文档介绍：干细胞移植治疗AMI临床研究进展
哈尔滨医科大学第一临床医学院
李悦
Despite advances in reperfusion strategies and medical treatment, MI and subsequent HF remain major causes of morbidity and mortality.
The use of cell therapy to promote myocardial repair has gained profound scientific and public interest.
干细胞移植(stem cell transplantation) 亦称为
细胞心肌成形术(cellular cardiomyoplasty, CCMP)
胚胎干细胞
伦理问题、来源有限、免疫排斥、发生肿瘤风险,研究受到很大限制。
成体干细胞
横向分化(transdifferentiation)
临床角度,成体干细胞优于胚胎干细胞,自体干细胞优于同种干细胞。
骨髓间质干细胞(mesenchymal stem cells,MSC)     从骨髓中分离,可使用G-CSF动员或在体外扩增。
内皮祖细胞(endothelial progenitor cells,EPC)
数量往往不足,特别是从外周血采集时,需要分离、纯化并在体外培养扩增EPC。
成骨骼肌细胞(skeletal myoblasts,SM)     为获得足够数量SM, 需要大块肌肉组织。体外培养、扩增卫星细胞周期较长。
可供移植干细胞
Experimental studies have shown that bone marrow cells (BMCs) are capable of inducing myogenesis and angiogenesis; this leads in turn to amelioration of cardiac function in mice and pigs.
Nature. 2001;410:701–705
Nat Med. 2001;7:430–436
Proc Natl Acad Sci U S A. 2001;98:10344–10349.
J Thorac Cardiovasc Surg. 2002;123:1132–1135.
The first study on intracoronary mBMC therapy shortly after AMI in humans was reported in 2002.
Circulation 2002;15:1913–8.
10 patients were transplanted with autologous mononuclear BMCs via a balloon catheter placed into the infarct-related artery during balloon dilatation。
From bench to bedside
Conclusions:
Demonstrate for the first time that selective intracoronary transplantation of autologous, mononuclear BMCs is safe and seems to be effective under clinical conditions.
However, the efficacy results vary between studies.
Possible explanations for these differences are small study samples, different imaging techniques and differences in timing of treatment, cell dose, placebo treatment or cell processing protocols.
Concerns have been raised about accelerated atherosclerosis, intramyocardial calcifications and risk for arrhythmias.
Long-term data on safety and efficacy of this treatment are needed.
2004~2005年,黄禹锡在《科学》杂志发表伪造的干细胞论文,夸张干细胞治疗