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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Stem cells are defined by 2 fundamental characteristics&#58; their capacity for self-renewal and for differentiation into all cell lines within their tissue of origin&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In adults&#44; stem cells have been identified in different organs&#44; including the skin&#44; intestine&#44; muscle&#44; hematopoietic system&#44; and even the human brain&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">2</span></a> These cells are responsible for maintaining tissue homeostasis where they reside and also for repairing damage when it occurs&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The discovery of stem cells in adult organisms and characterization of their markers to enable isolation of specific cells have opened up new perspectives and new horizons in biomedical research&#44; with new hopes for treatment in an range of diseases&#46; Epidermal stem cells are of particular interest as they are relatively numerous and also accessible&#44; making them easy to obtain&#46; In the first part of this review&#44; we have aimed to summarize the main findings of basic research in the field of epidermal stem cells&#46; We then discuss their potential applications in clinical dermatology&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Different Stem Cell Populations in the Epidermis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Two types of progenitor cell are present in the basal layer of the interfollicular epidermis&#58; &#945;6<span class="elsevierStyleSup">&#43;</span>CD34<span class="elsevierStyleSup">&#8211;</span> stem cells&#44; characterized by slow division rates &#40;4-6 times a year&#41; and a long lifespan&#44; and basal layer K14<span class="elsevierStyleSup">&#43;</span>Inv<span class="elsevierStyleSup">&#43;</span> progenitor cells&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">3</span></a> as well as possibly Axin2<span class="elsevierStyleSup">&#43;</span> cells&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">4</span></a> characterized by faster division rates &#40;once a week&#41; and shorter lifespan&#46; After a certain number of divisions these cells undergo terminal differentiation into differentiated keratinocytes&#44; thereby losing their capacity for division&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the main characteristics of the markers&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The hair follicle has 3 phases&#58; anagen or growth phase &#40;lasting on average 3 years&#41;&#44; catagen or involuting phase &#40;which lasts several weeks&#41;&#44; and telogen or resting phase &#40;which lasts several months&#41;&#46; The stem cells responsible for hair follicle regeneration during anagen reside in the bulge &#40;the lower part of the permanent portion of the hair follicle&#41; and are characterized by expression of the markers CD34&#44; Lgr5&#44; and K15&#46; The cells are multipotent&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a> as they can differentiate into all cell lines present in the hair follicle unit&#46; During anagen&#44; the stem cells in the bulge give rise to transit-amplifying cells&#44; which reside in the hair follicle&#46; These rapidly and transiently proliferate before embarking on 7 differentiation programs which finally give rise to the mature hair follicle&#46; When the matrix cells have exhausted their proliferative capacity&#44; hair growth stops and the follicle enters catagen&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">6</span></a> leading to degeneration of the lower two-thirds of the follicle while the bulge region remains intact&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The hair bulb is found in the lower part of the hair follicle&#46; This structure&#44; which rests on the dermal papilla&#44; is made up of differentiated progeny of stem cells from the bulge&#46; The dermal papilla contains specialized dermal fibroblasts&#44; nerve fibers&#44; and a capillary loop&#46; It plays a fundamental role in the development of the hair follicle and control of the hair cycle in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">7</span></a> Cells in the dermal papilla can differentiate into neuronal and mesodermal cell lines&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">8&#44;9</span></a> In a recent study&#44; Rahmani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">10</span></a> eliminated stem cells from the dermal papilla and observed a delay in the regeneration of the hair follicle&#44; along with change in hair type&#44; suggesting that the dermal papilla plays a fundamental role in restoring hair growth after damage&#44; disease&#44; or aging&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">At least 3 types of epithelial stem cells have been identified recently&#58; these types reside in the sebaceous glands&#44; the infundibulum&#44; and sweat glands&#46; The sebaceous glands are maintained by unipotent Lgr6<span class="elsevierStyleSup">&#43;</span> stem cells&#44; which originate from Blimp1<span class="elsevierStyleSup">&#43;</span> progenitor cells&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">11</span></a> In addition&#44; stem cells from the isthmus express the MTS234 marker&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">12</span></a> and if transplanted to an immunodeficient mouse&#44; are surprisingly able to give rise to epidermal&#44; follicular&#44; and sebaceous cell lines&#44; suggesting that these might be multipotent cells&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">13</span></a> The stem cells in the infundibulum are characterized by expression of the Lrig1 marker and their multipotent capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">14</span></a> It is also thought that they may contribute to the homeostasis of the sebaceous glands&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">15</span></a> Finally&#44; although sweat glands have traditionally be considered as quiescent in adults&#44; a study published recently suggests 4 different types of progenitor cells are present in the epithelium of these structures&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">16</span></a><a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows a microphotograph of the hair follicle &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41; and a schematic of the different compartments in the epithelium of the skin and where the stem cells reside&#44; as well as a summary of their markers &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Self-Renewal of Stem Cells</span><p id="par0040" class="elsevierStylePara elsevierViewall">As mentioned earlier&#44; stem cells can give rise to differentiated cells&#44; but they also propagate to maintain a constant pool of stem cells&#44; and can divide symmetrically or asymmetrically&#46; During the process of asymmetric division&#44; a stem cell gives rise to a daughter cell with the same phenotype&#44; and another daughter cell which will differentiate&#46; Symmetric division of a stem cell gives rise to 2 identical daughter cells&#44; both with a differentiated or somewhat differentiated phenotype &#40;Fig&#46; 2<span class="elsevierStyleHsp" style=""></span>A&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">During the development of the embryo&#44; most basal cell divisions are symmetric and parallel to the axis of the basal membrane &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#44; thereby allowing growth of the embryo surface and ensuring that the epithelium remains as a single layer&#46; In contrast&#44; during stratification of the epithelium&#44; approximately 70&#37; of divisions are asymmetric &#40;Fig&#46; 2<span class="elsevierStyleHsp" style=""></span>C&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">6&#44;17</span></a> thereby allowing development of suprabasal cells and establishment of the skin barrier during development and epidermal homeostasis in adulthood&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Role of Epidermal Stem Cells in Skin Homeostasis and Scarring</span><p id="par0050" class="elsevierStylePara elsevierViewall">Homeostasis is a physiological process whereby the number of cells with capacity for regeneration in a given organ remains constant&#46; In skin homeostasis&#44; the stem cells in each compartment are those responsible for replacing the differentiated cells that die in that compartment&#46; However&#44; during the evolutionary process&#44; stem cells have acquired the capacity to participate in the repair of neighboring compartments in the event that stem cells in those compartments become damaged&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The form in which stem cells respond to damage varies drastically&#44; depending not only on the compartment where these reside&#44; but also how close they are to the wound&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">18</span></a> The technique of in vivo lineage tracing offers valuable functional information on the behavior of stem cells in homeostasis and during tissue repair&#44; given that cell development can be followed over time in the natural environment &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">During repair of damage to the interfollicular epidermis&#44; massive recruitment of interfollicular stem cells to the area of the wound occurs&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">3</span></a> Clones derived from these cells are observed migrating from the periphery of the wound towards the center&#44; and remaining there for a long time after healing&#46; However&#44; much fewer Inv<span class="elsevierStyleSup">&#43;</span> cells &#40;short-lived progenitors&#41; migrate towards the damaged zone&#44; the clones are much smaller&#44; and 35 days after injury&#44; most of these have disappeared&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">3</span></a> That is&#44; it seems that the short-lived progenitors are responsible for maintaining homeostasis of the epidermis in normal conditions&#44; whereas stem cells&#44; which are normally in a quiescent state&#44; are activated when an injury occurs &#40;wounds or drug administration&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">19</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In addition&#44; stem cells both in the bulge and in the infundibulum can migrate towards the epidermis in response to a wound stimulus&#44; and participate in repair of the damage&#46; Surprisingly&#44; and through mechanisms that are still not well understood&#44; when these cells migrate towards the epidermis&#44; they lose their specific hair follicle markers and adopt a phenotype more similar to those of the stem cells of the interfollicular epidermis&#46; However&#44; once in the epidermis&#44; these cells are short-lived and disappear soon after repair of the damaged tissue&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">20&#44;21</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Another phenomenon of great interest&#44; which was observed on elimination of stem cells of a specific component of the epidermis with laser light&#44; was that the empty niches were able to recruit normal differentiated cells from that compartment and induce cell proliferation and undifferentiation towards a state similar to that of stem cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">22&#44;23</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Epidermal Stem Cells as the Origin of Nonmelanoma Skin Cancer Cells</span><p id="par0075" class="elsevierStylePara elsevierViewall">The identification of the cells that give rise to cancer is still a challenge in most malignant tumors&#46; Theoretically&#44; these cells acquire the first genetic or epigenetic abnormalities that culminate in the initiation of the malignant process&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">24</span></a> It follows that&#44; given their characteristics &#40;capacity for self-renewal over a long period of time&#41;&#44; stem cells are at an increased risk of accumulating oncogenic mutations&#44; and so they may be the cells that initiate the cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">25&#44;26</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Using mice modified genetically with the inducible CreER-LoxP system &#40;CreER refers to the estrogen receptor &#91;ER&#93; Cre-recombinase enzyme&#44; such that administration of tamoxifen induces recombination of Cre&#44; with the subsequent activation or deletion of the target gene&#41;&#44; it has been shown that activation of the SmoM2 mutation in stem cells of the bulge or in transit-amplifying cells of the hair follicle