Abstract
Background: Alzheimer's disease (AD) is a neurodegenerative impairment mainly recognized by memory loss and cognitive deficits. However, the current therapies against AD are mostly limited to palliative medications, prompting researchers to investigate more efficient therapeutic approaches for AD, such as stem cell therapy. Recent evidence has proposed that extensive neuronal and synaptic loss and altered adult neurogenesis, which is perceived pivotal in terms of plasticity and network maintenance, occurs early in the course of AD, which exacerbates neuronal vulnerability to AD. Thus, regeneration and replenishing the depleted neuronal networks by strengthening the endogenous repair mechanisms or exogenous stem cells and their cargoes is a rational therapeutic approach. Currently, several stem cell-based therapies as well as stem cell products like exosomes, have shown promising results in the early diagnosis of AD.
Objective: This review begins with a comparison between AD and normal aging pathophysiology and a discussion on open questions in the field. Next, summarizing the current stem cell-based therapeutic and diagnostic approaches, we declare the advantages and disadvantages of each method. Also, we comprehensively evaluate the human clinical trials of stem cell therapies for AD.
Methodology: Peer-reviewed reports were extracted through Embase, PubMed, and Google Scholar until 2021.
Results: With several ongoing clinical trials, stem cells and their derivatives (e.g., exosomes) are an emerging and encouraging field in diagnosing and treating neurodegenerative diseases. Although stem cell therapies have been successful in animal models, numerous clinical trials in AD patients have yielded unpromising results, which we will further discuss.
Keywords: Neurodegenerative diseases, Alzheimer's disease, aging, stem cell therapy, exosomes, clinical trial.
Graphical Abstract
[http://dx.doi.org/10.4252/wjsc.v12.i8.787] [PMID: 32952859]
[http://dx.doi.org/10.1101/cshperspect.a006239] [PMID: 22908189]
[http://dx.doi.org/10.1186/s13287-017-0567-5] [PMID: 28494803]
[http://dx.doi.org/10.1016/S1474-4422(07)70178-3] [PMID: 17616482]
[http://dx.doi.org/10.1038/nrm2241] [PMID: 17717515]
[http://dx.doi.org/10.4103/1673-5374.265544] [PMID: 31552889]
[http://dx.doi.org/10.1007/s11064-020-03111-1] [PMID: 32840760]
[http://dx.doi.org/10.3389/fphys.2012.00359] [PMID: 22973239]
[http://dx.doi.org/10.1074/jbc.M114.577213] [PMID: 25037226]
[http://dx.doi.org/10.4103/1673-5374.255978] [PMID: 31089063]
[http://dx.doi.org/10.1007/s00018-008-8053-y] [PMID: 18500448]
[http://dx.doi.org/10.1016/j.stem.2019.05.003]
[http://dx.doi.org/10.1111/j.1582-4934.2002.tb00451.x] [PMID: 12611637]
[http://dx.doi.org/10.1016/j.neurobiolaging.2021.03.019] [PMID: 34256190]
