Mesenchymal Stem Cell Therapy for Airway Restoration Following Surgery

Post-resectional bronchopleural fistula is a pathological connection between the airway (bronchus) and the pleural space that may develop after lung resection; it may be caused by incomplete bronchial closure, impediment of bronchial stump wound healing, or stump destruction by residual neoplastic tissue. The clinical effect of impaired bronchial stump healing after anatomic lung resection may culminate in a life-threatening septic and ventilatory catastrophe. Stem cells can be used to repair defects in the airway wall, resulting from tumors, trauma, and diseases associated with epithelial damage; two groups of stem cells can be used for this purpose: endogenous progenitor cells present in the respiratory tract or exogenous stem cells derived from other tissues in the body; in this second group of stem cells there are embryonic stem cells, induced pluripotent stem cells, amniotic fluid stem cells, and fat-derived or bone marrow-derived mesenchymal stem cells (MSCs). Experimental and clinical evidence exists regarding MSC efficacy in airway defects restoration; although clinical MSC use—in the daily practice—is not yet reached for airway diseases, we can argue that MSC do not represent any more merely an experimental approach to airway tissue defects restoration but they can considered as a “salvage” therapeutic tool in very selected patients and diseases.