The idea of being able to replace, restore or regenerate damaged or diseased tissues and organs in order to establish normal function in the human body has never been so prominent and possible than with the development of the field of regenerative medicine. Utilizing material from the body or activating the body's own repair mechanisms to prepare and grow or heal irreparable tissues or organs is now a real possibility as demonstrated by research and clinical studies published over the last 10 years. Born from the collaboration of several biomedical disciplines and clinical approaches, regenerative medicine promises the real possibility of not only replacing pharmaceutical solutions to disease but also paves the road to a more autologous and holistic approach in clinical treatment of disease and disease control.1 Historically, the foundation of regenerative medicine was cemented with the successful transplantation of corneas, soft tissue and bone in the early 20th century, the first kidney transplantation in 1954 followed by pancreas, liver and heart transplants in the 1960's and continued success in the 1980's with heart-lung and living donor liver and lung transplants. Progressively, an increase in demand for tissues and organs and subsequent decrease in organ availability has left a need for new technology to meet the demand for suitable organs and organ donors as well as leading to an increase in the disgraceful enterprise of black market organs. Currently, tissue-engineered skin used for burn victims and diabetic ulcers, products derived from tissue-engineering to induce bone growth and regeneration as well as the autologous reintroduction of ex-vivo engineered bladder is a reality, once again establishing a firm foothold for the development of further and more advanced applications for regenerative medicine.2
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The discovery of stem cells by the Russian histologist Alexander Maksimov in 1908, as part of his theory of hematopoiesis followed by the presentation of scientific proof of constant stem cell activity in the brain by Joseph Altman and Gopal Das in the 1960's and the demonstration of self-renewing cells found in the bone marrow of mice by James E. Till and Ernest A. McCulloch in 1963 established stem cell research and the development of stem cell therapy as a new and very promising and exciting discipline for regenerative medicine. Embryonic and adult stem cells are available from a variety of sources, holds variable differentiation potential not to speak of the myriad of potential therapeutic applications albeit associated with some ethical and political concerns. Mammalian stem cells can be sourced from either the embryo or the adult organism.3 Embryonic stem cells originate from the inner cell mass of blastocysts while adult stem and progenitor cells can be found in various tissues repairing or replenishing adult tissue. Of specific interest and application in regenerative medicine are autologous adult stem cells accessible from bone marrow, adipose tissue or blood. Contemporary stem cell therapy include bone marrow transplants for the treatment of leukemia while extensive current research is undertaken for the implementation of stem cell therapy for the treatment of cancer, spinal cord injuries, Parkinson's disease as well as multiple sclerosis and muscle conditions including heart disease. Vascular grafts for heart bypass surgery and cardiovascular disease treatment are at the pre-clinical trial stage.4 Advances in therapeutic applications do not come without much debate and controversy surrounding risks associated with it. The risk that transplanted stem cells could form tumors and metastasize uncontrollably is but one of the concerns of stem cell therapy. Inducing forced expression of specific genes in order to derive pluripotent stem cells from non-pluripotent cells generate the so-called induced pluripotent stem cell (iPSC). Reprogramming of adult cells to obtain iPSCs may pose significant risks that could limit their use in humans. The use of viruses to genomically alter the cells may lead to the expression of cancer-causing oncogenes.5, 6
Low level laser therapy has been scientifically proved as a beneficial therapeutic modality for numerous diseases and diseased conditions. Using very specific laser and light emitting diode irradiation parameters, specific cellular activities can be induced viz. cellular proliferation and viability while stimulating mitochondrial activity thereby increasing adenosine-triphosphate (ATP) production, synthesis of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) and activating cell signaling cascades including the production of reactive oxygen species, nitric oxide (NO) release, activating cytochrome c oxidase and modifying intracellular organelle membrane activity, calcium flux and expression of stress proteins.7, 8, 9, 10 The molecular mechanism underlying these cellular activities are less well understood and several research groups are conducting intensive research studies in an effort to elucidate the relation between these biological effects. Far more well established is the clinical effects and benefits that low level laser therapy introduces in the diseased conditions. Reduction of pain, anti-inflammatory effects, wound healing and significant application of low level laser therapy in the field of dentistry is but a few of the clinical applications. However, it is the cellular effect of increasing proliferation and viability that may significantly contribute to the addition of low level laser therapy to the many biomedical disciplines that further augments the successes of regenerative medicine. Low intensity laser irradiation has been shown to induce stem cell activity by increasing migration, proliferation and viability, activate protein expression and induce differentiation in progenitor cells.11, 12 With the addition of particular growth factors, stem cells can be differentiated into a particular cell type that could be used in tissue engineering and regenerative therapies, particularly autologous grafting.13 Ideally, stem cells for potential use in regenerative medicine should meet the following criteria: (i) ought to be found in abundant quantities; (ii) can be differentiated along multiple lineages in a reproducible manner; (iii) can be collected and harvested in a minimally invasive procedure; (iv) can be effectively and safely transplanted to either an allogenic or autologous host.14, 15
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By providing healthy, functional tissues and organs, regenerative medicine will improve the quality of life for individuals. By introducing autologous stem cell therapy in combination with regenerative medicine, the spectrum of treatment options will increase largely resulting in improving the audience of deserving people and, finally, by combining regenerative medicine, stem cell therapy and low level laser therapy, the numbers and patients will increase, the applications will expand and so the quality of life of millions of people may be improved. The long term promise of regenerative medicine to transform the treatment of human disease through the development of innovative new therapies such as stem cell and low level laser therapy that offer faster, complete recovery and reducing the risks of donor organ transplantation rejection through autologous grafts seem harder to believe than what it is possible. Regenerative medicine empowers scientists to grow tissues and organs in the laboratory and safely implant them when the body cannot heal itself. Importantly, regenerative medicine combined with stem cell therapy have the potential to solve the problem of the shortage of organs available for donation compared to the number of patients that require life-saving organ transplantation while eliminating organ transplant rejection if the organ's cells are derived from the patient's own tissue or cells. Revitalizing or replacing worn out body parts in a "made to order" fashion may well be orchestrated in the not so distant future with the use of regenerative stem cell laser therapy.