[http://dx.doi.org/10.1016/0197-4580(92)90027-U] [PMID: 1311804]
[http://dx.doi.org/10.1001/jamaneurol.2019.1424] [PMID: 31157827]
[http://dx.doi.org/10.1371/journal.pone.0234255] [PMID: 32726311]
[PMID: 27505014]
[http://dx.doi.org/10.1111/acel.12802] [PMID: 29963744]
[http://dx.doi.org/10.1016/j.ijbiomac.2020.04.207] [PMID: 32353498]
[http://dx.doi.org/10.1016/j.bcp.2014.01.008] [PMID: 24445162]
[http://dx.doi.org/10.1016/j.neuroscience.2015.01.007] [PMID: 25595973]
[http://dx.doi.org/10.1038/s41593-019-0372-9] [PMID: 30936558]
[http://dx.doi.org/10.1016/j.scitotenv.2018.07.369] [PMID: 30235600]
[http://dx.doi.org/10.3727/096368914X679237] [PMID: 24612635]
[http://dx.doi.org/10.1016/j.cell.2008.01.033] [PMID: 18295581]
[http://dx.doi.org/10.1038/nn.2385] [PMID: 19701197]
[http://dx.doi.org/10.1126/science.aaf7073] [PMID: 27846470]
[http://dx.doi.org/10.3389/fncel.2020.576444]
[http://dx.doi.org/10.29245/2572.942X/2018/4.1192]
[http://dx.doi.org/10.1152/physrev.00004.2014] [PMID: 25287858]
[http://dx.doi.org/10.1038/s41583-021-00433-z] [PMID: 33633402]
[http://dx.doi.org/10.1142/S0219635216500175] [PMID: 27650784]
[http://dx.doi.org/10.1002/hipo.20167] [PMID: 16435309]
[http://dx.doi.org/10.3389/fnins.2014.00053] [PMID: 24672424]
[http://dx.doi.org/10.1080/15548627.2019.1630222] [PMID: 31234698]
[http://dx.doi.org/10.1038/nature08983] [PMID: 20336135]
[http://dx.doi.org/10.1667/RR3206] [PMID: 15222778]
[http://dx.doi.org/10.1038/nn.2672] [PMID: 20975758]
[http://dx.doi.org/10.1016/j.biopsych.2021.01.010] [PMID: 33771348]
[http://dx.doi.org/10.1016/j.ebiom.2017.01.005] [PMID: 28153772]
[http://dx.doi.org/10.1126/sciadv.aav0618] [PMID: 30547091]
[http://dx.doi.org/10.1016/j.stem.2017.11.005]
[http://dx.doi.org/10.1016/j.neulet.2021.136071] [PMID: 34147540]
[http://dx.doi.org/10.1016/j.bbih.2020.100102]
[http://dx.doi.org/10.3389/fncel.2013.00229] [PMID: 24319411]
[http://dx.doi.org/10.1016/j.celrep.2018.03.037] [PMID: 29617675]
[http://dx.doi.org/10.1016/j.stem.2018.01.020]
[http://dx.doi.org/10.1523/JNEUROSCI.19-19-08487.1999] [PMID: 10493749]
[http://dx.doi.org/10.1016/j.mcn.2006.04.003] [PMID: 16730456]
[http://dx.doi.org/10.1016/j.neulet.2008.09.030] [PMID: 18822350]
[http://dx.doi.org/10.1016/j.neulet.2013.10.043] [PMID: 24466594]
[http://dx.doi.org/10.7150/thno.46332] [PMID: 32641991]
[http://dx.doi.org/10.3390/ijms20020257] [PMID: 30634650]
[http://dx.doi.org/10.1186/s13287-020-01883-5] [PMID: 32831148]
[http://dx.doi.org/10.1016/j.jgeb.2018.09.002] [PMID: 30733756]
[http://dx.doi.org/10.1126/science.aan8821] [PMID: 30190379]
[http://dx.doi.org/10.1038/s41591-019-0375-9] [PMID: 30911133]
[http://dx.doi.org/10.1002/stem.2357] [PMID: 26991735]
[http://dx.doi.org/10.1097/YCO.0000000000000478] [PMID: 30557266]
[http://dx.doi.org/10.2174/1574893614666181212102749]