did not induce tumor formation in basal cell carcinoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">27&#44;28</span></a> In fact&#44; the authors demonstrated that 90&#37; of surface-spreading basal cell carcinomas originate from the interfollicular epidermis and the remaining 10&#37; originate in the infundibulum&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the case of spindle-cell carcinoma in mice&#44; expression of the <span class="elsevierStyleItalic">KRas</span> mutation in stem cells in the bulge and in the interfollicular epidermis&#44; but not in transit-amplifying cells&#44; induces the formation of benign tumors but combination of the <span class="elsevierStyleItalic">KRas</span> mutation and deletion of the tumor suppressor gene p53 is necessary for progression to carcinoma&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Potential Applications of Stem Cells in Clinical Dermatology</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Burns</span><p id="par0090" class="elsevierStylePara elsevierViewall">For the treatment of extensive skin burns&#44; successful outcomes have been obtained with in vitro epidermis generated using autologous epidermal stem cells from a biopsy of undamaged patient&#39;s skin&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">30</span></a> The skin biopsy sample is dissociated with tripsin<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">31</span></a> and the epidermal stem cells are isolated&#46; These are then expanded on a base of irradiated fibroblasts&#44; which secrete extracellular matrix and growth factors&#44; making the environment particularly conducive to keratinocyte proliferation&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">32</span></a> The keratinocytes are cultured until formation of a stratified epithelium that can be used to cover the wound&#46; However&#44; there are 2 main drawbacks with this technique&#58; the first is the long time needed for in vitro expansion of keratinocytes and the second is the high cost of the procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">33</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Of note is that the skin obtained with this method does not have any appendages &#40;hair follicles or sweat glands&#41;&#46; In a third-degree burn&#44; the disappearance of hair follicles is due not only to destruction of multipotent stem cells in the follicle but also to the destruction of the dermis &#40;the papillary dermis&#41;&#46; To achieve regeneration of the hair follicles&#44; cells from the papillary dermis need to be transplanted along with keratinocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">34</span></a> In a recently published study&#44; researchers managed to transplant human cells from the papillary dermis to a nude mouse &#40;immunodeficient and without fur&#41; and reported the regeneration of hair follicles&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">35</span></a> To achieve a similar hair color to the original color of the patient&#44; a group of Swiss investigatorss added melanocytes isolated from skin biopsy to a culture of keratinocytes&#44; achieving favorable results&#44; both in patients with clear phototypes and with dark phototypes&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">36</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">A culture of keratinocytes on a bed of human fibroblasts embedded with a plasma matrix has been used as an alternative to transplantation of layers of keratinocytes cultured on a bed of irradiated fibroblasts&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">37</span></a> This approach enables restoration of both the epidermal and dermal compartment&#46; After 24-26 days of culture&#44; the authors achieved a 1000-fold cultured-area expansion&#44; and successfully transplanted artificial skin from 2 patients with severe burns&#46; Researchers from the University of Granada in Spain used fibrin-agarose biomaterials as a base to generate skin substitutes from human fibroblasts and keratinocytes&#46; The artificial skin obtained was transplanted to nude mice and samples were taken for histological analysis and electron microscopy after 10&#44; 20&#44; 30&#44; and 40 days&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">38</span></a> The results of these analyses showed that the structure of the skin obtained through tissue engineering was very similar to that of normal mouse skin&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Two studies of murine models published recently pointed to a possible alternative to the method used traditionally&#46; Stimulation of the stem cells from the bulge of the hair follicle in third-degree burns in mice induced with human &#945;-defensin-5 derived from the intestine accelerated wound healing and&#44; notably&#44; induced hair regeneration&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">39</span></a> Similarly&#44; transplantation of Lgr6<span class="elsevierStyleSup">&#43;</span> stem cells isolated by fluorescence-activated cell sorting and administered by injections into the wound promoted reepithelization&#44; hair growth&#44; and angiogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Therapeutic Correction of the Epidermal Stem Cell Genome in Genetic Diseases</span><p id="par0110" class="elsevierStylePara elsevierViewall">In recent years&#44; the cost of genetic sequencing has decreased significantly&#46; As a result&#44; the volume of data on the human genome in different contexts and diseases has increased exponentially&#46; These advances in knowledge have generated high expectations around the potential therapeutic applications in genetic diseases&#46; Although gene therapy is not applied in everyday clinical practice by dermatologists&#44; in recent years&#44; large steps forward have been made and the field shows great promise&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">To date&#44; the 2 most powerful therapeutic genetic techniques are gene therapy&#44; which enables the reestablishment of the lost function of a given gene through expression of a transgene that is incorporated into the genome by viral vectors&#44;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">41</span></a> and interference RNA&#44; which can suppress expression of the defective gene through inhibition of messenger RNA&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">42</span></a> In