran
| | - Reza Kowsari-Esfahan
- National Cell Bank Department, Pasteur Institute of Iran, P.O. Box 13169-43551, Tehran, Iran
| | | | - Leila Montazeri
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mohammad Mehdi Dehghan
- Institute of Biomedical Research, University of Tehran, Tehran, Iran; Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Hossein Gholami
- Institute of Biomedical Research, University of Tehran, Tehran, Iran
| | - Saeed Farzad-Mohajeri
- Institute of Biomedical Research, University of Tehran, Tehran, Iran; Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Morteza Mehrjoo
- National Cell Bank Department, Pasteur Institute of Iran, P.O. Box 13169-43551, Tehran, Iran
| | - Mohammad Majidi
- National Cell Bank Department, Pasteur Institute of Iran, P.O. Box 13169-43551, Tehran, Iran
| | - Philippe Renaud
- Laboratory of Microsystems (LMIS4), École Polytechnique FÉdÉrale de Lausanne, Station 17, CH-1015 Lausanne, Switzerland
| | - Shahin Bonakdar
- National Cell Bank Department, Pasteur Institute of Iran, P.O. Box 13169-43551, Tehran, Iran.
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6
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Kautz R, Phan L, Arulmoli J, Chatterjee A, Kerr JP, Naeim M, Long J, Allevato A, Leal-Cruz JE, Le L, Derakhshan P, Tombola F, Flanagan LA, Gorodetsky AA. Growth and Spatial Control of Murine Neural Stem Cells on Reflectin Films. ACS Biomater Sci Eng 2020; 6:1311-1320. [PMID: 33455403 PMCID: PMC7833438 DOI: 10.1021/acsbiomaterials.9b00824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023]
Abstract
Stem cells have attracted significant attention due to their regenerative capabilities and their potential for the treatment of disease. Consequently, significant research effort has focused on the development of protein- and polypeptide-based materials as stem cell substrates and scaffolds. Here, we explore the ability of reflectin, a cephalopod structural protein, to support the growth of murine neural stem/progenitor cells (mNSPCs). We observe that the binding, growth, and differentiation of mNSPCs on reflectin films is comparable to that on more established protein-based materials. Moreover, we find that heparin selectively inhibits the adhesion of mNSPCs on reflectin, affording spatial control of cell growth and leading to a >30-fold change in cell density on patterned substrates. The described findings highlight the potential utility of reflectin as a stem cell culture material.
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Affiliation(s)
- Rylan Kautz
- Department
of Chemical Engineering and Materials Science, University of California, Irvine, 916 Engineering Tower, Irvine, California 92697, United States
| | - Long Phan
- Department
of Chemical Engineering and Materials Science, University of California, Irvine, 916 Engineering Tower, Irvine, California 92697, United States
| | - Janahan Arulmoli
- Department
of Biomedical Engineering, University of
California, Irvine, 3120
Natural Sciences II, Irvine, California 92697, United States
- Sue
and Bill Gross Stem Cell Research Center, University of California, Irvine, 845 Health Sciences Road, Irvine, California 92697, United States
| | - Atrouli Chatterjee
- Department
of Chemical Engineering and Materials Science, University of California, Irvine, 916 Engineering Tower, Irvine, California 92697, United States
| | - Justin P. Kerr
- Department
of Mechanical and Aerospace Engineering, University of California, Irvine, 4200 Engineering Gateway Building, Irvine, California 92697, United States
| | - Mahan Naeim
- Department
of Biomedical Engineering, University of
California, Irvine, 3120
Natural Sciences II, Irvine, California 92697, United States
| | - James Long
- Department
of Chemical Engineering and Materials Science, University of California, Irvine, 916 Engineering Tower, Irvine, California 92697, United States
| | - Alex Allevato
- Department
of Chemical Engineering and Materials Science, University of California, Irvine, 916 Engineering Tower, Irvine, California 92697, United States
| | - Jessica E. Leal-Cruz
- Department
of Chemical Engineering and Materials Science, University of California, Irvine, 916 Engineering Tower, Irvine, California 92697, United States
| | - LeAnn Le
- Department
of Chemical Engineering and Materials Science, University of California, Irvine, 916 Engineering Tower, Irvine, California 92697, United States
| | - Parsa Derakhshan
- Department
of Chemical Engineering and Materials Science, University of California, Irvine, 916 Engineering Tower, Irvine, California 92697, United States
| | - Francesco Tombola
- Department
of Physiology and Biophysics, University
of California, Irvine, 825 Health Sciences Road, Irvine, California 92697, United States
| | - Lisa A. Flanagan
- Department
of Biomedical Engineering, University of
California, Irvine, 3120
Natural Sciences II, Irvine, California 92697, United States
- Sue
and Bill Gross Stem Cell Research Center, University of California, Irvine, 845 Health Sciences Road, Irvine, California 92697, United States
- Department
of Neurology, University of California,
Irvine, 200 South Manchester
Avenue, Orange, California 92868, United States
| | - Alon A. Gorodetsky
- Department
of Chemical Engineering and Materials Science, University of California, Irvine, 916 Engineering Tower, Irvine, California 92697, United States
- Department
of Chemistry, University of California,
Irvine, 1102 Natural
Sciences II, Irvine, California 92697, United States
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7
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Vadlamani RA, Nie Y, Detwiler DA, Dhanabal A, Kraft AM, Kuang S, Gavin TP, Garner AL. Nanosecond pulsed electric field induced proliferation and differentiation of osteoblasts and myoblasts. J R Soc Interface 2019; 16:20190079. [PMID: 31213169 DOI: 10.1098/rsif.2019.0079] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Low-intensity electric fields can induce changes in cell differentiation and cytoskeletal stresses that facilitate manipulation of osteoblasts and mesenchymal stem cells; however, the application times (tens of minutes) are of the order of physiological mechanisms, which can complicate treatment consistency. Intense nanosecond pulsed electric fields (nsPEFs) can overcome these challenges by inducing similar stresses on shorter timescales while additionally inducing plasma membrane nanoporation, ion transport and intracellular structure manipulation. This paper shows that treating myoblasts and osteoblasts with five 300 ns PEFs with intensities from 1.5 to 25 kV cm-1 increased proliferation and differentiation. While nsPEFs above 5 kV cm-1 decreased myoblast population growth, 10 and 20 kV cm-1 trains increased myoblast population by approximately fivefold 48 h after exposure when all cell densities were set to the same level after exposure. Three trials of the PEF-treated osteoblasts showed that PEF trains between 2.5 and 10 kV cm-1 induced the greatest population growth compared to the control 48 h after treatment. Trains of nsPEFs between 1.5 and 5 kV cm-1 induced the most nodule formation in osteoblasts, indicating bone formation. These results demonstrate the potential utility for nsPEFs to rapidly modulate stem cells for proliferation and differentiation and motivate future experiments to optimize PEF parameters for in vivo applications.
