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4.5 Pulmonary Diseases
Due to their ability to regenerate pneumocytes, remodel the extra cellular matrix
and immune suppressive effects, mesenchymal stem cells have been studied in
treating several pulmonary conditions. Unlike in most organs where more targeted
routes of administration have to be performed to circumvent the first pass effect that
occurs in the pulmonary circulation, simple intravenous infusion can be directly
used in treating pulmonary conditions.
4.5.1 Chronic Obstructive Pulmonary Disease (COPD)
COPD is a chronic inflammatory process affecting the airways, which results in
irreversible alveolar damage and progressive decline of pulmonary function. Due to
their immune-modulatory effects and ability to regenerate type 1 and type 2 pneu-
mocytes, mesenchymal stem cells have been tested in several clinical trials in
patients with COPD. Although some of the preliminary larger studies did not show
significant change in pulmonary function tests or change in quality of life indica-
tors, they showed good safety profiles and reduction in inflammatory markers such
as C-reactive protein at 2 year follow up [ 37 ].
Recent studies however with smaller sample size have shown improvement in
pulmonary function tests as well as improvement in quality of life, thus making this
a promising treatment option for COPD patients [ 38 ].
Other pulmonary conditions where stem cells have been studied include idio-
pathic pulmonary fibrosis and pulmonary hypertension. Endobronchially adminis-
tered adipose derived mesenchymal stem cells studied in Idiopathic pulmonary
fibrosis (IPF) in phase 1 clinical trials have shown good safety, although their clini-
cal efficacy still needs to be determined [ 39 ]. Similarly, mesenchymal stem cells in
animal models have been studied in treating pulmonary arterial hypertension as well
[ 40 ]. Further studies are needed to extrapolate this data to human subjects.
4.6 Cardiovascular Diseases
Due to their ability to differentiate into cardiomyocytes and endothelial cells, mes-
enchymal stem cells have been shown to be useful in regenerating diseased myocar-
dium as well in promoting angiogenesis (Fig. 4.7). Several routes of administration
of these cells including intra myocardial and intracoronary have been described in
the literature.
In a study published in 2004, 69 patients with acute myocardial infarction who
were treated with intra coronary mesenchymal stem cells within 12 h after present-
ing showed significant decrease in ischemic extent at 3 months and improvement in
R. Ram et al.