![]() ![]() Stem cell therapy, as one of the methods used in the bone repair process, has been developed over the last 2 decades. Despite several efforts that have been made to invent and characterize various bone graft substitutes and engineered tissue scaffolds, none could be globally accepted as an ideal alternative option to autografts due to the low ability of the bone substitutes to enhance osteoinduction and osteogenesis. An ideal bone graft substitute should have certain properties, including osteoconduction, osteoinduction, osteoincorporation, osteointegration, and osteogenesis. First of all, after the diseased bony tissue has been removed and the remaining bones fixed, the resulting defect should be reconstructed and filled with various grafts and materials. In order to improve and accelerate the healing process, several options are currently available in clinical practice. Despite these advancements, malunions, delayed unions, or nonunions occur and persist in clinical cases where the osteogenesis and subsequent bone remodeling are impaired, particularly in those involving large bone defects. Using the latest equipment and surgical techniques, better protocols and more effective rehabilitation procedures have contributed to a better prognosis for bone healing. Today, the correction of bone regeneration impairment has been achieved by advances in healing process management. This failed healing process can eventually lead to the formation of malunions, delayed unions, nonunions, and osteomyelitis. These include those injuries that cause large bone defects to occur and develop, such as necrosis, tumors (e.g., osteosarcoma), high-energy traumas, and compound-, multiple-, gunshot-, open-, comminuted-, and osteoporosis-related fractures. Bone healing is not always completely satisfactory, and many reasons might be responsible for its failure. Bone healing is a complex process of overlapping phases, including inflammation, repair, and remodeling that involves the many intracellular signaling pathways which are responsible for regeneration of the new bone with the help of surrounding tissues. We will also review the most recent clinical trials to find out how MSCs may be beneficial for treating bone defects.īone has a self-repair ability so that it can repair itself when the nature and extent of injury is not large, chronic, severe, and complicated. ![]() In this review, we update the recent advances in the mechanisms of MSC action and the delivery approaches in bone regenerative medicine. Although several in vitro and in vivo investigations have suggested the potential roles of MSCs in bone repair and regeneration, the mechanism of MSC therapy in bone repair has not been fully elucidated, the efficacy of MSC therapy has not been strongly proven in clinical trials, and several controversies exist, making it difficult to draw conclusions from the results. Tissue engineering and regenerative medicine, together with genetic engineering and gene therapy, are advanced options that may have the potential to improve the outcome of cell therapy. The effectiveness of MSC therapy is dependent on several factors, including the differentiating state of the MSCs at the time of application, the method of their delivery, the concentration of MSCs per injection, the vehicle used, and the nature and extent of injury, for example. MSCs are multipotent stromal stem cells that can be harvested from many different sources and differentiated into a variety of cell types, such as preosteogenic chondroblasts and osteoblasts. There is growing interest in the application of osteoinductive and osteogenic growth factors and mesenchymal stem cells (MSCs) in order to significantly improve bone repair and regeneration. Healing and regeneration of bone injuries, particularly those that are associated with large bone defects, are a complicated process. ![]()
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