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Neural stem cells for brain and spinal cord repair
  1. G Raisman

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    Edited by Tanja Zigova, Evan Y Snyder, and Paul R Sanberg. Published by The Humana Press, Totowa, 2002, pp 425, US$149.50. ISBN 0-58829-003-4

    For scientists, clinicians, patients, and the biotech industry, transplantation of stem cells has become one of the major hopes for repair of what are currently incurable degenerative diseases and trauma to the brain and spinal cord. The 16 contributions contained in Neural stem cells for brain and spinal cord repair deal with these questions. They provide a needed, very handy, and comprehensive review, defining the current state of knowledge in this rapidly moving area.

    The contributions cover the many possible sources of stem cells, embryo, and adult, including brain, neurospheres, neural crest, bone marrow, and already established human stem cell lines such as human neuroteratocarcinoma cells. Several chapters summarise the current methods for obtaining the various types of stem cells, the signalling pathways in differentiation, and the degree to which it is known that stem cells are able or can be induced by appropriate growth factors to adopt or turn into the differentiated cell types that would be needed for functional replacement in damaged tissues.

    A number of contributions deal with practical applications, such as the possibility of glial cell precursors being used for treatment of demyelinating diseases, the use of stem cells to boost a failing host dopaminergic system in Parkinson’s disease, and the concept of global replacement by genetically modified cells able to replace enzymes non-functional because of inherited genetic defects. Particularly interesting are the provocative observations (Magavi and Macklis) that transplanted stem cells are able to “detect” defects at a distance, and migrate through the host brain to repair damaged areas. A number of chapters consider the issue of stem cells for spinal cord injury and the questions of the relative contributions of local cell damage versus axonal disconnection.

    Over the past few years stem cells have become something of a Holy Grail. The concept of a stem cell is one that can divide indefinitely, that will, like the genie of the lamp, become whatever the master requires, and that can be transplanted to repair virtually any affliction of the nervous system. It is, therefore, a sobering thought that although the haematopoietic stem cell has been identified and characterised for 40 years, and is readily available, many forms of leukaemia and radiation sickness can still be incurable. If we are still uncertain how to obtain beneficial effects with a tissue such as blood, which has no structural organisation, how much greater are the problems we must expect to encounter in the brain and spinal cord, the most complex tissue known in biology?

    There is a gold rush feel to the stem cell area, and many of the claims currently being staked owe as much to hope as to practicality. Many basic questions remain to be solved. What range of cell types does the term stem cell include? How can we direct their development so that they become specific cell types? And, having done so, how can they be introduced into the nervous system in such a way that they will integrate themselves, detect deficiencies, and repair them? And to what extent do we have a clear concept of the dangers in using stem cells? But notwithstanding these unsolved issues, the concept that there exist, not only within the embryo, but also within the adult, cells with as yet uncharted reparative potential offers real hope for a new way to treat injuries and diseases for which there is currently no cure.

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