Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. Mar 26, 2020; 12(3): 168-177
Published online Mar 26, 2020. doi: 10.4252/wjsc.v12.i3.168
Mesenchymal stem cells in neurodegenerative diseases: Opinion review on ethical dilemmas
Matteo Scopetti, Alessandro Santurro, Vittorio Gatto, Raffaele La Russa, Federico Manetti, Stefano D’Errico, Paola Frati, Vittorio Fineschi
Matteo Scopetti, Alessandro Santurro, Vittorio Gatto, Raffaele La Russa, Federico Manetti, Paola Frati, Vittorio Fineschi, Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome 00185, Italy
Raffaele La Russa, Paola Frati, Vittorio Fineschi, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Sapienza University of Roma, Pozzilli 86077, Italy
Stefano D’Errico, UOC Risk Management, Quality and Accreditation, Sant'Andrea University Hospital of Rome, Rome 00189, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting, critical revision, and approval of the final version.
Conflict-of-interest statement: The authors declare no conflict of interest. This study received no external funding.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Vittorio Fineschi, MD, PhD, Director, Full Professor, Professor, Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy. vittorio.fineschi@uniroma1.it
Received: October 21, 2019
Peer-review started: October 21, 2019
First decision: December 26, 2019
Revised: February 13, 2020
Accepted: March 1, 2020
Article in press: March 1, 2020
Published online: March 26, 2020

The treatment of neurodegenerative diseases presents a growing need for innovation in relation to recent evidence in the field of reconstructive therapy using stem cells. Understanding the molecular mechanisms underlying neurodegenerative disorders, and the advent of methods able to induce neuronal stem cell differentiation allowed to develop innovative therapeutic approaches offering the prospect of healthy and perfectly functional cell transplants, able to replace the sick ones. Hence the importance of deepening the state of the art regarding the clinical applications of advanced cell therapy products for the regeneration of nerve tissue. Besides representing a promising area of tissue transplant surgery and a great achievement in the field of neurodegenerative disease, stem cell research presents certain critical issues that need to be carefully examined from the ethical perspective. In fact, a subject so complex and not entirely explored requires a detailed scientific and ethical evaluation aimed at avoiding improper and ineffective use, rather than incorrect indications, technical inadequacies, and incongruous expectations. In fact, the clinical usefulness of stem cells will only be certain if able to provide the patient with safe, long-term and substantially more effective strategies than any other treatment available. The present paper provides an ethical assessment of tissue regeneration through mesenchymal stem cells in neurodegenerative diseases with the aim to rule out the fundamental issues related to research and clinical translation.

Keywords: Mesenchymal stem cells, Neurodegenerative diseases, Stem cell research, Stem cell therapy, Ethical principles, Patient safety

Core tip: Neurodegenerative diseases constitute a set of pathologies affecting the central nervous system whose main characteristic is a chronic and selective process of neuronal cell death. The study of stem cells and the advent of new methods able to induce neuronal differentiation, is having a significant impact in this sense in recent years, offering the prospect of transplanting healthy and perfectly functional cells, able to replace those diseased. The objective the present paper is to contribute to the construction of an ethical framework that allows a close monitoring of the scientific activity in the experimental and translational fields.