Table 4 Comparison between cell-based and cell-free approaches for cardiac repair and regeneration
From: Mending a broken heart: current strategies and limitations of cell-based therapy
Cell-based therapy | Cell-free therapy | |||||
|---|---|---|---|---|---|---|
Adult stem cells | Embryonic stem cells | Induced pluripotent stem cells | Growth factors | Modified mRNA | Exosomes | |
Origin | Accessible in various organs and tissues | Derived from embryos | Derived from adult somatic cells | – | – | Cell source dependent |
Ethical issues | No | Yes | No | No | ||
Genetics stability | Genetically stable | Genetically unstable | – | |||
Safety | No evidence for tumorigenesis | Possible tumorigenic risk | Non-tumorigenic | |||
Immunogenicity | Low risk of immune rejection | Possible risk of immune rejection | Possible risk of immune rejection (unless autologous) | Non-immunogenic | Non-immunogenic | Depend on the nature of donor cells |
Risk of arrhythmia | Low risk of arrhythmia | Possible risk of arrhythmia | No evidence for risk of arrhythmia | |||
Factors determining therapeutic efficacy | Highly dependent on the state of maturation, cell number, and viability during transplantation | Loading dosage | Protein expression efficiency | Content (biomolecules) in the exosomes | ||
Approach-related limitations | Large number of cells are required for significant therapeutic effect | Short biological half-life and low specificity | May require multiple injections due to transient protein expression | Risk of unknown side effects due to unidentified biomolecules in the exosomes | ||