Stem cells have moved from lab to bedside, and many initial studies showed promising results. Therefore big companies are entering the business. However, most initial studies did not used controls to make sure of the efficacy of stem cells. Many phase-1 studies showed safety of stem cell therapies, when precaution measures were adapted.  However, efficacy needs to be proven by randomized controlled trials (RCT) to exclude placebo effects. Recently, various RCTs for various conditions have been done with various contradictory results. Therefore, a meta-analysis is very useful to know whether a stem cell therapy really work for a certain condition.  As various centres used various type of stem cells, various dose, and route of application, as well as different outcome measures with various results for one certain condition, sometimes it is difficult to conduct a meta-analysis when there is high heterogeneity, which is like pooling ‘apples’ with ‘oranges’ and ‘avocado’ that will lead to a misleading conclusion. In many cases, where the studies are highly heterogeneous, and the heterogeneity can’t be identified, then a descriptive systematic review is the best solution to take a conclusion which protocol is the best and valuable to be standardized.

Formerly it was believed that stem cells that are given to patients work by differentiating into the needed cells, and thus replacing damaged cell. However, recent evidence showed that only a few stem cells homed to the desired area, while a large amount went to various areas that were remote from the damaged area. Even though they were trapped in remote areas, the stem cells still exerted beneficial effects by remote signalling and secretion of various beneficial factors. Therefore, there are attempts to produce substitute tissue/organs ‘ex vivo’ to be transplanted to replace a damaged organ. There are various means to produce a tissue/an organ/organoid ‘ex vivo’ (tissue engineering) by using various stem cells, scaffold, and soluble factors, in various vessels from static vessel to bioreactors, and ‘on chips’. Though these attempts are in the initial stage, but some translational animal studies have been done.  A more usual use of these ‘ex vivo’ developed tissues/organs/ organoids is for drug testing, such as toxicity testing, and for studying the mechanism of certain diseases that is directed toward the development of a cure of the diseases.

In conclusion, many stem cell therapies have entered RCTs, but no standardized and approved protocol has been established, while organoids are usually used for drug testing and studying the mechanism of certain diseases.

Prof. dr. Jeanne Adiwinata Pawitan, PhD  has been Graduated from the Faculty of Medicine, Universitas Indonesia (FMUI) as Medical Doctor, and Master in Medical Biology, and started working at the Department of Histology FMUI. Later on she obtained her PhD from Osaka University, Osaka, Japan, continued working at the Department of Histology FMUI, and was appointed as Professor in 2005.   Presently, besides serving as Professor in the Department of Histology, Faculty of Medicine Universitas Indonesia (FMUI), Jakarta, Indonesia,  she also works at Stem Cell  Medical Technology Integrated Service Unit, RSCM - FMUI as GLP lab coordinator, and at Stem Cell and Tissue Engineering Research Center, Indonesia Medical Education and Research Institute (IMERI), FMUI as lab manager.

Her research interests and projects are in stem cell and regenerative medicine, and she published various research papers mainly in the isolation, culture, characterization, differentiation and production of mesenchymal stem cells from bone marrow, adipose tissue and umbilical cord. Recently her newest project is liver organoid culture. In addition she is active in writing review articles and systematic reviews concerning production method and usage of stem cells in regenerative medicine.