Dr. Kenneth Dickie from Royal Centre of Plastic Surgery in Barrie, Ontario explained the use of stem cells technology in plastic surgery. If you have any questions, please contact Dr. Kenneth Dickie at http://royalcentreofplasticsurgery.com/

1. Stem Cells and Plastic Surgery
Dr. Kenneth Dickie
Royal Centre of Plastic Surgery

2. Stem cell Plasticity and Cloning
Why are these topics suddenly so prevalent?
What are key issues relating to stem cell use in
Medicine

3. Mature
Tissues
Stem Cell
How are stem cellsHow are stem cells
defined?defined?
Differentiation and Commitment
1) Self-renewal
Multi-potential
Highly proliferative

4. Key Issues:
• There are many different types of stem cells-an important
distinction: Embryonic vs. Adult
• Embryonic stem cells are derived from an egg shortly after it
begins to grow, and are totipotent-able to generate any tissue
in the body
• Adult stem cells are found in many different tissues in the
body, and appear to have more restricted and specialized
functions

5. Key Issues:
• New research in the field of “stem cell plasticity” has
suggested that adult stem cells may have greater
regenerative potential than was previously suspected

6. Embryonic
stem cells:
Isolated from
human tissue
(1998)

7. Derivation of Embryonic Stem Cells
Totipotent ES Cells
The generation of federally approved human ES cell lines was all done in
test tubes from eggs collected from human donors, salvaged from cryobanks.

8. The National Bioethics Advisory Commission recommended only
using human ova left over from in vitro fertilization procedures.
It was from these otherwise discarded cells that the 64 human ES
cell lines were generated which were ultimately approved by the
Bush Administration.
From these lines, only 8 are dividing continually and are available
for use in the investigation into their potential to be used in
regenerative medicine
(not currently studied at Wash U).
It is not known yet if they will be better, be able to repair more
tissues, or live longer than stem cells from adult sources. More
comparisons are needed.

9. • Federally approved stem cell lines are derived from discarded eggs from
fertility clinics.

10. Will human cloning be used to create new people?Will human cloning be used to create new people?
Cloning human stem cells
is being
Studied to learn how to
regenerate
a patient’s own damaged
NO!

11. Combining cloning with the use ofCombining cloning with the use of
embryonic stem cellsembryonic stem cells
Egg Cell
Healthy Adult Cell: nuclear material
“matches” the patients; no rejection
Generate human
Embryonic stem cells
without using sperm
Spinal cord
injured
patient
Regenerative
Therapy

12. Nuclear transfer is done with a finely drawn glass pipette. Nuclei are shown
in the pipette, ready to be injected into the recipient egg.

14. Do we have to interfere with human development?
Stem cells also exist in many adult tissues
Embryonic Stem cells

15. Adult Stem Cells found i
Bone marro
Bra
Liv
Pancre
Sk
Musc
Intesti
&
other orga
Embryonic stem
cells: Isolated
from human
eggs after in
vitro
fertilization OR
donation of
nuclear material
from an already
differentiated
adult cell
(cloning)

16. Characteristics of Adult Stem Cells
• Found in discreet anatomical sites in many major
organ systems
• Typically, restricted in potential to the organ of
residence (i.e. brain stem cells only make brain
tissue, marrow stem cells make blood, etc.)
• In many cases, most readily evident as a reservoir
of tissue for repair functions.
• Some studies have SUGGESTED that adult stem
cells may be able to contribute to the repair of
liver, brain, muscle, and other tissues.

17. Adult stem cells exist for many different human organs - can
they serve as an alternative to embryonic stem cells?
Current use of adult stem cells:
• Bone marrow transplantation
Potential uses of adult stem cells:
• Brain and spinal cord injury and disease.
• Repair of heart tissue.
• Regeneration of liver tissue.
• Diabetes therapy - pancreas repair.
• Repair of muscle, blood vessels, and skin
(potential therapies for burn victims)
• And many other possibilities……..

18. HSCBLOOD
VASCULAR STEM CELLS
HEPATIC STEM CELLS
MUSCLE
STEM
CELLS
NEURAL STEM CELLS
MESENCHYMAL
STEM CELLS
FAT
CARTILAGE
MUSCLE
CARDIAC
AND
SKELETAL
BONE
FIBRO-
BLAST
NEURONS
WHOLE
MOUSE
LIVER
?
?

