Pulmonary hypertension is a rare and progressive illness with a devastating prognosis. Promising research efforts have advanced the understanding and recognition of the pathobiology of pulmonary hypertension. Despite remarkable achievements in terms of improving the survival rate, reducing disease progression, and enhancing quality of life, pulmonary arterial hypertension (PAH) is not completely curable. Therefore, an effective treatment strategy is still needed. Recently, many studies of the underlying molecular mechanisms and technological developments have led to new approaches and paradigms for PAH treatment. Management based on stem cells and related paracrine effects, epigenetic drugs and gene therapies has yielded prospective results for PAH treatment in preclinical research. Further trials are ongoing to optimize these important insights into clinical circumstances.
Major effects and clinical obstacles of stem cells and exosomes therapy
Stem cells can be obtained by adult stem/progenitor cells, ESCs, and iPSCs. ESCs and iPSCs which have multi-potency to differentiate are faced several clinical obstacles as tumorigenicity, immunogenicity effects and de-differentiation after transplantation. Also, ESCs have ethical consideration and iPSCs confront financial burden. Adult stem/progenitor cells have limited proliferative capacity and variability quality. Exosomes which act anti-autophagy, anti-apoptosis, anti-proliferation, and mediating the proangiogenic action are presented as effective treatment. As intracellular messengers, exosomes can modulate critical role to reverse vascular remodeling process, but they have limitations in optimal isolation and less potency. ESC = embryonic stem cell; iPSC = induced pluripotent stem cell; PAH = pulmonary arterial hypertension; RV = right ventricular.