Gene therapy for dentin regeneration with bone morphogenetic proteins

Recent advances in stem cell biology and gene therapy technology have provided the great potential of adult stem cells for therapeutic use in regeneration of lost tissue due to diseases including cancer, trauma, and even caries. Dental pulp tissues harbor mesenchymal stem/progenitor cells and have potential to regenerate and/or repair dentin-pulp complex after injury such as caries. There are two main methods, in vivo and ex vivo gene therapy. In in vivo gene therapy the healing potential of pulp tissue is enhanced by genes inducing dentin directly applied on the exposed/amputated dental pulp. In ex vivo gene therapy, pulp stem/progenitor cells transfected with some therapeutically proven genes to induce differentiation into odontoblasts which are transplanted on the exposed/amputated pulp. In the inflamed pulp under deep caries or trauma, possibly due to the limited supply of pulp stem/progenitor cells, it might be useful to apply cell-based ex vivo gene therapy compared to in vivo gene therapy. Before clinical use of ex vivo gene therapy for dentin regeneration in endodontics, there is a need for establishment of isolation, identification and expansion of the pulp stem cells. A safe and efficient gene delivery system also needs to be optimized. In this review we provide an overview of our current knowledge in the biology and function of adult pulp stem cells. This is followed by a discussion of the challenges of translating basic cellular and molecular biology of differentiation of pulp stem cells to safe and efficient gene therapy for dentin regeneration.