[http://dx.doi.org/10.1016/j.stem.2015.08.001] [PMID: 26321199]
[http://dx.doi.org/10.1016/j.isci.2019.04.036] [PMID: 31132746]
[http://dx.doi.org/10.1016/j.isci.2021.102126] [PMID: 33659884]
[http://dx.doi.org/10.14336/AD.2020.1020] [PMID: 33269095]
[http://dx.doi.org/10.2165/11587830-000000000-00000] [PMID: 21699269]
[http://dx.doi.org/10.1016/j.biopha.2017.04.034] [PMID: 28448871]
[http://dx.doi.org/10.3390/ijms22042153] [PMID: 33671500]
[http://dx.doi.org/10.1056/NEJMoa1915872] [PMID: 32402162]
[http://dx.doi.org/10.1002/jdn.10101] [PMID: 33650716]
[http://dx.doi.org/10.1016/j.stemcr.2015.09.010] [PMID: 26489896]
[http://dx.doi.org/10.2174/1574888X14666190823142911] [PMID: 31441732]
[http://dx.doi.org/10.1056/NEJMoa1608368] [PMID: 28296613]
[http://dx.doi.org/10.1016/S0140-6736(12)60282-7] [PMID: 22559899]
[http://dx.doi.org/10.1016/j.exphem.2006.06.020] [PMID: 17046576]
[http://dx.doi.org/10.1371/journal.pone.0028175] [PMID: 22194812]
[http://dx.doi.org/10.31622/2020/0003.2]
[http://dx.doi.org/10.1002/stem.1909] [PMID: 25447379]
[http://dx.doi.org/10.15283/ijsc19031] [PMID: 32114741]
[http://dx.doi.org/10.1002/sctm.17-0260] [PMID: 29489062]
[http://dx.doi.org/10.1089/scd.2010.0466] [PMID: 21303266]
[http://dx.doi.org/10.1002/jcb.27202] [PMID: 30074262]
[http://dx.doi.org/10.1016/j.tips.2020.06.009] [PMID: 32709406]
[http://dx.doi.org/10.4103/1673-5374.264455] [PMID: 31535654]
[http://dx.doi.org/10.1101/2020.05.05.078741]
[http://dx.doi.org/10.1038/s41598-020-67460-1] [PMID: 32612165]
[http://dx.doi.org/10.3389/fimmu.2019.01191] [PMID: 31214172]
[http://dx.doi.org/10.3233/JAD-200219]
[http://dx.doi.org/10.2174/1574893615666200207094357]
[http://dx.doi.org/10.2174/1574888X16666210303151237] [PMID: 33655876]
[http://dx.doi.org/10.1089/scd.2014.0487] [PMID: 26154268]
[PMID: 26451119]
[http://dx.doi.org/10.1155/2013/438243]
[http://dx.doi.org/10.1002/sctm.19-0202] [PMID: 31804767]
[PMID: 30820070]
[http://dx.doi.org/10.1261/rna.069112.118] [PMID: 30425123]
[http://dx.doi.org/10.4103/1673-5374.128214] [PMID: 25206807]
[http://dx.doi.org/10.7150/ijms.21666] [PMID: 29333086]
[http://dx.doi.org/10.1038/nrm.2017.125] [PMID: 29339798]
[http://dx.doi.org/10.1007/s12035-015-9670-8] [PMID: 26746668]
[http://dx.doi.org/10.3389/fncel.2018.00317] [PMID: 30319358]
[http://dx.doi.org/10.1155/2017/6305295]
[http://dx.doi.org/10.1371/journal.pone.0033115] [PMID: 22431999]
[http://dx.doi.org/10.1002/stem.1129] [PMID: 22605481]
[http://dx.doi.org/10.1681/ASN.2008070798] [PMID: 19389847]
[http://dx.doi.org/10.1155/2016/7653489]
[http://dx.doi.org/10.1186/1757-2215-7-14] [PMID: 24460816]
[http://dx.doi.org/10.1038/nri855] [PMID: 12154376]
[http://dx.doi.org/10.7150/thno.21945] [PMID: 29290805]
[http://dx.doi.org/10.1146/annurev-cellbio-101512-122326] [PMID: 25288114]
