Stem cellTherapy for

Xerostomia

Srija. Ch

SALIVAIt helps to speak , swallow , masticate , taste food and maintain healthy oral cavity.

In a healthy individual, production of saliva is 0.75-1.5 liters/ day (approx.)

3

MA

JOR

GLA

ND

SPAROTID

SUBMANDIBULAR

SUBLINGUAL

SALIVARY GLANDS

• There are 800-1000 minor salivary glands

• In oral cavity, 70% of saliva – Submandibular 5% - Sublingual• From ectoderm – Parotid• From Endoderm – Submandibular and

Sublingual

65-75%20%

7-8 %<10 %

Contribution of salivaSubmandibular gland Parotid glandSublingual gland Minor

The 3 main type

of cells

• Serous producing acinar cells:

• Pyradmidal morphology and are joined to form spheroidal shapes. • Mucous producing

acinar cells:• Cuboidal in shape

and are grouped together to form tubules.

• Myoepithelial cells:• Located near the

ductal openings and contracts the ducts for secretion

•Xerostomia is the subjective feeling of oral dryness, which is often associated with hypofunction of the salivary glands.• It may be associated with a change in the composition of saliva, or reduced salivary flow (hyposalivation).•Also known as:

- Cotton mouth - Des (desert like)

- Drough mouth

XEROSTOMIA

CAUSES

1. IATROGENIC ORIGIN ( Radiation therapy for head and neck cancers )

2. Developmental origin ( Salivary gland aplasia )3. Water / metabolite loss ( impaired intake, haemorrhage, diarrhoea, vomiting )4. Local factors ( smoking, mouth breathing )5. Systemic diseases • HIV• DM and DI• HEP-C6. Side effects of medications ( Diazepam, Atropine )

TREATMENT

1. Chew sugar free gum

2. Limit you caffeine intake

3. Don’t use mouth washes that contain Alcohol

4. Stop all tobacco use

5. Sip water regularly

6. Saliva substitutes

7. Avoid mouth breathing

8. Avoid excess use of anti-histamines and decongestants

9. Stem cell therapy

STEM CELLS

PROPERTIES 1. Self renewal 2. Potency

STEM CELL THERAPYUse of stem cells to treat or prevent a disease

or condition.

STEM CELL THERAPY

There are different sources of stem cells Rodent SSPCSs :o Isolated cells were culturedo 7th day – growth factorso expression of ductal, acinar and myoepitheilial cells.o salispheres with proliferating cells are seen.o 70% recovery

Salivary gland- derived stem cells:

Isolated from parotid or submandibular or a combination of both.

They display MSC like characteristics

After 60 days - twice when compared to the untreated ones.

Acinar cell surface area

They are multipotent stem cells capable of differentiating into many types of cells.

They have a high potential to repair damaged tissues and low immunogenicity.

Both for in vivo and in vitro as well as clinical treatment of various diseases.

Mesenchymal stem cells

Mesenchymal stem cell implantation

•The intravenous injection of MSCs reduced lymphocytic infiltrate and inflammation of salivary glands.• It also preserved the saliva flow rate – 2 fold higher•Reduced cell apoptosis and increased microvessel density.•Additional tissue repair and regeneration was observed when given with CFA.

ADIPOSE-DERIVED MSC Readily available, contributes to angiogenesis secretes cytokines and growth factors.After precutaneous administration, saliva flow rate increased by 75%The ADSC treatment displayed group had more acinar cells and blood endothelial cells.

Human amniotic epithelial cells:

Derived from the top most layer of the amniotic membrane during c-section.

Intra-glandularly injected hAECs were capable of differentiating into acinar cells and restoring saliva.

The salivary flow rate at 30 days was restored to 48%

Bioengineered organ germ

Timeline:

Isolation of stem cells.

Day 1: epithelial-mesenchymal interactions developed to an initial bud stage.

Day 3:Branching followed by stalk elongation and cleft formation.

After 3 days:Accumulation of saliva in the ducts

Transplantation

They are developed in vivo with the correct connection to the recipient parotid glandular duct.

It is detected by fluorescence.Histological analysis is done by H&E and PAS

ASSESSMENT OF SALIVA

The acinar cell differentiation and acinar cell formation is analysed.In response to the nerve stimulations.In response to citrate stimulation by citrate.By analyzing the protein components, such as amylase.

FUNCTIONAL RECOVERY OF SWALLOWING AND SURVIVAL

Among salivary functions, the swallowing function is critical for

nutrition and reducing the risk

of aspiration.

It is investigated by the analyzing the relationship between body

weight and survival of

salivary gland defect mice.

After the transplantation

of the bioengineered

gland, the symptoms

caused by the swallowing

dysfunction are decreased.

The recovery is done after 4

days which is the amount of time required

by the development of

acini.

CONCLUSION:

When the damage is beyond repair, there is a need for methods to salvage the RT damage that has occurred.

Stem cell therapy does not provide a symptomatic treatment but rather treats the underlying cause: a lack of functional acinar cells.

More research should be done regarding the stem cell therapy for the complete and a better treatment for these diseases

THANK YOU