A comprehensive presentation on Clinical Application of Stem Cell

1. APLIKASI KLINIS SEL
PUNCA

2. Differentiation Human Stem Cells

3. Trans-differentiation

4. Why Stem Cells ?
 By definition, a stem cell is
characterized by its ability to self-
renew and its ability to trans
differentiate along multiple lineage
pathways.

5. Self-renewal of stem cells
Asymmetric cell division
Symmetric cell division
Morrison & Kimble 2006

6. Self-renewal of stem cells
 Asymmetric cell division : to maintain the
stem cell number
A. Intrinsic asymmetric cell division
B. Extrinsic (Eviromental) asymetric cell
devision
Morrison & Kimble 2006

7. Intrinsic asymmetric cell division
 One stem cell divides into two daughter cells,
which are different from each other.
 One of daughter cells is similar to the parental
cell and
 The other daughter cell becomes progenitor
cell, which will eventually differentiate into
tissue committed resident cell.

9. Symmetric cell division
Daughter cells

10. Stem cells NICHE
 The microenvironment in which stem cells
are found.
 The microenvironment interacts with
stem cells to regulate stem cell fate.
 Various niche factors act on stem cells to
alter their gene expression, and induce their
proliferation or differentiation.

11. Stem Cells NICHE
Niche factors include:
 1. cell-cell interactions between stem cells,
 2. interactions between stem cells and neighboring
differentiated cells,
 3. interactions between stem cells and extra-
cellular matrix components, adhesion
molecules,growth factors, cytokines and
physiochemical nature of the microenvironment.
 4. Niche has both anatomic and functional
dimensions.

13. Regenerative medicinal applications should
meet the following criteria:
 Can be found in abundant quantities
(millions to billions of cells)
 Can be harvested by a minimally invasive
procedure
 Can be differentiated along multiple cell
lineage pathways in a regulatable and
reproducible manner.
 Can be safely and effectively transplanted
to either an autologous or allogeneic host

15. Overview of Healing response after injury

16. Goal of The Wound Healing
Reconstruction of :
 Original Architecture
 Function of the injured tissue.
(Cotran et.al. 1999., Majno & Joris 2004)

17. Tissue Wound Healing
 Repair
 Regeneration
(Majno & Joris 2004, Kumar et al. 2009)

18. Tissue Repair
 Replacement of injured tissue
by different tissue, usually
by fibrosis or scar
(Kumar et al. 2009, Majno & Joris 2004)

19. Tissue Regeneration
 Replacement of injured tissue
by the same resident cells, or
by differentiation of
progenitor/stem cells into
tissue committed cells.
(Kumar et al. 2009, Majno & Joris 2004)

21. PERANAN BERBAGAI KOMPONEN PADA “NICHE” JARINGAN KULIT
(Copyright © 2012 VictorW.Wong et al.)

22. Stem Cells Transplantation
 Autologous
 Allogeneic : from individuals belonging to
the same species but genetically dissimilar
(and hence immunologiccally
incmpatible)
 Syngeneic : between geneticcally identical
individual (tween)
 Xenogeneic : From individuals of different
species (hence of disparate cell type)

23. Adult (Somatic) Stem Cells
Hematopoietic stem cells (HSC)
Mesenchymal stem cells (MSC)
Endothelial progenitor cells (EPC)
Neural stem cells
Hepatic stem cells
etc.
Adipocyte Stem Cells

25. Why Adipocyte Tissue ?

26. Bone marrow harvest (2)

27. Flow Chart Elucidating possible commitment,
lineage progression and maturation ADMSCs
from Aldeman D., Alexander ,R.W.,PPM : Oct 2011

28. Hasil lemak dari liposuction

29. pellet

30. Adipocyte after 24 hours Adipocyte after 24 hours
ADSC pasage 1 : hari ke 3

31. A. ADSCs hari ke 7 dan B. ADSC hari ke 14
A B
by dr Indah Yulianto – dr. Yuyun Rindiastuti

32. Alopecia Universalis : 1 month after MChSc and
Product (AAPE)

33. Alopecia Universalis :1 month after MCSc
+ Product MSCc
By Indah Yulianto

34. After 2 Months

35. After :2 Months
By Indah Yulianto

36. After 4 months

39. EPC : Primer Culture
80% 100%
Courtesy by : Yuyun, Wiwied & Yenni

40. SECRETOME FROM HUVEC (HUMAN UMBILICAL
VEIN ENDOTHELIAL CELLS) from patient Alopecia
Areata for more than 10 years.

41. Secretome from HUVEC

42. Homing and Trafficking Mesenchymal
Stromal cells to sites tissue injury after
infusion

43. Neuroischemic lesion of fifth metatarsal with
application : EPC & amnion membrane (2 months)
Courtesy : By Indah Yulianto, &Yuyun Rindiastuti

44. Female patient (64 years old) with
Basaloma in her left cheek

45. Preparing Secretome from Wharton Jelly

46. BASALIOMA
(Surgery + Secretome fetal Endothelial progenitor
Cells / EPC)

51. Peeling the amniotic membrane from
the placenta
(Once again using Hypoxia methode)
Figure 1: Processing of amniotic membrane.

52. Preparation of the amniotic membrane
Amniotic membrane in its and the wound dressing interface before
preserving fluid placement of a wound dressing.

53. No healing ulcer (1 month) post op-
Squamous Cell Carcinoma Surgery in
Head (Male, 84 yr)
Placing AMNION

54. Wound Regeneration
after 2 Surgeried : SCC and
UNSECCESSFUL Dermagraft
Healing Process with renewal
damage tissue

55. AMNIOTIC MEMBRANE DRESSING
PROMOTES EPITHELISATION &
GRAANULATION + INJ EPC
1.5 MONTH AFTER

56. CLI – post Amputation
EPC + Amnion membrane

57. What kind of Stem cells that we Need ?

60. (3) Scar acne pasca skin needling + product &
(4) 1 week after skin needling + MCSs +_ Product
3
4

61. Acne Papulo Pustular + Scar
Courtesy by dr Titik Moertolo

62. Acne Scar & Box scar 1 week post Dermaroller

63. 2 weeks after Skin Needling +
Acne Scar before (Box Scar)
MShCs
Courtesy by dr Titik Moertolo

64. Infant 2 weeks, with fistula supra ani

65. Tissue regeneration after 1 week using MshCs
Product - Cream
BY Indah Yulianto

66. One week after
Fistula – Before
Therapy
1 Year after – no Scar

67. Leprosy after 30 years + 3
3 weeks after MSCs
months burning ulcer +
Infection Product Injections +
Cream
BY Indah Yulianto

68. Male 23 yr, Combutio more than 5 months :
Injections and Topical :
HUVECs (Spheroid and Hypoxia)
25-Jan-13 68

69. Luka bakar + infeksi 5 bulan intra kutan produk MShCs
y.l.
regenerasi
Hari ke 15 : penyembuhan 75% tanpa
Pengolesan Krem + Produk MShCs Cicatriks ataupun Retraksi persendian

70. Starting to heal and without scar
after 2 months
25-Jan-13 70

71. ACNE CONGLOBATA and Scar : USING
‘HUVEC’

72. AUTISM AND PARAPLEGIA (FEMALE
CHILD – 4 YEARS : USING HUVEC : 2
TIMES)

73. Multiple sclerosis , Asthma Bronchiale, Parkinson
and Ventricle heart disease

74. Terimakasih atas perhatiannya
25-Jan-13 74