Can exogenous stem cells be used in transplantation?

Today's most urgent problem in transplantation is the lack of suitable donor organs and tissues and as the population ages, demands for organs and tissue therapies will only increase. One alternative to organ transplantation is cell therapy whose aim is to replace, repair or enhance the biological function of damaged tissue or diseased organs. One goal of cellular transplantation thus has been to find a renewable source of cells that could be used in humans. Embryonic stem (ES) cells have the potential to proliferate in vitro in an undifferentiated and pluripotent state. Theoretically, ES cells are capable of unlimited proliferation in vitro. ES cells spontaneously differentiate into derivatives of all three primary germ layers: endoderm, ectoderm and mesoderm, hence providing cells in vitro which can theoretically be isolated and used for transplantation. Furthermore, these pluripotent stem cells can potentially be used to produce large numbers of cells that can be genetically modified in vitro. Once available, this source of cells may obviate some of the critical needs for organ transplantation. Murine ES cells have been extensively studied and all available evidence indicates that all aforementioned expectations are indeed fulfilled by ES cells. ES cells as well as embryonic germ cells have recently been isolated and maintained in culture. The recent descriptions of human ES cells portend the eventual use of allogeneic in vitro differentiated cells for human therapy. This goal, however, is fraught with obstacles. Our aim is first to review the recent advances made with murine ES cells and then to point out potentials and difficulties associated with the use of human ES cells for transplantation.