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Affiliation(s)
- Ram Anand Vadlamani
- 1 School of Nuclear Engineering, Purdue University , West Lafayette, IN 47907 , USA
| | - Yaohui Nie
- 2 Department of Health and Kinesiology, Purdue University , West Lafayette, IN 47907 , USA
| | | | - Agni Dhanabal
- 3 Department of Agricultural and Biological Engineering, Purdue University , West Lafayette, IN 47907 , USA
| | - Alan M Kraft
- 1 School of Nuclear Engineering, Purdue University , West Lafayette, IN 47907 , USA
| | - Shihuan Kuang
- 4 Department of Animal Sciences, Purdue University , West Lafayette, IN 47907 , USA
| | - Timothy P Gavin
- 2 Department of Health and Kinesiology, Purdue University , West Lafayette, IN 47907 , USA
| | - Allen L Garner
- 1 School of Nuclear Engineering, Purdue University , West Lafayette, IN 47907 , USA.,3 Department of Agricultural and Biological Engineering, Purdue University , West Lafayette, IN 47907 , USA.,5 School of Electrical and Computer Engineering, Purdue University , West Lafayette, IN 47907 , USA
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8
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Hay DC, O'Farrelly C. Designer human tissue: coming to a lab near you. Philos Trans R Soc Lond B Biol Sci 2019; 373:rstb.2017.0212. [PMID: 29786548 PMCID: PMC5974436 DOI: 10.1098/rstb.2017.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 11/12/2022] Open
Abstract
Human pluripotent stem cells (PSCs) offer a scalable alternative to primary and transformed human tissue. PSCs include human embryonic stem cells, derived from the inner cell mass of blastocysts unsuitable for human implantation; and induced PSCs, generated by the reprogramming of somatic cells. Both cell types display the ability to self-renew and retain pluripotency, promising an unlimited supply of human somatic cells for biomedical application. A distinct advantage of using PSCs is the ability to select for genetic background, promising personalized modelling of human biology ‘in a dish’ or immune-matched cell-based therapies for the clinic. This special issue will guide the reader through stem cell self-renewal, pluripotency and differentiation. The first articles focus on improving cell fidelity, understanding the innate immune system and the importance of materials chemistry, biofabrication and bioengineering. These are followed by articles that focus on industrial application, commercialization and label-free assessment of tissue formation. The special issue concludes with an article discussing human liver cell-based therapies past, present and future. This article is part of the theme issue ‘Designer human tissue: coming to a lab near you’.
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Affiliation(s)
- David C Hay
- MRC Centre for Regenerative Medicine, University of Edinburgh, 5 Little France Drive, EH16 4UU Edinburgh, UK
| | - Cliona O'Farrelly
- Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse St, Dublin 2, Dublin, Republic of Ireland
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Abstract
Change is an absolute so long as time does not stand still. We should expect it, embrace it, and try to predict its direction. Dermatology, as a specialty practice, has been changing rapidly over the past 30 years concurrent with the changes in medicine. What are these changes, how did they come about, and what may be the consequences? The goal of this review is to follow the march of time, as we move from one era to the other in step with what is happening in the world as a whole and the United States in particular. The growth of our specialty, Dermatology, is divided into 3 eras which are quite different in generational cultures. The first era spanning the 1980s and 1990s is dubbed as "old school." The second era begins with the new century, 2000 until today. This era will forever be remembered as the business era, the rise of elite cultures, and the losses and threats to academia. The third era begins now; it is that of technology which is fast progressing into the future. One can theoretically project what may occur during this technologic revolution and the directions in medicine as a whole. Dermatology can be at the forefront of this era or it could be lost as a whole if we do nothing to keep up. These eras are based on my personal experience as a dermatologist in a large academic institution in the United States and may not apply to other communities or societies elsewhere. The United States serves as a good example of a western technologically oriented society that is often emulated by others.
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Affiliation(s)
- Rokea A El-Azhary
- Department of Dermatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
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