19. MESENCHYMAL
STEM CELLS
FAT
CARTILAGE
MUSCLE
CARDIAC
AND
SKELETAL
BONE
FIBRO-
BLAST
NEURONS
??
??
Phenotype of the most primitive MSC populations?Phenotype of the most primitive MSC populations?
Trafficking properties in vivo? In response to injury?Trafficking properties in vivo? In response to injury?
BoneBone
marrowmarrow
AdiposeAdipose
TissueTissue

20. Adipose-derived
mesenchymal stem
cell (AMSC)
Fat
Bone Cartilage
Muscle

21. Generation of Adipose-derived MSC (AMSC)
Isolation procedure:
• Take a bucket to the OR; collect fat excised during
liposuction (LA) or gastric bypass (St Louis)
• Dissect away visible vessels and mince
• Collagenase digest and separate by density centrifugation
• +/- HSC removal
• Defined initially by plastic adherence and rapid growth in
minimal mediuum
• Easily transduced and very proliferative
• Collaborators: De Ugarte and Hedrick: UCLA
Chris Eagon, Wash U. St Louis

22. Neo-organoid (new tissue) created from
adipose – derived adult stem cells seeded
onto a biodegradable matrix
• The tissue was created by
implanting human AMSC on the
matrix into a laboratory strain of
mice that have no immune system.
It is the size of a dime.
• Matrix is very well tolerated, non-
immunogenic, and permissive for
neo-vascularization and systemic
protein delivery.
• These organoids are currently
being used to deliver therapeutic
drugs and proteins such as clotting
factors needed in hemophiliacs,
and their potential to form specific
tissues such as a new pancreas for
diabetic patients.

24. Adipose Derived Stem Cells
• Recent research has shown that stem cells from fat
have the ability to regenerate nerve tissue, strengthen
damaged heart tissue, heal intestinal fistulas in
Crohn’s Disease, and may be able to be used as a
building block to cosmetically enhance the female
breast.

25. Adipose derived stem cells
• Clinical evidence that traumatic scars can be eliminated
following stem cell grafting into the scarred region
• If cutaneous scars can be recognized, and eliminated by
stem cells, the same should be true for cutaneous tumors
such as Basal Cell carcinoma, Squamous Cell carcinoma,
and Malignant Melanoma.

26. There are more urgent needs for stem cells:

27. Stem Cells and Autogenous Skin Grafts

28. Skin Grafting of Burn Wounds

29. Post burn mortality and morbidity:
What if fat from every burn patient could be immediately
harvested at the time of admission, and sent to the tissue lab
for isolation and growth of the patients stem cells.
Under the appropriate chemical stimulation, autogenous skin
would be available for skin grafting by the time the patients
burns have been stabilized.

30. Post Burn Mortality and Morbidity:
• Cord blood banked stem cells due not possess immune
competence, thus , tissue banks could continue to grow, and
store tissues of varying types (bone, cartilage, fascia, tendon,
skin) which would be immediately available for treatment of
deformities which are either post traumatic, or post tumor
resection-where immediate reconstruction is mandatory.

31. Bone Regeneration: Mesenchymal stem cells (MSC)
MSCs repair large gaps in
bones in 32 weeks
No evidence of immune
rejection following implantation
of MSC from an unrelated
donor
Phase 2 clinical trials for
large cranio-facial and long
bone defects began in 2002
in Europe and US
Phase 2 clinical trials for
large cranio-facial and long
bone defects began in 2002
in Europe and US

32. Control MSC treated
MSCs protect cartilage and bone
Phase 1 clinical trial
began in 2002 in
Europe and US
Phase 1 clinical trial
began in 2002 in
Europe and US
Meniscal Repair - Cartilage Protection
Complete menisectomy Partial menisectomy
goat model

33. •Experimental data suggests that
adipose derived stem cells have the
ability to lodge in a variety of tissue
types following a variety of routes of
administration
•In models of acute local injury ,
these cells appear to preferentially
home to, or accumulate in, the
damaged tissue
•The mechanism of recruitment of
adult stem cells to sites of injury or
disease is a cell-mediated response

34. What is the Physicians responsibility?
• When medical breakthroughs have the potential to improve
the mental, social or physical wellbeing of our patients, we as
physicians , should exert our influence and knowledge such
that these breakthroughs do not linger in “no mans land”
while the politics are still being debated.

35. If you have any questions, feel free to contact Dr.
Kenneth Dickie at royalcentreofplasticsurgery.com
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