© Primal Pictures Ltd.

2014

TISSUE REPAIR

Cells become damaged and die constantly, so new cells must be produced to replace them. This is achieved by cell
division and the process of differentiation.

During differentiation, pluripotent cells mature and develop the characteristics of a specific cell type. In the epidermis for
example, cuboidal cells produced by the division of pluripotent basal cells start to produce keratin and take on a stratified
appearance. As a result, these cells are no longer pluripotent and have become specialized (or differentiated).

The cells undergoing division and differentiation may originate from either the parenchyma or stroma of a tissue or
organ: parenchymal cells form the functional parts of a tissue or organ, while stromal cells form the structural framework
of the tissue or organ. In the liver for example, the hepatocytes involved with the major functions of the liver, such as
protein synthesis, are part of the parenchyma, whereas the fibroblasts in the connective tissue are part of the stroma.

Full tissue regeneration is possible if parenchymal cells divide and differentiate to form fully functioning new tissue.
However, if only stromal fibroblasts divide and differentiate, non-functioning scar tissue is formed. This process is known
as fibrosis. During repair of extensive tissue damage, the effective combination of parenchymal and stromal cell division
and differentiation, and the development of new blood vessels, forms what is known as granulation tissue. This forms
across the wound, acting as a protective barrier, promoting the migration of epithelial cells, and producing a defensive,
bactericidal serum. Nutrients, such as protein and vitamins, and good blood circulation, are vital for the effective repair of
body tissues.

Different tissue types renew and replenish damaged or dead cells differently:

Epithelium
Epithelium is often under constant heavy wear and tear and therefore must be highly regenerative. This
occurs either by division and differentiation of stem cells (e.g., in the epidermis) or by division of mature,
differentiated cells (e.g., endothelial cells).

Connective tissue
Connective tissue is also under constant stress, and continually renews and replenishes cells. A good
blood supply, such as in bone, promotes repair.

Muscle tissue
Muscle tissue has a relatively poor capacity for the repair of dead or damaged cells.

Skeletal muscle contains specialized stem cells, called satellite cells, but their slow division means
they are only capable of repairing limited damage.
Cardiac muscle is completely lacking in stem cells capable of mitosis for tissue repair. However, the
migration of stem cells to the heart from other regions of the body has been suggested as an alternative
repairing mechanism.
Smooth muscle is capable of slow and limited repair.
Nervous tissue
The most common response to the damage of nervous tissue is gliosis: the formation of scar tissue
composed of astrocyte glial cells. Until relatively recently, it was believed that adult nervous tissue
contained no stem cells and as such, had virtually no capacity for repair. However, it has recently been
discovered that certain areas of the adult brain do indeed possess neural stem cells, although to what
extent they are capable of repairing damage to neurons or neuroglia is still uncertain.