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ARTÍCULOS DE REVISIÓN 229 En el campo de la medicina intensiva, además de la modulación del SIRS, se ha identificado un efecto paracrino antimicrobiano que hace atractiva la infusión de MSC como sinergia a la terapia antibiótica. El mayor desafío es demostrar ahora el beneficio de la terapia celular en modelos clínicos. Por primera vez el conocimiento acumulado en ciencias básicas está siendo transferido a ensayos en humanos en sepsis, SDRA e IRA. De comprobarse su beneficio, las MSC podrían representar una alternativa terapéutica real en el paciente crítico con una sepsis o un SDRA refractarios a las medidas convencionales, así como para otros pacientes con enfermedades inflamatorias o auto-inmunes resistentes a la terapia inmunosupresora convencional. Referencias 1. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307 (23): 2526-33. 2. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014; 311 (13): 1308-16. 3. Friedenstein AJ, Petrakova KV, Kurolesova AI, Frolova GP. Heterotopic of bone marrow. Analysis of precursor cells for osteogenic and hematopoietic tissues. Transplantation 1968; 6 (2): 230-47. 4. Friedenstein AJ, Chailakhyan RK, Latsinik NV, Panasyuk AF, Keiliss-Borok IV. Stromal cells responsible for transferring the microenvironment of the hemopoietic tissues. Cloning in vitro and retransplantation in vivo. Transplantation 1974; 17 (4): 331-40. 5. Owen M, Friedenstein AJ. Stromal stem cells: marrow derived osteogenic precursors. Ciba Found Symp 1988; 136: 42-60. 6. Caplan AI, Bruder SP. Mesenchymal stem cells: building blocks for molecular medicine in the 21st century. Trends Mol Med 2001; 7 (6): 259-64. 7. Hermann A, List C, Habisch HJ, Vukicevic V, Ehrhart Bornstein M, Brenner R, et al. Age-dependent neuroectodermal differentiation capacity of human mesenchymal stromal cells: limitations for autologous cell replacement strategies. Cytotherapy 2010; 12 (1): 17-30. 8. Cho KA, Ju SY, Cho SJ, Jung YJ, Woo SY, Seoh JY, et al. Mesenchymal stem cells showed the highest potential for the regeneration of injured liver tissue compared with other subpopulations of the bone marrow. Cell Biol Int 2009; 33 (7): 772-7. 9. Dominici M, Le Blanc K, Mueller I, Slaper-Cortenbach I, Marini F, Krause D, et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy 2006; 8 (4): 315-7. 10. Pittenger MF, Mackay AM, Beck SC, Jaiswal RK, Douglas R, Mosca JD, et al. Multilineage potential of adult human mesenchymal stem cells. Science 1999; 284 (5411): 143-7. 11. Mosna F, Sensebé L, Krampera M. Human bone marrow and adipose tissue mesenchymal stem cells: a user's guide. Stem Cells Dev 2010; 19 (10): 1449-70. 12. In 't Anker PS, Scherjon SA, Kleijburg-van der Keur C, de Groot-Swings GM, Claas FH, Fibbe WE, et al. Isolation of mesenchymal stem cells of fetal or maternal origin from human placenta. Stem cells 2004; 22 (7): 1338-45. 13. Mitrano TI, Grob MS, Carrion F, Nova-Lamperti E, Luz PA, Fierro FS, et al. Culture and characterization of mesenchymal stem cells from human gingival tissue. J Periodontol 2010; 81 (6): 917-25. 14. Chan RW, Schwab KE, Gargett CE. Clonogenicity of human endometrial epithelial and stromal cells. Biol Reprod 2004; 8 (6): 1738-50. 15. Prockop DJ, Gregory CA, Spees JL. One strategy for cell and gene therapy: harnessing the power of adult stem cells to repair tissues. Proc Natl Acad Sci USA 2003; 100 (S1): 11917-23. 16. Franquesa M, Hoogduijn MJ, Reinders ME, Eggenhofer E, Engela AU, Mensah FK, et al. Mesenchymal Stem Cells in Solid Organ Transplantation (MiSOT) Fourth Meeting: lessons learned from first clinical trials. Transplantation 2013; 96 (3): 234-8. 17. Le Blanc K, Ringden O. Immunomodulation by mesenchymal stem cells and clinical experience. J Intern Med 2007; 262 (5): 509-25. 18. Yagi H, Soto-Gutiérrez A, Parekkadan B, Kitagawa Y, Tompkins RG, Kobayashi N, et al. Mesenchymal stem cells: Mechanisms of immunomodulation and homing. Cell Transplant 2010; 19 (6): 667-79. 19. Luz-Crawford P, Kurte M, Bravo-Alegría J, Contreras R, Nova-Lamperti E, Tejedor G, et al. Mesenchymal stem cells generate a CD4+CD25+Foxp3+ regulatory T cell population during the differentiation process of Th1 and Th17 cells. Stem Cell Res Ther 2013; 4 (3): 65. 20. Meirelles Lda S, Fontes AM, Covas DT, Caplan AI. Mechanisms involved in the therapeutic properties of Terapia celular en medicina intensiva - F. Espinoza et al Rev Med Chile 2016; 144: 222-231


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