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Relatively few clinical experiences have been published on this subject, but when a natural selective advantage exists for the cell graft, a degree of \u201crescue\u201d is possible. Strategies have been developed to confer a selective advantage through genetic engineering of donor cells, and this approach may prove valuable in the treatment of birth defects, as it is in hematological malignancy. Stem cell (SC) plasticity, or transdifferentiation, may offer another route for delivery of cells to established or developing organs. A wide variety of studies support the concept that adult tissue\u2010specific SCs can, if displaced from their normal niche to another, be reprogrammed to produce cell types appropriate to their new environment. Clinical observations reveal that persistent tissue microchimerism develops not only in blood lineages after transfusion, but also in thyroid follicular epithelium via transplacental exchange. In addition, hepatic and renal parenchyma also become chimeric following allografts or bone marrow transplantation (BMT). Experimental models indicate that a renal glomerulosclerosis phenotype can be transferred by grafting whole BM, and that a severe liver disorder in <jats:italic>fah<\/jats:italic><jats:sup>\u2013\/\u2013<\/jats:sup> mice can be overcome by grafting HSCs and then exerting a selection pressure. It may be possible in the future to exploit the ability of adult SCs to contribute to diverse tissues; however, our understanding of the processes involved is at a very early stage. Birth Defects Research (Part C)69:238\u2010249 2003. \u00a92003 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/bdrc.10019","type":"journal-article","created":{"date-parts":[[2003,8,27]],"date-time":"2003-08-27T13:38:51Z","timestamp":1061991531000},"page":"238-249","source":"Crossref","is-referenced-by-count":10,"title":["Cell\u2010based therapies for birth defects: A role for adult stem cell 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