recent years&#44; moreover&#44; new technologies have been developed with a promising future potential in gene therapy&#46; These are based on the use of programmable nucleases&#44; which are able to edit the genome of cells in damaged tissues&#44; resulting in the elimination or correction of harmful mutations or the insertion of protective mutations&#46;<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">43&#8211;46</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">From a theoretical point of view&#44; there are 2 possibilities for the treatment of genetic skin diseases &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Ex vivo therapy consists of extracting epidermal stem cells with a genetic abnormality &#40;such as for example&#44; laminin 5 deficit<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">47</span></a> or collagen 7 deficit<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">48</span></a> in the case of patients with epidermolysis bullosa&#41; by skin biopsy&#44; correcting the mutation in vitro by gene transfer&#44; selecting cells in which the transfer has been successfully accomplished and the defect has been corrected&#44; and transplanting keratinocytes once again in the skin of the patient&#46; In a recently published study&#44; before transplanting the corrected epidermal stem cells back into patients with epidermolysis bullosa&#44; the authors assessed the integrity of the genome and also the oncogenic potential of these cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">49&#44;50</span></a> They demonstrated that the procedure is safe &#40;given that this is a transfection using viral vectors&#44; one of the main concerns and drawbacks is the possibility of mutagenesis&#41;&#46; In vivo therapy consists of delivery of viral or programmable nuclease vectors directly to the affected cells in their natural environment through intravenous drug administration or injection into the organ itself&#46; This approach has several technical difficulties and safety concerns&#44; which we will not discuss in this review but which have impeded the use of these techniques in patients with genetic skin diseases&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusions and Perspectives</span><p id="par0125" class="elsevierStylePara elsevierViewall">The characteristics of stem cells&#44; whereby they are able to self-renew and give rise to different cells types&#44; along with the startling developments in bioengineering&#44; make for a promising future&#46; Epidermal stem cells are particularly attractive given their relatively high number proportional to the body surface and their accessibility&#46; Although these are complex techniques with a high cost&#44; it is likely that in the coming years&#44; knowledge of the biology of stem cells&#44; as well as the safety of the techniques used&#44; will increase&#44; and so allow a more widespread application in medicine and in dermatology in particular&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">The work of I&#46; Pastushenko was funded by the T&#233;l&#233;vie grant&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of Interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Epidermal Stem Cells as the Origin of Nonmelanoma Skin Cancer Cells"
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          "titulo" => "Potential Applications of Stem Cells in Clinical Dermatology"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Stem cells are characterized by their ability to self-renew and differentiate into the different cell lineages of their tissue of origin&#46; The discovery of stem cells in adult tissues&#44; together with the description of specific markers for their isolation&#44; has opened up new lines of investigation&#44; expanding the horizons of biomedical research and raising new hope in the treatment of many diseases&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this article&#44; we review in detail the main characteristics of the stem cells that produce the specialized cells of the skin &#40;epidermal&#44; mesenchymal&#44; and melanocyte stem cells&#41; and their potential implications and applications in diseases affecting the skin&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Part <span class="elsevierStyleSmallCaps">I</span> deals with the principal characteristics and potential applications of epidermal stem cells in dermatology&#46;</p></span>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las c&#233;lulas madre son c&#233;lulas que se caracterizan por su capacidad para autorrenovarse y diferenciarse hacia c&#233;lulas de todos los linajes que constituyen su tejido de origen&#46; El descubrimiento de las c&#233;lulas madre en un organismo adulto&#44; y la descripci&#243;n de los marcadores que han permitido aislar de forma espec&#237;fica estas c&#233;lulas&#44; han abierto nuevas perspectivas y nuevos horizontes en la investigaci&#243;n biom&#233;dica y tambi&#233;n nuevas esperanzas en el tratamiento de muchas enfermedades&#46; En este art&#237;culo se revisan de forma detallada las principales caracter&#237;sticas de las c&#233;lulas madre que dan origen a las distintas c&#233;lulas de la piel humana&#44; incluyendo las c&#233;lulas madre epid&#233;rmicas&#44; mesenquimales y melanoc&#237;ticas&#44; y sus potenciales implicaciones y aplicaciones en las enfermedades cut&#225;neas&#46; La primera parte de este art&#237;culo revisa las c&#233;lulas madre epid&#233;rmicas&#44; con sus principales caracter&#237;sticas y sus potenciales aplicaciones en dermatolog&#237;a&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Pastushenko I&#44; Prieto-Torres L&#44; Gilaberte Y&#44; Blanpain C&#46; C&#233;lulas madre de la piel&#58; en la frontera entre el laboratorio y la cl&#237;nica&#46; Parte <span class="elsevierStyleSmallCaps">I</span>&#58; c&#233;lulas madre epid&#233;rmicas&#46; Actas Dermosifiliogr&#46; 2015&#59;106&#58;725&#8211;732&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Structure of the hair follicle and different types of epidermal stem cells&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The figure shows &#40;A&#41; microphotography of the hair follicle &#40;hematoxylin and eosin&#44; &#215;<span class="elsevierStyleHsp" style=""></span>20&#41; and &#40;B&#41; illustration of the different types of stem cells and progenitor cells in the epidermis&#44; as well as their specific markers&#46; IFE indicates interfollicular dermis&#44; SC&#44; stem cells&#46;</p>"
