Is there a clinical future for spermatogonial stem cells?

Like every other adult stem cell in the human body, spermatogonial stem cells (SSCs) have the capacity to either renew themselves or to start the differentiation process, namely, spermatogenesis. Due to the continuation of the stem cell population in the testis, several possible options for preservation and re-establishment of the reproductive potential exist. Currently, spermatogonial stem cell transplantation (SSCT) is considered the most promising tool for fertility restoration in young cancer patients. This technique involves the injection of a testicular cell suspension from a fertile donor into the testis of an infertile recipient. Although, SSCT could prove important for fertility preservation, this technique is not without any risk. Testicular cell suspensions from cancer patients may be contaminated with cancerous cells. It is obvious that reintroduction of malignant cells into an otherwise cured patient must be omitted. Decontamination strategies to solve this problem are discussed. Another alternative to preserve male fertility could be in-vitro culture of SSCs. This approach may be applied to generate spermatozoa in-vitro from cultured spermatogonial stem cells, which, in turn, could be used for intracytoplasmic sperm injection. Xenogeneic transplantation and xenografting are two other hypothetical methods to preserve fertility. However, because of the ethical and biological concerns inherent to these approaches, xenogeneic transplantation and xenografting should be limited to research. When SSCT or SSC culture becomes available for clinical use, efficient protocols for the cryopreservation of SSCs and testicular tissue will be of great benefit. The search for an optimal freezing protocol is discussed. Apart from fertility preservation, SSC studies are useful for other applications as well, such as transgenerational gene therapy and cell-based organ regeneration therapy.