Progress and Perspectives in Allogeneic Cell-Based Pulp Regeneration

Area of Science:

• Endodontics
• Stem Cell Biology
• Immunology

Background:

• Cell-based regenerative endodontic procedures (REPs) show potential for pulp regeneration using dental pulp stem cells (DPSCs) and stem cells from human exfoliated deciduous teeth (SHEDs).
• Clinical implementation is hindered by low cell survival, immune rejection in allogeneic transplantation, and inconsistent protocols.

Purpose of the Study:

• To review regenerative methodologies for autologous and allogeneic DPSC/SHED transplantation.
• To analyze discrepancies between preclinical and clinical REP studies.
• To explore mechanisms of alloimmune responses and propose strategies to minimize immune rejection.

Main Methods:

• Searched clinicaltrials.gov and PubMed for clinical trials and case reports on DPSCs and SHEDs.
• Included studies on specific cell products like NestaCell and Cellavita HD.
• Utilized advanced search filters for case reports and clinical trials.

Main Results:

• Included 27 clinical trials and 11 case reports, showing favorable outcomes for REPs.
• Preclinical studies indicated limited in vivo cell survival, with DPSCs becoming immunogenic in stressful conditions.
• Strategies to prolong DPSC survival have been developed.

Conclusions:

• Significant limitations persist in standardizing protocols and cell tracking.
• Future research should focus on optimized delivery systems and immune-evasive cell engineering.
• Rigorous clinical trial designs are needed to advance REPs into predictable therapies.