Clinical Radiology 71 (2016) 307e311

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Review

Interventional stem cell therapy J.D. Prologo a, *, M. Hawkins a, C. Gilliland a, R. Chinnadurai b, P. Harkey c, T. Chadid d, Z. Lee e, Luke Brewster d, f a

Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, 1364 Clifton Rd NE, Suite AG05, Atlanta, GA 30322, USA b Department of Hematology and Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365B Clifton Rd NE, Suite B506, Atlanta, GA 30322, USA c Division of Musculoskeletal Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Suite AG05, Atlanta, GA 30322, USA d Department of Surgery, Emory University School of Medicine, 1364 Clifton Rd NE, Suite H100, Atlanta, GA 30322, USA e Department of Radiology, Case Western Reserve University College of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA f Department of Surgical and Research Services, Atlanta Veterans Medical Center, 1670 Clairmont Road, Decatur, GA 30033, USA

art icl e i nformat ion Article history: Received 23 September 2015 Received in revised form 26 November 2015 Accepted 4 January 2016

The ability to deliver cells in appropriate doses to their targeted site of action is a well-known obstacle to optimising stem cell therapy. Systemic administration of cells results in pulmonary “trapping,” which significantly decreases the number of available circulating cells to impact underlying disorders. Directed delivery of stem cells in interventional radiology may provide an additional option for bypassing the lungs, as well as introduce novel potential avenues for decreasing doses required to effect cellular therapy, efficiently obtain local paracrine effects, and/or to simplify targeting strategies. Ó 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Introduction There are more than 5000 clinical trials currently registered that involve stem cells for disorders ranging from multiple sclerosis to osteogenesis imperfecta.1,2 A wellknown obstacle to optimising stem cell therapy in many of these applications is the ability to deliver cells in

* Guarantor and correspondent: J.D. Prologo, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, 1364 Clifton Rd NE, Suite AG05, Atlanta, GA 30322, USA. Tel.: þ1 404 778 4747. E-mail address: [email protected] (J.D. Prologo).

appropriate doses to their sites of action.3 Systemic administration of cells results in pulmonary “trapping,” which significantly decreases the number of available circulating cells to impact underlying disorders.4e15 To date, there is a paucity of prospective randomised trials in humans comparing routes of stem cell administration. Efforts to improve cellular presence at target sites have focused on overcoming this phenomenon through (1) cellular modification for tissue targeting, (2) characterisation and manipulation of soluble cellular homing profiles, and/or (3) modifying the first-pass mechanism itself.6,14,16e18 Directed delivery of stem cells in interventional radiology may provide an additional option for bypassing the

http://dx.doi.org/10.1016/j.crad.2016.01.005 0009-9260/Ó 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

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J.D. Prologo et al. / Clinical Radiology 71 (2016) 307e311

lungs, as well as introduce novel potential avenues for decreasing doses required to effect cellular therapy, efficiently obtain local paracrine effects, and/or to simplify targeting strategies.

The first-pass effect The majority of intravenously administered stem cells are trapped in the lungs.4e6 Studies have consistently demonstrated peripherally administered stem cells in the lungs, most reporting