[http://dx.doi.org/10.1016/j.jmb.2015.09.019] [PMID: 26434508]
[http://dx.doi.org/10.1007/s10571-015-0309-0] [PMID: 27017608]
[http://dx.doi.org/10.1016/j.phrs.2019.04.030] [PMID: 31028902]
[http://dx.doi.org/10.1111/j.1600-0854.2009.00920.x] [PMID: 19490536]
[http://dx.doi.org/10.1126/science.aau6977] [PMID: 32029601]
[http://dx.doi.org/10.1007/978-3-7091-1368-4_3]
[http://dx.doi.org/10.3390/ijms20071728] [PMID: 30965555]
[http://dx.doi.org/10.1097/NEN.0b013e3182345e46] [PMID: 22002425]
[http://dx.doi.org/10.1074/jbc.M110.149468] [PMID: 20876579]
[http://dx.doi.org/10.1038/srep01197] [PMID: 23378928]
[http://dx.doi.org/10.1016/j.lfs.2019.116733] [PMID: 31394127]
[http://dx.doi.org/10.1186/s12979-019-0150-2] [PMID: 31114624]
[http://dx.doi.org/10.1186/s13195-020-00670-x] [PMID: 32928293]
[http://dx.doi.org/10.3389/fcell.2020.00149] [PMID: 32226787]
[http://dx.doi.org/10.3389/fcell.2021.641469] [PMID: 33732706]
[http://dx.doi.org/10.1371/journal.pone.0189165] [PMID: 29211799]
[http://dx.doi.org/10.3233/JAD-150238] [PMID: 26402622]
[http://dx.doi.org/10.1080/15476286.2019.1582956] [PMID: 30836828]
[http://dx.doi.org/10.1016/S0002-9440(10)64463-X] [PMID: 12414533]
[http://dx.doi.org/10.3390/ijms16034800] [PMID: 25741766]
[http://dx.doi.org/10.1186/s13048-017-0368-6] [PMID: 29100532]
[http://dx.doi.org/10.3389/fnins.2017.00229] [PMID: 28487629]
[http://dx.doi.org/10.1038/s41467-017-02533-w] [PMID: 29348617]
[http://dx.doi.org/10.1074/jbc.M112.340513] [PMID: 22532571]
[http://dx.doi.org/10.3233/JAD-170278] [PMID: 28826183]
[http://dx.doi.org/10.1038/nbt.1807] [PMID: 21423189]
[http://dx.doi.org/10.3389/fimmu.2015.00203] [PMID: 25999947]
[http://dx.doi.org/10.1016/j.jalz.2014.06.008]
[http://dx.doi.org/10.3389/fnmol.2020.00038] [PMID: 32265650]
[http://dx.doi.org/10.1016/j.neuroscience.2018.03.016] [PMID: 29559383]
[http://dx.doi.org/10.1186/s40035-019-0169-5] [PMID: 31592314]
[http://dx.doi.org/10.1038/mp.2014.127] [PMID: 25349172]
[http://dx.doi.org/10.3389/fnins.2019.01208] [PMID: 31849573]
[http://dx.doi.org/10.3892/mmr.2014.2484] [PMID: 25119742]
[http://dx.doi.org/10.1007/s12035-018-1032-x] [PMID: 29603092]
[http://dx.doi.org/10.1186/s13287-019-1165-5] [PMID: 30808416]
[http://dx.doi.org/10.1016/j.trci.2015.06.007] [PMID: 29854930]
[http://dx.doi.org/10.1016/j.neurobiolaging.2004.09.016] [PMID: 15748782]
[http://dx.doi.org/10.31083/j.jin.2020.01.1142] [PMID: 32259896]
[http://dx.doi.org/10.1016/j.addr.2019.02.007] [PMID: 30797953]
[http://dx.doi.org/10.3390/ijms15069372] [PMID: 24871366]
[http://dx.doi.org/10.1016/j.omtn.2017.04.010] [PMID: 28624203]
[http://dx.doi.org/10.1186/s40824-016-0068-0] [PMID: 27499886]
[http://dx.doi.org/10.1002/stem.1132] [PMID: 22644660]
[http://dx.doi.org/10.2174/1567205014666170706112701] [PMID: 28720071]
[http://dx.doi.org/10.3390/ph13090243] [PMID: 32932746]