        ]
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      1 => array:7 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Self-renewal of stem cells&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A&#41; Concept of symmetric and asymmetric cell division&#46;</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">During the development of the embryo &#40;B&#41;&#44; most of the divisions are symmetric and the axis of division is parallel to the basal membrane&#44; thereby allowing extension of the embryo surface during growth&#46; During stratification of the epithelium&#44; which occurs during morphogenesis and in adulthood &#40;C&#41;&#44; most of the divisions are asymmetric&#46; During asymmetric division&#44; the axis can be perpendicular to the basal membrane &#40;on division&#44; a daughter cell on losing contact with integrins and growth factor secreted by the basal membrane&#44; undergoes differentiation&#44; and the second daughter cell&#44; on remaining in contact with the basal membrane&#44; maintains the characteristics of the stem cell&#41;&#46; Division can also be parallel to the basal membrane &#40;in this case&#44; differentiation of one of the daughter cells is induced by another mechanism&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Concept of lineage tracing&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The figure shows a schematic of the information obtained from lineage tracing experiments&#46; The technique consists of introducing a reporter gene associated with the marker of the cells of interest &#40;A&#41;&#44; thereby obtaining a fluorescent signal in the subgroup of cells of interest&#46; All daughter cells of the labelled cells also have a fluorescent signal &#40;B&#41;&#44; but the intensity of the signal will decrease as the cells continue to divide&#46; Thus&#44; on the one hand&#44; we can identify cells descended from the initially labelled cells&#44; and on the other&#44; assess the rate of division &#40;the cells that maintain an intense signal over time will be the quiescent cells that divide very slowly&#8212;the stem cells&#8212;whereas the cells that lose color intensity will be the compromised progenitor cells &#91;C&#93;&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Example of application of gene therapy in a skin disease&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The figure shows a schematic of a the study conducted by Droz-Georget Lathion et al&#46; in epidermolysis bullosa&#44; as an example of the efficacy and safety of gene therapy in a skin disease&#46;</p>"
        ]
      ]
      4 => array:7 [
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        "etiqueta" => "Table 1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Abbreviation&#58; SC&#44; cell&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Marker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Full Name&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cells that Express the Marker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Expression Pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#945;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Integrin &#945;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SC of interfollicular epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Membrane&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Axin2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axin-like protein&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Progenitors of the interfollicular epidermis&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cytoplasmic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CD34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CD34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bulge SC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Membrane&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Inv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Involucrin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Progenitors of the interfollicular epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cytoplasmic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">K5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Keratin 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SC of interfollicular epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cytoplasmic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">K14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Keratin 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SC and progenitors of the interfollicular epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cytoplasmic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">K15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Keratin 15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bulge SC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cytoplasmic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lgr5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leucine-rich repeat-containing G-protein-coupled receptor 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bulge SC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cytoplasmic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lgr6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leucine-rich repeat-containing G-protein-coupled receptor 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Isthmus SC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cytoplasmic&#47;membrane&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lrig5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leucine-rich repeats and immunoglobulin-like domain protein 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Infundibulum SC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cytoplasmic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">MTS24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MTS24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Isthmus SC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Membrane&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Summary of the Main Characteristics of Markers for Epidermal Stem Cells of Different Compartments&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
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