Perspectives on the Use of Mesenchymal Stem Cells in Vascularized Composite Allotransplantation

Abstract

Reconstructive transplantation has emerged as clinical reality over the past decade. Long-term graft acceptance has been feasible in extremity and facial vascularized composite allotransplantation (VCA) under standard immunosuppression. Minimizing overall burden of lifelong immunosuppression is key to wider application of these non-life saving grafts. Allograft tolerance is the holy grail of many cell-based immunomodulatory strategies. Recent protocols using mesenchymal stem cells from bone marrow and adipose tissue offer promise and potential in VCA. This article provides an overview of the experimental basis, the scientific background and clinical applications of stem cell-based therapies in the field of reconstructive allotransplantation.

Vascularized Composite Allotransplant in the Realm of Regenerative Plastic Surgery

“…82,83 In animal models, treatment with bone marrowederived mesenchymal stem cells was found to result in prolonged survival of VCAs, as well as development of stable and high-level chimerism. [84][85][86] The use of bioreactors for ex vivo allograft modulation before transplant has also been proposed to reduce antigenicity and enhance the function of grafts. 87 Compared with SOT, the incidence of chronic rejection has been exceedingly low in VCA, with one case reported for hand transplant and none for face transplant.…”

Composite tissue allotransplantation: opportunities and challenges

“…114 MSC infusion may also impact neural regeneration, with improved clinical and electrophysiological outcomes. [115][116][117] Drug interferences between MSCs and immunosuppressants are also relevant, 118 as rapamycin and tacrolimus antagonize some of the immunomodulatory effects of MSCs. 119 The induction of chimerism in transplant recipients based on Tcell depletion and full body irradiation combined with hematopoietic cell transplantation has shown promising results in a VCA animal model.…”

The Impact of Mesenchymal Stem Cell Source on Proliferation, Differentiation, Immunomodulation and Therapeutic Efficacy

“…Furthermore, when allografts containing multiple types of tissues, termed vascularized composite allotransplant (VCA such as face transplants or limb transplants), were transplanted, MSCs were shown to induce donor-specific tolerance and prolong VCA survival [75][76][77][78][79]. BM-MSCs and AT-MSCs were the two types that were mostly utilized, although they have not yet been compared side-by-side in terms of influencing VCA survival.…”