State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
Stem Cell Rev Rep. 2021 Aug;17(4):1251-1263. doi: 10.1007/s12015-020-10117-3. Epub 2021 Jan 18.
Deep caries, trauma, and severe periodontitis result in pulpitis, pulp necrosis, and eventually pulp loss. However, no clinical therapy can regenerate lost pulp. A novel pulp regeneration strategy for clinical application is urgently needed. Signaling transduction plays an essential role in regulating the regenerative potentials of dental stem cells. Cytokines or growth factors, such as stromal cell-derived factor (SDF), fibroblast growth factor (FGF), bone morphogenetic protein (BMP), vascular endothelial growth factor (VEGF), WNT, can promote the migration, proliferation, odontogenic differentiation, pro-angiogenesis, and pro-neurogenesis potentials of dental stem cells respectively. Using the methods of signaling modulation including growth factors delivery, genetic modification, and physical stimulation has been applied in multiple preclinical studies of pulp regeneration based on cell transplantation or cell homing. Transplanting dental stem cells and growth factors encapsulated into scaffold regenerated vascularized pulp-like tissue in the root canal. Also, injecting a flowable scaffold only with chemokines recruited endogenous stem/progenitor cells for pulp regeneration. Notably, dental pulp regeneration has gradually developed into the clinical phase. These findings enlightened us on a novel strategy for structural and functional pulp regeneration through elaborate modulation of signaling transduction spatially and temporally via clinically applicable growth factors delivery. But challenges, such as the adverse effects of unphysiological signaling activation, the controlled drug release system, and the safety of gene modulation, are necessary to be tested in future works for promoting the clinical translation of pulp regeneration.
深龋、外伤和重度牙周炎可导致牙髓炎、牙髓坏死,最终导致牙髓丧失。然而,目前没有任何临床治疗方法可以再生失去的牙髓。因此,迫切需要一种新的牙髓再生策略用于临床应用。信号转导在调节牙髓干细胞的再生潜能方面起着至关重要的作用。细胞因子或生长因子,如基质细胞衍生因子(SDF)、成纤维细胞生长因子(FGF)、骨形态发生蛋白(BMP)、血管内皮生长因子(VEGF)、WNT 等,可以分别促进牙髓干细胞的迁移、增殖、成牙分化、促血管生成和促神经生成潜能。信号调制方法包括生长因子的递送、基因修饰和物理刺激等,已应用于基于细胞移植或细胞归巢的牙髓再生的多项临床前研究中。将牙源性干细胞和包裹在支架中的生长因子移植到根管内可生成血管化牙髓样组织。此外,仅注射可流动的支架,利用趋化因子募集内源性干细胞/祖细胞也可用于牙髓再生。值得注意的是,牙髓再生已逐渐进入临床阶段。这些发现为我们提供了一种新的策略,通过在时空上精细地调节信号转导,通过临床应用的生长因子递送来实现结构和功能牙髓的再生。但是,未来的工作还需要测试一些挑战,如非生理信号激活的不良反应、可控药物释放系统和基因调控的安全性等,以促进牙髓再生的临床转化。
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